Texas nursing facilities are facing shortage
LUBBOCK — Robert Lozoya started a recent shift as a nurse manager for Carillon, Lubbock’s biggest senior home, at 7 a.m.
For the next 12 hours, he triaged his duties, picking up the slack for the nurses who did not show up for work. He made sure patients didn’t choke on their lunch, treated wounds and fielded a myriad of calls to doctors, families and pharmacies.
By the time Lozoya left, well after 7 p.m., he was exhausted. And he knew tomorrow would be more of the same. He and his team will adjust to being understaffed, as they’ve had to do so often in recent years.
“We’ll do it one way or another,” Lozoya said. “We’ve worked it out so far, so it’s been OK, it just hasn’t been ideal.”
Texas does not have enough nurses for its senior care facilities. The shortage is fueled by a number of factors. There is a growing apathy burning through the nursing industry, and the COVID-19 pandemic only fanned the flames. Baby boomers are both retiring from the nursing profession and needing care themselves. Nursing homes have been hit particularly hard by this crisis due to financial constraints and medical students wanting jobs in more prestigious fields.
In the backdrop of the staffing crisis is another troubling trend in Texas: Nursing homes are closing. A report from Texas Health and Human Services shows that from 2018-22, at least 60 nursing facilities in the state — 2 percent — have lost the battle to inflation, low Medicaid reimbursement rates and other financial burdens.
For Texas elders and their families, the dearth of new health care professionals in aging populations is dire. At best, they are waiting longer to find beds and paying more when they do. At worst, they are deserted, forced to navigate their last years without the sort of support an aging facility can provide.
“We’ve seen over time that individuals are sicker by the time they get in nursing homes and need a higher level of care, and providers don’t have the trained staff to take that type of patient in,” said Kevin Warren, president of the Texas Health Care Association.
Finding a home where elders can live out their lives safely and with dignity is hardest for families that live in the empty stretches of rural Texas. Nearly twothirds of the nursing homes that have closed since 2018 were in rural areas. And seven were in the High Plains, the region that stretches from Lubbock to the top of the Panhandle.
“In rural areas, it’s common for the next closest nursing home to be 30 miles away or farther,” said Alyse Meyer with Leadingage Texas, an advocacy organization that works with 200 aging-service providers across the state. “There are other factors that are important to families
Powell said her team tries to approach cases from a place of compassion and understanding when working with their clients.
“What we have found is that sometimes people love their pets so much but just need a little extra help,” Powell said. “Sometimes, they don’t know they aren’t compliant with the city codes or don’t know what they need to do to reach compliance. Sometimes, they don’t have the money and are just doing the best that they can.”
Thursday morning, Powell and CASA team members Elva Anderson and Paul Trujillo visited Ignacio Elizondo’s Flores Street home to deliver food, blankets and toys for the stray dogs that Elizondo has rescued over the years. They even brought a new collar and teether to replace the daisy chain of leashes and rope that held the dogs to the fence.
Elizondo excitedly told the CASA team about his newest rescue, the rottweiler he named Ima who had followed him home one day and became part of the family. As he chatted with the trio, Elizondo thanked them profusely for helping him keep his dogs.
“It helped so much,” Elizondo said. “I wouldn’t know what to do without them.”
While the program is new, CASA’S impact is already noticeable. Powell and the team started building the program at the beginning of the year, though it didn’t start taking clients until about October. And in that month alone, it prevented 91 owners from surrendering dogs from 135 requests, distributed 2,254 resources and dropped the recidivism rate almost 2 percent.
ACS director Shannon Sims said they spent a lot of time deciding what the CASA program should look like and how to achieve its goals. He likened the program to a homemade recipe because the department had to build the program from scratch as there isn’t anything like CASA in the industry.
The program also signals a shift in mindset for the department, taking a more humanizing approach instead of heavily focusing on enforcement to achieve compliance.
“This addresses the human aspect of San Antonio’s animal population problem,” Sims said. “Before we were fixing the symptoms and not the sickness, so I think this is a new way forward for San Antonio and the animal industry.”
As the program evolves, Sims said the team will readjust it as necessary to make sure it is making as big a difference as possible. He emphasized that CASA is designed to be fluid and evolving to continue to reflect the community’s needs.
Many of CASA’S cases involve pet owners who have been cited multiple times by ACS or owner surrender requests that come into the department. The CASA team reviews such documents to determine whether there is something they can do to help keep dogs in their homes.
ACS’S Live Release and investigations teams will also refer potential clients to CASA. If they identify a nonemergency case that meets CASA’S criteria, they will pass the client along to Powell and her team for review.
Powell and her team will reach out to the owner to talk more about their situation to take an appropriate course of action.
After visiting Elizondo’s home, the CASA team visited two other homes to help build three doghouses and drop off food and blankets. One of them was the home of Frank Salinas and his wife.
The couple had fallen on financially difficult times and were unable to buy food for themselves or their dogs, so when they asked ACS for a donation of dog food, CASA stepped in. For the next two months, CASA will provide food and supplies every two weeks to the Salinas house.
“People like them, they are a blessing,” Salinas said. “I love my dogs so much, but I hurt my ankle and haven’t been able to work, so we didn’t know what to do. It is good that there are good people like” CASA.
In addition to bringing food, the CASA team built two doghouses for the Salinas’ home. The team spent more than an hour building the doghouses, happily chatting with Salinas as his rednose mix Elsa and her puppies supervised from behind the fence.
As the trio built the doghouses, word spread down the street, and several neighbors stopped by to ask about how they could receive help from ACS. One woman told the team that she was “rubbing my pennies and nickels together this week trying to buy dog food.”
“I love having a job that helps people,” Anderson said as she threw a large bag of dog food over her shoulder and walked down the street to the woman’s home. “It is really rewarding to get to do this.”