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Many skilled nursing and assisted living providers have the profession in their blood, with families passing down or recasting their businesses from one generation to the next. A case in point is Deborah Meade, chief executive officer (CEO), Health Management, Warner Robins, Ga., a third-generation owner-operator with “28 years in” in a profession she loves.

A board member of the American Health Care Association (AHCA), Meade’s story is one that she wishes there were more of, which is to say more examples of women CEOs in the long term and post-acute care

(LT/PAC) space.

“When I originally got into the business in 1999, there were few of us female owners,” she says. “In the nursing profession and among administrators, you see a lot of females, but as you go up, you see fewer females. And, I don’t know why. If I could do anything in this article, it would be to encourage women to believe in themselves, believe in their leadership, and know that they can do these jobs.”

Meade says she certainly has experienced nothing but positive relationships among fellow CEOs from her time on the AHCA board and in her regular, professional interactions. She says while there is much sharing of best practices and how to handle the current challenges of today’s LT/PAC profession in the C-Suite, there is always room for different voices.

“When I got on the AHCA board, I did not think I would be of any help or have any input. There are a roomful of extremely intelligent people, and at times it can be intimidating. However, you come to realize we are all serving the same people, offering the same services, and all want the same goals in the big picture,” Meade says. “The bottom line is you have a voice and an opinion, and they want to hear it.”

In her own story, Meade says the key was to take what she knew from the way her father had built the family skilled nursing organization and evolve that model. So, in 1999, Meade leased a pair of buildings from the existing family business to create her own company.

“I started Health Management then with two of the facilities, and grew that to include assisted living in 2001, and added two more skilled facilities in 2002. So, I have four skilled and one assisted living, which covers post-acute care, skilled care, traditional nursing home, and assisted…really a little bit of everything,” she says.

All told, this portfolio translates to 368 skilled beds, 88 assisted living units, and 39 independent apartments, with 400 employees overall.

Meade appreciates the balance of her current community makeup and her role as a small provider. “I like to be a small provider and to have my thumb on the triggers,” she says. “I like to know what is going on in my homes and know the people who are providing that care. I personally don’t see getting any larger, but I do see transitioning some, and I would do some more assisted living.”

As she evolves her business, Meade would also like to see more forward-thinking regulations, for the sake of her own business and that of her peers.

“Yes, everybody needs an audit, and everybody needs oversight. But a reasonable amount, which can free up dollars for a company and not have to use people and their skills in places just for compliance,” she says.

To put her beliefs into action, Meade has worked in Georgia to help defeat legislation that would have increased the regulatory burden. From that experience and others, she learned that lawmakers need to understand LT/PAC to see why more rules are not always necessary.

“I got involved in politics 14 years ago and was shocked that they [lawmakers] don’t get what we do, nor the population we serve. They don’t know anything about it, like how frail and sick our residents are on the skilled side, for instance,” she says.

There is no way to talk about the business climate in LT/PAC without addressing how providers can best manage the current occupancy challenge. Meade says for Health Management it is all about budgetary discipline, which means looking at what is real and what is doable.

“We know that our population right now will not support an 85 to 90 percent census that we have all been accustomed to. So, you adjust your budgets,” she says. “What I have done is I have met with my leaders and my administrators, we have adjusted our budgets to a reasonable census.”

The company has around a 50 percent Medicaid and Medicare reimbursement structure in its PAC facility, and 73 percent Medicaid for its other skilled buildings. “It is nice to have the split (50-50), but not reasonable to think most facilities will have that. You find yourself getting extremely creative in surviving under Medicaid reimbursement.”

Communicating the pressures to staff is key, too, allowing Health Management to hold everyone accountable to that budget.

“You cannot have overages or you don’t survive. Then we keep employees educated on where we are at and why we need to [keep to the budget] to be efficient,” she says.

And one of those staff brings Meade back to the matter of generational pull to the profession. Yes, there is a fourth generation behind Meade to continue the family tradition.

“My daughter Kaelyn, she is 23, came onboard last May and is doing work to become an administrator. She wants to take over the company when it is her time. I am very proud to say we have a fourth generation,” she says.