By Steve Moran

A year ago I wrote an article titled “The Nursing Home Flimflam Game,” then sent the draft to leaders at a number of senior living trade associations, who universally hated it. One person even called me up and yelled at me for 45 minutes. In the end …

I chickened out and didn’t publish it.

This time I am not so foolish to ask anyone’s opinion before publication. And at some point, I will likely update that article and publish it, but without asking for input.

The Problem Still Exists

The problem is that, when it comes to nursing home staffing, regulations, and reimbursement, everyone has an agenda they are aggressively trying to advance. This means they are telling, using, and quoting a version of the truth but not the whole truth.

It is emotionally charged, because all sides say all they care about is the welfare of the residents and team members. I am even willing to grant that with great prejudice this is true.

What We Need

What we need is for all sides to tell and acknowledge the whole truth, not just their version of the truth — only the parts that support their agenda.

Framing the Problem

Here is what we hear:

  • The nursing home industry is on the verge of going broke.
  • Nursing home leaders are making fortunes.
  • Nursing home companies are paying big bonuses and doing stock buybacks.
  • Nursing homes are selling at astronomical prices.
  • Nursing homes are closing at astonishing rates.
  • There are not enough nurses and CNAs to come close to meeting the new mandates.
  • There are nursing home companies that are filing for bankruptcy.
  • We need to increase the regulation and fines on nursing home operators.
  • Increasing the fines and regulation only increases costs and does not improve care.
  • Nursing homes have more regulations than the nuclear power industry.
  • Nursing homes will go broke when the new staffing regulations go into effect.
  • Even if we increase staffing, quality won’t really increase.

I am sure we could add another 20 or 50 “truths” to this list. And under certain specific circumstances, each one of these truths is true, but the way they are promulgated ends up over and over again painting a distorted picture of truth.


If we could get all sides to tell the whole truth, we would find solutions that would better serve the nation, the residents, and team members. It would cost the government less money. Caregivers would make more money and have better working conditions. Operators would make more money. Regulations would make sense and benefit everyone doing a good job, while crushing those who are only doing it for the money.

Even inside the industry, the for-profits and not-for-profits are rightly suspicious of each other.

I suspect I am dreaming, but maybe the industry will start.