Some liken relations between long-term care operators and the government to a game of cat-and-mouse.

Uncle Sam plays the cat: ever vigilant, lest some cheese is misappropriated. Operators are rodents trying to outwit a dangerous adversary to postpone starvation.

I think the relationship plays out more like a chess game. Combatants have various pieces at their disposal, which they regularly use to attack and counterattack.

The government’s most powerful piece, obviously, is money, funneled through Medicare and Medicaid in amounts and with conditions as deemed appropriate.

The most lethal piece in the nursing home industry’s arsenal?  It’s the residents and the industry’s willingness to serve them.

Remove that linchpin and the government faces an epic challenge. If nursing homes depart, where would hundreds of thousands of people requiring care go? Both sides understand this threat, and in a way, it is the industry’s ultimate trump card. Or, at least it was.

As for what’s changed? That was made abundantly clear recently during a webinar hosted by Yale University. Several speakers talked not only about a growing role for home care, but a redirection of public funds away from skilled care for that purpose.

Many claim there is no way home care operators can deliver the same level of care as a skilled care facility. That becomes less true with each passing day. The home care sector has greatly stepped up its post-acute game. It wasn’t long ago that skilled care operators were throwing the same shade at assisted living.

The home care sector is willing, if not yet completely able, to become a core post-acute option. It also has two trump cards of its own: the potential to reduce caregiving costs, and overwhelming public support.

So what might home care’s intrusion mean for skilled care? The end of the road? Not exactly.

But it surely means skilled care operators must find a new and better story. Believe me, the demands we heard were not idle threats. Given even a modicum of care and feeding, home care could become a real game changer.