Episode Transcript
Alan Helgeson:
“Reimagining Rural Health,” a podcast series brought to you by Sanford Health. In this series, we explore the challenges facing health care systems across the country from improving access to equitable care, building a sustainable workforce, and discovering innovative ways to deliver high-quality, low-cost services in rural and underserved populations. Each episode examines how Sanford Health and other health systems are advancing care for the unique communities they serve.
In this episode, Ann Nachtigal with Sanford Health News talks with Mark Parkinson, president and CEO of the American Health Care Association and the National Center for Assisted Living. Mr. Parkinson joins an expert panel at the 2023 Summit on the Future of Rural Health Care with the topic “sync or swim,” aligning workforce solutions to support care across the continuum.
Ann Nachtigal (host):
Mark Parkinson, welcome. Thank you for joining us here at the Summit on the Future of Rural Health care.
Mark Parkinson:
Glad to. Excited for the day.
Ann Nachtigal (host):
Yeah, I think it’s going to be just so fun to have this incredible group of thought leaders here to talk about the future of rural health care. Such an important topic. We are here, of course, to talk about that and I want to know, what is the current environment in the long-term and post-acute care providers? What are they operating in right now?
Mark Parkinson:
Well, long term, I’m optimistic and I want to make sure that comes through, but in the short term, we’ve got some real challenges. The short-term challenges are that we’re still recovering from COVID. I mean, obviously COVID was a once-in-a-hundred year, hopefully once-in-a-thousand year type experience. And even now, three years out from the vaccine we’re still in the recovery phase. And it’s really a twofold issue for operators.
The first is census. Census has come back pretty well, but not completely back. The bigger problem is what we’re talking about most of the day today, which is workforce. We saw a massive decrease in the number of people that were working in nursing homes and long-term care facilities across the country. And it has slowly recovered, but it has got a long way to go.
When we look at the data, you know, we started out with 1.5 million people working in nursing homes at the start of the pandemic. We lost 250,000 of them that left our sector. We’re still 150,000 short. Which, to put that in perspective, that’s about 10 workers a building. So it’s a big deal. And it makes it very hard.
Ann Nachtigal (host):
So the staffing mandate, obviously that’s a huge topic right now. And I know that you’ve published an op-ed in The Hill back in March talking about you know, let’s not leave some really practical solutions on the table. Let’s talk about how we can you know – that’s not the solution, to have a mandate when we can’t even find the workers. So let’s talk a little bit about that. What’s that environment like? What are your expectations for how that comes out?
Mark Parkinson:
Well, the staffing mandate was clearly put together by people that do not understand rural America, do not understand the staffing challenges that we have, particularly in rural buildings. And it is basically a death sentence to nursing homes that are in rural areas.
Because when you look at the data, there are virtually no buildings in the rural part of the country that meet the staffing requirement. We are then mandated to meet a requirement where the workers aren’t available. And if we don’t meet the requirement, it’s not like we just get like a negative notation or a slap on the wrist. They can shut us down.
And so, we’re taking this extremely seriously. We need folks to contact members of Congress and say, “Hey, just don’t let the administration do this.” It’s very, very worrisome. Now, I have faith in our system, you know. I’ve been involved in public policy for almost 50 years now, and I think that we’ll get some improvements in this policy. We’ll eventually get it right. But it is an enormous threat.
Ann Nachtigal (host):
Let’s talk about, we’re here to talk about workforce solutions. What about trying to, like you said, we’re down a lot of people, right? In the long-term care, post-acute care environment, how do we attract, retain those good workers going forward? What are some of those strategies to find that?
Mark Parkinson:
Well, as a Kansan and a person that still has a farm in western Kansas, I’m pretty bullish about just rural life in general. You know, one of the things that happened with the pandemic is that all of a sudden, companies across the country started saying you can live and you can work where you want to. And we’re going to let you make your choice on where you want to live and work.
And what we’ve seen over the last three years is we’ve seen an increasing number of people that said, I don’t want to live in a big city. I’d like to live, you know, where I grew up or out in the country, or where the pace is, there’s no traffic. There’s not the craziness of the big towns.
