Nurses leaving Texas nursing homes for better pay ‘at McDonald’s or Wendy’s,’ advocates say

April 18, 2016

AUSTIN — Nurses and other medical staff are leaving their positions in Texas’ nursing homes because of low pay, advocates say, setting up the possibility for a nursing shortage in long-term care facilities as the state’s 65-and-over population booms in the next few years.

The state’s low Medicaid reimbursement rate contributes to the low pay, a dynamic that’s driving nurses out of nursing homes or out of the health industry entirely, said Julie Sulik, vice president of Clinical Services for Southwest Long Term Management.

“Sometimes they can go down to the drive-through window at McDonald’s or Wendy’s and make more money,” Sulik said. “Morale can be hurt when we have a hiring freeze or a wage freeze, because we can’t compete.”

Advocates warned lawmakers about the trend in a House Appropriations subcommittee hearing Wednesday. Scot Kibbe, director of government relations for the Texas Health Care Association, said Buc-ee’s convenience stores can pay some employees $14 an hour, and it’s hard for nursing homes to pay certified nursing assistants a wage comparable to that.

“What our providers tell us is their inability to pay competitive wages is a major factor [in turnover],” Kibbe said.

The portion of caregivers to elderly people older than 80 was seven to one in 2010. That is expected to fall to four to one by 2030.

“It’s important to keep in mind where Texas is heading,” Kibbe said. “We are on the verge of significant growth in elderly in this state. Obviously people are living longer and a lot of people are moving to Texas.”

Texas has one of the lowest Medicaid reimbursement rates in the nation, which means nursing homes often spend more caring for residents than they are reimbursed. About 85 percent of Texans in nursing homes depend on Medicaid or Medicare.

Texas Health Care Association President Kevin Warren said the shortfall between what the state reimburses nursing homes and what nursing homes spend is more than $300 million. As a result, he said, nurses in these long-term care facilities often have poor salaries.

“At the end of the day, employees have their own responsibilities to their own families,” Warren said. “You have some of the most compassionate and caring people that work in long-term care. When you lose a staff member that’s been there for many years … it is a very difficult decision for them to uproot and move.”

According to the 2013 Nursing Facility Cost Report, the annual turnover rate for registered nurses in the state’s nursing homes is 94 percent. Warren said this in turn can affect patients in nursing homes.

“Obviously such high turnover raises costs for all of you,” Rep. Four Price, R-Amarillo, noted in the committee hearing Wednesday. “Sounds like we’re paying a lot as a state and maybe not getting a whole lot for that.”

Price requested an analysis that compares the cost of raising wages vs. the costs of high turnover.