The juxtaposition could hardly be more jarring.

As this goes to press, the nursing home industry is anxiously waiting for the federal government to release a first-ever staffing mandate.

When that happens, operators will be under unprecedented pressure to fill every available position. It’s also safe to predict the field will need to rely more on a key labor source: workers born elsewhere.

Yet less than a month ago, the US State Department issued a visa freeze that will absolutely reduce that labor supply.

“Washington often means well, but sometimes the left hand isn’t talking to the right.” That’s how American Health Care Association President and CEO Mark Parkinson diplomatically described the contradiction in The Hill. 

Those of us who are not quite so eloquent might respond with a less gracious statement. Something less nuanced. Something more base. Something like: You have got to be kidding!

But regardless of how the paradox is described, it boils down to this: Operators are being asked to do more with less. Again.

This unjust treatment is particularly galling as it affects staffing. After all, it’s a pretty rare facility that is not looking for more help these days.

According to figures from the AHCA, nearly a quarter million workers have departed the sector in the three years since COVID-19’s arrival. Assuming we have 15,000 nursing homes nationwide give or take, that works out to roughly 16 people per facility. Which, frankly, strikes me as a bit low. But either way, that’s a massive hole to fill.

The no-brainer fix here would be immigration reform that does the opposite of what’s actually happening. One of the reasons why that reversal seems unlikely is political. Lots of people in this country believe it’s important to keep as many non-US citizens as possible beyond our borders.

There is another and perhaps more disturbing roadblock as well. For reasons that run the gamut from crazy talk to legitimate, a lot of policymakers seem to have a hard time trusting the nursing home industry.

On the one hand, it’s clear that thousands of dedicated caregivers are doing a heroic job at facilities each year caring for more than a million frail, mostly older citizens who clearly need assistance.

On the other hand, this sector seems to be a magnet for a limited but destructive core of opportunists who simply cannot pass up the temptation to fudge for funding. All too often, invoices they submit for usual and customary charges turn out to be anything but.

As a consequence, those in authority tend to view the field with a certain amount of, well, skepticism. Not skepticism toward your facility, perhaps. But trust me. It exists.

That suspicion helps explain why every skilled nursing facility in the nation will be subject to a five-claim audit, beginning today. 

The stepped up oversight comes in the wake of a massive spike in improper payment rates. To be fair, some of the rate uptick could be tied to confusion and errors. But it is kind of odd how the numbers are consistently skewing toward the overpayment side of the ledger.

So yes, it would be nice if Washington could be a bit less contradictory when it comes to policy. But what would also be nice is if the bad actors in long-term care didn’t make it so easy for policymakers – and others – to view this field as a sketchy enterprise.

John O’Connor is editorial director for McKnight’s.

Opinions expressed in McKnight’s Long-Term Care News columns are not necessarily those of McKnight’s.