April 7, 2026
Maintaining quality of care with slim resources, while seeing patient acuity continue to rise, keeps nursing home clinicians up at night – and these challenges are compounded by insurance pressures, particularly from Medicare Advantage (MA) plans.
Varion Walton, VP of clinical services at Texas-based Methodist Retirement Communities (MRC), discussed the daily frustrations borne from managed care organizations’ idea of an adequate skilled nursing stay. He also outlined staffing initiatives for his organization in response to workforce shortages, including shortages among nursing professors responsible for training the next wave of nurses.
Multiple types of resources are sorely needed to help with staffing, managed care and acuity, among other challenges, he said.
“Number one is a lack of resources. That could be physical resources, that could be funding from different agencies, insurance. Those resources could be staffing issues as well as educational opportunities,” Walton said. “Beyond that, keeping up with all the changes from the Centers for Medicare and Medicaid Services (CMS), the state, the Centers for Disease Control and Prevention (CDC), wherever they’re coming from, we get it from all angles.”
Walton’s role means he is a resource to all of the communities, especially to the directors of nursing (DONs), executive directors and administrators.
With one foot in the clinical world and the other in regulatory and compliance, Walton develops policies and procedures. He also helps streamline processes and resolves matters if there are glitches or updates with CMS regulations, parsing guidelines and implementing any changes in MRC communities.
Walton sat down with Skilled Nursing News at the annual Post-Acute and Long-Term Care (PALTC) conference in California last week to share his thoughts on the challenges facing SNFs and how to overcome them.
MRC operates 13 communities across Texas offering a full continuum of care, including skilled nursing, memory support and short-term rehab.
The following conversation has been edited for length and clarity.
SNN: What keeps you up at night?
Walton: Quality. We all know the CMS Five-Star Rating System – not to say the business or the industry is all numbers – but that’s what society gives individuals to rate us, same as the hotel industry and grocery stores, restaurants … we’re all in a little pod. That’s what individuals know us by.
So right now, what keeps me up at night is just keeping up with the regulations, as well as ensuring that each community provides the best quality service to our residents.
Any clinical trends you’re seeing ramp up?
Acuity is definitely increasing within the skilled nursing industry, and when we cycle down to our assisted living communities, they’re seeing increased acuity too. There’s things that we’re seeing today that we weren’t seeing years ago, individuals coming in with comorbidities and polypharmacy.
And there are certain things that insurance may or may not pay for, things they used to pay for, and now it’s a little harder to get services covered for individuals. We have sicker individuals coming in and we have less time given to us for treatment from an insurance standpoint.
I’m guessing you are thinking of Medicare Advantage when you talk about insurance hurdles?
Correct. With traditional Medicare, the nursing staff, the therapy staff, dieticians, we all come together and try to decide on a game plan for those individuals. It may be 10 days, 14 days, maybe 30, up to 100.
With these managed care plans, we send them updates weekly, sometimes multiple times a week, and you have someone from their team deciding what’s best for our patient without laying eyes on them. On average, we may have a 21-day stay for someone on traditional Medicare dwindling down to 7 to 14 days for managed care. You need to provide the same services for sicker individuals with less time.
But those decisions seem to differ based on the insurance group, and what’s baked into the managed care contract, yes?
It’s individualized based on the different insurance groups, but those managed care organizations have the same guidelines as Medicare.
Medicare states that that individual can have up to 100 days, but they’re telling us they’re nominating them for discharge on day seven or 10, even if we’re telling them that they’re not ready to go home yet. Who’s making that decision? If they have the same standards of Medicare, then my question will be, why so many early nominees?
Talk a little bit more on the staffing angle. We know the Trump administration has discussed continuing and/or expanding the staffing campaign originally announced several years ago, with at least $75 million in funding.
We’re waiting to see how it works in our favor, to see if it’s going to be expanded or if there will be changes to the campaign in the future.
For skilled nursing in general, it’s hard to get new nurses because of the nursing professor shortages, and on the other end of that is the high number of nurses that are retiring from the industry. So we’re trying to fill those gaps.
I appreciate CMS for including certified nurse aides (CNAs) in the campaign, because 60% of the staffing shortages that we see relates to the CNA.
Does Methodist have an internal staffing campaign?
We have an excellent team within our central office that’s all about recruiting. They’ll host job fairs, career fairs, whether it’s at local organizations within the communities or the counties.
We visited high schools as well, not necessarily always pushing for employment, but more so broadening the knowledge that these jobs are available. Yes, you can graduate nursing school and maybe go to the hospital setting or go to the acute-care settings, but post-acute, long-term care, we need you all as well.
We’re marketing and pushing the agenda and education for those individuals, and hopefully we’ll bring in an influx of individuals that are willing to work for us.
There’s a few volunteer organizations within middle schools, they’re doing activities for the elders, but it’s also opening up that doorway of communication and letting them know that that space exists. There’s sometimes a negative viewpoint on nursing homes, and we’re trying to change that course. I think the earlier we bring those students in, just to see what we do on a daily basis, that’d be more open to try it.