A.G. Rhodes CEO on Nursing Home Survey Flaws, New Expansions, Immigration-Based Workforce Initiatives

Georgia nonprofit A.G. Rhodes’ CEO, Deke Cateau, is all about solutions.

To that end, he has had a busy couple of years, successfully expanding one of the operator’s three campuses to be all private rooms with a dementia area built with the household model in mind – a $37.5 million endeavor.

Cateau said he would like to see such expansions at A.G. Rhodes’ two other locations while also making plans with a local university to create a unique immigration program for students that are already in the country and running an in-house staffing agency.


Skilled Nursing News spoke with Cateau about all of these plans and more, while also touching on hot button topics like the survey process and survey backlogs that are negatively affecting nursing home admissions, quality and public perception, not to mention stressing out an already fatigued workforce.

“Where’s the mandate for additional surveyors? It’s really a difficult, unfair situation with the civil monetary penalty (CMP) process, which I honestly think needs a lot of revamping,” Cateau said.

A.G. Rhodes operates three facilities in the metro area of Atlanta, Georgia with a majority of Medicaid beneficiaries. After Skilled Nursing News’ conversation with Cateau, Georgia Gov. Brian Kemp signed the 2025 budget into law, which earmarks $416 million for skilled nursing facilities in the state and rebase to its 2022 cost report. It’s a welcome collaboration with the state, which already has carve outs for certain needed services like dementia care, said Cateau.


This interview has been edited for length and clarity.

Fill us in more about the expansion at your Cobb campus.

It’s really exciting – it offers us the opportunity to take care of 72 residents living with dementia in a household model type of care. Our remaining 58 residents are now going to all have private rooms as well. That campus will be 100% private rooms.

It is the same 130-bed certificate of need (CON). We have been operating at about 124 for several years because of market demand. In five acres that we had adjacent to the property, we built the brand new memory care. That part of the building is brand new, and then we retrofitted the existing building and turned all our shared occupancy rooms into private rooms.

What’s next since Cobb is completed?

We don’t want to stop. We want to modernize and build out all three of our homes. We’re very realistic financially; that’s no easy task. This Cobb project cost us $37.5 million dollars. A lot of people say we’re crazy for having done it. But of course we did it because we know that is the most dignified way of caring for our elders. We have a little time to rest and then think about how we are going to get this done for our other two communities.

Let’s dive into what you’re facing now with the survey process, and survey backlog.

This survey backlog has hurt not just us but many communities. There are many communities that have substandard surveys, that have abuse warnings that cannot be removed until they have a new survey.

Thus, they’ve been affected from an admission standpoint, from a quality standpoint, from a public perspective standpoint. We have one such community that has waited over two years now to be surveyed. That is excessively punitive. Where’s the mandate for additional surveyors? It’s really a difficult, unfair situation with the civil monetary penalty (CMP) process, which I honestly think needs a lot of revamping.

Has the process changed, in terms of the goal of surveyors?

The survey teams coming into our homes now, there’s not one ounce of quality improvement, quality assurance in our survey process now. It is 100% a punitive process. That needs to be revisited. We understand fully the need for a robust survey and recertification process. That’s the only way we can ensure that actors stay clean and do the right job. I get that. But I also think there can be some level of quality inserted into that process as well.

The survey process has just become a very stressful situation for nursing homes and nursing home staff. I have staff describing how their stomach starts to churn. It’s almost an abusive process. I myself was called to one of our homes two years ago, I literally walked in on 10 surveyors descending on this nursing home, no explanation on why we have 10 surveyors. It took several hours for us to find out that that home was actually going through a process where some of these surveyors were observing the quality of the survey process. That would have been good to know, on coming in.

How does this change in tone affect staff?

It felt like they’ve just descended on us and that’s not good for caregivers. That’s not good for the certified nurse aides (CNAs) and licensed practical nurses (LPNs) already stressed out; it’s not helping our industry. There’s no other segment of our health care sector that has that level of scrutiny. None. It all seems to be bearing down on the nursing home.

Any other business lines you’re looking at?

Last year, we also started our own staffing agency to help with some of our labor issues for our three homes only; that has been immensely successful. We also built an in-house dialysis clinic on two of our three campuses in partnership with DaVita.

As a nonprofit, it was very important for us to do that for the quality of life of our elders living with end stage renal disease. It’s also a huge community service because those two zip codes, the Atlanta zip code and the Cobb County zip code, I actually have two of those zip codes of highest incidence of end stage renal disease in Georgia. It’s a very fitting service, not just for the community but for the quality of life for our elders.

Other than the in-house staffing agency, what else is AG Rhodes doing to bolster its workforce? Any updates on immigration initiatives?

We are working on an interesting immigration arrangement with a local university to help with that process as well. It’s in the very early stages.

These are actually individuals that are here now, in the United States with nursing licenses already that are studying at this institution not doing nursing but they’re studying in a different program currently. Our hope is to give them some exposure on the nursing side and see if they can help us, from a labor perspective.

How does Georgia stack up in terms of Medicaid reimbursement?

Medicaid in the state of Georgia does a good job. They have several carve outs, such as a ‘pay for performance’ within the Medicaid system. The carve outs are for cognitive deficits, for acuity. Used well, that program can offer more incentive. It looks like the state administration is working with nursing homes to see that improve more.

The state has had for some time quite a couple of carve outs based on a behavioral score. There’s opportunity for communities to give proper dementia care and be properly incentivized for it. That for me is the most exciting thing about it. Other than that, the district has rebased and tried its best to get to current costs.

These funding conversations, and Medicaid is a perfect example. It requires both the state and federal government because of their matching portion, and the providers to sit down and really evaluate – particularly for nursing homes – where that funding is most needed. With calmer heads doing that, we’ll come up with a better solution than we have for the current Medicaid system.

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