Perspectives in Long Term Care

American Health Care Association
  • 3.0 (4)
  • Health & Fitness
  • Monthly

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. Oct 21

    Building a Culture of Compassion, Service and Excellence

    In this episode of Perspectives in Long Term Care, host Debbie Stadtler welcomes Hilanie Hauk, executive director of Oasis at 30th in Indianapolis, for an inspiring conversation about resilience, leadership and the power of serving others. Hilanie shares her remarkable journey from growing up with limited resources in the Philippines to building a career in long-term care, beginning as a certified nursing assistant and eventually becoming an executive director. She reflects on how determination, education and the encouragement of mentors helped her overcome obstacles and embrace new opportunities. The conversation explores her people-first approach to leadership, the importance of balancing compassion with accountability, and why creating a true sense of community requires more than meeting operational and regulatory standards. Hilanie also discusses the responsibility leaders have to recognize potential in others, invest in their professional growth and lead by example. Throughout her story, she emphasizes that where someone begins does not have to determine where they finish, and that meaningful success comes from helping others rise along the way.   Perspectives in Long Term Care is produced by Association Briefings.   Transcript Debbie Stadtler: Rising from humble beginnings and working her way up from CNA to executive director, Hilanie Hawk has lived her values of service and resilience in her career. Hear more about Hilanie's story in this episode of Perspectives in Long Term Care. Hi, I'm Debbie Statler, 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 guest today is Hilanie Hauk. Hilanie serves as executive director of Oasis at 30th in Indianapolis. Rising from a bamboo hut in the Philippines to executive director of a facility, she has focused her career on serving others with compassion. Welcome, Hilanie.  Hilanie Hauk: Thank you, Debbie. It is my pleasure to be here. Debbie Stadtler: Well, I know you have a very unique background, and I really want to dive more into that. So tell us your story. How did you get to where you are today? Tell us about your background.  Hilanie Hauk: Yes. So my story really begins in southern Philippines. My father, who was a soldier, he passed away before I was born. And when I was only a few weeks old, a tsunami destroyed our family home. So I grew up with very limited resources because I was, like, raised by a single mother, and from an early age, I learned responsibility, resilience, and how to make the most of what I had. So with that being said, growing up, I can say that education became very important to me because I saw it as opportunity to change not only my life, but eventually the lives of others. So I earned my degree in education in the Philippines. Later on, I came to United States, entered health care as a CNA, became a nurse, then assistant director of nursing, then director of nursing, and eventually an executive director. And keep in mind, none of this happened overnight, of course. It was one opportunity, one lesson, one person believing in me at that time. Looking back, I think every difficult experience prepared me for the responsibility I have today.  Debbie Stadtler: With those circumstances growing up, I'm sure that you learned a lot. You mentioned resilience, relying upon education. How did those circumstances growing up shape your views on things? How does resourcefulness show itself in your life now? What's your view on hard work?  Hilanie Hauk: So growing up, we didn't have a lot of choices or resources, so I learned to use what I had. So with that being said, I learned very quickly that if you wanted something different for your life, you had to work for it. So there was time when continuing my education was difficult. I worked while going to school. With that being said, I have three brothers, so I had to care for my younger brothers and had to find ways around obstacles instead of allowing those obstacles to stop me. So it doesn't matter how hard life is, if you have that determination, it will push you through because you know that you have a goal, that you need to get through it And that is probably why education means so much to me today, because education gave me something circumstances cannot easily take away from you. And being resourceful taught me something equally important, that you don't always need perfect circumstances to move forward. Sometimes simply have to ask, "What can I do with what I have right now?" That mindset has stayed with me throughout my entire career.  