Dear Editor:
We commend the state’s General Assembly’s bipartisan Regulation Review Committee for their prudent decision to postpone implementing new staffing metrics for skilled nursing facilities until a thorough analysis can be conducted and its recommendations fully vetted. This careful approach demonstrates an understanding of the complexities inherent in healthcare regulation and the potential unintended consequences that could impact Connecticut’s most vulnerable populations, not merely its cost implications.
Healthcare is not a static environment; it requires a nuanced understanding of the causal relationship between staffing levels and quality outcomes, the differing challenges faced by nonprofit versus for-profit facilities, and the interplay between federal and state reimbursement rates. Financially motivated regulatory changes risk creating operational instability without achieving the desired improvements in patient care.
Terms like “managing care” and “advantage” often mask a focus on cost containment through reimbursement cuts and rigid service restrictions rather than delivering true value—defined as the highest quality care at the lowest cost. As the “grey wave” of aging impacts the state’s economy, even minor regulatory adjustments can have oversized effects. According to CTData analysis, Connecticut’s population aged 65 and older is projected to increase by 57% between 2010 and 2040, while the working-age population will grow by less than 2%. These demographic shifts will necessitate revisions to the state’s appropriation models to ensure sustainability.
The recent closures of skilled nursing facilities across the state have rightly raised concerns about geographic accessibility to care. Other contributing factors—such as the increase in the state’s minimum wage, the ongoing loss of affordable workforce housing, extended commuter times, and the lasting effects of healthcare workforce shortages post-pandemic—deserve equal attention. These issues collectively strain the healthcare economy and further challenge the industry’s ability to provide high-quality care.
We support a “pay-for-performance” model that incentivizes measurable staffing levels and care quality metrics on a consistent basis without provider’s concerns over frequent methodological changes in reimbursement. The Centers for Medicare and Medicaid Services (CMS) already publish metrics on staffing levels and quality outcomes. Aligning reimbursement with these metrics could create financial incentives for underperforming facilities to improve.
Raising minimum standards is undeniably beneficial for the healthcare market and, most importantly, for the patients and families served. Let us ensure that these changes are thoughtfully implemented to sustain and strengthen the healthcare system for our constituents. Such reforms, however, must be carefully structured to account for the complexities of healthcare market dynamics with the understanding of the federal dollars seniors bring to their local and state economies.
Russell Barksdale, Jr., PhD, MHA/MPA, FACHE
President and CEO
Waveny LifeCare Network.
