Louisiana’s nursing homes are among the nation’s worst.

The state ranked 50th in patient quality of care in a recent AARP report, which noted high rates of pressure sores and antipsychotic medications.

Elderly citizens widely prefer staying in their homes with help as long as possible, studies show. And advocates for changing the system say that making institutionalization a last resort would save the state money.

But when legislation was introduced this year to address that imbalance, three prominent former lawmakers helped torpedo it before it could progress.

Former House Speaker Jim Tucker urged the House Appropriations Committee to kill the proposal. Joe McPherson, the former chair of the Senate Health and Welfare Committee, told his onetime colleagues the reform was impractical. And Sherri Buffington, the committee’s former vice chair, watched from the audience.

Each of them is deeply connected to the nursing home industry, which has strongly opposed the changes.

Tucker is the CEO of CommCare Corp., a nonprofit that runs 13 Louisiana nursing homes. McPherson is the administrator and part-owner of a nursing home in Lafayette. And Buffington, who as a legislator sponsored laws that helped nursing homes reap more money, now lobbies for the health care sector, including a Shreveport hospital system that owns a nursing home.

The muscular display from former lawmakers is not unusual in Louisiana, a state known for a pro-business climate, and in particular a lax regulatory environment. Former lawmakers, whose legislative jobs brought in $30,000 to $40,000 a year in combined salaries and per diems, frequently leverage the part-time jobs into much higher-paying roles in the private sector or in the upper ranks of government. The bills they sponsored and positions they espoused at the Capitol give them a launching pad for lucrative future opportunities.

Some work around the state ethics law requiring them to wait two years before lobbying the Legislature. Instead, they push industry positions before other government branches, or sign on as “consultants” rather than lobbyists. Others take on top jobs at state agencies or in the executive branch, working on behalf of interests they once championed from the floor.

“There’s a whole flock of them,” said State Sen. Conrad Appel, a Republican who sponsored the bill this year supporting more home- and community-based care. “Do they have any extra authority because they were a legislator? I’d say no. But they do have a leg up because they’re friends with people there, and they know how the system works, and they have contacts.”

To gauge the continuing influence of former lawmakers, The Advocate and ProPublica tracked the 99 former members who left the Legislature between 2010 and last month’s elections. Thirty-five went on to jobs in the spheres of lobbying, consulting, governmental affairs, state government, state boards or as legislative advocates for businesses they run. The group includes members of all political affiliations.

“They’ve proven their loyalty to the industry already, and they still have influence,” said Bruce Blaney, a former state health official, about lawmakers who advocate for nursing homes. As the head of an association of more than 300 in-home support providers, Blaney has often tangled with the nursing home industry. He has yet to prevail.

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Troy Hebert, a 14-year veteran of the House and the Senate, parlayed his lawmaking experience into a top government job under former Gov. Bobby Jindal. He’s hardly alone, as governors frequently fill out their cabinets with legislators. Among the former lawmakers Gov. John Bel Edwards has tapped to fill out his cabinet: Robert Adley, who represented him on the Commerce and Industry Board; Legislative Affairs Director Noble Ellington; Office of Motor Vehicles Commissioner Karen Gaudet St. Germain; Wildlife and Fisheries Secretary Jack Montoucet; and former chief of staff Ben Nevers.

Other former legislators have landed high-profile jobs elsewhere in state government, including State Parks Assistant Secretary Gene Reynolds, Grambling State University President Rick Gallot and chief deputy insurance commissioner Nick Lorusso.

But in Hebert’s case, the independent from Jeanerette built a legislative track record as a friend of bar owners and alcohol suppliers. Some critics complained when, in 2010, the senator took over the industry’s regulation as state alcohol and tobacco commissioner.

“His record on legislation — regarding alcohol — had definitely leaned toward a less regulatory perspective and a weakening of laws as they existed at the time,” said Janet Dewey, a former state executive director of Mothers Against Drunk Driving who testified against a 2005 bill of Hebert’s.

