Perspectives in Long Term Care

American Health Care Association

An original podcast series produced by the American Health Care Association and the National Center for Assisted Living, created specifically for leaders in the long term and post-acute care profession.

  1. Jun 15

    The Power of Showing Up: Advocating for the Long Term Care Profession

    In this episode, host Debbie Stadtler sits down with Barry Carr, chairman and co-founder of Ignite Medical Resorts, and Randi Carr, Ignite’s chief of staff, to discuss the importance of advocacy and relationship-building in the long-term care profession. As they celebrate 40 years of marriage and prepare to receive the Joe Warner Patient Advocacy Award, Barry and Randi reflect on how their involvement with AHCA/NCAL inspired them to become more engaged with policymakers at the local, state, and federal levels. They share practical insights on building lasting relationships with elected officials, emphasizing the value of consistency, education, and offering solutions rather than simply highlighting challenges. The conversation explores how facility tours can help policymakers better understand the realities of long-term care and why providers must stay engaged on issues ranging from Medicaid reimbursement and staffing mandates to federal regulations. Barry and Randi also discuss current advocacy priorities, including Medicare Advantage obstacles and the ongoing challenges surrounding the three-midnight rule and observation stays. Throughout the episode, they highlight how proactive advocacy helps strengthen the profession, improve patient care, and ensure policymakers have a clearer understanding of the vital role long-term care providers play in their communities.   Perspectives in Long Term Care is produced by Association Briefings.   Transcript Debbie Stadtler: Politicians are people too. Learn more about building relationships with policymakers and advocating for our profession from Barry and Randi Carr in this episode of Perspectives in Long term Care.  Hi, I'm Debbie Stadtler, editor-in-chief of Provider Magazine, the flagship publication of the American Health Care Association and the National Center for Assisted Living. I'd like to welcome you to this episode of Perspectives in Long Term Care, a monthly podcast produced by AHCA and NCAL. Each month, we'll talk with long term care and assisted living professionals about the opportunities and challenges impacting the long term and post-acute care profession. My guests today are Barry and Randi Carr. Barry is chairman and co-founder of Ignite Medical Resorts. Before founding Ignite, he spent years growing new care services from roughly 1,000 to nearly 5,000 beds. Randi serves as Ignite's chief of staff and engages regularly with state and federal policymakers. Barry and Randi met at the University of Michigan and are celebrating their 40th wedding anniversary this year, which deserves a hearty congratulations. Welcome to the podcast, Barry and Randi.  Barry Carr: Thank you.  Randi Carr: Thank you. Glad to be here.  Debbie Stadtler: Well, tell us about your career journey. What led you to get started in long term care? How did you get to where you are today?   Barry Carr: I started about 41 years ago. My father-in-law was an investor in a group of facilities, and they needed an assistant administrator, so I came on board, said I would do that for a year or two, and they ended up selling the company a few years later. And then I got back together with his old partner, and we grew that company together. His family was getting involved. There was a nice growth. I left after 27 years and then broke off and started Ignite with my partner, Tim Fields, about eight years ago now.  Randi Carr: When Barry and Tim, in 2018, when they were starting up the company, Barry had one facility on his own. They were trying to acquire more properties, and Barry said to Tim, "The company doesn't really have any money yet, but we do need someone to help us out, and Randi's really organized, and we don't have to pay her." So that's how I got my job. In the beginning, he always had such a really busy work life, I was in charge of the kids and the house, and I was a stay-at-home mom, but I also was a substitute teacher for 20 years. So that overlapped a little bit with when I started with Ignite. But then when COVID shut the schools down, it just kind of got busier at that time, and it just evolved.  Barry Carr: Yeah. Timing was right.  Randi Carr: Yeah.  Debbie Stadtler: You're both receiving the Joe Warner Award. Again, congratulations. For those who don't know, the Joe Warner Patient Advocacy Award honors members who embody compassion, service, leadership, and an unwavering dedication to the elderly and people with disabilities. What does this award mean to you?  Barry Carr: It's a great honor. It surprised us both.  Randi Carr: It really surprised us. We weren't vying for it. Yeah. We didn't even really know much about it.  Barry Carr: But we don't do things for the award. Our focus is really on people and making sure that the patients are taken well care of, the families are happy, the staff is happy. So really for us, it was, it's just a Randi Carr: Bonus ...  