Summer 2026

Vol. 53 No. 2

Cover Story

Seniors Needing Care Struggle to Navigate Medicare Advantage

https://www.providermagazine.com/Issues/2026/Summer/Pages/Seniors-Needing-Care-Struggle-to-Navigate-Medicare-Advantage.aspx

Seniors Needing Care Struggle to Navigate Medicare Advantage

<img src="/Issues/2026/Summer/PublishingImages/CF%20MA_sum26.jpg" class="ms-rtePosition-2" alt="Medicare Advantage" style="margin:5px;width:300px;height:300px;" />When seniors sign up for Medicare Advantage (MA) plans, they’re drawn to the promise of more comprehensive coverage at a lower cost. For a growing number of enrollees, however, their experience falls short of that promise. Some wait in the hospital for an authorization that takes days to come through; others are discharged from skilled nursing facilities (SNFs) before their doctors think they’re ready. They file appeal after appeal with their plan, not knowing if they’ll be cleared to stay and recover. Maybe they go home early, only to end up back at the hospital. Or maybe they pay out of pocket for care they thought their premiums were supposed to cover.Meanwhile, the federal government pays handsomely for their experience. MA enrollment reached <a href="https://www.kff.org/medicare/medicare-advantage-enrollment-grew-by-about-1-million-people-mainly-due-to-special-needs-plans/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank" title="Medicare Advantage Enrollment Grew">35 million</a> this year, constituting a little over half of the eligible population. A recent <a href="https://www.medpac.gov/wp-content/uploads/2026/03/Mar26_Ch12_MedPAC_Report_To_Congress_SEC.pdf" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" title="status report" target="_blank">MedPAC analysis</a> found that MA plans will cost the government 14 percent more than fee-for-service Medicare plans, or about $76 billion in payments to participating insurers. Provider spoke with a range of long term and post-acute care leaders to understand why so many patients aren’t seeing the benefits, and what can be done to give them the care they deserve. <h3>Delays and Denials</h3>For patients, the gap between MA’s promise and its reality is felt most potently in the prior authorization process. It’s a constant battle. In many cases, MA plans simply don’t recognize certain procedures, for example, IV administration or wound care, as skilled care and deny authorization accordingly. In addition, plans typically only approve SNF stays for a few days at a time, requiring providers to go through the whole process again—and again—for patients who need longer stays. In some cases, the plan might need to be notified when the patient it authorized actually comes to the building; if it doesn’t receive that notification within 24 hours, it doesn’t pay. In other cases, they only approve the lowest level of acuity care they can justify, putting the patient at increased risk of re-hospitalization.“You almost have to have a dedicated authorizations team” to navigate this labyrinth, said Caryn Miller, who handles billing at Elmbrook Management Company, which manages 13 facilities across rural Oklahoma. Part of the problem is the lack of any standardized system across the different plans: each plan has its own rules, procedures, portals, and timelines. “Humana has one set of rules; UnitedHealthcare (UHC) wants something else; Aetna has their own fee screen that doesn’t match what any other company does,” Miller said. “Even within an MA company’s umbrella, you’ve got so many different plans that you have to understand the rules and what each resident’s policy looks like.”<img src="/Issues/2026/Summer/PublishingImages/MA%20quote1.png" alt="'It's frustrating for families.'" style="margin:5px;width:850px;height:266px;" /> Patients face a grueling stream of delays or denials of authorization, often against clinical recommendations. In AHCA’s May 2025 <a href="https://www.ahcancal.org/News-and-Communications/Press-Releases/Pages/Survey-Medicare-Advantage-Denials-For-Nursing-Homes-.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank" title="Medicare Advantage survey">survey</a> of 363 nursing home providers, two-thirds reported that MA plans deny or delay post-acute care on a daily or weekly basis. A January 2026 <a href="https://acentraqio.com/wp-content/uploads/2026/01/SNF_Focus_Study_Webinar_508-1.pdf" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank" title="Medicare Advantage Plan Appeals">study by Acentra Health</a> looked specifically at MA-issued notices of Medicare non-coverage, finding that 92 percent of beneficiaries who received them still required skilled nursing or therapy services. The study also found that 72 percent were at risk for decline, injury, or readmission if discharged prematurely. A 2024 Senate investigation into the three largest MA insurers corroborated the providers’ experiences, finding that the plans deny prior authorization requests for post-acute care at a higher rate than other forms of care. In 2022, per the <a href="https://www.hsgac.senate.gov/wp-content/uploads/2024.10.17-PSI-Majority-Staff-Report-on-Medicare-Advantage.pdf" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank" title="Refusal of Recovery">Senate’s report</a>, UnitedHealthcare and CVS issued denials for post-acute care at about three times their overall denial rates. Meanwhile, Humana’s post-acute denial rate was more than 16 times higher than its overall rate.These factors inevitably impact patient care and recovery, sometimes requiring lengthy, unnecessary hospital stays while patients wait for approval for an SNF transfer, then early discharges from the SNF against medical advice. They have the right to appeal, of course, but the appeals process adds compounding stress for all parties. “We have probably an average of four appeals for each Advantage patient and as many as 14,” said the administrator of a five-star facility in the northeast, who requested anonymity to speak candidly. “Every two days the Advantage plans are issuing [Notice of Medicare Non-Coverage] (NOMNCs). Every two days, a patient is appealing. Every two days, Medicare is overturning that decision and saying, ‘No, they’re still skillable.’”<img src="/Issues/2026/Summer/PublishingImages/Len-Russ.jpg" alt="Len Russ" class="ms-rtePosition-1" style="margin:5px;" />Providers are reporting an increase in NOMNCs after the issue of prior authorizations was put under the microscope by federal policymakers. In June 2025, the Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) announced a <a href="https://www.hhs.gov/press-room/kennedy-oz-cms-secure-healthcare-industry-pledge-to-fix-prior-authorization-system.html" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank" title="Pledge to Fix Broken Prior Authorization System">new pledge</a> by insurers to streamline and improve the prior authorization process, and in April 2026, insurers announced that they had reduced prior authorizations by 11 percent. The result has been an uptick in frequent reauthorizations, suggesting a new strategy by MA insurers to maintain costs. “That’s of course very stressful for the families, because every two days they’re not knowing if they’re going to have to take the patient home,” the administrator added. “They’re having to file appeal paperwork and wait to see what’s going to happen.” The uncertainty inherent to this process makes it difficult for providers to arrange the home care services a patient would need for a safe discharge. “We don’t have home care agencies just on standby in case somebody loses their appeal, and all of a sudden they’re having to leave in 48 hours.”“It’s frustrating for families,” agreed Len Russ, Principal Partner of Bayberry Care Center in New York and co-chair of AHCA/NCAL’s Reimbursement Cabinet. “They have a direct dialogue with the provider and the caregivers onsite, but not the ones who are pulling the strings from somewhere else. It’s not the most user-friendly structure of care.”<h3>The Magic Machine</h3>In some cases, the ones pulling the strings aren’t exactly human. “They’re using algorithms to determine average length of stay based on the patient’s conditions, and they’re sending out prior authorizations with that amount of time or less,” said Maureen McCarthy, CEO of Celtic Consulting. “You have to have the ability to extend that for patients who would need more time, who have multiple comorbidities.”<img src="/Issues/2026/Summer/PublishingImages/CF-MA_congress.jpg" class="ms-rtePosition-2" alt="Congress on the Case" style="margin:5px;width:350px;" />Susie Mix, CEO of Mix Solutions, put it a little more bluntly. “They submit the patient information into a little magic machine, and it spits out what we’re supposed to provide the patient and what reimbursement we should receive,” she said. “Unfortunately, that machine is not somebody looking at that patient and assessing them from head to toe.”Also concerning to McCarthy is the way MA plans are using algorithms to identify providers with a record of successfully challenging denials. “There are also algorithms built to look at who’s appealing and who’s winning the appeals, and they’re no longer sending patients to those who are winning the appeal,” she said. She described a client who received a call from a plan challenging its 85 percent overturn rate—as if the provider was the party at fault. She had to reassure her client that this meant they were doing things right: “If they’re being overturned 85 percent of the time, they are the ones making the inappropriate decisions, not your facility.”A <a href="https://www.statnews.com/2023/03/13/medicare-advantage-plans-denial-artificial-intelligence/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank" title="Denied by AI">2023 investigation</a> by Stat News attested to these providers’ experiences, describing the use of “unregulated predictive algorithms, under the guise of scientific rigor, to pinpoint the precise moment when they can plausibly cut off payment for an older patient’s treatment.” Doctors, medical directors, and administrators claim that the denials often target care that’s usually covered under traditional Medicare, though they often struggle to get satisfying explanations from the insurers.