Special Interest Groups

• WHAT IS ITS MISSION?
• HOW IS IT STRUCTURED?
• PRIMARY FUNCTIONS
• PROGRAMS
• BUDGET INFORMATION
• HISTORY
• CURRENT POLITICAL ISSUES
• FUTURE DIRECTIONS
• GROUP RESOURCES
• GROUP PUBLICATIONS
• FAST FACTS
• BIBLIOGRAPHY

ESTABLISHED: September 1949
EMPLOYEES: 21
MEMBERS: 12,000

Contact Information:
ADDRESS: 1201 L St. NW Washington, DC 20005
PHONE: (202) 842-4444
TOLL FREE: (800) 555-9414
FAX: (202) 842-3860
URL: http://www.ahca.org
CHAIRMAN: Daniel D. Mosca
INTERIM PRESIDENT: David Seckman

WHAT IS ITS MISSION?

The American Health Care Association (AHCA) is a federation of 51 state-affiliated associations that represents the interests of the long-term health care community. Long-term care facilities include nursing facilities, subacute care centers, rehabilitation centers, intermediate care facilities for the mentally retarded, residential care facilities, and assisted living facilities. The organization seeks to improve the standards of service and administration of long-term care, and to help quality long-term care facilities secure public trust and approval. The AHCA attempts to achieve its mission by offering educational information to its members and to the public, and by lobbying for regulatory and legislative changes.

HOW IS IT STRUCTURED?

The AHCA is a federation of 51 affiliate associations, with one in each state plus one in Washington, D.C. These state affiliates are grouped together into 13 regions, each of which has its own governing vice president. AHCA membership is granted to long-term care institutions, not individuals. Between all of its affiliate organizations, the AHCA boasted a membership of nearly 12,000 institutions in 1999.

The AHCA has two governing bodies, the House of Delegates and a board of directors. The House of Delegates meets once a year, and the board of directors at least three times a year. Between them, they set the overall policy and goals of the AHCA. The AHCA's Executive Committee is responsible for implementing the decisions of the House of Delegates and board of directors. The national staff is managed by a president, and is composed of four departments: Regulatory Affairs, Legislative Affairs, Administration, and Public Relations/Professional Development.

PRIMARY FUNCTIONS

The AHCA works on behalf of almost 12,000 member facilities, which care for more than one million residents, through several different avenues. One major activity of the AHCA is to help members provide the best possible care to their patients. To this end, the ACHA works to develop and maintain standards of long-term care. The AHCA's many professional publications and educational resources also help maintain high quality care in the industry, by keeping the skills of long-term caretakers current. Through these quality efforts, the ACHA not only ensures that residents in its members' facilities are well cared for, but that the public image of the long-term care industry is maintained.

The AHCA also works on behalf of its members to shape legislation and regulation to benefit the long-term care industry. To do so, the AHCA lobbies members of Congress, testifies before congressional committees and regulatory agencies, and informs both the legislative and executive branches of the impact pending legislative and regulatory reforms may have on the long-term care community. According to AHCA literature, its goal is to develop "necessary and reasonable public policies which balance economic and regulatory principles to support quality care and quality of life."

PROGRAMS

The AHCA maintains few national programs, however AHCA state affiliates all sponsor initiatives of their own. The programs that the ACHA does maintain are primarily educational in nature. Since its inception in 1949, the AHCA has sponsored an annual convention and exposition. This three-day event is designed for professionals in subacute medical care, skilled nursing care, managed care, care for the developmentally disabled and other special populations, adult day care, home-based care, and residential and assisted living. Nurses and nursing home and assisted living administrators can earn up to 20 hours of continuing education credit by participating in a selection of over 60 seminar topics. The convention also features addresses by keynote speakers and a large exposition of companies which serve the long-term care industry. Smaller conferences are also held throughout the year and focus on particular issues of concern to the AHCA.

BUDGET INFORMATION

Not made available.

HISTORY

Nursing facilities first developed in the United States around 1900. They traditionally began when boarding-house operators found themselves caring for their aging boarders. Such residences developed into facilities that specialized in the needs of the disabled and aged. By the 1920s, states began to regulate these facilities by developing licensing programs that were implemented and monitored by state health departments.