The bill would have allowed convenience and grocery stores to sell frozen alcoholic concoctions such as daiquiris. When Hebert presented the bill, he sat beside liquor lobbyist Christopher Young, a close friend who was a formidable voice on alcohol-related issues. Young pleaded guilty last year to a misdemeanor charge of transmitting obscene images. He declined to comment for this story.

Hebert also unsuccessfully sponsored a 2008 bill that would have allowed military members under 21 to drink legally. That was a pared-down version of a 1997 bill he sponsored that would have called a statewide vote on whether to lower Louisiana’s drinking age to 18. That bill also failed.

When Hebert became commissioner of the Louisiana Office of Alcohol and Tobacco Control, a job that paid up to $107,800 in salary and benefits and included use of a government-owned Chevy Tahoe, some credited Young’s influence.

In a sworn 2017 deposition taken in a civil case, Brian Dejean, the ATC’s former lawyer, testified that Young “carried a lot of weight in regard to decisions that involved the industry” and said Young had helped install Hebert in the job. Screenshots included in the court file showed texts between Dejean and a former employee suggesting that Hebert and Young “ought to get a (prison) cell together” after Young’s obscene images charges. The exchange suggested that Young offered guidance to Hebert on which ATC employees should be fired.

Louisiana’s powerful lobbies for bar owners and alcohol distributors have long carried clout with the Governor’s Office and other high-ranking politicians largely because of their campaign contributions and statewide activism, according to Arthur Smith, who has represented multiple ATC employees in lawsuits against Hebert. Jindal also appointed Hebert as his legislative liaison in 2015.

But Hebert disputes that Young had anything to do with his appointment and says he doesn’t believe Jindal consulted anyone from the alcohol industry before naming him. Jindal’s former chief of staff Timmy Teepell said separately that Young played no role, and that Hebert was “the best guy for the job” among many applicants. Hebert left the job as Jindal was exiting office, and he said he now works as a contractor.

In the ATC job, Hebert’s signature accomplishment was slashing the budget by more than a third and cutting the staff by 40 percent. The cuts were especially deep in the law enforcement staff. When Hebert took the role in 2010, ATC had 76 employees. By the time he left, the staff count was down to 46.

Hebert’s friendship with Young led to recurring questions about his performance as commissioner. It also drew close scrutiny from federal law enforcement.

The FBI suspected Hebert of misusing his position to do favors for Young’s clients, according to an FBI memo included in court filings. When agents discovered Young had emailed an obscene image of a child, which Young claimed was a joke, they urged him to help his own cause by offering information on Hebert. Young declined to comment.

Hebert was never charged, and in an interview, he said he was never approached by the FBI.

Smith said he found an intervention by Hebert in 2012 on behalf of one of Young’s clients unusual. That came after an intoxicated man left the Bulldog bar in Baton Rouge and crashed into two cyclists, killing one and severely injuring the other. Hebert interceded into an ATC agent’s investigation of the Bulldog and cleared the bar of any violations.

Hebert said he pitched in because the investigator was inexperienced and slow. He said his involvement was unrelated to Young.

“There’s significant testimony that enforcement of alcohol and tobacco laws decreased substantially under Hebert’s reign,” Smith said. “He always bragged about reducing the number of employees, but the testimony was that the enforcement went down drastically. And it’s very much tied to his relationship to the alcohol industry.”

Hebert disputed the criticism and said enforcement skyrocketed amid the cuts by 500 percent. “That is the narrative of civil service workers, that if you cut staffing, you’re less effective,” he said.

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The ranks of Baton Rouge lobbyists are thick with former lawmakers. Erich Ponti left the Legislature in mid-2015 to head the Louisiana Asphalt Pavement Association. Ann Duplessis is now the president for the Louisiana Federation for Children, which advocates for charter schools. Anthony Ligi represents the Jefferson Business Council. Another former House speaker, Chuck Kleckley, advocates on behalf of casinos and makers of body cameras. Mike Michot’s clients range from local governments to grocery stores.

Nick Gautreaux served six years as a Democrat in the state Senate before the governor named him commissioner of the Office of Motor Vehicles in 2010. He served less than two years, then registered as an executive branch lobbyist. That was permissible under state ethics laws, so long as he did not lobby the OMV.