“Some give up and go home before they’re clinically ready, risking readmission,” said the administrator of the facility in the northeast. “Others end up paying out of pocket for care their premiums were supposed to cover.” <h3>When the Bill Comes Back</h3>Even after care is approved and delivered, MA plans may still conduct an audit and end up refusing to pay—or even recouping the reimbursement they already paid. “We see numerous instances where they’ll do an audit and then they’ll take the money back after the fact,” said Russ. “Sometimes it’s just very technical—the right signatures and the order wasn’t put in the right place for the therapy, or the doctor didn’t sign the order. They can use a myriad of excuses to deny payment or claw back payments, while disregarding the patients’ positive outcomes.”Although audits are a necessary, legitimate part of safeguarding system integrity, administrative burdens invariably lead to adverse consequences for patients. Providers who have been burned by clawbacks may become more cautious about which MA plans they’ll accept. The administrator of the five-star provider in the northeast said that their facility sometimes has to refuse plans that don’t approve patients for the care durations they need, even if the facility has cared for the patient previously. “It’s very sad because they have a comfort level with us,” they said. “Oftentimes it’s a lovely family and a lovely patient with great potential for significant improvement and independence.” However, the administrator does not want to compromise on the level or length of care patients need, especially for those with medically complex conditions. Patients being discharged prematurely may have to be readmitted to the hospital, which is not desirable for the patient and impacts the SNF’s quality data, potentially leading to penalties.While some facilities have the resources to navigate the maze of prior authorizations, reauthorizations, and appeals, others don’t. Smaller facilities may be less equipped to absorb clawbacks or train staff to adapt to new procedures. If they stop accepting certain MA plans, the nearest alternative for patients could be hours away. That’s why providers are calling for more transparency and accountability for these practices; the alternative is that patients, especially the most vulnerable ones, will lose access to the safe, timely, high-quality care they deserve.<h3>How Providers Are Adapting</h3>Providers across the country have found their own ways of making sure they have the tools to serve MA patients. At Cascadia Healthcare, which operates dozens of facilities across Idaho, Montana, Washington, Oregon, and Arizona, Chief Financial Officer Steve LaForte created a dedicated authorization team to handle approvals. “We have a managed care department and brought in a full-time director of managed care in 2021,” he said. “She’s now got a staff of, I think, five people dedicated to managed care, really proactively managing the sustainability of the relationships. They’ve gotten really good at it.”<img src="/Issues/2026/Summer/PublishingImages/Steve-LaForte.jpg" alt="Steve LaForte" class="ms-rtePosition-1" style="margin:5px;width:125px;height:154px;" />For the administrator of a five-star facility in the northeast, patient education is key to navigating managed care. As they explained, many people enroll in MA because they think they’ll get better, easier care than through traditional Medicare. They don’t know about the issues involved, which is why it’s so important for providers to give them the facts. It’s about education, not persuasion, as federal guidance stipulates that providers can aim to inform patients and families without influencing decision making or marketing specific plans. “When a Medicare Advantage patient is admitted, we immediately begin educating them on the Medicare Advantage process,” the administrator said. “Patients and families are informed that the MA plan will be approving a 3- to 4-day stay and then they will receive a downgrade, at which time we may need to do an appeal. Families and patients are made aware they will need to be readily available to participate in their appeal.” “During open enrollment, we open up to the public to receive education on what the Medicare Advantage plans cover and don’t cover,” they added. “Until you need the coverage, you likely would not know what is and isn’t covered.”At Celtic Consulting, McCarthy encourages her clients to study the existing regulations so that they can leverage regulatory tools that already exist but which they may not know about. She pointed to the CMS appeals process, in which the first two levels involve desk reviews of paperwork but the <a href="https://www.cms.gov/medicare/appeals-grievances/fee-for-service/third-level-appeal" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank" title="Third Level of Appeal">third level</a> involves an administrative judge. “It’s human to human, and you get to explain the circumstances of the case. That’s usually the best chance of winning,” she said. “I would encourage providers to get out to at least level three if they’re not successful at levels one and two.” As for those first two levels? “Become familiar with what those regulations are, so you can use that language when you’re appealing to the insurance companies,” she said. She also pointed to a <a href="https://www.ahcancal.org/News-and-Communications/Blog/Pages/CMS-Releases-New-Online-Provider-Complaint-Form-for-MA-Plans-.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank" title="CMS MA Provider Complaint Form">new CMS complaint form</a>, which allows providers to submit complaints about MA plans. “We’re very excited that CMS came out with that earlier this year,” she said. “The problem is that not a lot of providers are aware of it just yet.”Elmbrook’s Caryn Miller advised providers not to be afraid to seek help from their peers. “Reach out to other companies; ask how they’re doing it,” she said. “We’re all happy to share our information and our knowledge and take care of each other, because we need to.”<h3>What Providers Want from Policymakers</h3>In interviews for this article, providers stressed that MA plays a vital role in the health care ecosystem, offering patients lower costs, bundled benefits, and more coordinated care. As they discussed the pain points they experienced with managed care, they said that what they want most from policymakers are common-sense reforms that help MA live up to its promise.One of the top priorities is standardization. “If MA companies are going to have rules outside of Medicare, then we need a standard set of rules for billing and authorizations with the managed care groups,” said Miller. “UHC can’t decide they want a 24-hour notice and not pay us. Humana can’t decide that they want to assign the assessment instead of accepting the facility MDS. I get it; maybe that’s the concept of outsourcing it to save money and protect the Medicare system, but at least standardize some of the rules.”In addition to standardized authorization and appeals processes, providers hope for more reliable payment processes, no more retroactive denials, and enforcement mechanisms that keep MA plans accountable to the system’s promise—ideally with penalties for noncompliance. “CMS has done some fantastic things in creating certain guardrails and protections for beneficiaries, but it needs more teeth,” said McCarthy. “The plans need to be held accountable for not following the rules.” “I’d hope to see some type of system where CMS is monitoring the percentage of overturns,” she added. “If you have an 85 percent overturn rate, you should not even be a Medicare Advantage provider anymore. You’re obviously not managing the benefits appropriately.”<img src="/Issues/2026/Summer/PublishingImages/MA%20quote2.png" alt="'There are also algorithms built..."" style="margin:5px;width:850px;height:264px;" /> Echoing McCarthy’s concern about accountability for plans with high overturn rates, the northeast facility’s administrator also proposed enhancing the MA Star Rating System to increase transparency for consumers and score plans more appropriately. “There should be some kind of published documentation about where the Medicare Advantage plans score in certain things—length of stay, appeals that are overturned, things like that,” they said. “The public has a right to know.”“We call the Department of Insurance or whoever it is, and nobody’s going out to these health plans and monitoring this,” agreed Susie Mix. “The issue is that there is no accountability after a regulation is set. Ensuring that there is some arm of the regulation holding these folks accountable is critical to the success of the regulation.”<h3>“Careening into a Crisis”</h3>Whatever the solution may be, providers believe it’s essential for patients that regulators help chart a more practicable route forward. “Medicare Advantage has to work,” said LaForte. “We’re careening into a crisis unless we find a way to be more collaborative and more sustainable.” In his view, the solution might look like a public-private partnership where the government has more effective means of holding MA plans accountable. “We need the government to create better accountability and more parity with fee-for-service Medicare,” he said. “There’s got to be an equitable middle ground there.”Bayberry Care Center’s Len Russ agrees. “Medicare has been steadily increasing reimbursement to the plans, but the plans have not been passing it on to the providers they contract with—not even fractionally.” He and many other providers say they have not seen an MA rate increase in more than a decade even though SNFs are seeing patients with higher levels of acuity with each passing year. Coupled with the significant resources providers have had to dedicate to the mountain of MA documentation requests, the popular coverage option could create significant financial strain for the post-acute sector. Russ pointed to what he called a “paradox” at the heart of the issue, one which may eventually force the government’s hand: as patients get older, become more complex, and need more services, they’re increasingly disenrolling from MA and enrolling in traditional Medicare. “The government’s getting the worst of both worlds,” he said. “The companies are getting a lot of money and not having to deliver a lot of services for the healthier, younger, post-65 population. But then when they get older and sicker, they go to Part A—and that’s more expensive on the government’s end.”<img src="/Issues/2026/Summer/PublishingImages/Mike-Bassett.jpg" alt="Mike Bassett" class="ms-rtePosition-1" style="margin:5px;width:125px;height:154px;" />Through its <a href="https://www.ahcancal.org/Advocacy/Pages/The-Better-Way-Agenda.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank" title="AHCA’s Bold Solutions for Ensuring Quality Long Term & Post-Acute Care">Better Way policy agenda</a>, the American Health Care Association has been elevating these MA issues to federal lawmakers, which have the attention of Republicans and Democrats. “We are really encouraged that members of Congress in both parties and in both chambers want to address these concerns with Medicare Advantage,” said Michael Bassett, AHCA Senior Vice President of Government Relations. With numerous bills being introduced, he is hopeful that meaningful legislation could be considered during the lame duck session at the end of the year. “Consensus in Congress is challenging, but we can all get behind ensuring our nation’s seniors have access to the benefits they have earned.” Until policymakers step in, providers are doing what they can to work around administrative obstacles, appeal denials, educate patients and families, and help build a better path forward. “We have to keep our voices in the mix,” concluded LaForte. “We have to be as loud as possible.” Steve Manning is a journalist based in New York City.

