Providing the best possible quality is increasingly a challenge with growing expectations of nursing centers, increasingly frail residents, and uncertain funding. The problem with reducing quality standards in response to the current budget concerns, such as backing off from the new rule, is the slippery slope that will, over the longer run, damage your reputation and ultimately your organization. 

We provide care to our frailest elders, who are growing not only in numbers, but in frailty in terms of function and acuity of illness. This is one of those times where the regulations for nursing centers have caught up with other health care sectors, in areas such quality assurance and performance improvement (QAPI), reducing adverse events, infection control and treatment, staff competency and training, and person-centered care. 

All of health care is experiencing these same expectations. This movement is not an unrealistic plan by the Centers for Medicare & Medicaid Services; rather, it is a response to societal expectations of the most advanced health care system in the world.

If you want to be successful over the long term, this is not the time to take your foot off the gas and coast. Instead, this is the time for putting the pedal to the metal on quality, and to demonstrate that we can deliver on these expectations.

Resisting this movement does two things: First, it takes away from energy that could be used to work on providing better care. That is, working together to develop the best and most efficient solutions, learning from one another, and collaborating with other health care sectors. Second, it undermines the reputation we continue to establish that we are committed to quality, which is the one thing that will enhance our negotiating power for a greater share of the health care dollar.

In the short term, there are costs associated with training, implementing more rigorous quality systems, and evolving to higher standards of care. I have observed in several studies that the benefits of QAPI and investments in quality are real and measurable. I have also observed the eventual decline of organizations that do not make these investments. To survive in the current health care environment, you will need to make this commitment. And more importantly, the sooner you do, the better it will be for your business. 

Your bottom line is driven by many factors, and two of them, higher occupancy and a favorable payer mix, are paramount in supporting organizational success. Once you get on the slippery slope and back off on providing the best care possible according to today’s standards, it is hard to climb back up the slope and regain a reputation for quality. 

Accept the challenge and become the highest-quality health care organization you can be. In the end, your reputation will attract the best talent, the most referrals, and pride in the work you do each day.​