September 10, 2025 • 29 mins
The crisis in senior care isn't coming—it's already here. With Utah nursing homes forced to deny 1,200 admissions in 2023 and the state's senior population projected to grow 18% by 2027, we're facing critical questions about how to care for our aging loved ones.
Allison Spangler, President and CEO of the Utah Healthcare Association, takes us behind the curtain of healthcare policy and advocacy. Her journey from hands-on caregiver to policy champion offers a unique perspective on the challenges facing senior care today. "I fell in love with helping older adults, being their family," she explains, describing her early days as a CNA that sparked a lifelong mission to serve this often-forgotten population.
The conversation reveals startling truths about the regulatory and financial pressures squeezing senior care providers. Nursing homes operate with a staggering $100 per patient per day shortfall in Medicaid reimbursement, while navigating what Spangler describes as "the most regulated industry in the nation outside of NASA." This combination creates an unsustainable model threatening access to care precisely when demographic shifts demand expansion.
We explore the crucial distinctions between skilled nursing facilities and assisted living communities, the special challenges facing rural providers, and innovative approaches like Utah's quality improvement incentive program. Spangler also shares her exciting "Stories of Caring" initiative designed to change public perceptions of long-term care by showcasing the dedication of caregivers who make these communities home.
For anyone concerned about the future of elder care, this conversation offers both sobering realities and hopeful pathways forward. Whether you're a healthcare professional, have aging loved ones, or simply care about this growing societal challenge, you'll gain valuable insights into the complex world of senior care advocacy.
Ready to make your voice heard? Connect with the Utah Healthcare Association at www.uthca.org or reach out to Allison at allie@uthca.org and join the movement to ensure quality care for our seniors.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:08):
Joining me is a true leader in the space Allison
Spangler, president and CEO ofthe Utah Healthcare Association.
With years of experience inhealthcare policy and advocacy,
allison is at the forefront ofefforts to improve care for
seniors across Utah.
Today, we're going to explorethe impact of government
regulations, the biggestchallenges facing the industry
(00:28):
and what we can do to advocatefor better policies.
So, allison, thank you so muchfor jumping on.
Speaker 2 (00:34):
Absolutely.
Thank you so much for having me.
Speaker 1 (00:37):
Yeah, Jumping into it .
I always like to learn moreabout you.
So what inspired you to work inhealthcare?
And then specifically kind ofyour story that got you into
advocating for seniors?
Speaker 2 (00:50):
I started out as a CNA in high school.
I thought I was going to be anurse.
So I did the CNA course and Iworked actually in a long-term
care facility here in Utah and Ifell in love with it.
And I still thought, okay, I'mgoing to go to college, I'm
going to be a nurse.
I get to college and I hatedchemistry.
I absolutely hated it and I waslike, okay, abandon ship, we're
(01:12):
not doing the nursing thing.
But I was still working as aCNA and I I just I fell in love
with helping older adults, um,being their family, getting
opportunity to care for themevery single day, help them get
ready for meals, for their day,to see their family.
You really do become, becometheir family and you get that
chance to see them at reallyvulnerable places but then also
(01:35):
see them grow.
And I knew that was a spacethat I wanted to be in.
And so I changed my my route incollege and decided to go the
business route and I was tryingto figure out you know, what can
I do with that?
And so I thought, well, let'srun nursing homes.
And so I went to college out ofstate, came back to Utah, got
(01:56):
my MBA in healthcare managementand then found my way into a
nursing home to do myadministrator and training, got
my license license and I rannursing homes for about five
years here in the state of Utahand again it just renewed my
love and my passion for olderadults.
I really think that they're aforgotten population in not just
(02:19):
Utah but in the nation, and Iwanted to dedicate my life to
serving them and to serving thepeople that work with older
adults and that are doing thiswork and caring for these people
day in and day out.
And so after about five yearsof working on the administrative
side of things, I then moved toUtah Healthcare Association, so
(02:41):
I celebrated my 10 years withUtah Healthcare Association this
year.
It has been amazing.
I really love the opportunityto make changes more on that
global scale here with UHCA andknow that what I'm doing impacts
residents, it impacts workforceand really anyone in the
(03:02):
long-term care space in theentire state, where before I was
working just in an individualfacility.
Now I have that chance toreally make meaningful change
and know that my main goal is toensure that those living in
long-term care facilities haveresources and the opportunity to
have the best quality of care,at whatever setting they're in.
Speaker 1 (03:26):
Yeah, yeah, it's really cool thinking about when
you were an administrator, likeyou said, you were making an
impact on all of the residentswithin your facility, but then
you were running into thebarriers with policy and like
everything that you had to dealwith and so being able to, a
decade on the other side,actually make those changes and
those impacts that more broadlyaffect the tens of thousands of
(03:49):
seniors that are living inlong-term care in Utah.
So that's really cool, um onthat.
So what?
Over 10 years now that nowyou're the president and CEO,
which is super cool, um, reallyrunning the show on how Utah
looks at long-term care and thepolicies.
But what does your typical daylook like?
(04:10):
What are you doing day-to-dayas the president of UHCA?
Speaker 2 (04:15):
So I mean we are a trade association.
A large part of my role issupporting our members.
Our members are long-term careand senior living facilities, so
our job is to support thoseworkers within these communities
and within these facilities sothat they can do their job,
which is providing great qualitycare.
In communities, every day looksreally different A lot of
(04:39):
meetings, putting out a lot offires but the large part of my
job really is on the advocacyside.
I spend a lot of time lobbying.
We large part of my job reallyis on the advocacy side.
I spend a lot of time lobbying.
We've got fantastic contractlobbyists that we work with.
I myself am also a lobbyist.
We meet with a lot oflegislators.
We do a lot of work during thesession.
A lot of work outside of thesession but really trying to
gather stories from our membersof what's going on in their
(05:00):
communities so that we can sharethose with legislators.
So working with our members onin their communities so that we
can share those with legislators.
So working with our memberstouring facilities and really
that advocacy piece is huge.
The grassroots efforts, as wellas just the efforts on our own
as an association to changepolicy, gain favor of
legislators, trying to help themreally understand and get a
clear picture of the sector.
