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Medicaid is the primary payer for nursing home care in the United States. In order to supplement state with federal funds to pay for nursing home care, states are required to provide a certain level of care to Medicaid beneficiaries. But inspections are done once and year and, in Texas, ombudsman assigned to nursing homes are volunteers, making it difficult to set and enforce requirements.

How do nursing home residents receive safe care?

If real problems arise, there is the office of the Texas Long-Term Care Ombudsman (1-800-252-2412). But we would much rather problems not arise in the first place.

One of the reasons they do is that certified nurse’s assistants, who provide most of the care, are undertrained and underpaid.

Another is that, partly because of this, nursing homes are woefully understaffed.

Yet a third is whether the Residents’ Bill of Rights, part of the Federal Nursing Home Reform Act is even enforceable in federal court. The U.S. Supreme Court has heard a case, Health and Hospital Corporation of Marion County, Indiana v.Talevski, which, if decided in favor of the former, would say not. Unlike most nursing homes, Health and Hospital Corporation of Marion County, Indiana, is state-run. In theory, the Court could protect state-run nursing homes from being sued but still allow residents and their families to sue private-run nursing homes.

Individual families rarely have the money to file suit.

The Department of Health and Human Services does not have the funds or the people to monitor compliance. It can issue warning letters. It can withhold funds – but that would hurt the very people who are supposed to be helped.


Elder law attorney, Terry Garrett, is a member of the National Academy of Elder Law Attorneys and is an Approved Guardianship Attorney. She assists people in elder law, estate and special needs planning, guardianship and settling estates. She graduated with honors from Cornell University. She was on the Dean’s List at Wharton Business School. She earned her J.D. at Columbia Law School, receiving the Parker Award and a Mellon Fellowship.

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