If We Want Real Solutions, We Need to Challenge the Stories Holding Us Back

For years, certain narratives have shaped how we talk about nursing homes—repeated so often that they’ve become accepted as fact. Trade associations and industry leaders push these messages, and policymakers build funding and regulation around them. But what if some of these core beliefs are outdated, misleading, or even counterproductive?

Our goal isn’t to reinforce comfortable assumptions—it’s to question them. If a belief holds up under scrutiny, great. But if it doesn’t, we should be willing to rethink it. The future of long-term care depends on our ability to separate fact from fiction and to build policies based on reality, not rhetoric.

Below, we examine some commonly accepted ideas in the industry—not to dismiss them outright, but to push for smarter, more effective solutions.

Nursing Homes are Underpaid

“Government reimbursements don't cover the cost of care, and facilities are struggling to stay afloat.”

Questioning the Narrative: If this were true, why do investors continue pouring money into the sector? Markets don’t reward unprofitable businesses. If nursing homes were truly on the brink, we’d see capital fleeing—not surging.

A closer look reveals that the problem isn’t the amount of money allocated, but how it’s being spent. Some operators have mastered the art of tunneling—diverting funds through related-party transactions, real estate deals, and management fees, rather than investing in frontline care. Others structure their businesses to extract maximum revenue while keeping core services underfunded.

At the same time, there’s no clear link between higher spending and better care. Some of the worst-performing facilities receive the same—or higher—reimbursement rates as those delivering top-tier care. Simply pouring more money into the system does nothing to ensure it’s used effectively.

A Better Way: Instead of blindly increasing funding, we should be asking: Are we structuring payments in a way that drives real improvements? Public dollars should follow results, not excuses. Operators that prioritize direct care and measurable outcomes should be rewarded, while those extracting value without reinvesting should not be propped up by taxpayer dollars. The issue isn’t how much we’re spending—it’s whether we’re rewarding the right behaviors.

If you want quality, you need to pay for it first

“Higher reimbursements are necessary to improve care.”

Questioning the Narrative: This idea sounds reasonable, but it goes against how markets work in every other industry. In most sectors, investment comes first—companies take risks, innovate, and then get rewarded for results. But in nursing homes, some providers insist they can’t improve conditions unless the government pays them first. Shouldn’t the system work the other way around?

A Better Way: Instead of throwing money at the problem and hoping for better results, we should tie higher payments to actual improvements in care. Some operators are already investing in high-quality facilities without waiting for a handout. Policymakers should focus on rewarding those who deliver results, not those who demand more funding.

We have a staffing crisis

“There aren’t enough nurses and aides to meet regulatory standards.”

Questioning the Narrative: Do we actually have a staffing shortage—or are we just measuring the wrong things? Regulations focus narrowly on licensed nursing staff, ignoring the broader care team. Today’s nursing homes rely on a range of professionals—therapists, social workers, and care coordinators—who all contribute to resident well-being. Yet these workers are often invisible in policy discussions.

A Better Way: Instead of rigid nurse-to-patient ratios, we should recognize the full scope of caregiving. Modernizing staffing regulations to count all essential care workers would provide a clearer, more realistic picture of how care is actually delivered.

More government oversight will improve care

“The solution to poor-quality care is more regulation and harsher penalties.”

Questioning the Narrative: Regulation plays a role, but is it making a real difference? The best facilities already exceed minimum standards. The worst ones continue to fail, despite layers of oversight. Instead of piling on more rules, we should ask: Are we regulating in a way that actually improves care?

A Better Way: A tiered regulatory system could free high-performing providers from excessive bureaucracy while focusing stricter oversight on poor performers. This would allow surveyors to target problem facilities instead of micromanaging those that are already delivering great care.

Government should fund more nursing home construction and renovations

“We need public funding to build new, modern facilities and upgrade aging infrastructure.”

Questioning the Narrative: This argument assumes that providers won’t invest in new buildings or modern renovations unless the government pays them first. But why should success be guaranteed? In most industries, investment comes first, and rewards follow for those who deliver a better product.

Yet in long-term care, some providers insist they can’t invest in better buildings unless taxpayers cover the cost. Meanwhile, others have found ways to upgrade and build without subsidies, proving that capital will flow when the right incentives are in place. The problem isn’t a lack of money—it’s a lack of structured rewards for those who take the risk.

A Better Way: Instead of handing out funding, policymakers should incentivize investment without guaranteeing success. A provisional 5-star rating for new or newly renovated facilities could create natural market incentives, rewarding those who improve infrastructure without requiring upfront government dollars.

The focus should be on paving the way for investment, not shielding providers from risk. Operators who believe in their ability to deliver quality should have the opportunity to succeed—but not a guaranteed payday.