When long-term care becomes a slugfest

by James M. Berklan

If you ever want to see something really wrong, just watch two sides fight when both think they’re really right. It usually isn’t pretty.

That describes the climate created by the nursing home staffing mandate proposed on Friday.

Even before the release, providers had lobbied hard to impress upon rulemakers that there isn’t enough money in the government propped-up system to fund what they want. Nor enough bodies to fill the workstations they desire.

On the other side of the arena stands a crowd of regulators, consumers/voters, labor groups and academics who want more for patients. Some seem to be suspicious of any provider that doesn’t prolong health status indefinitely. Most are pretty adamant that they are going to fight for higher nurse-hours-per-day requirements, and — fair warning — they will have public sentiment on their side.

With the official publishing of the rule in the Federal Register today, the Centers for Medicare & Medicaid Services opens a 60-day comment period on its staffing proposal. Hold on to your hats, folks. It’s likely to become one of the most prolific, passionate comment periods ever.

All in the name of getting the “right” views out.

Who’s right? Those who want more people to live longer lives. Those who say they could use a lot more help making this happen, especially since government funding is supposed to make it all work.

Those who say there aren’t enough nurses to meet targets in the controversial proposal — and won’t be for years, even with increased focus on raising the number. Those who say Friday’s proposal could have been much worse for providers. Those who think the final rule will make providers’ tasks tougher.

Those who say bolstering training programs for nurses — and their would-be educators — is needed. Those who sneer that 75 million federal dollars for building such programs is anywhere near enough to do it.

Who else is right? Those who say there ought to be some kind of floor put on the level of staffing in skilled nursing facilities. Those who say a one-size-fits-all approach won’t work. 

Those who want surveyors to be more consistent, and more open with advice. Those who wonder where more surveyors will come from since their ranks are also so depleted.

Who else is right in this Story of the Year showdown? Centers for Medicare & Medicaid Services report authors who found “no single staffing level that would guarantee quality care.” Also, those who believe that report will be one of providers’ most powerful tools against mandated staffing levels. 

Also right are those who look to build flexibility and waivers into any final rule.

The right crowd includes those who say more skilled nursing wings, floors and entire facilities will continue to close if staffing levels have to go up. And maybe even if they don’t. Others right include anyone who frets that out on the prairie, and other secluded areas, it is going to get tougher if you need, or want to provide, nursing home care.

Who else is absolutely right? Those who say skilled nursing is a needs-based industry that will never go away. 

Most of all, those who are right include those who see Friday’s proposal as only the beginning. 

In other words, considering all of the above, everyone has some share of “right” in their corner.

The howling about the rule picked up right after it was released Friday. But more, stiffer blowback is coming — and from all directions. On that, I know I’m right.

James M. Berklan is McKnight’s Executive Editor.

Opinions expressed in McKnight’s Long-Term Care News columns are not necessarily those of McKnight’s.

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When long-term care becomes a slugfest