Seniors are increasingly drawn to Medicare Advantage plans, until they need post-acute care. Here’s what can be done to protect the benefits seniors have earned.

2026-06-01T04:00:00Z

Medicare Advantage;Caregiving

Providers Conquer Challenges Each Day

https://www.providermagazine.com/Issues/2026/Summer/Pages/Editor's-Desk.aspx

Providers Conquer Challenges Each Day

<img src="/PublishingImages/default-editor.jpg" alt="Debbie Stadtler" class="ms-rtePosition-2" style="margin:5px;width:230px;height:278px;" />Long term care providers face challenges every day—but they also have no shortage of dedicated people meeting those challenges with creativity, compassion, and resolve. In this issue, we examine the systemic pressures that complicate care delivery, the regulatory progress that makes us optimistic, and the individuals and programs that remind us why this work matters.One feature takes a close look at the growing tension between the appeal of <a href="/Issues/2026/Summer/Pages/Seniors-Needing-Care-Struggle-to-Navigate-Medicare-Advantage.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank" title="Seniors Needing Care Struggle to Navigate Medicare Advantage">Medicare Advantage</a> (MA) plans and the difficulties seniors face when trying to access post-acute care through MA. As enrollment in these plans continues to climb, providers must understand the barriers residents encounter—and advocate for solutions that ensure every beneficiary receives the care they deserve.We shine a long-overdue spotlight on <a href="/Issues/2026/Summer/Pages/Unsung-Heroes-Help-Communities-Soar.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank" title="Unsung Heroes Help Communities Soar ">maintenance directors</a>—the unsung heroes whose work underpins safety, quality, and compliance in long term care communities. From preventing costly repairs to creating environments where residents and staff can thrive, these professionals make an outsized contribution that deserves recognition and investment.In addition, <a href="/Issues/2026/Summer/Pages/Regulatory-Updates-Echo-AHCA%27s-Better-Way.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank" title="Regulatory Updates Echo AHCA's Better Way">recent updates</a> by the Centers for Medicare and Medicaid Services (CMS) are helping to put patients over paperwork in skilled nursing facilities, reflecting years of advocacy by AHCA and signaling that policymakers are listening. We also <a href="/Issues/2026/Summer/Pages/Sarah-Silva-The-Leader-with-Heart.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank" title="Sarah Silva: The Leader with Heart">profile Sarah Silva,</a> the new National Center for Assisted Living (NCAL) board chair, whose heart-driven approach to care shows her dedication and passion. Also, learn how aligning talent with mission and vision builds a <a href="/Issues/2026/Summer/Pages/Strengthening-the-Care-Workforce.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank" title="Strengthening the Care Workforce ">stable, high-performing workforce</a>. Celebrate the 30-year legacy of the <a href="/Issues/2026/Summer/Pages/30-Years-of-National-Quality-Award-Examiners-Advancing-Excellence.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank" title="30 Years of National Quality Award Examiners Advancing Excellence ">National Quality Award Examiners,</a> who volunteer their time and expertise to advance excellence across the field. Explore how NCAL’s <a href="/Issues/2026/Summer/Pages/Resources-and-Advocacy-Set-a-Strong-Path-for-the-Future.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank" title="Resources and Advocacy Set a Strong Path for the Future ">regulatory resources and advocacy</a> efforts are equipping assisted living leaders for the road ahead. And examine the policy solutions and workforce initiatives essential to building a strong, sustainable care workforce for the future.Taken together, these articles reflect long term care professionals that refuse to stand still—people who advocate for residents, provide quality care despite changing regulations, and continue to move the profession forward each day. <img src="/PublishingImages/bs_DStadtler_sig.jpg" alt="Debbie Stadtler" style="margin:5px;width:175px;height:38px;" /> Deborah Stadtler Editor in Chief

In this issue, we examine the systemic pressures that complicate care delivery, the regulatory progress that makes us optimistic, and the individuals and programs that remind us why this work matters.

