Clif Porter might not officially become president and CEO of the largest US nursing home association until later this year, but the new hire already has a pretty good idea of how he wants to guide the American Health Care Association/National Center for Assisted Living and the rest of the sector — and what it will take to get it done.
A penultimate goal is getting regulators to rationally and consistently assess providers throughout the country, he told McKnight’s Long-Term Care News Thursday in his first interview since his promotion was announced July 15.
He expressed cautious optimism about the possibility of getting bills passed by the end of the year to ease LTC workforce challenges. He also said he looks forward to making long-term care site visits a regular part of his routine again. The administrator of a 34-bed nursing home at the start of his career, Porter said he was still energized a day after visiting a handful of facilities in inner city and suburban Detroit, and he was looking forward to more visits in Pittsburgh Friday.
“I like to hear from those closest to wherever the problem or issue exists, and have them as an integral part of whatever solution exists,” he said, labeling his management style “empowering and participative.” “I want our folks to feel they’re leading on whatever issue they’re facing and I’m more or less there to support them.”
He said when problem-solving, he plans to listen, make collaborative decisions “and then require people to move fast. That’s probably one trademark: I like to move fast.”
The music buff and self-proclaimed audiophile praised the man he will be succeeding, current President and CEO Mark Parkinson, for teaching him how to listen closely and make “everybody feel a part of the team.” Over the last decade of working under Parkinson, Porter said the AHCA team has built a great “launch pad for our future.”
Below, edited highlights of the McKnight’s interview with Porter reveal his desire for continuity and creativity and a wish to capitalize on the sector’s “extremely bright” future.
What do you want to be a signature of the Clif Porter term as AHCA/NCAL’s top exec?
There’s a couple things I want to continue. The first is it’s critically important we stay united. I learned early, particularly in government affairs, you get nothing done if you’re not unified. And the nature of democracy is about majorities and consensus. Our political process just doesn’t work if you don’t have that.
Mark started his tenure bringing organizations together. My intention is to continue to be united as one voice and hopefully build an even bigger tent to include more groups through coalitions and other organizations working together on common problems.
A hallmark I want is for people to view me as someone who is very engaged with what’s going on in their operation.
I want people to view not only me, but also AHCA, as not only someone who cares and is aggressive and is pushing the agenda, but also is out there listening, observing and experiencing the challenges our operators are facing. Ultimately, that just makes us better advocates.
What do you see as the biggest opportunities ahead?
Our future is extremely bright. The main reason is we have a service that people need and the folks that need it are exploding. There’s lots of pessimism and different opinions on long-term care, and specifically institutional care, in that construct.
Ultimately, the care we provide is an essential portion of the healthcare system. That got highlighted during the pandemic, and I think policymakers fully understand that now.
Policymakers understand, one, we’re essential. As demand grows, it puts us in a position to where we can obviously scale on that growth and hopefully create an environment for our providers where we can do a better job caring for people and ultimately prospering.
The changes in demographics is a huge tailwind for us. I also think from a policy construct, there’s going to continue to be a focus on new ideas, new ways to deliver care, how can we do it more efficiently, how can we do it more effectively, how can we solve problems in disparate rural communities, for example.
I’m super-excited because I think there’s going to be some opportunities ahead where we can be innovative and potentially work in partnership with other types of care delivery models and potentially be able to innovate and diversify our services, and partner our services in ways never looked at before.
How about challenges?
We’re used to challenges. Obviously, workforce is a huge one. I think our country, and policymakers in particular, have put on blinders as it relates to this impending crisis. It’s already a challenge but it will soon become a crisis.
There’s studies that show there will probably be a shortage of 200,000-450,000 RNs by next year. So we’re not talking about 10 years from now or five years from now. Next year. A shortage of 200,000-450,000.
That’s serious, and we’re nowhere near the peak of demand, so that’s just going to grow if we don’t do something differently.
I also think we have to … observe the push to regulate us more, penalize us more. That, to me, seems to be intensifying. It’s always been a point of friction as long as I’ve been in the business, but it’s probably worse than it’s ever been.
I don’t see that changing immediately, but we’ve got work to do to change the construct that’s ultimately going to promote and improve while we care, not just be about penalizing and punishing providers.
Do you think the Supreme Court’s Chevron decision is going to make the regulatory environment less punishing going forward?