Barry Carr: it's a bonus, yeah, on top.  Randi Carr: I mean, it's really, we're very honored. It's very nice to be recognized, but again, we just do it for helping people out.  Debbie Stadtler: The name of the award has advocacy in it, and we know that you guys are very deeply involved in advocacy work. How did that get started? What kind of got you interested in doing advocacy and speaking up to policymakers?  Barry Carr: I think, again, over the 40 years there's always been a lot of regulatory issues and a lot of issues that are coming up. We just started seeing just more and more over the last few years and decided that we would get involved with talking to people who we've met along the way, know along the way, and try to just get in front of people who could help make changes that could make things better for us. There, there's so much in the news about our industry and so many bad things, and there really are some really great things that we do and not a lot of people recognize it.  Debbie Stadtler: Yes.  Barry Carr: So we just got into it, I wouldn't say accidentally.  Randi Carr: But I think a lot of it was because of AHCA and NCAL, like really when you were on the independent owners council, when we only had a couple buildings, and we just learned a lot about it through AHCA.  Barry Carr: The people were great. At that point I had met Mark Parkinson and Phil Scalo and Phil Fogg and Chris Wright and of course-  Randi Carr: Clif,  Barry Carr: of course ... Clif Porter and LaShawn Bethea. So when we started talking to them, started realizing just how many resources they had and how many ideas that they had that really were pro-care. And we decided that was just something we liked. Randi Carr: Yeah, we really clicked with the organization, like right away. It just felt really comfortable for us.  Barry Carr: And Randi's gotten involved with me in that because she's so organized and-  Randi Carr: And going to Congressional Briefing, it's a lot to manage and especially when we became operators over several states. There were like quite a few meetings all in one day, and so we tried to organize and we realized that we could get to people. Barry Carr: There's a synergy there that the two of us created a much bigger circle than each individual could do. So it worked out really well for us.  Debbie Stadtler: I love that you mention the positive aspects of long term care and the work, because I agree, sometimes things get focused on the challenges and the problems, and the positive side of it, the great things that are happening get a little lost along the way. So I'm glad that you guys focused on that and really feel that's a good story to tell, because it really is.  Barry Carr: No, it's... We're a punchline to a joke sometimes, our industry. My mom used to joke with me all the time saying, "Ah, bet you one day you're gonna put me in a nursing home." And is that bad? Exactly. But again, her take on it was that it was the worst thing that could possibly happen to you.  Randi Carr: And also Ignite's model is a little bit more upscale, and that's another positive thing that Barry and Tim have really tried to make it a place where you wanna be and you can get amazing therapy and-  Barry Carr: Yeah, live in a boutique hotel. Randi Carr: But there are plenty of facilities that are people on Medicaid and they're serving... We definitely always advocate for those facilities as well. Medicaid doesn't necessarily always affect us or our guests or patients, residents, but  Barry Carr: But we do advocate strongly for it because it's so important for the industry. Debbie Stadtler: Absolutely. Very vital. You've been doing this kind of work for several years, and through a couple different administrations, through a few changes of policy makers at CMS. How has the advocacy work changed over time? What has changed about how you interact with policy makers?  Barry Carr: I think we've really decided to really get to know the policymakers rather than just showing up once in a while saying, "Hi, I have a problem. Can you help me?" We've spent a lot of time now getting to know the policymakers, especially the ones in our areas or in other areas that are important for the different states.  And in doing that, I think they start to realize that we are human. We're not just there to always ask for something. Sometimes we're there to offer help, and we've also learned that if you show up with solutions to problems, much better than just showing up with a problem. Randi Carr: Complaining.  Barry Carr: Complaining. So we've kept in touch when there are things we'd like to talk about. We've kept in touch when there's nothing to talk about, and I think when they start seeing that you are real and that what you want to do is real and it's important, that changes. So that, I think, has changed for us at least over time. Yeah. The different administrations, it's sometimes you're dealing with Democrats and explaining to them why your piece of legisla