Debbie Stadtler: I think those are some incredible lessons. I think the one you mentioned about you don't have to have perfect circumstances to move forward, that's so true, and something we all would do well to remember from time to time. Hilanie Hauk: Yes.  Debbie Stadtler: Your path in health care, you said you started as a CNA, you moved up to nurse, director of nursing, executive director. Was that pathway always your goal, or how did you know what the next step was at each level of your career?  Hilanie Hauk: Absolutely not. Being poor, you really didn't know what is the next day, right? So when I became a CNA, I wasn't thinking that someday I'm going to be an executive director, right?  So I was thinking about doing the job in front of me well. So do the job with your heart. This is what is important to me. It's not just, oh, I want that title because this makes my life better. It's just the nature takes its course, right? So as I became a nurse, I started seeing things differently. So I wanted to understand why decisions were being made, and how I could make things better for residents and staff So then as I moved into nursing leadership, I realized that I enjoyed developing people, solving problems, and improving systems. So with that, each step showed me that next one. So then eventually becoming an executive director made sense because I wanted to influence the entire community, not just one person. It's now the whole community that you are the operator, right? Okay, how can I make this better? So it's not just the clinical side. I wanted to understand the operation aspect with it, the finance, of course, staffing issue, because you need to make sure that you have enough staff to care for these people that need you. As a leader, you can't just say, "Okay, I have to follow my budget," but, "Oh, hold on a minute. Somebody's not really taken care of properly because we're short-staffed."  And the quality care is important to me because I was raised with my grandparents. So I want to make sure that these fragile individuals who are being cared by me and my staff are being taken care of properly. And it's not just the regulation. Yeah, I have to follow that because as a administrator, you'll get tags if you don't follow that. So the resident's experience and everything that comes together to create a successful community. I just don't want a building. I want a community that when somebody works and walks into my building and says, "Oh, it's a good place. I want my loved ones here." Yeah. "I want my mom, dad, my aunt," anybody that walks in, I want them to feel that they're welcome and it's their home.  That is also why I pursued my master degree in health care administration. So my career wasn't built from perfect plan. It was built by continuing to learn and being willing to accept the next challenge. Debbie Stadtler: I love that. And I love that you mentioned that you grew up with your grandparents. I find in talking to a lot of folks in long-term care that there's often a personal connection to this work for them that really makes it so valuable and such a passion for them. So I can clearly see that your passion for this industry just shows itself in your work every day. Hilanie Hauk: Yes. Health care to me, Debbie, is not money. It's more of caring the person who were there for us, and it can be anybody, because at the end of the day, they are your family.  Debbie Stadtler: I've heard you talk about your story, and at a couple of points in your story, you've mentioned mentors. Yeah. I know there were a couple of mentors that really inspired you, pushed you to that next level. So tell us about the role that those mentors have played in your life.  Hilanie Hauk: Of course. So to me, mentors have been extremely important in my life because sometimes another person can see something in you before you see it in yourself. It's like looking outside the box, right? So one of those opportunities came from someone who had previously been my assistant director of nursing, then she later became a director of nursing at another company. So she asked me if I wanted to be her assistant now because she's a director of nursing. So I said, "Okay." So when she took that position, she asked me to follow her and become her assistant director of nursing, and that was an important step in my career because she had already worked with me. She knew my abilities, and she believed that I was ready to take on in a leadership role because she knows that I am determined. So with the same company, we have my administrator, which is, her name's Kay, and Kay had enormous influence on me. She is also a nurse. She had decades of experience as an administrator, and she saw leadership potential in me. So she kept following me. And I said, "What do you want from me?"  She said, "Can I have a minute?" I said, "Yeah," because I was doing my rounds. And she said, "I need to sit down with you." She said, then she said, "I see leadership potential in

