One of the first things Mark Parkinson plans to do after he retires from serving as president and CEO of the American Health Care Association/National Center for Assisted Living in January 2025 is take a trip to India with his wife, Stacy.
It’s “a place I’ve always wanted to go but just haven’t had the time to do it,” he told McKnight’s on Tuesday, the day he publicly announced that he was stepping down from the leadership role that he has held for more than 13 years. His retirement will be effective Jan. 15, 2025.
Other travel and “a lot more” time with his and Stacy’s three adult children and their families, including two grandchildren, are on the to-do list as well.
And he won’t be stepping away completely from long-term care — or even AHCA/NCAL.
“I do plan to continue staying in the sector,” Parkinson said, adding that he will remain in the Washington, DC, area, where his offspring are or will be located.
“Part of my agreement is to consult with the new CEO for the next few years. It’s up to the new CEO,” he said. “Then I plan to do some work with companies committed to doing great care.”
There’s a lot of time and much to accomplish between now and January 2025, but Parkinson paused briefly Tuesday to reflect on his tenure at the helm of AHCA/NCAL and share his thoughts on what the future holds for assisted living.
Quality a focus
“Great care” has been a priority for Parkinson during his time at AHCA/NCAL, which, combined, is the largest organization representing both assisted living and nursing home providers in the United States, with more than 14,000 members. He assumed the top post for the groups after working in private practice as an attorney and serving as a state legislator, lieutenant governor and then governor of Kansas.
“I would not have taken this job if I was not convinced that providers wanted to improve quality,” he said, adding that “there’s no room for providers who aren’t committed and passionate about providing great care and are willing to make the sacrifices and take the time to do it.”
Under his leadership, Parkinson said, AHCA/NCAL has improved its credibility in the healthcare arena as well as its position on Capitol Hill. “We’re not just an association of lobbyists and political people,” he said. “We’re also filled with clinical people.”
Those clinical people include Chief Medical Officer David Gifford, MD, MPH, whom he recruited before even joining the association, and Senior Vice President of Quality, Regulatory and Clinical Services Holly Harmon, and their teams, Parkinson said. The Centers for Disease Control and Prevention and the Centers for Medicare & Medicaid Services have contacted AHCA/NCAL at times “to get our opinions on how things ought to be done,” he noted.
“That proved incredibly valuable during the pandemic, when no one knew what best practices were and … government agencies were calling us and saying, ‘How do we do this?’” Parkinson said. “I think that developing credibility not just on the political and lobbying side, but also on the substantive quality side, has been a really good thing.”
Parkinson was aiming for that good thing when he created a division focused on quality upon his arrival. That division has helped “make a lot of progress,” he said.
During his time at the top, AHCA/NCAL has developed and launched the Quality Initiative, a multi-year national effort to try to improve quality outcomes in assisted living communities and nursing homes. Other quality-related projects, Parkinson said, have included the development of networks through which assisted living and skilled nursing providers can “come together to get better contracts with managed care companies, both Medicare and Medicaid,” and population health management, which he said enables assisted living and skilled nursing providers, but especially the latter, “to be reimbursed for keeping people well.”
Outside of quality-related efforts, Parkinson said he also is pleased that AHCA/NCAL started a group purchasing organization during his tenure, to help members save money on goods and services. “We finally figured out how to do it, so we launched our own GPO three years ago, and it’s done really, really well,” he said. The quality and GPO work “will provide a lot of stability for organizations,” he added.
Many changes since the 1990s
Senior living has changed greatly since the mid-1990s when he and his wife first opened an assisted living community, Parkinson said, adding that he thinks assisted living “is a fantastic service and product.” The Parkinsons would go on to have 10 long-term care properties in Kansas and Missouri.
Now, the CEO said, it’s “really exciting” that in several states, Medicaid waivers enable assisted living providers to care for “people of modest means.”
“When Stacy and I were involved with the product, it was available only for upper-income and wealthy people, because virtually all of the facilities were private-pay,” he said. “We spent hours and days and weeks trying to figure out how to provide more services to people, and we couldn’t figure it out. But a bunch of providers have, and so now assisted living is available in many states to people of all incomes, and I think that’s fantastic.”
Future is bright
As for the future, Parkinson predicted that assisted living will “continue to flourish.”
