On the path to additional oversight?

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John O'Connor
John O'Connor

It's amazing how many people in the senior living field cut their professional teeth in skilled care. From an employment standpoint, nursing homes are practically the minor leagues.

But when you ask senior living pros with SNF experience about their memories, there's little need to prepare for warm and fuzzy recollections. More than likely, you'll be treated to Shawshank-like tales.

The reminiscing probably will reveal owners focused on money rather than residents, chronic understaffing — and constant pressure to do more with less. But those almost are trifling concerns compared with the proverbial elephant in the room: regulatory oversight that just kept getting worse. Frankly, that more than anything is what pushed many skilled care professionals out the door.

It's well known that nursing homes are one of the most closely watched sectors in America. To be fair, many operators practically invited outsiders to take a closer look. They did this largely by running businesses in ways they would hardly want to detail with their grandchildren. Few were surprised when Congress passed sweeping nursing home legislation in 1987 — or that they have been padding the rulebook ever since.

But nearly three decades later, you'd think Congress might be wrapping up. Fat chance. In July, more than 30 members of Congress penned a letter to the Centers for Medicare & Medicaid Services. Their indignant missive claims that the latest nursing home regulations simply do not go far enough. What's needed, they wrote, are far harsher requirements. As in tougher oversight for quality-, staffing- and arbitration-related matters.

Luckily, those are just additional rules for nursing homes, right? Yes, that is true. But before you take comfort in the notion that only skilled operators need to be worried, consider this:

Assisted living operators are taking care of residents with profiles identical to those of nursing home residents circa 1996. Nor can it be argued that assisted living is exclusively a private-pay option. Most states are now allowing Medicaid dollars for such care. Plus there's the matter of more and more assisted living operators running afoul of good practices, not to mention laws. If you think I'm making this up, Google news about “assisted living.” It's a safe bet that most of what you encounter will be less than flattering.

To paraphrase Bob Dylan, you don't need to be a weatherman to see which way the wind is blowing.

For all its claims of being different, assisted living operators increasingly are serving residents with severe physical and cognitive challenges, are accepting Medicaid dollars and are getting into trouble while doing so. In other words, they are doing many of the same things that landed nursing homes in trouble.

For a sector dead set against federal rules and regulations, such practices hardly seem helpful.

John O'Connor is editorial director of McKnight's Senior Living. Email him at john.oconnor@mcknights.com.


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