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  • John & Terri Hale

COVID creates opportunity to explore options to nursing home care

Updated: Dec 4, 2020

An edited version of this article appeared in the Des Moines Register.

A recent guest commentary in the Des Moines Register (Nursing home closures are your next emergency, October 25) suggested that the financial health of the nation’s 15,000+ nursing homes is at risk, and that local and state governments would have to assume operational and financial control of many of these facilities as they failed.


The author stated that government officials need to begin planning now to prepare for this imminent emergency.


We suggest that it’s important to take a breath, get beyond the-sky-is-falling predictions and have a more balanced discussion.


Here’s what we know:

  • There are approximately 440 nursing homes in Iowa, employing thousands. The owners and administrators of these facilities know their legislators well, contribute dollars and efforts to their campaigns, hire numerous lobbyists, and have substantial political clout.

  • Billions of taxpayer dollars have gone to nursing homes across the nation to compensate for lost revenue due to COVID (with billions more requested and expected). Tens of millions of those dollars have gone to nursing homes in Iowa.

  • Most nursing homes are for-profit businesses, with many controlled by national ownership chains. Their business structures are anything but transparent, involving investors and profits related to the actual nursing home operation, the real estate, and often-affiliated entities that handle management, accounting, medical supplies, pharmacy, etc. This complexity means that the while the nursing home operation piece of the business might be, for accounting purposes, showing financial stress, the other pieces of the business may be doing extremely well.

  • The mechanisms used by federal and state governments to fund nursing homes are mind-numbing; with complex formulas and language understood by only a select few accountants and lawyers specializing in this arena. The public, and most legislators, have little ability to determine how much money goes to whom and whether care is sacrificed for profits.

  • A few years ago, a nursing home lobbyist summed up the industry’s legislative agenda in eight words: “Give us more money and leave us alone.” Those eight words said it all – the industry expects increased taxpayer dollars to flow to it with little scrutiny on how these dollars are spent.

  • There is an ample supply (some say an over-supply) of nursing home beds in Iowa. Iowa ranks first in the nation in the ratio of nursing home beds to total state population. It also spends more taxpayer dollars on facility-based care vs. home and community-based care options than most states. While some people will need to spend their later years in a nursing home, no one wants to. Alternatives exist that people prefer, and that cost less. Those options include staying in one’s own home or apartment with services and supports from family and paid staff, living with friends or family and sharing the costs of services needed, assisted living centers, and yes, even living in the yard of a friend or loved one in a tiny-home or “pod.”

  • The easiest thing in the world for elected leaders to do is spend their effort and dollars sustaining the nursing home status quo. The right thing to do is to shift more of the dollars now going to nursing homes to support the alternatives that people desire.

In summary, the public and elected officials should: 1. Be skeptical of claims about financial duress and imminent widespread closures of nursing homes, 2. Demand more transparency and accountability from the nursing home industry for the taxpayer dollars they receive in order to give attention to what’s really important – whether the dollars are producing enhanced quality of care for residents, and 3. Use the focus on nursing homes due to COVID 19 as an opportunity to re-think our later years; where we want to be served and supported, by whom, at what expense and with whom paying, and with what quality.

Opportunity and re-think are the key words here. We urge those elected to serve, at all levels of government, to provide the leadership it will take to seize the moment and support the need for change.



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©2019 by The Hale Group

Contact Us: terriandjohnhale@gmail.com 

Des Moines, Iowa

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