The Center for Excellence in Long Term Care Advisory Board in collaboration with the Texas Health and Human Services Commission Quality Management Program is working to address the issue of quality in Texas nursing homes. There is a need for nursing leadership at the bedside while improving revenue to the home for use to improve staff outcomes. We have spent the last year working on a model of care in Texas that helps the homes to hire patient centered care providers who may bill for their healthcare services. If revenue is sufficient, the excess can be used to improve staff to patient ratios, but our main objective is to improve the quality of care provided to the resident and their families. The Advanced Practice Registered Nurse model of care is our recommendation at this time. We are working to gain revenue to test this model and improve quality. Please read the attached white paper.