I’ve written on topics ranging far and wide across the long-term care spectrum. But I’m pretty sure this will be my first foray into the world of fake butt accusations.

A suit filed earlier this month in New York alleges a nurse aide named Milouse Laguerre was subjected to workplace-related sexual harassment.

The catalyst? Other CNAs who insisted her gluteus maximus exceeded the maximus limit. There was simply no way its dimensions were within the boundaries of what her Mama could have given her, her co-workers allegedly claimed.

Not only did they judge that her backside’s dimensions were beyond what nature intended, they demanded for months that she provide the name of the physician behind such robust proportions. When Laguerre rejected both the allegations and the request, they allegedly proceeded to make her life a living hell.

So, is this really a story of buttocks envy gone bad? It could be that, too. But after reading the court documents, I’m not sure we’ve gotten to the bottom of this story.

You see, it appears that some of her colleagues were unhappy with Laguerre, who happens to be Haitian, being offered full-time employment in the facility three years ago. They allegedly claimed Haitians are “ugly.” They also insisted that Haitians, in the vernacular of Sir Mix-A-Lot, don’t have “back.”

While the facility’s CNAs were supposed to work as a team, her requests for assistance were largely ignored.

Moreover, when she repeatedly asked management for relief, her requests went nowhere. In fact, she was suspended, then fired, according to her attorney.

For other providers, there are two lessons to glean from this unusual case.  

The first is that turning a blind eye to harmful statements and toxic interactions among employees is a risky strategy that may lead to legal consequences. 

The second is that when employee conflicts persist, human resources must play a proactive role in addressing and resolving disputes, preventing them from festering into more significant issues.

This is an alleged situation that never should have been tolerated by those in charge, much less allowed to worsen.

And now the lawyers are involved. By the time this matter is resolved,  there’s a very good chance the facility will find itself paying out the, well, you know.

John O’Connor is editorial director for McKnight’s. Read more of his columns here.

I’ll say this for Congress: Its members sure know a thing or two about aesthetics.

Let’s say you’re a lawmaker and believe nursing homes need a closer look under the hood. Why not make that proclamation at a union rally where you will be cheered like a conquering hero, as Rep. Jan Schakowsky (D-IL) recently demonstrated. 

Yep, find a friendly crowd and a good backdrop, and you’ve got the ideal mix for a Kodak moment. One that will surely look good on your next campaign video.

Of course, if such theatrics are not convenient, a damning speech recorded after hours to an empty chamber can be an effective alternative. 

I suppose such tactics are harmless enough. But let’s face it. In the long run, the grandstanding isn’t going to amount to much more than what the old folks call a hill of beans. That’s because those carefully chosen words are doing little to change the status quo.

But don’t take my word for it. The scorekeepers reveal that more than 95% of all proposed bills are never voted into law. 

To truly understand where Congress wields its power, heed the advice of Washington Post Executive Editor Ben Bradley during the Watergate era: “Follow the money.” More precisely, follow the money Congress approves.

But don’t stop there. Also follow where it doesn’t go. I was reminded of this latter addendum while reading colleague Kim Marselas’ excellent story Friday on new Centers for Medicare & Medicaid Services plans to streamline its survey activities.

Now the official reason for streamlined surveys is that inspections will become more efficient. I suppose that is true enough, as far as it goes.

But the announcement does beg a deeper question. Namely, what else is going on here? In a nutshell, Congress has been squeezing and continues to squeeze funding to CMS. And as a result, federal regulators are being forced to cut back on their activities, such as inspecting skilled care facilities.

I can’t imagine many skilled nursing operators are crying in their Cheerios over this particular development. Fewer, less intense surveys? Oh, that really is too bad, isn’t it?

But this episode does highlight how Congress serves as a significant agent of change. When lawmakers turn a funding spigot on or off, they really are making quite a statement.

Even if it’s one that’s unlikely to be captured in a photo op.

