McKnights: As goes Texas?

For nearly a year and half, Texas nursing home operators have been waiting for the moment before them: the early days of the most promising legislative session in nearly a decade.

What happens to Medicaid rates there between now and the end of May, when lawmakers will leave Austin until 2025, could either save or sink skilled nursing providers. But what happens in Texas surely won’t stay in Texas.

Big expectations for a long-awaited and significant increase in the state’s daily reimbursement rate also have been driving excitement among major owners and investment companies.

The big guys like Sabra and Ensign are all-but banking on better days in the Lone Star State, even as the nation faces continued talk of possible recession. If lawmakers don’t hit the targets these major players have set internally, we could see resources pulled from Texas and diverted to more provider-friendly states.

And if Texas denies providers a substantial rate increase, they likely won’t be the only ones. Already, providers in New York, New Hampshire and other states are crusading for rates that more accurately reflect the cost of the work they do — and new operating expectations that are very likely coming, and coming soon.

Of course, there are plenty of small and mid-size Texas operators whose fates ride on this session, too.

Mark McKenize, founder of Focused Post-Acute Partners, tells me he is “laser focused” on securing the Medicaid rate increase this year, for budget years 2024 and 2025.

“In terms of time, investment and local access to public officials who have the power to improve the skilled nursing care sector in Texas, this is where I have to focus my energy,” he said last week, noting the uphill battle for understanding and support even in the face of COVID and, now, historic labor shortages.

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McKnights: ‘Critical access’ not at critical mass, but skilled nursing providers push on

Support for the concept of critical access nursing homes is growing among providers, but it has yet to gain much traction among industry leaders or the politicians who would need to create such a safety net for seniors and people with disabilities.

Such a program could bring more stability to a struggling subset of nursing homes, much as it has for about two-thirds of the nation’s rural hospitals.

Certified critical access hospitals are paid based on their costs, rather than on patient lengths of stay or services. This creates a reliable funding source to help sustain providers with potentially low patient volumes. The special designation originated in the 1990s after a string of rural hospital closures in the previous decade.

A similar program has never been created for nursing homes, but some providers believe now could be an ideal time. Many skilled nursing operators, especially those in some rural states, were squeezed hard by stagnant Medicaid rates even before the pandemic. Now, they are inching ever closer to closure amid continuing COVID-19 precautions and staffing shortages.

“Policymakers need to understand ‘rural’ doesn’t mean low-cost. We are unique and the unique needs for providing care in rural communities need to be addressed,” said Mark McKenzie, CEO of Focused Post-Acute Partners, which operates 29 skilled nursing communities in Texas. Twenty of those are in rural areas, some in towns with as few as 3,000 residents. “Years ago, it wasn’t a detriment to be a rural SNF provider, but COVID process mandates had a real and lingering negative impact on staffing and overall costs.”

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McKnights: ‘Critical Access’ nursing homes could be game changer: Focused Post-Acute Partners’ Mark McKenzie

While struggling rural nursing homes must innovate to survive, their efforts would be bolstered by a federal program similar to one that provides additional funding and staff resources to challenged rural hospitals.

So says Mark McKenzie, CEO of Focused Post-Acute Partners, which operates 30 skilled nursing communities in Texas. Twenty of those are in rural areas, some in towns with as few as 3,000 residents.

McKenzie has spent more than 30 years in long-term care, a period that included nearly eight years at the helm of Senior Care Centers of America. During that time, he has seen a major shift in the costs of operating rural skilled nursing facilities, complicated by reimbursement that has failed to keep up with increased patient complexity. Add in a staffing crisis that has made costs explode, and many of his colleagues are questioning how they’ll keep their doors open.

“When we talk to our legislators and the public, there’s still that assumption that if you’re in a rural market, your cost of doing business is significantly less than what it is in your major metropolitan areas,” McKenzie told McKnight’s Long-Term Care News this month. “That just isn’t true, and our payroll bears that out …To get someone into our rural markets, you have to sweeten the pot and that’s in their pay and their benefits.”

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Baytown Sun: Coming off COVID, nursing workforce needs resuscitation

By: Mark McKenzie

The dedication, professionalism and commitment from nurses during the raging pandemic is for the most part, indisputable. But if we stay the course on which we presently find ourselves, there will be a dangerous void in the health care delivery system.

