Nursing facility operators did a strange thing when assisted living first made its presence known about four decades ago. They barely noticed.

At the time, most skilled operators saw little reason to worry about these newcomers. After all, assisted living was basically a concierge service, right? This new model was certainly not in the area of ​​health service delivery. Also, assisted living (which now prefers to be called seniors’ residence) was a fee-paying private enterprise. Why sweat over these new pipsqueaks when so many real issues needed attention?

These days, privately paid low acuity residents have all but disappeared from the skilled care scene. Now why do you think that would be? And by the way, Medicaid now reimburses these pipsqueaks in almost every state. No wonder there are now more than two assisted living communities for every skilled care facility nationwide.

I mention this cautionary tale because skilled care operators are likely to repeat a similar mistake. Except this time, the unsung challenger seems even more harmless. This is called home care.

Home care a threat? Really, John?

They don’t offer the same kinds of high end 24 hour care that skilled care can provide, do they? Well, yes, that’s technically correct. At least for now.

But here are a few things home care can offer:

• Care (including skilled care) at lower cost
• A la carte service options and hourly pricing
• Care in a privileged setting
• An increasingly complex range of care and support options that closes the gap.

We keep hearing about how value-based care is going to be the new litmus test for Medicare and Medicaid payments. Compared to skilled nursing facilities, home care options promise similar results at a fraction of the cost.

So are skilled nursing facilities doomed? Not necessarily. But they’re going to have to up their value game and better document their strengths. They might also want to start treating home care operators as less of a nuisance and more like a business partner. In fact, some of the most enlightened skilled care operators have started doing just that.

Yet far too many operators continue to treat home care as nothing. For their sake, let’s hope they’ll be wise, and soon.

John O’Connor is McKnight’s Editorial Director.