John O’Connor is editorial director for McKnight’s Senior Living and its sister media brands, McKnight’s Long-Term Care News, which focuses on skilled nursing, and McKnight’s Home Care. Read more of his columns here.

The GOP struggled mightily  to find a suitable House speaker, then settled on an election-results denier who likes to talk about the “so-called separation” of Church and State. It may be 2023, but it feels more like 1823.

Meanwhile, having narrowly averted a government shutdown, it appears Congress is going to come through this time. As for the leading candidates for the presidency, it’s probably best to avoid a review of each one’s extensive shortcomings.

So it was certainly refreshing to hear a well-informed, articulate, policy-driven leader talk at the NIC Fall Conference. I’m referring to former House Speaker Paul Ryan. You may or may not agree with his politics, but at the very least he seems to have a policy-driven perspective — and clearly cares about the nation’s future direction.

One of his most encouraging points for skilled care operators was his belief that Congress could reach an agreement to prevent a federal staffing mandate. Of course, given the current political climate,  getting Congress to agree on whether zebras have stripes would be a major accomplishment.

Ryan also noted that we need good, smart immigration laws as a way to help alleviate worker shortages in long-term care and elsewhere.

Agreed, but it should be noted that one man’s “good,” and “smart” can be another man’s fighting words. Frankly, there are many parts of this country where it would be political suicide for a lawmaker to support fewer barriers to US entry, under any circumstances.

Entitlement reform was another point Ryan raised. Which, I suppose, amounts to another way of suggesting future spending reductions for programs like Medicare, Social Security and Medicaid.

Given the fiscal condition of the treasury and the money available for these noble causes, suggesting a fix seems like common sense. But the political reality is that suggesting any adjustments is even more politically dangerous than advocating for immigration reform.

The truth is, his message, if enacted, would be inconvenient for many, and painful for many more. Telling people what they don’t want to hear rarely leads to a long career in politics. Small wonder so many lawmakers now seem far more interested in trivial pursuits.

Admittedly, some of the strategies and tactics being served up were quite detailed, and unless one diligently jotted down notes, most may have faded from memory by now.

That’s one reason why I am a big fan of pithy business advice. Brief quotes from those in the know have a way of quickly getting to what the receiver really needs to focus on. They also tend to stick in our heads.

In that spirit, here’s a sampling of some of my favorite business quotes.

• “Your work is going to fill a large part of your life, and the only way to be truly satisfied is to do what you believe is great work. And the only way to do great work is to love what you do.” – Steve Jobs
• “Success is not final, failure is not fatal: It is the courage to continue that counts.” – Winston Churchill
• “Your most unhappy customers are your greatest source of learning.” – Bill Gates
• “The function of leadership is to produce more leaders, not more followers.” – Ralph Nader
• “The only limit to our realization of tomorrow will be our doubts of today.” – Franklin D. Roosevelt
• “The way to get started is to quit talking and begin doing.” – Walt Disney
• “In the business world, the rearview mirror is always clearer than the windshield.” – Warren Buffett
• “The secret of change is to focus all of your energy not on fighting the old, but on building the new.” – Socrates
• “Opportunities don’t happen. You create them.” – Chris Grosser
• “The only limit to our impact is our imagination and commitment.” – Tony Robbins
• “The greatest glory in living lies not in never falling, but in rising every time we fall.” – Nelson Mandela
• “Don’t be afraid to give up the good to go for the great.” – John D. Rockefeller
• “The only thing standing between you and your goal is the story you keep telling yourself as to why you can’t achieve it.” – Jordan Belfort
• “The best way to predict your future is to create it.” – Peter Drucker

I hope you find these quotes useful. But more importantly, I hope you can find ways to incorporate this distilled wisdom into all you do.

John O’Connor is editorial director for McKnight’s.

Opinions expressed in McKnight’s Long-Term Care News columns are not necessarily those of McKnight’s.

