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LTC's 10 most influential people

January 1, 2011
by Richard L. Peck, Contributing Editor
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Long-Term Living 60th Anniversary Special

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The long-term care field has had a rich history, full of ups, downs, hair-raising regulation and heartwarming innovations. It is a story encompassing many decades, featuring a cast of heroes and, yes, villains whose impacts long-term care providers experience virtually every day of their working lives. I've composed my own idiosyncratic “Top 10” list of these people, based on my nearly three decades of experience in geriatric publishing, including 18 years as editor-in-chief of this publication. I take full responsibility for my choices. Perhaps not everyone will agree with them, but I'll do my level best to make the case for each and every one.

Diane Carter, RN, President and CEO, American Association of Nurse Assessment Coordination (AANAC)

There's no question that the Minimum Data Set (MDS) has had a major impact on long-term care. The MDS is a complex, intricate document that serves simultaneously as a resident care guideline/checklist, a regulatory compliance template, and a Medicare/Medicaid reimbursement calculator for the vast majority of nursing facilities in America. The “author” of the MDS would easily deserve ranking in my Top 10, but the MDS is more a collaborative product of several university academics and federal government managers. It is not at all difficult, however, to credit one individual for leading the way in helping nursing homes comprehend the MDS and make optimal use of it: Diane Carter. A former nurse, healthcare academic, and Colorado state survey official, Carter founded AANAC in 1999 to help long-term care nurses assigned to “do” the MDS to do it right. AANAC was one of the very first “virtual” associations in the United States, with membership and membership activities conducted primarily online, but its members have also benefitted over the years from live national conferences featuring presentations by MDS experts from government, academia, and healthcare. For her focus on the MDS and its proper implementation, Carter earns a spot in my Top-10 ranking.

Sen. Frank Moss (D-Utah)

During his political heyday in the 1970s and '80s-and particularly the early '70s, when he chaired Senate nursing home investigations that led to Public Law 92-603, the progenitor of the Nursing Home Reform Act of 1987 (known popularly as OBRA '87)-Sen. Moss spearheaded the crackdown on nursing homes and virtually all the negative publicity they've experienced ever since. Moss rose to prominence on the wave of the “Medicaid mill” scandals of that period in which hospitals, mental hospitals, and nursing homes were accused of accepting millions in Medicaid dollars in return for minimal and in many cases abusive care. Though he went on to coauthor a muckraking book on nursing homes, Too Old, Too Sick, Too Bad: Nursing Homes in America, in 1977, Moss came to be identified more with other aspects of long-term care, specifically hospice and home care, cosponsoring key enabling legislation for these in the 1980s. But the dark side of nursing homes' reputation over the past several decades can be traced back definitively to Sen. Moss.

Photo: Courtesy of UMBC Erickson School of Aging Studies

William H. Thomas, MD

Known universally as “Bill” Thomas, it's hard to know of anyone who's had more impact on the quality of the nursing home experience than he. Thomas is known for not one, but two major innovations in long-term care delivery: the Eden Alternative and the Green House Project. People who write off the Eden Alternative as “plants, fur and feathers”-alluding to Thomas's advocacy of on-premises pets and vegetation in the nursing home environment-are missing the fundamental point: to help residents stay in touch with and enjoy the real world around them despite isolating circumstances. Similarly, the Green House is more than a cottage with 12 bedrooms surrounding a family room/kitchen. It's a way of reducing the scale of institutional care to very personal levels-important for anyone residing in such an environment 24/7/365. Both innovations pose significant challenges to administrators adopting them, but they point to a way out of the nightmares that quality-of-care advocates have railed about for 40 years. And Thomas himself is a most entertaining advocate, as anyone who has attended his lively and inspiring presentations can attest.

Photo: Courtesy of The Heinz Awards/photographer Jim Harrison

Elma Holder, Founder, the National Citizens' Coalition for Nursing Home Reform (NCCNHR, currently the National Consumer Voice for Quality Long-Term Care)




A very accurate list...looking out the rear window. What about the windshield? Who are the leaders of today, the leaders of tomorrow? Consider Steve Shields, Dr. Al Powers, Dr. Richard Taylor, and Carmen Bowen.
Who is building influence today moving ahead with innovation and changing the culture of aging?
-Lee Kroencke