I really hope so. I’m no attorney, but we’re talking about legal doctrine and talking about courts and judges making decisions about statutes.
I think fundamentally that’s probably a good thing. The basis of the decision was to say that agencies do not have the authority to determine what’s intended in the statute, but judges do. And judges should have the ultimate deference in determining where there’s vagueness and how to clarify that.
The nice thing about judges is they’re accustomed to process, and due process and fairness, the essential nature of fairness.
If I were going to be dealing with a structure, I’d much rather deal with more of a judicial structure on certain regulations rather than having one surveyor in one state interpret something one way and then you go to another region of the country and you interpret it completely differently.
At a minimum we’re hopeful we’ll see consistency, but a lot of this will have to evolve as judges make decisions. I do think it’s going to be positive. Exactly how it looks going forward is unknown at this point, but at least I’m optimistic it creates opportunity for us.
What workforce legislation do you think has the best odds of traction and passage?
I’m cautiously optimistic about a couple of bills we’ve been working on for a few sessions of Congress. During the pandemic one allowed us to have temporary nursing assistants. [The Building America’s Health Care Workforce Act (H.R. 468)] That was a lifesaver during the pandemic, at least to get hands on deck to provide care.
We’re seeking to make that program permanent because it was an excellent career ladder, if you will, to becoming a nursing assistant and getting skills. That’s out there and bipartisan.
We’re excited and the growing cadre of members who are interested.
Then another piece of legislation we’re feeling good about. We call it the CNA lockout bill. It’s the Ensuring Seniors’ Access to Quality Care Act. [S. 1749/H.R. 3227]. It’s bipartisan, bicameral legislation [and] deals with nurse training programs.
It essentially helps us control our destiny a bit. We know we have [worker] shortages. Why not create the ability to let us grow our own?
I think they have a legitimate chance, particularly in a lame duck session [of Congress at the end of the year]. So we’re going to be pushing for inclusion once we identify a moving vehicle to actually pass these. If you think about it, again, it’s just common sense.
There are other big ideas, particularly with immigration, that get caught up in macro politics that make them less likely to pass.
Fast-forwarding, what do you hope people ultimately will say about your time at the AHCA helm?
I want to be able to retire and have folks say Clif’s time at AHCA was a time when the regulatory environment was fundamentally changed in a way that improved quality. If we were to accomplish that, I would be thrilled.
I want our sector to be attractive to young people.
The thing I learned, particularly in the first part of my career, is there’s no business in America that offers a 20-something the opportunity to lead and have real responsibility and make consequential decisions as long-term care does. Our leaders really do lead. They really do manage our businesses, they really do take care of and are licensed professionals responsible professionally to take care of people, and it’s a heavy responsibility for a young person.
I think it gives you a headstart in life. It just really creates a strength and a balance early, where you work through some of the fears in leadership in your 20s, which makes you so much of a stronger leader in your 30s and 40s and 50s.
I hope to create an environment where young people say I really want to do this.
What’s the key to that?
We’ve got to fundamentally rationalize the regulatory environment sector for that to happen.
We have an irrational regulatory construct. I don’t use the term “reform.” I don’t use the term “repeals.”
I had to take care of my own mother and I loved that lady. That’s an emotional, heavy responsibility that families all across America have to bear. And guess what? I wanted her protected because I love her. So having a regulatory environment is important and is something I fully and completely support. But what we have now is completely irrational. It’s inconsistent by geography. It’s inconsistent by surveyor, It’s inconsistent by regions. It’s inconsistent based on the administration that’s in the White House.
It’s the only sector where you have a grading scale that’s not clear. You don’t know what an A is going to be. Today’s it’s an A, tomorrow it’s an F. For a leader, that’s beyond frustrating and discouraging.
You have some surveyor come in and throw the book at them over something that doesn’t make sense. It just cuts back your efforts for your team and there’s only so much you can take. All I would love to see is a grading scale that’s consistent across the country in every geography in America. This is what an A is, this is what an F is. And it’s enforced in a clear and consistent way.
If we can accomplish that, we’re going to have phenomenal leaders coming into our sector because there’s no sector like ours.
Hear more from Porter next week when he joins McKnight’s Executive Editor Jim Berklan for a Newsmakers Podcast.
