As a LNHA and BSN I can see how you all would view this but let me shed some light on this subject. Most nursing homes profit range from 1-2 percent annually. For business this is clearly not the best scenario and a catastrophic occurrence could have that slim profit from happening...i.e. new roof, new dishwasher. I am speaking about nursing home chains not the locally owned ones. Some profit comes form the selling of land that the facility bought years ago and no longer needs or just does not have the monies to develop that land. Some profit comes from accepting Sub acute rehab for a specific amount of time on Medicare and the patient goes home after rehab. This has been a saving grace for many facilities. Most residents in SNF are on Medicaid. The reimbursement for Medicaid is this:
Medicaid reimbursement is based on urban and rural factors and I think many are based on 1995 statistics and are jointly funded by the state and federal government. Paying for nursing home care costs with Medicaid means you qualify for low socioeconomic earnings, the average monthly cost for a Medicaid person is $2000.00 per month NO MATTER WHAT THEIR ACUITY LEVEL IS. There are a lot of conditions that must be met and this can differ from state to state. Typically we see what is considered spending down assets that can include car(s), or a home, and this depends on if married or not. In order to get the SNF cares you must be an individual who is unable to afford to pay for the medical care you need based on what you own, and what you have for assets.
Most Medicare services covered are in a Managed Care delivery system this means no matter what the services needed Medicaid will pay out the same amount. If the patient receives higher level of services the providers receive less per service, again because Medicaid pays out the same amount. Think about this mix of say 50 percent Medicaid, 30 percent Medicare and maybe 20 percent commercial to include private. For Medicare these people stay up to an average of 90 days then go home. Commercial/private pay has restrictions and most private pay are spending down until they get Medicaid. Commercial has a set number of days before the insurance says well this is all you have, you must get the cares in your own home or private pay. This leaves 50 percent already on Medicaid and these people are depending on your care for everything. SNF are truly not a money maker.
There are fraud facilities and this is what we hear all the time and fortunately this is not the norm. Most of the time we strive to give the best care we can with the limited amount of staff because this is all we can afford. The expectations of a SNF have come a long way from the days of when we tied residents to a hand rail in a posey vest. The incidents of workers comp remain high due to the hard job of taking care of these residents. There is no easy fix except with staffing rations which cost monies which the state and federal government control. It is not all big business stuffing their pockets, the reality is this SNF model is not working for our seniors, the reimbursement is not that big, and the rules/regulations often cause more work than we can afford.
I do know that SNF's get a bad reputation when trying to provide services that clearly are needed (otherwise we would not have so many), that reimbursement needs to change to reflect the cares that are needed for the regulations we must adhere to. Currently we do not have that. What we have now is rules from CMS that make us jump through hoops to serve and make the resident happy, unfortunately making people happy cost monies we do not have.