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Legal Speak

The Public/Private Distinction

Published April 4, 2013 9:32 AM by Tony DeWitt

Of the care delivered in SNFs, much of it is delivered in non-profit nursing homes operated by charitable organizations including churches and Catholic religious orders. The other non-profit type of nursing home is the public facility funded by taxpayer dollars.

In a recent newspaper editorial a reader opined that public nursing facilities are, more often than not, the best option for community-based skilled nursing care. The editorial argued that for-profit nursing homes are not delivering good care, and that as a result publicly-funded nursing homes are the answer.

The data, however, does not bear out that opinion. Not only are many for-profit nursing homes providing excellent and cost-effective care every day, but many state and county owned homes tend to be inefficient and operate more expensively without providing any better care than their for-profit counterparts.

The secret is in the management and supervision of the employees. In most corporate-owned for profit facilities, employees work at will. They can be hired and fired for any reason or no reason. There is no convoluted disciplinary process to let an employee go. Corporate facilities have built in processes designed to make sure the operation runs efficiently.

Not so at many public facilities. Not only do some employees enjoy tenure that protects them from all but the most serious of violations, but seniority and union status often complicate the improvement of the quality of care through work rules and grievances.

Worse, because the public facility can simply ask for more tax money, there is no incentive for a public facility to be efficient and save money. In fact, just the opposite. Government operations often take the view that if they don't spend money, they won't get it in their budget next year.  As a result they buy supplies and equipment that they don't need in order to secure funding for future years.

Certainly not every public facility is inefficient or delivers bad care, but neither is every corporate owned facility a death trap with bad care. The truth is never at the extremes and viewing an industry through that lens is fraught with peril. 

Nursing home staff and administrators should take every opportunity they have to educate their friends and family about the reality of the work that they do, why its difficult, and how it is compensated. If people understood more about the funding and administration of nursing facilities, federal laws on the subject might well improve.

Read more blogs on this topic:

For-Profits Under Attack

Return to ADVANCE for Long-Term Care Management Homepage


posted by Tony DeWitt


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About this Blog

    A.L. "Tony" DeWitt, RRT, CRT, JD, FAARC
    Occupation: Attorney
    Setting: Jefferson City, Mo.
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