There will be far too few nurses and certainly not enough to keep up with health complications of aging baby boomers and a broader population of those with chronic conditions.

The nursing workforce shortage was dire before the pandemic and we have now in Texas and the rest of the nation reached a tipping point. Something has to give.

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The Dallas Morning News: ‘It’s the hardest job you’ll ever love’: What it’s like to work in a nursing home during COVID-19

The employees at Focused Care of Waxahachie end each staff meeting with a group chant.

“RAMP it up!” they yell in unison. RAMP, which stands for “residents are my priority,” is a call to action for the nursing home’s 62 workers, charged with caring for the community’s highest-risk populations.

And it’s evident that the staff members take that message to heart. The nurses; certified nursing assistants, or CNAs; kitchen staff and housekeepers say they know their residents as if they were part of their own family.

As the omicron variant spreads, sickening some employees and forcing others to quarantine, Focused Care’s staff have stepped up, as they did in every previous surge. They work overtime, stay late and answer calls in the middle of the night – all to ensure their residents are properly cared for.

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Baytown Sun: Focused Care donates turkeys to local seniors

By Matt Hollis

Nov 25, 2021

Focused Care has stepped up to the plate in the spirit of Thanksgiving and donated turkeys to the Baytown Senior Center.

Seniors at the center went through a drive-thru to get their turkey and a bag of trimmings complete with stuffing mix, potatoes, cranberries, sweet potatoes, and gravy.

“This is fantastic,” Dave Weber, Baytown Senior Center activity director.

Weber said he spoke to Becky Davis, Focused Post-Acute Care Partners Baytown community liaison, to help the seniors out.

“She got a hold of her boss, and they said they would help with anything we ever need,” Weber said. “So, I took her up on it. I asked Becky if she could get this to happen. And she made it happen.”

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Baytown Sun: Focused Care Baytown Communities Donate and Deliver Turkeys to Baytown Senior Center For Thanksgiving Meal

Baytown, TX – Four Focused Care Baytown area skilled nursing care communities are pooling their resources and showing their gratitude to local seniors by donating 24 turkeys to the Baytown Senior Center so it can host a traditional Thanksgiving meal. Inflationary prices, food insecurity and trimmer budgets are putting a damper on the holiday meal for many families this season so Focused Care wants to ensure Baytown seniors do not go without a turkey for their centerpiece entrée as folks gather next week for Thanksgiving.

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News West 9: Group of veterans visits Focused Care Midland to honor veterans

By: Jonathan Polasek
November 12, 2021

A day in which veterans are honored for their service, one group of veterans wanted to do something a little different.

Veterans Day is a day to honor those who have served, but one group of veterans went out to honor other veterans to show them that they love and care for them.

For a lot of the veterans at Focused Care Midland, this Veterans Day was an exciting time. They got to meet with other veterans and share their own experiences.

“Some are very excited, of course I don’t know, they may just wanna talk to anybody but because we are part of their veteran family, they’re much more comfortable. It’s not like we don’t have to say ‘hello my name is, this my name is that.’ We can just sit down and say ‘hey where did you serve? Hey I was there,'” Darrell Thornton, an Air Force veteran who went to visit, said.

It’s something like that gives these veterans a sense of community with the veterans that came today.

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Skilled Nursing News: Texas Nursing Homes to Receive $200M after State Lawmakers Pass Bill

By Alex Zorn | October 20, 2021

As a way to pump some much needed funding into nursing homes to help with staffing shortages, Texas lawmakers passed Senate Bill 8, also known as the ARPA Funds bill, which includes financial support for long-term care in the state.

The bill proposes $200 million as grants for nursing homes and $178.3 million in grants for assisted living facilities, home health agencies, community attendants and facilities that serve individuals with intellectual or developmental disabilities in an intermediate care facility.

It authorizes the use of American Rescue Plan Act (ARPA) funds as a way to help these facilities recruit and retain staff.

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Skilled Nursing News: Administrator Losses are ‘Critical Issue’ for Nursing Home Workflow, Morale

By Amy Stulick | October 3, 2021

Focused Post Acute Care Partners CEO Mark McKenzie is starting to see burnout among his senior leaders take its toll on overall operations, with at least three of the operator’s administrators recently leaving the profession for other industries.

