As the dust finally began to settle in 2024 from the operational storm unleashed by the COVID-19 pandemic, nursing home operators found themselves in a good position to turn to an issue that had not been so much ignored as largely postponed in the wake of the lasting damage.

Closures along with mergers and acquisitions altered the landscape of the sector in 2024, with major nursing home organizations such as the Evangelical Lutheran Good Samaritan Society, undergoing substantial changes to its footprint. Now, these organizations are planning to give more attention to improving infrastructure, opening more service lines and recentering facilities on new business models.

While the nursing home industry continues to battle an ongoing worker shortage amid a slew of operational pressures in the post-COVID era – including a tough economic environment, deeper government regulation, low reimbursement rates, and rising Medicare Advantage growth, to name a few – it is also beginning to reap the benefits of creative workforce initiatives and take greater advantage of value-based care programs. Given this, it seems fitting that some of the monetary gains are being reinvested into improving facilities and operations.

“We’re looking forward to continuing to invest in new programs and initiatives to provide the right care in the right place at the right time,” Nate Schema, president and CEO, Good Samaritan Society, told Skilled Nursing News.

But larger organizations aren’t alone in this bid to improve their facilities. Smaller for-profit providers, especially those located in rural communities, also recognize the need to update infrastructure even as they attempt to keep their doors open, according to Kimberly Green, COO of Diakonos Group, an Oklahoma-owned and operated long-term care provider.

“These improvements are important not only for resident comfort but to be able to implement new technologies and care approaches that modern health care and society will demand from us,” Green told SNN. “We must strongly advocate for incentive programs and funding mechanisms that would allow providers to take care of the needs of their facilities.”

Moreover, improving infrastructure is a matter of polishing badly damaged public image, nursing home executives said.

“Until we can correct the misperception that our nursing homes are outdated institutions, we will continue to be stigmatized and not gain the public support needed to invest in updating our physical spaces and operate at the standard of quality care we know we can provide – and that our residents deserve,” Deke Cateau, CEO at A.G. Rhodes, told SNN.

But workforce issues are also a top priority for these providers.

With retirements of nursing home leaders on the horizon and demand for skilled nursing services still strong, building stronger leadership and improving patient experience becomes ever more important as these operators hope to grow their organizations in 2025, while working to create more sophisticated facilities.

And implementation of creative staffing solutions is one thing, operators are also putting their weight behind altering workforce policies, including defeating the federal minimum staffing mandate.

“On the policy front, our top priority is ensuring the minimum staffing mandate is rescinded and a permanent fix is implemented,” Schema said.

And even as 2024 showed considerable improvements in staffing towards the latter end, organizations such as A.G. Rhodes are continuing to keep an eye on the issue and support workers through creative staffing initiatives that both aim to improve skills and bolster the workforce.

Meanwhile, others are also looking across global borders to get clinical staff.

“[Our workforce] can only be sustained through two avenues: the domestic workforce and immigration,” Cateau said, who named many programs currently underway at A.G. Rhodes aimed at increasing the pool of nurses. “Investing in the wellbeing and career growth for both groups through legislative reform, pathways for upward mobility, and a changed mindset that often places direct care workers at the bottom of the hierarchical structure is critically important in the next year.”

And while the shadow of the Medicare Advantage and the problems stemming from its growth loom large, with uncertainty on the path that the new White House might take in enforcing certain checks and balances on the preauthorization and denials process, advocacy groups such as ADVION are hoping that the incoming Trump administration will not make payment cuts.

“[We] will be watching what they want to do with the extension of the expiring tax cuts because if Republican Congressional leadership wants to offset that new spending with reductions, then Medicaid, and maybe Medicare, could be targeted for reductions as an offset,” Cythnia Morton noted in her remarks to SNN.

SNN reached out to nursing home executives to provide their insights – and solutions – on the headwinds and tailwinds shaping the sector in 2025, and where, on balance, they project that there is a sense of hope for better things to come. This article is the final installment in a two-part series, where these executives shared their thoughts in their own words.

Editor’s Note: As nursing home execs look ahead to 2025, our CLINICAL Executive Conference promises to be an excellent opportunity to glean the latest insights into care practices and network with leaders who are driving innovations. Tickets are available here. If you’re a leader with a nursing home provider company and interested in speaking at the event, email [email protected].

Nate Schema, president and CEO, Good Samaritan Society:

As we look ahead to 2025, I am bullish about the opportunity to shape the future of senior care in America’s Heartland. We remain focused on investing in new care delivery models to meet the comprehensive and evolving needs of our seniors today and into the future.

