Caring for our elders





A nurse practitioner friend of mine recently posted on Facebook that she was “convinced ICD-10 was developed by terrorists trying to make healthcare providers insane. What ever happened to patient care?”

As an attorney, I jokingly commented that the over-regulation of healthcare providers is actually good for my profession! But then a question came to mind: should government regulation of healthcare really be the “Attorney Employment Act?” And, is it taking away from the true mission of healthcare?

Government regulation of the healthcare sector has gotten so over burdensome that we have lost sight of one of the main reasons healthcare is regulated, which is to ensure quality of care.

Don’t get me wrong. A properly functioning regulatory system is necessary to ensure quality and reduce the costs of delivering care. I spent 16 years of my career in state government working as an attorney, a policymaker, and – yes, even a regulator. I found the work challenging, educational, and even a lot of fun.

It is time to bring a little common sense back to government regulation.

Hopefully, during that time my actions (and even inactions) did more good than harm. However, I am by no means naïve enough to think that I did not cause some people a little heartburn. I can still remember one particular meeting with some powerful outside of government people when it dawned on me that maybe we as “regulators” perhaps did not know their business as well as they did.

As Oprah would say, that was an “Aha! Moment” for me.

Toward the end of my tenure in government a friend who often accused me of being a “government insider” gave me a coffee mug with the words, “Government – If you think the problems we create are bad, just wait until you see our solutions.” I remember at the time thinking it was fairly clever. But today, as the president of the Association representing nearly 300 long-term care centers, I find it concerning.

Regulating Long Term Care

The Kentucky Association of Health Care Facilities was recently given the opportunity to present to the Interim Joint Committee on Health & Welfare in Frankfort about the long-term care survey process and how Kentucky nursing centers are regulated. Long-term care services are important to Kentucky not only because of the people we serve but also because of the impact on Kentucky’s economy.

Nursing homes operate in all 120 Kentucky counties and overall the industry contributes more than $200 million per year in state and local taxes. The 289 licensed nursing centers in Kentucky serve over 23,000 residents and employ over 25,000 Kentuckians. In short, long-term care is a very big part of healthcare and business in Kentucky.

Of course regulation is required to ensure quality, safety and the protection of our most vulnerable citizens. And long-term caregivers are among the most regulated providers in the healthcare industry. There are more than 180 regulatory standards that certified Medicare and Medicaid facilities must meet. Every nursing center is subject to at least one unannounced inspection (survey) on a 12-month average.

Immediate Jeopardies

However, Kentucky’s regulatory system has become increasingly adversarial, and in some cases, downright hostile toward the facilities. According to the Kentucky survey system, our facilities are 500 percent more likely to have “immediate jeopardies” (the most serious deficiencies) than the national average. Kentucky facilities account for 11.5 percent of all civil money penalty fines in the nation but represent only 1.6 percent of all nursing facilities in the country. Per facility, Kentucky has over 500 percent more CMPs assessed compared to the national average.

On the other hand, Kentucky long-term care centers are on par with or slightly better than other states with regard to certain quality and staffing measures. That tells me that there is something amiss in Kentucky, and that it has little if anything to do with the quality of care delivered in our facilities.

I do not know how or why Kentucky’s regulatory system has reached this point, but our Association is committed to working with our regulators to improve the process so that it can achieve what should be the ultimate goal of any regulatory process – the protection of the people being served. Long-term care centers and government regulators need to be partners in ensuring that the highest level of quality services are being provided to Kentucky citizens.

Abraham Joshua Heschel said it best, “a test of a people is how it behaves toward the old. It is easy to love children. Even tyrants and dictators make a point of being fond of children. But the affection and care for the old, the incurable, the helpless are the true gold mines of a culture.” 

Betsy Johnson is president of the Kentucky Association of Health Care Facilities.


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