2026-06-01T04:00:00Z

Editor's Desk

Unsung Heroes Help Communities Soar

https://www.providermagazine.com/Issues/2026/Summer/Pages/Unsung-Heroes-Help-Communities-Soar.aspx

Unsung Heroes Help Communities Soar

<img src="/Issues/2026/Summer/PublishingImages/CF-maintenance_sum26.jpg" class="ms-rtePosition-2" alt="Unsung Heros" style="margin:5px;width:375px;height:375px;" />Maintenance directors in long term and post-acute care (LTPAC) don’t wear capes, but their efforts are heroic. They repair, reimagine, replace, and renovate. They improve, install, initiate, and innovate. They work to keep residents, staff, and visitors safe, comfortable, secure, happy, and healthy. These often-unsung heroes deserve support and recognition, including training to enable them to function as team leaders and key colleagues.<h3>Safety First</h3>Working to ensure community-wide safety is an essential but time-consuming endeavor that maintenance commits to every day. For instance, the maintenance team makes sure the sidewalks are safe. As concrete sidewalks or driveways age, maintenance finds and repairs holes that develop. In addition, they mount surge strips above the floors and conduct regular, comprehensive assessments of common areas, resident living spaces, and the exterior grounds to identify and immediately mitigate potential trip hazards, such as loose carpeting, uneven walkways, or loose or missing handrails. They check appliances and cords regularly and conduct safety checks to prevent electrical fires. They maintain air filters, air conditioners, and heating systems that keep buildings comfortable and the air clean. They replace lightbulbs indoors and outdoors for safety and security. They fix water leaks and work to prevent mold and mildew. Maintenance teams may also keep vans, buses, and other vehicles operational and safe. <img src="/Issues/2026/Summer/PublishingImages/Tina-Sandri.jpg" alt="Tina Sandri" class="ms-rtePosition-1" style="margin:5px;width:125px;height:154px;" />During bad weather and natural disasters, maintenance doubles down on their safety efforts. <a href="/Video-Resources/Podcasts/Pages/Employee-Well-Being-in-Long-Term-Care.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank" title="Employee Well Being in Long Term Care ">Tina Sandri,</a> a senior living executive in the Washington, D.C., area, said, “When it snows, they make sure driveways and sidewalks are cleared and salted for snow and debris. Sometimes they do it themselves and other times it’s with help from outside contractors they oversee.” Even before weather-related or other disasters happen, the maintenance team focuses on preparedness. Tom Gojcaj, BBA, senior plant operations director for Avista in Mesa, Ariz., said, “Routine inspections and maintenance are conducted on critical life safety equipment, including fire systems, smoke detectors, sprinklers, emergency generators, and exit signs to ensure they are in working order and compliant with regulatory requirements.” They ensure all poisonous, toxic, combustible, and/or flammable materials are properly labeled and stored in locked areas. David Hood, Senior Advisor/Technical Fellow at Jensen Hughes, Fairport, N.Y., added that the maintenance director’s role in emergency preparedness “could involve anything from developing various procedures and conducting training for staff to running exercises. They often are the first person called when there's something that's immediately impacting the facility, whether that's a snowstorm or a power outage.” Gojcaj said, “The maintenance department’s role in safety is not merely reactive; it is the physical foundation for a secure and healthy environment, particularly concerning falls prevention and infection control. Our efforts are driven by proactive maintenance and environmental quality control.” He added, “I think the most important contribution maintenance can make in general is awareness, directly minimizing risks by ensuring the physical environment is consistently free from hazards that lead to accidents or injuries.”<table cellspacing="0" width="100%" class="ms-rteTable-0"><tbody><tr class="ms-rteTableHeaderRow-0"><th class="ms-rteTableHeaderFirstCol-0" rowspan="1" colspan="1" style="width:100%;"> <div style="background-color:#e6dae4;color:black;padding:15px;"> Maintenance Director Training Like other team leaders, maintenance directors and facility managers benefit from training and education to enable them to fulfill their roles effectively, identify opportunities for change and improvement, and sharpen their skills and competencies. To provide this education and training, the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) developed a Maintenance Director Training Course, which is structured into seven focused modules, each addressing critical areas of facility safety and compliance:<ol><li> Maintenance Director Overview </li><li> Fire and Smoke Door Inspection</li><li> Generator Inspection, Testing, and Maintenance</li><li> Portable Patient-Care Related Electrical Equipment (PCREE) Testing</li><li> Kitchen Fire Safety & Compliance</li><li> Oxygen Cylinder Storage</li><li> Sprinkler System Inspection, Testing, and Maintenance</li></ol>Each module is brief (about 10-20 minutes) and includes educational videos, downloadable presentations, and handouts to support learning and implementation.Upon successful completion, participants receive a certificate that can be used to demonstrate competency in fire and smoke door inspections, fulfilling annual requirements under NFPA 80 and NFPA 105, as part of the 2012 Life Safety Code®. This course is intended for those who are new to their facility maintenance role, focusing on life safety and emergency preparedness compliance. However, experienced maintenance directors, administrators, and other facility leaders can benefit from learning about what to expect from and how they can support their maintenance director. The course offers guidance on how to prepare for a survey and focuses on some of the most commonly cited survey issues and tags. It offers tips on how to best remediate these issues prior to a survey and stay in compliance over time. Hood observed, “This course requires just a short investment of time, and it’s free for AHCA/NCAL members. In return, you get practical information about and work toward a successful life safety survey.” Meghan Medvitz, MSHS, Director of Quality Improvement and Emergency Preparedness at AHCA, noted that the course could help facility maintenance programs function more seamlessly when there may be turnover or new maintenance directors that come in with limited experience in long term care. Not only will participants learn about life safety survey issues, but they will also get practical guidance on safety and life-saving issues, such as fire and smoke door inspections, generator maintenance, and kitchen fire safety. “We started with four modules and now have seven. This is a growing course, and we are continually looking at additional topics that might be useful for participants,” said Medvitz. She stressed that the course is a great resource not only for maintenance directors but also for administrators and corporate staff who oversee maintenance. “There’s a real value to organizations having a wider awareness of how maintenance protects residents, staff, visitors, and volunteers and helps ensure regulatory compliance,” she offered.Online participation is available all year long. For more information or to register for the course, go to <a href="https://educate.ahcancal.org/products/maintenance-director-training#tab-product_tab_overview" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank" title="Register at ahcancalED">ahcancalED</a>. </div></th></tr></tbody></table><h3>Contributing to Quality and Compliance</h3>The maintenance director and their team make significant contributions to quality and regulatory compliance. For instance, according to Gojcaj, they can assist the quality management program by participating in safety surveillance, which includes identifying and following up on incidents like resident injuries and falls, as well as monitoring the environment for compliance with safety standards. He added, “The maintenance director also may coordinate contracted services—such as for fire systems, generators, pest control, and plumbing—to ensure they meet regulatory requirements and maintain a safe and comfortable environment.”In settings such as nursing homes and assisted living communities, the maintenance director is often the unsung hero of risk management, said Gojcaj. “While clinical staff focus on patient outcomes, the maintenance team ensures the physical environment doesn't become a liability. The maintenance director is the primary custodian of the [National Fire Protection Association] 101: Life Safety Code. Accountability here isn't just about fixing things; it is about documentation and verification.”Elsewhere, under the Centers for Medicare & Medicaid Services (CMS) Emergency Preparedness Final Rule, maintenance directors are responsible for the “Physical Plant” section of the facility's emergency plan. Even though CMS dictates emergency preparedness compliance for skilled nursing facilities, it is also adopted in assisted living at the state level. Gojcaj said, “There is a significant weight placed on this role. Maintenance directors are expected to be subject-matter experts in complex regulatory codes, even if they don't have a background in law or engineering. In short, the maintenance director acts as the shield between the facility and massive fines or ‘Immediate Jeopardy’ citations. They turn abstract safety laws into a functional, breathing building.”Sandri said, “Maintenance is part of our [Quality Assurance and Performance Improvement] team and produces QAPI reports like all other departments.” Elsewhere, Andy Hughes, Regional Vice President of Operations at Pathway South LLC in Louisiana, said, “We have a monthly maintenance meeting where we go through any hazards, any falls out of the building, and anything we’ve added. Our maintenance director also is part of our morning meetings and is active in our quality improvement efforts.”<h3>Providing That Ounce of Prevention</h3>Gojcaj said, “While the maintenance department is typically viewed as a cost generator and not a revenue source, especially with tight budgets, it plays a vital, proactive role in controlling expenses and reducing costs.” For instance, continuous vigilance, which involves regular monitoring and swift action to identify and address issues that lead to waste, such as minor water leaks or instances of excessive electrical usage, can help prevent small problems from escalating into expensive repairs. Elsewhere, maintenance helps ensure energy efficiency by addressing issues such as lack of insulation or doors that do not seal properly. The maintenance team also ensures that mechanical equipment, such as refrigerator or air conditioning condensers, are kept clean. In addition, they leverage technical knowledge to implement efficiency upgrades that yield major savings. These include the strategic installation of smart technologies, such as light switch sensors, LED conversions, and water-reducing fixtures (e.g., in toilets, showerheads, and sinks), to conserve resources and lower utility consumption. <img src="/Issues/2026/Summer/PublishingImages/CF%20maintenance-121.jpg" class="ms-rtePosition-1" alt="maintenance worker" style="margin:5px;width:350px;" />Hughes said, “If you have a good maintenance person or team, someone who is a jack-of-all-trades, you don’t have to rely as much on external contractors. Our maintenance manager can do a little bit of everything—from installing or repairing sheetrock to making small electrical and plumbing repairs. Also, he’s been here for several years, and he really knows the buildings and grounds.” Gojcaj added, “By maintaining a skilled, knowledgeable in-house team, we are able to execute a significant amount of repair and installation work internally. This core competency substantially reduces overall labor expenses and streamlines budget management.”The maintenance team’s expertise and focus on maintaining equipment and systems can help increase their operational life and delay costly replacements. Sandri concluded, “An ounce of prevention is worth a pound of cure. A good preventative maintenance program is essential. Likewise, a good capital expense plan to retire/replace equipment is also needed. Technology to help monitor equipment live in real time, with remote access, seems to be the trend.”<h3>It Takes a Team</h3>The maintenance director doesn’t work in isolation. As with other components of LTPAC, team leaders throughout the facility coordinate and cooperate to troubleshoot, identify maintenance issues, and target opportunities for improvement. Gojcaj said, “Effective maintenance management, especially given the extensive physical size and limited maintenance staff that is common in our communities, relies entirely on robust cross-department collaboration.” He added, “The maintenance director depends heavily on other team members, such as caregivers, to serve as on-site eyes and ears, ensuring continuous awareness across tens of thousands of square feet. This essential partnership requires open communication and is executed through a specific process.” The process involves identifying hazards and information technology needs. “This ensures that no issues are missed, provides a maintenance history, and allows for organized troubleshooting,” said Gojcaj. Through staff collaboration and data captured in these systems, the maintenance director identifies patterns, prioritizes challenges, and executes timely repairs, ultimately improving both safety and service outcomes.Good communication skills are key for the maintenance director, Hood suggested. “There’s a real need to be able to communicate and collaborate with staff and others.” Maintenance needs to work with all departments to identify repair or improvement needs and ensure they are addressed promptly. Hughes agreed, adding, “Everyone at the facility needs to support and work with the maintenance team to make sure problems—such as a water leak or the need for lightbulb or filter replacements—don’t fall through the cracks.”<h3>Fostering a Community Built on Trust</h3>They may not realize it, but the maintenance director and team contribute to the emotional and psychological well-being of residents, staff, and visitors. Heather Harris, LCSW, Social Services Director at Heritage Manor of Mandeville, La., said, “The environment affects how people feel on a day-to-day basis. How someone feels about their surroundings has an impact on how they engage and interact in the community.” At the same time, when families come to visit, they see a place that is structurally sound, well maintained, and inviting. “This can make them feel more confident that their loved one is safe and well cared for,” Harris suggested. Joanne Kaldy is a freelance writer and communications consultant based in New Orleans.

