With major pressure coming down from government entities, further shaped by public perception as the nursing home industry faces a crushing staffing crisis, shared accountability among operators, their lobbying representatives and resident advocates has become even more important.
Health Management CEO Debbie Meade has a seat at the table, with roles at the American Health Care Association (AHCA) and the Georgia Health Care Association (GHCA) helping her gain the ear of policymakers and administrative leaders alike as a SNF operator.
While living in both worlds, she believes there needs to be better understanding between advocates and operators, as well as regulatory bodies.
Meade oversees four facilities in Georgia alongside her daughter; Health Management is a fourth generation company. She said her time on national boards has better informed her role as a small, independent operator in the state.
Skilled Nursing News connected with Meade during the AHCA/NCAL conference earlier this month to learn more about Health Management and how a small operator can have a big impact by bridging advocacy and operational leadership.
The conversation with Meade has been edited for length and clarity.
Skilled Nursing News: How have your roles with AHCA and GHCA informed your role as CEO for Health Management and how you see policy change in the space?
Meade: We can’t be on opposite sides of the fence. On both sides, there needs to be education, because sometimes what the advocates are angry about, calling for more oversight, the regulations already there, there’s already oversight there, they just don’t know it.
It’s interesting when you have been going to Washington, D.C. now for 20 some odd years and doing congressional visits – you think they know, but they do not know. Unless we educate them, they’re not going to know. They don’t know the resident of today, they don’t know how sick that resident is and the needs for the correct staff in which to provide that care.
Mental health in this country is lacking. We need support in mental health, but CMS has written regulations that skilled facilities are supposed to identify a behavior before it happens? Where is that education for our staff to identify that?
Most operators wish they were in a room with CMS every day – you actually are, with your advocacy roles. What do you tell them?
The subject we talk to CMS about, that we try to get through, is shared accountability. We cannot be perfect every day. No one can. There’s always free will, somebody making a bad decision. That doesn’t say that’s a deficient practice. If a staff member got nervous and gave the wrong answer, but three other staff members gave you the right answer, is that deficient practice?
It’s demoralizing when you work that hard, and state surveyors just want to strike somebody down because of one minor thing that happened. The survey process needs to be changed and not [be] a punitive system.
How do you think this relationship affects the ability to staff?
Expectation is one of our staffing issues. Do you want to work in a building, do you want to work in a profession where it is expected for you to be perfect, and if you make the slightest error, your job could potentially be on the line? Who wants that pressure?
How does that pressure mix with higher acuity among residents?
Ballpark figures – a nursing home gets 100 admissions a year. A post-acute care facility gets 400 admissions a year. You’re getting a group that took one admission, every other week, or maybe one a month … to getting seven admissions in a day.
That is a huge cultural change to get everybody to understand. Then you get 24 hours to make an impression on a post-acute care patient, because they’re only going to be with you eight days, 12 days, at the most 18 to 20 days, the clock is ticking. We need to know everything about them that we can to provide the best quality care, we need to have all the preventative measure care planned in 24 hours. That is a huge cultural change to make when under the nursing home regulation, you have 14 days to complete the MDS and 21 days to complete the plan of care.
How has Health Management specifically fared amid continuing staffing challenges?
The staffing challenges are real. I’ve been through seven administrators in the last year-and-a-half. There’s a lot of burnout … it’s been really hard. I don’t have weeks and months to train somebody, so I need someone that can basically take it and it’s theirs, and treat it as theirs. That’s hard to find. Today they need more of, ‘What do you want, I need you to show me everything, I need you to write everything down.’ I don’t have the resources to do that so it’s been a little difficult, and then I have a very high expectation.
I’ve learned that I’m not going to lower my expectation, I’m going to work with somebody more on that expectation … to maintain and keep that culture.
Anything else you’d like to say in terms of operator-government relationships?
I’ll preface this with, I’m not Republican and I’m not Democrat; I’m a policy person. I follow policy, especially when it comes to my profession. I will say under the Trump administration, Seema Verma was a rock star to long-term care. Mike Pence was the rock star, being behind the funding. I was at the White House across the table from him, he looked me in the eye and said, ‘How do we help?’ That goes a long way with me. It’s about the people.
With the new administration, we’re the bad people, we do everything wrong, we have way too much funding. That flip, when we’re already having such a hard time recruiting, we went from hero to zero with the change of administration. That would be the one thing I want to say: ‘What did we do differently? What’s different?’ I would like someone to answer that question.
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