Stars upon thars
It's notoriously difficult, not to mention foolish, to try to predict the future of long-term care in America. In all of our nation's recorded history, only one man can lay claim to true prescience on this topic. His name? Dr. Seuss.
Decades ago, in a forgotten time called the '60s, he created what first appeared to be a simple satire against racial discrimination. But re-reading it now, I feel a spooky chill. The Sneetches is clearly an underappreciated and prophetic text for our profession — far eclipsing in accuracy anything by Nostradamas or the ancient Maya:
Now, the Star-Belly Sneetches had bellies with stars.
The Plain-Belly Sneetches had none upon thars.
That's how the story starts, and, remember, Dr. Seuss wrote it in 1961. Medicare hadn't even been created yet, but he foretold a future where nursing home operators would be called a dishonest-sounding name —Sneetches — and have potentially misleading labels slapped on their stomachs. I'm sure he would have been even more specific, but couldn't find a rhyme for Five-Star Quality Rating System.
In this Seussian dystopia, he believed the ubiquitous presence of those stars would trigger feelings of superiority, and drive aggressive marketing initiatives:
But, because they had stars, all the Star-Belly Sneetches
Would brag, “We're the best kind of Sneetch on the beaches.”
Recognizing the jealousy and panic that would arise within star-deficient providers, Dr. Seuss then boldly predicted the rise of an entirely new profession:
Then one day, it seems while the Plain-Belly Sneetches
Were moping and doping alone on the beaches,
Just sitting there wishing their bellies had stars,
A stranger zipped up in the strangest of cars!
Sylvester McMonkey McBean was the first of the long-term care consultants, an aggressive, self-assured, smooth-talking salesman who knew how to identify a problem and propose himself as the solution:
I've come here to help you. I have what you need.
And my prices are low. And I work with great speed.
And my work is one hundred per cent guaranteed!”
Using cutting-edge, proprietary technology developed over years of industry experience, he promised to put stars on Sneetch/provider tummies across the nation. For a small fee, of course:
“Just pay me your money and hop right aboard!”
So they clambered inside. Then the big machine roared.
And it klonked. And it bonked. And it jerked. And it berked.
And it bopped them about. But the thing really worked!
When the Plain-Belly Sneetches popped out, they had stars!
They actually did. They had stars upon thars!
Now the story gets a little graphic, and you should probably put the children to bed:
Then, of course from then on, as you probably guess,
Things really got into a horrible mess.
In the swirling, chaotic passage that follows, the author painted a vivid “On again! Off again!” picture of stars appearing and disappearing without any visible rhyme or reason, confusing providers and baffling their customers. Although he didn't explicitly say so, he was obviously predicting the recent “rebasing” of the Five-Star system, with an inevitable result:
… until neither the Plain nor the Star-Bellies knew
Whether this one was that one or that one was this one.
Or which one was what one or what one was who.
It's a disconcerting, haunting scene, and I get emotional reading it. But fortunately, the lesson was learned. The profession was wiser, and regulators realized that ratings based on sometimes-questionable data interpretations shouldn't be the only measure of a long-term care facility's quality. Then everybody hugged in the glow of the magical epiphany:
That day, all the Sneetches forgot about stars
and whether they had one, or not, upon thars.
Apparently Dr. Seuss isn't such a great prophet after all. Never mind.
Things I Think is written by Gary Tetz, a national Silver Medalist and regional Gold Medal winner in Humor Writing in the 2014 Association of Business Press Editors (ASBPE) awards program. He has amused, informed and sometimes befuddled long-term care readers worldwide since his debut with the former SNALF.com at the end of a previous century. He is a multimedia consultant for Consonus Healthcare Services in Portland, OR.