Workforce shortages are still the most urgent concern for nursing home staff, with facilities continuing to struggle with recruitment, retention and burnout especially in leadership roles like directors of nursing (DONs).
The American Association of Post-Acute Care Nursing, (AAPACN), for one, is focused in the years ahead on prioritizing culture change, leadership development and stronger career pathways to make the sector more attractive and sustainable, AAPACN CEO and President Tracey Moorhead told Skilled Nursing News.
“Many owners [believe] that the sector doesn’t have a culture problem, but the reality is that their staff, including their leadership, will tell you a different story,” Moorhead said.
Financial instability caused by Medicaid cuts and managed care reimbursement gaps, and growing administrative and survey burdens, are yet more challenges the association will help members prepare for, via survey-readiness resources and Quality Assurance and Performance Improvement (QAPI) training.
Noteworthy developments for this year include a survey on workforce culture in partnership with LTC100, along with its education and certification programs. Looking ahead, AAPACN aims to train nurses by leveraging technology to reduce documentation burdens while improving care planning accuracy among its members.
The following transcript has been edited for length and clarity. Click here to subscribe to RETHINK via Apple Podcasts, and scroll to the end of this article to access the complete audio of the Tracey Moorhead episode.
SNN: What are the top three policy issues for your members?
Moorhead: Our top concern, policy or not, is the workforce. Just because the staffing mandate has been eliminated, the problem of adequate staffing for our sector has not gone away. We still need staff, and more specifically, we need registered nurses (RNs) and certified nurse aides (CNAs) in the care delivery sector. We also need to better tell the story of why long-term and post-acute care is a viable career option, as well as shine a light on and improve workforce culture in skilled nursing.
Our second concern is really the ongoing financial uncertainty and instability in reimbursement. We all know that Medicaid and managed care reimbursement are often not adequate to cover the cost of higher acuity residents. Inadequate reimbursement, including the increase in managed care reviews and financial take backs, results in significant financial uncertainty and instability.
The One Big Beautiful Bill Act has created the real possibility that states will have to make some decisions in the distribution of funds across all providers, not just skilled nursing, obviously. And that leads to questions about which providers get cuts. Who gets paid less, but still is expected to provide quality care? The pie is simply going to get smaller.
Our third concern is really the complexity of the survey and compliance burden. This includes changes to quality measures and the addition of claims data, including for antipsychotic use.
What compliance trends are creating administrative burdens right now?
We hear repeatedly and often from our members that survey is one of their biggest pain points, and we know that regulatory oversight remains a focus for CMS. AAPACN has and continues to develop new resources to address these burdens and to provide guidance, such as survey readiness, preparation and tools, a guide to resident safety and QCP, which is a QAPI Certified Professional Program, which is celebrating its tenth anniversary this year. We believe that the key to survey success is both staff and facility readiness. Staff must be trained and have resources on how to monitor systems, conduct audits and review documentation, especially on new admissions and those residents with a significant change or changing condition.
How does AAPACN plan on improving workforce culture?
Our chief nursing officer, Amy Stewart, has been on a campaign for the last two years about culture. We believe that culture comes from the top. It requires daily care and feeding to engage and support staff at all levels, from owners to administrators to laundry and maintenance. We know that a good culture improves retention and outcomes, but a strong culture is more than just lip service. Staff must feel supported and empowered.
One of the things we’re doing at AAPACN that I’m very excited about for 2026 is that we have partnered with LTC100 on a survey that will be released at that conference in April, and that survey will provide some real insights for owners and administrators on what drives staff satisfaction and culture and where culture might need to change and how it can change.
Any work you’d like to highlight AAPACN is doing to change public perception of nursing homes?
I know many owners who have said to me, to our CNO Amy Stewart, that the sector doesn’t have a culture problem, but the reality is that their staff, including their leadership, will tell you a different story. There’s a disconnect there, and we’re very hopeful that our partnership with LTC100 will help bridge that gap, that disconnect, and really focus on that culture. That’s part of what we’re trying to do to change that discourse.
In addition, AAPACN is launching a very significant initiative this year, a communications initiative to really rebrand and elevate the perception of nursing in long-term and post-acute care. This is really coming directly from the leadership of our board of directors, and we want to highlight this sector as a career opportunity for current and future health care professionals.
