The author in today’s McKnights of the above titled article believes that mistrust is a problem … And I agree that long-term care mistrusts Government for good reason, but underfunding  is THE problem.

There will never be enough money when the surveyors and State and Federal Governments are head hunting so they don’t have to take any responsibility for underfunding minimum standards that become maximums. If anyone feels more laws, regulations and fines will solve the problem, after 35 years of frustration, go out and buy a struggling nursing home and try to make a difference.

As a CPA and consultant, I have been assisting nursing homes deal with their negative image for 30+ years. Most of that time I blamed the operators as being too focused on rate increases than improving the culture of bad odors, wrongful death law suits, poor response to complaints, purveyors of high staff turnover, etc. So my You are right mistrust is universal and underpayment is a problem but not the problem. There is wife, son and I decided to become a part of the solution by buying three SNF’s. During the six+ years we owned the facilities we invested $500,000 at each location to undo the squalor created by the prior owners. Big mistake.

We weren’t big enough to fend off the vicious and illegal survey process taking it out on us for the previous owners’ violations. After six and a half years of subjective, capricious and arbitrary treatment we were forced to sell. It took us two times as the surveyors’ created IJ’s … the first was for a patient on patient slapping incident within days of our closing costing us $2 million in sales price and $365,000 in fines … as a result we had to find another buyer … same thing … within two weeks of closing of the second deal we got hit with another IJ for the hospice walking away from a dying patient and claimed we were responsible for not doing CPR. We repaired a failed reputation of all three facilities and discharged over 300 patients back to the community with our restorative nursing program. None of this mattered to the Departments of Inspections and Appeals because of my stated views that the negative enforcement culture destroys the entrepreneurial spirit and invites consolidation into large chains that are politically connected and can survive what is truly the worst problem … the use of a negative over reaching enforcement and under payment culture destroying the small independent ownership where the owner is there every day pursuing true quality of life for our elderly. I have chronicled this travesty in my latest book “Failing Government Taketh Away” Xlibris, 2015.

My family owned business lost every battle (IDR and ALJ appeals) with accumulated fines of $500,000 and holds on admission by CMS five different occasions and put into special focus two and one half months after buying our Washington Iowa facility and decertified in the Arkansas facility after another IJ within 2 months after taking over a special focus provider. I also spent $200,000 in attorneys fees attempting to hold the State of Iowa and Arkansas accountable and filed for Chapter 11 protection when the State of Iowa underpaid my facilities $950,000 for one year in retroactive case mix rate rebasing. My attorneys rightly reminded me that every good deed gets punished. But the war is not over … your article is only seeing the tip of the iceberg as the small independent operators disappear and the consolidation of the chain providers become an appendage of the Monopsony (a one buyer enforcement driven market). My goal is to use being victimized as the catalyst for reeling in the “gotcha system” and replace it with a re-enforcement system that I have proposed in my book “Remedy Eldercide, Restore Elderpride” iUniverse 2009.

It is a quality incentive reinforcement (QUIP) program implemented in Illinois during the 1980’s where six stars truly represented quality of life.  The few facilities that got six stars in an annual QUIP survey were in fact the best of the best and were paid incentive payments for each star.  The one and two star facilities were inn fact the worst and received much lower reimbursement … the two facilities I took over started out being one star and ended up being six stars and that enabled me to reward the staff accordingly.  A far cry from the negative five star system promulgated by CMS so the surveyors dictate the ratings.  I rest my case …   thanks to Word Press for giving me a forum to state my opinion.  Jerry Rhoads