Nursing facility operators did an odd thing when assisted living began making its presence known about four decades ago. They barely noticed.

At the time, most skilled operators saw little reason to worry about these new upstarts. After all, assisted living was basically a concierge service, right? This new model certainly wasn’t in the business of delivering healthcare services. Besides, assisted living was a private-pay enterprise. Why sweat over these new pipsqueaks with so many real problems?

Now, private-pay, lower-needs residents have all but disappeared from the skilled care scene. Why do you think that is? And by the way, Medicaid now reimburses those pipsqueaks in just about every state. Small wonder there are more than two assisted living communities for every U.S. skilled facility.

I mention this cautionary tale because skilled care operators are very much at risk of repeating the mistake. Except this time, the overlooked challenger seems even more harmless. It goes by the name of home care.

Home care a threat? Really, John? They don’t offer the same high-end, 24-hour care that skilled care can deliver, right?

Well, yes, that is technically correct. At least for now.

But here are a few things home care can offer:

• Care at a lower cost

• A la carte service options and per-hour pricing

• Care in a preferred setting

• An increasingly complex array of care and assistance options that’s reducing the gap.

We keep hearing about how value-based care is going to be the new litmus test for Medicare and Medicaid payments. Compared to skilled nursing facilities, home care options hold the promise of similar outcomes at a fraction of the cost.

So are skilled nursing facilities doomed? Not necessarily. But they are going to have to up their value game.

They also might want to start treating home care operators less like a nuisance and more like a partner. Some more enlightened skilled care operators have begun doing exactly that.

Still, far too many continue to see home care as a nothingburger. Let’s hope they wise up, and soon.