James M. Berklan

We finally did it. We took the plunge, and now we can exhale.

That’s the feeling my wife and I had over the weekend when we jammed in the final five episodes of the Netflix series “Ozark.” It had taken us many more months than expected to get through the 30-episode run. But that’s only because the award-winning show’s action-packed episodes were so dark and foreboding.

I heard numerous fellow fans say they couldn’t sit through more than one episode at a time. Eventually, though, the ominous overtones were surpassed by our curiosity over how the magnetic — both likable and despicable — characters would wind up. 

The broad plot is that the Byrde family learns how one moral lapse quickly leads to another, and then another. As they try to make up for one compromise of their principles, they must commit to another. White collar crime quickly leads to brushes with illegal drugs, bloodshed and other unsavory acts. The Byrde family descends into a black hole that only seems to grow each episode.

The inescapable conclusion is that once you give up on a core principle too easily, bad things follow. (A fourth season was interrupted by the pandemic but it is now in production, and by all accounts promises more intricate troubles ahead.)

Compromising decisions can bite us all. Granted “Ozark” is a fictional drama, but each character’s reactions are believable and rational, no matter how odious, once the figurative boulder at the top of the hill is dislodged.

Some in long-term care have drawn the same conclusion about one of its biggest boulders of all — Medicare Advantage. By all accounts it’s a megalith that is growing larger all the time, squeezing provider margins every step of the way.

While it might not be rooted in immorality, it has forced countless ethical dilemmas. But, hey, as we learn in “Ozark,” as long as the financial ledgers look good, that’s all the justification that’s needed.

Another long-term care connection is the dire labor situation many providers face. Last week, the American Health Care Association posted results of a study showing that 94% of operators are struggling with a worker shortage. 

Almost inevitably, this has forced many providers to turn to the dreaded agency nursing option. More expensive and less familiar than regular full-time staff, the number of agency nursing shifts doubled last year, according to at least once source. There could be even greater use in 2021.

There’s nothing implicitly unethical about using agency nurses. But it’s rarely a first choice, and the practice typically represents a concession. 

Sometimes as a provider, you’re backed into a corner and must do non-preferred things. But the big question becomes what’s the next step after the first concession? 

It might sound obvious, but the provider community must aggressively pursue alternative ways to deal with funding and staffing issues. Not every new bundled payment initiative or accountable care organization will pan out, nor is an I-SNP for everybody, but to not pursue them would be outrageous. The same can be said about not trying vigorously enough to improve employee recruiting and retention. Or not eagerly acting to improve workplace conditions. Inertia can be a deceptively powerful enemy.

Without solid efforts to stick to their guns, providers could face a fate much like the Byrdes’. Once the undesirable compromises start, it’s look out below.

Follow Executive Editor James M. Berklan @JimBerklan.