AHCA CEO: ‘Enormous Problems’ for Rural Skilled Nursing Providers Demand Innovation

Rural nursing homes will survive, but they are currently facing severe problems that will require creative solutions, American Health Care Association/National Center for Assisted Living CEO and President Mark Parkinson said Wednesday.

“We have some massive workforce challenges that will create opportunities and innovation, and we will be fine down the road, but in the short run, we’ve got some enormous problems,” he said at Sanford Health’s Summit on the Future of Rural Health Care.

Sanford is a South Dakota-based health system, of which The Evangelical Lutheran Good Samaritan Society — one of the largest non-profit nursing home providers in the United States — is a part. Many of the themes and messages put forward Tuesday at the Summit dovetail with recent comments and concerns that Good Samaritan Society executives have voiced to Skilled Nursing News, including the threat to nursing home access posed by the challenges facing rural operators.


These challenges, especially in skilled nursing facilities and long-term care, have been exacerbated by the pandemic, with the sector experiencing a workforce loss of 250,000 workers.

While other health care sectors have seen a recovery in workforce numbers, long-term care is struggling, and this issue is compounded by demographic trends, including an aging population and a decline in the fertility rate.

Parkinson said that addressing this workforce challenge will be a critical matter for the next five to ten years, and finding solutions for this challenge will be a daunting task for thought leaders and health care providers.


Issues at the top of mind for Parkinson were patient transfers and staffing.

He explained that from a hospital’s perspective, delaying the transfer of a patient to post-acute care facilities can cost about $1,000 per day, which is a substantial financial burden for rural hospitals. He emphasized that these financial implications immediately impact rural hospitals.

He also noted that the proposed federal staffing mandate further exacerbates this problem, making it more difficult for rural facilities to operate and posing additional financial challenges for rural hospitals.

Alan Morgan, CEO of the National Rural Health Association, echoed staffing as a challenge facing rural hospitals in the United States, and one that has worsened in recent years.

The health care education system in the United States often takes students from urban areas and exposes them to urban settings, which results in them being less inclined to practice in rural regions, he said.

“Across the United States, we’re taking the best and the brightest urban kids,” he said. “We’re bringing them to urban areas, putting them into urban cohorts, doing rotations in urban areas, and then we’re dumbfounded they don’t want to practice in western South Dakota?”

Morgan criticized the current approach of trying to attract health care professionals to rural areas and pointed out that the system is poorly designed for this purpose.

“From a policy perspective, it’s so frustrating when you’re talking in Washington D.C., and they clutch their pearls and they wring their hands. What can we do about rural America to make it better? How do we deal with this? Nothing,” he said

He emphasized the need to focus on “growing our own ” by encouraging students from rural backgrounds to return to their small towns to practice health care. He noted that the healthcare industry needs to become better at marketing the opportunities in rural America.

“Let’s start getting the right kids and as it was mentioned, right off the beginning, let’s grow our own,” he said. “Let’s get our kids interested in coming back to their small towns where they can be with their families and be in environments that they love to be in and enjoy.”

Nancy O’Connor, Director of the Office of Program Operations & Local Engagement, Centers for Medicare & Medicaid Services, addressed the unique challenges faced by patients and healthcare providers in rural areas compared to urban regions.

“Rural communities have higher rates of uninsured individuals, they face more pronounced health care workforce shortages,” she said. “Hospitals and other health care services are often at more significant distances compared to urban areas, and rural populations have a higher proportion of older adults and those with disabilities.”

These factors contribute to inequities that make it more challenging for rural residents to access quality health care, she said.

O’Connor discussed how CMS introduced a framework for advancing healthcare in rural, tribal, and geographically isolated communities, released in November 2022.

This framework outlines six priorities for the next five years, including applying a community-informed geographic lens to CMS programs, collecting and using standardized data, supporting healthcare professionals, optimizing medical and communication technology, expanding access to comprehensive health care coverage, and promoting innovations and value-based care in rural areas.

“Additionally, Medicare will now pay for mental health visits via telehealth when they are provided by rural health clinics and federally qualified health centers,” she said. “These are significant accomplishments, but they’re only the beginning.”

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