John O’Connor

Seems like every now and then a study sizing up the state of long-term care comes along. More often than not, it is quickly filed away and largely ignored.

Last week’s 600-pager from the National Academies of Sciences, Engineering, and Medicine is different. Very different.

“The way in which the United States finances, delivers, and regulates care in nursing home settings is ineffective, inefficient, fragmented, and unsustainable,” its authors proclaimed.

Those are some pretty strong words. Essentially, these folks are demanding an overhaul. And they just might get one.

By the way, there’s precedent for this approach to reform. The 1987 federal nursing home law — better known to many as OBRA ’87 — didn’t just suddenly happen. Many of the new rules and requirements it codified were recommended in an earlier market analysis by the Institute of Medicine.

Here’s how big of a deal OBRA ’87 was: When I joined McKnight’s Long-Term Care in 1990, many parts of it were still being massaged into place. What’s different this time? If anything, last week’s report seeks reform on a grander scale.

So is this development a cause for optimism or concern?  Depends on a few things. One is whether you are a nursing home operator. If that’s the case, this is probably a good time to be a bit concerned. The operating environment you have been living in and with might soon change dramatically.

The other big factor? Whether adequate payments for the report’s various remedies will be a part of the package deal. If not, operators will have reason to be extremely concerned. That is, unless more unfunded mandates happen to be a good thing.

Katie Smith Sloan, who leads LeadingAge, perhaps offered the best assessment:

“As policymakers consider how to enact the report’s recommendations, they must back their actions with sufficient funding to make changes a reality,” she said. “Without that, the committee’s work will be for naught.”


 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.