As Clif Porter prepares to become the next president and CEO of the American Health Care Association/National Center for Assisted Living, he sees good things ahead for assisted living providers, but he also has some concerns.
Over the course of his three and a half decades working in long-term care, said Porter, the current senior vice president of government relations at AHCA/NCAL, the health and assistance needs of assisted living residents have increased, and yet people continue to prefer to age in place in the setting if they are able to do so.
“So what assisted living has done is, it’s tried to figure out ways to provide more services to prevent a move,” he told McKnight’s in an exclusive interview. “And with that, obviously, comes, for me at least, some level of trepidation, because with that is risk, and the more risk that you have, then there is additional pressure or a negative outcome. And if there’s a negative outcome, then it becomes additional pressure for regulation, and it can more or less spiral out of control. So that’s something that we’re watching really closely.”
He said that a benefit that assisted living operators have from NCAL and its connection with AHCA, which advocates for nursing home providers, is “a really good wall of protection.” Assisted living primarily is regulated at the state level, whereas nursing homes primarily are regulated at the federal level.
“We obviously understand what a regulated world looks like, and we can obviously advocate in that kind of environment and, ideally, protect our members from being, particularly, regulated at federal level,” Porter said.
He noted that the association believes that regulation of assisted living should remain at the state level.
“We think that states do a better job in regulating, particularly because assisted living models and community-based models are extremely unique,” Porter said. “In every state, they look different. And for that reason, we want to make sure that regulation stays as close to local as possible.”
When it comes to resident acuity, Porter advises assisted living operators to “be careful, and be thoughtful.”
Providers, he added, should “meet the demands of the marketplace, without question, but you do have to be careful, because acuity and patients’ needs can change quickly, and there are a lot of crosscurrents there as it relates to folks wanting to stay in their place and just being sure that their placement is appropriate.”
Another change? Demand
Beyond changes in residents’ needs, another big change in assisted living over the decades has occurred in demand, he said.
“The demand curve for assisted living has, surprisingly, grown, and grown faster than I thought it would,” Porter said, noting “lots of construction, particularly when the interest rate environment was a little different.”
Here again, the incoming CEO has some advice for operators: lean into the growth.
“There continues to be and will be exploding demand,” Porter said, adding that he would advise assisted living providers to “continue those efforts in examining markets where there are needs.”
The middle market is one such area, he said.
“I think one thing that we really need to figure out is how do we create and facilitate and grow a mid-market assisted living product and to go to urban markets and lower-income areas that don’t, in many places at least, have assisted living even as an option,” Porter said.
The opportunities are “huge,” he added, saying that solutions exist for “creative folks,” including “creative policymakers.”
“I would encourage members to really think about that and try to design in markets services that can meet that population’s needs, because they’re exploding,” Porter said, adding that “very, very little competition” exists in this area, which has “not necessarily been financed or thought about in a deep way.”
Workforce issues an ongoing challenge
Recruiting and retaining workers continues to be a challenge for assisted living providers, and Porter said that addressing that challenge will be one of his goals. One way to do address workforce shortages, he said, is to make the long-term care profession attractive to younger 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,” Porter said. “I think it gives you a head start 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.’”
The future
Porter will succeed Mark Parkinson, who in February announced his intention to retire on Jan. 15, 2025, after more than 13 years with the organization. AHCA/NCAL said that Porter’s new appointment will be effective this fall and will start in early 2025, and Porter said that the education needed for the transition already has begun.
“I’ve learned so much from Mark Parkinson and his leadership style, and I have great respect for, most importantly, how he treats people and how he listens and makes everybody feel a part of the team,” Porter said. Over the past decade of working under Parkinson, Porter said, he and the rest of the AHCA/NCAL team have built a great “launch pad for our future.”
The team includes LaShuan Bethea, who has been executive director of NCAL since September 2021.
“I have great respect for her,” Porter said, noting Bethea’s experience as a licensed practical nurse, registered nurse and attorney. “I’m excited to learn from her in my new role,” he said.
“We will … really keep our eyes on the wall as it relates to developments in Congress,” Porter added. “And, most importantly, we will continue to provide our NCAL members with support, with services. …We’ve got to continue to help support and provide solutions there. We’ve got to continue to be more or less a wall of protection, if you will, on The Hill, to prevent bad things from happening.”
The formal beginning of Porter’s tenure as president and CEO will align with that of a new presidential administration, along with new terms for some members of Congress. The outcomes of the election remain to be seen, but he noted that “one-party power” — wherein the same political party controls both the executive and the legislative branch of the federal government — “is not good for our sector, usually,” since Republicans often look to make cuts to so-called entitlement programs such as Medicaid and Democrats typically favor a “hyper-regulatory environment.”
“But we’re going to be looking at everything … and try to make sure that we have a path regardless of the outcome of the election,” he said.
Read Porter’s comments about skilled nursing on the website of sister brand McKnight’s Long-Term Care News, which covers skilled nursing.