  2. Sep 9

    Wellness First: Building a Value-Based Care Model

    In this episode, host Debbie Stadtler welcomes Irene Borgen, PhD, MBA, MSN, MJ, FACHE, RN, vice president of innovation and clinical partnerships at Sunrise Senior Living, for a conversation about why value-based care represents an important inflection point for assisted living. Irene explains how the shift from fee-for-service to outcomes-focused care aligns with Sunrise’s wellness-first approach and the evolving expectations of residents and families. She shares how Sunrise established baseline measures around hospitalizations, emergency room visits, readmissions, falls, polypharmacy and satisfaction before developing a relationship-based model that brings clinical partners into communities while preserving residents’ choice of primary care provider. The conversation explores the realities of implementing this model, from change management and team training to consistent measurement and selecting the right partners. Irene also discusses how value-based care can benefit residents and families while strengthening care teams, referral relationships and business outcomes such as occupancy and retention.   Perspectives in Long Term Care is produced by Association Briefings.   Transcript Debbie Stadtler: Superior clinical outcomes for residents, increased family trust, and better metrics for your facility? That's the promise of value-based care in assisted living. Learn how to get started with Irene Borgen 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 guest today is Irene Borgan. Irene serves as vice president of innovation and clinical partnerships at Sunrise Senior Living. She is a registered nurse, a licensed nursing home administrator, a board-certified nurse executive, a certified professional in health care quality, and a fellow of the American College of Health Care Executives. Welcome, Irene. Thanks for being with us.  Irene Borgen: Thank you, Debbie. Thank you so much for having me.  Debbie Stadtler: Well, let's start at the beginning. Tell us about your career journey. What led you to get started in long-term care?  Irene Borgen: I joined Sunrise just over three years ago after spending more than two decades in the broader health care industry. I started my career as a clinician and gradually moved into hospital administration and executive leadership with an increased focus on operations, quality and safety, care transformation, population health, and most recently, value-based care. Over the years, I've worked across hospital, home care, skilled nursing, ambulatory, and health insurance settings, and have been very fortunate to bring that experience with me to Sunrise. Today, I have the opportunity to help advance Sunrise's strategy around innovation and clinical partnerships, and to think about how we can apply value-based care principles within senior living while continuing to strengthen our person-centric holistic approach to wellness.  Debbie Stadtler: So Irene, tell me about your organization. When did value-based care first come onto your organization's radar, and what made you realize this was something that assisted living could not afford to ignore?  Irene Borgen: Let me start with a bit about us and how this fits in a much bigger ship. Sunrise is one of the largest senior living operators in the US with some communities in Canada. We have around 240 communities currently. We offer independent living, assisted living, some skilled nursing, and are serving around 20,000 residents. Wow. And we've always been an organization focused on hospitality and wellness. That's in our DNA, and it's the promise we make to residents and families. But I would frame the value-based care itself as bigger than one company's decision. It's an industry-wide inflection point. Since the introduction of the Accountable Care Act in 2010, also known as Obamacare, the US health system has been shifting from paying for volume, also called fee-for-service To paying for quality and improved health care outcomes. And that shift continues to reshape every care setting, including senior living. In other words, value-based care movement aims to help people stay healthier longer, prevent unnecessary hospitalizations, improve overall health care outcomes, and contain escalating health care costs. And senior living is really uniquely positioned in that shift. Our teams don't just provide services, they truly know our residents. They notice when someone isn't quite themself, whether it's a change in appetite, energy level, participation in activities, just overall well-being. We know it long before those changes would be visible in a traditional health care setting. Those everyday observations, combined with close partnerships between our care teams, families, our clinical providers, create really unique opportunities to intervene earlier and support better health care outcomes. In many ways, senior living has always played an important role in helping older adults stay healthier and avoid unnecessary hospitalizations, whether we have formally described it this way or not. And families and residents have already been pointing the industry in this direction through decisions they make when they choose a community. They're actually telling us how much access to health care and wellness matters. Increasingly, we see that they're looking for communities that can help their loved ones maintain their health, independence, quality of life, not just to provide a place to live. So value-based care wasn't something we had to be talked into. Our mission, the evidence, and our residents and families really all pointed in the same direction. It felt less like a trend and more like the natural next chapter in how senior living can support residents.  Debbie Stadtler: I think that's a great point, that this was something that generally you were already doing, and this just formalized it and really gave it a name and a direction, but you were already providing that better life for longer, better health for longer kind of thing. As you began exploring value-based care, what convinced you and your leadership team that this was something your organization needed to embrace? How did you know your organization was ready to take the first step?  Irene Borgen: Honestly, in addition to the feedback from residents and families, the peer-reviewed published evidence did a lot of the convincing. There's a really large and growing body of recent peer-reviewed research linking primary care to longevity. Most recently, in 2025, a study was published by Harvard Medical School and the Harvard School of Public Health that included nearly 11,000 of older adults aged 65 to 84, and they found that access to primary care was associated with roughly two additional years of life expectancy. That reframes primary care from a nice-to-have into a genuine longevity lever When the evidence shows access to primary care adds years of life, then the conversation stop being, should we? It becomes, how fast can we? The other thing that made us ready was recognizing that this wasn't a pivot for us. It was a natural extension of what we were already doing, an organization where we have our wellness-first mission, culture, and the infrastructures to support it. So bringing value-based care, focused primary care on top of that just felt natural. It fit really well with Sunrise's vision of creating the preferred lifestyle for enjoying longer, healthier, happier lives. And the last piece of readiness is a mindset shift that's available to any operator. You don't need to become a medical group to do any of this. What you need is the willingness to bring in the right clinical partners, collaborate with them closely, and collectively drive better health care outcomes, and ultimately, greater longevity for our residents.  Debbie Stadtler: I love that. You don't have to have a fancy system or change everything. It's really collaboration and working closely for the best outcomes. That's great.  Once you decided to move forward, where did you start? Walk us through the early days. What were the first priorities? What capabilities did you have to build? And also, what were some of the challenges you encountered along the way?  Irene Borgen: Great question. I think, like always, we started with data because you truly can't manage or prove progress on something you haven't measured. Before you change anything, you establish your baseline. Things like what we looked at was emergency room visits, hospitalizations, 30-day readmissions to the hospital, falls, polypharmacy, multiple medications on res- with residents, the distribution of primary care providers across our communities, and finally, resident and family satisfaction with primary care. That baseline became what we hold ourself accountable to, and later, it really becomes your proof. From there, it's the care model. At the concept level, it's consistent relationship-based clinical support embedded in the community, focused on prevention and proactive chronic disease management rather than reactive care. It's predictable, timely access and coverage, so concerns can be identified earlier, can be better coordinated, and resident can continue to thrive in place, at home. One part that I do want to make concrete because families feel it so directly, residents always have a choice of who their primary care provider is. And even if they choose to stay with their existing provider with whom they have a long-standing relatio