We truly want to be a place where seniors come to live out the best days of their life. That’s why we’re so excited about the groundbreaking of Founder’s Crossing, which will allow seniors to age in place in a safe and supportive environment. This new campus will bring together the full continuum of care and services and infuse technology and innovation to improve quality of life and quality of care. Simplifying the health care experience will allow seniors and older adults to live healthy and fulfilling lives.

The recent opening of the Sanford Virtual Care Center also presents tremendous opportunities to reimagine how care is delivered in our Good Samaritan Society long-term care locations. Soon, virtual on-call RNs will support our teams and bring care closer to residents, with around-the-clock access, no matter where they live.

After our success opening a groundbreaking dialysis den in Sioux Falls, South Dakota, we expanded on this model in Bismarck, North Dakota. In the New Year, we’ll open the first home hemodialysis den within a skilled nursing facility in the state of North Dakota. This is a game-changer for residents who were leaving at 5 a.m. in the dark and cold for dialysis appointments multiple times a week. We’re looking forward to continuing to invest in new programs and initiatives to provide the right care in the right place at the right time.

On the policy front, our top priority is ensuring the minimum staffing mandate is rescinded and a permanent fix is implemented. We need to focus on common-sense solutions to attract, retain and grow the long-term care workforce and protect access to high-quality care close to home. That includes advancing policies and solutions that leverage technology to support care delivery and help address workforce shortages. In addition, streamlining the visa application process for health care workers would help us tap into a global talent pool committed to caring for seniors. Recapturing unused employment-based visas for foreign-born nurses and foreign-born physicians from previous years would also help grow our workforce.

Our people are core to our caregiving mission. We recently launched an organization-wide initiative known as SAFE, which is focused on improving safety and quality by creating a culture of trust. A hallmark of our program is providing employees with a space to voice their concerns and ideas. We give employees a seat at the table to solve problems together. Every single employee, no matter their role, is encouraged to speak up. Collaborating on solutions helps our teams feel empowered, engaged and more resilient. When our people are happy, the resident care is going to follow.

One of the things that has really energized me is the tremendous response we’ve seen from young professionals who are pursuing a career in long-term care in a leadership role. These up-and-coming leaders are talented, creative and motivated to make a difference. We need to do everything we can to help them find fulfilling careers in long-term care and then support them while they grow. The bottom line: We know fostering a great culture is the foundation for success in all other areas – retention, safety and quality.

Deke Cateau, CEO at A.G. Rhodes:

As we look ahead to 2025, I believe that the most pressing issue facing the nursing home sector is our public image and how we are perceived by consumers. Until we can correct the misperception that our nursing homes are outdated institutions, we will continue to be stigmatized and not gain the public support needed to invest in updating our physical spaces and operate at the standard of quality care we know we can provide – and that our residents deserve.

The second most pressing issue is the ongoing labor shortage, which is quickly becoming a crisis. Our care partner workforce is our most valuable resource in providing that standard of quality care and can only be sustained through two avenues: the domestic workforce and immigration. Investing in the wellbeing and career growth for both groups through legislative reform, pathways for upward mobility, and a changed mindset that often places direct care workers at the bottom of the hierarchical structure is critically important in the next year.

A.G. Rhodes is a 120-year old nonprofit nursing home in metro Atlanta. I am proud to serve the mission of this organization, first as an Administrator starting in 2009, then as COO, and now as its CEO since 2018. The community we have cultivated over the years, both within our walls and as an active member of our larger community, is strong and vibrant. And we continuously strive to be innovative in programming and our approaches to care – for both the wellbeing of our residents and our staff. This focus on community is what I believe will help us in addressing the public image issue we face. We can’t hide behind the walls of our nursing homes. Creating connections with community organizations, volunteer and civic groups, local businesses, etc., benefits us all and will naturally lead to that public support, in good times and in not-so-good times.

One of the programs we have at A.G. Rhodes that demonstrates this community connection is our intergenerational program, Generation Connect, where youth can volunteer in activities with our residents. The signature event within Generation Connect is our Summer Service Camp where teens spend the week with us volunteering, learning more about the resident “buddy” they’re matched with for the week, exploring careers in the long-term sector, gaining greater appreciation for aging-related issues, and creating shared memories with their buddies. It’s truly one of the most heart-warming weeks for both the teens and our residents. The labor shortage is multi-faceted and therefore requires a similar approach. Caring for the workforce we already have is vital. One of the ways we are doing that is by offering learning and growth opportunities for all of our care partners, not just those in “management.” Our Leadership Development Program is perhaps the most successful of those opportunities as it is tailored to front-line staff.

