I saw a topsy-turvy world of battling initiatives, of contradictory impulses, of clashing visions-a whirl of forces trying to pull people out of institutions and, at the same time, support them. I saw strange creatures called Money Follows the Person, Cash and Counseling, Home- and Community-Based Services, and Consumer Choice all tugging at potential residents to keep them out of nursing homes. I saw quality initiatives-so many quality initiatives-with such names as Quality First, the Nursing Home Quality Initiative, Advancing Excellence in America's Nursing Homes, all beckoning alluringly, even while the state survey process whirlpool grew ever larger. I saw creatures called DRA and PACE advancing upon LTC operators and changing their world. And I saw one of the scariest creatures of all, Managed Care, lurking about as an alternative for Medicaid-financed LTC.
In the land of assisted living, which once prided itself on being consumer-based and anti-regulatory, I saw it being ravaged by a creature known as CBS News, while a white knight known as NCCNHR-well known to nursing homes-prepared to administer a regulatory knockout blow.
Yet, turning about, I saw a sunny side: states flush with cash starting to look kindly again on nursing homes (if only for a little while) as the only safe venue for very sick elderly. I saw long-term care insurance finally evolving into a stable, serviceable product, and middle-aged individuals taking notice and beginning to plan for their future care needs. Also on the bright side I saw entrepreneurial owners and operators moving to take advantage of the new long-term care trends, master the various creatures lurking about, and create new and flourishing businesses in the age-old profession of caring.
This was heartwarming but, having seen all this, I felt that I had to get down from the fence. I needed to take a breath and rest a bit. Yes, I am ready to move ahead-it is December, after all. It's just that I'll take my sweet time finding the gate.
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