The maintenance director is an unsung hero in long term care with the ability to boost safety, contribute to quality and compliance, and prevent future problems for staff and residents.

2026-06-01T04:00:00Z

Management

Cover Feature

Joanne Kaldy

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30 Years of National Quality Award Examiners Advancing Excellence	https://www.providermagazine.com/Issues/2026/Summer/Pages/30-Years-of-National-Quality-Award-Examiners-Advancing-Excellence.aspx	30 Years of National Quality Award Examiners Advancing Excellence	<p><img src="/Issues/2026/Summer/PublishingImages/QA_30years.jpg" alt="30 years" class="ms-rtePosition-1" style="margin:5px;" />For 30 years, the AHCA/NCAL National Quality Award Program has challenged providers to strengthen systems, improve outcomes, and pursue excellence across long term and post-acute care. Since its establishment in 1996, the program has helped organizations at every stage of the quality journey build stronger processes rooted in continuous improvement.</p><p>Behind every application reviewed, every feedback report delivered, and every award recommended is a dedicated group of professionals who make the program possible: the National Quality Award examiners.</p><p>This group of more than 200 individuals volunteers their time and expertise over the course of several months to carefully review applications, assess performance against the Baldrige Performance Excellence criteria, and provide meaningful feedback that helps providers improve. For many, serving as an examiner is more than a volunteer experience—it is a professional development and leadership opportunity as well as a chance to help elevate the entire profession.</p><p>The examiner program is rigorous. Examiners complete training, work in teams, review multiple applications, participate in meetings and discussions, and produce detailed feedback reports for each applicant. For the Silver and Gold awards, teams are comprised of professionals from across the country—and even the world—with a range of backgrounds in long term care, quality improvement, operations, and leadership. Team leaders are selected based on experience and guide the review process, while Gold judges—a smaller panel of highly experienced experts—determine which applicants advance to site visits and ultimately achieve the Gold award.</p><p>The work is substantial, often spanning six months, but participants consistently describe the experience as one of the most valuable learning opportunities of their careers. Some even compare it to a mini-MBA program because of the depth of learning involved.</p><p>As AHCA/NCAL celebrates the 30-year anniversary of the National Quality Award Program, three long-time examiners offer a powerful view into what it means to be an examiner and what it offers beyond being an essential part of the program’s success.</p><h3>From Pilot Program to Pipeline</h3><p>For Silver examiner team leader Nicolette Reilly, Senior Vice President of Quality at the Oregon Health Care Association, the value of the examiner experience is clear.</p><p><img src="/Issues/2026/Summer/PublishingImages/QA2_sum26.jpg" class="ms-rtePosition-2" alt="Examiners" style="margin:5px;width:420px;height:315px;" />“Being part of this program has made me focus more on the quality journey not just for my organization, but in my own professional growth as well,” Reilly said. “That was training that I would have paid thousands and thousands of dollars for.”</p><p>Reilly, who has served as an examiner for nearly two decades, helped create an innovative pipeline for new examiners in Oregon. Recognizing that first-year examiners often need additional support, she launched a pilot program that brings together first-time examiners for a hands-on, in-person training. What began as one team has now expanded into multiple teams and introduced more than 14 new examiners to the program.<br>“We created a space where first-year examiners could learn, ask questions, and grow together,” Reilly said. “It’s grown into something special—we’re building a pipeline of quality leaders.”</p><p>The effort created a ripple effect. Participants return to their organizations with a stronger grasp of quality improvement, share best practices, and often become champions for the National Quality Award Program within their companies and across the state.</p><p>Reilly also emphasized the professional network that comes with being an examiner. Because examiners work in teams made up of leaders from across the country and from different disciplines, the experience creates valuable relationships and broadens participants’ understanding of the profession. </p><p>“You build relationships across the country—people you can call and say, ‘What do you think about this?’” she said. “There’s this incredible sharing of ideas, best practices, and real solutions. You end up with an entire network of people focused on getting better.”</p><p>In the end, Reilly’s efforts not only support examiners but also help to shape the future of quality in long term care.</p><h3>Reaching the Next Generation</h3><p>For <a href="/Video-Resources/ProviderTV/Pages/Defining-Value-Based-Care-Success.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank" title="WATCH: Defining Value-Based Care Success ">Samantha Vosloo,</a> Senior Director of Value-Based Care at PointClickCare and a Silver examiner team leader for more than a decade, the program has offered a front-row seat to what high-performing organizations look like in practice.</p><p>Vosloo first became involved in the National Quality Award Program while working as an administrator-in-training and helping write a Silver Award application. After seeing firsthand how the process strengthened organizations, she became an examiner and never looked back.</p><p>“What I love about being an examiner is that you get an inside peek into these high-performing organizations and see what process excellence looks like,” Vosloo said. “I was able to take those key learnings and bring them back into my building.”</p><p style="text-align:center;"><img src="/Issues/2026/Summer/PublishingImages/QA1_sum26.jpg" alt="Examiners" style="margin:5px;width:400px;height:300px;" /> </p><p>That perspective shaped her leadership early in her career and continues to influence her work today. She credits the program with helping her better understand continuous improvement, develop stronger management skills, and learn how to identify issues and bring resolution.</p><p>“What Baldrige and the Quality Award teaches us to do is examine an issue and determine if that issue was a people issue or a process issue,” she said. “A lot of times, if we really take a step back, we find it was never a people issue—it was a process issue. That makes us better leaders.”</p><p>Vosloo is also helping build the next generation of Quality Award examiners. She has spearheaded a new partnership with the University of South Florida, where students in the university’s health care administration program learn the Baldrige framework in class and are then placed on Silver Award examiner teams to apply what they learned in real time.</p><p>She hopes that more future administrators enter the field already understanding what high performance, process improvement, and organizational excellence look like.</p><p>“Through this partnership, we’re helping them build those muscles before they even get out there into their career,” Vosloo said. “We’re graduating high-performing leaders who already know what it takes to run a good organization.”</p><p>The partnership currently has three students participating in the program.</p><h3>A Full-Circle Quality Journey</h3><p><span><img src="/Issues/2026/Summer/PublishingImages/QA_sum26.jpg" class="ms-rtePosition-2" alt="Examiners" style="margin:5px;width:275px;height:275px;" /></span>Few people have seen the National Quality Award Program from as many angles as <a href="/Video-Resources/Podcasts/Pages/What-It-Takes-to-Achieve-Quality-Excellence.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" title="LISTEN: What It Takes to Achieve Quality Excellence" target="_blank">Renee Ridling,</a> Executive Director of Gingerbread House, Inc. Over the years, Ridling has engaged with the program at nearly every level—as an applicant, award recipient, Silver examiner, Gold examiner, team leader, independent examiner, and now she has joined the elite group of eight Quality Award judges. A Gold Quality Award recipient herself, she has spent 17 years in the examiner program and says the experience shaped her both personally and professionally.</p><p>“We tell applicants all the time that quality is a journey,” Ridling said. “For myself, going from examiner through the process to judge has been a personal journey in learning not just about the Quality Award Program, but also about the concept of quality improvement and getting better.”</p><p>In 2014, Ridling became the first provider in Missouri to earn the Gold Award, a milestone she still carries with pride. In fact, she believes that one of the most meaningful parts of her examiner work has been helping other facilities achieve the same kind of progress.</p><p>“It’s fulfilling to have that impact—to know that something I said or something I shared in a feedback report may help another facility get to the next level,” she said. “Every year, when I watch the facilities I helped achieve their award, it’s very moving and very rewarding.”</p><p>Like many examiners, Ridling acknowledges that the program requires a significant investment of time, especially during the height of review season, but she is quick to emphasize that the investment is worth it.</p><p>“If you want to become better at your job…you won’t find a better way to become better at what you do,” she said. “This program helped me grow a lot.”</p><p>Reflecting on how far the journey has taken her, Ridling added, “When I wrote that first application in 2008, I had no idea that in 2026 I would be a judge for this program. I was just a facility in small-town Missouri. It’s one of the best learning experiences that you will ever have.”</p><h3>Celebrating 30 Years </h3><p><img src="/Issues/2026/Summer/PublishingImages/Cristina-Walls.jpg" alt="Cristina Walls" class="ms-rtePosition-2" style="margin:5px;" />As the National Quality Award Program celebrates 30 years, the examiner community remains one of its greatest strengths. Examiners bring expertise, champions, and passion to the Quality Award journey. They also bring a commitment to helping others improve.</p><p>For those considering becoming an examiner, the message from these longtime leaders is simple: do it! It is demanding and it takes time, but the return—for the individual, for their organization, and for long term care—is invaluable.</p><p>As the National Quality Award Program looks ahead to its next 30 years, it is the people behind it who will carry it forward and define its future.</p><p><em><strong>Cristina Walls</strong> is senior manager, public affairs at the American Health Care Association/National Center for Assisted Living.</em><br></p>	Behind the scenes of the National Quality Award Program is a dedicated group of more than 200 volunteer examiners.	2026-06-01T04:00:00Z	<img alt="Examiners" src="/Issues/2026/Summer/PublishingImages/QA_sum26.jpg" style="BORDER:0px solid;" />	Quality Awards	Quality Awards
Hiring the Right Person for the Right Position	https://www.providermagazine.com/Issues/2026/Summer/Pages/Hiring-the-Right-Person-for-the-Right-Position.aspx	Hiring the Right Person for the Right Position	<p style="text-align:center;"><img src="/Issues/2026/Summer/PublishingImages/caregiving2_sum26.jpg" alt="medical staff" style="margin:5px;width:500px;height:263px;" /></p><p>Providing quality care begins with selecting the best candidates to join the organization’s team. Hiring is more than simply filling open positions. It’s ideally about building a workforce whose competence, reliability, and compassion align with the organization’s values and standards of care.</p><p>The right staff directly influences resident experiences, safety, regulatory compliance, and overall facility performance. Skilled and dependable employees offer consistently high-quality services that strengthen relationships with residents and families, reduce rehospitalizations, and support positive outcomes. Therefore, making the correct hiring decisions from the start is essential to maintain stability, protect the organization’s reputation, and ensure high-quality care. This article will help organization leaders hire the right staff for the right position, a crucial first step to improve outcomes for both residents and the facility.</p><h3>The Hiring Process</h3><p>During recruitment, the prospective staff member and employer have their first contact, with each forming an initial impression of the other based on image, attitude, communication style, and the exchange of information. It is important to remember that both the applicant and the prospective employer are making decisions about each other that could influence their potential future working relationship.</p><p>The next steps after recruitment include job application submission, interview, reference check, and pre-employment health screening. The hiring manager should ensure that this process is completed as quickly and efficiently as possible. Failure to evaluate an applicant swiftly could result in an organization losing a great candidate to another position elsewhere.</p><h3>Pre-Screening</h3><p>Some organizations conduct a screening before the formal interview. In this case, the pre-screening should be brief but thorough enough to allow the leader to determine if the candidate will be scheduled for a comprehensive interview that requires a significant amount of time and energy. This pre-screening process may be delegated to another individual or third-party organization as long as specific criteria are established to structure the process. The following describes a potential approach:<br></p><ul><li>Offer the applicant a written summary first, stating the salary range for the job and the requirements of a criminal background check and Drug-Free Workplace Program. The organization then completes a checklist based on the applicant’s responses. </li><li>If another employee or a third party conducts the pre-screening, that individual must understand the skills required for the open position, such as the desired education and experience.