Feeling under fire? No wonder

James M. Berklan
James M. Berklan

How do you know you have a room with three people feeling sorry for themselves in it? Find a room with two nursing home workers. Their persecution complex levels will add up.

Or so the, supposed, joke goes.

It's no secret that certain healthcare workers — long-term care's in particular — feel put upon. Over-regulated, underfunded and overworked.

And then overworked, underfunded and over-regulated some more. 

If you've been in the profession since, oh, Tuesday, you probably know the feeling.

As the rock group Boston put it, however, sometimes it's “More than a feeling.” You don't just think you're being piled on. Maybe you are.

There's a reason for feeling like you have a target on your back sometimes because … well, somebody is taking extra shots at you.

Start with an existing dash of stress and disrespect — from residents, family members, government officials, physicians, co-workers, you name it — and you definitely have fertile conditions for feeling dumped on.

And as if the prospect of facing 400-plus pages of newly revised nursing home regulations isn't enough, there's this week's letter from congressional leaders to the leader of the Centers for Medicare & Medicaid Services.

An even 32 U.S. Representatives, led by Democrat Jan Schakowsky of Illinois, signed the letter asking for tougher burdens for skilled nursing providers. This looks good for voting constituents but is not practical in certain cases.

Demanding, for example, that a registered nurse be onsite at all times is great in theory. But mandate that task to small, rural providers and see how many fewer small rural providers you soon have to serve the frail and elderly. It's difficult enough for them to find qualified staff as it is. To find them and then afford them is an even deeper whammy, especially when an RN might rarely be needed overnight. The same holds for many non-rural providers, by the way.

Other points in the letter could be tougher to fend off. It seems that everyone from the New York Times to the corner grocer is attacking pre-dispute arbitration clauses in nursing home admissions agreements.

Providers will have to trust that their well-funded lobbyists can continue to make sure that this option is preserved. They've done it in the past, but the job may be getting tougher. Don't blink.

In some ways, it seems that the provider community — or at least its lobbying arms — might have seen this day coming. Just ahead of the feds issuing goals for lowering antipsychotics use a few years back, the American Health Care Association issued its own goals. (They've been met.)

Maybe sometimes a carrot, or other means of self-motivation, will serve better than the intimidation stick of ever more regulation.

Follow James M. Berklan @JimBerklan.

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Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Emily Mongan.

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