Opinion: Nursing Homes Need to View Regulators as Partners — Or Perish

My job involves combing through Google Alerts in search of the latest filings and nuggets of news about the skilled nursing industry. Most are false positives — especially during the autumn, when my alert for “SNF” returns more information about the coming week’s Sunday Night Football matchup than skilled nursing facilities.

But ever since I started covering the industry this spring, I’ve come to dread the alert for “nursing home,” a daily parade of stories about abuse, neglect, and other crimes.

The tragedy at the Rehabilitation Center at Hollywood Hills was perhaps the most visible bit of horror that has occurred during my time on the beat, but there’s a steady stream of mini-Hollywoods every day: sexual assaults on residents, thefts, and even the occasional murder. There are so many that I choose to cover almost none of them; otherwise, this site would have no other content.


Average Americans with loved ones who need long-term care most likely don’t have nursing home news delivered into their inboxes every morning. But they do watch television and go online, and they see the headlines about deadly nursing home fires, mismanagement during disasters, and unspeakable neglect — such as the the story of World War II veteran James Dempsey, whose death while his calls for help went unheeded was caught on video.

The Dempsey story dominated my inbox for days, just as the Hollywood Hills tragedy had done before it. That’s because mistreatment of the vulnerable is major news for both noble and cynical reasons: People genuinely care about those who can’t help themselves, and news organizations know that outraged readers and viewers will pay attention — and like, share, and angry-face emoji their content over and over.

This coverage doesn’t help the industry from a public relations or investor standpoint: The more skilled nursing facilities are portrayed as dens of abuse and cold indifference, the less likely investors are to take a chance on an already embattled industry.


So given the persistent image problems, I was a bit shocked to overhear the occasional trashing of regulators when I attended the American Health Care Association’s annual conference in Las Vegas back in October. To be sure, the group itself and many others in the industry — such as LeadingAge — acknowledge the necessity of rules such as the controversial generator mandate in Florida, even if there were reasonable objections about the timeframe and potential costs.

Still, there was enough anti-government, anti-regulation rhetoric to make me, a relative newcomer to the space, uncomfortable. Surely I understand the pressures that skilled nursing operators face in this landscape of changing payment models, declining Medicare reimbursements, and staffing shortages. And I’m well aware of the SNF-world truism that aside from nuclear power, there’s no more heavily regulated industry than the nursing home space in the United States.

But don’t most people enter the SNF business, at least on some level, to help people during the most trying time in their lives? And, if nothing else, isn’t the industry aware of the optics, to use a trendy Washington word, of even appearing to be anti-regulation after 14 people died due to substandard care in a building where they were supposed to be safe?

The Centers for Medicare & Medicaid Services is a complicated bureaucracy, and I can only imagine the frustration of administrators and employees forced to take marching orders from people who may never have set foot in a SNF.

But there’s certainly an opportunity for individuals in the industry to work with, not against, CMS on issues that affect resident safety. Sure, conferences are safe zones where people can blow off steam about potentially specious regulations with their colleagues from around the country, but that attitude shouldn’t carry over into a SNF’s day-to-day operations. Nursing home staffs should follow the lead of major industry groups and always think of ways they can view CMS and local authorities as partners, not adversaries — even if the relationship can be a bit overbearing at times.

Obviously, even in a perfect world, patients would still fall through the cracks. There will always be negative headlines when our most vulnerable citizens are injured. How individual SNFs respond will go a long way toward preparing SNFs’ damaged reputation in the court of public opinion, and on Wall Street.

Written by Alex Spanko

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