  3. Aug 13

    Keeping Pace with a Changing Reimbursement Landscape

    In this episode, host Debbie Stadtler welcomes John Kane, senior vice president of reimbursement policy at AHCA/NCAL, to discuss how reimbursement policy directly impacts the resources providers have to deliver quality care and the challenge of keeping pace with an ever-changing policy landscape. Kane explores the development of the Patient-Driven Payment Model (PDPM), its shift from volume-based reimbursement to a model centered on patient characteristics, and the challenges states face when adapting PDPM for Medicaid populations. He also examines major Medicaid changes under H.R. 1, ongoing Medicare Advantage challenges related to access and payment, and the growing regulatory demands facing facilities. The conversation highlights why staying informed and engaged is increasingly important as reimbursement continues to evolve toward value-based care.   Perspectives in Long Term Care is produced by Association Briefings.   Transcript Debbie Stadtler: 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 guest today is John Kane. John is the senior vice president of reimbursement policy at AHCA and NCAL. Prior to this, he spent almost 15 years at the Centers for Medicare and Medicaid Services. Welcome, John. Thanks for being with us.  John Kane: Thank you very much, Debbie. It's a pleasure to be here.  Debbie Stadtler: We like to start at the beginning. So tell us how you got involved in long term care. How did your career lead you to where you are today?  John Kane: A combination of things probably. I think one part of the journey started back years ago when I was studying philosophy of all things... and had every intention of becoming a college professor: teaching, publishing, sipping wine. And but I found that as I was talking with my colleagues, and I would be asking questions that they didn't seem to really care much about. We would be talking about health policy, and I would ask questions like, "Well, how are we gonna pay for that?" Or "How are providers going to implement this?" And they didn't really seem to care, and I realized at that point I wanted to do something that was more applied and less theoretical. And at the same time, as a matter of coincidence, I was actually working at a facility in Blacksburg, Virginia, Five Stars Warm Hearth, shout out. Nothing glamorous but very important role. I worked in the kitchen. And I'll tell you that trying to make a soft liquid diet palatable takes a lot of skill. But my experience there also helped me to see the daily struggle of the people that were working in that industry and the amount of passion that they brought to it and really just dedicating their lives to valuing the lives of seniors. And I loved being a part of it, even a small part. And as I was there, I felt like there was more that I could do, and I wanted to get deeper into it. And so that eventually led me into the deeper areas of health policy and eventually led me to CMS. Debbie Stadtler: I love that story. A little hands-on kitchen experience really leads you to your greater purpose in health policy and helping those in long term care. I love that story.  John Kane: I like to think that I've done more not burning people's food than-  Debbie Stadtler: Always important. Your background includes years spent working at the Centers for Medicare and Medicaid Services, what we know as CMS. What's that like working on the government side of reimbursement, and how did that time kind of influence your views?  John Kane: My time at CMS was some of the most formative and memorable time of my life, especially my career. I can't speak highly enough about the people that I worked with at CMS and that continue to work within CMS. They are dedicated public servants, all of them, and it was also just an incredible feeling to be at the genesis of policy development. It was hard to not feel as though you were doing something that was impactful and you were making a difference every day. At the same time, I also felt a certain disconnection from the industry that I had grown to love. I would go to visit facilities, whether it was because my dad was in a facility or just to get back out in the field and go and visit with residents or visit into the various homes, and it felt different. I was no longer just a person walking through the halls. I was CMS now. And so conversations became more focused on policy than on people, and I missed it. And moreover, I think being at CMS, you develop a level of specialization that is nurtured by the, the siloed nature of the agency. While I was there, like you said, I was there for about 15 years, and while I was there, I primarily worked on Medicare Part A SNF payment, and every word of that is relevant because if it wasn't SNF, if it wasn't Part A, if it wasn't payment related, that belonged to someone else. Okay. And good policy just isn't made in a silo. It's made usually at the intersections of those different silos, where quality and payment and innovation come all together. And that's actually something that when I've spoken with my former colleagues at CMS, I've actually tried to emphasize is to begin meeting more at those intersections and to really be thinking about the downstream effects of policies within one silo on, on other areas. And so it's something again that I've really enjoyed of my time here, being able to think about that in retrospect.  