Putting a new FACE on long-term care. (View on Washington).

It's no secret that the long-term care field has wrestled for years with a terrible public relations image on Capitol Hill and in many state capitals. Rather than viewed as dedicated providers of services to people whose health needs cannot be met by family members, SNFs often are targeted in legislative testimony and speeches as greedy, uncaring exploiters. Many Washington analysts believe that this image--so different from the positive image of the nation's for-profit hospitals--explains much of the oppressive regulation and chronic underfunding of long-term care (or serves as an excuse for them).

One operator of a successful chain of facilities in Connecticut and Vermont decided that the solution lies in an alliance between SNF administrators and the family members of SNF residents. Raymond S. Termini, president and CEO of Haven Healthcare, has been trying for years to build this type of collaboration. Within Haven Healthcare, Termini established the position of resident satisfaction manager, and provided a toll-free resident satisfaction hotline to address issues before they became politicized problems. But Termini wanted more- a group of family members who could add their voices to the industry's pleas for fair treatment from government.

Termini's vision bore fruit this fall at the annual convention of the American Health Care Association (AHCA). After Termini made his case to Alan DeFend, AHCA vice-president for public affairs, and the association's directors, AHCA announced the establishment of a nationwide program to enlist families in grassroots efforts on behalf of long-term care. The program, entitled the Family Alliance for Compassionate Elder-Care (FACE), is designed to meet the need for balanced messages directed to legislative and regulatory bodies involved with long-term care.

FACE is expected to look and function very differently from the organizations that traditionally communicate to government about LTC needs. The National Association for the Support of Long Term Care (NASL), for example, pursues a 'legislative agenda that is closely linked to AHCA's (and other provider organizations') concerns, although NASL membership consists primarily of businesses that provide services and equipment to SNFs. FACE will be a more informal operation, encouraging family members and residents to voluntarily add their voices to calls for legislative action in support of long-term care.

The rationale for FACE is the realization that families of long-term care residents share an interest with providers in policies that promote flexible, quality care. In introducing FACE to the AHCA members meeting in New Orleans, DeFend said, "The program focuses on the positive.... Families can form an undeniable force of individual advocates who can make their collective voices heard. We can assist in giving them a distinct organizational identity in order to instill a sense of membership in each participant."

Implementation of FACE already has begun with a pilot test in three states: Connecticut, Minnesota, and West Virginia. AHCA has provided nursing home administrators in these states with talking points, materials, and a guide to making presentations that will encourage relatives of the residents to participate in FACE. AHCA is also financing a distinct organizational Web site for FACE that will include an online registration function and up-to-date information on issues pertinent to families of long-term care residents. A centerpiece of the effort is a recently completed promotional videotape using the theme that family members can be "rays of light" cutting through prejudice and misinformation about long-term care.

Lessons learned from the three-state trial effort will help guide a full national rollout of FACE in early 2003. The eventual goal of FACE is to create a national database of individuals committed to improved government support for long-term care. Besides enabling the industry to target these individuals for persuasive information about national long-term care issues, the FACE database will permit AHCA state affiliates to reach their local and state policymakers and legislators.

However, FACE encounters three significant challenges. First, providers whose facilities have lacked mechanisms for resident and family input comparable to Haven Healthcare's could encounter some hostility, at least initially. Second, AHCA officials acknowledge that the initial materials developed to kick off FACE might not be the most appropriate for assisted living facilities. Assisted living residents, in contrast to most SNF residents, are likely to have both the time and the independence to participate actively in the FACE program. AHCA may need to develop a separate set of promotional and informational materials to recruit and mobilize assisted living residents.

The most difficult challenge, however, is to provide FACE with a distinct identity that instills a sense of involvement in each participant, while ensuring that the program adheres to an issue agenda consistent with the interests of long-term care providers. Maintaining a balance between these objectives is essential-AHCA and the long-term care industry do not want to bring life to an organizational "Frankenstein" that turns on its creators.

This has been a difficult and often disappointing year for the long-term care industry; the federal government's sponsorship of long-term care insurance for federal employees has been one of the few highlights of an otherwise dismal legislative performance. Termini's success in getting AHCA to accept his ideas for enlisting family members as advocates could provide a much-needed boost to the long-term care field in its efforts to gain a more favorable reception from the public and policymakers. FACE won't provide all of the answers to staff shortages, over-regulation, and underfunding, but it might mark the industry's emergence at last as one that is worthy of public support.

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