The Affordable Healthcare Act and proposed changes to Medicaid funding will significantly impact the long-term care industry and seniors. Block grants that reduce Medicaid reimbursement to states would dramatically cut funding for nursing home services as over 50% of patients rely on Medicaid. With already slim margins under 5% on average, further reimbursement reductions could force some nursing homes to close. This would jeopardize care for patients who require 24-hour nursing care and have no alternative living arrangements. Advocates encourage families to write their legislators to preserve Medicaid funding for elderly care.

1. Affordable Healthcare Act and the Workforce
Katherine: Helloeveryone.Thankyousomuchfor joiningustodayon ThisNeeds ToBe Said.We
are joinedbyourfriendPaul Contris,andhe'sgoingtoget us upto speedonthese
changesthat we are goingto be experiencinginthe verynearfuture if youare
consideringusing,orif youare usingthe Affordable Healthcare Act,aswell as,we're
goingto talka little bitaboutthe workforce.
Paul,welcome back.How are you?
Paul: Good.How are youKatherine?
Katherine: I'm doinggood.I thinkforme the Affordable Healthcare Acthasgottenreallyconfusing,
so I'm lookingforwardto whatyouhave to share aboutthat.
Paul: Well,unfortunatelyI'mnotanexpertonthe Affordable Care Act,butI can commenton
howit mightimpactour industry,the long-termcare industry,seniorcare industry.
ObviouslyI'minfavorof havingmore people insured,andthat'ssomethingthat
basicallycostsmoney.Imean,ourhealthinsurance costshave gone upas a resultof the
Affordable Care Act.But,whateverthe numbers,Idon'tknow how exacttheyare,there
are 23 millionpeoplethatare on health insurance roles,andwhatthey're
contemplatingrightnow is,youneedacrystal ball to know how it's goingtoendup, but
one of the provisionsthat'sincludedinwiththe healthcare ballot,isgoingtoblock
grants forMedicaidby state.
That's somethingthatwe're veryconcernedabout,because reallywhatthatwoulddo
is,it wouldreduce the fundingfornursinghome services,fairlydramatically,if theydo
that. Rightnowthe federal governmentmatcheswhatthe statespayon Medicaid for
nursinghome services.Sothat'sa bigsubstantial portionof ourpatients; mostare on
Medicaid,over50% of ourpatientsare.So a substantial portionof ourrevenuescome
fromMedicaid.
Typically Medicaiddoesn'tcoverthe costforthose patientsingeneral,andwe're kindof
forcedto make our marginsbythe private,the insurance,andthe Medicare patients.
Really,if youlookatthe industry,ouraverage marginswhenall issaidanddone,are
well under5%.Soit's a prettyslimmarginbusiness.Actually,right now the industryin
general isprobably...Manycompaniesare actuallynotmakingmoney,andwe've gota
lotof pressure onbothsidesof the equation;onthe revenuesandexpenses.
The ideathat theywould blockgrantsand furtherreduce Medicaidreimbursementis
veryconcerningtous. We're doingeverythingwe canto letour legislatorsknow thatwe
needtohave some helpinthat arena.There has beensome talkof carvingout the
Medicaid reimbursementforseniorswiththisnew legislation,orwhatever, we mayend
up withthe newrepublicanlegislation.
Obviouslythat'ssomethingwe're veryin-tunedto,andkeepinganeye on,andwe're
hopeful thatitwill notsignificantlyreduce ourrevenuesgoingforward,because things