    23 min

  2. May 13

    Finding Solutions to Long Term Care Workforce Shortages

    In this episode, host Debbie Stadtler is joined by Rachel Bunch, executive director of the Arkansas Healthcare Association, for a conversation about innovative approaches to addressing workforce shortages in long term care. Bunch shares her professional journey and discusses how the association responded to member needs by launching the Arkansas Healthcare Association School of Nursing. What began as a medication assistant program designed to help CNAs expand their responsibilities and allow nurses to practice at the top of their license evolved into a tuition-free, employer-focused CNA-to-LPN pathway. The discussion explores how the program incorporates accelerated coursework, coordinated work schedules, and wraparound student support to improve retention and completion rates. Bunch also highlights the school’s strong outcomes, including a nearly 92% graduation rate, ongoing expansion efforts across the state, a focus on geriatric care training and faculty development, and future plans to explore an LPN-to-RN pathway. She also reflects on the importance of listening to members and being willing to pursue nontraditional solutions to workforce challenges.   Perspectives in Long Term Care is produced by Association Briefings.   Transcript Debbie Stadtler: We know that finding workers in long term care is a challenge. Learn more from the Arkansas Health care Association, who have seen great success in starting a nursing school to address that need. Hi, I'm Debbie Stadtler, editor-in-chief of Provider Magazine, the flagship publication of the American Health care Association (AHCA) and the National Center for Assisted Living (NCAL). I'd like to welcome you to this episode of Perspectives in Long Term Care, a monthly podcast produced by AHCA and NCAL. Each month, we'll talk with long term care and assisted living professionals about the opportunities and challenges impacting the long-term and post-acute care profession. Today, my guest is Rachel Bunch, executive director of the Arkansas Health Care Association. Rachel also serves on the Governor's Council on Aging and the Alzheimer's Disease and Dementia Council. She is the president of the Arkansas Health Care Association’s School of Nursing, which we are going to talk more about shortly. Welcome, Rachel.  Rachel Bunch: Thank you very much.  Debbie Stadtler: Let's start at the beginning. Tell us about your career journey. What led you to get started in long term care?   Rachel Bunch: I guess you could say it's one of those... What's the quote about the best laid plans are not plans? So I actually started working at the Arkansas Health Care Association when I was in college back in 2008. Started working there and really enjoyed it. I, at the time, didn't know really what an association was or the role that they played, and really enjoyed my work there so much with them, and then did a lot of different duties with them. Started in my position at the end of 2013, and so I'm going on my 18th year now with the Health Care Association in Arkansas, which is really wild and hard to believe that it's been that long. Time flies when you're having fun, right? Definitely. A little bit of a non-traditional route.  Debbie Stadtler: We know that workforce challenges are top of mind for long term care providers, and the Arkansas Health Care Association decided to help address this challenge with a nursing school. Tell us more about it. Rachel Bunch: Sure. Thank you. So it's been a really exciting journey and something that has really, we've laid the groundwork over the last several years. We didn't necessarily seek out to do this. We've done education at the association for many years, just like a lot of the other state affiliates offer, and this really started with our medication assistant program in 2023. That was a, a level in our workforce, a licensure level that a lot of other states had, and we didn't, and worked to add that through legislation and with various state boards in Arkansas. And once we started offering that program, it really took off, I think because we were a little bit behind the curve on having those professionals in the state, but also the workforce shortage was so great. And the key difference that it made for us, it allowed us... The structure of our program, it allowed us to take existing CNAs and put them through this medication assistant program for higher wages, more responsibility, and they went through the program, and they were so motivated to go to school. The facilities really embraced it, and it went well because it gave our nurses on the floor got time back in their day to do other nursing tasks other than pass meds, and it really allowed those nurses to work at the height of their license, which made such a difference. And so that was the beginning, and we had a lot of motivated students, a lot of motivated providers that really had done some tuition reimbursement before but hadn't had a real structured process to be able to offer those things, and it took off from there. And here we are today, just finished our first graduation and looking forward to beginning our second cohort this summer.  Debbie Stadtler: It's really been awesome. The nursing school is quite unique because it's the first nursing school run by a state provider association, and you're training CNAs to become LPNs in long term care facilities, and students have a guaranteed position when they graduate. That's huge. So what other things make the nursing school special and just right for Arkansas?  Rachel Bunch: I think one of the biggest things is that we, through our work with a lot of our facilities and a lot of work with our students, we've really made this facility and employer-focused, and in turn, there's a lot of student focus that went into it as well. So we identified a lot of the reasons. Again, we did not start out seeking to do this, but it really made sense, and it seemed like a great service that we could provide to our members. So we identified a lot of the barriers with traditional programs. We don't believe that this competes with traditional programs. We think that we're serving a different population of people that would otherwise never go on to a traditional higher ed program. But we identified the barriers. What has held these people back? What has kept someone who's been a CNA for their career, and they've loved it and found meaning and purpose in that role, but they're willing and able to do more. They've just not had the opportunity. We identified a lot of those barriers and tried to eliminate those as much as we could with the program. I would say the biggest ones are that the program is tuition-free for students, which is a really big bonus, and what a gift for them and their families. The other thing is that the tuition-free is due to a combination of grant money, matching money from the facilities, and then some help from our association as well. It's a true group community effort to make them successful. The other thing that we do is partner with our member facilities to coordinate work schedules of our students. In the traditional school, you might be in class Monday to Friday, eight to five, but then you can't work nights and then go to school. It just makes it impossible to do. So our program, we have the students in school Tuesdays, Wednesdays, Thursdays, and then they work in the facility Monday, Friday, and then either Saturday or Sunday. And the employers help them with some wraparound supports and gap pay, and we coordinate those things together to make it possible for them. And it is fast-tracked, but we help them with things that we're helping the students with licensure fees. The facilities are helping reimburse us for the licensure fees. That's a common barrier. We looked at a lot of research, and we interviewed even a lot of our staff members that had attempted a traditional nursing program in the past, but they weren't successful for one way or another. And it was really interesting to hear their stories and understand why that didn't work. But here we have a great employee that is dedicated, committed to our facility locally. They want to do more and grow in their role, but there have been different barriers that have prevented that. And so we just, we really try to work hard to eliminate those. Debbie Stadtler: I love what you said about this is a different audience, and you guys tried to eliminate a lot of these barriers, because some of the things that you're talking about we've heard over and over about go to school and work at the same time and things of that sort. It's working out. The nursing school has had great success so far. Like, you mentioned the first class, it boasted a graduation rate of nearly 92%. That's amazing. And enrollment for next classes is growing fast. What do you think contributes to that success?  Rachel Bunch: It's one of those things that it's been a really hard journey, it's been a lot of work, but it's one of those things that is so worthwhile and paying off for our members. We're so excited about it. I think it's one of those things that we're going to look back and think, "Why in the world did we not do this 10 years ago?" It's one of those things, it's so obvious, but it was also so different at the time and hadn't been done, and we took a chance on it. I remember saying many times throughout the process, "This hasn't been done before, and I hope I don't figure out why." It was really just a very different approach, and just it took some time. But yes, 92% graduation rate for the first class. We had 66 students that graduated a couple of weeks ago. The ceremonies were so special involving both their families and friends, their children, but also their facility family, their, the facility staff, their administrators, their DONs, the facilities there to cheer them on. So just having all of that together was really special. So far, out of the 66

