Q&A with Charles Roadman II, retiring chief of AHCA

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After undergoing knee surgery to treat an old gymnastics injury and wrapping up other affairs this summer, Charles Roadman II plans to retire to San Antonio, TX, to be closer to his two sons and other family members. "I've been away from home since going into college actually," the 60-year-old said. A forthright speaker who previously rose to the rank of lieutenant general in the Air Force, he explains where progress has been made for long-term care providers, and where work is still needed.

Q What is your proudest accomplishment during your tenure as chief executive of the American Health Care Association?
A I'm really not sure there's a single answer to that. Obviously, the pulling together of the community as much as it has. And the transitioning out of the "industry" mindset to that of a profession, along with the quality partnership with CMS (Centers for Medicare & Medicaid Services) and the community with the Alliance for Quality Nursing Home Care and AAHSA (American Association of Homes and Services for the Aging) and Quality First.
In many ways, it's really recalibrating the profession of long-term care as we start to face the really tough issues ahead of us.

Q When you say "tough issues," what specifically are you referring to? How will providers cope with them?
A We have laid down the beginning of quality. Clearly the full implementation of quality of life and quality outcomes is a critical issue for the profession.
But I think the underpinnings of getting to quality is stabilization of staffing, and training aides so capability at the bedside is elevated.
The only way to do this is to consolidate our partnership with the government so that we get sustainable funding. The system has been able to produce exactly what it's produced. If we want something different, there has to be handholding with people who make policy as a nation to us as providers.

Q So what needs to take center stage, now and in the future, after you're gone??
A None of the answers I'll give you will be a surprise. Just the same old broken record it's always been. It's always about quality, and quality is about staffing, which is about funding. That is the backbone, if you will, about fixing long-term care in our country.
In many ways, quality costs what it costs. People point the finger at providers, but the issue comes right back to statehouses and Congress to make sure that, in fact, we do have the resources necessary to do that care.
Q What's been the most unexpected occurrence during your leadership period with the American Health Care Association?
A In many ways, reaching out to the community and they responded. OSHA (the Occupational Safety and Health Administration), the Department of Labor and CMS have all responded to overtures of quality, and they've responded to overtures for helping fix staffing.
That's not really unexpected. It's really just saying there's a strategy of reaching out and forming coalitions, getting critical political mass of anyone who has a stake in the issues. Many of us are moving in the same direction and want to have the same results. It's a lot easier if it's not an adversarial relationship.
My view is that consumers (consumer advocates) have been the last ones to the dance. The providers and governmental structures have responded better. Remember, there's been an almost adversarial relationship in the past with a lot of the consumer groups. And many see their role as to continue to the flogging rather than fixing the problem.

Q You're a big proponent of long-term care providers' voluntary Quality First initiative. How do you view its performance at this point?
A We have 98% of the states signed on and about 40% of the facilities signed on. I would describe it as embryonic. The goals of where we're going are out there.
It is moving. I'm obviously disappointed the National Commission for Quality Long-term Care hasn't been announced and put out yet. We've been working with the National Quality Forum to get that going, and going strong.
Everything's moving in the right direction. Nothing ever moves as quickly as you'd want it to.
Nothing's ever good enough for me. Part of leadership is being unsatisfied with where we are and wanting more and more.
On the other hand, this is a sea change for a large part of the healthcare system. We're making progress.

Q Looking back, what would you do differently regarding the Quality First initiative and the Nursing Home Quality Initiative, which, to the surprise of some, you c

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