On January 15, 1945, nine licensed nursing facility administrators met in Indianapolis, Indiana, to discuss the development of a national organization. Plans were made for a midwestern conference of nursing facilities, which subsequently took place in January 1948 with 103 people in attendance. Another conference was held a year later, at which time the American Association of Nursing Homes was formed. The first organizational meeting was held in September 1949 in Toledo, Ohio. The objectives of the newly founded organization was to improve standards of service and administration of member nursing homes, to secure recognition and approval of the public for the work of nursing homes, and to promote education, legislation, and awareness of long-term care issues.

In November 1952, the American Association of Nursing Homes Journal was first published. In 1975 the organization changed its name to the American Health Care Association and the publication was renamed the American Health Care Journal. In 1986, the magazine name was changed again to Provider.

During its history, the AHCA has grown from a small organization into the largest representative of the long-term care community. Because an incident of abuse, neglect, or mismanagement often receives national media coverage, the AHCA has been dedicated to improving methods of quality control for its member organizations. On the other hand, the AHCA also has worked against what it considers to be over-regulation imposed upon the nursing care industry by government agencies such as the Occupational Safety and Health Administration (OSHA). According to reports released by the Health Care Financing Administration (HCFA) and President Bill Clinton, the quality of care in the nursing facility industry has improved. In the 1990s, "overuse" of anti-psychotics was reduced by 50 percent, inappropriate use of physical restraints was reduced from 38 percent to less than 15 percent, and inappropriate use of urinary catheters was reduced by almost 30 percent. Because of its efforts, the AHCA can claim at least partial credit for these improvements.

CURRENT POLITICAL ISSUES

The long-term care industry has expanded rapidly since the founding of the AHCA, as the need for extended care has increased with an aging population. The AHCA has been involved with the increasingly diverse range of services including nursing facilities, subacute care centers, rehabilitation centers, intermediate care facilities for the mentally retarded, residential care facilities, and assisted living facilities. The AHCA has worked to influence legislation and enact regulatory reforms on behalf of the long-term care community.

According to the Health Care Financing Administration (HCFA), in 1998 approximately 1.5 million people were living in nursing facilities in the United States. The HCFA also reported that Medicaid was the primary payer source for 68 percent of patients, and Medicare was the primary payer source for 9 percent. On average, nursing facility care costs almost $41,000 annually per patient. These numbers add up to an extremely expensive industry in which government funding is a critical component. Thus, AHCA members have an important stake in how and when government funding, namely Medicaid and Medicare, is appropriated.

Case Study: The Medicaid Community Attendant Service Act

With the cost of institutional care rising yearly and the popular movement to allow people with disabilities to live as independently as possible, issues surrounding attendant services in home- and community-based (HCB) settings became increasingly popular in the 1990s. In an effort to save tax dollars and increase the quality of life for people with special needs, legislation to create HCB services emerged in 1997.

The Medicaid Community Attendant Service Act was introduced in the House of Representatives as H.R. 2020 by Speaker Newt Gingrich on June 24, 1997. It was subsequently referred to the House Committee on Commerce. The act called for the creation of a national program of HCB services, which it called attendant services. The intent of the bill was to allow people with disabilities to receive personal care services, household services, mobility services, and other health-related tasks in their homes. Under the Attendant Service Act, any individual eligible for Medicaid funding for a stay in a nursing facility, or an intermediate care facility for the mentally retarded (ICF/MR), would qualify for attendant service funds. They could then use these funds to pay for necessary services at home, or in a community setting such as a school, workplace, or religious facility. The legislation allocated $2 billion over six years to help states transition people from institutional to HCB services.

The main proponent of the act was the organization American Disabled for Attendant Programs Today (ADAPT). This organization represents people with disabilities who wish to be cared for in their homes, rather than in long-term care facilities like nursing homes. Representing much of the U.S. long-term care industry, the AHCA stood to lose many patients and future patients if the Medicaid Community Attendant Service Act passed. The AHCA asserted that HCB care is not a cost-effective substitute for nursing facility care. According to the AHCA, the act was fundamentally flawed, because it was based on mistaken assumptions regarding cost, quality of care, and nursing facility population. The AHCA did not believe that the act would accomplish what it was meant to do, but would only place new burdens on the government and taxpayers.

