‘It’s demoralizing’: Health management CEO on misunderstandings shaping nursing home policy

With significant pressure coming from government entities, further shaped by public perception as the nursing home industry faces a crushing staffing crisis, shared accountability between operators, their lobbying representatives and local advocates has become even more important.

Health Management CEO Debbie Mead has a seat at the table with roles at the American Health Care Association (AHCA) and the Georgia Health Care Association (GHCA) that are helping her gain the ear of policymakers and administrative leaders as an operator of the NHS.

Although she lives in both worlds, she believes there needs to be better understanding between advocates and operators, as well as regulators.

Mead runs four facilities in Georgia with his daughter; Health Management is a fourth generation company. She said her time on national boards better informed her role as a small independent operator in the state.

Skilled Nursing News caught up with Meade during the AHCA/NCAL conference earlier this month to learn more about healthcare management and how a small operator can have a big impact by connecting advocacy and operational leadership.

The conversation with Mead has been edited for length and clarity.

Skilled Nursing News: How have your roles at AHCA and GHCA influenced your role as CEO of Health Management and how do you see policy changing in the space?

Mead: We can’t be on both sides of the fence. There has to be education on both sides, because sometimes what advocates are angry about, calling for more oversight, the regulations are already there, there’s oversight already there, they just don’t know it.

It’s interesting when you’ve been going to Washington, D.C. for 20 years now and making visits to Congress – you think they know, but they don’t. Unless we educate them, they will not understand. They don’t know today’s resident, they don’t know how sick that resident is and what the needs are for the right staff to provide that care.

Mental health is lacking in this country. We need mental health support, but CMS has written regulations that say qualified facilities must identify behavior before it happens? Where is the training for our staff to identify this?

Most operators wish they were in a room with CMS every day – you actually are with your advocacy roles. What do you tell them?

The topic that we are talking about with CMS and that we are trying to overcome is shared accountability. We can’t be perfect every day. Nobody can. There is always free will, someone makes the wrong decision. That doesn’t mean it’s a deficient practice. If a staff member gets nervous and gives the wrong answer, but three other staff give you the correct answer, is that not enough practice?

It’s demoralizing when you work so hard and the state surveyors just want to screw someone over a minor thing that happened. The research process should be changed and not [be] penal system.

How do you think this relationship affects staffing ability?

Expectations are one of our staffing issues. Do you want to work in a building, do you want to work in a profession where you are expected to be perfect and if you make the slightest mistake, your job could be potentially in jeopardy? Who wants that pressure?

How does this pressure mix with more poignancy among residents?

Balance sheet figures – a nursing home receives 100 admissions per year. A post-acute care facility receives 400 admissions per year. You get a group that has taken one every other week or maybe one a month… up to seven intakes a day.

This is a huge cultural shift that everyone needs to understand. Then you get 24 hours to make an impression on a post-emergency patient because they’re only going to be with you for eight days, 12 days, 18 to 20 days at most, the clock is ticking. We need to know everything about them to provide the best quality care, we need to have all preventive measures planned for 24 hours. This is a huge cultural shift to make when under nursing home regulation you have 14 days to complete the MDS and 21 days to complete the care plan.

How specifically has healthcare management fared amid ongoing staffing challenges?

Staffing challenges are real. I’ve been through seven admins in the last year and a half. There’s a lot of burnout…it was really hard. I don’t have weeks and months to train someone, so I need someone who can take it and be theirs and treat it as their own. This is hard to find. Today they need more than “What do you want, I need you to show me everything, I need you to write everything down.” I don’t have the resources to do this so it was a bit difficult and I have very high expectations.

I learned that I will not lower my expectations, I will work with someone more than that expectation… to maintain and preserve that culture.

Anything else you would like to say regarding operator-government relations?

I’ll preface this with, I’m not a Republican and I’m not a Democrat; I am a politician. I follow politics, especially when it comes to my profession. I will say that under the Trump administration, Seema Verma was a long-term care rock star. Mike Pence was the rock star behind the funding. I was in the White House at the table across from him, and he looked me in the eye and said, “How can we help?” This suits me very well. It’s about the people.

With the new administration, we are the bad guys, we are doing everything wrong, we have too much funding. This turnaround when we are already having such a hard time recruiting, we have gone from hero to zero with the change in administration. That would be the only thing I want to say, “What did we do differently? What is different? I would like someone to answer this question.

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