Hi, Merrill--Agree with everything here. One other option--doesn't get us out of spending more money--is to overhaul the SNF regs (1987!) People thrive in more home-like settings, with more interactions, focus on self-care and preserving functions, more respect for what they can do rather than focus on what they can't. Assisted living, while a mixed bag, has some of these characteristics. Has the added benefits of being more rewarding for staff (more cross-trained functions) and it seems to help residents retain function. I don't believe regulation works because states won't shut dow/stop new admissions to the bad facilities--at least they wouldn't when they had shortage of SNF beds. Now if existing beds can't be staffed and demand by families has dropped "permanently", states may be more confident in shifting more funding to home and community options.

Expand full comment