</li></ul><h3>The Interview</h3><p>Once a candidate has been vetted and appears to have the required skills for the job, an in-person interview should follow as soon as possible. The interview is a critical part of the hiring process to determine if the candidate possesses the desired qualities, talents, and skills. It can also help evaluate if the candidate would be a good fit for the organization’s culture. Remember that the interview is also the candidate’s opportunity to assess the organization, so staff should aim to make a positive impression. </p><p>The following offers recommendations for a successful interview:<br></p><ol><li>Choose personable staff to greet the candidate and help calm their nerves. Engaging in light conversation and offering a beverage can help create a warm welcome. A candidate who is kept waiting too long or treated dismissively may leave before the interview even begins.</li><li>Conduct the interview in a quiet environment without interruptions. An office in disarray or with distractions, such as a ringing phone or knocks on the door, gives an impression of disorganization.</li><li>Smile, be courteous, and pay attention to the interviewee. Keep in mind that the goal is to get acquainted with the candidate and help them feel comfortable, relax, and open up during the interview. If the interviewer begins by bombarding the candidate with questions, the candidate may become tense and guarded. Terse yes/no responses can mask the candidate’s true qualities.</li><li>Share with the candidate what the job means. Relate the story of the organization in a personal way by sharing its history, mission, goals, and vision for the future. Gauge the candidate’s response. The interviewer should be clear about what the role entails and honest about the job’s requirements, working hours, benefits, and salary. Pay attention to the candidate’s responses and body language that indicate enthusiasm or lack of affect.<sup>1</sup></li></ol><p>During the interview process, it is best to use a behavioral-based model. By discovering the candidate’s default behaviors, the interviewer can predict how the candidate will perform in the future and also gain some insights into their character and talents. </p><h3><img src="/Issues/2026/Summer/PublishingImages/caregiving_sum26.jpg" class="ms-rtePosition-2" alt="recruitment, workforce" style="margin:5px;width:250px;height:250px;" />Characteristics of a Strong Candidate</h3><p>Hiring staff with staying power begins with finding strong candidates whose characteristics mesh well with the organization. This goes beyond competency. For example, the following list describes characteristics to look for in a capable candidate:<br></p><ul><li><strong>Alignment with organization mission:</strong> Once the organization’s mission has been shared, does the candidate’s belief system correspond with it? Are they inspired?</li><li><strong>Experience in the role:</strong> Does the candidate need extra training? Be transparent regarding the requirements of the position and ensure that resources and training are provided if needed to ensure the candidate’s success.</li><li><strong>Complementing current team culture:</strong> Will the candidate fit in with the existing team, or will they cause tension or controversy?</li><li><strong>Promoting collaboration and dignity: </strong>Does the candidate appear compassionate and reliable? Share processes and expectations regarding communication and maintaining each resident’s dignity and well-being.</li><li><strong>Problem-solving:</strong> Is the candidate a problem solver? Ask the candidate to tell you about a problem they experienced and how they resolved it. Offer the candidate examples of how the organization helps secure the safety of residents and employees through creative problem-solving. </li><li><strong>Enhancing resident quality of life:</strong> Does the candidate exhibit the characteristics needed, such as empathy, to maintain or improve the residents’ quality of life? Explain the expectations of the position.</li></ul><h3>Beyond the Conversation</h3><p>Although the question-answer session is certainly important, the interview is not just about how the candidate can converse. Paying attention to the candidate’s body language can also help assess confidence, ability to work as part of a team, and trustworthiness. Facial expressions can offer insight into how a candidate feels about a question. Genuine natural smiles show an interest in the job. Good eye contact shows a willingness to cooperate and engage with others. </p><p>A candidate’s posture can show their interest in the position. Interested candidates will most likely sit up straight with an open posture facing the interviewer. Although the candidate may be nervous and fidget a little, increased restlessness may reveal low self-confidence or social awareness. When a candidate pauses to consider a question, it shows thoughtfulness. When a candidate is given an opportunity to speak but doesn’t ask any questions about the organization or the job, it may indicate a lack of interest. </p><p>By prioritizing candidates who align with the organization’s values and demonstrate both technical skill and compassion, hiring managers can create a foundation for staff who provide better resident outcomes, ensure stronger compliance, and are less likely to resign. In a field where trust and care unfold inside the facility, the right hire makes all the difference. </p><p><span class="ms-rteStyle-Normal"><img src="/Issues/2026/Summer/PublishingImages/Denise-Winzeler.jpg" alt="Denise Winzeler" class="ms-rtePosition-2" style="margin:5px;width:125px;height:154px;" />Reference<br>1. Pavlou, C. (2023). How to reduce new hire turnover. <a href="https://resources.workable.com/tutorial/new-hire-turnover-rate" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank" title="How to reduce new hire turnover">https://resources.workable.com/tutorial/new-hire-turnover-rate</a>.</span></p><p><em><strong>Denise Winzeler, BSN, RN, LNHA, DNS-MT, QCP-MT,</strong> is director of education and certification strategy for AAPACN.</em></p><p><em><br></em></p><p><img src="/Issues/2026/Spring/PublishingImages/AAPACN.jpg" alt="AAPACN" class="ms-rtePosition-1" style="margin:5px;width:165px;height:48px;" /> <span class="ms-rteFontSize-1">The American Association of Post-Acute Care Nursing (AAPACN®) champions innovation and transformation across the post-acute care continuum by enabling providers to deliver unparalleled care. Representing more than 18,000 post-acute care nurses and leaders in over 6,100 facilities nationwide, AAPACN provides industry-leading education, certification, and evidence-based resources that elevate quality of care and drive operational excellence. Learn more at <a href="https://www.aapacn.org/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank" title="AAPACN">AAPACN.org</a>.</span></p>	Organizations must align talent with mission, vision, and quality care to build a stable workforce that delivers positive outcomes.	2026-06-01T04:00:00Z	<img alt="recruitment, workforce" src="/Issues/2026/Summer/PublishingImages/caregiving_sum26.jpg" style="BORDER:0px solid;" />	Caregiving;Recruitment	Focus on Caregiving
Strengthening the Care Workforce	https://www.providermagazine.com/Issues/2026/Summer/Pages/Strengthening-the-Care-Workforce.aspx	Strengthening the Care Workforce	<p style="text-align:center;"> <img src="/Issues/2026/Summer/PublishingImages/workforce1_sum26.jpg" alt="medical staff" style="margin:5px;width:650px;height:317px;" /> </p><p style="text-align:center;"> <br> </p><p>Across long term care, one reality continues to unite providers: a strong workforce is essential for delivering quality care. The dedication of caregivers shapes every resident experience and defines the strength of communities across the country.</p><p>To care for the 4 million seniors who rely on nursing homes and skilled nursing facilities for care each year, nursing homes employ 1.5 million individuals. More than 500,000 individuals work in the nation’s assisted living communities, and nearly 120,000 work in intermediate care facilities for individuals with developmental disabilities. As the competition for workers increases, providers continue to seek new ways to maintain and build the long term care workforce.</p><p>According to an <a href="https://www.ahcancal.org/News-and-Communications/Press-Releases/Pages/Report-Nursing-Homes-Making-Significant-Progress-Workforce.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank" title="Report: Nursing Homes Making Significant Progress with Workforce">analysis</a> from the American Health Care Association and National Center for Assisted Living (AHCA/NCAL), providers are making measurable gains in rebuilding their workforce. In 2025 alone, nursing homes added more than 40,000 jobs, and nearly two-thirds of providers reported improved workforce conditions. Turnover has steadily declined since 2022, and reliance on agency staffing has dropped by more than 40 percent since 2023. These improvements reflect the commitment of providers to strengthen recruitment, retention, and training efforts, even amid ongoing financial pressures.</p><p>At the same time, workforce challenges remain. Staffing shortages continue to affect access to care in many communities, and demographic trends will place additional demands on the system in the years ahead. The progress achieved so far is meaningful, but it must be sustained.</p><h3>Building on Progress with Smart Policy</h3><p>Sustaining workforce gains requires more than operational changes. It depends on a policy environment that supports providers and recognizes the realities of delivering long term care.</p><p>Engagement with policymakers plays a critical role. Clear communication about workforce challenges and practical solutions helps ensure that policies align with the needs of providers and the individuals they serve.</p><p>The <a href="https://www.ahcancal.org/Advocacy/IssueBriefs/CNA%20Lockout%20IB.pdf" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank" title="Certified Nurse Aide Training: A Vital Resource for Providers and Communities">Ensuring Seniors’ Access to Quality Care Act</a> offers an example of a targeted, thoughtful policy solution. AHCA/NCAL has endorsed this bipartisan legislation because it addresses one of the most pressing workforce challenges: strengthening the pipeline of certified nurse aides. The bill would help providers resume and expand nurse aide training programs by reducing unnecessary stoppages tied to civil monetary penalties that are unrelated to quality of care or resident safety. In addition, the legislation would give Medicare and Medicaid providers (e.g., skilled nursing facilities) access to the National Practitioner Data Bank, which would help strengthen background screening and support more informed hiring decisions.</p><p> <br> </p><table cellspacing="0" class="ms-rteTable-2" align="center" style="height:200px;width:85%;"><tbody><tr class="ms-rteTableEvenRow-2"><td class="ms-rteTableEvenCol-2" colspan="2" style="width:35%;height:100px;"><img src="/Issues/2026/Summer/PublishingImages/workforce3_sum26.png" alt="educate.ahcancal.org" style="margin:10px;width:233px;height:184px;" /></td><td class="ms-rteTableOddCol-2" rowspan="1" style="width:50%;height:100px;"><span>AHCA/NCAL continually hosts long term care webinars on a variety of workforce-related topics. You can learn more on this series at <a href="https://educate.ahcancal.org./" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank" title="ahcancalED">https://educate.ahcancal.org.</a><br><br>If you are interested in learning more about AHCA/NCAL’s Workforce Committee, policy, and initiatives, please contact AHCA’s Associate Vice President of Workforce & Constituency Services, Dana Ritchie, at <a href="mailto:dritchie@ahca.org" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">dritchie@ahca.org</a>.</span></td></tr></tbody></table><p> <br> </p><p>Together, these provisions would make it easier for providers to train, recruit, and retain qualified caregivers. This type of practical, targeted policy approach helps remove barriers and supports the long-term stability of the workforce.</p><p>Policy leadership also extends beyond individual legislation. The <a href="https://www.ahcancal.org/Advocacy/Pages/Caregivers-for-Tomorrow.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank" title="Caregivers for Tomorrow">Caregivers for Tomorrow</a> initiative represents a nationwide effort to drive policy change and strengthen the long term care workforce through innovative, sustainable solutions. These efforts focus on attracting new caregivers, supporting current staff, and ensuring that older adults and individuals with disabilities have access to high-quality care for years to come.</p><p>This is a critical moment for policymakers, regulatory agencies, and stakeholders at every level to come together and advance meaningful, supportive solutions that address workforce challenges in a lasting way.</p><p>These priorities are further reinforced through AHCA’s <a href="https://www.ahcancal.org/Advocacy/Pages/The-Better-Way-Agenda.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank" title="The Better Way">The Better Way</a> agenda, which outlines a comprehensive approach to strengthening the profession. By focusing on sustainable funding, regulatory alignment, and workforce investment, the framework provides a roadmap for long-term stability and success.</p><p>Taken together, these policy efforts reflect a unified strategy: remove barriers, expand opportunity, and ensure providers have the tools needed to build and sustain a strong workforce.</p><h3>Strengthening the Workforce Pipeline</h3><p>While policy solutions are essential, long-term success also depends on continuing to build awareness and interest in caregiving careers.</p><p>For example, efforts like like AHCA’s <a href="https://careersincare.org/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank" title="Careers in Care">Careers in Caring</a> campaign help raise awareness about opportunities in long term care. By sharing the stories of caregivers and highlighting the purpose behind the work, the campaign encourages more individuals to explore careers in the field.