Much has changed during the last 18 months. There’s the political dynamics on Capitol Hill, bringing new challenges to leaders in health care. On the frontlines, assisted living providers continue to battle the COVID-19 pandemic, saving lives and protecting residents from the virus’ latest iteration—the Delta variant. In Washington, there is a new face in assisted living leadership.

Being the first woman and first person of color to hold the title of executive director of the National Center for Assisted Living (NCAL), LaShuan Bethea is a force, bringing 25 years of experience as a nurse and fierce advocacy from the front lines of long term care. She most recently served as vice president of legislative affairs and reimbursement for Genesis HealthCare.

In an interview with Provider, Bethea shares her message to Washington and assisted living providers across the country, along with a sneak peak of what providers can look forward to at this year’s NCAL Day at the 72nd American Health Care Association/National Center for Assisted Living Convention & Expo.
Provider: You’ve just recently come on as NCAL’s new executive director, congratulations! What made you take this position? What challenges do you want to tackle?

Bethea: I’ve been a nurse for over 25 years. I have a range of experience in a variety of different long term care settings. One of the things I’ve developed a passion about is advocacy. I’ve focused on legislation, regulation, and quality care for excellent outcomes. Having 25 years’ experience, I see this as an opportunity to expand my role for quality and great outcomes in the assisted living care setting.

Provider: How can assisted living providers be successful with the Phase 4 application process with the Provider Relief Fund?

Bethea: We’re thankful to the Biden administration for making these funds available to all providers and prioritizing the needs of those we care for in our assisted living communities. The application is open until Oct. 26, and there are webcasts that will help providers with applying. I encourage providers to complete their applications sooner rather than later so that they have enough time to get their applications in.

Provider: How do you balance the needs for assisted living providers to get federal COVID relief while at the same time maintaining that assisted living remain a state-regulated area of long term care?

Bethea: I think it is important that the federal government as well as state governments understand the wide variety of individuals who are providing assisted living care. We have some assisted living providers that have a social or hospitality model, and we have other assisted living providers who provide more of a medical model—they collaborate with hospitals or SNF [skilled nursing facility] settings.

Assisted living, no matter what range of the spectrum it falls in, we are not a true medical model, and we do need additional resources to make sure that we can be competitive in terms of wages and hiring caregivers to work in our settings, as well as having access to personal protective equipment, testing, and vaccines.

It’s important for the state and federal government to recognize that the government’s role in assisting providers during the pandemic should not be setting-agnostic; they should be providing assistance to those who need assistance in providing care to a vulnerable population—whether that’s in a skilled setting, a hospital, or an assisted living setting.

Provider: Are there any current discussions on Capitol Hill about increased regulation or scrutiny of assisted living communities?

Bethea: There is nothing specific that I’m aware of, but it’s definitely something that we’re keeping our eye on. Right now there is definitely an opportunity for Congress to continue to prioritize assisted living, including the individuals who choose to call assisted living their home as well as their caregivers. And they can do that through the Human Infrastructure Act. They can make sure that funds are allocated to cover wages.

Workforce is one of our most significant challenges. Another bill in Congress, the Care for our Seniors Act, also addresses our ongoing workforce challenge. It uses a multitiered approach to help providers not only recruit new caregivers but retain them by providing services that support them, such as affordable housing, child care, tax credits, and loan forgiveness for any new graduate who chooses to work in a care setting.

So while there is no regulation that’s looking to increase scrutiny, I think that Congress is focusing where they should be focusing right now, which is making sure that seniors and individuals living in a senior living community have the resources that they need to successfully get through this pandemic.

Provider: There seems to be some movement to make assisted living care more affordable. What do you think are the prospects for more development in this area? To enhance access to assisted living for those with middle to low incomes?

Bethea: With the use of home- and community-based services waivers and the funding that’s been allocated for them, I think that we should absolutely make sure that assisted living is a part of what is considered when those resources are distributed. It is a way to make sure that not only those individuals who have sufficient financial resources can afford to make assisted living their home but also individuals with a moderate or low income can use Medicaid reimbursement to select assisted living as their home.

Provider: Will the vaccine mandate for health care workers cause any type of staff exodus from member facilities in the assisted living world?

Bethea: There is definitely some vaccine hesitancy. One of the ways we can deal with that is while we are fully supportive of health care providers being vaccinated, I think that in order to help us deal with the vaccine hesitancy it will be important for the Biden administration to provide some type of guidance to help us manage or deal with giving additional time to unvaccinated workers.

In addition, when the mandate goes into effect, if we lose some individuals who are choosing not to get vaccinated, we believe that the administration can also assist us by providing some supplemental staffing or other resources to help us fill that gap that we may have so our staffing challenges don’t continue to get worse.

Provider: Considering the post-COVID push to have elders and people with disabilities cared for more at home, how will that affect business? And will you see more of your members go into the home care space?

Bethea: Assisted living is a perfect option for individuals to choose. I wouldn’t say that one is better than the other. Whether more people will stay at home or more in a facility, I think that is to be determined. Assisted living is absolutely an option for individuals whether they are people looking for a more social or hospitality environment, or whether they have additional medical needs, assisted living is an environment that has something for all those individuals.

Provider: At Genesis, you were chair of the Diversity, Equity, and Inclusion Committee. As you know, more than half of the frontline workers in long term care are people of color. This is way over the national average for a workforce in any industry, but the ranks of owners, administrators, and other key leadership spots are not diversified. How is NCAL planning to support the growth in the number of people of color into management and executive positions in long term and post-acute care?

Bethea: One of the ways any organization has the ability to support diversity in executive positions is making sure that when they have open positions, they interview individuals from a diverse candidate pool, and that at least one of the candidates be a diverse candidate.

I think the other option, because we know that more than 50 percent of our workforce are persons of color, is succession planning. Succession planning is another way to look at individuals in the workforce and give people a chance to move up within an organization and within a trade association.
It’s important to share those potential options with members and let them know what paths they can take to expand diversity within their organization, either through mentoring, succession planning, and/or ensuring diverse candidate pools with hiring and with promotion. It’s also about looking at representation within their leadership but also within their board.

Great ideas and options for opportunities come when you have diverse representation in committees and boards that are making decisions about how policy is being structured within an organization. 

Provider: This month is the largest gathering of your members of the year, and the first since the start of the COVID-19 pandemic. What can your members expect from NCAL Day?

Bethea: I’m extremely excited about our fifth annual NCAL Day on Oct. 10. It’s a great opportunity where like-minded assisted living providers can join together to enjoy thought-provoking education that is tailored to the assisted living sector.

We have lots of great educational opportunities, including one provided by the Ritz Carlton leadership center. They will conduct a presentation that is going to walk through how to foster a culture of personalized service in genuine care. Attendees will hear a national update from NCAL leadership, they will hear more about how the federal government will potentially impact the assisted living profession, and how NCAL is working on their behalf.

One of the other benefits, especially after 18 months of working remotely and having video conference calls, is that this is an opportunity to safely network, meet new people, share ideas, and innovate with your fellow assisted living professionals as well as discuss some best practices and some of the experiences that individuals have had within the last 18 months.