About a decade ago, the Clinton Administration had a big fight with the State of California about its failure to force nursing homes that it certified to meet Federal standards. As I recall these events, New York was one of the states that had minor or no compliance issues. Many of us assumed that standards compliance was one of the things that made New York's nursing homes more expensive and New York's Medicaid program more expensive.
Evidently, the problem persists. Half of California's nursing homes fail to meet the State's own standards and one-third have insufficient staff. Annually two-thirds of the staff turnover. Here are the facility-by-facilty data.
Here's the news story in the Sacramento Bee.
Perhaps we can find some editorial writers or elected officials to propose that New York mimic California in this manner in order to reduce Medicaid expenditures. Now that would take nerve. Certainly there are means to operate all manner of services more efficiently and effectively. But let's face it. There are lots of folks who complain about spending, but the fact is that overpromising in the public sector is pervasive. And this isn't just elected officials; it's the public itself and its demands. It's us.
We promise a certain level of service and quality and perhaps fund programs sufficiently at the beginning. But support is allowed to erode as we promise new programs and initiatives. Then we get a scandal in those programs that have been allowed to erode and we make new, crisis, promises. And on and on it goes ...
Though historically, we've done better in New York at funding nursing home quality than other states (though we have funded too many of them.) And now nursing homes in NYS are edging toward the financial tipping point and some are closing Closings are fine. Better that we let some close than drain all of them and allow quality to deteriorate while looking the other way.
And when we do a better job because we make a bigger financial commitment, let's at least acknowledge it and be honest when we talk about spending.