2. Paul Contris May 2017 Interview Page 2 of 3
are prettytightas theyare. I thinkwe're goingto talka little bittodayaboutwhat's
goingon inthe labor front.The goodnews,I guess,isforthe labor pool ingeneral inthe
country,the unemploymentrate islow andwagesare goingup, and that'sgood forthe
country,it's goodfor the employees.Butitdoesputpressure,youknow,increasesour
expenses.Sowe're havingtokindof deal withthatchallenge.Obviouslywe have to
increase ourwages;isone way of dealingwithit.Butthe otherway isjustby being
betteremployers.
People ingeneral Ithink,they're definitelymotivatedbymoneytoacertainextent,but
they're alsomotivatedbyhavingajobthat theyfeel appreciatedat,andthat'sfulfilling
for them.Whatwe're workinghardon isworkingwithourhuman resources
departmentto...We do interviewsandwe're havingouremployeescritique howthey
feel they're beingtreated,andwe're takingthatinformationandactingonit, andtrying
to make our workenvironmentamore positiveandpleasantplace forthem.
Because we thinkthat's good ...Andobviouslyyou've gottobe competitive onwages,
and if wagesingeneral are goingup,you've got to increase yourwages.Butwe thinkit's
justas importantif not more importanttowork withourleadershipandour
managementdepartmentheadstogetthemto reallycreate apositive work
environmentforouremployees.Andthat,we're finding,isreallyhelpingasfar as the
retentionandrecruitment.Becausewordof mouthisa bigdeal ina lotof our
communities.If you're knownasa good place towork,it's goingto helpyougetthose
people,recruitthose people,andthenobviouslyhelpyouretainthem, whichwe have.
Katherine: Absolutely.Iwantedtoask,whatwoulditmean... Because yousaid, "We're reaching
out ..." I want to go back a little bitinthe interview.Yousaid,"We're reachingoutto
our legislatorandlettingthemknow we needthisfunding."Whathappensif youdon't
getthe funding?Howdoesthisaffectthe patientsthatare there?Orhow doesthis
affectthe families?
Paul: Well,Imean,that's a real good question.They're alreadyputting,likeIsaid,they're
puttingdownwardpressure onwhatthey're payingus,andthey're demanding,they
wantmore care,theywant more hours.You know,we're takingcare of more medically
complex people.Andit'sreallyatoughsituationtobe in,where peoplewantmore for
less,andwe're tryingto figure outhow we can do that and still give highlevelqualityof
care to our patients.Imean,obviouslyif atsome pointthey're notgoingtoreimburse
youenoughto coveryour expenses,you're goingtogooutof business.Thennursing
homesare goingto close,andthenthat's not goingto be goodfor the patients.Because
theninsteadof beingable togo to a facility,maybe intheirhome town,they're goingto
have to drive twohours,or move to a differenttownorsomething,andthentheywon't
be able to be around theirchildren,theirlovedones.Itcancreate all sortsof problems.
Katherine: Do yourecommendthatthe familiesalso...Like,whodotheyneedtobe writing?Do
yourecommendthe familieswrite the legislator?Wouldthatbe effective?
Paul: Oh yeah.Imean,for sure.You know,theircongressman,theirsenators,andletthem
know that theywantto protectthe fundingforthe elderly,andthattheyare opposedto

3. Paul Contris May 2017 Interview Page 3 of 3
the ideaof the blockedgrants,because the blockedgrantsbasicallyare justgoingto
ratchet downthe amountof moneyspentoncare for the elderly.The people thatare
on Medicaid,they're on Medicaidfora reason.It'sbecause theydon'thave the fundsto
be able to pay fornursingcare. Andonce again,thisis notthe nursinghome of 40, 50
yearsago where people are beingwarehousedinnursing...Imean,anybodywho
doesn'tneed24-hourRN coverage isnow inassistedliving,orindependentliving.Sothe
people thatare innursinghomesnow,byand large,have some sortof medically
complex orchronichealthissue where theyneed24-hournursingcare.Sowhat are you
goingto do withthose people?Are yougoingtoput themonthe streets?Theycan'tlive
withtheirfamilybecause theyneed24-hournursingcare.
Now,youcouldmake an argumentin,maybe independentliving,ormaybe even
assistedisbecomingmuchmore service intensive.Butmaybe independentliving,those
people maybe couldlivewiththeirchildren.Butpeople inskillednursingsettings,really
by andlarge can't. There'snoreal optionfor them.Some of themmaybe couldlive at
home withveryintense home healthassistance.Butthat'sverycostlytoo.Which,they
don't have the moneyforthat.
It's a big issue,abigchallenge thiscountryisgoingtohave to come to gripswith,
because the age wave reallyisgoingtohit ina couple of years.I think 2020 iswhenthe
age wave reallytakesoff.It'sabig challenge forthe country.
Katherine: Notlongfrom nowat all.Our time isaboutup, but I wantedtogetintowhat thisalso
meansforthe workforce.
Paul: Right.Well forthe workforce,Ithinkit's a positive thing.Imean,obviouslythe demand
isnow kindof outstrippingthe supply.SoIthinkit'sa goodthingfor the workforce.
There'sgoingto be plentyof opportunityinourindustry,inthe seniorcare industry,
particularlywhenthe age wave hits.There'sgoingtobe a lot of openings,alotof
employmentopportunities.
Katherine: Mm-hmm.Prosand cons here.
Paul: Yeah.
Katherine: Paul,thankyouso much for joiningusonThisNeedsToBe Saidand sharingthiswithus.
Tell people howtheycangetintouch withyouand yourorganizationoutside of This
NeedsToBe Said.
Paul: Our website iswww.Welcov.com,that'sW-E-L-C-O-V,Welcov.com.
Katherine: All right.Until nexttime,Paul.Have awonderful day!
Paul: You too!Thanks,Katherine!