Spotlight On: Chris Downing, President & CEO, Georgia Health Care Association
September 2024 — Georgia Health Care Association President Chris Downing spoke with Focus: about the evolution of the long-term healthcare industry in Georgia, and how the GHCA continues to battle the lasting effects of COVID while contending with shifts in the field resulting from regulatory changes and technological advancements.
What milestones did the GHCA achieve over the last 12 to 18 months?
The Georgia Health Care Association (GHCA) is a trade association in Georgia for nursing homes, assisted living and home and community based service providers. Trade associations exist in every industry, and ours represents post-acute and long-term care. We find that there is strength in numbers, and our members come together under our umbrella because we can advocate on their behalf.
This industry is highly regulated and requires frequent interaction with government agencies, legislators, and Congress. We focus on those relationships so we can represent our members in their times of need, allowing them to focus on providing healthcare while we handle the red tape.
Our lobbying efforts are significant, along with continual education and training for industry workers to keep up with their necessary certifications and training credits. Hitting quality metrics and indicators is crucial for complying with regulations. Our goal is to offer the best quality healthcare possible, as value-based care is critical to those we serve and Georgia’s healthcare system as a whole.
While many outside of healthcare have put COVID in the rearview mirror, long-term healthcare is still feeling its effects, though we are gradually seeing improvement. Staffing shortages remain a significant challenge. The toll of the pandemic has left a lasting impact, as we dealt with our patients dying and our staff getting sick themselves, burning out, and being isolated within buildings while witnessing these tragedies. We are actively focused on recruiting and encouraging people to return to the industry and are working on understanding why we’ve not seen an increase in people entering this profession.
If you’re operating a nursing home that is sitting empty or which is operating under 85% occupancy, it severely impacts the bottom line and finances. Thankfully as we move further away from COVID, these occupancy numbers are increasing, though facing the pressure of reimbursement remains a particular challenge. Navigating Medicare and Medicaid, with Medicaid as the predominant payer for long-term care in the United States, presents its own challenges as our demographic shifts to an older population.
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What advocacy efforts are underway at the association?
We lobby at both the federal and state levels on behalf of our members. At the state level, our main priority involves lobbying for additional Medicaid funding and continued innovation in service delivery models. At the federal level, staffing is a daunting challenge for which we advocate. Even before COVID, the state of Georgia was down 5,000 employees in our industry. The federal government has imposed minimum staffing requirements for nursing homes, which sounds beneficial but is problematic given the staffing deficit. Implementing this requirement would cost around $6 billion, and the necessary staff simply aren’t available. We’re frustrated and disappointed, and this mandate is being challenged in court.
What successful strategies are you employing to attract and retain staff?
The burnout, public perception, and competition from other industries are all factors in attacking this challenge. Medicaid is our predominant payer, but they do not pay competitively compared to what potential hirees would be making in other industries. It’s a lower reimbursement stream, but 75-80% of our funding comes from Medicaid. Hospitals and doctor’s offices offer better pay and less stressful environments, which leads nurses to leave for those positions. Some of our members are utilizing strategies like increased pay, favorable bonus structures, time off, vacation, flexible hours, and remote work to attract and retain workers, but we still continue to face strong headwinds.
How is the association supporting its members in adopting new technologies to advance care, increase operations, and ease workloads?
There has been significant advancement in technology utilization in our space in the past ten years. Of course, the degree to which this may be adopted varies by provider. Electronic health records, patient monitoring devices, remote monitoring, and assistive technologies are just some of the areas that have advanced quality of care and quality of life for residents. These advancements typically take place at the facility level. Each provider decides how much technology they want to incorporate into the care they provide. More sophisticated providers are more involved in technological processes like medical record storage and providing direct care. Smaller mom-and-pop facilities still operate without much technology and function the old-fashioned way. Limited reimbursement can restrict how much money can be spent on technology, which some view as a luxury rather than a necessity.
What trends are you observing in patient care that you are excited about?
There’s a strong movement in healthcare toward pay-for-performance, which is beneficial for everyone. Under this model, if you provide quality care, the federal government will pay you more. Patients are being closely monitored, and higher quality care results in better reimbursement. On the flip side, if the care provided doesn’t meet quality standards, providers won’t have access to these additional funds or incentives. As a result, everyone is incentivized, and the good actors are benefiting.
How do you envision the future of long-term care in Georgia, and what is your outlook for the association?
The industry is constantly evolving and is driven by demographic shifts. The aging baby boomer population has specific desires, such as staying home as long as possible before moving into a facility. Likely we will continue to see growth in the home and community-based setting as consumers seek to remain at home as long as possible. Admission to nursing centers will occur as chronic conditions progress and higher levels of care are required. Facilities are responding to consumer preference as they continue to evaluate their physical plant environments and service models. The intersection of healthcare and hospitality will continue to emerge as providers think outside the box to cater to patients’ needs and offer amenities such as Starbucks and computer stations.
Can you provide an example of an amenity or outreach endeavor initiated by the association that benefits residents?
Every year we host a pageant for our nursing home residents. At the facility level, the homes host their own local pageants where their residents compete and are celebrated. The winners at those local pageants enter into a statewide pageant competition, which we hosted this year in Macon. Our yearly escorts are veterans of foreign wars dressed in their traditional military uniform. It’s a heartwarming event that brings joy to everyone involved.
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