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Reflections of a nursing home administrator

December 3, 2009
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Elliott D. Cahan, a retired administrator, gives in his book, A Place Like Home, candid reflections on running facilities for for-profit and not-for-profit operators in Maryland

Peck: Among the more controversial statements you make in your book is that, from a quality standpoint, not-for-profit facilities are preferable to for-profit facilities. Would you discuss that?

Cahan: That probably is the most controversial statement in my book. But I can only go by personal experience. I’ve heard for-profit management of one chain admit that it was all about the quarterly share price, not the residents. At least they were honest. In general, the for-profit chains thought that they would create efficiencies through centralization but it never happened. Also, they went through a period when they bought provider companies at crazy prices, with huge mortgages that operations could never support. It made me wonder whether investors really understood the field, but this had a bearing on quality. I’m not saying this is a hard-and-fast rule—there were for-profit facilities in inner city neighborhoods that offered much better environments than was available at home, and I’ve seen not-for-profits that provided low quality of care. I was just addressing the overall situation with that comment.

Peck: Why did you leave the United States for Israel?

Cahan: Moving to Israel in 2004 was a long-standing dream of ours—we had family connections there. The events of 9/11 certainly impacted that decision. There is terrorism in Israel but 9/11 told us that we weren’t safe in the U.S. either. What’s more, an employee’s husband was carjacked and killed at a local Wendy’s shortly afterwards—a form of terrorism in its own right. We thought it was time to pursue our dreams of moving to Israel. I now run a postgraduate school for religious studies.

Peck: Have you had a chance to compare how Israeli long-term care facilities compare with ours?

Cahan: The reimbursement situation here is similar, but there is less regulation. They have the same range of services and quality and a focus on trying to keep people at home. There is government reimbursement for that and the home services are staffed by many workers from overseas, particularly the Philippines.

Peck: Would you consider coming back to the U.S. as an administrator?

Cahan:

I’ve maintained my license, but we’re very happy here right now. When I hear about the state Medicaid cuts that are being discussed and made these days, I’m happy to be out of it. They’re quite arbitrary, and government decision makers really have no idea of what they’re doing.

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