The nursing home industry is caught between a growing demand for services and evolution of the delivery model, all while policymakers and the wider community cling to an outdated version of the sector.

This has made lobbying for the industry a tricky endeavor, and yet, it also offers a unique – even urgent – opportunity to change the narrative about the sector given that its public perception has been fundamentally changed since the pandemic.

Clifton J. Porter II, incoming president and CEO of the American Health Care Association and National Center for Assisted Living (AHCA/NCAL), sat down with Skilled Nursing News to discuss his goals once he takes over the reins as well as the shifts in nursing home advocacy, and how associations like AHCA/NCAL can best utilize the current attention shown to the industry.

“We’re delivering care in different ways. As a result, it’s changed the narrative in D.C., at least as it relates to how we advocate,” said Porter. “Unfortunately, we’ve seen a gripping to the past, by certain policymakers … intensifying the penalties and pushing harder on the center. That’s a 1970s solution to a 2025 problem.”

As he prepares to take on his new role, Porter reflects on his time as Senior VP of Government Relations and how that will impact his leadership style at the association for years to come.

Porter also expressed excitement for near-term AHCA-led initiatives that will offer members actionable data to improve clinical standards and workforce innovations, and rigorous award programs to support quality claims.

Highlights of the podcast, edited for length and clarity, are below. Subscribe to RETHINK via Apple Podcasts, or SoundCloud.

Let’s start with your new role as the new president and CEO of AHCA/NCAL. How are you feeling about the new position?

I want to start by saying that everything has been pretty overwhelming. Many folks may not know, but I’ve been in the business now for 35 years. To end up with my peers, validating me leading them is an incredibly humbling experience. I’m really grateful, probably a bit introspective, particularly when the decision was announced. The other piece is just the outpouring of encouragement from not only our constituents, but folks on the Hill, policymakers, just lots of really good, good feelings and mojo coming in from the community.

When I started 35 years ago, I may have been the second or third practicing administrator in Virginia at the time that was African American. It was like that in school as well … I’m a little bit accustomed to, particularly in our field, being the first. I don’t focus on it a lot, to be honest with you. But I’m definitely grateful. I hope me being here inspires people to look higher and reach higher, and hopefully, I’m not the last.

Do you anticipate a shift in advocacy efforts pursued by AHCA/NCAL?

The future, at least from my viewpoint, is bright. We have to continue to build on the foundation that Mark built here at AHCA, really focusing our efforts on quality and being a mission driven organization. I think it’s just important that we not only learn from the past, but look to the future. One thing I learned very early in my government affairs experience is that if you’re divided you fall – you accomplish nothing divided. Policy is about consensus and getting majorities, moving issues and getting a broad consensus.

Mark started his tenure at AHCA with a pretty major coup, if you will, bringing two large organizations together. Since then, the organization has continued to grow. We need to continue that and look for opportunities to expand our membership.

What we’ve learned is that we can be very, very effective together. One of the major initiatives we’re going to be focused on is to expand and identify alignment, and expand these coalitions and work together. Workforce is a perfect example of that but there are many others.

Tell us about your previous role and how it informs your new role.

The government affairs role absolutely prepared me for this next step. As CEO there’s going to be a lot for me to learn but I think at the core, our members want us to advocate in Washington, that’s why our association exists. Coming from this background, obviously, it’s going to have me pretty well prepared for that component of the job. We have to continue to do what Mark has always encouraged us to do, which is offer solutions. They’re always going to be problems. Even the folks that we serve, even our critics, we can agree that we have problems, I think oftentimes what we disagree about is the solution to those problems. My goal is to ensure that we continue to be innovative, thoughtful, and realistic. It’s my intention to really put those different, unique solutions in front of policymakers and hopefully achieve something great.

What are some of the initiatives you would like to put into action?

We have to continue to advance innovative quality initiatives, our Quality Award Program is something we’re super excited about. We’ve got record applications to get on the quality journey. It is a challenging, challenging process and a very structured progression with our Baldrige Foundation credit program. We have more and more people getting the silver awards, and ultimately, the gold, and lots getting in the bronze area, which is where you start. It’s something that keeps all of our members focused on quality.

It’s all about measures and ensuring that, you know, we’re helping our members stay focused on what matters. A big part of that is just making sure that we can provide as an association important data, and continue to improve our data capabilities, to give our members actionable information that they can use to improve quality. Members enjoy a very robust data set that helps them understand where they are with quality metrics, and how they compare to others.

Workforce is obviously the elephant in the room. That’s been an issue for a long, long time. The critical issue that I think policymakers in particular are largely ignoring right now is that we have to fundamentally do something differently and do it soon. If we don’t, I think we’re going to have real problems throughout our health care system. There’s got to be real policies and we’re going to be working hard at that. The coalition is looking at ways to get other groups [in the care continuum] where we can work together to really come up with a plan; we’ve got to make investments. International nurses is a biggie. Immigration is something we always talk about, it’s probably the greatest conundrum that we have in our country politically.

If we intend to turn the tide on workforce, we have to think of new ways to not only attract people, but get them to understand what it is that we do. A young person, if they can ‘get bit’ early, with what we do, they’ll fall in love with it in spite of how challenging it is.

How have lobbying efforts for the nursing home industry shifted over the years?

I’ve definitely seen some shifts and changes. We’ve seen a growing demand for services. We’ve seen a lot of innovation, as it pertains to our delivery model. We’ve shifted and changed from just a basic kind of custodial center, convalescent center. The perception around what we do has changed. I think that’s been a positive. We’re delivering care in different ways.

As a result, it’s changed the narrative in D.C., at least as it relates to how we advocate. Unfortunately, we’ve seen a gripping to the past, by certain policymakers … intensifying the penalties and pushing harder on the center. That’s a 1970s solution to a 2025 problem. When it comes to how we advocate, we definitely have to push against an archaic viewpoint about what we do and how we do it.

The second piece, which I think is even more meaningful, is that I do think the pandemic fundamentally changed how we’re perceived. Oftentimes, we were ignored or not seen. Our society wants us to do something for their loved one that they no longer can do. All of those [pandemic] experiences have brought what we do to the forefront of policymakers’ minds. Going forward, folks appreciate us a little more. They definitely listen and I think are open to our ideas because of the impact that we had.

Folks also want to blame us for the consequences of the pandemic, seeing it as justification for the staffing mandate. It irritates me when I see that. The administration has used the pandemic as some justification. But that’s becoming less and less of a credible position. We’re hearing a little less of that and getting more support.