The nine-month program provides training, mentorships, and leadership development so that our care partners are equipped with the skills and resources needed to pursue advancement in their careers. I am so proud that since its inception in 2021, several graduates have assumed leadership roles within the organization, including an Administrator, Assistant Activity Director and Nursing Supervisor.

We also realize that our workforce is largely sustained by those immigrating to the United States. To that end, we recently launched a partnership with Georgia State University’s Gerontology Institute called Scholars With A.G. Rhodes at GSU (SWAGR@ GSU). The program will offer students with nursing backgrounds, particularly international students, the opportunity to pursue a master’s degree in gerontology in the United States while also gaining valuable hands-on experience in a long-term care setting at A.G. Rhodes.

The long-term care sector is always going to have its challenges, both those we have voiced for years and those new on the horizon. But we are a resilient and innovative group, and I am hopeful that we will continue to make progress in 2025 as we all work towards the common goal of providing the best care for our nation’s elders.

Cynthia Morton, CEO at ADVION:

The sector faces broad challenges from the new Administration and Congress.

For the Administration, ADVION is going to be watching very closely the views of the incoming HHS Secretary and CMS Administrator during their confirmation process. This could give us an indication as to where they want to take policy. For Congress, as the new Republican leadership moves on President-elect Trump’s priorities, we will be watching what they want to do with extension of the expiring tax cuts because if Republican Congressional leadership wants to offset that new spending with reductions, then Medicaid and maybe Medicare, could be targeted for reductions as an offset.

During the first Trump Administration, CMS hosted several successful efforts to reduce provider burden. ADVION will be seeking these types of opportunities with CMS.

Kimberly Green, COO at Diakonos Group:

The skilled and long-term care industry stands at an influential moment as we enter 2025. Our industry continues to show amazing resilience and innovation in how we deliver care regardless of the constant challenges in workforce development and funding. Our industry must continue to develop and lift up leaders that will champion the essential role we play in the health care continuum and not be afraid to fight to change the public’s narrative. The demographics of our resident population are quickly changing and present both serious challenges and great opportunities. We are witnessing unprecedented growth in residents requiring specialized memory care and mental health services, alongside rising acuity levels that demand enhanced clinical capabilities. We are in a historic time. This shift requires a sophisticated, integrated approach to care delivery. We must find the health care and legislative partners that recognize our unique position in the health care landscape and want to help us not just navigate it, but thrive within it.

Our industry faces unique challenges that set us apart from other health care settings. Our care model requires clinical excellence for our patients and long-term relationships with our residents. This demands specialized clinical training and the ability to also meet the mental and psychosocial needs of those we care for. These approaches must be both comprehensive and sustainable. In 2025, we are focusing on developing innovative, cost-effective integrated training programs that address our specific needs while ensuring our staff can effectively manage increasing acuity levels.

As we all know, infrastructure is another priority for our industry. Many facilities across our industry face aging physical plants that require, or will require, significant investments in the coming decade. We must strongly advocate for incentive programs and funding mechanisms that would allow providers to take care of the needs of their facilities to not just meet care needs, but also resident expectations. These improvements are important not only for resident comfort but to be able to implement new technologies and care approaches that modern health care and society will demand from us.

Our focus for 2025 centers on several critical initiatives. First, we are expanding our integrated health initiatives through strategic partnerships with specialists across multiple disciplines – from wound care and respiratory therapy to mental health services. We are particularly focused on enhancing our respiratory and memory care programs and our mental health support services to meet rapidly growing needs and higher acuity in these areas.

Second, we are creating innovative approaches to workforce development and support. This includes developing specialized training programs that address our specific care requirements while being mindful of cost and time constraints. We are building a culture that extends beyond professional development to the holistic wellbeing of our staff and their families. We want our staff to know that their well-being, and their family’s well-being, are important to us.

Third, we recognize our responsibility in changing the public narrative around long-term care. By being transparent about our challenges with the public while educating about our innovations and successes, we hope to reduce the stigma associated with aging and long-term care, which will hopefully not just attract talented professionals to our workforce, but will create advocates for necessary legislative support and funding.

We know that success requires more than operational excellence. We must be open and honest about our challenges and make a fundamental commitment to addressing them. The future of our industry lies in all of our ability to balance these challenges while continuing to improve at what we do and keep our eyes focused on the future. The future is bright…absolutely blinding!