Scott Ball / Rivard Report
After nearly 40 years of providing services to San Antonio seniors, the Chandler Estate in Monte Vista will close its doors on Feb. 28. Managers at the senior living community, owned and operated by Morningside Ministries, notified residents and employees of the forthcoming closure Tuesday.
Morningside Ministries President and CEO Patrick Crump said the faith-based nonprofit made the decision due to the increasing cost of care, insufficient Medicaid reimbursements per patient, and rising maintenance costs for the 130-year-old building, all of which made continued funding impossible.
“When the board saw the budget projections for 2018, they realized that [funding the Chandler Estate] wasn’t going to be sustainable any longer,” Crump said.
Roughly 75 percent of patients receiving independent living, assisted living, or skilled nursing services at the Chandler Estate pay through Medicaid, which reimburses the organization around $145 per patient per day, Crump said. But Morningside Ministries spends "well over $200 a day to care for [a patient]."
The Chandler estate, located at 1502 Howard St. and listed on the National Register of Historic Places, can accommodate 180 people. When Crump told the around 90 current residents about the closure, most "weren’t happy, [but] because we explained it with the intent to be transparent [about funding], I think they understood.”
There are no immediate plans to put the historic property up for sale, according to a Morninside Ministries press release.
The organization is working to transfer patients to sister facilities such as The Manor and The Meadows on the Northwest side and Menger Springs in Boerne, but nearly half of the current residents will have to find placement outside of the organization.
Of the facility's 130 employees, only 50 will be guaranteed continued employment with Morningside Ministries. Positions will be granted based on seniority.
While there are senior homes throughout Bexar County that currently accept Medicaid and have the capacity to take more patients, Crump said he worries that long-term care in Texas is “becoming more about the haves and the have-nots.”
“People that have resources always have good options, while people that have spent down their resources have fewer options to receive quality care,” he said.
Texas is “at the bottom of the barrel” when it comes to spending on long-term care for Medicaid recipients, Crump told the Rivard Report. And while the Department of Health and Human Services requires organizations to outline their spending per patient in annual reports, “Texas consistently does not fund or increase Medicaid anywhere near what it costs, [even though] their own reports show them what it takes to provide decent care,” he explained.
Medicaid is jointly funded between the federal and state government – the more the State puts in, the more the federal government contributes. Crump called the Texas Legislature's recent decisions on patient care “very short-sighted,” adding that state lawmakers need to “tie dollars to outcomes and what gets those outcomes.”
Those outcomes, according to Crump and a growing body of research, depend on increased staff-to-patient ratios that enable quality care. The State formally recognizes that providing high-quality care heeds better outcomes, and offers enhanced funding to facilities that maintain care options above the minimum requirement.
“They need to pay for quality,” Crump said. If lawmakers want elderly people to get well, “they have to pay providers to do the right things.”
George Linial, president and CEO of LeadingAge Texas, a trade association that represents nonprofit aging services providers statewide, told the Rivard Report that reimbursement rates in Texas are half of those in others states. "You can make up for some of that [money] with private pay and donations, but you can’t make it all up."
Linial said every day, 1,000 people in Texas turn 65; across the nation, it's more than 10,000. As the 65-plus population continues to age and develop health problems, there will be "more pressure to take care of them," he added.
He compared the closing of the Chandler Estate – and organizations like it throughout Texas that are succumbing to similar financial strains – to a slow bleed.
"As organizations get tighter and tighter with budgets, they try and figure out ways to make ends meet, and at a certain point they say they just can’t," Linial said. "At a certain point you cannot make it anymore, particularly because you hurt other residents," namely those paying out-of-pocket for the quality of care promised.
Of the nursing home residents in Texas, two-thirds are paid for through Medicaid funding, and the fastest growing segment of the population is 80 years and older, Linial said.
"There is no one answer in improving the quality and cost of care for our [aging populations], but it boils down to Texas making the commitment to take care of seniors."