James M. Berklan, Editor

There it was, at the end of an exhaustive press release on one of the biggest wish list reports ever concerning nursing homes.

The press release detailed conclusions and fixes found in a 605-page quasi-governmental report calling for the tweaking or replacement of just everything involving skilled care except Tuesday’s weekly serving of carrot cake. 

The hefty product from the all-star team of researchers is at once the biggest headache or, as we shall see, the best gift a nursing home stakeholder could ask for. All thanks to … Abraham Lincoln?

The report was produced by the National Academies of Sciences, Engineering, and Medicine (NASEM), which operate under an 1863 congressional charter to the National Academy of Sciences, signed by none other than … Honest Abe. It might be a stretch to say that if there had been no Lincoln, we wouldn’t be seeing the unintentional, almost comical, response to the report’s flogging of the U.S. eldercare system. But the reactions would have emancipated at least a few grins from the Old Rail-Splitter himself.

Not just another nursing home blame game

First, the report: Upon first blush, it seemed to me to be another round of taking providers to the woodshed. There is no doubt some of that. But upon closer reading, it’s also government overseers who receive a  big, bony-finger wagging.

Backing up a bit, as McKnight’s has reported extensively over the past few days, the new report assails the way nursing home care has been regulated, financed, staffed, managed and generally overseen. “Ineffective” and “unsustainable” were two of the key adjectives of many used in this opus.

Seven conclusions and about 10 key areas to focus on form a framework for producing the biggest revolution in care since a similarly ambitious 1986 report. Just keep in mind that 36 years is a long time to build a wish list. Researchers did.

Committee member after member, almost on cue, independently told McKnight’s how important it is that the recommendations not be cherry-picked. Harvard health policy professor David Grabowski, Ph.D., provided the most precious quote: 

“I will stress that this is a comprehensive package of reforms. Many stakeholders will want to grab their preferred recommendations and ignore the ones that are more challenging. That is a mistake.”

Enough validation to go around

While various stakeholder groups talked nicely upon the report’s release, each also found narrowed-down validation. Providers nodded their heads at talk about underfunding, aides gave a big “I-told-you-so” about pay levels, and consumer groups simply didn’t know which jab against the system to embrace the longest.

Amid the ironic chuckles was committee members’ own homage to the eternal wisecrack about researchers’ findings usually coming to the conclusion that more research is needed. Of course, this time they specified that more sophisticated types of research are still needed. So the observation isn’t entirely self-serving.

The biggest fear, the report authors seemed to acknowledge, was that their 18 months’ worth of work might simply become a daisy-chain of non-progress. If one reads between the lines hard enough and has a certain knowledge of children’s literature, the story arc of “If You Give a Mouse a Cookie” could start to emerge in one’s mind.

Of course, the researchers’ recommendations are intentionally self-reinforcing.

And I guess it could be worse. Rather than looping in circles, the system could create outcomes like that old lady who swallowed that fly.

Talk about grounds for a citation, whether academic or regulatory.

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.