Debbie Stadtler: That's an interesting point, though. From the government perspective, you really are at a very impactful position to influence the policy. At the same time, there are, layers of bureaucracy and silos because it is the government, and that kind of works against you a little bit. So it's like a push and pull situation. One of your major accomplishments at CMS was developing the patient-driven payment model, like you said, for the skilled nursing Medicare Part A, all the words are important, benefit. How hard was it to develop this whole new reimbursement model, and what did you learn along the way? John Kane: Yes, I think I'll start by saying, I am incredibly proud of the work that we did in developing PDPM at CMS, and I was honored to be trusted with leading that effort. The shift under PDPM, away from volume-driven metrics ... and focusing more on patient characteristics and the specific needs of patients that often drove cost. Couple that with the massive reduction in administrative burden, the realignment with quality, and really just getting the payment model out of the way, if you will, of providers being able to decide how best to care for their residents, rather than any sort of weird artifacts of the payment model. It was incredibly difficult, but it was also very, very rewarding. I think one of the most rewarding aspects of developing that payment model, though, was the interaction and engagement we had with groups like AHCA and other advocacy groups. It wasn't just us at CMS in a back room crafting policy. It was a dialogue. It was sometimes a tough dialogue with AHCA and other industry advocates, and so much that when I remember back when CMS actually proposed PDPM, most of the comments that I remember reading at that point from the most respected, outspoken members of the community were just basically saying, "Okay, yes, that's the model we discussed. Looks good."  And it was the best example of collaborative policy development that I'd ever experienced, and I think that the success of PDPM, particularly with how it worked during the COVID pandemic of all things, is a real testament to the value of that collaboration. It's not to say that everything's perfect with the model. There's definitely room for the model to grow and change but I think it's working well overall, and I think that it reflects the importance of focusing on patient characteristics versus focusing on the volume of services that those patients are provided.  Debbie Stadtler: That's a really good point, because you're crafting policy and this model that's going to affect the whole industry. And so by really harnessing that collaboration of industry groups and the government and providers, all of that together really formulated the successful model. So that's, kudos to you. I can only imagine that process, but a great result from it.  John Kane: Thank you.  Debbie Stadtler: Now PDPM is being adopted by many states for Medicaid. How's that going, and where are some of the challenges?  John Kane: Talk about operating from within a silo and ... the potential downstream effects of that type of approach. Again I feel a great amount of pride for how we constructed and implemented PDPM, but I have to admit a complete and utter blindness to the impact that this was going to have on states. And I think this really goes back to the structural siloing of CMS and its impact on policy development. To put a really fine point on it, I didn't really have a lot of conversations with the Medicaid side of CMS until PDPM was about to be implemented. The states, I mean, that was someone else's job. Because it wasn't, it was mine, and it was the responsibility of those of us who were developing this policy. And we were warned. AHCA, other groups did warn us about the potential impact of this change on reimbursement on state programs.  And in that, I think lies the truth about our sector that I think makes us unique among our partners in the post-acute community. Our providers don't serve a single population, and I think that's what you usually find throughout health care. There ar

