SNFs and cabbies agree that more regs are needed — for the other guy

John O'Connor
John O'Connor

You can gain real insights about your future by examining what the competition is up to.

So one of the issues I wanted to learn more about at Argentum's conference in Denver last week was this: Once accountable care organizations and bundled payments take hold, how serious are assisted living operators about abducting your hospital referrals? The short answer, my dear reader, is this: They are very serious.

Remarkably, there are still some skilled care operators who don't see assisted living as the competition. For them I have only two words: dementia care.

There was a time in the not-too-distant past when residents suffering from Alzheimer's disease or another cognition-impairing illness were routinely placed in nursing homes. It was a great deal for skilled nursing facility operators, as these were high-margin customers who didn't require major staffing upgrades.

Then assisted living came along and basically snatched away this lunch money. And it appears they are now gearing up for Round Two. Many are already breaking in a story for hospitals that goes like this: Assisted living offers a higher quality, lower cost post-acute placement option than skilled care.

Wait, I thought assisted living wasn't in the healthcare business? That it is all about choice, dignity and autonomy? And that it shouldn't be regulated at the federal level because it's not licensed healthcare? Well, in the immortal words of Cyndi Lauper, money changes everything.

The seeming double standard hit me on during a $70 cab ride back to the Denver airport, as a genial cab driver told me about the challenges he and his brethren now face thanks to Uber.

Denver cabbies face limits on how many hours a day they can drive. They must get licenses and meet other regulatory requirements. And they must prove that they are healthy enough for the job. As for the upstart Uber drivers, those rules do not apply.

He said he didn't mind competing against Uber, but that a more level playing field was in order. Sound familiar?

As the competition for post-acute patients heats up, I think we are going to hear similar-sounding concerns and demands from skilled care operators. Why are we required to endure federally run inspections? Why must we abide by thousands of pages of federal regulations that assisted living operators can ignore? And how in the name of all that is good and decent can assisted living take care of so many sick, frail and otherwise broken seniors without one specific federal rule guiding their conduct?

Those would appear to be fair concerns. Besides, it's not like residents aren't being harmed or worse in assisted living facilities.

Nor is the assisted living sector free of shady business practices.

You don't have to be anti-assisted living to conclude that many of its operators are on the cafeteria plan. For decades they have insisted they are not in the healthcare business. Now it seems, many want to claim they can do it better than you. But no federal rules, please. We're senior living.

I'm not sure which voices will be strongest in insisting that assisted living can't have it both ways. But I have a feeling skilled operators will soon be among them. After all, it's not really a fair match when the contestants get to play by different rules.

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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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