April 23, 2024

Uvenco

Interior Of The Road

Nursing home funding: Worth a closer look

A stunning photo stopped me dead in the midst of a LinkedIn scroll earlier this week.

In a feed filled with corporate logos and job announcements, there stood Nursing Home Administrator Lakeshia Bell, resplendent in a satiny black dress, ruffles flouncing over one shoulder and a layered cut-glass necklace rounding out her look.

Lakeshia Bell in hallway wearing formal black dress
Lakeshia Bell stands inside the halls of Hartford Nursing and Rehabilitation in Detroit. Credit Nic Antaya/Crain’s Detroit Business

Bell’s unmistakable personal style — skillfully set off against the muted colors of a traditional-looking nursing home hallway — made me want to click in for a deeper look at what she’d been doing in Detroit.

It turns out Bell, leader of Hartford Nursing and Rehabilitation, has managed to move her facility from an overall rating of 2 stars on the Centers for Medicare & Medicaid Services’ Care Compare site to 5 stars in just two years.

The article doesn’t dive deeply into how those changes occurred through the survey process; instead, it highlights Bell’s role in making residents feel as special as she looks in that photo.

Among her strategies: holding a monthly “administrator’s tea,” during which the six invited residents are encouraged to dress up for lunch and are waited on by staff.

“It’s the regular lunch they would get normally, but given a five-star treatment,” Bell told Crain’s Detroit Business. “Patients share their stories. They look forward to it. They get dressed up. It’s just us talking, but it is really about assessing the needs of the patients and making everyone feel important.”

Here’s the thing: We all love to feel heard, to be seen, to feel confident and beautiful when we are seen.

But when it comes to nursing homes, we, as a society, have forsaken beauty on our quest to see below the surface. Yes, we need to hold providers accountable for the details, even the ugly ones. How often residents are toileted, where cleaning supplies are stored, these things matter for residents’ care and safety.

But as much as the survey process leans on paperwork, processes, and data (and then more data), appearances and feelings really do matter.

They matter in attracting residents. They matter to referral partners. They matter when it comes to community reputation. Heck, beautiful lighting, clean dining rooms, residents with nails trimmed and hair groomed, these little things draw the attention of inspectors because even the government acknowledges they matter.

But on the bigger things, we’ve built a nursing home funding system that neglects outer beauty. When times get tight — and inflation and staffing costs are seeing to that —  providers chop capital outlay first. Many may swap out furnishings or wall coverings in interior common areas, but how many older buildings do you drive by where someone clearly sunk money into an exterior that feels fresh and new?

The hard truth is when operators are forced to limit expenses — and more of those choices will surely be coming if recession predictions come true — non-functional upgrades fall to the bottom of, or entirely off of, the to-do list.

That leaves residents, particularly those who rely on Medicaid, without much choice when it comes to living somewhere beautiful. The community hospital may be gleaming from the outside; but the neighborhood nursing home is too often left to wilt into its surroundings.

Long-term care needs a capital funding mechanism to support the kind of ambitious goals the White House is calling for, especially when it comes to modernizing facilities and reducing shared rooms. How can today’s providers be expected to cover the short-term and long-term costs of downsizing, when they’re struggling as is?

Green House operators, set aside as an industry example, have been able to build from the ground up, thanks largely to nonprofit status, patronage and cheap land in rural areas. But until payment reform happens, other new skilled nursing construction and even major renovations will remain starkly limited. The nation’s facility inventory is getting older, as are the seniors who will soon need skilled care.

We know we have plenty of Lakeshia Bells out there doing their best to make residents and staff feel beautiful and appreciated every day. Don’t they deserve homes just as admirable?

Kimberly Marselas is senior editor of McKnight’s Long-Term Care News.

Opinions expressed in McKnight’s Long-Term Care News columns are not necessarily those of McKnight’s.