Abraham Lincoln had the advice that a house divided against itself cannot stand.
While he directed this sentiment at slavery, it also reflects why efforts to create a more rational long-term care system face ongoing challenges. In the skilled care field, contradiction seems to be everywhere.
Let’s start with facility ownership. Many operators advocate for conservative values, particularly like limited government. Ironically, however, the financial viability of this industry hinges on two of the largest government programs ever established: Medicare and Medicaid. Imagine if those funding streams were cut off tomorrow. For nearly every US skilled care operator, it would be game over.
Our regulatory landscape adds another layer of complexity. Providers despise red tape and bureaucracy — who wouldn’t? But many regulations exist to prevent the mistakes and misdeeds of the past from being repeated. While these rules are intended to protect residents, they often become a nightmare for operators to navigate.
But let’s not simply put the burden on providers. The fact is, they are often held to standards that are, well, unfair. To cite just a few examples:
• Operators are expected to deliver high-quality care, yet they often operate with razor-thin margins due to inadequate reimbursement rates. As the saying goes, you can’t have champagne tastes on a beer budget.
• Facilities are endlessly criticized for staffing shortages, but they struggle to recruit and retain workers primarily because of those same low payments. Perhaps, instead of imposing staffing mandates, Uncle Sam should loosen the purse strings a bit.
• SNFs are pressured to innovate and improve care delivery, yet they frequently find themselves handcuffed by outdated regulations and bureaucratic hurdles, which can hinder their ability to adopt new technologies or implement best practices swiftly. It’s hard to improve your swim time if you’re swimming in molasses.
• They are also expected to keep residents safe during crises like the pandemic, yet they frequently receive delayed or unclear guidance from government agencies, leaving them to navigate unprecedented situations with little support. And Lord help any operator, should tragedy result.
The list of contradictions goes on, but you get the idea. I’m not sure where this is going to lead. But it’s probably fair to say that Honest Abe delivered a pretty good warning.
John O’Connor is editorial director for McKnight’s.
Opinions expressed in McKnight’s Long-Term Care News columns are not necessarily those of McKnight’s.
