Issues for the 84th Legislative Session
Legend is a leading independent owner and operator of skilled nursing facilities in Texas,
with 17 facilities across the state. The company is consistently regarded as one of the top
owner/operators in Texas and within each of its individual markets.
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Create a special committee to study the realities of skilled nursing care in Texas today and where
modernization of the industry’s regulatory oversight is needed.
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Our current regulatory system is outdated and regulates a Nursing Facility (NF) system that has evolved
greatly over the last decade to include more skilled patients.
The legislature should create a special committee to conduct an overview of the state of the industry
with suggestions to modernize regulations and survey processes.
The special committee should be made up of legislators and public members appointed by the Office of
the Governor, Lieutenant Governor, and the Speaker of the House.
The Facts
The industry has evolved into two disparate businesses;
o Nursing Facility:
 Residence where individuals have a room, meals, and assistance with activities of daily
living.
 Care is delivered around the clock by trained and licensed healthcare professionals,
including Registered Nurses (RNs) and Licensed Vocational Nurses (LVNs), for
residents who require close, but less clinically complex, medical supervision.
 NF care accounts for 74% of the patients and only 47% of the revenue.
o Skilled Nursing Facility (SNF):
 Care Facility certified by the federal Medicare program to provide short-term clinical
care for post-acute patients admitted from a hospital.
 In addition to registered and licensed nurses, the SNF has licensed physical and
occupational therapists, speech-language pathologists and audiologists to meet the needs
of patients with highly medically complex issues and with multiple comorbidities. Much
like a hospital, it is common for these facilities to have nurse-practitioners and physicians
rounding daily.
 SNF care accounts for 26% of the patients and 53% of the revenue.
However, both are operated under the Long Term Care (LTC) Facility License with the same regulatory
oversight.
Because the current antiquated regulatory and survey systems are not designed to appropriately evaluate
and monitor the modern-day NF/SNFs environment, it inaccurately assesses facilities that specialize in
treating the more medically complex patients. As a consequence, Texas is erroneously and
embarrassingly portrayed as one of the “worst nursing home states” and ranked “poorest in Long-Term
Services and Supports.”
608 Sandau Rd.
San Antonio, TX 78216
210-564-0100