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McKnight’s Editorial Director John O’Connor
John O'Connor
John O’Connor

The Washington Post recently reported on a growing trend in assisted living: Communities turning down Medicaid participation and evicting residents.

You might say it’s a classic case of bad choices forcing more bad choices.

There once was a time — about 30 years ago or so — when assisted living (which now prefers to identify as senior living) was essentially a private-pay enterprise. Operators proudly marketed their buildings and approach as nonmedical alternatives to the brutish nursing homes down the street.

In those simpler days, residents moved into assisted living communities and paid rent each month. It was a pretty straightforward arrangement. And for the most part, it worked really well for residents who could keep cutting checks (or had children who could).

So long as the rent was paid and it wasn’t painfully obvious that skilled care was required, the person could remain on the premises. But if the payments stopped? Well, the resident had to leave. End of story.

But then a funny thing happened. Some states started allowing their Medicaid programs to offer payments for assisted living. To be fair, the idea came from a good place. But this move proved to be a real game-changer for the industry. And it must be said, not entirely in good ways.

Sure, the additional government funding was nice. Especially for properties that were barely scraping by. But over time, many operators came to some obvious yet startling realizations.

One was that the new funding was nowhere near enough. A second was that they might be better off as a nonsubsidized enterprise. But how to elegantly transition back? Easier said than done.

For it’s one thing to throw deadbeats to the curb. Happens all the time at apartments nationwide. But to accept Medicaid payments and admit people relying on such assistance — and then throw residents to the curb? As they say in politics, the optics here are not good.

That’s the kind of thing that just might generate a lot of hard feelings and resentment, not to mention news stories that are less than flattering.

Unfortunately, there’s no easy fix here.

The real time for action would have been when Medicaid dollars were first being waved in front of operators. And the best response then probably would have been a polite, but firm “no thanks.”

But that is not what happened. And a part of what made assisted living special and unique was lost.

Just as more will be lost as operators chase the next tempting cash cow: identification as a healthcare player. Sure, once again, some short-term revenue will be gained. But what about what gets lost?

One thing’s for sure: senior living will never be the same. And that’s not necessarily a good thing.

John O’Connor is editorial director for McKnight’s Senior Living and its sister media brands, McKnight’s Long-Term Care News, which focuses on skilled nursing, and McKnight’s Home Care. Read more of his columns here.

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