    21 min

  3. Apr 13

    What It Takes to Achieve Quality Excellence

    In this episode, host Debbie Stadtler sits down with with Renee Ridling, Executive Director of the Gingerbread House, to explore quality improvement and the AHCA/NCAL Quality Award program. Ridling shares her journey into long-term care—from marketing to licensure—and her experience helping organizations earn Bronze, Silver, and Missouri’s first Gold award. They break down the progression of the program, from defining an organization’s identity (Bronze), to documenting processes and data (Silver), to achieving results through a rigorous Baldrige-based framework (Gold). Along the way, Ridling highlights common pitfalls—especially focusing too much on “what” instead of “how”—and underscores the importance of repeatable processes, team engagement, and using feedback reports as a tool for sustained improvement. Perspectives in Long Term Care is produced by Association Briefings.   Transcript Debbie Stadtler: Improving quality is always a goal in long-term care. Hear more about the ins and outs of the continuous quality improvement journey in this episode of Perspectives in Long-Term Care.  Hi, I'm Debbie Stadtler, editor-in-chief of Provider Magazine, the flagship publication of the American Healthcare Association and the National Center for Assisted Living. I'd like to welcome you to this episode of Perspectives in Long-Term Care, a monthly podcast produced by AHCA and NCAL. Each month we'll talk with long-term care and assisted living professionals about the opportunities and challenges impacting the long-term and post-acute care profession.  My guest today is Renee Ridling, executive director of Gingerbread House, a nonprofit provider for high acuity, medically fragile, developmentally disabled individuals in Rolla, Missouri. Renee has served as a silver and gold level examiner for the AHCA and NCAL Quality Award program for eight years. She joined the quality award panel of judges in 2018 and continues to serve as a judge for the program. She has also successfully led two skilled nursing facilities to two bronze and two silver quality awards, and in 2014, her facility became the first facility in Missouri to achieve the gold quality award. Welcome, Renee. Thanks for being with us.  Renee Ridling: Thank you for having me.  Debbie Stadtler: Those are some awesome accomplishments, and I want to talk much more about the Quality Award program. But first, tell us about your career journey. How did you get into the field? What led you to choose this career?  Renee Ridling: I actually got into long-term care by accident. I'd always wanted to work in healthcare, and I had a background in marketing. I interviewed for a position in marketing with a long-term care facility and I fell in love with it. And I worked at that time for Beverly Enterprises, a company that had over 200 facilities nationwide at that time. And I was asked if I would be interested in the AIT program and. It was intriguing, so I said yes, and the rest, as they say, is history. I obtained my license in late 1992, early 93, and I've been working in long-term care consistently since then. I just fell in love with everything about the people that we care for and the challenges that we face as an industry every day.  Debbie Stadtler: It's amazing, and as I talk to folks about their career and how they get started, it's so evident that there is a love and a passion for the industry and for the people that are in it. So I can see that is reflected in your career as well. But let's talk about the quality improvement journey. You have a unique perspective because you've seen it from both sides, both as an applicant and recipient, but also as an examiner and a judge. So give us a quick overview of the program and your experience with it. Renee Ridling: Well, I actually became an examiner after we received our bronze quality award in 2008 for my facility here in Missouri. And I wanted to learn more about the criteria, wanted to be able to help my organization to understand the process better and just to do a better job of learning and finding out what the quality improvement journey was all about. So that's when I became an examiner. I've stayed an examiner because I found it to be helpful in learning about my organization, how continuous improvement can benefit all aspects of the organization, not just the leadership part of it, not my job, but quality improvement continuously. Looking at opportunities to get better can help everybody, my residents, my staff, and really just became a student of that criteria. I really enjoyed the silver. And then I became a gold examiner. I've been a team lead at both levels. And then I was approached to be a judge, and that was a really interesting term. So it's been a really great opportunity for me not only to learn about myself, but to also learn about the organizations that I've had the opportunity to work with. Debbie Stadtler: I love how you mentioned that becoming an examiner was a way for you to learn the knowledge for your facilities, firsthand knowledge of seeing what they're looking for. But that's a great point though that each level of the quality improvement journey and each level of the Quality Award program are looking for different things. And so what advice would you give to those aiming for each of the three levels or applying for each of the three levels? What's the difference there?  Renee Ridling: I think beginning at the level we're really asking: What is your organization all about? Who are your customers? What are your key services? What challenges do you face? What advantages do you have over your competition? Then you take that piece and you move it into silver, and then we start digging into those questions about, okay, we, we know who you are and we know what you do, so tell us now how you do it. I think that's probably the biggest jump from bronze to silver. So those questions are how do you lead your organization? How do you make sure that you are focused on your customers. And then moving into the gold, that's a big trick. You go from the bronze, which is five pages, and then you go into silver, which is 26, and starting to be asked for some data, and then you open up the Baldrige framework for healthcare criteria and then you're asked to provide 55 pages of  a response.  So you now have basic questions and you have overall questions just like you had in silver. But now you have those multiple levels that really dig in and help you to identify gaps within your organization and opportunities to get better. It's just, it's, wow, I've never thought about that for my organization, but now I am, and I think we need a process for that.  And so I think the biggest difference is just learning at each level what is expected, how to address what is expected of you, and then moving into gold. It's really challenging for your whole organization to become better, the results throughout your goal. But what's presented in category seven is really a visual representation. You're like, wow, we did that. We really are getting better at what we do. For me, the biggest thing is just that moving from face to face along that journey and seeing at each level how we can grow and get better.  Debbie Stadtler: I like how you described it, that each piece builds on the previous one, so you're not just thrown into the deep end on day one, where you start with the bronze and it's more introductory, basic questions, a shorter application, a good starting point. And then by the time you're ready for silver, you have more data, you have more information, more details, things of that sort, so you're building. And then by the time you're ready to stretch for that gold, then you really can put all of that on display and showcase your organization.  Renee Ridling: Yes, I think that's a good summary. It is just the only way we talk about the journey, and I know sometimes people look at us strangely, but the honest truth is that it really is a journey and really you're moving from step to step. I think that's one of the great things about the AHCA/NCAL Quality Award program is that it is progressive. As a Baldrige recipient at the national program level for Baldrige, you start at the top. You start with that full criteria. You don't get that opportunity to start small and grow. And I think that the way AHCA in has developed this quality award program over the years has been really well thought out and just phenomenal in that it gives organizations an opportunity to move through those progressive levels and gain understanding throughout.  Debbie Stadtler: I always hear people describe it as a journey, and I think that's really the most accurate word there. From the examiner and the judge side. What are some common issues with applicants? What are some sticking points that a lot of folks get caught up in?  Renee Ridling: I think probably the biggest thing that we see at the silver and the gold especially is we know what we do as organizations. If we ask someone a question, how do you do something? They can tell us what they do. They can tell us we do this, but the real question is how do you do it? So the how question is really indicative of process steps. First we do this, then we do this, then we do this, and then we achieve an outcome. So all of those what things, those meetings that we have and that interaction that we have with one-on-one, with that resident or that family, all of those things that we do. Those what things. Go into the how, but the steps have to be there. And the important part about those steps is that they need to be well ordered. They need to have a first, a second, a third, a fourth. They need to be repeatable, they need to be consistent so that you're doing things the same way all the time to produce consistent results. Because that's really what we want, is we want those outcomes to be consistent and we want them to get better. And

