Associations are seeing operators cap occupancy due to crippling staff shortages, including the American College of Health Care Administrators (ACHCA), whose membership consists overwhelmingly of nursing home administrators along with students learning the role and those retired from it.
Its incoming president and CEO Bob Lane discussed this vicious cycle with Skilled Nursing News, along with ways he intends to advocate for members in the years ahead.
Lane has 34-plus years of experience in the long-term care industry, starting at National HealthCare Corporation (NHC) and leading initiatives for the Oklahoma Quality Improvement Network-Quality Improvement Organization (QIO-QIO). More recently, he’s known for his consulting work with BKD CPAs and Advisors.
Lane will officially start on Sept. 7. He served as past board chair of ACHCA and has been a board member since 2013.
This interview has been edited for length and clarity.
What are you hearing from members in terms of staffing and occupancy?
Occupancy had just started to rebound to a degree and then of course, this next round of delta hits. I’ve never seen more buildings unilaterally capping their occupancy based on staffing. They’re self-limiting their revenue while they’ve got these exorbitant expenses on the labor side. That’s not a good equation for long term success.
How does the Biden administration’s vaccine mandate exacerbated this situation?
As an individual, I can tell you that while requiring staff to be vaccinated is a noble undertaking, even if tied to federal funding, singling out one segment of the health care profession will have a devastating impact on those providers’ ability to provide even some semblance of quality care to the elders in their care. With roughly one-third of nursing home staff unvaccinated, this requirement would have the impact of pushing these individuals to other sectors, thus creating an unbalanced playing field.
What other concerns do you see for administrators?
The direction that the profession seems to be going in terms of Medicare Advantage. I did see a headline … requesting some congressional intervention, relative to Medicare Advantage plans and how one sided many of them are.
As Medicare Advantage becomes more widespread, as the predominant Medicare payment methodology, that’s going to have a major impact in terms of the dollars that are available as well as the turnaround time for your revenue stream.
Thoughts on the CMS Final Rule 2022, Patient-Driven Payment Model (PDPM) delay?
I think we need to keep our eyes out on what the future could hold, even though the profession sees this as somewhat of a near term victory because CMS has held off on making any adjustments. PDPM, we were barely five months into it when this pandemic hit.
It’s not apples to apples — in no way apples to apples at this point. Extending it without any adjustments is certainly a good opportunity to get better data for better comparison to determine what if any adjustments need to be made.
Marc [Zimmet] indicated that could backfire on us in the form of even higher adjustments. [But] I don’t think we’re in a good position right now to say ‘okay, go ahead and adjust it.’ I just don’t think that’s reasonable, especially given the issues that we’re having with the resurgence of the delta variant, the absolutely crippling problems we’re having with staffing; We need every dollar we can get.
Advocacy to make any PDPM changes more palatable?
When we get a year down the road, let’s have already, you know, plowed the field a little bit here so that CMS has a better understanding of where we’re coming from and so maybe the adjustment won’t be as bad, if at all.
Other advocacy efforts in the works for ACHCA?
We’re still trying to get the rest of the Provider Relief Funds [PRF] distributed. There’s still 20 some odd billion left to go. I know that there’s work being done by both major trades to get the administration to release it.
What changes or additions do you intend to make to the organization?
It’s very important to me that we have an infrastructure that allows us to have a regular ongoing dialogue with our membership. That’s something that we don’t necessarily have right now. It might be informal at various meetings or calls, but we don’t have a way in which we’re regularly tapping into feedback from our members.
How will you do that?
We have not regularly conducted any kind of member surveys. And as you can imagine that members are the lifeblood of any association and if you’re not hearing from them regularly, it kind of demeans the value of being a member so conducting a member survey that is inclusive of the right questions and the information that we need to have.
Were there any early career challenges that helped inform your choices or leadership style today?
[NHC] was in expansion mode, they pulled me up to a St. Louis building that they had just taken over, and I got to experience a lot of different things, from poring through personnel records that were 20 years-plus old to trying to figure out how to pull wallpaper off the walls. It was a pretty full experience in various areas.
They also had a union, instead of shutting the building down and decertifying the union they actually just threw down the census and kept it open, which kept the union in there. Eventually the employees decertified it themselves, but that was my first exposure to organized labor.
Going into a scenario, such as the one that I did, in the midst of a union organizing attempt, you become very sensitive to the issues of the staff … you don’t survive if you’re not a good listener.
It helped me to be more collaborative and it drove the point home that the best decisions are many times made when you at least give consideration to those in which the decision is affecting them. Instead of the top-down, ‘I know what’s best’ paternalistic approach, much of my style is going to be more collaborative. It doesn’t mean that I’m not willing to step up and make decisions as need be, but I usually seek feedback to get as much information as I can to make the best decision.
So how do you apply these lessons to the multitude of challenges nursing homes and their administrators face today?
We do a good job of caring for the patient, or the elder, but we haven’t consistently done a great job across the board of caring for our staff. A competitive advantage is a strong, supportive nurturing culture, led by a leader that is well-versed in that.
I think colleges as well as other associations have an opportunity — if we are focused not just on providing education, or some of what I would call hard skills.
[Our members are] exhausted, they’re overwhelmed in many cases, and yet there are young people still coming into this profession. We’ve got to buoy them up so that they have not only confidence in their skill sets and proficiency, but they also know that they’re not in this boat alone.
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