It’s easy to take what we have here for granted. But the fact remains, this is a land of unmatched freedom and opportunity. Not that it’s always crimson and clover.

For example, consider what skilled care providers are up against. They are steering their facilities through some pretty turbulent waters these days. Many might be inclined to conclude that all things considered, there’s not much to be thankful for at the moment.

Starting with staffing shortages. Yes, it can feel like searching for a needle in a haystack when it comes to finding compassionate employees. Still, isn’t it wonderful that you have the rare chance to create a workplace culture that attracts people who want to make a difference? That opportunity to help build a team that cares as much about the residents as you do seems like something to be pretty grateful for.

Nor do inadequate payment rates and more regulations make the job easier. In recent weeks alone, we’ve seen proposals emerge that would put staffing requirements and new financial disclosure requirements in place. But here’s the thing: Your commitment to providing quality care despite such challenges speaks volumes about your character. You have chosen to persevere in the face of constant adversity. That you have been able to find and demonstrate that ability is indeed something to be grateful for.

And don’t forget, not everyone is given the chance to make a difference. You get to be a real hero — ensuring that the oldest and frailest among us receive the care and attention they deserve. It’s a tough gig on the best days. But the smiles you help bring to the faces of your residents in their time of need are truly priceless.

So, as you prepare to carve the Thanksgiving turkey, remember to carve out a moment for gratitude. Despite the challenges, your role is indispensable. And your commitment is changing lives. Here’s to you, and here’s to the immeasurable impact you make.

Happy Thanksgiving!

John O’Connor is editorial director for McKnight’s.

Opinions expressed in McKnight’s Long-Term Care News columns are not necessarily those of McKnight’s.

That’s when 103 House members, led by Lloyd Doggett (D-TX) and Jan Schakowsky (D-IL) decided not to leave bad enough alone. Instead, they called for a 40% increase in the mandated number of nurse hours per patient day.

Yes, that is on top of staffing increases CMS has already proposed.

I’m not saying that even what CMS is calling for is impossible. But that alone would likely require an infusion of at least $6 billion in taxpayer support. Does anyone believe that is going to happen any time soon?

Look, I get where consumer advocates and other skeptics are coming from. While nursing homes have made major improvements in care quality during the past decade, more than a few unscrupulous players remain. Either that, or Google is making up a lot of stories about operators being charged with fraud, abuse and other misdeeds these days.

Moreover, the industry is doing itself no favors by failing to hold its nefarious characters in any way accountable. So yes, there is certainly room for improvement.

But here’s the thing: facilities cannot find enough help as is. Piling on to an impossible demand seems akin to the adage about beatings continuing until morale improves.

And by the way, has the need-for-more-staffing crowd bothered to take a look at the existing state of nursing homes? Despite increased demand for services, the construction of new facilities has been minimal, with fewer than10 built in the past five years and numerous closures.

In fact, the available evidence suggests that more facilities, especially in rural areas, might soon shut down. This poses a significant challenge as individuals seeking long-term care services are already grappling with the scarcity of facilities, often being forced to travel long distances. Some are already crossing state lines to access required care.

As some lawmakers advocate for higher staffing levels, they might want to consider the potential consequences of getting their wish.

Enacting stringent regulations, without considering the challenges faced by existing facilities, could worsen the shortage of nursing homes and create a significant service gap for those in need of long-term care.

If that happens, we all lose.

John O’Connor is editorial director for McKnight’s.

Opinions expressed in McKnight’s Long-Term Care News columns are not necessarily those of McKnight’s.

Ask not for whom the Centers for Medicare & Medicaid Services staffing proposal tolls, long-term care provider. It tolls for thee.

And today is your last chance to let federal regulators know what you think about an unfunded staffing proposal that could cost nursing homes billions of dollars to implement.

This most burdensome regulatory proposal in decades has sparked intense industry blowback. In fact, more than 26,000 comments had already been submitted before the final weekend started.

