"I am committed to ACHCA being a premier organization..." (interview with American College of Health Care Administrators Exec. VP Karen S. Tucker)

Interview with Karen S. Tucker, Executive Vice-President, American College of Health Care Administrators

Just as the nursing home industry faces a period of fundamental change in challenges and opportunities, one of its most visible and influential leadership positions has itself changed. In February, Karen S. Tucker took over from the departing Richard L. Thorpe as executive vice-president of the American College of Health Care Admininstrators. She brings a timely combination of administrative experience and health care perspective to her new position. For more than 20 years Tucker served in various administrative capacities with the American Nurses Association, most recently heading its membership and marketing division, overseeing a staff of 53 and an $11 million budget. One of her foremost tasks was coalition building, a key element of ACHCA's Strategic Plan and, at the facility level, one of the key skills in demand with the rise of integrated health care delivery systems. Recently, Nursing Homes Editor Richard L. Peck asked Tucker to share her views and perspectives on the long-term care administrative profession and the industry it serves.

Peck: What do you "bring to the table" for ACHCA and its members?

Tucker: I bring a broad background in association management, including financial planning and analysis, member services, governance, program planning, certification and education, and government relations. Along with that I have an understanding of today's health care environment and its dynamics and their relation to quality of care - particularly from the perspective of nursing, which is a huge component of long-term care. While it is true that most nurses are in acute care, that is changing, and the ANA has always dealt with the full continuum of care. Finally, I am committed to ACHCA's vision of being a premier organization in empowering administrators to serve professionally throughout the continuum of long-term care.

Peck: In line with that, what would you say are ACHCA members' three greatest needs?

Tucker: The first two are information and education, both pertaining to managed care, especially. As managed care begins to "take over the world," administrators are being asked to juggle a wider variety of health care services while at the same time assuming some degree of financial risk. Home health care and hospice are beginning to integrate with traditional nursing homes, assisted living is growing, and the entire picture is changing rapidly for us all.

That leads to the third membership need: leadership development and strategies for coping with these new demands. That means controlling costs while at the same time focusing on quality of care. Long-term care can't just be bottom line-oriented, which is what everyone fears about managed care. There must be a continual balance of quality and cost-efficiency, and administrators need strategies to achieve this.

Peck: What is ACHCA doing to advance members' skills in two key developing markets, subacute care and assisted living?

Tucker: We are offering our first certification examination in sub-acute care management and assisted living management in May. Those taking the exam have the opportunity to obtain a nationally-recognized credential that will be valued by consumers and employers as well as by managed care organizations. ACHCA will also continue to develop and offer continuing education courses in both these areas.

Peck: How do you see these two markets evolving, at least over the short term?

Tucker: Both are growing and flourishing because of a combination of demographics, continuing advances in health care delivery and today's emphasis on delivering services in non-acute settings if at all possible. All of these factors will lead to continued growth. There is also a sense that the Baby Boom generation will be expecting more long-term care options to be available to them. In fact, organizations that can provide all three services - subacute care, assisted living and traditional nursing home care - will most likely be very much in demand.

Peck: Your predecessor, Dick Thorpe, noted that one of the most pressing needs expressed by members was for negotiating skills to deal both with managed care contracting and with other providers in putting together and managing integrated delivery systems. Do you agree?

Tucker: Very much so. That is one essential leadership skill. There is a need for administrators to possess what I call "systems thinking" and for good, effective communication skills, both of which are essential to effective negotiating. We will be actively seeking to develop course offerings and articles in our publications to help along these lines.

By the way, concerning the publications we offer - the Journal of Long-Term Care Administration, The Long-Term Care Administrator and College Notes - we are considering refocusing our communications channels more on administrators' specific concerns in such areas as strategic leadership, career growth and future management trends.

Peck: Changing the subject to OBRA survey enforcement, now that HCFA's survey revision proposals appear to be in limbo, at least for a while, with not much hope of improvement in sight, how are you counseling members about this?

Tucker: Though we generally applaud the quality of care improvements that have resulted from OBRA '87, we have long been concerned about survey inconsistencies and over-regulation. Some of the proposed revisions would have streamlined the process; they would have saved staff time while still educating them about quality of care, such as appropriate charting, an outcomes focus and continuously improving effectiveness. We also believe that there should be more emphasis on communication and cooperation between administrators and surveyors to prevent deficiencies and improve outcomes. That's why I hope that efforts to improve the survey process are revived sooner rather than later.

Peck: In an ideal world, what is your personal view on how long-term care should be financed, both in the short and the long term?

Tucker: Managed care may be the way to go if there is a focus on quality outcomes and not just the bottom line. However, I believe that consumers will continue to demand a choice in their third-party payers and have access to quality care regardless of the cost, even if that means more financial risk for all concerned, including the individual.

There is certainly a need for continuing Medicaid waivers to provide reimbursement for social and health maintenance needs of patients and to fund services such as home health care and assisted living. This kind of reshaping of the Medicaid program is critical to improving long-term care. As for Medicare reform, I would prefer to see more emphasis on eliminating waste, fraud and abuse rather than cutting into quality of care. As for private long-term care insurance, these purchases should be encouraged. Unfortunately, many in the current generation of elderly were expecting social support for their health care needs in old age and have experienced a great deal of surprise at the level of personal financial responsibility required - including the price of long-term care insurance, which has been too expensive for many of them.

While it will take us a while to deal with this, privatization coupled with other innovative long-term care financing strategies, supported in part by continuing programs such as Medicare and Medicaid, should be the ultimate goal.