Guess who's asking whether to discontinue skilled care?

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John O'Connor
John O'Connor

The audience member had a question that in previous years would have been found at the corner of Blasphemy and Crazytalk.

She wanted to know whether it would be advisable to drop skilled care from her nonprofit organization's portfolio. Not too long ago, that might have been like Toyota asking if it should make cars without seats.

But in the new world of caring for the aged, a new rule is emerging: many of the old ones no longer seem to apply. Rules like skilled care being the backbone of long-term care. Or the notion that nonprofits need to put the most essential services front and center, revenues be darned.

But given the changes happening to long-term care, wondering whether skilled care has a place in the portfolio might not be so crazy after all.

Thanks to changing policies and marketplace realities, standalone skilled care appears headed for the proverbial ash heap of history. Sure, there may still be more than 15,000 certified facilities operating across the nation. But the number of new facilities being built has been reduced to a rounding error. Moreover, those that are not closing are desperately seeking the kinds of partners and services that will let them stay in business. Yes, there may be a ton of merger and acquisition activity taking place at the moment. But industry consolidation is not necessarily tantamount to industry growth.

Not that nursing homes are alone.

Continuing care retirement communities have had a pretty rough go of it since the real estate bubble burst about seven years ago. Hospitals too are going down in numbers. Even assisted living communities are finding that their models have an incredibly short shelf life, especially when dementia/memory care services are omitted. And it's not like homecare doesn't have plenty of its own demons to wrestle with these days.

While it might be a stretch to say things are tough all over, it's probably fair to say they are ultracompetitive. So much so that when a nonprofit operator speaks openly about discontinuing skilled care services, her colleagues don't question her sanity or mission commitment. Instead, they too want to hear the answer. For as the saying goes: no margin, no mission.

John O'Connor is McKnight's Editorial Director.

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 Marty Stempniak.