(05:21):
Another huge piece of the jobis working on the regulatory
side here locally and federally.
We work very closely with DHHShere in Utah as they're changing
rules or as they're providingsurveys in the facilities just
to better educate ourselves sothat we can better educate our
(05:43):
members.
So it really just is advocacyon many different sides, whether
it's legislatively oradvocating on the policy
regulatory side.
We're also working very closelyon the reimbursement side.
We work a lot with the Medicaiddepartment here in Utah and
also Medicare and Medicaidfederally at the national level
(06:10):
Medicare and Medicaid federallyat the national level.
But it's really a greatopportunity for us as Utah
Healthcare Association to beable to be the ones who are
sharing the voice of the peoplethat are providing the care in
facilities.
We have a lot of really greatcaregivers who deserve their
stories to be heard and again, Ithink that this industry
oftentimes gets a bad rap, andso my job is to change that and
(06:32):
to change that in the community,to change that federally, to
change that with our legislators, and so that's really what we
do here.
Utah Health Association.
Speaker 1 (06:42):
Yeah, on the policy change side, what would you say
are some of the biggest policychallenges that senior care are
facing today?
Speaker 2 (06:53):
Yeah, I think senior care and nursing homes
specifically.
So there's two aspects.
Maybe it'd be helpful if I backup here, so senior care can be
kind of broken down in a coupleof different aspects.
There's the nursing home side,which is extremely regulated and
has a lot of oversight.
You're typically gettingpatients that are a lot sicker.
(07:15):
Some come in just for rehab fora couple of weeks and go home,
some that nursing home or thatnursing facility is going to be
their long-term home, whetherthat's indefinitely or until
death.
Speaker 1 (07:27):
That's typically like a skilled nursing facility.
Speaker 2 (07:30):
Correct.
Yeah, so you may hear skillednursing facility, nursing home
nursing facility, long-term carefacility.
We kind of use all those termssynonymously and the majority of
residents living in a nursingfacility are paying for their
care through Medicaid.
There are some privateinsurances, you know short-term
patients typically are usingMedicare, but in Utah over 60%
(07:55):
of people residing in a nursinghome are on Medicaid.
Now you move into senior livingside, which is more on the
assisted living care.
The majority of people livingin those homes are on private
pay.
Medicare doesn't pay for thatstay.
There are some waiver programsin the state of Utah for
Medicaid, but the majority arepaying privately.
(08:17):
Now assisted living communitiesalso are a lot less regulated.
They aren't federally regulated, they're only regulated on the
state level and those patientsdon't typically residing in
those communities don't need asmuch care.
They aren't needing thatround-the-clock RN coverage.
They don't need quite as muchextensive direct care staff for
(08:39):
their activities of daily living.
So there's really a hugedifference between those two
sectors of the senior living orlong-term care industry.
And that's really what we focuson when we're talking to
legislators is what's thedifference?
Because that really makes adifference when we are trying to
change policy or enact newpolicies, because something that
(09:02):
may be a good change for anursing facility might not be
the same for an assisted livingfacility or vice versa.
So it's really important for us, as we're working with
policymakers, to distinguish thedifference between the two, so
that they both don't get lumpedin together with a new rule or a
new policy, because that couldbe really damaging to a
(09:23):
particular industry.
We don't want a lot ofregulations in assisted living
facilities, for a reason theyjust don't.
They don't need it.
They need certain parameters,they need standards.
But nursing facilities they'retaking care of really sick
patients, so we understand thatthere's a lot more policy that
goes into that.
Speaker 1 (09:40):
Yeah, and a lot of times I think you can see like
too much policy.
We had Adam Benton on thepodcast from Stellar about a
year ago and he was trying to Ithink it was a Colorado facility
or something, but he was tryingto put in a ice cream parlor
that was ran by adults withdifferent disabilities or
different abilities and he saidsomething along the lines of
(10:04):
like if they want to stop us,they could go to hell or
something like that.
Like when you get so muchregulation, sometimes it can
hinder doing good in one ofthose things.
So it is an interesting kind ofbalance of like which
regulations are needed, whichones help the facility, which
ones hurt the facility, likejust add more administrative
overload to an alreadyadministratively heavy industry.
(10:27):
I'm curious on how governmentregulations on that line impact
the quality of care that theresidents are getting in the
facility.
Like do you see what?
I guess, what governmentregulation have you seen have
the biggest positive impactwithin the facilities?
Speaker 2 (10:48):
Yeah, you know, you just summarized policy and
burdensome regulations reallywell.
There's this joke out there.
I think there is some merit toit.
But we joke in the industrythat nursing homes are the most
regulated industry in the nationoutside of, like NASA.
(11:09):
And you know, nuclear, notnuclear.
But you know, like spaceexploration and you know those
type of you know big scientificindustries and I really actually
believe that to be true.
I think there is a lot ofextensive oversight and major
burdensome policies andregulations that are just
(11:30):
excessive, major burdensomepolicies and regulations that
are just excessive.
And I think for decades federalbureaucrats really have doubled
down on these excessive andreally punitive systems that I
think fail to produce realchange.
You know, they just continue topile on regulations, guidance,
penalties.
It just ends up being thishamster wheel effect and then
(11:53):
they're also administeringenforcement really
disproportionate.
It ends up being verysubjective instead of objective,
which to begin with thepolicies are supposed to be
everyone following the samething.
But when you get differentpeople coming in to provide
surveys or people interpretingrules different ways, again it
(12:14):
just becomes really burdensomeand it becomes difficult and I
think the system right now as itis is very inconsistent and
ineffective and in my mind, theway the system is, it's not
driving quality improvementamong these nursing facilities
or senior living facilities toenhance the quality of care, and
I think that's a real problemand a huge opportunity for
(12:38):
change.
We've been really excited aboutthe change of administration
and some of the things that it'sbrought.
Cms has put out some requestsfor information to the many
associations throughout thecountry and we're excited about
what that means because it givesus the opportunity to respond
(12:58):
and say here's how muchoversight's happening.
Here's why we think that it'sburdensome and why there needs
to be a change with theselong-term care facilities so
that we can focus on quality ofcare.
