Have you ever asked a question, even though the answer is obvious?

“Would you like another homemade chocolate chip cookie?” “Do you want to sit where you have a view of the ocean?”

Even when the answer is assuredly going to be “no,”  you just can’t help yourself.

“Looking forward to your colonoscopy?” “Are you glad to be losing your hair?”

When I asked 100 SNF owners and operators if they personally wanted to receive post-acute rehab or end-of-life care in a nursing home, I felt like a child holding his breath. Even though I knew what the answer would be,  I was hoping to change the outcome. 

That strategy didn’t work 50 years ago, nor did it now.

The answer to this telling question was a resounding “no.”

Would you choose a nursing home?

Only 7% of those asked here said they would choose skilled nursing for short-term rehabilitative care. 

When asked about care due to frailty or end of life, on a scale from 1 to 5 (5 being the highest), owners and operators gave nursing homes a 1.8 rating. Ouch.

To be fair, please understand that those answering were trying to tackle this industry challenge. We were part of LTC 100, a Lincoln Healthcare event held last month in Indianapolis. 

No one was arguing that we don’t provide excellent care and deliver superior outcomes, despite challenges of underfunding and overregulation.

Our job was to explore our own attitudes as professionals to describe how we could bolster confidence among consumers, payers and referral sources. 

Joining me were Tim Fields, CEO of Ignite Medical; Kimberly Green, COO of Diakonos Group; and Matthew Salmon, CEO of SALMON Health and Retirement. Each has complementary, yet unique insights into how to address these challenges and move forward.

We all agreed that COVID-19 did not cause our industry to “fall from grace” in the eyes of the public and the Centers for Medicare & Medicaid Services, but it accelerated the trajectory and revealed much about how the public and legislators think about us. 

What steps are you taking to reposition and battle stigmas?

Fields aims to hire staff from hospitals, LTACH, acute rehab and new grads for his medical “resorts.” He said his company is “relentless in establishing a culture that tries to say, ‘We are NOT a nursing home.’ ”

Diakonos’ philosophy is that happy staff translates into happy residents. The company is focused on workforce development and meeting caregivers’ needs, not just the needs of residents.

Green said collaboration is one way to combat negative stereotypes portrayed in an attorney’s commercial or negative headlines.

“It’s about the industry and not about us [Diakonos} individually,” she said. “We succeed and fail together. Therefore, we share everything we do with our competitors. Our programs, policies and program development strategies are shared across the state.”

Salmon said his company aggressively pursued new care models — including home- and community-based services and independent living — in part for the reputational advantage.

“Having a continuum of services that begins well before the nursing home really helps to shape perception of who we are before the consumer enters into acute care,” Salmon said. “The consumer has a broad view of who we are beyond ‘just a nursing home.’”

Audience polling of those 100 owner-operator participants also suggested there strategies to help combat a negative image: 

  • Tell your story through social media
  • Maintain an unrelenting focus on quality
  • Focus on patient experience and engagement

What role does funding play?

All of the panelists agreed that the regulatory or reimbursement environment — in particular its inflexibility when it comes to community creativity — contributed to the public perception problem.

One of our panelists described how innovation happening around the world would not be accepted in the U.S. For example, co-locating nursing homes and college campuses could help foster healthier perceptions of aging. Yet, the concept is nearly impossible to consider here. 

We also discussed whether “outside money” contributed to poor performance. Does private equity or REIT involvement exacerbate our negative public image as is often suggested by the media and politicians? The panelists disagreed with that assumption.

Instead, they believe financial support provides options to pursue improvements in care and capital improvements.  But you must be careful whom you choose as a partner, ask the right questions up front, be transparent and make certain they understand the ebbs and flows of the industry.

Bring outside partners “under the tent” to collaborate. Consider them colleagues, and include them in the solutions to our public relations challenges.

We have to do a better job sharing what goes on in our buildings with the community.  Yes, we all measure what we are required to by CMS, but we don’t put enough effort into explaining to outsiders what we actually do.

Our society doesn’t like to talk about death and dying, or even aging. This very well may be the crux of our challenge. It is a societal and cultural issue. How can we make it acceptable to talk about end of life? This is our burden and our opportunity. 

Steven Littlehale is a gerontological clinical nurse specialist and chief innovation officer at Zimmet Healthcare Services Group.