Thanks, I enjoyed reading your post. It’s nice to see someone writing something worth reading.

As a Nursing home administrator the pressure is constantly upon us to "put a head in the bed". I've lost jobs because I stood firmly against taking in what I felt was dangerously mentally ill residents. What happens is the older facilities are viewed with less favor and therefore to keep a census they get the most acute and mentally ill residents. This combination is alarming. The newer facilities get those residents who are there for rehabilitation (therefore the ever welcomed Medicare dollar versus Medicaid dollar). They use up there Medicare days then transfer them to the older facilities when it is time for Medicaid to be the payer source. Those who can go home in the 100 day Medicare period (those less acute) go to the newer facilities because they appreciate the newer surroundings and because of the lower amount of the mentally ill in the facility. The better (more experienced, more compassionate etc) employees also go to the newer facilities. Since they make more money they can pay higher wages and also since they don't take in the higher acute care or mentally ill the work load is lighter. It is a vicious circle.
The only way to stop this is to require all facilities regardless of their appearance to have an even number of Medicaid residents to their Medicare residents etc.