You call this a plan to reduce nursing homes?

John O'Connor
John O'Connor

It appears that a federal effort to downsize nursing homes might end up doing just the opposite.

Some might say this development shows that the law of unintended consequences is alive and well. That may be true. But I think another adage might be more apt: Too many cooks spoil the broth.

A big part of the reason that new federal regulations may backfire is that they were designed largely to assist a largely different cohort: young people with disabilities. They make good sense when it comes to helping the young disabled live lives of greater choice and independence. But in the context of improving care for our nation's fragile geriatric population, they may be a bit misguided.

For example, the measure subjects non-institutional settings to heightened scrutiny when they are located near a hospital or nursing home. Apparently, it's a bad thing to have such upstream services nearby for the aged. Better to put those options as far away as possible, the thinking seems to be.

And in what could be a stinging blow to assisted living operators trying to deliver Medicaid-covered dementia care, the measure makes it illegal to lock exits. As anyone who has worked in this field for any amount of time can tell you, trying to secure a memory care unit without the use of locks is extremely difficult.

Already, some states and non-institutional providers are complaining that these new requirements may be virtually impossible to carry out.

As a result, states may have to actually rely on skilled care operators even more going forward. That is, unless the rules are significantly adjusted. And by the way, good luck with that.

This twisted tale sort of reminds me of a national effort launched in 2001 to bring more clarity to the “assisted living” concept. The workgroup put in charge of this exercise kept taking on more members, to the point where it reached nearly 50 separate organizations.

That's not to say its goal was not laudable. It was. Unfortunately, the assembled consumers, providers, regulators and accrediting groups working out the details tended to have very different agendas. Reaching consensus on even the smallest matters quickly proved elusive.

In the end, the group could not even agree on a definition for assisted living. I swear, I am not making this up.

As groups like ADAPT have been telling us for decades, the young and the old can have very different needs and preferences. By now, most everyone seems pretty well aware of that reality. Except, apparently, the folks who make the rules.


John O'Connor is McKnight's Editorial Director.

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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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