Fighting for assisted living facilities

Fighting for assisted living facilities
© Greg Nash

Mark Parkinson says he hasn’t had a good night’s sleep in five years. Parkinson is the CEO of the trade group for nursing homes and assisted living facilities, which means the possibility of funding cuts always looms in the back of his mind.

“Every other week, there is some threat to our funding,” the former Kansas governor said in an interview in his Washington office. “The reason that it is so hard to sleep is that our margins are small. We’re a high-revenue business, but our margins are only 1.9 percent.”

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Over 70 percent of the funding for nursing homes and assisted living facilities comes from Medicare and Medicaid, he estimates, which means that even small tweaks to payment formulas can have major implications. 

“We are completely dependent on the safety net,” Parkinson said.

For Medicaid in particular, state budget problems can lead to proposals for drastic cuts, like the possibility of a 25 percent reduction in Oklahoma right now. 

Other times, another organization comes out with a report calling for cuts to nursing homes. 

“Each of these proposals that’s out there is very worrisome, and it’s why we have an army of lobbyists, and it’s why we host 150 political events a year, and it’s why we try to come up with policy solutions, because if we don’t, changes would be made that I think would make most of our members no longer able to succeed,” he said.

Adding to the worries, the Obama administration is in the midst of an effort to try to dramatically change how the government pays for healthcare. The goal is to move toward rewarding quality outcomes for patients and away from the traditional system of paying a fee for each service provided, which rewards quantity but not necessarily quality. 

Parkinson’s organizations, the American Health Care Association (AHCA) and the National Center for Assisted Living, support this shift in payment philosophies, but the devil is in the details. 

For example, the AHCA has concerns about a new Obama administration payment model for hip and knee replacements. The new model puts forward one bundled payment for all of the care associated with the joint replacement, rather than paying separately for each service provided. 

If providers keep costs below the bundled amount and meet quality targets, they are financially rewarded. 

The AHCA wants to make sure that its members at skilled nursing facilities (SNFs) aren’t being skipped over in this model as a way to hold down costs. Parkinson said the answer is to have strong quality measures, not just cost measures, in a bundled payment model. 

“Time will tell, but our specific concern is that there’s such an emphasis on reducing costs that hospitals will skip the SNFs altogether just to get the person home to reduce the cost,” Parkinson said. 

An added challenge is the aging of the population, which is expected to add to the burden on nursing homes and other care providers for the elderly. 

Twenty percent of the population will be 65 or older by 2050, compared to 12 percent in 2000, according to the Congressional Budget Office, which added that spending on care for the elderly will “rise substantially in the coming decades.”

Parkinson’s passion for the work started in the mid-1990s, when he was a lawyer and a Democratic Kansas state senator and happened to tour an assisted living facility in his district. At the time, assisted living was a new model, providing a pleasant place to live and get care that was in between staying at home and going to a nursing home. 

Parkinson was blown away. He asked his wife, Stacy, to come tour the facility as well, and that night they decided to open their own. 

He and Stacy went on to open 10 assisted living and nursing facilities and operate them for more than 15 years. 

He said he was inspired on that first tour of an assisted living building because “before then, there were no residential-type-feeling places for older people, and so assisted living was the first thing that came along and created a real home-like environment.”

But Parkinson was not done with politics. In 2006, he became lieutenant governor of Kansas under Gov. Kathleen SebeliusKathleen SebeliusJohn Roberts has tough job of keeping faith in Supreme Court Price was a disaster for HHS — Time for an administrator, not an ideologue Trump says he's unhappy with Price MORE. When Sebelius moved to Washington in 2009 to become secretary of Health and Human Services (HHS), Parkinson moved up to become governor, and then on to his AHCA job when the term expired in 2011. 

And while Parkinson worked for years with Sebelius in Kansas politics, he says that didn’t lead to any access perks when she was HHS secretary. 

For one thing, there were a few things going on at HHS, such as an overhaul of the national healthcare system. 

“To say that she had her hands full would be a massive understatement,” Parkinson said.  Moreover, the AHCA’s issues are more commonly handled by career officials lower down the food chain, not the secretary. 

“I never called Kathleen when she was the head of HHS and said, ‘I need you to do this for me,’ ” Parkinson said. “First of all, I wouldn’t do it, and second of all, she would have hung up.”

When not worrying about impending Medicare cuts or on the road traveling to the AHCA’s state chapters, Parkinson says he brings his metric-based approach to his own life.

“My wife and I are both sort of health nuts, and we have been for a long time, and so I’ve been running for 35ish years,” he said. “Running is an overstatement. It’s more like a very pathetic jog.”

Parkinson has three kids, now out of the house, and two dogs. While he sometimes works 80-hour weeks, he often comes home at night to watch the Golden State Warriors.

Despite the long hours, he sees the job as a perfect fit, combining politics with his time in the business. 

“I would not have gotten the job if I hadn’t had my political background,” Parkinson said. “But it’s really the fact that I had been in the buildings; I know what it is that our members are generally thinking about. I know what makes them really happy and the joys of it, and I also know the frustrations, and sometimes the outright terror, that’s connected with owning these buildings.”