It Must Be That We Don’t Value Our Elderly…

Exit interview with Charles H. Roadman II, MD, CNA, Past-President and CEO, American Health Care Association

Peck: What do you consider to be the largest problem long-term care faces in Washington?

Roadman: Long-term care hasn't gotten the respect, political clout, or resources it needs. It is the Rodney Dangerfield of healthcare. If there is any historical analogy that comes to mind, it is the situation with electric power production in California. Leaving aside Enron's involvement, the state contributed to the problem by deregulating one side of the equation-the costs of production-but maintained a fixed price, which contributed to a shortfall of electricity production in that state. Similarly with long-term care, labor, technology, and pharmacy costs are starting to burgeon, but with government's fixed prices, expenses are surpassing income. Meanwhile, demand is increasing; California is seeing steadily growing demand for electricity, and long-term care is facing an explosion in the population in need. Yet the field just can't seem to get any traction politically.

Peck: Why is that?

Roadman: It must be that we, as a nation, don't value our elderly. Every day we're confronted with the "heartbreak" of not being young-the cosmetic surgeries, the extreme makeovers. Is this denial? Certainly, and people in Congress are no exception. And yet more and more of us have parents who are facing the issues of long-term care and the costs involved. Political leaders gag and blink at this, and say, "Give us a problem we can work with." We need a champion in Congress. Congressman Claude Pepper [the Florida legislator who passed away in 1989] was one, but we don't have them anymore.

Peck: With which issue would you say that Washington has been most receptive?

Roadman: I would say the Quality First initiative cosponsored by several of our organizations in long-term care. Today we see the field stepping up to the quality challenge, not fighting the issue the way it used to. We're starting to see a partnership developing with government, replacing the old mutual vilification. It has made a huge difference. I would caution, however, that if government doesn't continue to recognize its responsibilities in this, the whole thing could be derailed pretty quickly.

Peck: Of the issues you've dealt with on Capitol Hill, which in particular has been the most frustrating for you?

Roadman: I want to emphasize that I don't view our role in long-term care organizations as adversarial with Congress. That's really the opposite of my point. But, I must say, when I see MEDPAC looking at Medicare-12% of our revenue, compared with 66% paid by Medicaid-and maintaining that facilities are overpaid, I've found that very frustrating. This "silo mentality" overlooks how the system works as a whole, and it stops us as a nation from having a coherent strategy for long-term care.

Peck: Would more grass-roots activity by long-term care providers be helpful?

Roadman: You know, providers are the wrong messengers in this context, because what they say is often immediately discounted as expressing vested self-interest; it's "business," as if that were some dirty word. The real grass roots are the residents and their families. We, as providers, need to help them understand that the problems they confront in service delivery come, in large measure, from the design of the system. The grass roots also include the CNAs. Many of my beliefs come from my experience as a CNA, a real eye-opener.

As a doctor, I used to write orders like "a.m. cares" and see them done the next day, as if by magic. Then I became a CNA and found out that psychologically, emotionally, and physically, this was a very difficult thing to do. This was all very high-acuity, high-touch, and highly time-consuming. My low level of experience and the sheer number of people I had to take care of only compounded my problem. I came away with a very strong appreciation of what it takes.

Peck: During your tenure, AHCA and AAHSA began to collaborate more closely than ever before. Your comments?

Roadman: It's important that we're at the table talking with one another. We do come from different cultures, and we need to celebrate that, but we have to realize that, at bedside, we're all delivering the same services. Larry Minnix and I like and respect each other. We recognized areas where we shared common ground, and areas where we didn't, but we didn't focus on the latter and accepted that we're really not going to resolve them. The issues of common ground are quality, staffing, and sustainable funding, and we've chosen to focus on these.

Peck: What are your personal plans for the future?

Roadman: I want to stay in the fight because I am passionate about these issues. We're in an argument in this country about what it means to be an aging American. We can't have something that was designed in 1935 or 1965 take us into the 21st century. We need a public/private system allowing personal choices. I mentioned Sen. Pepper earlier, and I generally favor his approach of a private system backed up by a public safety net. We do have a feeling that, as Americans, we should be responsible for ourselves, and we know that aging is an insurable event. But we've got to start planning now, and we need political leaders who recognize the transformation that's needed.