With intense pressure from government agencies further shaped by public perception as the nursing home sector faces a crushing staff crisis, the shared responsibility between practitioners, their lobbying representatives and resident advocates has become even more important.
Health Management Chief Executive Debbie Meade has a seat at the table, with roles at the American Health Care Association (AHCA) and Georgia Health Care Association (GHCA) helping her gain the ear of policy makers and administrative leaders alike as an SNF operator.
While living in both worlds, he believes there needs to be a better understanding between advocates and practitioners, as well as regulatory bodies.
Meade oversees four facilities in Georgia along with her daughter; Health Management is a fourth generation company. She said her time on national councils better informed her role as a small independent operator in the state.
Skilled Nursing News connected with Meade at the AHCA / NCAL conference earlier this month to learn more about health management and how a small operator can make a big impact by combining support and operational leadership.
The conversation with Meade has been modified for length and clarity.
Skilled Nursing News: How have your roles with AHCA and GHCA impacted your role as CEO for health management and how do you see policy change in the space?
Meade: We can’t be on opposite sides of the fence. On both sides, there has to be education, because sometimes what the defenders are angry about, they ask for more supervision, the regulations already there, there is already supervision there, they just don’t know.
It’s interesting when you’ve been going to Washington, DC for 20 odd years now and visiting Congress – you think they know, but they don’t. Unless we educate them, they won’t know. They don’t know the resident of today, they don’t know how sick that resident is and the needs of the right staff to provide that care.
Mental health in this country is lacking. We need mental health support, but has CMS written regulations that qualified facilities should identify behavior before it happens? Where is that training for our staff to identify it?
Most traders would like to be in a room with CMS every day – actually you are, with your advocacy roles. What do you tell them?
The topic we talk about with CMS, which we try to address, is shared responsibility. We can’t be perfect every day. Nobody can. There is always free will, someone who makes a bad decision. This does not mean that it is a poor practice. If a staff member got nervous and gave the wrong answer, but three other staff members gave you the right answer, is that a poor practice?
It’s demoralizing when you work so hard, and the state inspectors just want to hit someone because of a little thing that happened. The investigation process must be modified and not [be] a punitive system.
How do you think this relationship affects staffing capacity?
Expectation is one of our staffing problems. Do you want to work in a building, do you want to work in a profession where you are expected to be perfect, and if you make the slightest mistake, your job could potentially be at stake? Who wants that pressure?
How does this pressure mix with greater acuity among residents?
Figures Ballpark: A nursing home receives 100 admissions per year. A post-acute care facility receives 400 hospitalizations per year. You’re getting a group that took one admission, every other week, or maybe one a month … to get seven admissions in one day.
This is a huge cultural shift to make everyone understand. So you have 24 hours to impress a post-acute patient, because they will only be with you for eight days, 12 days, at most 18-20 days, time is ticking. We need to know everything we can about them to provide the best quality care, we need to have all preventive measures planned in 24 hours. This is a huge cultural shift to make when, under the nursing home regulation, you have 14 days to complete the MDS and 21 days to complete the care plan.
How has health management specifically performed amid continuing staffing challenges?
The challenges for the staff are real. I’ve been through seven administrators in the past year and a half. There is a lot of exhaustion … it was really difficult. I don’t have weeks and months to train someone, so I need someone who can basically accept it and it’s theirs, and treat them like them. It is difficult to find. Today they need more than “What do you want, I need you to show me everything, I need you to write everything down”. I don’t have the resources to do it, so it was a bit difficult, and then I have a very high expectation.
I have learned that I will not lower my expectations, I will work with someone more on those expectations … to maintain and maintain that culture.
Is there anything else you would like to say in terms of the relationship between the operator and the government?
I state that I am not a Republican and I am not a Democrat; I am a political person. I follow politics, especially when it comes to my profession. I will say that under the Trump administration, Seema Verma has been a rock star for long-term care. Mike Pence was the rock star, behind the funding. I was in the White House across the table, he looked me in the eye and said, ‘How can we help?’ This goes a long way with me. It’s about people.
With the new administration, we are the bad people, we get it all wrong, we have too many funds. That reversal, when we’re already going through such a tough time for recruiting, we’ve gone from hero to zero with the change of administration. That would be the only thing I want to say: ‘What have we done different? What’s different? ‘ I would like someone to answer this question.