A talk with Larry Minnix.

In January 2001, Larry Minnix became president and CEO of the American Association of Homes and Services for the Aging (AAHSA), which consists of more than 5,600 not-for-profit providers of long term care and seniors housing. Prior to this appointment, he was president and CEO of Wesley Woods, a long term care, housing, outpatient, and acute-care program in Atlanta. Minnix, who holds a doctor of ministry degree from Emory University, is also an ordained elder in the United Methodist Church.

What reforms would you like to see CMS (formerly HCFA) make in the regulatory system for nursing homes?

Minnix: First of all, I'd like to see the United States of America, in a policy statement by President Bush and HHS Secretary Thompson, say that we're going to value our elders and have a healthy, affordable, and ethical long term care system. Second, at the CMS level, we need to get serious about the quality-improvement clinical-measurements protocol system. We've got to be open about public accountability so that the public knows what we're doing, why we're doing it, and what it means. We should have no mercy on providers who don't measure up--they should be run out of business. And we need to put "nursing" back in the nursing home. If we don't find a way through reimbursement to pay for good nursing care, then we're not going to attract and retain the type of people that we all want taking care of our mothers. Professional oversight must also be strengthened because nursing home care is increasingly complicated.

Nursing homes are becoming more like hospitals, aren't they?

Minnix: And hospitals have the professional presence and the technology available to do a good job; nursing homes don't have that yet. The whole professional presence needs to be improved. We must continue to develop alternative settings, such as assisted living, home-and community-based programs for those people who don't need the high-acuity care of today's nursing home setting.

Many consumers are not clear on what assisted living does and does not offer. How can providers help instill consumer confidence?

Minnix: If I could put the "nursing" back in nursing home, I'd also put the "assisted" back in assisted living. Number one, we've got to make sure that what we do is consumer-focused, not industry-defensive. We have to standardize the definition of assisted living. States need to have a more standardized approach so that it doesn't have to become a federally regulated program. There should be some type of "model" statute that states could use. Assisted living also has to have staffing levels according to need. It needs more professional oversight, especially with higher-acuity residents. Facilities with special programs such as Alzheimer's units must require more specialized training.

What do you think is going to happen over the next few years with home care?

Minnix: Home-and community-based services are going to be a major growth area. If you define long term care as a system of care and services that can help support people across time, place, and provider, then what we need is multiple venues, both home and institutional, where people can get the care they need consistently.

According to a report released in July 2001 by Rep. Henry Waxman (D-Calif.), the percentage of nursing homes cited for abuse violations has tripled since 1996 (see "Triple Trouble," page 9). If this is indeed the case, does it indicate that the current system is not working?

Minnix: I think what you'd find out if you could really look at it is that elder abuse and neglect in this country is a big problem. It's in private homes and in unregulated places. In nursing homes today, you have to be so sensitive as to over-report anything that looks like abuse or neglect, until somebody from the state can come out and render a judgment about it. Sometimes you're dependent on that person's interpretation.

Until we have a good long term care policy in this country, we'll keep having these problems. The root of all this, in my theory, is ageism. All of the "isms" are based on people's fear of those they don't like or don't know what to do with. When I came into the field 28 years ago, there was a theory of aging called "disengagement" saying that older people disengaged themselves from society because they were fading away, and that was the process of the inevitability of aging. It was our way of saying, "That's what happens to the old folks. That's what they do; that's what they want." It reminds me of racism. We have to deal with what growing old means in society and the fact that elders are people to be valued.