Gautreaux now represents the Louisiana Quarter Horse Breeders Association, after promoting its interests in the Legislature. In the Senate, he carried bills on behalf of the horse racing industry — one of which protected quarter horses specifically by legally enshrining the number of days they had to run on Louisiana racetracks.

As a lawmaker, Gautreaux also supported the legislative agenda of the Louisiana Horsemen’s Benevolent and Protective Association, a nonprofit group that receives public money and uses racing proceeds to provide medical and pension funds for horse owners, trainers and others. There had long been concerns about how the nonprofit was spending its money.

The Legislative Auditor’s Office wanted to apply rigorous governmental auditing standards to the HBPA. But Gautreaux sponsored a bill in 2010 that crossed out language that said an HBPA account “shall at all times be subject to audit by the legislative auditor.”

In recent interviews, he noted that he supported a compromise measure after his bill did not go forward, as evidence that he did not oppose accountability for the HBPA and said the auditor could still scrutinize public funds. And Gautreaux also referenced a 2008 letter he said he sent to the legislative auditor that requested audits of two other HBPA accounts.

But even today, Gautreaux believes the HBPA should be exempt from rigorous public auditing standards, even after the HBPA’s past president, Sean Alfortish, pleaded guilty in 2011 to fraud charges.

Among other misdeeds, Alfortish had tried to rig elections to ensure his selection to a second term. After Alfortish went to prison, a report by the legislative auditor — which was ultimately granted oversight — said Alfortish and two other employees had also spent more than $800,000 in public funds on lavish trips, meals and parties. Auditors also found that HBPA employees raised money for Gautreaux’s and Jindal’s re-election campaigns while on the clock, with whoever raised the most for Gautreaux getting a $500 bonus.

Alfortish said in an interview that it was OK for HBPA employees to fundraise because he views the organization as a private one. He said the legislative auditor’s report was “wrong in many aspects,” but declined to comment further on his actions at the HBPA.

Auditors flagged the fundraising as a potential Internal Revenue Service violation that could have hurt the HBPA’s nonprofit status. And the HBPA, in a lengthy response to the audit at the time, promised reforms.

Gautreaux shrugged off the fundraising and said he didn’t know that had been going on. “If I’m a horse supporter and they raise money for me,” he said, “that’s their deal, not my deal.”

Gautreaux filed other bills favorable to the HBPA and Alfortish, including one that would have allowed the HBPA to open its own off-track betting operation.

“I emphatically know he was one of the floor leaders for the racing industry,” Bryan Krantz, whose family used to own the New Orleans Fair Grounds racetrack, said of Gautreaux. Gautreaux and Alfortish were close, he added.

But Gautreaux said he only recently became friends with Alfortish. He said he advocated for horse racing because he grew up with horses, as have many of his former constituents.

“He was a great advocate for horse racing in Louisiana during his time as a legislator,” Alfortish said.

Gautreaux said he doesn’t need to apologize for his advocacy. Lobbying is hard work, he said, adding that lobbyists are now needed more than ever because term limits have drained institutional knowledge from the Legislature.

That’s a sentiment many lawmakers share. Many legislators told The Advocate they see nothing wrong with the revolving door connecting lawmaking to lobbying.

“The people of Louisiana need lobbyists, OK?” Gautreaux added. “If the general public were smart, they would elect a lobbyist as a legislator.”

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Also passing through the Capitol’s revolving door are legislators who may not need to register as lobbyists, but who continue to influence legislation by advocating for businesses and industries in which they have an interest.

When Tucker, McPherson and Buffington returned to the Capitol this year, they were welcomed with mentions of their past service. The chairman of the House Appropriations Committee greeted Tucker as “Speaker,” while the chairman of the Senate Health and Welfare Committee thanked McPherson for his prior work in that committee.

Tucker and McPherson testified against separate attempts to let insurance companies manage the state’s long-term care patients, determining whether they are better served in nursing homes or home- and community-based services. After the failures, AARP criticized lawmakers for ignoring “tens of thousands of older adults in their districts who want to live at home.”

