An industry expert like Grabowski would say the problem goes deeper than transparency and staffing. A small percentage of firms are PE controlled, 60% of long-term care patients are Medicaid--and not changing, Medicare Advantage is ratcheting down payments and prioritizing home health, and SNF work is at the bottom of the totem pole as far as institutional employment goes. Its drudgery. Even if a few percentage points of revenue got redirected into SNF operations, there still would be a shortfall. It's not that SNFs don't need more staffing--they do. But if you implemented a staffing mandate, even over three years, the foundation of nursing home care is so broke we would find the false prophecy of chaos is not so false. A mandate without other big-time changes would likely lead to more harm than benefit, and CMS would have to proffer new regs in short order.


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