The American Health Care Association and Leading Age have proposed a reform agenda for skilled nursing. As usual, the problem is Medicaid.

The American Health Care Association and Leading Age have proposed a policy “agenda” to address some of the problems that exist in skilled nursing facilities today, which were obviously highlighted by the impact of the pandemic. 

As part of the reforms, they want enhanced infection control practices, 24-hour RNs, 30-day minimum supply of PPE, better recruiting and retention of staff, improved oversight systems, and a shift to all private rooms. There is little here to disagree with, except that they expect Medicaid to pick up most of the $15 billion tab, since the majority of the patients are funded by Medicaid.

One of the problems with this effort is the reliance on Medicaid and 50 different state budgets. Perhaps the real problem is just Medicaid itself. 

Absent from the reform proposals is how to get rid of the bad apples in the industry. While certainly fewer than when I started out in the sector 35 years ago, rarely do you see a state close down a facility or an operator because of bad quality, and rarely do you see industry trade groups kick out bad apples. 

They should, since it would go a long way towards proving that they really want change and not just more funding. More funding is needed, but increasing the reliance on more Medicaid funding is a slippery slope. Been there done that. Time to think bigger.