Welcome to TANHR 

Texas Advocates for Nursing Home Residents

New: Civil Monetary Penalties Report


Survey Reports on Nursing Homes

TANHR Is Amazed!

Our Mission

Journal Articles

° Civil Monetary Penalties Report


Policies and Regulations























Welcome to Texas Advocates for Nursing Home Residents (TANHR), a non-profit, volunteer organization advocating improvement in the quality of life and care of Texas nursing home residents.  TANHR is not associated with nor funded by any nursing home or health care company.

WELCOME TO OUR WEB SITE  TANHR understands the importance of research for the accumulation of accurate and reliable information about nursing homes and nursing home residents.  We appreciate the difficulty of achieving and acquiring this knowledge, and we support academic and professional researchers in this sometimes thankless work.  Journalism and mass media play an important role in informing the public about what is happening in nursing homes and in the offices of the companies and organizations that own or run them.  We are grateful for those who have the courage and determination to spend their time and resources in pursuit of factual and precise data about conditions, structures, and procedures in nursing facilities.  Many Texas nursing home residents have no one to stand up for them or to reveal to the public the pitiful and inhumane treatment and conditions in which they frequently live.

We are interested in helping you and in your research.  Please let us know about information you have or need that will further public knowledge about nursing homes and nursing home residents.   We are especially in need of your comments and/or suggestions about our new Web site.  Please E-mail our -- or our -- or contact us by mail or phone using the information at the end of this page.

To get information about a particular nursing home's performance and care, see our web page: Resources.

TANHR continues to be amazed that State officials substantiate only 19% of the allegations made against nursing homes. TANHR recently acquired this data* from the Texas Department of Human Services (TDHS). What is the reason for this dismal result? Is it that the complaints are unfounded? TANHR thinks not.
TANHR believes there are three reasons for the poor rate of substantiation:
1) the extended and difficult regulatory procedure required to find nursing homes blameworthy,
2) the fear or retaliation against  residents' loved ones and nursing home staff who make complaints,
3) the requirement that State surveyors (inspectors) must actually see the abuse or the outcome of the abuse in order to label it as "substantiated."
It is not surprising that those state regulatory officials are unable to find persons and evidence that substantiate complaints.
TANHR Board members recently met with Jim Lehrman of TDHS. He indicated that the data results cited above could be misleading because, on their visits to nursing homes, state surveyors frequently find violations other than those that have received official complaints. These violations can then be pursued by the TDHS.
TANHR Board members believe that TDHS needs more funding for additional surveyors, legal staff, and surveyor training. TANHR strongly supports attempts to increase TDHS funding in the current legislative session.

From "Texas Department of Human Services Facility Types (0100,0101,0102,08), Complaint Allegation Validity Rate.

JOURNAL ARTICLES  This section, still under development, will provide abstracts, reviews, and/or full text of professional journal articles.   The reviews are written from the point of view of TANHR.  They are done by a sociologist associated with TANHR and teaching in the Dallas County Community College District. 

We suggest reading the material below, if you already have, you can go directly to the newest Civil Monetary Penalty Report now.

  • Long Term Care Regulatory Civil Monetary Penalties Report Summary: One of the sanctions that can be imposed against a long-term care facility for deficiencies are civil monetary penalties.   These sanctions  were originally authorized by federal law (OBRA '87), but states have historically enforced these sanctions.  The penalties are potentially substantial, ranging from $3,050 to $10,000 a day for violations deemed an immediate jeopardy, and from $50 to $3,000 a day for other violations. 
    Although the potential fiscal impact is great, civil monetary penalties cannot be collected without the facility having an opportunity for a hearing.  The regulations, however also stipulate that penalties can be imposed retroactively from the date of a survey, for dates that the provider was found to be in non-compliance (Fogg, 1994).* 
    The Texas Department of Human Services (TDHS) at (800)458-9858 is the agency charged with gathering and providing information about nursing home care and practices.  The Long Term Care Regulatory Civil Monetary Penalties Report Summary is produced periodically. 
    TANHR completes the time-consuming task of data entry in order to publish an electronic version of this important data.  We think the State of Texas should publish this data on the Internet, but because they do not, we do. All you have to do is click on the hyperlink below to go to this data.  But before you do - two points:
    1.  When you get to the report, if you wish to quickly find the name of a particular nursing home,  you may press
    Ctrl-F and in the box type the name of the city in which the facility is or type the name of the nursing home.  The cursor will then move to that place in the report.
    2.  We STRONGLY ADVISE you to read the
    Key Terms
    below prior to reading the Civil Monetary Penalties Report Summary - posted to this site 8-3-99.


