It is curious that two days before the publication of this final article in the three part series, Senior Housing News published a feature article titled Will the Nation Go Broke Paying for Senior Housing & Long-Term Care? in which they carefully layout the impending financial risks that seniors are facing. They also will be digging deeper into the issue and it will be worth watching.

You can read  the first two parts of my series here:

Part 1: Is the Nursing Home Industry on the Verge of Collapse

Part 2: Defining the Problem

I humbly offer some ideas for solutions.

1. Regulations need to be be person centered.

Unfortunately most regulations are written under the assumption rules are what motivate care givers to treat residents well and by extension, that without regulations, residents will be abused. This is a false assumption. There are care givers who have a heart for seniors and will provide excellent care, because that is what they do. There are care givers who are only motivated by short-term profits and have no regard for the seniors they are responsible for. It doesn’t not matter how big the rule book is, these providers will still abuse seniors. The ideal regulatory environment would: A. Be just narrow enough to shut down bad operators. B. Be flexible enough to be corrective of problems that do occur with good operators. C. Allow significant flexibility to allow new ways of providing care, without having to jump through costly and time consuming regulatory hoops.

2. Initial Licensing and Certification Needs to be less rigid and more streamlined.

This process needs to be designed to allow tremendous flexibly and in terms of both building design and program structure. In addition, while fire and building codes are really important to protect seniors they need to be reasonable. Finally the process needs to be rapid. It should not take two years to get a skilled nursing community through plan check as it does in California.

3. Medical Records Requirements need to be reasonable.

In our current environment, documentation is about three things, maximizing reimbursement, protection from law suits, and staying out of trouble with regulators. Is documentation necessary, you bet, but history has shown that increasing the documentation process has done little to protect residents and has become a major factor in adding costs. As importantly, resident care is now primarily driven by documentation requirements, which means a particular care activity may be done well or may be done badly, and it hardly matters as long as it is done and documented.

4. Significant Resources Need to be Applied to Creating Radically New Solutions.

Some of this is already being to take place. In the last few weeks I have had the opportunity to explore some really amazing ideas with executives at Christian Living Communities, Watermark Senior Living and New Dawn Memory Care. The Greenhouse project is a great example of radical thinking. Here are some other ideas: – Multi-generational communities – Trading of labor by family members in return for reduced fees. – Using Medicaid dollars to pay for assisted living care (this is being done in some areas) – Allowing more flexible staffing models – Allowing more flexible building designs Two areas I would love to see further comment on:

1. What areas do you see that need to be changed?

2. What radical ideas do you have for doing a better more cost effective job?

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