McKenzie said administrator and director of nursing loss has turned into a “critical issue” for the Burleson, Texas company; its highest compensated, highest educated team members, for the most part, and those with the greatest experience are leaving the industry altogether and it’s been difficult to recruit more.

“When you start to lose those [positions], other issues start to occur. Our industry continues to see a loss of team members within the industry itself, and you’re catching it on both ends,” said McKenzie, referring to a lack of people entering the industry coupled with an exodus of staff leaving.

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The Texas Tribune: Texas nursing homes turn to state for help with staffing woes as vaccine mandate looms

Texas nursing homes, struggling during a pandemic that has ravaged their residents and decimated their workforce, are asking the state for $400 million in federal coronavirus relief to address a staffing crisis in the system that cares for the state’s oldest and most fragile residents.

Adding to the urgency is the fact that 40% of the state’s 100,000 nursing home employees aren’t vaccinated against COVID-19 and they could face a federal ultimatum to do so later this month.

Industry advocates fear the federal vaccination mandate could mean the potential exodus of tens of thousands of workers from facilities across the state before Halloween.

“We know we are going to lose additional staff when that vaccine mandate comes out,” said Becky Anderson, head of clinical operations for Focused Post Acute Care Partners, which runs 31 nursing homes and employs about 2,500 workers in Texas. “We just have some staff that are very adamant that they will not get the vaccine.’”

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Cass County Citizen’s Journal-Sun: Linden Health Fair Coming

September 15, 2021

By Shawn Larson

On Friday September 24 from 9:00 a.m. to 12:00 p.m. Focused care at Linden will be holding a health fair. While there you can enjoy food trucks, door prizes, free health screenings and participate in a blood drive with LifeShare. There will be activities for the whole family.

Executive Director of Operations Christine Donald, LNFA, of Focused Care at Linden is hoping for a good turnout from the greater Linden area in order to serve the community and provide essential health information. Donald would also like to introduce themselves to people in the community who might want to know more about the assisted living facility.

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Brenham Banner: Long-term care facilities aiming to correct staffing shortages

By Alison Bryce

From COVID-19 to severe staffing shortages, places like long-term care facilities have had to adapt just to keep running. Now, as staffing shortages continue to strike facilities hard, some are striving to change the path.

The Texas Health Care Association (THCA) has announced a proposed plan to address staffing shortages in the long-term care profession, which have been at critical shortage levels and were exacerbated by the pandemic. The plan would draw on funding from the American Rescue Plan Act (ARPA) funds allocated to Texas.

In a recent survey of THCA members, 70% of long-term care facilities cited that they are unable to hire enough nurses and more than 30% have restricted new admissions due to staffing shortages.

“Since the beginning, COVID-19 has disproportionately affected long-term care residents as well as the facilities and staff that care for them,” President and CEO of THCA Kevin Warren said. “Despite an increase in vaccination rates, the Delta variant has prolonged increased costs related to the pandemic and have continued to make it difficult for facilities to attract staff to the profession and afford to retain them due to a hyper-competitive labor market for direct care staff.”

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Skilled Nursing News: Leaders Urge Texas to Allocate $400M to Bolster SNF Staffing as 30% of Facilities Have Restricted Admissions

The Texas Health Care Association (THCA), in a joint proposal with aging services organization LeadingAge Texas, this week requested $400 million in funding to help providers staff buildings amid the skilled nursing workforce shortage.

That’s less than 3% of the total federal aid funding allocated to the state, THCA said in a letter to Texas Gov. Greg Abbott — the state received approximately $16.7 billion for pandemic purposes from the American Rescue Plan Act.

Federal dollars can’t come soon enough, with more than 30% of facilities in the state having to restrict admissions due to staffing shortages, according to a member survey conducted by the association; about 70% of surveyed members are unable to hire enough nurses.

Fort Worth, Texas-based Focused Post Acute Care Partners has been operating with 60% of its workforce, and conservatively expects to lose 40% more to the federal vaccination mandate.

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New West 9: Vaccine Mandate Could Make Nursing Home Staff Shortage Worse

Read this Article on News West 9 and watch the Coverage Video Here

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Focused Care at Lamesa Thanks Local Businesses for their Support of Fundraiser for Lamesa Senior Citizen Center

Focused Care at Lamesa, a long term care community providing skilled nursing care and short term rehab to the town’s seniors hosted a fundraiser last week that raised $1655 for the local chapter of Meals on Wheels which is run by the Lamesa Senior Citizen Center.  A hamburger lunch for sale brought in the proceeds by attendees who were able to also participate in a raffle.

