Sam Perlin

March 13, 2008


Testimony presented March 13th, to the Texas House of Representative Committee on Human Services

I appreciate the opportunity to speak to you about concerns in our community resource.

I am 89 years old. I have been actively involved in concerns of the aged and disabled for over 30 years.  I was one of the first Ombudsman group in 1975 appointed by then Gov. Bob Graham in Florida.  I moved to Texas in 1983 where I continued my advocacy effort.  --------------


In my opinion nursing home conditions are worse today than ever before.  There is a lot of blame to go around.  I blame the people mostly because they don't involve their own legislators in understanding the concerns.  It is impossible for any person to know what is going on in the government without reality input. 

But there has been reality input by media and multiple GAO reports to Congress. 

  • A Time Magazine article Oct 27,1997: "state efforts at regulating quality are meager."
  • U.S. News & World Report Sept 30, 2002: "The nursing home industry is profitable and growing, with operators spinning a far brighter tale for Wall Street than Capitol Hill. Many nursing homes are earning exceptionally healthy profit margins, often 20 to 30 percent."
  • N.Y. Times Sept 23, 2007: "Investors sold 185 nursing homes to General Electric for $1.4 billion.  Estimates is investors gain from the sale was more than $500 million in just 4 years." 

Legislation always says: The department shall report to the legislature how they carried out the intent of the legislation.  I don't know if anybody reads the stuff but I do know that nothing happens for the better.


One local nursing home is on their 17th administrator in 7 years.  The last survey showed 22 deficiencies.  The state and national average is 8. In order to get this low average many nursing homes do a good job with the same case mix and reimbursement. So it is not a money problem.  It is a management and lack of supervision problem.

I looked at Nursing Home Compare web site for Nueces County:

There are 9 zip codes, 16 nursing homes.  4 had more than 8 deficiencies--2 had 18, 1 had 12, 1 had 10.  How come the other 12 are doing well?  Shouldn't some attention be paid as to why? Quality Monitoring is supposed to help them upgrade their performance. 

Everytime the penalty amount is raised the category of deficiencies goes down to less severe. A plan of correction is produced on paper which long term care regulatory, due to staff shortage, accepts as correction. When the family council tries to deal with the administration about a concern corporate says: give him/her a chance. By the time chance is over the administrator is gone.  So this game is played for years. A GAO report, March 2007: "Almost half of the homes reviewed continued to cycle in and out of compliance." "Civil Money Penalties were imposed at the lower end of the allowable range of $3000 per day; usually $350 to $500 per day." A 35% automatic discount if they don't appeal.  Many discounts are closer to 75%.


(In Texas) The nursing homes get Enhanced Direct Staff money to stop the turnover, hire more and better trained workers. When I ask for an audit I am told a desk review is done. A State audit report April 2005--05-33 said: "the commission reports that in fiscal year 2003 it paid 948 nursing facilities an extra $75 million (on top of the per diem rates) as part of the enhanced staffing agreements with those facilities.  The commission currently pays 27 different levels of enhanced staffing supplements based on increasing staffing levels at each facility rather than on recognized standards of sufficient staffing." This results in unrealistic work loads for those workers that show up; who quit resulting in high turnover.


Most of the staff at nursing homes are licensed. Their license carries responsibility and loyalty to the people they care for. I understand they have to cater to corporate to keep their job so in effect they are covering up for corporate policy: aiding & abetting. The family council I am with is on record to report poor survey results to the respective boards for disciplinary action against the licensed persons.

Somebody has to be held responsible.  This includes the Medical Director. Administrator, Director of Nurses, Charge nurses, Social worker, and therapists. Corporate has isolated itself, the governmental agencies by legislation and budget are impotent. Maybe the licensing boards will be responsive.  If not, things will just keep getting worse.  In the 1982 Texas City Murder by Neglect court case the workers were indicted as well as the owners.


When a facility, be it a nursing home, assisted living, or community based alternative has deficiencies, the public in whose district this occurs should immediately contact their legislators in the district to take corrective action by doing more than contacting the agency bureaucrats for excuses.  Politics is the process of change.  You get involved and you can affect the outcome Until society can say "we are they," things will remain much as they are.


If Medicaid budget is a concern you might check into the state condoned waste and fraud with applied income.  I could address that more fully later if you are interested.

Thank you for the adventure today.

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All material copyrighted 2010 - Sam Perlin