As McKnight’s earlier reported, the Ensign Group has rallied approximately 1,500 submissions from its partners and affiliates. Similarly, Cascadia Healthcare has contributed over 400 comments, and Diversicare has provided more than 500 unique comments. Their proactive involvement underscores the rule’s significance for the industry.

Diversicare CEO Steve Nee pointed out that the rule aims to enhance care quality but has several inherent flaws. These include the rule’s rigid staffing ratio, potential financial implications, the ongoing workforce shortage, and the possibility of limiting access to care.

Quality Life Services Chief Administrative Officer Susie Tack Beardsley, representing a family-owned company in Pennsylvania, highlighted the challenges of navigating state-specific staffing requirements that conflict with CMS proposals. Beardsley emphasized the urgent need to reconsider the proposed staffing ratios.

Administrator Brittney Bright from Radford Health & Rehab Center supported increased staff and higher quality outcomes but stressed the need for realistic solutions to address the workforce shortage and funding constraints. She suggested investing in programs to attract and train healthcare workers, offering nursing student scholarships, and enhancing front-line staff salaries.

Cindi Janzing, a Social Services Coordinator at Good Samaritan Society Miller, shared the harsh realities of rural nursing homes in South Dakota, emphasizing the potential consequences of forcing compliance with RN hiring standards. Janzing made several recommendations, including allowing virtual RN support, loan forgiveness policies, increased funding, prioritizing permanent staff over agency workers, and addressing the national nursing shortage.

Donny Pelligrino, Director of Financial Services at Bridgeway Senior Healthcare, highlighted the persistent staffing issues in the long-term care industry, exacerbated by the COVID-19 pandemic. He noted the need for full funding, a 5-year phase-in period, and the inclusion of staff other than RNs and CNAs in the hourly requirements.

I can’t overemphasize how important it is for all nursing home providers to make their voices heard on this matter. Active participation in the comment process can dramatically affect whether and to what extent new staffing rules are enacted.

But don’t delay. Tomorrow will be too late.

 John O’Connor is editorial director for McKnight’s.

Opinions expressed in McKnight’s Long-Term Care News columns are not necessarily those of McKnight’s.

The reasons for this unfortunate situation range from convenient scapegoats for the ravages of aging to, in some cases, the well-deserved scrutiny of those who’ve strayed from the righteous path.

At the American Health Care Association’s recent convention, many attendees commiserated about the unfavorable relationship this sector often seems to have with the outside world.

Critics on the other side of the fence aren’t just grumbling, either. They are compiling quite a list of changes they’d like to see. Items include staffing requirements, stricter oversight, higher care benchmarks and more obvious corporate structures. And those are just the greatest hits.

Look, I’m not going to deny that scoundrels running facilities exist. And as far as I’m concerned, those who dance on the edge of the rulebook deserve every bit of trouble they get themselves into. These charlatans don’t tarnish just their own reputations; they cast a long shadow over the whole field.

But here’s the kicker: Despite its challenges and rapscallions, the long-term care sector has been a godsend for those who need it. Each and every day, operators provide care and services to the oldest and sickest among us. If it were not for long-term care operators, how many of those in need would be left to fend for themselves?

The notion that operators are bad and not held accountable is, well, laughable. From the government’s Care Compare website to rigorous state inspections and a slew of other websites dissecting every facility, customers have plenty of ways to separate the wheat from the chaff.

Most in this sector could probably make more money elsewhere. They could certainly find positions that offer better hours and fewer headaches. My experience has been that one of the driving forces in this field is the natural instinct to make a positive difference.

As the negativity keeps raining down, let’s not lose sight of the big picture. The heart of this field beats with compassion, dedication and commitment to making lives better. That’s a story worth remembering.

If it seems like it’s the silly season again in Washington, maybe that’s because it is. Congress can take a bow.

