On staying afloat.

As a very amateur sailor, I believe there are two types of watercraft in the world: (1) the craft that forges ahead steadily through wind and wave, indifferent to countervailing forces until it hits the ultimate iceberg, rogue wave, or boat bigger than itself, and (2) the craft that skips nimbly from wave to wave, riding the good, avoiding the bad, and at all times seeking the best winds to move it forward (sort of like my boat, when I don't get in the way).

The comparison came home recently as I was reading a commentary by consultant K. James Hunt, CPA, a partner for the Pennsylvania firm Carbis Walker, LLP, discussing the many--and I mean many--influences that state's long-term care administrators must contend with in running their facilities these days. Published in a recent Western Pennsylvania Hospital News, Hunt's review alludes to trends that administrators throughout the United States have become aware of--sicker residents, pressures to treat them quicker, fixed reimbursement replacing cost-based, and government's favoring of home- and community-based services. But Hunt goes on to list further items that just came in over the transom this year: Part B therapy caps and exceptions, nine new RUG categories, elimination of intergovernmental transfers to boost Medicaid reimbursement, and reduction of Medicaid rates themselves.

Hunt concludes, "The constant throughout this past decade is the providers' ability to adapt to the changing environment. If there is one lesson to be learned over this period, it would be that providers who attack each change quickly and aggressively and modify their operations accordingly are the providers who become the most successful."

It would be nice if it were simpler--if nursing homes and assisted living facilities could simply forge ahead, doing what they do best--providing supportive care and active lifestyles around the clock for the frail, the vulnerable, and the handicapped, and being paid fairly for it, end of story. But, of course, it hasn't been this way for years--or, in the case of nursing homes, decades. Society has seen fit to impose many legal requirements and restrictions covering virtually all facets of operations and enforced by government agencies of varying degrees of competence, even as the regulations change in substance and in detail without cease.

Mr. Hunt is right: You have to function like the sailboat that takes things as they come and makes the most of immediate conditions as it moves toward its destination. The "forge ahead" gang may laugh--I hear them out there on Lake Erie even now--but I'm betting that, at the end of the day, our little boats will be the ones staying afloat.

To send your comments on this editorial to the author and editors, e-mail [e-mail].

BY RICHARD L. PECK, EDITOR-IN-CHIEF