You know, you find a nursebecomes a nurse because they
want to help people, but then anurse gets promoted to be a
(13:20):
nurse manager and then whatlittle do they know that they're
going to be burdened with a lotof paperwork and a lot of rules
and policies that they have tofollow.
That may seem at first glancelike a really good idea, but the
more you dig into it, sometimesI think we're wasting resources
(13:41):
when those nurses could beproviding the care that they
need or coming up withinnovative solutions for quality
of care or for ways to improvethe industry.
So I think you know Utah hasdone some really good things
with changing a policy or addingthings to promote quality of
care.
We've got a really greatquality improvement incentive
(14:02):
program that really, like thetitle says, incentivizes
facilities to look at qualityand to have quality improvement
and to make innovative changes.
They get a little bit of extramoney to do this, but they have
a lot of stipulations that theyhave to follow, and I think that
is a good trade-off.
Value-based payments andvalue-based care is really
(14:23):
popular right now.
We're giving you this fundingand what are you going to do
with it and how are you changing?
And I think people respondreally well to that.
They really do.
The caregivers and the peoplethat are running these
facilities really want to dowhat's best for the people
living in their facilities.
But when you're burdened down byhefty rules and policies and
(14:47):
then to add on top of that theenforcement, the civil money,
penalties, it can be reallydiscouraging.
And because of that there havebeen a significant amount of
closures throughout the countryof nursing homes because they
just following the rules arereally expensive, or they have
infractions and they can't paythe fines, or just, you know,
(15:11):
lack of reimbursement there's.
You know, there's a lot ofthings that go into it.
So I think overall there needsto be an overhaul of changing
federally and then I thinkstates then can continue to
follow suit and making things,you know, easing those
regulations and those policies.
I think another thing that Utahhas done policy-wise has been
(15:33):
implementing home andcommunity-based waiver programs.
That has been really beneficialfor a lot of seniors in Utah
because they can't care forthemselves at home anymore or
they need a little bit more carein the home.
So there's a waiver programthat allows them to do a couple
of things, to have someadditional care at home under a
Medicaid waiver program, so thatthey can afford it or reside in
(15:58):
an assisted living communityunder that Medicaid waiver
program which helps supplementthat care to where they can
afford it, and I think that'swhere it's really needed most.
There are a lot of low-incomeseniors out there and, as you
know, the amount of older adultsaging into the system is
growing exponentially.
(16:18):
In Utah by 2027, it's going togrow by 18%.
That's a huge number.
We're also going to see in Utaha decline in caregivers, which
you know is historically in Utahwe take care of our own, but
we're seeing now the cost ofliving.
People can't afford to have twoparents stay at home anymore,
two people in the home, or oneperson stay in the home and one
(16:42):
person work.
They need two people working.
So we're going to see a declinein caregivers, an increase in
older adults.
So having programs like theseMedicaid waiver programs or
Medicaid program in general forseniors to live in a nursing
facility long-term are reallybeneficial for people that are
going to need this care.
Moving forward.
Speaker 1 (17:04):
Yeah, you touched on one of the points, but I'm
curious what you think thebiggest gaps are currently in
the healthcare system when itcomes to senior care.
I think there is a huge gap,one of my biggest pet peeves,
and I wish that there was asolution.
But like a sliding scale.
It's like Medicaid pays for itbut if you make $10 more, you
have to come up with $3,000 tocover or $10,000 to cover your
(17:26):
own bills.
Anyway, we've seen that a lotwith people that need, even like
caregivers, where they needmoney, but they're like I only
can work this many hours or elseI lose all my benefits, and
it's like.
It's like so tricky, and so I'mcurious that's, of course, one,
but what other big gaps do yousee in the health care system
when it comes to supportingseniors?
Speaker 2 (17:46):
I would say the largest gap is reimbursement for
the facilities, for theassisted living side on the
waiver or for the nursing homeside, just on their Medicaid
rate.
And the reason I think that's abig gap for senior care is
because currently both assistedliving and nursing facilities
(18:06):
are operating in a significantshortfall for Medicaid.
So, for example, nursingfacilities operate about $100
per patient per day in ashortfall.
So if they're receiving I'mjust going to throw out some
numbers out there around $230per patient per day, and sorry,
I'm like totally getting intothe weeds on this.
(18:26):
It's okay, I'm all about math,but I think it's important for
people to understand why this isan access to care issue.
Because if nursing homes arenot receiving the reimbursement
that they need to care for apatient, so if it's $100 a day
shortfall, then that is $100 aday that they have to make up
somewhere and that means thatthat's money that they have to
(18:51):
cut because they're notreceiving the full amount of
reimbursement from the state fortheir Medicaid patients.
And when 60% of patients in thestate are on Medicaid, that is
a large chunk of people residingin our facilities that we are
not being wholly funded for is alarge chunk of people residing
in our facilities that we arenot being wholly funded for and
costs keep rising.
(19:12):
Their supplies, their workforce, potentially their rent, their
mortgage, whatever it is.
All their overhead issignificantly increasing and
their Medicaid rate increasesmaybe at a very slow amount.
If we're lucky, the legislaturehas been very generous in the
last few years that we havegotten some rate increases.
Very grateful for that, but westill have a long way to go to
(19:34):
be whole.
And that gap, that shortfall,then becomes an access to care
issue, because if you are notreceiving the full reimbursement
that you need, that means thatyou can't increase wages as much
as you want to, so you can't becompetitive.
It's a very difficult-findingworkforce.
A lot of your money is havingto go to expensive supplies and
(19:55):
DME and things to support thepeople in your facility.
But if you're having to pay forthose things, you're going to
have to consider well, I've gotthese very subacute patients.
Can we afford to take more withthe limited staff that we have?
Because we all know we're stillin a significant workforce
shortage?
So it's just all these thingsthat stack up, and what that
(20:16):
means is can these senior livingcommunities, can these nursing
facilities, really remain viableat a time that seniors are
going to need them the most andthat will become an access to
care issue In 2023, nursinghomes in Utah had to deny around
1,200 admissions because theydidn't have the workforce or
(20:38):
because they just simplycouldn't take these patients
because of cost constraints orworkforce constraints.
That's a significant numberthat I would anticipate.
That will only grow if we don'tfind some way to make changes.
