As editor-at-large at Irving Levin Associates, a leading source of news and research into the business of long-term care, Steve Monroe has unique insight into what makes providers want to spend money on something new – and what doesn't.

In a sector where new regulations grab the biggest headlines, there's just as much – if not more – change to be made by changing funding sources.

Monroe joins Alex Spanko for this frank discussion on the financial mechanisms that the government can use to create lasting change in nursing homes and other eldercare settings, as well as the state of an industry often characterized as shadowy and opaque by its critics.

Explore Irving Levin Associates: https://www.levinassociates.com/

This week on "Mission Possible," we step back from the U.S. to explore a unique model from the Netherlands. Thijs de Blok, CEO of Buurtzorg International, joins Anne Montgomery to discuss his organization's mission to bring care directly to Dutch elders through a network of self-managed care teams.

Based on the belief that people thrive in their own communities, Buurtzorg relies on nearly 900 teams of nurses to provide direct care in elders' homes – all without managers, and all consisting of no more than 12 individual members.

The idea, according to de Blok, is to provide a seamless combination of formal and informal supports that empower elders to stay connected to the people and activities they love, in the places they've always called home.

Tune in to learn more about this incredibly successful alternative to traditional communal care, and how the Buurtzorg principles could be adapted to work in the home, the community, and even new types of forward-thinking care communities.

Learn more about Buurtzorg: https://www.buurtzorg.com/about-us/

Far too often, nursing home reform investigations and reports exclude input from the very people impacted the most by their conclusions: nursing home residents themselves.

On this week's episode of "Mission Possible," we pass the mic over to Washington, D.C.-area writer, advocate, and nursing home resident Maurice Miller to learn what he really wants to see from providers, lawmakers, and caregivers as we work to improve the system.

Maurice brings a unique perspective to the "Mission Possible" conversation, and not just because he's a resident in a dialogue that consists primarily of operators, regulators, politicians, and lawyers – but also because as someone who's lived in a nursing home since suffering a stroke in his late 40s, he's still the self-described baby of his community more than a decade later.

The long-term care landscape has much to learn from residents like Maurice, so tune in and then find ways to incorporate his words into your own LTC advocacy.

No long-standing issue in long-term care seems more persistent – and unsolvable – than workforce shortages at nursing homes, assisted living communities, and home- and community-based service providers.

"Mission Possible" assembled a team of experts to tackle some practical solutions to the workforce crisis, all with extensive experience and unique perspectives on the issue:

• Tara Cortes, clinical professor and executive director of the Hartford Institute of Geriatric Nursing at New York University
• Kezia Scales, vice president of research and evaluation at PHI
• Otis Woods, administrator, Division of Quality Assurance, Wisconsin Department of Health Services

With your host and longtime eldercare policy expert Anne Montgomery, the panel dives into workable solutions that organizations, policymakers, and other leaders can implement now to develop the strong, well-trained, and well-compensated workforce that elders and people living with disabilities deserve.

Nursing home reformers have long been stymied by questions that seem simple but have no clear answers: Who actually owns any given nursing home? How many other nursing homes does that person or group own? And where is all the Medicare and Medicaid money going in the end?

We've assembled a panel of leaders calling for more public information regarding nursing home ownership and spending:

• Sam Brooks, director of public policy, National Consumer Voice for Quality Long-Term Care
• Taylor Lincoln, research director, Public Citizen
• Richard Mollot, executive director, of Long-Term Care Community Coalition
• Anne Montgomery, host, and independent policy expert

Together, they lay out the problems with nursing home data reporting and enforcement, and offer a host of policy prescriptions for letting more sunshine into the sector – a key first step toward building lasting, system-wide reforms.

Learn more about our panelists' organizations:

https://theconsumervoice.org/

https://www.citizen.org/

https://nursinghome411.org/

Read more about the New York attorney general's nursing home lawsuits: https://www.empirecenter.org/publications/the-ags-nursing-home-lawsuits/

At the moment, one of the fiercest debates in long-term care is over staffing mandates, with resident advocates calling for a strictly enforced minimum staffing standard on the federal level and industry officials protesting that there aren't enough available workers to meet a legal minimum.

This week's episode of "Mission Possible" brings together a group with a diverse set of perspectives on the issue:

• Charlene Harrington, professor emerita of nursing, gerontology, and sociology at the University of California, San Francisco
• Chris Laxton, executive director, AMDA – The Society for Post-Acute and Long-Term Care Medicine
• Amy Robins, director of advocacy at PHI, an organization representing the interests of direct care workers
• Lori Smetanka, "Mission Possible" cohost and executive director of the National Consumer Voice for Quality Long-Term Care

Together, the panel navigates the policy prescriptions for building a robust, empowered, and sufficient caregiving workforce that can provide elders with high-quality, dignified services and supports.

Learn more about today's guests:

https://profiles.ucsf.edu/charlene.harrington

https://paltc.org/

https://www.phinational.org/

https://theconsumervoice.org/

Please note that this interview was conducted in fall 2022; while some of the references to macroeconomic conditions may have shifted since then, the overall discussion on reform strategies remains timely and relevant.

As the co-founder and former CEO of the National Investment Center for Seniors Housing & Care (NIC), Robert Kramer has a deep and broad perspective on the financial factors that shape long-term care. Like it or not, in a for-profit healthcare system, where investors put their dollars – and where they don't – has a direct impact on the types of services that are available to elders across the country.

It also has a significant effect on the quality of those services provided. For decades, capital has generally shied away from building new infrastructure dedicated to Medicaid-funded long-term care services, and the nation's nursing homes continue to age into obsolescence. But per-bed prices for those homes remain at record highs, illustrating the continued profitability of an existing system that far too often falls short of even adequacy – and highlighting the need for serious shifts in the way we fund eldercare.

The Center for Innovation's Alex Spanko sat down with Kramer to talk through the current nursing home investment landscape, and discuss possible financial levers for driving change in long-term care.

For a transcript of this podcast, CLICK HERE.

Learn more about the producers of "Mission Possible":

https://thegreenhouseproject.org/

https://theconsumervoice.org/

https://paltc.org/

Since the first nursing homes opened in the 1960s, people have been asking why they can't be better, more enriching places for elders and people living with disabilities. Coming this March, "Mission Possible" will present concrete answers to that question through interviews with advocates, residents, visionaries, financial leaders, and other stakeholders in the world of long-term care. While the history of nursing home reform is littered with reports and blue-ribbon committees whose suggestions have gathered dust over the years, we're determined to not let the same fate befall a landmark 2022 report from the National Academies of Sciences, Engineering, and Medicine. NASEM issued a striking call to action, and we're here to help the entire eldercare community answer it.

Listen to the trailer and get ready for the first episode, coming on Thursday, March 23!

"Mission Possible" is a joint production of the National Consumer Voice for Quality Long-Term Care, AMDA – The Society for Post-Acute and Long-Term Care Medicine, and the Center for Innovation, the non-profit home of The Green House Project and Pioneer Network.