In the midst of the second fall season in the COVID-19 pandemic, much is on table for skilled nursing providers and the residents and patients they care for. With the Delta variant top of mind and providers working harder than ever to save lives, opportunities with the latest round of provider relief funds are at hand, mixed with new staffing challenges and occupancy ebbs and flows.

In an interview with Provider, American Health Care Association/National Center for Assisted Living President and Chief Executive Officer Mark Parkinson outlines the current political dynamics in Washington, D.C., how vaccine mandates are affecting long term care, what providers should focus on with relief funds, and what attendees can expect at the 72nd AHCA/NCAL Convention & Expo.

Provider: This month your members are coming together at the 2021 AHCA/NCAL National Convention & Expo. It’s the first time since the start of COVID that you’ve held this event at a physical site. What can attendees expect?

Parkinson: We are really thrilled to be able to get back together in person with everyone. Our hope is the conference will be a time where people can refresh, get reinvigorated, share experiences, and prepare for the recovery of the future. The conference will be focused on really educating people, but also the theme of inspiring people will run through the conference. There will be a lot of inspirational sessions.

Provider: How can nursing homes be successful in applying for the latest round of provider relief funds? Is it enough aid for the sector?

Parkinson: The most important thing at this point is that people get applications in well before the deadline on Oct. 26, 2021. We don’t believe that CMS [Centers for Medicare and Medicaid Services] will grant an extension for applications on this phase. Everyone should have everything filed at least a week before the deadline. HRSA [Health Resources & Services Administration] has had some webinars on how to properly apply, and we encourage everyone to review those webinars, as well as additional materials we’re putting out.

Unfortunately, even with this additional funding, it won’t be enough. The Delta variant has caused a pause in the financial recovery of the sector. Combined with increasing staffing costs that we were already experiencing, we’re going to need continued help from both the federal and state governments.

Provider: Workforce is the current major issue it seems. Is there any legislation that you would like to see passed in Congress to help make it easier to find and retain workers for long term care?

Parkinson: There are two things the federal government can do right now to help us with our workforce shortage. First is to test incentives for workers to stay in our workforce in the reconciliation bill. We are advocating for some funding increases to SNFs [skilled nursing facilities] that would be passed through in the form of wage increases. That’s the first thing that Congress can do.

The second thing is that the administration can do some things to make immigration easier. We don’t expect a broad immigration bill to pass on the Hill, but there are some administrative changes that the Biden administration can make that would increase the ability for nurses to come to the United States, and that’s what we’d like to see happen.
Provider: What are the current political dynamics in Washington, and how does long term care fit in?

Parkinson: Washington continues to be very partisan and quite divided, and as long as that remains the case, it’s difficult for bills to pass Congress. What that means for long term care is that, for us to achieve our objectives, a lot of work has to be done with the administration on actions that do not require Congressional approval. 

The good news for the sector is that, because of the hard work of providers, we have broad support from both parties—Republicans and Democrats, leadership and rank and file members—from the efforts that providers have undertaken, particularly the work that they’ve done during the pandemic.

After the pandemic occurred, I was concerned that the attitude on the Hill and in the general public would be to blame nursing homes for what happened. Initially there was a lot of blame out there. But as time has passed, politicians and the general public have really begun to understand that this pandemic was a once in a hundred-year event, and the virus was so contagious that there was nothing that long term care providers could do. The work that was done saved tens of thousands of lives in the buildings.

So the overall attitude about long term care on the Hill is positive, but they still have a hard time helping us because they can’t pass any bills. They are that divided.

Provider: What will be the effect of the administration’s vaccine mandate for health care workers on skilled nursing and assisted living staff?

Parkinson: It’s too early to tell right now because the administration has announced the vaccine mandate, but they have not enacted the mandate yet. Until we get to the point where either workers have to be vaccinated or they will be terminated, we’re not going to know what the impact of the mandate is.

It’s very clear to me that there are parts of the country where there is so much vaccine hesitancy, that if there isn’t some alternative to the vaccine, assisted living centers and skilled nursing facilities are going to lose a lot of employees. We encourage the administration to provide some exceptions or alternatives in those cases or we believe they are going to exacerbate the already challenging staffing situation.

Provider: Do you see further specialization by providers to diversify their care settings? For example, are memory care and non-skilled settings still booming?

Parkinson: Successful providers are branching off into all sorts of different areas beyond the core work of long term care. We have seen great success of providers going into memory care but also the ancillary businesses, like creating their own pharmacies, their own hospices, their own rehab companies, their own institutional special needs plans.

The financial lessons of the last 10 to 15 years has been that if all you have is the core business of long term care, you’re going to have a hard time surviving financially, particularly in the vast majority of states that underpay for Medicaid. And so the successful providers now and into the future will be those that take part in ancillary businesses that surround the basic long term care work that we do.

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?

Parkinson: The major misunderstanding of many home care advocates is their belief that there are many residents who can be taken care of at home. And that simply is not true. The average resident of a SNF or assisted living building is typically in their 80s and needs help with multiple activities of daily living. It’s just not possible for these people to be taken care of at home. Many states that have attempted to provide home care services and move people from nursing homes into home residences have found it doesn’t work out.

There are some people who are at home who do need additional home care services, and that’s why we support the efforts of the administration to expand home- and community-based services for those people. Those are important services for those people, but it will not dimmish the number of people who still do need skilled nursing and assisted living care.
Because of the caregiving work that all skilled nursing and assisted living providers perform, many of them also provide home care services. If that funding is expanded, as the Biden administration would like to have happen, I think you’ll see more long term care operators expand into home care as well.

Provider: On occupancy, did we bottom out months ago as some expected, or have we still not hit the bottom? What are the prospects in the coming months and in 2022?

Parkinson: I think we hit the bottom in January. We had a huge wave of COVID in November and December in the U.S., and the country-wide occupancy hit a low of 67 percent. We are now at 72 percent. We were at 80 percent before the pandemic. We’ve had a pause in the census recovery during the time of the Delta variant, but as the variant recedes, our hope is the pause turns into a slow and steady increase in occupancy through the end of the year, and then we can fully recover in 2022.

Provider: You’ve been at this for a number of years. Do you still find the challenges exhilarating? What have you learned from heading AHCA/NCAL?

Parkinson: The last two years have been the most important work that I’ve been able to do at any point in my career. Our mission statement at AHCA/NCAL is to improve lives by delivering solutions for quality care. We feel like the work that we’ve been able to do both at AHCA and more importantly for our members in their buildings hasn’t been just to improve lives but to actually save lives. And I believe that our work and our members’ work have saved tens of thousands of lives over the past 10 years. And so yes, that’s been exhilarating.

On the other hand, all of us at AHCA/NCAL have been working hard every day for the past year and a half, and we haven’t been working as hard as our members have. It’s been tiring at times, and it’s been exhilarating at times, but it’s been the most important part of my career.