Speaker 1 (20:53):
Yeah, if we're growing by 18%, then that 18% of
1200 is another 40, 30, 40people that just don't get care
after an injury, an injury, yeah, when you go to lobby for these
(21:16):
improvements and theseincreases, how, I'm super
curious on the backside, likewhere are you saying you know
this?
Funds, like?
One example I could say is likemaybe if Medicare or Medicaid
pays the actual amount insteadof having that lower amount,
then we're able to help morepeople.
They live longer, like where, Iguess, what levers are you
(21:37):
trying to pull as anorganization to say like we need
the funding and here's ourideas of where we can
potentially get it from to helpseniors?
Speaker 2 (21:46):
Yeah, I mean I think it's really easy to go up there
and highlight rural facilities.
We have a lot of ruralcommunities throughout the state
of Utah and if you think abouta person who grew up in a very
small rural community theyworked there, their family is
there they come to a point intheir life where they need
(22:11):
long-term care, whatever thatmeans, but the local long-term
care facility just closedbecause they weren't getting
enough funding or because ofburdensome regulations or fines.
Where does that person go?
Then they end up goingsomewhere two, three, four, 500
miles away, getting completelydispersed from where they grew
up, from where their family is,where their community is.
(22:33):
I think that's a really easyselling point for us to the
legislature.
We have a lot of amazing rurallegislators in our great state
that are sympathetic to that andunderstand that.
So that's one really strongselling point that we have.
I think also it's easy to tie itback to workforce because no
(22:54):
matter what the legislators do,what their profession is, they
all are seeing the workforceshortage.
I mean you can go everywhereand see that there are not
enough workers.
You go to Jersey Mike's and theline is an hour long because
they don't have enough workforce.
You go to the grocery store,the lines are long, your food
costs more.
I mean, it's so easy to showthat the cost of workforce is a
(23:18):
lot more, there's a shortage ofworkforce the cost of care, but
really framing that in a waythat they understand, trying to
get personal helping them,helping them understand like
what if this was your loved one,you know, we, we want them to
have good care, we want them tohave access to care.
Access to care is reallyimportant to legislators, and so
I would say those are, you know, a lot of the, the, the main
(23:41):
points that we make when tryingto advocate to, to policymakers.
Speaker 1 (23:47):
Yeah, and to your point on the rural communities.
It's one thing if the communityshuts down, but it's also
another thing when you have apopulation of 2,500 and
everybody's like oh, you don'twant to work at the nursing home
because you don't get paid,like it's really quickly to go
around, and then all of a suddenyou're cycling back through of
like oh yeah, I worked here fouryears ago.
(24:08):
We just need some money, so I'llbe here for the next three
months and then they're cyclingthrough the same 2,500 people
trying to keep it staffed.
So it's-.
Speaker 2 (24:14):
Yeah, 100% correct.
They have such a small pool ofworkforce in that small
community it is it's adouble-edged sword access to
care, but also the staff to carefor them.
Speaker 1 (24:25):
Yeah, Going back to something you said earlier of
like a lot of your time is spenton trying to kind of change the
stigmas around long-term care.
What does that look like?
Like?
What are you guys activelydoing to try to make it so
people don't think of nursinghomes as the nursing homes of
the seventies?
That are like where they'vesaid their mom, that's like
(24:46):
terrible.
Speaker 2 (24:47):
Oh my gosh, I know I it's.
It's so wild that people stillthink of the nursing homes from
the 70s and the 80s becausethings have changed so much.
I mean you'll see the personcentered care, focus.
They've completely remodeledand refocused how they look.
I mean listen it's still.
It's still a long-term caresetting and I understand that
(25:08):
nobody wants to live there, butwe are making some strides and I
think we just encourage thepublic to come and tour, we
encourage legislators to tour.
But one of the things that I'mreally excited that we're
working on is our Stories ofCaring series.
We have not debuted it yet, butwe are going into our
communities, into our memberfacilities and interviewing
caregivers.
(25:29):
We are trying to understand whythey work in long-term care,
what they feel in theirday-to-day work makes a
difference or gives them meaning.
And so, because of that, we'retaking all these videos and
we're putting them together tohave 20-second clips or a minute
clips or, you know, whatever itis for us to share with
(25:49):
legislators, for us to sharewith our members and to use,
just in marketing in the general, to try to, you know, bring
more positive light to theindustry.
And this is going to take along time.
It's going to take a long timeto change people's mind.
Covid gave us a really bad rap.
You know that we're going tocontinually work to grow our way
out or to claw our way out ofthat hole, but I'm really
(26:11):
excited about our stories ofcaring.
I think that that's going to bea really good marketing tool
for us to spread some goodnessin the community.
And it really is that feel goodof, you know, getting to see
these caregivers and howmeaningful the work in long-term
care is for them.
Speaker 1 (26:26):
Yeah, no, I love that .
I think that'll be awesome andthat's really the biggest lever.
I think that a lot.
I think, just in general, thatthe senior care space, long-term
care and in-home care, likeit's yet we've yet to see them
fully come into the digital eraof using video and content and
(26:48):
brand and all of that toactually showcase, like, what is
happening.
Um, and so it's cool that youguys are working on that.
I love that.
Um, we're already at time,which is crazy.
Um, what message would you giveto someone who wants to make a
difference in senior careadvocacy, a difference in senior
care advocacy, I would say letyour voice be heard.
Speaker 2 (27:18):
There are so many amazing caregivers and
supporters of long-term care,especially in our great state of
Utah, and it is so much easierfor me to do my job when I can
understand the passion that isfrom these caregivers, the
passion that these caregivershave and the stories that they
have.
There are so many good thingshappening in our communities
throughout the state and we wantto be able to share them.
(27:39):
So my advice to people workingin long-term care or that have a
passion in long-term care is tolet your voice be heard.
Reach out to places like UtahHealthcare Association or
wherever you can, so that we canshare your story or help us
understand your concerns.
Where do you feel that thereneeds to be changes?
You guys are the ones in thefront lines working every single
(28:04):
day.
Let us be your big voice, butshare that with us so that we
can try to enact change.
Speaker 1 (28:12):
Yeah, I love that.
Who should reach out to UtahHealthcare Association if we
have administrators or peoplelistening?