The defeat of the “managed care” model preserved a status quo that has benefited nursing home operators, but not necessarily their clients. Multiple attempts to change the system have failed.

When Republican state Rep. Rick Edmonds tried to amend the state’s budget in the House Appropriations Committee to pave the way for managed care this year, Tucker argued against it and support dissipated.

“With his experience in the Legislature and his longtime experience in the industry, I do think that it carried weight,” Edmonds said.

In an interview, however, Tucker downplayed his influence.

“Former members are like day-old French bread,” Tucker said. “We go stale in a hurry.”

Tucker, a Republican, said his relationship with the nonprofit nursing home conglomerate he heads, CommCare, predated his legislative service. He was an investment banker for the nonprofit in 1994, and he joined its board in 2008. Tucker left the Legislature at the beginning of 2012, and he was named CommCare CEO in 2015, a job that pays a salary of $597,230, according to the nonprofit’s tax filings.

Tucker said his service on CommCare’s board presented no conflicts while he served in the Legislature — even when he voted on nursing home legislation — because the bills under consideration would have affected the industry as a whole, not CommCare alone. That’s a frequent defense from lawmakers in similar scenarios. State ethics laws — written by legislators — allow lawmakers to write, advocate for and vote on bills that would enrich themselves, their family and their clients as long as others in the industry would benefit as well.

“This is a citizens’ Legislature,” Tucker said. “Anybody who has any outside experience votes on things that impacts their world. … As long as you don’t cross a line where you don’t vote on something for your company in particular, I don’t see a conflict.”

But Elliott Stonecipher, a Shreveport-based pollster and government watchdog, disagreed. He said recusals should apply across the board. And Stonecipher said Tucker should have resigned from the Legislature if he wanted to be involved “in any way, shape or fashion with legislation even remotely affecting CommCare.”

McPherson also has said his ownership of a nursing home did not bar him from chairing the Senate committee that regulates them — or from corralling legislators in the years since to vote down managed-care bills.

In 2017 testimony, McPherson boasted that Edwards had visited his nursing home and sought advice about managed care. Both are Democrats. The governor has been criticized for changing his position on managed care to be more supportive of the nursing home industry. Edwards’ spokesman, Richard Carbo, confirmed that the visit happened.

“While Gov. Edwards doesn’t recall the specifics of his conversation with Mr. McPherson, he did solicit input from a broad group of stakeholders throughout the state,” Carbo said.

McPherson said by email that he would continue to “factually provide balance to thwart the powerful influence of AARP and their financial business partners the Insurance industry as they try to siphon hundreds of millions of dollars from needed and mandated services for the state’s frail and elderly.”

Buffington, a Republican, was a key ally of nursing home owners during her time in the Legislature. She carried bills that helped to ensure that nursing homes got the major share of the Medicaid dollars marked for the elderly and physically disabled. In Louisiana, 79 percent of that money goes to nursing homes, compared with 21 percent allocated for community-based services, while in other states, the ratio is closer to 60-40.

In 2006, Buffington also sponsored a key bill that locked in a generous nursing home payment structure. The bill came a year after the legislative auditor released a blistering report suggesting major changes.

She also won passage of a bill that drove up state costs and protected nursing home profits by requiring the state to “rebase” reimbursement rates for nursing homes at least biannually. Rates ballooned by 54 percent between 2006 and 2016, jumping up to $173 a day, according to a 2017 legislative audit.

Buffington is registered as a lobbyist, and the Shreveport Willis-Knighton health care system she lobbies for also owns a nursing home in north Louisiana.

Appel said he was not surprised to see Buffington in the committee room when his bill came up.

“She’s always been very close to nursing homes,” he said.

Buffington did not return calls seeking comment.

“It is fairly common for us to see former legislators back at the Capitol to work on issues either personal to them, or to another industry,” AARP lobbyist Andrew Muhl said. “Whether they work for nursing homes, personally own a nursing home or have a business interest, they work hard to protect policies that are important to them and work twice as hard to defeat the others.”

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