    PROPOSED:  Amount recommended by regional enforcement team to be imposed.
    MORATORIUM: Amount recommended but not imposed yet due to HCFA policy to suspend imposition CMP's at the lower levels of non-compliance, pending a study of the proportionality of the penalties being recommended.
    IMPOSED: Amount after the State Medicaid Agency or HCFA has reviewed the recommendation of a penalty and has decided on an amount of the penalty.
    PENDING:  Penalties that have been imposed but TDHS has not been notified of the facility's status under due process (request for appeal, or request to waive their right to an appeal).
    APPEALED:  Penalties currently under appeal, but the hearing has not been conducted yet.
    REDUCED:  Amounts that will be collected due to reductions based on negotiations, bankruptcies, or automatic 35% reductions based on facility's request to waive a right to a hearing.
    ASSESSED:  Due and payable.  Amount due after the appeal/review process is completed, and waiver request, negotiated settlement or hearing processed or finalized in a final assessed amount, and due date, is agreed upon.
    COLLECTED:  Amount facilities have paid to the State Medicaid Agency or to HCFA.
    OUTSTANDING:  Monies that are due and payable but have not yet been collected in full due to 1) the penalty being paid in installments, or 2) they are not yet due.
    To go to the report click here> Civil Monetary Penalties Report Summary - Posted 8-3-99

  • Health Care Financing Administration (HCFA)  The other agency that provides information about civil monetary penalties on nursing homes.   TDHS provides HCFA information on dually-certified facilities in the report described above.  For information about various Medicare issues, call the Medicare hotline at (800)638-6833 or go to the Health Care Financing Administration Web site.


  • The Texas Department of Human Services (TDHS) is the agency charged with gathering and providing information about nursing home care and practices. 

  • The Health Care Financing Administration (HCFA)
    HCFA is the federal agency that administers the Medicare, Medicaid, and Child Health insurance programs. 

This section, still under development, will provide copies of certain regulations and policies of agencies overseeing nursing home practices.

The 75th Legislature passed and the Governor signed new laws revising the regulations for nursing homes, Senate Bill 190 and Senate Bill 118.  The Texas Department of Human Services published a revision of changes to the Health and Safety Code that gives the Texas Department of Human Services additional authority to deny, suspend, or revoke the licenses of providers of poor quality care and also provides greater enforcement remedies for providers who violate licensure rules.  TANHR keeps a copy of this revision and if you have questions about the law and this revision, call us. 
Although Senate Bill 190 is a great improvement over previous legislation, there is still much work to be done, especially in enforcement.  TANHR continues to work for nursing home residents through its contacts in the Texas Legislature, in numerous hearings, and on the phone with legislators and state agencies.

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TANHR is a non-profit, volunteer organization working to improve the quality of life and care of Texas nursing home RESIDENTS.


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Texas Advocates for Nursing Home Residents (TANHR)
P.O. Box 763143  |  Dallas,  Texas  75376
Call our toll free number: (888)TANHR4U   [(888)826-4748]
In the Dallas area call or FAX us at:  (972)572-6330
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The organization and presentation of all information on this site is © 1998 by Texas Advocates for Nursing Home Residents.