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Advocacy in Action

Posted By Jennifer Gill, Friday, November 8, 2019
Updated: Friday, November 8, 2019
November 8, 2019


LeadingAge NC, NCHCFA, and Others Collaborate on Letter to Congressional Delegation
Earlier this week, LeadingAge North Carolina, the North Carolina Health Care Facilities Association, and others collaborated on a letter to the North Carolina Congressional delegation sharing our concerns about the CNA training lockout issue. Adam Sholar, CEO at NCHCFA, played a key role in this initiative. We continue to look for ways to leverage our voice with others in North Carolina to reach common goals.

Governor Roy Cooper Signs Into Law a Major Legislative Priority for LeadingAge North Carolina
Senate Bill 537 provides for a seat on the North Carolina Medical Care Commission for an individual “affiliated with a nonprofit continuing care retirement community.” The NC Medical Care Commission plays a key role in the financial health of our member communities and this action will help ensure that the Commission benefits from the wisdom of our membership’s collective knowledge.

As with any success, a number of folks shepherded this particular issue over the finish line:

  • Members of the Conference Committee that produced the final language approved by both chambers worked tirelessly to craft a bill that could garner support. Those conferees include Senators Ralph Hise, Joyce Krawiec, Harry Brown, and Andy Wells, as well as Representatives Josh Dobson, Donna McDowell White, and Donny Lambeth.
  • From the Department of Health and Human Services, Mark Payne and Matt Gross were especially helpful.
  • The LeadingAge North Carolina Public Policy Committee, chaired by Jonathan Erickson from United Methodist Retirement Homes, was instrumental in identifying this issue and pushing to keep it at the forefront.
  • None of our efforts would have been successful without the sustained hard work of our lobbyist, Lu-Ann Perryman…a very special thanks to her.

We’ll keep you informed as the opportunity becomes available to weigh in on potential nominees to the Commission. In the meantime, we hope you’ll celebrate with us!

Skilled Nursing Regulatory Update from LeadingAge Annual Meeting
LeadingAge national’s Division of Nursing Homes Director Evan Shulman last week presented a skilled nursing regulatory update at the LeadingAge Annual Meeting in San Diego. Presenting via a live remote feed, Mr. Shulman touched on a number of key topics before fielding questions from audience members. Click here for a comprehensive summary of Shulman’s presentation.

Final Bill Elusive as Senate Passes HUD Funding
The Senate passed its fiscal year 2020 HUD appropriations bill on October 31. The House passed its HUD FY20 appropriations bill in June. The two bills must be reconciled. Before the two can be reconciled, House and Senate Appropriations Committees must agree on spending limits for each of the 12 subcommittees, including the one that funds HUD. Without this subcommittee allocation agreement, the enactment of a final bill cannot occur.

The Senate’s bill is written under funding caps agreed to by the House, Senate and White House after the House’s HUD bill was passed. Because of the caps, the Senate has about $34 billion less in overall spending (across all the appropriations subcommittees) than the House bill does. The Senate’s HUD appropriations bill (which also includes funding for the Department of Transportation) is $5 billion below the House’s Transportation-HUD bill for FY20. For example, the Senate bill does not provide any funds for new Section 202 homes; the House bill provides $140 million. LeadingAge housing advocates are urging $600 million for new Section 202 homes in FY20.

Besides a lack of consensus on how to allocate funding among the 12 subcommittees, whether funding for a border wall should be included in an FY20 appropriations bill is a major area of disagreement. Funding for a border wall triggered the 2018 – 2019 longest-ever partial government shutdown.

Federal programs, like those funded by HUD, are now operating under a Continuing Resolution until November 21. Under the CR, programs are funded at FY19 levels for the duration of the CR. It’s very possible the CR will be extended until sometime in December, or even early in 2020. Another shutdown is also a possibility.

16th Annual LeadingAge Ziegler 200 Report Now Available
LeadingAge and Ziegler (a leading U.S. underwriter of financings for not-for-profit senior living organizations) announced the release of the 16th Annual LeadingAge Ziegler 200 (LZ 200) report. This report is a ranking and analysis of the nation’s 200 largest, most complex not-for-profit senior living organizations across the country as of December 31, 2018. It also outlines relevant business trends in the industry to showcase the variety of older adult services and offerings provided in the sector.

