Gary Tetz
Gary Tetz

The troubling news that the Centers for Medicare & Medicaid Services is conducting a “comprehensive review” of nursing home regulations hit me like a truckload of giant boulders dropped on a homeless camp.

You didn’t see that comparison coming, did you? Allow me to explain.

Here in Portland, OR, as in many American cities, we have a significant problem with homelessness. You could call it a crisis even, and it’s complicated and difficult to solve. Strong feelings abound on all sides, and citizens rightfully clamor for a response.

It’s a tough spot for a leader to be in, caught between the need for a long-term solution that truly addresses the root of the problem, and the political necessity of appearing decisive, aggressive and engaged. It’s the age-old battle between the elusive cure and the expedient Band-Aid.

On a Portland street not far from where I live, it’s clear that Band-Aid has won the day. In an area frequently used in the past as a campground by the homeless, about an acre of rocks has been strewn. They’re huge and jagged, forbidding and inhospitable, the kind that might have shipwrecked an unsuspecting 18th century explorer. I found the sight shocking and sad, so naturally stopped to take a picture of it to share with you.

No homeless people sleeping here. (Gary Tetz photo)

When I heard about the new CMS edict to pursue even more punitive Band-Aids, still without much attention to cure, that’s the image that came to mind. And when I watched last month’s Senate hearing on elder abuse, that’s what I thought of — all those ridiculous rocks. Brought in to create the appearance of action, with no discernible impact on solving fundamental problems, and little apparent curiosity in exploring the many factors that create and sustain them.

Admittedly, when it comes to homelessness, the rock-dumping approach definitely works — If out of sight and out of mind is our only societal concern. No one appears to be pitching tents on them, or sleeping between them, so mission accomplished, I guess. And if I thought a credible search was also underway for programs and services that would make life on the street, and thus the rocks themselves, unnecessary, I might even be okay with a field of boulders here and there.

Similarly, punitive threats and explosive hearings also are effective to some degree, probably identifying valid gaps in the long-term care oversight system and raising awareness of the problem of elder abuse — any instance of which is deplorable. I could accept them if, and if is the critical word, they were balanced by the appearance of genuine interest in the staffing and funding challenges that heighten the possibility of such despicable actions.

But unfortunately, that’s not the world in which we work.

Instead, dumping some rocks, or holding a hearing, or announcing a large-scale regulatory review of a profession already regulated into the ground, can be a masterful way to make it appear action is being taken. It’s a proven, empty formula we’ve seen televised many times from Capitol Hill committee rooms, for instance—find some admittedly horrible cases of elder abuse, amplify them through the megaphone of the media, bask in the outrage you’ve created on Facebook, and go triumphantly to dinner. No further action required.

What’s so puzzling to me is that I believe CMS is full of smart, compassionate people who genuinely care about seniors. They well know the importance of identifying root cause to solve a problem, because they’ve witnessed the effectiveness of this profession’s actions to reduce antipsychotic use. Those efforts have been successful largely because of the renewed focus given to finding the true source of difficult resident behaviors, rather than continuing to mask them with dangerous medications. Yet this fundamental approach seems seldom applied on a macro scale to the challenges we face.

It’s not holding a hearing on elder abuse or reviewing regulations that has senior care leaders I’ve talked to so riled up. It’s the absence of equal inquiry and action addressing the actual root cause. It’s the dearth of energy given to highlighting the million-plus employees who do wonderful work, and addressing the fundamental problem of long-term care staffing and funding.

“Instead of trying to help us figure out how to offer competitive wages and benefits, or enlarge the workforce supply, lawmakers and CMS just focus on the regulatory side,” one respected senior care provider told me. “I want to tell them, ‘People, you’ve been approaching it this way for 50 years. It doesn’t move the needle. Nothing changes.’”

I’m resistant to trying to discern the motives of these politicians and civil servants, most I’m sure well-intending, who seem so blindly committed to only punishment and vilification. I can’t see into their hearts and divine their true motivations. I can’t fully understand the pressures they’re under, and the reasons behind the things they do and the grandstanding they perform.

But I do know that these are knowledgeable folks. They have the data and experience. They know elder abuse is a symptom of much deeper challenges, that there’s a root cause to be considered — and that on its own nothing will be solved by throwing a cheap hearing into the distracted, vulnerable, easily outraged consciousness of America. But still, the punitive path is the road most traveled.

Maybe that’s because for all of us in life and long-term care, it can be so much simpler in the short run, and so very tempting, to shrink back from overwhelming challenges and seek a less complex and daunting path. It’s easier to berate and punish than it is to seek out the true source of a problem and actually try to create a long-term solution that works for all concerned.

Hearings and more regulations alone are not remotely enough. Curiosity about root cause, along with funding that insures allowable costs are covered, enables competitive wages and benefits, supports increased staffing and pays for regulatory mandates, will be the answer to elevating quality, improving outcomes and protecting one of America’s greatest treasures — our seniors.

Until we, as a society and the people who lead it, muster the energy and commitment to tackle the difficult task of divining and acting on the deepest, most fundamental challenges facing the care of the elderly, it appears only one viable option remains. Bring in the rocks.
Things I Think is written by Gary Tetz, a national Silver Medalist and regional Gold and Silver Medal winner in the Association of Business Publication Editors (ASBPE) awards program. He’s been amusing, inspiring, informing and sometimes befuddling long-term care readers worldwide since the end of a previous century. He is a multimedia consultant for Consonus Healthcare Services in Portland, OR.