Opportunities to make a difference and to have a say in policymaking on the state or national level are all around you every day. Taking advantage of them may seem challenging, but you can integrate advocacy into your daily routine and be effective without undue burdens on your already busy schedule. Ultimately, you can take the steps that get you in the door and give you a seat at the table.

Small but Mighty

“I am a small provider, so I don’t have a dedicated staff for advocacy; and a lot of us are in the same boat. However, I have some invitations pending right now for representatives from New Mexico and Nevada to visit our facilities and residents,” said Gerald Hamilton, owner, operator, and leader at BeeHive Homes. “Until they come and talk face-to-face with our residents and staff, they really can’t understand what we are doing and the challenges they are facing.”

These facility visits can make a powerful difference. Hamilton said, “We point out the difference in payors between skilled nursing and assisted living [AL]. Some policymakers are surprised to learn that Medicare doesn’t pay for AL. They also talk to residents and families about what care costs and how they pay.”

Additionally, legislators get to hear residents’ stories firsthand and learn about the challenges they face and how legislative efforts and federal funding can help them. They also can talk to staff about why they like working in this field and what positive changes might improve staffing and care.

Legislators may come with information and data about the long term care industry, Hamilton said, but they leave with a real picture of the people—their constituents—who live and work in these settings.

Like his other AHCA/NCAL colleagues, Hamilton has a more-than-full plate, yet he makes time to arrange tours, visit legislators in their offices, and attend the annual AHCA/NCAL Congressional Briefing. He said, “Every interaction is an opportunity to educate policymakers. We have a chance to correct some misperceptions and help them see a true picture of what we do to care for our residents and address the challenges we face and work to overcome. They also get to see how committed our teams are to providing quality care.” This effort may take more of a relationship than can be developed in one tour or meeting, he admitted, but each interaction opens the door and starts a dialogue.

Hamilton said, “We have been able to have open conversations about what we do in assisted living and the importance of keeping regulations for this sector at the state level. I think we’ve had some success on that front, as well as on preserving the Medicaid benefit in some states.”

During the pandemic, Hamilton and other AHCA/NCAL members had great successes dealing in a collaborative way with policymakers regarding such issues as vaccination guidelines. “Those relationships were productive for our residents. Working collaboratively was key to getting the resources we needed,” he observed.

How to Become an Advocate

Relationships are a big part of advocacy. Start by identifying who you need to engage at the state and federal levels. Then you can request to meet with legislators through their district offices. You don’t have to travel to Washington, D.C., or the state capital. In fact, you’re likely to have greater success if you offer to meet legislators in their home office during congressional recesses.

Know in advance what you want to accomplish. Do you want to introduce yourself to establish a relationship? Do you want to invite policymakers for a tour or to attend a special event? Do you want to introduce legislators and their staff to a professional issue impacting your industry and their constituents? Or are you asking them to support or oppose a particular piece of legislation that has been or is about to be introduced?

Help Is Here

While it’s true that advocacy is challenging, there is help available to make it easier. For instance, AHCA/NCAL has a webpage dedicated to advocacy at https://www.ahcancal.org/Advocacy/Pages/default.aspx. It includes an advocacy toolkit, a guide to political action and grassroots lobbying, tips on how to craft an effective message, and steps for meeting with a member of Congress. It also includes a how-to guide to facility tours for elected officials and steps for a successful facility tour.

“AHCA/NCAL has been helpful to us in setting up our invites for visits,” said Hamilton. Staff at the association and state affiliates know the players on Capitol Hill and the procedures for setting up appointments and arranging facility tours.

Leverage Connections

Whatever your goal, stressing your constituent connection is important. The best way to gain traction in Washington, D.C., is to connect with congressional offices where you are a voting constituent. This ultimately brings your issues “close to home and will get priority attention,” said Leigh Davitian, JD, founder and chief executive officer of The Dumbarton Group, based in Washington, D.C.

Once formal communication with your elected representatives begins, address your direct connection—where you live, where you went to school, and where you work. When discussing your work, be sure to comment on how many people you employ in their district, and how many constituents you care for within their district or state. Elected representatives are grateful to help their constituents because they can reap the rewards of helping with issues directly impacting their home district or state.