“Since the beginning of the LZ 200 report 16 years ago, we have helped drive change and innovation for older adults,” said Katie Smith Sloan, president and CEO of LeadingAge. “This year’s report demonstrates the significant role that LeadingAge members have in the aging services field and highlights the latest trends in the industry, like the continued increase in memory care offerings and the importance of resident engagement. Through this report, the entire sector can understand the latest technologies, services and growth opportunities that are driving the industry forward.”

The 2019 LZ 200 listing shows that senior living providers have grown primarily through community expansions and renovations, and affiliations. Nearly 30% of the total number of units for all senior living systems in the LZ 200 are represented by the 10 largest providers. The 2019 top 10 largest not-for-profit multi-site senior living organizations include:

  1. National Senior Campuses - Catonsville, MD
  2. The Evangelical Lutheran Good Samaritan Society - Sioux Falls, SD
  3. Acts Retirement Services, Inc. - West Point, PA
  4. Presbyterian Homes and Services - Roseville, MN
  5. Ascension Senior Living - St. Louis
  6. Trinity Health Senior Communities - Livonia, MI
  7. Covenant Living Communities & Services - Skokie, IL
  8. HumanGood - Pleasanton, CA
  9. Benedictine Health System - Duluth, MN
  10. Retirement Housing Foundation - Long Beach, CA

North Carolina was represented in the LeadingAge-Ziegler Top 200 by ten multi-site organizations, including:

  • Acts Retirement Services, Inc. (3)
  • Trinity Health Services Communities (6)
  • National Church Residences (41)
  • Lutheran Services Carolinas (60)
  • The Presbyterian Homes, Inc. (87)
  • United Church Homes and Services (91)
  • United Methodist Retirement Homes (94)
  • Givens (102)
  • Baptist Retirement Homes of North Carolina (153)
  • Friends Homes, Inc. (162)

The LZ 200 also showed that in the last 10 years, the average annual growth rate in total units was 2.8 %, with independent living and assisted living units growing each year but the number of nursing care beds decreasing. Other key areas of growth and innovation within the senior living industry include:

  • Similar to last year’s LZ 200 report memory care units are becoming an increasingly important component of the annual unit counts with 75% of the 2019 LZ 200’s listing offering specialized memory care units, compared to 60% in 2018.
  • Home-based services, such as home health, home care, adult-day care, continuing care at home (CCaH) programs and Program for All-Inclusive Care for the Elderly (PACE), continue to grow with approximately half of the 2019 LZ 200 offering some type of home and community-based service to nonresidents. However, the CCaH model is continuing to be eliminated from providers as only slightly more than 10 percent of this year’s LZ 200 offer it. This is 2% less than in 2018.
  • Adoption of new technologies slightly decreased as nearly 75% of providers use electronic point of care/point of service documentation systems and electronic health/medical records, compared to nearly 80% and nearly 76% in 2018, respectively. This year’s results on new technologies also showed that adoption of health and wellness technologies, such as medication monitoring or telehealth remote monitoring and care/case management and coordination is generally lower with less than 60% using these types of software. For the first time this year, the 2019 LZ 200 measured social connectedness/resident engagement, revealing that 49.5% of providers are using this technology.
  • Formal joint venture engagements marginally decreased this year with slightly more than 30% of 2019 LZ 200 organizations engaged in a formal joint venture, most commonly with another senior living provider, a health system or a home health/home care agency. However, engagement in a formal health care reform contract has steadily increased since the inception of the LZ report in 2014. This year, more than four out of 10 providers reported engaging in either Accountable Care Organization (ACO) or a bundled payment agreement.

The LZ 200 report is developed annually through a partnership between Ziegler and LeadingAge. It includes more than 200 providers of multi-site systems, more than 150 single-site campuses, and government-subsidized multi-site housing providers. To view the full report, please click here.


LeadingAge North Carolina
222 N. Person Street Suite 205 | Raleigh, NC  27601
Ph. 919.571.8333 | Fax 919.869.1811 | www.LeadingAgeNC.org


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