</p><p>These efforts are especially important as the demand for long term care services continues to grow. Building and sustaining a workforce requires both attracting new talent and supporting those already in the field.</p><h3>A Broader Approach to Workforce Support</h3><p>Workforce development does not happen in isolation. Instead, it is closely tied to broader issues, such as reimbursement, regulation, and access to resources.</p><p>The Better Way outlines a comprehensive approach for addressing these interconnected challenges. By focusing on sustainable funding, regulatory alignment, and workforce investment, the framework provides a roadmap for long-term stability.</p><p>Providers understand that meaningful workforce investments require adequate resources. At the same time, reducing unnecessary administrative burden allows for more focus on staff support and resident care. Aligning these priorities is key to maintaining progress.</p><h3>Advocacy in Action</h3><p>Advocacy remains one of the most effective tools for advancing workforce solutions. Providers bring valuable insight to policy discussions through their direct experience managing teams and delivering care.<br>Practical steps can help strengthen advocacy efforts, such as:<br></p><ul><li>Sharing real-world examples that illustrate workforce challenges and successes.</li><li>Engaging with elected officials through meetings and facility visits.</li><li>Utilizing data and resources to support policy recommendations.</li><li>Collaborating with peers to amplify a unified message.</li><li>Encouraging staff participation in advocacy efforts.</li></ul><p>These actions help ensure that policymakers have a clear understanding of the issues and the solutions that can make a difference.</p><h3>Looking Ahead</h3><p>The long term care sector continues to demonstrate resilience and commitment. The progress reflected in recent workforce data is a testament to the efforts of providers and caregivers across the country.</p><p>Maintaining that momentum will require continued collaboration and focus. Policy solutions must support the realities of care delivery. Workforce initiatives must continue to expand opportunities and strengthen the pipeline. Advocacy must remain a priority at every level.</p><p> <span> <span> <img src="/Issues/2026/Summer/PublishingImages/Claire-Krawsczyn.jpg" alt="Claire Krawsczyn" class="ms-rtePosition-2" style="margin:5px;width:125px;height:154px;" /></span></span>There is no single solution to the workforce challenges facing long term care, but there is a clear path forward. By building on recent progress, advancing thoughtful policies, and continuing to invest in caregivers, the sector can move toward a more stable and sustainable future.</p><p>The demand for care is growing, and meeting that demand depends on a workforce that is supported, valued, and empowered to succeed. With continued effort and engagement, we can reach this goal. </p><p> <em> <strong>Claire Krawsczyn</strong> is senior director of media relations at the American Health Care Association/National Center for Assisted Living.</em><br></p>	A strong workforce in long term care is essential. There is a clear path forward through policy solutions, workforce initiatives, and advocacy.	2026-06-01T04:00:00Z	<img alt="medical staff 740" src="/Issues/2026/Summer/PublishingImages/workforce_sum26.jpg" style="BORDER:0px solid;" />	Workforce	Management
Resources and Advocacy Set a Strong Path for the Future	https://www.providermagazine.com/Issues/2026/Summer/Pages/Resources-and-Advocacy-Set-a-Strong-Path-for-the-Future.aspx	Resources and Advocacy Set a Strong Path for the Future	<p><img src="/Issues/2026/Summer/PublishingImages/AL-summer26.jpg" class="ms-rtePosition-1" alt="leadership, assisted living, resource, support" style="margin:5px;width:300px;height:300px;" />This year, as we celebrate the 25th anniversary of the National Center for Assisted Living (NCAL), we have a unique opportunity to reflect on the vital role that regulatory guidance and advocacy played in shaping assisted living across the country. For a sector defined by both housing and personal care services, the ability to navigate evolving regulations while focusing on resident-centered care is no small task. NCAL has spent the last quarter century ensuring that providers are not only equipped to meet those demands, but to lead the way forward.</p><h3>Regulatory Resources</h3><p>At the heart of NCAL’s mission lies a commitment to supporting assisted living communities through a robust suite of regulatory resources. These tools are designed to simplify complexity, promote compliance, and ultimately enhance the quality of life for residents. From comprehensive manuals to interactive data platforms, NCAL provides members with practical, customizable solutions that meet them where they are.</p><p>The most foundational resources include the <a href="https://ahcapublications.org/products/assisted-living-policy-and-procedure-manual" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank" title="Assisted Living Policy and Procedure Manual">Assisted Living Policy and Procedure Manual</a> and the <a href="https://ahcapublications.org/products/assisted-living-emergency-preparedness-and-procedure-manual" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank" title="Assisted Living Emergency Preparedness and Procedure Manual">Emergency Preparedness and Procedure Manual</a>. These living documents offer a framework of policies, procedures, and forms that providers can tailor to their unique settings. In an environment where expectations and best practices are continually evolving, the availability of such adaptable, up-to-date guidance is invaluable. These manuals don’t just help communities stay compliant, they help them stay prepared and be proactive.</p><h3>State-by-State Information</h3><p>Another essential resource is <a href="https://www.ahcancal.org/Assisted-Living/Policy/Pages/state-regulations.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083">NCAL’s State Regulatory Review</a>, an annual publication that translates complex, state-by-state requirements into a clear and accessible format. Because assisted living is regulated at the state level, providers must navigate a patchwork of licensing standards, staffing requirements, and scope-of-care rules. The State Regulatory Review brings clarity to that landscape, offering summaries for all 50 states and the District of Columbia. It highlights key topics such as move-in requirements including required notifications, assessment requirements, and staff scheduling and training requirements, to name a few.</p><p>This state-driven approach to regulation offers both a challenge and an opportunity. While variability can create complexity, it also allows for innovation. Different states adopt different philosophies regarding the role of assisted living within the broader long term care continuum, enabling providers to develop models that reflect local needs and preferences. NCAL’s resources help members not only understand these differences but leverage them to deliver more responsive, person-centered care.</p><p>To further streamline access to information, NCAL offers an assisted living <a href="https://www.ahcancal.org/Assisted-Living/Policy/Pages/Assisted-Living-Regulation-Mapping.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083">Regulation Mapping tool</a>, which is a comprehensive, member-only database that serves as a one-stop shop for regulatory research. This interactive platform allows users to search regulations and key terms across all states, making it significantly easier to locate and interpret requirements. In an environment where time and accuracy are critical, this kind of regulation accessibility is a game changer.</p><p>In addition, the <a href="https://www.ahcancal.org/Assisted-Living/Policy/Pages/NCAL-State-Bill-Tracker.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083">NCAL State Bill Tracker</a> keeps members informed about legislation and regulatory activity in real time. With the ability to filter by state, topic, or bill number, providers can stay ahead of policy changes that may affect their operations. This proactive approach to monitoring ensures that members are never caught off guard and are always prepared to respond.</p><p>Another powerful tool is the <a href="https://www.ahcancal.org/Assisted-Living/Policy/Pages/Assisted-Living-State-Survey-Data.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083">Assisted Living State Survey Data resource</a>, developed in partnership with Formation Healthcare. By analyzing survey deficiencies across categories such as quality of care, staffing, and life safety, this platform helps providers identify trends, benchmark performance, and target areas for improvement. It transforms data into actionable insight, which is an essential step in driving continuous quality improvement.</p><h3>Advocacy Efforts</h3><p>While these regulatory resources are indispensable, they are only one part of the equation. Advocacy is the force that shapes the environment in which assisted living operates. NCAL’s growing membership represents a unified, influential voice on Capitol Hill and in statehouses across the nation. Through coordinated advocacy efforts, members can influence policy, protect access to care, and ensure that regulations support, rather than hinder, innovation and quality.</p><p>The connection between regulation and advocacy is inseparable. Understanding the rules is essential, but helping to shape them is transformative. NCAL empowers providers to do both, offering the tools, resources, and guidance needed to stay informed and take action. Whether it’s engaging with lawmakers, responding to proposed regulations, or sharing frontline perspectives, every member plays a role.</p><p>We encourage every assisted living provider to take action and invite your elected officials to visit your community. Show them the high-quality care you provide, have them meet your residents, and demonstrate the value and love you give every day. In fact, AHCA/NCAL provides all the resources you need to host a successful visit. On their <a href="http://www.ahcancal.org/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank" title="ahcancal.org">website</a>, navigate to the Advocacy tab to find “<a href="https://www.ahcancal.org/Advocacy/Documents/HowToGuide.pdf" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank" title="How to Guide">A ‘How To’ Guide to Facility Tours for Elected Officials</a>,” which includes sample templates for invitations, press, social media, and more. </p><p><img src="/Issues/2026/Summer/PublishingImages/Jill-Schewe.jpg" alt="Jill Schewe" class="ms-rtePosition-2" style="margin:5px;" />If you didn’t get a chance to attend the AHCA/NCAL Congressional Briefing in Washington, D.C., this year, we hope you’ll make plans to attend in 2027. You can also reach out to any NCAL staff for assistance in setting up meetings on Capitol Hill. It’s not too late, and we are here to support you.</p><p>As NCAL celebrates 25 years of service, its impact is clear—stronger communities, better informed providers, and a more cohesive, forward-thinking assisted living profession. By combining comprehensive regulatory resources with a powerful advocacy platform, NCAL continues to equip assisted living leaders not just to navigate the present, but to help define the future.</p><p><em><strong>Jill Schewe</strong> is director of policy and regulatory affairs for the National Center for Assisted Living (NCAL).</em><br></p>	By combining comprehensive regulatory resources with a powerful advocacy platform, NCAL equips assisted living leaders for success.	2026-06-01T04:00:00Z	<img alt="leaders, success, resources" src="/Issues/2026/Summer/PublishingImages/AL-summer26.jpg" style="BORDER:0px solid;" />	Assisted Living	Spotlight on Assisted Living
Continuous Quality Improvement in Nursing Homes	https://www.providermagazine.com/Issues/2026/Summer/Pages/Continuous-Quality-Improvement-in-Nursing-Homes.aspx	Continuous Quality Improvement in Nursing Homes	<p style="text-align:center;"><img src="/Issues/2026/Summer/PublishingImages/BTN3_sum26.jpg" alt="By the Numbers" style="margin:5px;width:398px;" /><br></p><p>America’s nursing homes and skilled nursing facilities have undertaken significant efforts to strengthen quality care in recent years, with measurable results. In its latest Quality Report, the American Health Care Association tracks improvements since the end of the COVID-19 Public Health Emergency (2023-2025) in several key areas that are meaningful to patients’ and residents’ quality of life.<sup>1</sup></p><p><sup><br></sup></p><p style="text-align:center;"><sup><img src="/Issues/2026/Summer/PublishingImages/BTN_measures-short.jpg" alt="short stay" style="margin:5px;width:500px;height:162px;" /></sup> </p><p style="text-align:center;"><sup><br></sup></p><p style="text-align:center;"><sup><img src="/Issues/2026/Summer/PublishingImages/BTN_measures-long.jpg" alt="long stay" style="margin:5px;width:500px;height:162px;" /></sup> </p><p style="text-align:center;"><span><span><img src="/Issues/2026/Summer/PublishingImages/BTN2_sum26.jpg" class="ms-rtePosition-1" alt="residents / families" style="margin:5px;width:129px;height:162px;" /></span></span><br></p><div><br></div><div><br></div>More than three-quarters of residents and families are satisfied with their care, demonstrating that facilities are improving the overall experience.² <div><br><p><span class="ms-rteStyle-Quote"><br></span></p><p><span class="ms-rteStyle-Quote"><br></span></p><p><span class="ms-rteStyle-Quote">References</span><br class="ms-rteStyle-Quote"></p><ol><li><span class="ms-rteStyle-Quote">AHCA analysis of Centers for Medicare and Medicaid Services Nursing Home QMs data: SS Discharge Function Score (Q4 2023-Q1 2025); SS ED Visits (Q1 2023-Q2 2025); SS Discharge to Community (Q3 2023-Q4 2024); LS data from Q1 2023 to Q3 2025.</span></li><li><span class="ms-rteStyle-Quote">Customer Satisfaction scores calculated by CoreQ; data from Calendar Year 2025.</span></li></ol><p></p></div>	In its latest Quality Report, the American Health Care Association tracks improvements since the end of the COVID-19 Public Health Emergency (2023-2025) in several key areas that are meaningful to patients’ and residents’ quality of life.	2026-06-01T04:00:00Z	<img alt="By the Numbers 740" src="/Issues/2026/Summer/PublishingImages/BTN_sum26.jpg" style="BORDER:0px solid;" />	By the Numbers	By the Numbers