    23 min

  4. Mar 16

    New CMS Models and What They Mean to Long Term Care Providers

    In this episode, host Debbie Stadtler speaks with Nisha Hammel, Vice President of Reimbursement Policy and Population Health for AHCA/NCAL, about the rapid shift from fee-for-service to value-based care and what it means for long-term care and assisted living providers. Nisha reflects on her journey from geriatric social work to national policy leadership and explains how CMS has introduced roughly 11 new payment models in the past year. These models place increasing emphasis on prevention, provider accountability, technology-enabled care, and patient engagement, with more than 70 percent of payments now tied to quality and patient experience. The conversation explores several models that could affect providers, including the mandatory TEAM model, the state-based AHEAD and GEO AHEAD initiatives, and the forthcoming 10-year LEAD ACO model. Nisha encourages providers to stay informed, talk with clinical partners about ACO participation, understand their baseline utilization data, strengthen on-site clinical workflows to reduce avoidable transfers, and take advantage of AHCA/NCAL resources such as toolkits and the Population Health Management Summit. Perspectives in Long Term Care is produced by Association Briefings.   Transcript Debbie Stadtler: [00:00:00] The transition from fee-for-service to value-based care is here. Learn the latest on new CMS payment models in this episode of Perspectives in Long Term Care.  Hi, I'm Debbie Stadtler, editor-in-chief of Provider Magazine, the flagship publication of the American Healthcare Association and the National Center for Assisted Living. I'd like to welcome you to this episode of Perspectives in Long Term Care, a monthly podcast produced by AHCA and NCAL. Each month we'll talk with long term care and assisted living professionals about the opportunities and challenges impacting the long term and post-acute care profession. My guest today is Nisha Hammel, vice president of reimbursement policy and population health for AHCA and NCAL. She leads the association's policy and strategic initiatives on value-based care and innovative payment models. She brings 20 years of experience in post-acute care and senior living. Welcome, Nisha. Thanks for being with [00:01:00] us.  Nisha Hammel: Thanks, Debbie. Thank you for having me.  Debbie Stadtler: We'd like to start at the beginning, so tell us a little bit about you and your career journey. What led you to get started in long term care?  Nisha Hammel: My career journey really began next door with my maternal grandparents who were like second parents to me. I grew up in a home and culture that really revered old adults, so my passion for aging was shaped early. You could say, I honestly never stood a chance of choosing anything else.  Even when my peers would ask like, what are you majoring in? I stuck with geriatric social work as my master's program back when only a couple of schools in the entire country offered it as even as an optional major. From there, I started out as a social worker in a skilled nursing facility and moved [00:02:00] through a variety of operational and leadership roles in assisted living, home health, hospice, affordable housing. Really, I think each step taught me something new about caring for older adults with dignity. I really feel very blessed for that incredible journey. Eventually, I joined a state association where I helped lead providers in exploring new ways to work together that included some of our earliest conversations around value-based care and population health, and even how long term care could participate in Medicare Advantage in a meaningful way. It was an experience I still consider a privilege, and it has carried me into essentially the next chapter of my journey, which led me to AHCA, where I now have the opportunity to help advance models and policies that [00:03:00] transform care for older adults and support the truly exceptional providers who care for them every single day. Also, having the opportunity to advocate for some common sense policies to Medicare Advantage. I'd say each position has really felt like something I was called to do, and I am deeply humbled by this path and incredibly grateful that it all started with two grandparents right next door.  Debbie Stadtler: I'm always amazed at how many people have that personal connection, whether it's a grandparent or a family friend or a mother/father that really started them out in this profession. And I think, like you said, so many people feel it's a calling. It's really such a personal connection to this work, and I think that makes it really special. I want us to talk about value-based payments. Set the stage for us. [00:04:00] Where are we now? What has happened recently? What's going on in this area?  Nisha Hammel: Sure. I'd say value-based care has consistently received support from both Democratic and Republican administrations. While each may emphasize different elements, I think the overall commitment to achieving better quality and outcomes for every dollar spent has remained steady. What's happening now is that value-based care has accelerated pretty significantly in the last several years, and especially I think with this administration, it has been very highly active releasing or finalizing numerous models. In the last year, going to this year, there's been about 11 models. Wow. Which, yes, which aligns with broader CMS movement to test, expand, or retire models, all with the [00:05:00] goal of improving outcomes and containing costs. So if we think about some of the pieces that may be slightly different in this administration, along with kind of let's say the cost-cutting, improving quality outcomes, patient experience, there's also been a strong shift towards prevention. Also a greater focus on provider risk and accountability. So there's greater attention to having providers have some skin in the game. So not only upside, but also some downside risk. Technology enabled care is becoming much more central and there is a growing focus on the facts and benefits. Individuals are important partners in care. And so the growing focus on patient engagement, you've seen that become much [00:06:00] more key in recent CMS models.  Sometimes there's a sense of Medicare Advantage and just thinking about Medicare Advantage and then pure fee-for-service. But if we think about what's happening today, you've really got more than 70% of payments that are now linked to patient experience and quality outcomes in some way. And that's, I think, an important statistic that's that we may not often think about. Debbie Stadtler: I think that's a surprising statistic. I would not have guessed that it was that high, but it just clearly shows why the value-based care and the population health area is so important for providers right now. What do long term care and assisted living providers need to know? You mentioned 11 new models that have just come out within [00:07:00] the past year. Do all the models apply to them? What do they need to know at this point in time?  Nisha Hammel: That's a great question. In the effort of CMS to redesign and look at things differently, there are certain models that apply more directly and there are models that are a little bit more adjacent, but helpful for long term care providers to track because. The models, and I'd say the developments are important to monitor and understand because they could affect referral patterns. For example, care coordination expectations, and financial relationships.  Debbie Stadtler: Tell us more about the models that apply to long term care providers. I know there are several.  Nisha Hammel: So let's just start with the first model, which is TEAMs. And TEAMs is a mandatory model. So the other thing you'll notice with this administration, they've launched a [00:08:00] few more mandatory models. So TEAMs is a mandatory episodic payment model that really holds hospitals in certain core based statistical areas accountable for the cost of care for an episode that essentially begins with the anchor hospitalization of the procedure. And follows about 30 days post discharge for five. CMS considers high volume, high cost surgical conditions, and long term care providers and assisted living providers can often play a major role in patient recovery. And if you think about hospitals need strong post-acute care partners to help reduce readmission and ensure coordinated transition. This makes facilities part of the ecosystem of this model. Like I said, important to note though the good news is that AHCA has a [00:09:00] toolkit and resources and data available for providers to understand. Does it impact me, first of all, am I one of those facilities there are in those CBSA, right? And then be able to look at data through Trend Tracker that enables them to understand scope, impact and be able to make more informed choices about the path that they may want to go down.  Debbie Stadtler: That's a good introduction to TEAMs. What's the next model we need to know more about?   Nisha Hammel: The second model that I'd like to call out is the AHEAD model, which is the achieving healthcare efficiency through accountable design. And the uniqueness about this model is that it is a state level model. It was introduced under Biden administration and finalized by the Trump administration, and it is a voluntary state total cost of [00:10:00] care model, which started with Maryland. Starting this year in 2026 and is extended all the way to 2035, and you've got three different cohorts and participating states. You've got Maryland, Connecticut, Hawaii, and Vermont as cohort two, and then Rhode Island and Downstate New York, certain downstate, New York counties, I should say in cohort three. And some of the kind of key features of these is that states can receive up to $12 million to build infrastructure to help design the program. It includes h

