ACHCA Position Statements

A Statement on Immigration Reform

July 2018 — ACHCA encourages The Department of Homeland Security, Immigration and Customs Enforcement, and the Administration to actively assess the impact of changing various immigration policies, thereby removing protection from refugee groups with protected status or other efforts to find qualified workers from other countries. We submit anecdotally that a disproportionate representation of these groups exists in the labor pool from which Skilled Nursing and assisted living facilities hire entry level staff members (e.g. food services, maintenance, direct care staff). In this case such removal of protections, potential deportations, or other changes to immigration policies will have a measurable impact on a workforce already in critically low supply for an industry that is already facing challenges on multiple other fronts.

A Statement on the Inconsistencies in Surveys of Skilled Nursing Facilities

July 2018 — The following proposed statement of position is derived from numerous anecdotal sources, including a survey of membership with a limited response (i.e., 45 responses from the current ACHCA membership).

For decades, administrators of long-term care and post-acute care centers have observed significant variations in surveyor behavior, survey protocols, survey expectations, scope and severity determinations, enforcement remedies, and informal and formal dispute resolution outcomes. We note that the prior survey structure did include different processes for surveying care communities in various states, and are hopeful that the uniform process adopted as part of the Phase II implementation of the Requirements of Participation (ROPs) will bring greater consistency to the survey and certification process. Accepting the current status quo, however, with its wide ranging dissimilarities does not serve to foster better staffing, reduce turnover in staff, improve the workplace environment, or attract workers at all levels. Additionally, inconsistencies in survey outcomes (e.g., number/type of deficiency citations issued, scope and severity of issued citations) and the varying outcomes of appeal processes do not assist care communities in their efforts to provide excellent quality of care, due to the uncertainty of how best to provide care and services without being cited further. Moreover, these inconsistencies in the survey process are also not in the best interests of the residents or clients, who we are privileged to serve, when care centers cannot respond appropriately to residents’ needs out of concern for further or more severe citations. We hope that efforts moving forward, including guidance provided to care communities and survey agencies, will ensure a more consistent and fair process with clear expectations, so that providers of long-term and post-acute services can continue to deliver outstanding resident-centered care across the country. Thus, the ACHCA urges the Centers for Medicare and Medicaid Services (CMS), as an integral part of the implementation of the new ROPs and new survey process, to take particular care and be diligent to ensure markedly greater consistency among intrastate survey teams and intrastate survey regions, between individual states, and among the ten CMS federal survey regions.

Medicaid Provisions in American Health Care Act

June 2017 — The American College of Health Care Administrators (ACHCA) represents over 2,000 administrators and other aging services professionals in the United States. Our mission is to be the catalyst of excellence in long term and post-acute care leadership. As a leader in aging services, ACHCA does not support the Medicaid reductions proposed in the American Health Care Act (House version) and the Better Care Reconciliation Act (Senate version).

Either of these pieces of legislation, which are intended to replace the Affordable Care Act, would slash Medicaid funding between $772 (Senate version) and $834 (House version) billion dollars between 2017 and 2026, severely impacting states’ ability to cover long term care services, especially those provided in skilled nursing facilities, nursing facilities, and many assisted living facilities nationwide.

Long term care in the United States is a growing field of health care delivery services; to be effective and to provide quality care to those who are most dependent on assistance during prolonged recovery periods or advanced age, resources are required. Cutting long term care coverage for Medicaid recipients will not only seriously risk the health of our aging population, but it will deny access to this care to those at lower ends of the economic scale, at a time when NO other options for these frail and elderly citizens exists.

A society is judged by how it treats the most vulnerable among them. As the leaders in aging services, we will not stand by while those we care for are at risk. ACHCA does not and will not support the American Health Care Act if this provision remains.

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For more information, contact Rudy Michalek, FACHCA, Interim CEO, ACHCA: [email protected] or office 202-536-5120.


Strict Liability for Nursing Home Administrators

June 2017 — The American College of Health Care Administrators (ACHCA) is an advocate of excellence in long-term care and post-acute care, and our organization works to develop and educate Administrators of nursing homes to ensure quality outcomes for residents and patients.

ACHCA supports a system of holding nursing homes accountable and responsible for the safety and quality of life of those in their charge and care.

However, ACHCA does not now, nor will it ever, support the concept of strict liability for the individual nursing home administrator.

Strict liability calls for the punishment of individuals who are not trained in health care. Strict liability holds the Administrator criminally, professionally and personally liable for the actions or inactions of other people. These are business people managing health care providers in a high-pressure situation. Administrators must deal with regulations, legislation, compliance issues, staff, residents, patients, and families, in addition to reporting to their owner or board of directors.

Currently, each of the 50 states in our country has rules and regulations governing management and practices of nursing homes, in addition to the federal regulations that provide oversight and guidance to nursing homes.

It is our position that the Administrator is well-regulated and held accountable for the performance of their duties. We do not believe any additional liability should be imposed on these professionals.

The federal regulations governing nursing homes do not call for strict liability for nursing home administrators so we do not see a legal precedent for strict liability at the state level.

Nursing home administrators are motivated by a desire to serve and to help those in need. They are a special kind of person in that they have compassion and selflessness in the service of others. While they are a different kind of business person, they are in the end, business people.

As “the CEO of the building,” the Administrator is responsible for the daily management of the facility and all its departments. They are not the individual providing direct care or medical services to the residents and patients in their care.

The training of the Administrator is not clinical. They do not dispense medications; they do not tend to the sick; they do not change bandages. The Administrator makes sure that qualified staff is hired to provide these services. Holding the Administrator personally and individually liable for the actions of others in a field that they do not practice is unacceptable.

No other similar professional is held to this standard and to this level of personal liability.

Strict liability places additional stress on individuals that we need to perform at their best every day.

ACHCA believes that strict liability will create a crisis in the delivery of long-term care, as those with the passion and experience to fulfill this important role will leave the profession. It creates a barrier to new professionals entering the profession. No one should fear losing their home, their license or their freedom because of someone else’s mistake at work.

ACHCA’s position is that Nursing Home Administrators should be supported, not punished.

Policy adopted by Committee June 8, 2017
ACHCA Board approval on July 13, 2017.

Click here for a downloadable version of the ACHCA Position Statement on Strict Liability for Nursing Home Administrators.