“We are so pleased the local business community came out with such a big presence to support the Lamesa Senior Citizen Center and its work for Meals on Wheels,” said Alice Gonzalez, executive director of operations for Focused Care at Lamesa. “Lamesa’s history and tight-knit community are to be celebrated and our fundraiser is a perfect example of how we come together to help each other as neighbors and friends.”

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News West 9: Nursing homes deciding next steps after federally-mandated staff vaccination rules

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Texas Tribune: COVID-19 cases are skyrocketing in Texas nursing homes, and nearly half of workers are unvaccinated

The number of nursing homes across the state with at least one active COVID-19 case has shot up nearly 800% in the past month — while nearly half of nursing home employees in Texas remain unvaccinated.

Nursing home residents were among the hardest hit by COVID-19 last year as the virus tore through facilities at an alarming rate. More than 400 Texas nursing home residents died during a single week in August 2020; since the pandemic began, 9,095 have died after contracting COVID-19, according to the Texas Health and Human Services Commission. As of Aug. 11, that’s 17% of the state’s COVID-19 deaths.

To slow the virus’s spread, Gov. Greg Abbott shut down nursing home visitation in March 2020, then eased those restrictions five months later for facilities that didn’t have active cases in the previous two weeks. HHSC’s current visitation guidelines for nursing homes require visitors to wear a mask at all times and limits visitation to no more than two “essential caregivers” per resident.

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The Banner Bulletin: U.S. nursing homes currently safest place for vulnerable seniors

Yes, according to an analysis by the National Investment Center for Seniors Housing & Care (NIC) of data produced by the Centers for Medicare and Medicaid (CMS), the chief regulator of our nation’s nursing homes, COVID case counts within skilled nursing facilities (SNFs) are down 98% since December 20 of last year and by mid-May 2021 account for about 0.3% of our country’s cases.

That is beyond encouraging news for seniors requiring skilled nursing care and their family members, long term care providers and their loved ones and communities across the nation. The federal government data in alignment with statistics from the Centers for Disease Prevention and Control (CDC) point to the vaccination rollout and those who have been inoculated as the initial knockout punch to the raging spread of COVID – though as any boxer knows, a knockout is typically not a fatal blow. Most of us understand the virus is here to stay in one mutation or another and that new variants are making their way back into our lives at an alarming pace.

Given these statistics, it is important that communities, elected officials and media view this progress through a pragmatic lens. If we think back to the height of the pandemic – when direct care providers went to work every day with fear of being infected, when asymptomatic individuals were not yet pegged as the majority of people who actually contract and unknowingly spread the virus, and critical supplies for health care workers were in dire shortage, there was no time for optimism. We now know with accurate scientific information, access to resources and availability of vaccines, we were able to save lives and we did.

While that last sentence may sound simple, living through it wasn’t.

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Skilled Nursing News: Monitoring Technology is on the Rise — SNFs Decide if it Helps or Hinders

By Amy Stulick | July 11, 2021

As nursing home operators introduce more sophisticated monitoring technology to their facilities, the benefits of such tools sit on a knife’s edge.

Monitoring platforms may help caregivers do more with less during a pandemic-exacerbated staffing crisis. It’s also possible that operators can open themselves up to potential litigation, depending on if they have the staff and education to utilize such tech properly.

“In my experience, it can cut both ways,” said Bill Wilson, founding partner and litigation attorney at Wilson Getty in San Diego, Calif. “I’ve had cases where … there was an inadequate response to an event, and when we were able to pull cameras in the common area hallways, it clearly shows staff responding within 10 seconds of an event.”

Wilson represents long-term care facilities, as well as other types of health care providers.

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Community Impact: Bay Area health care workers ‘accept, adapt and overcome’ to adjust to challenges amid COVID-19

For southeast Houston’s nurses and nursing educators, change has been the only constant while delivering care and instruction during the pandemic.

Kelsea Heiman, an emergency room nurse at Houston Methodist Clear Lake Hospital, said nurses have felt a lot of extra weight on their shoulders while treating patients as COVID-19 guidelines continue to evolve. This has led to a sense of exhaustion for the nurses putting aside their own fears to provide patient care, she said.