    27 min

  5. Feb 13

    Elevating the Customer Experience in Long Term Care

    In this episode, host Debbie Stadtler welcomes Heather TerHark, Chief Strategy Officer at Viva Senior Living, and Samantha Lawrence, Regional Vice President of Operations at Brightview Senior Living, for a conversation on redefining customer experience in long-term care. Together, they explore how organizations can move beyond traditional customer service to deliver more personalized, relationship-driven care. The discussion highlights the growing expectations of today’s residents, the impact of technology and AI on safety and engagement, and the critical role of staff training, empathy and culture in shaping meaningful experiences. The episode also invites listeners to get involved by joining the Customer Experience Committee to help advance resources and innovation across the industry.   Perspectives in Long Term Care is produced by Association Briefings.   Transcript Debbie Stadtler: [00:00:00] Is your facility making the best impression possible on everyone who walks through the front door? Learn easy ways to boost your customer experience in this episode of Perspectives in Long Term Care.  Hi, I'm Debbie Stadtler, editor-in-chief of Provider Magazine, the flagship publication of the American Health care Association and the National Center for Assisted Living. I'd like to welcome you to this episode of Perspectives in Long Term Care, a monthly podcast produced by AHCA and NCAL. Each month we'll talk with long-term care and assisted living professionals about the opportunities and challenges impacting the long-term and post-acute care profession. My guests today are Heather TerHark and Samantha Lawrence. Heather is the chief strategy officer at Viva Senior Living and brings more than 27 years of experience to the table. Samantha is regional vice president of operations at Brightview Senior Living in New Jersey and has served seniors in various capacities for 26 [00:01:00] years. Heather and Samantha are the co-chairs of AHCA's Customer Experience Committee. Welcome, Heather. Samantha. Thanks for being with us.  Heather TerHark: Thank you for having us, Debbie. We're so excited to be here.  Debbie Stadtler: We like to start at the beginning. So tell us a little bit about your personal journey, your career journey. How did you end up where you are now? What led you to get started in long-term care? Samantha, start with your journey. Tell us a little bit about it.  Samantha Lawrence: So I was fortunate to know three great-grandparents and all of my grandparents and wow, when I was about 10 years old, my one great-grandfather had developed Alzheimer's. And at that time, communities like Heather and I had the opportunity to be engaged with didn't quite exist, so it was in a rural nursing home. I went to visit my great-grandfather and a woman that was a patient/resident there grabbed my arm and said, honey, will you get me a laxative? I did not know what that was at the ripe old age of 10. But I knew she [00:02:00] needed something. So I went to the desk and I said, excuse me, this woman over there in blue, she needs a laxative and that nurse turned my career path. Because she said, “Honey, she says that all the time. Just ignore her.” I didn't know what the right answer was, but I knew that didn't sound like the right answer. So I just went back and started talking to her and then you could not peel me out of there. I'm like, “Mom, this woman can't reach her cup. This woman is shaking and her food's falling off of her fork and we have to go.” Like I said, these people need help. So volunteering closer to my home, playing the violin at dinner for a local nursing home, and they needed a part-time receptionist when I turned 16. I did a paper application. I called my mom on a payphone. I said I was really nervous about my big interview, and she said, “You are the only 16-year-old that is stoked about working in a nursing home. I think you'll get the job.” And so then I never looked back. I grew my career in different frontline roles in reception activities, moved into management roles, got my administrator's license [00:03:00] in assisted living. Went into a subject matter expert role in dementia programming, but realized my heart was in operations, and been with Brightview now for the past 11 years, about six of those in a regional capacity, and was an executive director in Paramus, New Jersey, for them. Opening that community actually prior to this role.  Debbie Stadtler: It's amazing how many people that I speak with that the beginning of their journey has some sort of family connection to how they start in this industry. So it's really interesting. Heather, tell us a little bit about your journey.  