  4. Jul 14

    Reflecting on the Past, Preparing for the Future

    In this episode, host Debbie Stadtler welcomes James Carlson, senior reimbursement advisor at AHCA/NCAL, and Nicolette Reilly, senior vice president of quality at the Oregon Health Care Association, for a conversation about the evolution of assisted living over the past four decades. They reflect on the origins of the assisted living model, how the definition of quality has expanded to focus on resident experience and continuous improvement, and the balance between regulation and innovation. The discussion also explores the role of NCAL in advancing the profession and looks ahead to the future of assisted living, including emerging technologies, workforce development, personalized care, and changing consumer expectations.   Perspectives in Long Term Care is produced by Association Briefings.   Transcript Debbie Stadtler: Since its inception in the 1980s, assisted living has used innovation to redesign aging. Hear more about the evolution of assisted living, how quality has matured, and why the next 25 years may be the best yet. 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 Jim Carlson and Nicolette Reilly. Jim is a senior reimbursement advisor at AHCA/NCAL, and he spent 30 years with the Oregon Health care Association, including 23 years as the CEO. Nicolette is the senior vice president of quality at the Oregon Health care Association. Welcome, Jim and Nicolette. Thanks for being with us.  Jim Carlson: Good afternoon.  Debbie Stadtler: Well, let's start at the beginning. Tell us about your career journey. What led you to get started in assisted living and long term care? Jim, do you want to kick us off there?  Jim Carlson: Sure. I'd say probably my first interest really in health policy and all the issues related to Medicaid and Medicare and the economics and aging demographics was, I worked for an economics professor of mine in college when he ran for Congress. And we spent hours upon hours driving around the Fourth Congressional District in Oregon, and he had a particular interest in health care and health care economics. And since he was running for Congress, he had a particular interest in federal level issues, dealing with Medicaid and Medicare and health care economics. And so it piqued my interest. He ended up losing that race, but I ended up, after graduation, going to work for another member of Congress, and being low man on the totem pole on the staff, Medicaid and Medicare came into my portfolio. And so I really, from just a very young age, got very interested in federal health care finance and reimbursement programs and the economics, and I always had a real keen interest about demographics and the impact that had on the economy and society. Debbie Stadtler: Nicolette, how did you get started?  Nicolette Reilly: My path was very different from Jim's. When I graduated with my undergraduate degree, I had a business minor, and right out of college, I started working as a finance and business office manager for a new assisted living in Fort Collins, Colorado. And as a very young, new into the profession, I never envisioned that my career would be in long term care. It just happened to be this door that opened up to me from a business perspective. So in 1995, I started out as a business office manager in an assisted living, and just over the years went from a business office manager to an assistant administrator to an administrator, and then to a regional ops person, and then a vice president of operations. Even did a stint as an owner/operator of an assisted living company a while back. And then about four or five years ago, really wanted to find a way to take my passion of working with seniors and take my passion around driving quality in long term care, and try and find different ways that I could engage and influence the quality that was happening in long term care and how to drive that. And so I had a great opportunity to come over to the Oregon Health Care Association, where now I've been able to see long term care from a completely different perspective, more from the legislative perspective and the regulatory perspective and what goes into that, and the wonderful opportunity to advocate on behalf of providers in both of those areas. Debbie Stadtler: That's interesting. So both of you come at assisted living from a different perspective than normal. Usually I hear about people have a family member that inspired them, or they start as a caregiver, a CNA, and things like that. But you guys really come from, like, the business economics perspectives, and yet you've developed a similar passion and desire to serve in this industry. So it's really interesting the variety of ways people start these careers. Knowing that assisted living started in Oregon, I want to focus on assisted living. You both are from Oregon. What was the profession like when you started, and how has it changed to where we are now? Jim, do you want to start us off? Jim Carlson: Sure. So I joined Oregon Health Care Association in 