And so you look at the data and for the last several years, there have been large parts of rural America that have actually had an increase in population. Now, I don’t know if that’s going to continue. We’ll find out in time. But I’m hopeful that it will. And I just think stabilizing the population in rural America will be very, very helpful to all these workforce challenges.
On top of that, what excites me are conferences like this. I mean, we’ve got some of the best thought leaders in the world, you know, with Sanford and with other rural health care organizations that are just super committed, not just to providing great health care, which is extremely important, but to preserving the way of life that people in rural America have. I mean, the listeners that live in the rural parts of the country know what I mean.
There’s a real mantra, sometimes unspoken, that we’re not going to lose this for future generations. We’re going to figure out a way to make this work. And just, you know, the excitement that you can feel already this morning, it’s just a part of that.
Ann Nachtigal (host):
It is really exciting. And, you know, rural America, we could be the leaders, right? I mean, I think that’s what the people that are here today are here to try to find those solutions and lead the way for the rest of America. Right? And it almost seems like in an earlier interview I did, we talked about that we can be more nimble.
Mark Parkinson:
Yeah, absolutely.
Ann Nachtigal (host):
And innovative.
Mark Parkinson:
Yeah. You just don’t have the bureaucracies that these super large organizations have. And the passion and the commitment to the community is not something that you see typically in an urban area. So I think there are a lot of challenges, but there are also a lot of things that rural America has going for it.
But the other thing that we’re going to have to figure out, and this is across the whole health care spectrum, but it’s certainly true in rural parts of the country, we’re going to have to figure out how to take care of people with less workers.
You know, you look at the demographics and for the whole country, we have a tremendous aging of the population going on. We’re going to have a lot more people that need hospitals, that need long-term care facilities. And we have a diminishing number of younger people, that the fertility rate is dropping, the number of young people coming along is less than we’ve had in the past.
So we’re going to have to be very innovative. We’re going to have to use technology. We’re going to have to actually go the opposite of the minimum staffing requirement where we figure out how to take care of people with less folks. And that’s the real challenge of the next 20 or 30 years.
Ann Nachtigal (host):
Innovate, right? Yeah. Forced to innovate. Look outside the box.
So we have a wide range of speakers here today. Why is that kind of broad perspective of continuum care so important when we’re talking about this field?
Mark Parkinson:
Well, I think we really learned in the 1980s, 1990s, before electronic medical records really became the standard in health care, we learned that having operators siloed in their own areas just did not work.
And so we would often see patients come into nursing homes that had several doctors that were getting prescriptions from multiple physicians. The physicians didn’t know what the others were giving and it just wasn’t working for the patient. By integrating care so that everybody is part of the team to improve the health care of one particular patient, it’s really improved care.
It’s also made care less expensive because there’s not the overlap and inefficiency. So Sanford, you know, bringing everybody together is a terrific thing. And I think that this integrated health care is something that we’ll see more and more in the future.
Ann Nachtigal (host):
Last question. Try to keep these fairly short for our listeners and know there’s lots more to talk about. But what excites you the most about the future of rural health care? Is it that we are convening groups like this? What is it?
Mark Parkinson:
You know, I’m getting towards my retirement and one of the things that’s exciting to me is to see really great young leaders coming into the space. I was able to spend some time with the Sanford leadership team and that’s pretty reflective of across the country.
You see younger people that are super smart, you know, really want to do the right thing, mission driven. I think we’re seeing a new generation of leadership and to me that’s very exciting.
Ann Nachtigal (host):
That is exciting. Mark Parkinson, thank you so much for joining us here at the Summit on the Future of Rural Health.
Mark Parkinson:
It’s been great to spend time with you.
Alan Helgeson:
You’ve been listening to “Reimagining Rural Health,” a podcast series brought to you by Sanford Health. Hear more episodes in this series or other Sanford Health series on Apple, Spotify, and news.sanfordhealth.org.
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Posted In Leadership in Health Care, News, Rural Health, Senior Services, Virtual Care