Heather TerHark: Sure I wasn't quite as soon as Sam at the age of 10, but a woman in college. We all think we're going into college and we have this career path all mapped at, and I was working at a hospital as just more of that part-time job that you do in college and I got the opportunity to work with physicians, walking seniors on the track, some of them doing [00:04:00] stress testing. I got to teach water aerobics to seniors, and that was the start in college of my entire career because I knew right then and there, those were the people and I learned so much from a medical component being in the hospital going through surveys. So I got started right off at the age of 18. And I've been so blessed in my career to work post-acute rehab, skilled nursing, the entire senior living continuum, and also home health, hospice and pharmacy through just a few companies throughout my career, and my mother and my grandmother also passed away with Alzheimer's dementia. So memory care communities have a very, very special place in my heart, and I'm so excited both Sam and I have the opportunity to have either memory care communities or memory care neighborhoods [00:05:00] and know that we do things to enhance the lives of those that live. And so it's a personal journey. I tell people I don't know what it's like to work outside of the health care field because I've never done anything that wasn't part of the world that we all live in today. Debbie Stadtler: It's amazing that passion and that connection with people with seniors is really just so evident in everyone who works in the industry. So I love how your journey really highlights that as well, Heather. I want to jump into our topic today, which is customer experience, which is a little bit different. I think a lot of people are used to hearing the term customer service, which I think is a little piece of it. But start us off and get us all on the same page. What is customer experience and what is that encompass so that we know what that term really refers to? Heather, start us off.  Heather TerHark: Sure. So customer experience is everyone that comes into contact [00:06:00] with your community. It doesn't matter who it is, it could be a potential resident, a family member, a potential employee, but it also could be a fireman that comes in when there's 9-1-1 call. It could be the postman, the UPS that drops off. That is the experience because they're all our customers, because whether they're looking to work or to live in our community, they're part of that ecosystem that makes up that community and they form an impression and they have a feeling about that community of how the vibrancy or in the involvement or the heartbeat of that community. So truly that customer experience talks about anyone that interacts or has any kind of touchpoint with what we do.  Debbie Stadtler: I think it's such a broad amount of people. I understand what you're saying, that it's really anyone who comes [00:07:00] into contact and has an experience with your organization, your facility, but that's a lot of different groups, potential residents, families, current residents. Those are all different groups with different needs. How do you serve each of those groups? How do you make sure this experience is consistent or excellent across all of these folks? Samantha, tell us more.  Samantha Lawrence: So the joy and the challenge of serving so many different customers, that the experience is unique to every single person. Everybody comes to us with different emotions about being in that community or that facility. You've got prospective residents and families that are very apprehensive. This could symbolize to them a loss of independence. It could symbolize a big change. They live in the same home for 60 years. For that, maybe somebody that's a vendor or if the fireman, maybe this is their first day on the job, maybe they've never been to a community like ours before. There's a combination of personalized and generic things that we all [00:08:00] need to do to make sure that we're giving a great customer experience when individuals come through our doors. When it comes to residents in particular and that kind of thought of. It's scary to transition into communal living after so many years just pretty much doing your own thing, really getting to know them as individuals from the prospect to moving in. We try to ask so many questions to get at the heart of their current situation, if they're a prospect or once they move into our doors. What is it that brought them joy, brought them purpose in the real world, quote unquote, because this is their real world as well. It's just going to feel maybe a little bit different, but how can we as an organization, focus on the possibilities, independence and choices that they still have, and really focus on those possibilities rather than the limitations they may be feeling? So it's really knowing them all as individuals as much as we can, and infusing resident centered hospitality along the way as much as we can throughout that experience. Heather TerHark: Debbie, if I could add to [00:09:00] Sam's comment that when she talks about the hospitality, it's the really small details. How were they greeted the mi