News Currents

Regulatory Updates Echo AHCA's Better Way	https://www.providermagazine.com/Issues/2026/Summer/Pages/Regulatory-Updates-Echo-AHCA's-Better-Way.aspx	Regulatory Updates Echo AHCA's Better Way	<p style="text-align:center;"><img src="/Issues/2026/Summer/PublishingImages/SF%20reg_2203581622.jpg" alt="staff meeting" style="margin:5px;" /> </p><p style="text-align:center;"><br></p><p style="text-align:left;">The American Health Care Association (AHCA)’s <a href="/Issues/2025/Summer/Pages/AHCA%27s-Better-Way-to-Support-an-Aging-America.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" title="Better Way agenda" target="_blank">Better Way</a> agenda is based on the principle that America’s aging population unequivocally deserves high quality care. In order to deliver that care, providers need an efficient, effective, transparent, and accountable regulatory system that prioritizes residents and their caregivers. Better Way begins with the premise that oversight is necessary—and that it must be rational. </p><p>Reform takes time, but recent Centers for Medicare and Medicaid Services (CMS) updates show that policymakers are listening to the concerns of long term care providers across the country. Recent rule changes address longstanding inefficiencies and restrictive policies, helping skilled nursing facilities (SNFs) redirect their focus from untangling bureaucratic red tape to caring for their residents. From faster dispute resolution to more accessible civil money penalty funds, here’s what’s changed and what those changes mean for AHCA members.</p><h3>Faster, More Transparent Dispute Resolution</h3><p>CMS’s Informal Dispute Resolution (IDR) process gives facilities the right to appeal citations. For many providers, their appeal has been complicated by the time it takes regulators to complete the process. Some AHCA members have waited close to a year for a decision, all the while facing reputational damage due to the deficiency cited on their record. In addition, they have often received decisions with no clear explanation, leaving them in the dark about the full picture of the alleged deficiency.</p><p><img src="/Issues/2026/Summer/PublishingImages/SF-reg_sum26.jpg" alt="Better Way" class="ms-rtePosition-2" style="margin:5px;width:250px;height:250px;" />This is why the Better Way agenda advocated for IDRs to require timely response from CMS and state health departments, with a written rationale for the regulator’s decision. New CMS guidance, which took effect on April 30, 2026, provides for just that: a decision completed within 60 days of the facility’s request, with a written explanation of the reviewer’s conclusions. </p><p>“We’re encouraged that they provide clarity on that process,” said Holly Harmon, AHCA/NCAL’s senior vice president of quality, regulatory, and clinical services. “We appreciate and advocated for that because understanding the rationale behind a decision is inherent to quality improvement so the right interventions can be applied.”</p><h3>More Efficient Reviews</h3><p>In another helpful update, CMS adjusted its guidance regarding offsite reviews of cited deficiencies, also known as desk reviews. As providers know, when surveyors issue citations to a facility, the facility responds by submitting a plan of correction, after which the surveyor returns to ensure compliance. However, many deficiencies don’t necessarily require onsite observation to ensure compliance, and because of state agencies’ backlogs, those return visits often happen only after considerable delays.</p><p><img src="/Issues/2026/Summer/PublishingImages/Holly-Harmon.jpg" alt="Holly Harmon" class="ms-rtePosition-1" style="margin:5px;width:125px;height:154px;" />It was with these backlogs in mind that AHCA advocated for CMS to allow desk reviews of some deficiencies—a change that would help increase government efficiency while speeding up the review process for providers. In guidance that also took effect on April 30, 2026, CMS allows offsite reviews for less serious deficiencies—D, E, and F without substandard quality of care—and for those that simply don’t require direct observation. “This update helps everyone use their resources more effectively,” said Harmon. “It means that state surveyors can be more effective in performing onsite or offsite follow-up, where indicated.”</p><p>The updates also provide clearer guidance on noncompliance survey timelines. In the past, agency backlogs could result in overlapping survey cycles, with facilities correcting alleged deficiencies only to have new complaint investigations extending the enforcement cycle—even if the facility returned to compliance after the earlier citations. The new framework, for which AHCA advocated, closes the original survey cycle and starts a new one, provided certain conditions are met. </p><p>CMS also updated the Nursing Home Compare Health Inspection Rating, providing a more accurate and timely picture for consumers. Previously, CMS used a facility’s three most recent standard surveys to calculate its star rating. However, starting in July 2025, as a result of ongoing backlogs, the tool refined the calculation to incorporate only the two most recent surveys. </p><h3>Reevaluating Revalidation</h3><p>In December 2025, CMS also announced the indefinite suspension of its January 1, 2026, deadline for the mandatory off-cycle SNF provider enrollment revalidation process. Ownership disclosures are nothing new for nursing homes; however, new reporting requirements drastically expanded the amount of information providers needed to gather, including information from unrelated third parties that have no ownership stake. Meanwhile, the off-cycle revalidation process was a first-time attempt to revalidate all 15,000 nursing homes at the exact same time. As a result, providers and CMS’s data reporting systems were overwhelmed, resulting in the need to suspend the deadline to submit the disclosures. </p><p><img src="/Issues/2026/Summer/PublishingImages/John-Kane.jpg" alt="John Kane" class="ms-rtePosition-1" style="margin:5px;width:125px;height:154px;" />AHCA was a champion of relaying the unrealistic deadline to CMS. “We appreciate CMS’s recognition of the significant challenges that providers faced throughout this unprecedented and extensive revalidation process, and we are grateful they are offering indefinite relief,” said John Kane, senior vice president of reimbursement policy at AHCA/NCAL. “Ultimately, this protects continuity of care for our residents.” Failing to properly submit their revalidation paperwork by the deadline threatened suspension of the facility from the Medicare and Medicaid programs. </p><p>Kane argued that there needs to be a sustainable balance between transparency and administrative burden, something AHCA will continue to advocate to policymakers. “We look forward to continuing to work with CMS on ways we can streamline reporting and focus on the information that is meaningful to residents, families, and stakeholders.”</p><p>While the deadline is suspended, the revalidation process remains as many nursing homes continue to submit their paperwork, and CMS continues to share this information publicly once processed. </p><h3>CMP Reinvestment Updates</h3><p>A vital update to the Civil Money Penalty (CMP) Reinvestment Program was implemented in late 2025, after years of advocacy by AHCA. As Hawley Hunt, AHCA/NCAL senior director, regulatory and quality services, <a href="/Issues/2026/Spring/Pages/Regulatory-Improvements—-and-What-Comes-Next.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank" title="Regulatory Improvements—and What Comes Next ">explained</a> in the Spring issue of <em>Provider</em>, the program is designed to let SNFs and other stakeholders access CMP funds for various quality-improvement projects. In 2023, however, CMS removed several reinvestment options, making the program too restrictive for many providers. </p><p>Thanks to CMS’s updates last year, providers can now use CMP funds for a wider variety of purposes, including technological investments, workforce development, and behavioral health services. In addition, whereas the application process used to be prohibitively complex—with different versions for providers in different states—CMS has now improved it to a single form. “We’re grateful to CMS for responding to our concerns about the program,” Harmon said. “We believe that these changes are significant to increase access and use of the available CMP funds in support of quality improvement in nursing homes.”</p><h3>Roadmap for the Future</h3><p>Another encouraging development is the new strategic <a href="https://www.cms.gov/newsroom/blog/optimal-health-all-within-nations-health-long-term-care-systems-ccsq-fy2025-2028-strategic-roadmap" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank" title="CCSQ FY2025–2028 Strategic Roadmap">roadmap</a> released by CMS’s Center for Clinical Standards and Quality (CCSQ) in early March 2026. The plan lays out five strategic goals that CMS CCSQ will advance over the coming years: Prevention, Quality and Safety, Coverage Innovation, Data and Technology, and Burden Reduction. It also <a href="https://www.cms.gov/files/document/optimal-health-all-within-our-nations-health-long-term-care-systems.pdf" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank" title="Optimal Health for All Within Our Nation’s Health and Long-Term Care Systems">describes</a> programs that align closely with AHCA’s Better Way proposals: risk-based surveys, an accrediting organization pilot, streamlining outdated regulations, simplifying redundant data systems, and updated guidance for evidence-based nutrition standards.</p><p>“We’re encouraged to see a number of changes in the CCSQ roadmap that we believe could bring holistic reform and drive better results and quality,” said Harmon. “CMS specifically states that everyone deserves care that is safe, reliable, and high quality, and AHCA fully agrees.”</p><p>As these updates show, policymakers and providers share a common goal: building a more efficient, rational oversight system that will improve the health and safety of America’s aging population. That objective is at the heart of AHCA’s Better Way agenda, and it will shape the organization’s advocacy in the years to come. </p><p><em><strong>Steve Manning</strong> is a journalist based in New York City.</em><br></p>	Recent updates by CMS signal that federal policymakers are receptive to finding a better way when it comes to oversight of skilled nursing facilities.	2026-06-01T04:00:00Z	<img alt="AHCA's Better Way" src="/Issues/2026/Summer/PublishingImages/SF-reg_sum26.jpg" style="BORDER:0px solid;" />	Policy	Special Feature	Steve Manning	53	2
Sarah Silva: The Leader with Heart	https://www.providermagazine.com/Issues/2026/Summer/Pages/Sarah-Silva-The-Leader-with-Heart.aspx	Sarah Silva: The Leader with Heart	<p><img src="/Issues/2026/Summer/PublishingImages/Sarah-Silva.jpg" alt="Sarah Silva" class="ms-rtePosition-2" style="margin:5px;" />Sarah Silva was a brand-new face when she walked into a skilled nursing facility (SNF) during her junior year of high school. The daughter of a coal miner and a horticulturist, she had no previous experience in the world of long term and post-acute care. The training program, which allowed students to perform clinicals outside of the classroom, caught her eye. But after spending some time in the SNF, something caught her heart.</p><p>“It wasn’t something I had experienced before,” she says. “In the moment, I just knew that I enjoyed it. I loved getting to know the residents, and it became obvious that it was something I loved. I look at it now and I can say it was life changing.” </p><h3>Enter Assisted Living</h3><p>Silva changed her focus from medical school to being a certified nursing assistant. With continued exposure to skilled nursing, she enjoyed the interaction with residents and the healing that took place, but she realized that the time spent with residents, although meaningful, was short. </p><p>She then heard about a new assisted living building that was being constructed in her local community. Once she went in, she was hooked. </p><p>“It was new and beautiful,” says Silva. “I fell in love with assisted living because I love meeting people where they are. You get to build long-term relationships with the residents, and you are with them every single day. Once I started down that road, I stayed there.”</p><p>Over 20 years later, Silva grew through a number of positions in assisted living, both in Oregon and around the country. Today, she is the chair of the National Center for Assisted Living (NCAL), the assisted living arm of the American Health Care Association (AHCA), where she helps guide priorities for the sector and represents assisted living to national audiences. </p><h3>Going for It</h3><p>Silva’s road to leadership started at home. Her family lived outside of town and had a large garden. One of 11 children, she and her siblings learned the value of hard work from their parents. Everyone had to pitch in to keep things going.</p><p>However, beyond the fundamental lessons of working hard and being prepared, Sarah says it was her mother who modeled one of the most important values to her and her siblings. “If you want something, you have to go for it,” says Silva. “Our mother taught us that. She is the one who went back to school after having been a stay-at-home mom, and she got her degree in horticulture.” </p><p>Her mother was successful in her new career, and soon her success brought the family to Oregon. </p><p>“Seeing her decide in her late 30s and 40s what her dream was, and going after it, that’s something that lives with me and all of my siblings,” says Silva. “Many of us went back to school as adults, and we have an ongoing love of learning. That is one of the things that propelled me.”</p><h3>Doing It All</h3><p>Silva often jokes that she’s worked every role in assisted living, but the truth is, she might have. She started as a caregiver and then became a medication technician, front desk assistant, care coordinator, business office manager, assistant executive director (ED), ED, administrator, and more.</p><p>“That ability to go to that next step at any point in my career was only brought about by having wonderful mentors and the value that was instilled in me and my in siblings to always be learning,” says Silva. “Always be willing to do something, even if you don’t feel like you’re ready for it. Those are the reasons that I’ve managed to go from being a caregiver to being a president.”</p><p>Silva’s most recent role was as president of Arete Living. Today, she is Chief Quality and Strategy Officer at Senior Housing Managers, LLC. The company, which is based in Wilsonville, Ore., owns, operates, develops, and manages senior housing communities.</p><h3>National Leadership</h3><p>As NCAL Board chair, Silva prioritizes amplifying the assisted living profession’s voice. Not only does she focus on carrying out NCAL’s work but also on bringing new voices from across the country to the table to share ideas and best practices.</p><p>“The more that we can pull in a variety of operators, from the small, independently owned, to the medium-sized regional operators, to the large national ones, the better,” she says. “Everyone is participating in the industry and making life better for seniors, and a critical element moving forward is to engage people at all levels.”</p><p>One place where Silva sees that providers are engaged is the AHCA/NCAL National Quality Award Program. And again, Silva’s experience here is vast. Having been an operator who went through the program, she says that going through all the levels changes how providers operate. </p><p>“It was a career-changing portion of my life to go through that with the team, to drill down and change how we think about quality,” she says.</p><table cellspacing="0" class="ms-rteTable-0" align="center" style="width:50%;height:87px;"><tbody><tr class="ms-rteTableEvenRow-0"><td class="ms-rteTableEvenCol-0" style="width:100%;"><div style="background-color:#e1a846;color:black;padding:15px;"><div style="text-align:center;"> <a href="/Video-Resources/ProviderTV/Pages/3-Ways-Assisted-Living-Providers-Can-Lay-the-Groundwork-for-Future-Success.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" title="3 Ways Assisted Living Providers Can Lay the Groundwork for Future Success" target="_blank"><span class="ms-rteFontSize-4"><strong><img src="/Articles/PublishingImages/2026/Sarah-Silva_play.jpg" class="ms-rteImage-1" alt="Sarah Silva" style="margin:5px;" /><span class="ms-rteFontSize-3">Watch <em>Provider's</em> interview with Sarah Silva</span></strong></span></a></div><p></p> </div></td></tr></tbody></table><h3>A Quality Champion</h3><p>The Baldrige Performance Excellence Program, on which the National Quality Award Program is based, is a national model for excellence that focuses on all parts of an organization. While providers collect data on clinical measures, such as falls, hospitalizations, rehospitalizations, off-label use of antipsychotic medication, etc., other areas of the program call for action. </p><p>“You look at your life enrichment team and say, ‘What does it look like in this department? How are we ensuring that the programming that we’re offering is inclusive and is meeting the needs of every one of our residents, not just the ones who are social and come out for every activity?’”</p><p>She also points out posing questions for other departments. “It’s taking that mindset of continuous quality improvement and applying it in every aspect of your business to transform the community and building a cohesive team so that everyone is moving in the same direction and has the same goal.”</p><h3>Looking Ahead</h3><p>Silva points to an incoming surge of individuals who are going to need care, roughly four million people over 80 every five years. Although providers are already meeting the demands, Silva says it will be critical to keep resident choice front and center. </p><p>“The generation we are going to continue to care for are people who have spent their entire life advocating for individual choice and to live life on their terms,” says Silva. “For providers, the key is to figure out how to overcome obstacles and ensure that residents get to live this next chapter of life on their own terms, and that it is just as fulfilling and life affirming as every other chapter of their life has been.”</p><p>Silva points out that she has already observed a surge of people who are staying home longer and entering assisted living at a higher acuity than seen in the past. </p><p>“We’ve been presented with a unique challenge of ensuring that we are supporting that resident’s independence as much as possible, while taking care of them,” she says. “The reality is we’re both hospitality and health care, and it’s our job to do both of them equally well.”</p><h3>The Workforce Task</h3><p>The key to meeting this challenge is to attract, retain, and support a large, dedicated workforce, which continues to be its own challenge for assisted living providers. Doubly so, Silva says, as the gap between the number of people who work as caregivers and the number of people who need them will grow. Still, she sees opportunities amid assisted living’s responsibility.</p><p>“There is such a credible hope in the fact that the generation that is entering the workforce wants to do great work,” she says. “They want their work to have meaning, and they want their work to have purpose.” </p><p>“It’s our job to find them. It’s our job to train them. It’s our job to introduce them to our field and to this very purpose-driven work as a career opportunity that isn’t always top of mind.”</p><h3>A Million Good for Every Bad</h3><p>Working in any health care field is not easy. The hours are often long, and many professionals are on call several hours a day. In her over 20 years in the profession, Silva says what keeps her energized is, hands down, the people. “You can’t help but be energized when you are surrounded by people every day that just want to do the right thing,” she says. </p><p>She lights up speaking about a friend, also named Sarah, who is just a phone call away. </p><p>“At any point, if I feel like I am having a bad moment, or there’s something that’s weighing me down, I know she’s just a phone call away,” she says. The profession is filled with people like her.</p><p>“When you’re done talking to them, they will have reminded you why the bad moment is okay, because there are a million more good moments than bad. They’ll say, ‘Okay, but do you want to hear what happened at this community today? Because you’ll love this story.’”</p><p>“Sometimes when you’re in a leadership position, your phone tends to ring with news that something bad has happened, but what keeps me energized is remembering that there’s a million good things for every one of those bad ones.” <br><br><em><strong>Amy Mendoza</strong> is a freelance writer and editor specializing in long term care, health policy, and health care operations.</em></p>	Silva often jokes that she’s worked every role in assisted living, but the truth is, she might have. She started as a caregiver and then became a medication technician, front desk assistant, care coordinator, business office manager, assistant executive director (ED), ED, administrator, and more.	2026-06-01T04:00:00Z	<img alt="" src="/Issues/2026/Summer/PublishingImages/Sarah-Silva.jpg" style="BORDER:0px solid;" />	Assisted Living	Special Feature	Amy Mendoza	53	2

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