Who do you want to work with?
Speaker 2 (28:24):
I mean you're always welcome to reach out to me.
My email is super easy.
I mean you're always welcome toreach out to me.
My email is super easy AllieA-L-L-I-E at U-T-H-C-A dot org.
You can always go to ourwebsite, wwwuthcaorg.
We have a great staff here.
We want to help you.
We want to be a resource foryou.
Speaker 1 (28:47):
Please let us do that .
Awesome.
This has been so awesome, allie, really great insights, and I
love what you guys are doing tohelp seniors across Utah.
So thank you for giving sometime.
Speaker 2 (28:52):
Yes, thank you so much.
I just appreciate theopportunity.
Anytime I can talk about thisindustry, I'm here for it.
So thank you.
Joining me is a true leader in the space Allison
Spangler, president and CEO ofthe Utah Healthcare Association.
With years of experience inhealthcare policy and advocacy,
allison is at the forefront ofefforts to improve care for
seniors across Utah.
Today, we're going to explorethe impact of government
regulations, the biggestchallenges facing the industry
(00:28):
and what we can do to advocatefor better policies.
So, allison, thank you so muchfor jumping on.
Speaker 2 (00:34):
Absolutely.
Thank you so much for having me.
Speaker 1 (00:37):
Yeah, Jumping into it .
I always like to learn moreabout you.
So what inspired you to work inhealthcare?
And then specifically kind ofyour story that got you into
advocating for seniors?
Speaker 2 (00:50):
I started out as a CNA in high school.
I thought I was going to be anurse.
So I did the CNA course and Iworked actually in a long-term
care facility here in Utah and Ifell in love with it.
And I still thought, okay, I'mgoing to go to college, I'm
going to be a nurse.
I get to college and I hatedchemistry.
I absolutely hated it and I waslike, okay, abandon ship, we're
(01:12):
not doing the nursing thing.
But I was still working as aCNA and I I just I fell in love
with helping older adults, um,being their family, getting
opportunity to care for themevery single day, help them get
ready for meals, for their day,to see their family.
You really do become, becometheir family and you get that
chance to see them at reallyvulnerable places but then also
(01:35):
see them grow.
And I knew that was a spacethat I wanted to be in.
And so I changed my my route incollege and decided to go the
business route and I was tryingto figure out you know, what can
I do with that?
And so I thought, well, let'srun nursing homes.
And so I went to college out ofstate, came back to Utah, got
(01:56):
my MBA in healthcare managementand then found my way into a
nursing home to do myadministrator and training, got
my license license and I rannursing homes for about five
years here in the state of Utahand again it just renewed my
love and my passion for olderadults.
I really think that they're aforgotten population in not just
(02:19):
Utah but in the nation, and Iwanted to dedicate my life to
serving them and to serving thepeople that work with older
adults and that are doing thiswork and caring for these people
day in and day out.
And so after about five yearsof working on the administrative
side of things, I then moved toUtah Healthcare Association, so
(02:41):
I celebrated my 10 years withUtah Healthcare Association this
year.
It has been amazing.
I really love the opportunityto make changes more on that
global scale here with UHCA andknow that what I'm doing impacts
residents, it impacts workforceand really anyone in the
(03:02):
long-term care space in theentire state, where before I was
working just in an individualfacility.
Now I have that chance toreally make meaningful change
and know that my main goal is toensure that those living in
long-term care facilities haveresources and the opportunity to
have the best quality of care,at whatever setting they're in.
Speaker 1 (03:26):
Yeah, yeah, it's really cool thinking about when
you were an administrator, likeyou said, you were making an
impact on all of the residentswithin your facility, but then
you were running into thebarriers with policy and like
everything that you had to dealwith and so being able to, a
decade on the other side,actually make those changes and
those impacts that more broadlyaffect the tens of thousands of
(03:49):
seniors that are living inlong-term care in Utah.
So that's really cool, um onthat.
So what?
Over 10 years now that nowyou're the president and CEO,
which is super cool, um, reallyrunning the show on how Utah
looks at long-term care and thepolicies.
But what does your typical daylook like?
(04:10):
What are you doing day-to-dayas the president of UHCA?
Speaker 2 (04:15):
So I mean we are a trade association.
A large part of my role issupporting our members.
Our members are long-term careand senior living facilities, so
our job is to support thoseworkers within these communities
and within these facilities sothat they can do their job,
which is providing great qualitycare.
In communities, every day looksreally different A lot of
(04:39):
meetings, putting out a lot offires but the large part of my
job really is on the advocacyside.
I spend a lot of time lobbying.
We large part of my job reallyis on the advocacy side.
I spend a lot of time lobbying.
We've got fantastic contractlobbyists that we work with.
I myself am also a lobbyist.
We meet with a lot oflegislators.
We do a lot of work during thesession.
A lot of work outside of thesession but really trying to
gather stories from our membersof what's going on in their
(05:00):
communities so that we can sharethose with legislators.
So working with our members onin their communities so that we
can share those with legislators.
So working with our memberstouring facilities and really
that advocacy piece is huge.
The grassroots efforts, as wellas just the efforts on our own
as an association to changepolicy, gain favor of
legislators, trying to help themreally understand and get a
clear picture of the sector.
(05:21):
Another huge piece of the jobis working on the regulatory
side here locally and federally.
We work very closely with DHHShere in Utah as they're changing
rules or as they're providingsurveys in the facilities just
to better educate ourselves sothat we can better educate our
(05:43):
members.
So it really just is advocacyon many different sides, whether
it's legislatively oradvocating on the policy
regulatory side.
We're also working very closelyon the reimbursement side.
We work a lot with the Medicaiddepartment here in Utah and
also Medicare and Medicaidfederally at the national level
(06:10):
Medicare and Medicaid federallyat the national level.
But it's really a greatopportunity for us as Utah
Healthcare Association to beable to be the ones who are
sharing the voice of the peoplethat are providing the care in
facilities.
We have a lot of really greatcaregivers who deserve their
stories to be heard and again, Ithink that this industry
oftentimes gets a bad rap, andso my job is to change that and
(06:32):
to change that in the community,to change that federally, to
change that with our legislators, and so that's really what we
do here.