    30 min

  6. Jan 12

    Building Trust Where It Matters Most

    In this episode, host Debbie Stadtler sits down with David Gifford, MD, MPH, chief medical officer of the American Health Care Association, for a thoughtful conversation on building trust in long-term care. Dr. Gifford shares his career journey and explores why trust is foundational to effective healthcare systems. Together, they discuss the role of empathy, authenticity, and clear communication in strengthening relationships among care teams, residents, and families. Dr. Gifford also addresses the challenges technology can introduce and offers practical strategies for cultivating trusted colleagues and leading with intention. The episode includes actionable guidance for fostering stronger trust and communication in long-term care settings. Perspectives in Long Term Care is produced by Association Briefings.

    30 min

  7. 12/10/2025

    Looking Forward in Long Term Care

    In this episode, host Debbie Stadtler sits down with Clif Porter II, CEO of the American Health Care Association and National Center for Assisted Living, to reflect on his first year in this dual leadership role. Porter shares key accomplishments from the past year—including meaningful progress on Medicaid reform and staffing mandates—while emphasizing the importance of staying connected to the “why” behind their mission and recognizing the diversity and purpose-driven nature of long-term care careers. Looking ahead to 2026, Porter discusses top priorities such as strengthening regulatory environments, addressing challenges with Medicare Advantage plans, and supporting a resilient workforce. He also underscores the critical role members play in shaping policy, calling for deeper engagement with Congress and continued advocacy for the sector.   Perspectives in Long Term Care is produced by Association Briefings.

    23 min

  8. 11/12/2025

    People Management in Long Term Care

    In this episode, host Debbie Stadtler talks with Mark Gogal, vice president of workforce development at the North Carolina Health Care Facilities Association. Their conversation focuses on the essential people management skills every leader needs—self-awareness, empathy, and active listening—and how these qualities shape effective servant leadership. They also explore strategies for recruitment and retention, the value of a welcoming workplace culture, and the ways technology and AI are transforming the long-term care landscape. Mark emphasizes the ongoing responsibility of leaders to grow, adapt, and create environments that support both their teams and the residents they serve. Perspectives in Long Term Care is produced by Association Briefings.

    31 min
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2.3
out of 5
3 Ratings

About

An original podcast series produced by the American Health Care Association and the National Center for Assisted Living, created specifically for leaders in the long term and post-acute care profession.

Information

  • Creator
    American Health Care Association
  • Years Active
    2023 - 2026
  • Episodes
    37
  • Rating
    Clean
  • Copyright
    © Copyright 2023. American Health Care Association. All rights reserved.
  • Show Website
    Perspectives in Long Term Care

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