Mark Parkinson at the 73rd annual AHCA/NCAL Convention (Photo by Lois Bowers)

NASHVILLE, TN — Leaders of nursing homes’ largest provider group Monday struck an optimistic tone as they officially kicked off their annual convention, exhorting providers to press on and commit to quality as they rebuild for a new generation of residents.

While hallway conversations at the 73rd annual American Health Care Association/National Center for Assisted Living convention expressed concerns about regulatory burdens and unceasing staffing demands, President and CEO Mark Parkinson told providers that the worst may be behind them. 

Skilled nursing occupancy still averages about 5% below pre-pandemic levels nationally, but 30% of operators are now at or above their pre-pandemic numbers.

“The naysayers that were out there that said, ‘People will never come back to facilities, the sector will never survive,’ were simply wrong,” Parksinon said during the opening session Monday morning. “Our services both in assisted living and skilled nursing facilities are critically needed, more people will need those services as the Boomers age, and we already have buildings that are in recovery.”

In a self-effacing speech in which he bemoaned turning 65, slowing down and getting injured more often, Parkinson also sought to boost his members.

“I do see some things clearer than I used to,” he said. “And one thing that I am sure about and that I do see very clearly is that you, your team and your company are going to survive this pandemic. You are going to make it.”

Parkinson stressed the need for more providers to follow in the steps of current top performers and commit to quality by building culture, seizing opportunities with ancillaries and special situations and building up leaders who hold themselves and their teams accountable.

He urged members to remain part of the sector’s broader efforts to shape national policy, even as they face their own challenges at home. 

“We’ve gotten policies reversed,” he said proudly in reference to letter writing and other grassroots work that led to changes in the federal vaccine mandate and later convinced the Centers for Medicare & Medicaid Services to phase in payment cuts more slowly. “It’s really, really tough to do that in DC.”

Finding purpose

Much of the conversation around the show floor Monday focused on staffing shortages and the recently expired national waiver for temporary nurse aides. Weighing heavily, as well, was the expectation that the Centers for Medicare & Medicaid Services will propose a challenging staffing minimum in spring.

AHCA Board Chair Phil Fogg Jr., president and CEO of Marquis Companies, addressed the staffing crisis in remarks about his own experience as a fourth-generation family operator. Fogg started his career as a 12-year-old who worked as a laundry aide, housekeeper and dishwasher. 

“I, as an individual, could make a difference in the lives of our residents every day,” he said. “The meaning and purpose I got from that made me a better person and happier person, and this is what caused me to fall in love with the profession.”

The industry is hungry for thousands more workers who will feel that pull and the reward of a job well done, Fogg said.

“Knowing the difference that we’ve made in people’s lives is what attracts and keeps us in this profession, and that is true even when we are faced with the perfect storm of fighting the pandemic, managing through unprecedented workforce shortages and navigating the financial challenges of skyrocketing inflation without adequate reimbursement,” he said.

Parksinson added that living through previous economic cycles has convinced him that this too shall pass — a position he said he wasn’t sure he’d come around to even a year ago.

“I have lived through 11 recession, eight of them as an adult. I’ve seen interest rates and inflation at 20%, and now I’ve seen negative interest rates and negative inflation. I’ve seen the market get cut in half multiple times … I‘ve seen the large companies in our space succeed and then fail and then succeed and then fail again … I’ve heard all the predictions about how we won’t make it. Then we survive and we struggle and we survive again.”

Parkinson said he was buoyed by an unspoken agreement and commitment from the federal government to continue funding these services.

He noted that in pre-pandemic times, margins averaged 2%, with top performers sometimes breaking 4%. During the pandemic, the margin band shifted dramatically south, where the top performers were breaking even or losing small amounts, while the average performers were losing 4%.

If the government had allowed that shift to last through 2022, attendance at the 2022 convection would have been remarkably low because “we would have gone broke” Parkinson said.

“They won’t make these extraordinary payments forever,” he added. “We will need to recover.”

Gritting it out

He urged providers to stay active in lobbying efforts, saying the lessons learned from sharing potential challenges of Patient Driven Payment Model cuts and narrow COVID vaccine rules demonstrated very real threats to critical services in the healthcare continuum. Parkinson expects providers will need to once again raise their voices if CMS proposes a staff mandate in April as expected.

For his part, Fogg said grit will be critical in coming months, especially as economic and political factors combine to bring new pressure on the industry.

“Staying united will be critical to the recovery of our profession because frankly, we are in a political climate that demands that we fight for all of the issues that impact our profession and the people that we serve,” he said. “Our future is brighter than today. If we work together, we will get through this stronger than when we went in. Optimism brings hope, and hope is the road between today and a full recovery. We know where we’re going. We just have to stay strong and navigate through some remaining bumps on that road.” 

About 3,100 attendees are registered for this year’s convention, which is not back up to pre-pandemic levels but outpaces last year. The meeting runs through Wednesday.