Utah Health Association.
Speaker 1 (06:42):
Yeah, on the policy change side, what would you say
are some of the biggest policychallenges that senior care are
facing today?
Speaker 2 (06:53):
Yeah, I think senior care and nursing homes
specifically.
So there's two aspects.
Maybe it'd be helpful if I backup here, so senior care can be
kind of broken down in a coupleof different aspects.
There's the nursing home side,which is extremely regulated and
has a lot of oversight.
You're typically gettingpatients that are a lot sicker.
(07:15):
Some come in just for rehab fora couple of weeks and go home,
some that nursing home or thatnursing facility is going to be
their long-term home, whetherthat's indefinitely or until
death.
Speaker 1 (07:27):
That's typically like a skilled nursing facility.
Speaker 2 (07:30):
Correct.
Yeah, so you may hear skillednursing facility, nursing home
nursing facility, long-term carefacility.
We kind of use all those termssynonymously and the majority of
residents living in a nursingfacility are paying for their
care through Medicaid.
There are some privateinsurances, you know short-term
patients typically are usingMedicare, but in Utah over 60%
(07:55):
of people residing in a nursinghome are on Medicaid.
Now you move into senior livingside, which is more on the
assisted living care.
The majority of people livingin those homes are on private
pay.
Medicare doesn't pay for thatstay.
There are some waiver programsin the state of Utah for
Medicaid, but the majority arepaying privately.
(08:17):
Now assisted living communitiesalso are a lot less regulated.
They aren't federally regulated, they're only regulated on the
state level and those patientsdon't typically residing in
those communities don't need asmuch care.
They aren't needing thatround-the-clock RN coverage.
They don't need quite as muchextensive direct care staff for
(08:39):
their activities of daily living.
So there's really a hugedifference between those two
sectors of the senior living orlong-term care industry.
And that's really what we focuson when we're talking to
legislators is what's thedifference?
Because that really makes adifference when we are trying to
change policy or enact newpolicies, because something that
(09:02):
may be a good change for anursing facility might not be
the same for an assisted livingfacility or vice versa.
So it's really important for us, as we're working with
policymakers, to distinguish thedifference between the two, so
that they both don't get lumpedin together with a new rule or a
new policy, because that couldbe really damaging to a
(09:23):
particular industry.
We don't want a lot ofregulations in assisted living
facilities, for a reason theyjust don't.
They don't need it.
They need certain parameters,they need standards.
But nursing facilities they'retaking care of really sick
patients, so we understand thatthere's a lot more policy that
goes into that.
Speaker 1 (09:40):
Yeah, and a lot of times I think you can see like
too much policy.
We had Adam Benton on thepodcast from Stellar about a
year ago and he was trying to Ithink it was a Colorado facility
or something, but he was tryingto put in a ice cream parlor
that was ran by adults withdifferent disabilities or
different abilities and he saidsomething along the lines of
(10:04):
like if they want to stop us,they could go to hell or
something like that.
Like when you get so muchregulation, sometimes it can
hinder doing good in one ofthose things.
So it is an interesting kind ofbalance of like which
regulations are needed, whichones help the facility, which
ones hurt the facility, likejust add more administrative
overload to an alreadyadministratively heavy industry.
(10:27):
I'm curious on how governmentregulations on that line impact
the quality of care that theresidents are getting in the
facility.
Like do you see what?
I guess, what governmentregulation have you seen have
the biggest positive impactwithin the facilities?
Speaker 2 (10:48):
Yeah, you know, you just summarized policy and
burdensome regulations reallywell.
There's this joke out there.
I think there is some merit toit.
But we joke in the industrythat nursing homes are the most
regulated industry in the nationoutside of, like NASA.
(11:09):
And you know, nuclear, notnuclear.
But you know, like spaceexploration and you know those
type of you know big scientificindustries and I really actually
believe that to be true.
I think there is a lot ofextensive oversight and major
burdensome policies andregulations that are just
(11:30):
excessive, major burdensomepolicies and regulations that
are just excessive.
And I think for decades federalbureaucrats really have doubled
down on these excessive andreally punitive systems that I
think fail to produce realchange.
You know, they just continue topile on regulations, guidance,
penalties.
It just ends up being thishamster wheel effect and then
(11:53):
they're also administeringenforcement really
disproportionate.
It ends up being verysubjective instead of objective,
which to begin with thepolicies are supposed to be
everyone following the samething.
But when you get differentpeople coming in to provide
surveys or people interpretingrules different ways, again it
(12:14):
just becomes really burdensomeand it becomes difficult and I
think the system right now as itis is very inconsistent and
ineffective and in my mind, theway the system is, it's not
driving quality improvementamong these nursing facilities
or senior living facilities toenhance the quality of care, and
I think that's a real problemand a huge opportunity for
(12:38):
change.
We've been really excited aboutthe change of administration
and some of the things that it'sbrought.
Cms has put out some requestsfor information to the many
associations throughout thecountry and we're excited about
what that means because it givesus the opportunity to respond
(12:58):
and say here's how muchoversight's happening.
Here's why we think that it'sburdensome and why there needs
to be a change with theselong-term care facilities so
that we can focus on quality ofcare.
You know, you find a nursebecomes a nurse because they
want to help people, but then anurse gets promoted to be a
(13:20):
nurse manager and then whatlittle do they know that they're
going to be burdened with a lotof paperwork and a lot of rules
and policies that they have tofollow.
That may seem at first glancelike a really good idea, but the
more you dig into it, sometimesI think we're wasting resources
(13:41):
when those nurses could beproviding the care that they
need or coming up withinnovative solutions for quality
of care or for ways to improvethe industry.
So I think you know Utah hasdone some really good things
with changing a policy or addingthings to promote quality of
care.
We've got a really greatquality improvement incentive
(14:02):
program that really, like thetitle says, incentivizes
facilities to look at qualityand to have quality improvement
and to make innovative changes.
They get a little bit of extramoney to do this, but they have
a lot of stipulations that theyhave to follow, and I think that
is a good trade-off.
Value-based payments andvalue-based care is really
(14:23):
popular right now.
We're giving you this fundingand what are you going to do
with it and how are you changing?
