By Steve Moran

I confess that I am often frustrated by the senior living associations for 3 reasons; I feel:

  1. they are too slow to act and react
  2. they are too cautious
  3. they are more interested in patching up the old, no matter how bad it is, when what is needed is a complete overhaul

This frustration kind of boiled over after reading the Wall Street Journal article titled “Covid Spurs Families to Shun Nursing Homes, a Shift That Appears Long Lasting” (paywall warning). According to the article, nursing homes have lost a net of nearly 200,000 residents and many healthcare providers. Some payor sources are committed to sending fewer residents to nursing homes.

Their conclusion was that the nursing home sector is in a precarious decline.Mark Parkinson

I shot off a quick email to my press contacts at AHCA/NCAL “passionately”  requesting an interview with Mark Parkinson, their CEO. I had two burning questions/frustrations about skilled nursing I wanted to talk about:

  1. Is the Wall Street Journal right about being on the verge of a precipitous collapse?
  2. Why does the senior living industry, and more specifically the nursing home industry, seem more interested in putting bandaids on an old broken system that is expensive and serves residents poorly, rather than BOLDLY proposing a new way of doing things?

Because of the holidays, it took a few days to get the interview set up, but we made it happen. Here is what he had to say:

Is The Nursing Home Industry Collapsing?

Mark believes there is “every reason in the world to believe” skilled nursing will play a significant role in the healthcare system for a long time to come. He believes that the people who talk about the demise of skilled nursing simply do not understand the business model, particularly when it comes to “long-term care” residents.

These are people who are typically at least 85 years old with multiple comorbidities that simply cannot be taken care of at home or any other setting. And because of demographics, this group will grow. In many states, the biggest challenge is that the reimbursement rates are so bad that nursing homes will not be able to survive and provide quality care.

He says there are more questions about the post-acute rehab business because there are other places people can get these services, including a home setting. We need to see if the referral patterns for at-home rehab continue after the pandemic. But, even if they do, he believes the demographics will create enough of a need for post-acute in an SNF-setting that the sector will be fine.

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Nursing Homes v. Assisted Living

Many, including me, believe that numerous nursing home residents would do fine in medical-model assisted living communities if there were funding; that it would cost society less, and provide a higher quality of care.  Mark pushed back like this:

Go to a nursing home, any nursing home near you, and walk through the door at lunchtime. Then take a look and tell me which ones could live in a different setting.

Revamping The System

Mark told me that before I give up on the industry, proposing something big and bold to reinvent the system, to wait until this upcoming legislative session. Government leadership recognizes that the COVID-19 pandemic is clinically the worst thing that has ever happened to the nursing home sector. And that we need to look at the long-term care system and figure out how to be better; how to make sure this kind of disaster never happens again.

He says no announcements yet, but to expect something big and bold that will fundamentally improve the care in nursing homes. That what they are working on will be bold and significant.

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