Margins aren't great (2-4%), but as new construction of long term care facilities across the country to meet growing demand, this isn't a business that corporations are running away from.

The cuts we're facing as entertainers are in part attributable to changes in Medicare funding for these type places. For years, Medicare/Medicaid reimbursement rates were based on estimates of what the various services actually cost providers. As public tax dollars are involved and as we finally begin to grapple with our out of control healthcare spending, this area of tax dollar use was reviewed. Turns out that the estimates the industry provided CMS several years ago was much higher than what it actually cost for the services. To no one's surprise, the LTC companies didn't bother to inform CMS of this better than expected performance. There was, in their defense, a reasonable concern about the overall economy and what the future held. That explains some of it.

Part of the Affordable Care Act addressed this over-payment for
services. Reimbursement are now more closely aligned with real costs, saving the US taxpayer millions of dollars.

Facing less reimbursement dollars, many LTC companies looked for ways to cut a comparable amount of spending from their operating budgets. Many find live entertainment to be an easy thing to cut.

Bringing this back to its effect on nursing home entertainers, yes, its very real. In my market, the biggest change has been the elimination of some of the more marginal acts. I've been told repeatedly by both Activity Directors and Administrators that as CMS tightened the LTC belt, there wasn't as much money to go around. Some places have reduced the amount of live entertainment during the month. With less demand, that means some acts are going to be left out. That results in the better acts working like crazy and the lesser acts struggling.

The industry is in a flux, to be sure. More and more Assisted Livings are popping up as families find AL's preferable to putting a loved into a traditional nursing home. The audiences in most of my AL's today look a lot like the audiences in my Nursing Homes 15 years ago. Some see that as a good thing. I do not.

We're also seeing a big increase in the number of people receiving in home care whereas they would've been in a facility a decade ago. That isn't great for our business, but it is probably better on a human level.

My advice to anyone who's seeing their business slip away? Be excellent at what you do. (Gary sets a great example for us all with his attention to detail and organisation.) Get out and see what the competition is doing. Not to mimic but to see what's appealing to the AD's in your area. I also think updating your repertoire is essential for today's OMB-ers. If you can't play songs from the 60's and 70's in a quality fashion, you're going to have a hard time. The audiences are getting younger in many cases and they will not always respond well to "sing-alongs" and tin pan alley stuff.