The AHCA argued that the act underestimated the cost of the proposed new system. Specifically, the AHCA claimed there would be a "woodwork effect." By this, the AHCA meant that if the government were to start paying for HCB, many people who had previously paid for home care themselves, or gone without rather than go into a long-term care facility, would come out of the woodwork and demand HCB aid. This meant that, rather than simply shifting money that had been paid exclusively to long-term care facilities over to HCB services, new funds would have to be found to pay for the increased number of eligible people actually seeking help.

The AHCA also challenged the idea that people who could get by with HCB services were being forced into nursing homes to get federal benefits. According to data compiled by the AHCA, nursing facility residents need much more assistance than the population currently served by HCB care. For example, 56 percent of home health patients, compared to 95 percent of nursing home residents, need help bathing. Only 13 percent of home health patients need help eating whereas 57 percent of nursing home residents need assistance with this activity. Many residential patients have complex medical problems that need the attention of highly trained professionals around the clock. Thus, asserted the AHCA, nursing facility residents are usually poor candidates for at-home care, and would have to remain in long-term care facilities even if the Medicaid Community Attendant Service Act was passed. For these same reasons, the AHCA maintained that enacting the bill would do nothing to reduce the number of people who would have to enter long-term care facilities in the years to come.

Due in part to AHCA efforts, the Medicaid Community Attendant Service Act never came up for vote in the 105th Congress. The AHCA helped convince congressmen that the system laid out by the bill would fail to give long-term care patients new options, while at the same time increase the amount of money the government spends on care for the disabled and elderly. The debate over the bill, however, failed to resolve the question of how home health care can be made practical and affordable for those who could benefit from it.

FUTURE DIRECTIONS

The AHCA is attempting to secure a place for a long-term representative on the Medicare Payment Advisory Commission (MedPAC), which currently has no members with extensive long-term care experience. MedPAC was created by the Balanced Budget Act of 1997 to provide Congress with advice and recommendations on Medicare policy. MedPAC replaced the Physicians Payment Review Commission (PPRC) and the Prospective Payment Assessment Commission (PROPAC). The AHCA will have to push for legislation to increase the number of seats on MedPAC in order to gain representation. The AHCA has partnered with rural health groups who also feel inadequately represented in this forum.

The AHCA will continue to work to reform the accreditation process. The AHCA maintains that the current HCFA inspection focuses too much on structural compliance and process-related activities and has little to do with actual quality of patient care. In addition, claims the AHCA, the ineffective accreditation inspection processes are carried out inconsistently from state to state. The AHCA hopes to see legislation introduced that allows more options and better accrediting processes to be established.

GROUP RESOURCES

The AHCA maintains a variety of current information and resources at its Web site, which can be accessed at http://www.ahca.org. The Web site contains information on the nature of the AHCA, its mission, and its members. Also available are AHCA press releases and statistical reports on long-term care, as well as the "Gazette," a daily electronic abstract of issues and trends in the industry. The AHCA also maintains a toll-free Consumer Information Line for families needing guidance about long-term care services, insurance issues, and tips for evaluating a long-term care facility. The line is open daily from 7 A.M. to 10 P.M., eastern standard time, at 1-800-555-9414.

GROUP PUBLICATIONS

The AHCA's largest and oldest publication is the Provider, which is available by subscription to the general public, and is provided free of charge to qualified long-term care professionals. The magazine covers trends, legislative and regulatory issues, management and financial issues, and other topics important to the long-term care professional. Selected articles are available at the AHCA Web site. The AHCA sells a variety of source books, brochures, and videos. The Facts and Trends Sourcebook Series contains three titles covering nursing facilities and assisted living. These publications are geared toward the long-term care professional whereas others, such as Helping Hands: The Right Way to Choose a Nursing Home, are aimed at the consumer. To order materials, write the AHCA at 1201 L St. NW, Washington, DC, 20005, or call (202) 842-4444.