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According to an article by the Associated Press and posted in The Houston Chronicle’s online version recently, the economy (vis a vis budget cuts to government nursing home enforcement bodies), legislative changes and discouraged inspectors all appear to be working together to reduce the enforcement of regulations governing nursing homes in Texas.

In Texas presently, revoking a nursing home’s license, not to mention seeking a court-appointed overseer to examine nursing home infractions of the rules, is almost unthinkable. Inspectors, too, are discouraged from carrying out their duties to the letter of the law because there isn’t a budget for it. According to one stunning revelation in the article, “State budget cuts have reduced staff by about one-fourth since 2001, even as the number of nursing homes in Texas is virtually unchanged, at about 1,200.” And we are projecting that the number of people going to nursing homes (Baby boomers, take notice) is on the rise.

We suggest this is not only happening in Texas. This situation appears to be prototypical for several states just now—and it appears that it is not only the economy but the confusion over what is going to happen with health care legislatively, in general, which is fueling this reduction in enforcement. The players—the government health departments, nursing homes, physicians, hospitals, to name only a few– don’t exactly know what cuts are in store for them and how the cuts will affect their organizations’ ability to participate in the healthcare system in the future. All of this trickles down in the form of big worries to the poor nursing home residents and those contemplating placing their loved ones in nursing homes.

While the Commissioner for the Texas Department of Aging and Disability Services, Chris Traylor, says that agency is not impeding tough enforcement of nursing home regulations, and the Texas Health Care Association representative Tim Graves will tell you he believes the system works, limits imposed on lawsuit damages have “virtually eliminated trial lawyers as de facto watchdogs of nursing homes.” Who is left to stand up to the large nursing home companies?

Due to some legislative changes, the State of Texas, itself, is even limited in its ability to fine nursing homes for infractions of the rules. So who’s protecting the residents of nursing homes in Texas these days? Where are the checks and balances in The Lonestar State? How about your state?

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