“Like all long-term care settings, it will benefit by the aging population,” he said. “Because it is so resident-focused, I think it will continue to do well in the marketplace. People will continue to choose it over other settings. …I think assisted living is in a really good position right now.”
That good position comes despite recent articles in the Washington Post, which reported on the deaths of residents who wandered from communities, as well as the New York Times and KFF Health News, which scrutinized an industry pricing structure that adds fees on top of basic charges to cover additional services, as well as rate increases and the for-profit status of most providers.
The coverage led members of the US Senate Special Committee on Aging to ask three large senior living companies to report back on some members’ “significant concerns” about costs, staffing levels and resident safety. It also led the committee chairman to schedule a hearing, call for a government study on industry pricing and transparency, announce a website and email address where consumers can share their bills and their experiences interacting with providers, and ponder increased federal involvement.
But Parkinson said that it’s “very unlikely assisted living will undergo federal regulation.”
“We’ve seen what a disaster it’s been on the skilled nursing side, so there’s a real commitment among the long-term care providers to not do that,” he said. “On top of that, there are robust regulations in virtually every state, so while I think there will continue to be questions about stability at the federal level and there will be hearings at the federal level, I think it’s very unlikely we will see a SNF-like regulatory system for assisted living at the federal level.”
The key to success
His advice to assisted living companies operating in the current environment? It goes back to quality.
“When you look at the outlier companies, whether it’s skilled nursing or assisted living, the first thing that jumps out about all of them is, there’s a genuine passion for taking care of their residents. They’re mission-driven to do that,” Parkinson said. “They talk a lot more about the care they’re providing and the quality that they’re providing than their bottom line.
“You look at companies that just focus mainly on their bottom line and don’t talk about their residents, and those are the ones that typically fail and don’t make money,” he continued. “My advice is to continue to be passionate about the care of the residents, be mission-driven, make decisions that are in the best interests of the residents, and if you do that, you’ll do well. If you don’t do that, you probably won’t do well.”
Moving from industry well-being to his own, the 66-year-old Parkinson said that he is thankful for his health.
“I’ve been super lucky. I’m healthy, no health conditions,” he said. But looking toward retirement, he added, “There are some things we want to do, and you have to do them while you’re healthy. I think it’s the right time.”
A few more years
Parkinson originally thought the right time to leave was a few years ago.
He said that, back in late 2010 when he accepted the role of president and CEO (he began in the post in January 2011), “I thought, if everything went well, that maybe I’d be in the position for five years. But it went better than really well, and I made a decision about five years into it that this would be my last job.
“At that point, I agreed to stay on another five years or so and then retire more toward the end of 2022,” he continued. “But with the pandemic and the challenges we were facing, [the board] agreed to extend my contract until 2025, to coincide with the end of this [presidential] term.”
Come January, someone else will be focused on delivering policy results and pulling members together, which Parkinson said are the major functions of the president and CEO.
“You have to win on the Hill, you have to win with CMS, you have to win in the states – really all three,” he said. “But in addition to that, you have to pull the members together. In many regards, the second part is the hardest, because long-term care operators are a very diverse group.”
The AHCA/NCAL membership, Parkinson noted, includes assisted living and nursing home operators large and small, for-profit and not-for-profit, financially healthy and not. “The challenge is, how do you hold everybody together so there’s one voice, one strong voice?” he said. “If you can succeed in doing that, you’re probably going to succeed on the policy side.”
Members have benefited from Parkinson’s success, Mark Maxfield, chair of the NCAL Board of Directors, told McKnight’s Senior Living.
“The assisted living profession is better because of Mark’s tireless advocacy and focus on doing what is right for our residents and providers. His work spans far more than efforts on Capitol Hill and in DC,” he said. “His vision for the future of assisted living has helped us in finding a true mission at NCAL, and we will honor his commitment to advancing quality care by the work we do each day. He has been a personal mentor to me and a leader to many long-term and post-acute care professionals, and we are all better for it.”
In preparation for Parkinson’s retirement, the AHCA/NCAL boards have begun searching for his successor. Details surrounding the leadership transition, timing and next steps will be forthcoming, the groups said.
Mark Parkinson will receive the Career Achievement Award on March 21 in Chicago as part of the 2024 McKnight’s Pinnacle Awards. Tickets and details about the event are available at mcknightspinnacleawards.com.