Personal connections are key, however, “if you want to meet with a congressional official from another district or state where you have no connection,” Davitian said, “It is doable and beneficial.”

First, identify other congressional officials who sit on germane committees leading ongoing health care initiatives. Then, reach out to their offices. Remember to make a connection between their interests and positions and your specific health care advocacy issue. Focus on both the House and Senate members who sit on committees that directly deal with Medicare, Medicaid, and, specifically, long term care.

Prioritize Preparation

“Preparation is huge. An organized meeting will make a huge impression,” said Davitian. “You don’t have to be an expert on the issues you’re advocating for, but you need to know the basics, including how [those issues] impact their district and state, as well as their constituents and other stakeholders. Cover all the bases.”

To make your meeting successful, know your audience. Davitian suggested, “Do some research and educate yourself about the elected official you’ll be meeting with. Study their legislative initiatives and know what committees they sit on so you have a sense of where their expertise lies. Do they sit on any committees impacting health care, and if so, how do they approach health care issues, and ultimately how do they seem to vote?” These are all important questions to research, said Davitian.

It will be important to know if the policymakers have a history of supporting the post-acute and long term care industry. If they don’t seem to have experience working on health care issues, be prepared to provide some background and education. Alternatively, if they have a health care background or focus, you don’t want to talk down to them or waste their time sharing information they already know.

Staffers Matter

If you make an appointment with your legislator, don’t be disappointed if your meeting turns out to be with a staffer. “Staff are the gatekeepers. Their primary role is to gather all the information and synthesize it into key points to present to the elected official. It some ways, it’s more important to meet with them than your representative,” said Davitian. These individuals have been tasked with learning the issues, asking questions, weighing the risks and benefits of various issues, and making recommendations to their boss.

Whether you meet with your representative or a staffer, be prepared to keep it short and sweet. “Understand you are trying to sell something to a very busy person. You have to find a choreographed way to present your elevator speech about the strength of an issue and what your ask will be,” said Davitian.

When Conflict Arises

In an ideal world, your legislator will be as enthusiastic about your issues as you are. However, Davitian suggested, “be prepared for retorts. They may not see eye to eye on your issue, and there could be some weaknesses in it or opposition to it.”

If your pitch gets derailed, you can offer some additional information that might help your case and get back to your legislator or staffer with answers to their questions or concerns. It’s OK to say, “That’s an interesting perspective. I will take your comments into consideration and give it some thought.”

If it becomes clear that you and your representative are on opposite sides of an issue and reach a stalemate, don’t push or try to force a discussion. In this case, it may be best to back off and find another issue or topic on which you have common ground.

Hamilton said, “If you can’t agree on something, maybe you can find something else you can work on together. Don’t be so laser-focused on one issue that it disrupts the conversation or your relationship.”
He suggested, “The most effective thing I’ve found is to focus on the real lives of residents no matter which political party they’re with. The human aspect resonates with most people, and it makes an impression.”

Ultimately, Hamilton said, “from my experience, most congressional representatives and staff will react positively to your input. They will take the time to listen, even if they don’t agree.”

Ongoing Advocacy

In some ways, advocacy is a 24/7 job. As a member of your community and industry, you can connect with policymakers and other decision-makers on an ongoing basis. This means:

• Getting involved in local politics, including town halls, meetings, and fundraisers.
• Getting to know county, city, state, and federal officials. Find out if you have common interests or activities—you go to the same church, your kids go to school together, you share a love of golf or tennis, you support the arts, etc.
• Participate in town council meetings, the chamber of commerce or Rotary Club, and other community organizations. Build on relationships you establish through these.
• Organize events and invite legislators to attend. For instance, invite them to a county fair day or a resident art show at your facility.
• Participate in letter-writing campaigns. Contact your representatives when issues arise that you want to have a say in. Let them know if you can provide them with information or support about an issue they’re working on.

In the end, said Kathy Gallin, vice president of legislative affairs and health policy at Signature HealthCARE, “If we are truly going to impact change and make a difference, we must be effective industry leaders with a strong political voice, actively engaged in building and developing proactive solutions.” She added, “Follow-up is vastly important once we get our foot in the door so our legislators remember us, the conversations we have had, and the stories we have shared. We must continue developing and maintain those key relationships with our elected officials.” ​