Shame is powerful motivator

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John O'Connor, Editorial Director
John O'Connor, Editorial Director

About a decade ago, I wrote a controversial column that offended some readers. In it, I suggested the industry start policing itself by identifying and reprimanding the bad actors in this field, lest the government feel compelled to intervene.

Not too surprisingly, my call to action didn't happen. There's not much upside to ratting out a colleague, especially when that person may be a solid member of the community. And who knows how a powerful person is going to return that kind of favor?

However, my prediction that Uncle Sam might step in did happen, and that effort is picking up more momentum each year.

Because the good and decent operators in this field have failed to hold their less scrupulous brethren accountable, the government is now taking the lead. It is demanding greater compliance during surveys. There also is more scrutiny, thanks to a government-sponsored "quality" movement.

Moreover, we're seeing more punitive action, including indictments. 

There's no doubt some people who own and operate nursing homes are now being convicted and sent to prison for deeds that might have been ignored or overlooked a decade ago.

Now we have Sen. Chuck Grassley piling on. The cantankerous Iowa Republican has had a checkered relationship with the industry. At times, he's complimented providers for the work they do. At other times, he's admonished them.

It might be a reach to characterize Grassley as a grump with a heart of gold. But his actions, so far as they have affected long-term care, appear to be honorable.

Grassley is now calling on the Centers for Medicare & Medicaid Services to list so-called "yo-yo" facilities on its Nursing Home Compare Website ( 

These communities have earned the moniker because they seem to yo-yo in and out of compliance with survey and certification requirements. Actually, that characterization may be too kind. More accurately, they tend to dodge and challenge established rules, and then do just enough at crunch time to avoid really getting nailed.

Consumer groups see them as pariahs. Providers view them like distant relatives with an addiction problem. Like crack houses and gang members, they are easy to identify but have proven to be almost impossible to get rid of. They are a pox on this industry, and the sooner they are permanently removed, the better.

After all, the work that needs to be done in this field should never be left to those with lethargy or larceny in their hearts.

In case Grassley or CMS is not sure where to list these facilities on the Web site, here's my suggestion: Put them first.