“COVID[-19] has caused a lot of burnout,” she said. “People are starting to evaluate [their] work-life balance.”

Educators at the University of Houston-Clear Lake and San Jacinto College also described a change in classrooms during the pandemic as both schools trained registered nurses in their RN-to-BSN programs. Working RNs can earn a bachelor’s degree in nursing at both universities, so UHCL and San Jac students have been coping with the realities of COVID-19 in the field while doing coursework.

These realities have led to the exacerbation of an already-present nursing shortage across the Texas Gulf Coast region, which includes Houston, local and regional experts said.

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Journal Sun: Focused Care maintains 5-star rating

Focused Care at Linden announced today that the Center for Medicare and Medicaid Services (CMS), the federal agency responsible for rating the quality of care provided by the nation’s skilled nursing facilities, awarded the long term care community a 5-star rating for Quality Measures – the category that focuses on direct resident care. Focused Care at Linden earned a 5-star for resident care in 2019 – during the last rating period.

“I know our culture of patient-centered care is driven by commitment and compassion for the seniors we are responsible for,” said Christine Donald, Executive Director of Operations for Focused Care at Linden.  “To achieve the highest rating for quality care following a raging pandemic, an unrelenting winter weather system and a comprehensive vaccination process, fills me with appreciation for my wonderful team members at Focused Care at Linden and their dedication in the most trying and challenging time of our century.

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The Banner-Press: Caring for the Vulnerable During Global Pandemic

May 11, 2021

For a while there it felt as though we were trying to get our sea legs in the midst of a Tsunami. The whole world was navigating unchartered waters and when a life raft was tossed out, it was frequently pulled back and another, slightly different one floated our way. Regulations, policies and guidelines on how skilled nursing communities must operate under COVID-19 came down from the Centers for Disease and Prevention Control (CDC) and the Texas State Health and Human Services Commission (HHSC) and changed daily – sometimes in minutes. We had to re-educate, retrain and modify communications to our team members. It’s understandable – these conditions were unprecedented – but it was challenging and created a lingering sense of uncertainty.

This was the year of the Coronavirus.

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Caller Times: Forum: A year look back on caring for seniors during a global pandemic

May 7, 2021

We will forever be bonded together as a band of frontline care providers for the most vulnerable population during a sweeping pandemic. The frightening, invisible enemy that can be in us with some exhibiting no symptoms and others being brought to their last days made its way through our Corpus Christi community, our state and the world.

Skilled nursing communities were initially vilified at the outbreak of COVID-19 as if the virus started in our buildings – not as if it walked through our front doors – which is of course, what happened. Heroes have emerged from this war on our public health. I work with many of them.

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Fort Stockton Pioneer: Dignity during the worst of the storm

May 5, 2021

As a ray of light is appearing through what has seemed like a very long, dark winter, I’ve learned through challenges and hardships that we can emerge with dignity and new knowledge about what we can endure and how we can triumph.

Many of us may not feel as though the last very trying year and ensuing months are at all worth celebrating. In fact, through our exhaustion, our grief, our life adjustments, and our determination, we may look at each day a bit differently than we did before. We may notice something new in a face we see every day, or feel a deeper appreciation for simple pleasures.

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Houston Chronicle Article: ‘Look at what the virus did’: Alief nursing home that lost 24 residents to COVID kept fighting

November 19, 2020

This fight through COVID it has been hard not only on residents and their families but also team members. Read this Houston Chronical article and see how our Westwood Community is working through everything.

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NY Times Article: Joy, Love, Grief: How It Looks When Families Reunite

The New York Times captured the long awaited reunions of nursing home residents and their family members in this beautiful article posted today.  Some of our families at Focused Care at Fort Stockton were kind enough to allow a photographer to be present at these intimate moments and memorialize their love and relief.  Thank you to our families and our residents for showing the world your dedication to each other.

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Texas Tribune Article: COVID-19 ravaged Texas nursing homes. Here are the stories behind the numbers.

April 15, 2021

This past year has been one of the hardest years many of us have experienced, being separated from family and friends for so long has not been easy. The Texas Tribune has done an amazing job showing the struggles that our Communities have faced across the state, the small victories that we have won along the way and the hope that we have as we begin the process to get back to hugging our loved ones.

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