1994, and came over to run their government relations program, and for the previous seven years, I'd been working on acute care and representing the Oregon Medical Association and doing a variety of health policy issues there. But I closely followed what was going on in long term care, really starting in the, the mid-'80s when I was working for a member of Congress from Oregon. And Oregon was the first state in the country to get a home- and community-based care Medicaid waiver from the federal government, and that happened in 1980. And after the state got that waiver, really it kind of took them until the mid to late '80s till they really started making a lot of serious programmatic changes. But one of those policy initiatives, if you will, was to kind of nurture this new growing model of care that a couple of the early pioneers who were based in Oregon had developed, called assisted living. And so you had people like Wendell White, who'd come from a long family history and background growing up in his mother's nursing home, and developed one of the very first assisted living facilities anywhere in the country. And then he and Karen Brown Wilson, who was another early pioneer... There's a lot of disagreement, or you could get a little argument on who, who had the first assisted living facility. Most of that conversation focuses around Karen and Wendell and some other folks who were early pioneers. Oregon had a Medicaid director at the time, a fellow by the name of Dick Ladd, and he wanted to kind of nurture this little care setting. And so using that waiver that Oregon had received from the federal government, he worked with some of these early developers of what we now call assisted living to come up with a Medicaid payment stream to essentially reimburse them for services in this model. And that led to what was the country's first licensed assisted living setting anywhere in the country. And so really from all that early pioneering work that was done in the '80s, you really saw it take off in the '90s. And as I was coming and transitioning away from an acute care focus into long term care and joined the Oregon Health Care Association in '94, assisted living was becoming a big focus, and the association and our leadership recognized that at the time and really made a heavy investment into trying to support and help guide that development and that growth of assisted living. Debbie Stadtler: Oregon has been a pioneer, and the growth of assisted living has really been impressive, even now, still on a big growth trend as well. Nicolette, how was it when you started, and what changes have you noticed over time?  Nicolette Reilly: I think I come... I look at this from a very different perspective. Jim is the all-knowing legislative, how these things started from a legislative perspective. But for me, coming from the operational side, when assisted living was first emerging, it was this exciting, new model that hadn't existed before. And so the goal was to move away from that traditional institutional model of care to create this place where older adults could actually receive support, but still maintain their independence, and their choice, and their kind of control over their individual lives. I think in the early days of assisted living, it was a lot about just knowing the person. It was a relationship-based care. It was focused on that home-like environment where residents were surrounded by people who knew their stories, and their preferences, and what really mattered most to them. But I also, because it was so new, there was a really strong entrepreneurial spirit too. Communities were, like, figuring out what worked, and they were learning each other, and they were building that foundation for what this kind of dream of what assisted living could be for the consumer. And so you had this great kind of fun, competitiveness, entrepreneurial spirit around who could build the better building, who could provide the best care, who could fill their buildings, and those types of things. And I think there was this great spirit of this new concept, really focusing on what the resident wanted and what the resident needed, and trying to create it all in this fun, social, home-like environment.  Debbie Stadtler: I love that. The entrepreneurial spirit really is so true, and everybody's finding their way and seeing what works and doesn't work. So I love that depiction of the environment where everybody's trying something new. Well, Nicolette

  5. 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

  6. 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

  7. 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

  8. 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

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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
    41
  • Rating
    Clean
  • Copyright
    © Copyright 2023. American Health Care Association. All rights reserved.
  • Show Website
    Perspectives in Long Term Care

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