Theater of the absurd - 1999 Buyers Guide - Health Care Financing Administration's Center for Medicaid and State Operations' letter about withdrawal of nursing home operations from Medicare and Medicaid - Editorial

Nursing Homes, July, 1999 by Richard L. Peck

Back in the 1950s and early '60s, a particular school of theater was in vogue. Called the "theater of the absurd," the central tenet seemed to be that if you broke the mold of traditional perceptions sufficiently - threw away logic and meaning, for example - you would arrive at some semblance of the truth of human existence. Hence, we had entire villages wearing rhinoceros heads (Ionesco's Rhinoceros) or actors dialoguing endlessly to no apparent point (Becket's Waiting for Godot). Not to be left behind, 40 years later, Washington has mounted its own production in the absurdist vein. It goes under the somewhat drab title, Dear State Agency Director.

The title is taken from a letter sent recently by Sally Richardson, director of the Health Care Financing Administration's Center for Medicaid and State Operations, warning state directors to get ready for possible withdrawal of nursing home operations from Medicare and Medicaid, and possibly even closures, because of reported "significant financial difficulties." Her letter, in itself, is a very responsible directive, suggesting several ways for state agencies to prepare for this event and smooth any transition in order to protect resident care. She recommends, for example, establishing contingency plans to handle multiple closures; identifying alternative resources for residents in urgent need; considering using civil money penalty revenues to help defray relocation costs; and reviewing state receivership laws to prepare for installation of new management, if needed.

Certainly, there is nothing absurd about federal officials exercising federal oversight responsibilities to prepare for a crisis - until one remembers that the potential crisis Ms. Richardson describes is of the federal government's making. Let's face it, HCFA's warning about nursing home closures because of "financial difficulties" is akin to an arsonist yelling "Fire!"

In all fairness, though, HCFA is only a costar in this absurdist romp. A Congress bent on cutting Medicare to the bone and Medicaid to the marrow is, after all, setting the rules and is, by definition, a major player. The strange thing about it, though, is that Congress is not at center stage, as one might expect a lead actor to be, but rather is seated in the audience, waiting to see what happens next.

Not even Ionesco or Becket could top that one.

Crucial to riding out these wild and crazy times is a firm handle on cost control. And central to this is an organization's purchasing policies. Modern purchasing offers a variety of options and resources for getting the most out of products and services - indeed, it has become a specialty in its own right. This issue of Nursing Homes/Long Term Care Management - our annual Buyers Guide - is intended to inform readers of some of the latest and greatest opportunities available. We hope it helps.