And I think people respondreally well to that.
They really do.
The caregivers and the peoplethat are running these
facilities really want to dowhat's best for the people
living in their facilities.
But when you're burdened down byhefty rules and policies and
(14:47):
then to add on top of that theenforcement, the civil money,
penalties, it can be reallydiscouraging.
And because of that there havebeen a significant amount of
closures throughout the countryof nursing homes because they
just following the rules arereally expensive, or they have
infractions and they can't paythe fines, or just, you know,
(15:11):
lack of reimbursement there's.
You know, there's a lot ofthings that go into it.
So I think overall there needsto be an overhaul of changing
federally and then I thinkstates then can continue to
follow suit and making things,you know, easing those
regulations and those policies.
I think another thing that Utahhas done policy-wise has been
(15:33):
implementing home andcommunity-based waiver programs.
That has been really beneficialfor a lot of seniors in Utah
because they can't care forthemselves at home anymore or
they need a little bit more carein the home.
So there's a waiver programthat allows them to do a couple
of things, to have someadditional care at home under a
Medicaid waiver program, so thatthey can afford it or reside in
(15:58):
an assisted living communityunder that Medicaid waiver
program which helps supplementthat care to where they can
afford it, and I think that'swhere it's really needed most.
There are a lot of low-incomeseniors out there and, as you
know, the amount of older adultsaging into the system is
growing exponentially.
(16:18):
In Utah by 2027, it's going togrow by 18%.
That's a huge number.
We're also going to see in Utaha decline in caregivers, which
you know is historically in Utahwe take care of our own, but
we're seeing now the cost ofliving.
People can't afford to have twoparents stay at home anymore,
two people in the home, or oneperson stay in the home and one
(16:42):
person work.
They need two people working.
So we're going to see a declinein caregivers, an increase in
older adults.
So having programs like theseMedicaid waiver programs or
Medicaid program in general forseniors to live in a nursing
facility long-term are reallybeneficial for people that are
going to need this care.
Moving forward.
Speaker 1 (17:04):
Yeah, you touched on one of the points, but I'm
curious what you think thebiggest gaps are currently in
the healthcare system when itcomes to senior care.
I think there is a huge gap,one of my biggest pet peeves,
and I wish that there was asolution.
But like a sliding scale.
It's like Medicaid pays for itbut if you make $10 more, you
have to come up with $3,000 tocover or $10,000 to cover your
(17:26):
own bills.
Anyway, we've seen that a lotwith people that need, even like
caregivers, where they needmoney, but they're like I only
can work this many hours or elseI lose all my benefits, and
it's like.
It's like so tricky, and so I'mcurious that's, of course, one,
but what other big gaps do yousee in the health care system
when it comes to supportingseniors?
Speaker 2 (17:46):
I would say the largest gap is reimbursement for
the facilities, for theassisted living side on the
waiver or for the nursing homeside, just on their Medicaid
rate.
And the reason I think that's abig gap for senior care is
because currently both assistedliving and nursing facilities
(18:06):
are operating in a significantshortfall for Medicaid.
So, for example, nursingfacilities operate about $100
per patient per day in ashortfall.
So if they're receiving I'mjust going to throw out some
numbers out there around $230per patient per day, and sorry,
I'm like totally getting intothe weeds on this.
(18:26):
It's okay, I'm all about math,but I think it's important for
people to understand why this isan access to care issue.
Because if nursing homes arenot receiving the reimbursement
that they need to care for apatient, so if it's $100 a day
shortfall, then that is $100 aday that they have to make up
somewhere and that means thatthat's money that they have to
(18:51):
cut because they're notreceiving the full amount of
reimbursement from the state fortheir Medicaid patients.
And when 60% of patients in thestate are on Medicaid, that is
a large chunk of people residingin our facilities that we are
not being wholly funded for is alarge chunk of people residing
in our facilities that we arenot being wholly funded for and
costs keep rising.
(19:12):
Their supplies, their workforce, potentially their rent, their
mortgage, whatever it is.
All their overhead issignificantly increasing and
their Medicaid rate increasesmaybe at a very slow amount.
If we're lucky, the legislaturehas been very generous in the
last few years that we havegotten some rate increases.
Very grateful for that, but westill have a long way to go to
(19:34):
be whole.
And that gap, that shortfall,then becomes an access to care
issue, because if you are notreceiving the full reimbursement
that you need, that means thatyou can't increase wages as much
as you want to, so you can't becompetitive.
It's a very difficult-findingworkforce.
A lot of your money is havingto go to expensive supplies and
(19:55):
DME and things to support thepeople in your facility.
But if you're having to pay forthose things, you're going to
have to consider well, I've gotthese very subacute patients.
Can we afford to take more withthe limited staff that we have?
Because we all know we're stillin a significant workforce
shortage?
So it's just all these thingsthat stack up, and what that
(20:16):
means is can these senior livingcommunities, can these nursing
facilities, really remain viableat a time that seniors are
going to need them the most andthat will become an access to
care issue In 2023, nursinghomes in Utah had to deny around
1,200 admissions because theydidn't have the workforce or
(20:38):
because they just simplycouldn't take these patients
because of cost constraints orworkforce constraints.
That's a significant numberthat I would anticipate.
That will only grow if we don'tfind some way to make changes.
Speaker 1 (20:53):
Yeah, if we're growing by 18%, then that 18% of
1200 is another 40, 30, 40people that just don't get care
after an injury, an injury, yeah, when you go to lobby for these
(21:16):
improvements and theseincreases, how, I'm super
curious on the backside, likewhere are you saying you know
this?
Funds, like?
One example I could say is likemaybe if Medicare or Medicaid
pays the actual amount insteadof having that lower amount,
then we're able to help morepeople.
They live longer, like where, Iguess, what levers are you
(21:37):
trying to pull as anorganization to say like we need
the funding and here's ourideas of where we can
potentially get it from to helpseniors?
Speaker 2 (21:46):
Yeah, I mean I think it's really easy to go up there
and highlight rural facilities.
We have a lot of ruralcommunities throughout the state
of Utah and if you think abouta person who grew up in a very
small rural community theyworked there, their family is
there they come to a point intheir life where they need
(22:11):
long-term care, whatever thatmeans, but the local long-term
care facility just closedbecause they weren't getting
enough funding or because ofburdensome regulations or fines.