The GOP struggled mightily in recent weeks to find a suitable House speaker, then settled on an election-results denier who likes to talk about the “so-called separation” of Church and State. It may be 2023, but it feels more like 1823.

Meanwhile, having narrowly averted a government shutdown, it appears Congress is going to come through this time. 

As for the leading candidates for the presidency, it’s probably best to avoid a review of the extensive shortcomings each brings to the table.

So it was certainly refreshing to hear a well-informed, articulate, policy-driven leader talk last week at the NIC Fall Conference in Chicago. I’m referring to former House Speaker Paul Ryan. You may or may not agree with his take or his politics, but at the very least he seems to have a policy-driven perspective — and clearly cares about the future direction of this nation.

One of his most encouraging points for skilled care operators was his belief that Congress could reach an agreement to prevent a federal staffing mandate. Of course, given the current political climate, even getting Congress to agree on whether zebras have stripes would be a major legislative accomplishment.

Ryan also noted — rightfully, I believe — that we need good, smart immigration laws as a way to help alleviate worker shortages in long-term care and elsewhere.

Agreed, but it should be noted that one man’s “good,” and “smart” can be another man’s fighting words. Frankly, there are many parts of this country where it would be political suicide for a lawmaker to support fewer barriers to US entry, under any circumstances. So there’s that.

Entitlement reform was another point Ryan raised. Which, I suppose, amounts to another way of suggesting future spending reductions for programs like Medicare, Social Security and Medicaid.

Given the fiscal condition of the treasury and the money available for these noble causes, suggesting a fix seems like common sense. But the political reality is that suggesting any adjustments is even more politically dangerous than advocating for immigration reform.

The truth is that many people don’t want to hear such thoughts expressed out loud. It’s not because Ryan’s suggestions are inherently wrong. Rather, it’s because his message, if enacted, would be inconvenient for many, and painful for many more.

Telling people what they don’t want to hear rarely leads to a long career in politics. Small wonder so many lawmakers now seem far more interested in trivial pursuits.

 John O’Connor is editorial director for McKnight’s.

Opinions expressed in McKnight’s Long-Term Care News columns are not necessarily those of McKnight’s.

If you’re looking to gain a deeper understanding of the long-term care market, better manage emerging challenges or simply need more cash, Chicago is the real deal place this week.

That’s because the 2023 National Investment Conference kicks off today in the Windy City — and runs through Wednesday.  It is by no means the most budget-friendly event to attend, but you’d be hard-pressed to find a better value.

The timing for this conference could hardly be better. It’s no secret that the long-term care sector is dealing with more than its share of headaches these days. COVID-19 alone caused tremendous damage to occupancy levels, worker retention and many a bottom line. Now the Centers for Medicare & Medicaid Services is floating a rule to establish staffing minimums in skilled care settings.

This week’s show promises to provide valuable updates on the state of the industry, the larger economy, capital market trends and actionable strategies.

Among the sessions designed to help you both survive and thrive:

•  Navigating the current skilled nursing environment

•  Embracing inclusive workforce practices

•  Understanding economic and policy influences

•  Adapting to the next generation of consumers

•   Staying informed about advances in Alzheimer’s research

•  Exploring creative capital relationships

•  A comprehensive exploration of the debt markets

•  Understanding capital markets and valuations

 And more.

The NIC show also stands out as the industry’s premier incubator for deal-making. It’s a veritable breeding ground for mergers, acquisitions, renovations, remodels, and all things capital-related. Simply put, there is no other marketplace quite like it.

Full disclosure, I might be a bit biased. Having attended nearly 30 of these events in recent decades, I can attest that each time, I leave feeling better informed, optimistic and genuinely inspired.

I’m eagerly anticipating what the next few days are going to reveal, and I hope to see you there.

John O’Connor is editorial director for McKnight’s Senior Living and its sister media brands, McKnight’s Long-Term Care News, which focuses on skilled nursing, and McKnight’s Home Care.

Read more of his columns here.