We’re trying to speak this year through this initiative, not only to health care professionals, but also to the people who are impacted, the families and the residents who are going to be cared for in those facilities.
These initiatives are part of AAPACN’s new direction?
AAPACN’s Board of Directors spent nearly the entirety of 2025 developing and eventually approved a new strategic direction for the organization. It’s ambitious, it’s exciting, it’s humbling to be able to help move in this new direction, AAPACN is really stepping up to highlight the value of the sector. We want to not only highlight the value of the sector at the facility level, we want to support operational efficiency and quality and excellence in these facilities. And then finally, provide educational resources and leadership programs for skilled nursing professionals at all levels.
We’ve got an opportunity to focus at the sector level, at the facility level and at the individual professional level in our new initiatives. One key component that underscores all of this is technology, and how we are going to utilize technology to support accuracy of the MDS assessment tool, accuracy and timeliness of care planning and implementation of that care plan and compliance. We want to create advanced tools that reduce documentation burden and staff burnout. We want to help improve resident outcomes with data driven decision making and collaboration through guidance, utilizing technology. These are a lot of the key components that AAPACN will be implementing over the next two to three years as we launch this new strategic direction for the organization.
Any thoughts on the new value-based care models that were announced at the beginning of the year?
If there’s something to take away from all of those models on how to improve care, the reality is that quality is a mindset. If you can align your care delivery and your care planning to ensure that you’re going to get the best possible outcomes, value-based care becomes second nature.
We have seen the director of nursing role be tied to quality care outcomes and value-based care. How is AAPACN meeting this shift?
The DNS, director of nursing services, or DON, is the team lead for skilled nursing facilities. In many ways, they’re a staffing lead. They’re a quality lead. Yet one significant challenge has been the high turnover for this role in facilities across the country. We’ve seen this since the beginning of Covid – new DONs or assistant DONs are being put in roles that they haven’t really had enough training for or don’t have the resources to succeed in, and as a result, we’re seeing increasing burnout; we can do better to support these professionals.
We have spent a number of years developing leadership training and career progression programs for DONs. This includes our DNS, CT certification program and the previously mentioned QCP QAPI Certified Professional Program. These programs help facility leaders such as DONs identify their facility needs and give them the tools to analyze the data and drive quality improvement in their facilities. For us and our legacy at AAPACN, it’s really about empowering through education.
Are there any other intersections of policy and staffing that are top of mind for AAPACN?
The issue of nursing as a professional degree is incredibly problematic. As I’m sure many of your listeners know, the U.S. Department of Education’s Reimagining and Improving Student Education (RISE) committee made a decision to exclude post baccalaureate nursing programs from the definition of professional degree. This could create ineligibility for student loans, and would, I’m sure, immediately impact the number of nurses available, let alone coming into our care delivery sector.
This is something that created a lot of consternation among nursing organizations and AAPACN has been supportive of an American Medical Association (AMA) initiative and through many of our other coalitions to try and push back on this.
What is your ideal partnership or initiative that could help the sector the most right now?
One thing that I’d love to see is a partnership that allows us to release civil monetary penalty (CMP) funds for workforce programs and staff training. If we were able to do this in an ideal way, it could result in a significant reduction of future CMP funds, because we have well-trained staff and facilities. Among surveyors, that would result in significant reduction in future citations and penalties. It’s a win for everybody. I just don’t know how to do it yet and haven’t found the right partner, and I’d be interested in hearing from anybody who might like to brainstorm with us on how to do that.
What should federal and state officials, and the public, rethink about nursing homes?
One: the skilled nursing industry, the post-acute care industry, is filled with people who genuinely care about residents, patients and families. They want to do the right thing, and that is their default every day when they walk into the facility, the vast majority of these people, these professionals, are trying their best to meet requirements set by state and federal regulators, and the public doesn’t know how often those requirements change or are not uniformly interpreted or applied across all facilities or regions or even states.
Regulatory enforcement looks very different even within one state. I’d love for federal and state officials and the public to have a brighter lens, a more clear lens, into that aspect.
Second: quality care is not inexpensive. Many payers do not reimburse for the actual cost of the high quality care and the concurrent staffing levels that are necessary to provide that care. The public doesn’t know, and frankly, they shouldn’t have to worry about how nursing facilities are paid. They should be able to find good quality care in their communities, provided by people who are fairly compensated for their work.
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