They say you can put a live frog in a pot of water and slowly boil it into a good snack without it ever knowing the master plan.

The key is to raise the temperature just a degree or two at a time, and Kermit will never know what did him in. 

I’ve never performed this culinary experiment, but I do know there are plenty of ways that dangers can creep up on someone if they’re unaware or unsuspecting. Whether it’s glaciers, boiling pots of water or mission creep at work, you can have big trouble at the doorstep and not be able to do anything about it if you’re not paying close enough attention.

Well, it looks like there could be more trouble headed for skilled nursing operators and the nursing home business model. The problem is, this column and other sources can tell you it’s coming, but you still might not be able to reverse it.

In the spirit of “forewarned is forearmed,” let’s take a look.

I’ve heard Harvard professor David Grabowski, an eminent long-term care policy researcher, speak many times. I’ve spoken with him often and know his research well. Yet one of his observations on Monday’s LeadingAge COVID-19 conference call was still a bit of a jolt.

He said the nursing home business model is going to look “very different” in a year, and even six months from now. 

Not particularly known for promoting hyperbole — neither he nor I — this seemed like a pretty bold statement. Regulation-strapped long-term care providers, after all, are used to being under siege. Just ask anyone in charge of regulatory filings or legal considerations.

But he’s right. As the biggest, most lethal COVID-19 dangers generally recede from the nursing home stage, there are other threats in the wings. If you haven’t noticed lately, the sympathy factor for nursing homes, which bore the brunt with 43% of U.S. COVID-19 deaths early in the pandemic, has waned, if not nearly evaporated. 

Those waiting for more COVID relief funding should not hold their breath without oxygen tanks nearby. That is going to stress weaker financial operations significantly.

Then, when the public health emergency designation is allowed to lapse, as surely it will at some point in the near future, regardless of word this week that it will be extended beyond July, helpful pandemic waivers and other supports will go away. Some, in fact, are already gone, and the Centers for Medicare & Medicaid Services will sunset another round in about three weeks.

Attracting and retaining staff will continue to be a problem for skilled nursing operators. In addition, getting short-term (i.e. Medicare reimbursed) residents in-house will become an even bigger industry biggest threat.

All of those rumblings about the growth of home care and hospital-at-home services aren’t just figments of someone’s imagination. Those movements are keeping census out of nursing facilities.

So we’re going to continue to see more providers in more hot water. Facility closures may keep popping up on the radar more frequently. It might look simply like smaller or “underperforming” facilities meeting their fate, but if you look closely day in, day out, “going out of business” signs have been selling at a relatively brisk pace. 

Expect more of the same and, as the temperature continues to rise, a “very different” marketplace in the months and year ahead.

James M. Berklan is McKnight’s Long-Term Care News Executive Editor.

Opinions expressed in McKnight’s columns are not necessarily those of McKnight’s.