The odds are we all will need a nursing home in our future. Hospitals are for short term and skilled nursing homes are for long term restorative care or long term living after a debilitating illness.

LEARN ABOUT NURSING HOMES

1. 1. Which ones are the best?
   2. Which ones are the worst?
   3. How are they paid?
   4. Are the regulators doing the job?

I have personally spent 37 years working with various nursing homes on their financial and operational problems. After being on the inside for at least 300 nursing homes I’ve found that there are many marginal providers and some blatant operators who are too big to care. But only a few excellent facilities. Fraud and abuse is blown out of proportion by the Government, media and the public. I used to think, before becoming an owner of three skilled nursing facilities, that the providers were doing the best they can do withstanding the regulators being unsympathetic and not paying for what they are demanding.

What Shari, my son and I found out is it’s not about the elderly or the aging American getting the best services possible. It is all about money being wasted on ineffective regulations, idiotic payment methods, no accountability measures and no definition promulgated on outcomes. Yes, the problems are caused by each of us and exacerbated by big Government, big business, absentee owners, uninformed media, a litigious environment and most importantly poor Self=Health commitment by an aging society.

Under the current circumstances the only providers that are more likely to provide acceptable quality are the church affiliated organizations and locally owned facilities run by the owners. Not perfect, not necessarily well managed but well meaning. Ownership is community based and a direct oversight by a Board of Peers … who themselves are aging.Which ones are the worst? Based on 37 years of experience with nursing homes we found that the corporate giants (over 20 facilities) with size as their leverage in politics and borrowing power as their method of financing are the worst. What are the typical signs of being bottom feeders and corner-cutters:

• Odors (Odors are caused predominately by unclean patients and poor cleanliness standards for clothing, oral needs, toileting, skin protection, bathing regularly, etc. As a result, our facilities never carried a pervasive odor. On the contrary, they smelled as good as home.)
• Lack of staffing (The right number is not an equation but system that determines the hours related to the individual needs of the patient.       We had a system that related staffing to the care plans and were there every day to solve any staffing problems).
• Lack of equipment for keeping the patients out of the hospital ER and continual use of the outpatient and inpatient services. (We had diagnostic equipment that alerted staff of additional problems and treatment needs before they get to a critical stage.
• Lack of involvement in the community (I belonged to the Rotary Clubs and welcomed the community to our doors for religious services, entertainment, celebration of holidays, patient birthdays, etc.)
• Lack of effective care planning for prevention and treatment of medical, mental and emotional problems, productive activities, restorative nursing and rehabilitative therapies. (We developed our own software to manage the care towards solutions of patient problems to their highest level of functioning with the ultimate goal a return to the community based services.)
• Lack of credibility with local hospital, hospice, home care and assisted living facilities to form continuums to deal with the large health care net-works and insurance companies due to lack of quality, staffing or ratings by the Government. (Unfortunately, the CMS five-star rating system is driven by regulatory definitions not measurements of quality outcomes.       This and the biased surveys we were forced to sell our facilities to out of state chains that turned them back into warehouses for Medicaid).
• Lack of adequate documentation of services needed and delivered to produce positive outcomes of improvement and/or prevention. (We developed our own software to document the care towards solutions of patient problems to their highest level of functioning with the ultimate-goal of billing the right payers for the right amounts and being able to keep it upon denials of claims.)
• Lack of cost management systems. Health care facilities are paid on input data not output results or costs. Hospitals are paid on diagnosis groups, physicians on relative value encounters, nursing homes on assessed activities of daily living, home care based on hours of nursing, hospice a daily visit rate. (We developed our own software to manage the costs related to the care needed to provide the highest level of care with the ultimate goal a return to the community based services.)
• Lack of community support to defend the providers against attack by the regulators and ambulance chasing attorneys using frivolous deficiencies to fine, and get egregious settlements, in violation of the rule of law to force the small independent operators out of business.

How are they paid. Health care facilities are paid on input data not output results or costs.  Hospitals are paid on diagnosis groups, physicians on relative value encounters, nursing homes on assessed activities of daily living, home care based on hours of nursing, hospice a daily visit rate.

Payment for services under Medicare and Medicaid have no relationship to results or quality. Over the years, the methods haven’t changed but the interpretations for what is covered have been narrowed to the point of not paying enough even for bad care.

Are the Regulators doing their job. The Congress has passed more regulations for inhibiting private interests to exercise productive practices merely to save money.  Of course, this generally saves very little and tends to reduce effectiveness and the quality that will be the results of local ownership.

I have changed my mind on the value of government accountability for enforcing the intent of the regulations based on the size of the organization supposedly violating the minimum standards of care.   It is our firsthand experience that the enforcement doesn’t work.  Using our six-star measuring stick with a reinforcement approach to reward quality outcomes is what is needed.

For a fee of $15 we will send you the six star measuring stick.  Order through our email jerry.l.rhoads@gmail.com or respond to the blog with your email address.