Where does that person go?
Then they end up goingsomewhere two, three, four, 500
miles away, getting completelydispersed from where they grew
up, from where their family is,where their community is.
(22:33):
I think that's a really easyselling point for us to the
legislature.
We have a lot of amazing rurallegislators in our great state
that are sympathetic to that andunderstand that.
So that's one really strongselling point that we have.
I think also it's easy to tie itback to workforce because no
(22:54):
matter what the legislators do,what their profession is, they
all are seeing the workforceshortage.
I mean you can go everywhereand see that there are not
enough workers.
You go to Jersey Mike's and theline is an hour long because
they don't have enough workforce.
You go to the grocery store,the lines are long, your food
costs more.
I mean, it's so easy to showthat the cost of workforce is a
(23:18):
lot more, there's a shortage ofworkforce the cost of care, but
really framing that in a waythat they understand, trying to
get personal helping them,helping them understand like
what if this was your loved one,you know, we, we want them to
have good care, we want them tohave access to care.
Access to care is reallyimportant to legislators, and so
I would say those are, you know, a lot of the, the, the main
(23:41):
points that we make when tryingto advocate to, to policymakers.
Speaker 1 (23:47):
Yeah, and to your point on the rural communities.
It's one thing if the communityshuts down, but it's also
another thing when you have apopulation of 2,500 and
everybody's like oh, you don'twant to work at the nursing home
because you don't get paid,like it's really quickly to go
around, and then all of a suddenyou're cycling back through of
like oh yeah, I worked here fouryears ago.
(24:08):
We just need some money, so I'llbe here for the next three
months and then they're cyclingthrough the same 2,500 people
trying to keep it staffed.
So it's-.
Speaker 2 (24:14):
Yeah, 100% correct.
They have such a small pool ofworkforce in that small
community it is it's adouble-edged sword access to
care, but also the staff to carefor them.
Speaker 1 (24:25):
Yeah, Going back to something you said earlier of
like a lot of your time is spenton trying to kind of change the
stigmas around long-term care.
What does that look like?
Like?
What are you guys activelydoing to try to make it so
people don't think of nursinghomes as the nursing homes of
the seventies?
That are like where they'vesaid their mom, that's like
(24:46):
terrible.
Speaker 2 (24:47):
Oh my gosh, I know I it's.
It's so wild that people stillthink of the nursing homes from
the 70s and the 80s becausethings have changed so much.
I mean you'll see the personcentered care, focus.
They've completely remodeledand refocused how they look.
I mean listen it's still.
It's still a long-term caresetting and I understand that
(25:08):
nobody wants to live there, butwe are making some strides and I
think we just encourage thepublic to come and tour, we
encourage legislators to tour.
But one of the things that I'mreally excited that we're
working on is our Stories ofCaring series.
We have not debuted it yet, butwe are going into our
communities, into our memberfacilities and interviewing
caregivers.
(25:29):
We are trying to understand whythey work in long-term care,
what they feel in theirday-to-day work makes a
difference or gives them meaning.
And so, because of that, we'retaking all these videos and
we're putting them together tohave 20-second clips or a minute
clips or, you know, whatever itis for us to share with
(25:49):
legislators, for us to sharewith our members and to use,
just in marketing in the general, to try to, you know, bring
more positive light to theindustry.
And this is going to take along time.
It's going to take a long timeto change people's mind.
Covid gave us a really bad rap.
You know that we're going tocontinually work to grow our way
out or to claw our way out ofthat hole, but I'm really
(26:11):
excited about our stories ofcaring.
I think that that's going to bea really good marketing tool
for us to spread some goodnessin the community.
And it really is that feel goodof, you know, getting to see
these caregivers and howmeaningful the work in long-term
care is for them.
Speaker 1 (26:26):
Yeah, no, I love that .
I think that'll be awesome andthat's really the biggest lever.
I think that a lot.
I think, just in general, thatthe senior care space, long-term
care and in-home care, likeit's yet we've yet to see them
fully come into the digital eraof using video and content and
(26:48):
brand and all of that toactually showcase, like, what is
happening.
Um, and so it's cool that youguys are working on that.
I love that.
Um, we're already at time,which is crazy.
Um, what message would you giveto someone who wants to make a
difference in senior careadvocacy, a difference in senior
care advocacy, I would say letyour voice be heard.
Speaker 2 (27:18):
There are so many amazing caregivers and
supporters of long-term care,especially in our great state of
Utah, and it is so much easierfor me to do my job when I can
understand the passion that isfrom these caregivers, the
passion that these caregivershave and the stories that they
have.
There are so many good thingshappening in our communities
throughout the state and we wantto be able to share them.
(27:39):
So my advice to people workingin long-term care or that have a
passion in long-term care is tolet your voice be heard.
Reach out to places like UtahHealthcare Association or
wherever you can, so that we canshare your story or help us
understand your concerns.
Where do you feel that thereneeds to be changes?
You guys are the ones in thefront lines working every single
(28:04):
day.
Let us be your big voice, butshare that with us so that we
can try to enact change.
Speaker 1 (28:12):
Yeah, I love that.
Who should reach out to UtahHealthcare Association if we
have administrators or peoplelistening?
Who do you want to work with?
Speaker 2 (28:24):
I mean you're always welcome to reach out to me.
My email is super easy.
I mean you're always welcome toreach out to me.
My email is super easy AllieA-L-L-I-E at U-T-H-C-A dot org.
You can always go to ourwebsite, wwwuthcaorg.
We have a great staff here.
We want to help you.
We want to be a resource foryou.
Speaker 1 (28:47):
Please let us do that .
Awesome.
This has been so awesome, allie, really great insights, and I
love what you guys are doing tohelp seniors across Utah.
So thank you for giving sometime.
Speaker 2 (28:52):
Yes, thank you so much.
I just appreciate theopportunity.
Anytime I can talk about thisindustry, I'm here for it.
So thank you.
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
The Breakfast Club
The World's Most Dangerous Morning Show, The Breakfast Club, With DJ Envy, Jess Hilarious, And Charlamagne Tha God!