Residential Care Financial Study

A recent study commissioned by the American Health Care Association and conducted by CliftonLarsonAllen LLP sheds light on the economic state of skilled nursing facilities (SNFs). This work underscores the dire financial situation faced by SNF owners. The authors used data from 2020 to 2022, which was the height of the public health emergency (PHE) or pandemic. Despite temporary relief measures provided in 2020, operating margins continued to plummet for the following two years reporting revenue of less than one percent annually. Today many SNFs are struggling to stay afloat.

Record High Shut Down Rate

Facility closures have been on the rise. Over 450 SNFs shutting down since the onset of the pandemic. The lack of PHE-related special funding, coupled with labor shortages and demand for higher wages, has further compounded the financial woes of SNFs.  Demand for residential care is surging while the number of beds and a qualified workforce are declining.

It is Broke, So Fix It

The three long years of the PHE forced most industries to live in a new reality.  Yet, many of the residential care owners are reluctant to change business as usual.  The labor shortage, due to low wages and unsatisfactory working conditions, existed before the PHE.  The pandemic just made it impossible to ignore.  Business as usual will not reverse this decline.  This study suggests embracing innovation by adopting technologies, re-configuring the environment, finding new revenue streams, and, most importantly, workforce development and better wages and working conditions are essential and urgent.

Florida Silver Solutions Coalition

Five years ago, I served as the moderator for the Florida Silver Solutions Coalition working to find short and long-term strategies to better serve the growing demand for senior care services.  Mary Ellen Philbin, Share the Care’s CEO,  and Juan Cruz, one of her long-time clients joined me on stage for an interview of the difficulties of finding and paying for high quality care in different settings, including home-based care

Connie Bend and Sophia Colley representing the 1199 SEIU United Health Workers East shared their stories of compassion, sacrifice, and dedication to upholding the dignity of many residents who were forgotten by the world.  I remain grateful that I had this opportunity to help them share their journeys. I recommend watching this interview using the Facebook video link.

Put Patient Care First

Here is a crazy thought, how about making residential care more appealing to consumers and caregivers? That is exactly what Justice in Aging does.  Like Connie Bend and Sophia Colley, this organization believes that ending senior poverty is essential.  Here is the Justice in Aging mission statement.

“Justice in Aging is the opportunity to live with dignity, regardless of financial circumstances—free from the worry, harm, and injustice caused by lack of health care, food, or a safe place to sleep. By using the law to strengthen the social safety net and remove the barriers low-income seniors face in trying to access the services they need, we work to ensure the future we all envision for our loved ones and ourselves.”

The organization released the Twenty-five Common SNF Problems and How to Resolve Them report. To be clear, these problems are not confined to a specific region. They happen in cities and in rural communities.  These issues happen in CMS sanctioned five-star facilities and in lesser quality ones. The Justice in Aging guide helps to improve the industry with strategies and policies to guide consumers, workers, and operators. It emphasizes the importance of advocating for high-quality care, which is a right guaranteed by federal law.

Where to Seek Assistance

The reality is residents, and their families, may require legal or advocacy assistance to address SNF problems effectively. State long-term care ombudsman programs offer free advocacy services.  Also, the state inspection agency is another avenue to hold a facility accountable. On the national level, the Consumer Voice for Quality Long-Term Care, is a great resource.

Speak Up!

Many SNFs violate the SNF Reform Law due to consumers’ lack of familiarity with their rights, shyness, and fear of retaliation. Residents and families must recognize their right to high-quality care and advocate for it. Federal law prohibits SNFs from retaliating against individuals who file complaints. Being assertive (but polite) in requesting individualized care can lead to better outcomes for residents.

HHS Office of Inspector General Report

In fact, a newly released government report underscores the need to strengthen workforce development and re-training and infection controls across the industry.  The findings shine a light on what when wrong during the PHE.

Don’t Send me to the Poor House

Years ago, I wrote a column “Don’t Send Me to the Poor House”  which is a quote from one of my first patients as a young medical social worker.  That man’s face and pleading remains with me all these decades later.  You see, he equated a nursing home stay with the poor houses of the Great Depression.  Today, few of us have first-hand knowledge of those days but we can relate to his feelings of helplessness and sadness.  SNF and other residential care should not be seen as the dumping ground for unwanted and terminally ill people.  Please join me in using the Justice in Aging’s work to educate and advocate for better residential care.