As Clifton J. Porter, II, officially assumed the role of president and CEO of the American Health Care Association and the National Center for Assisted Living (AHCA/NCAL) in October 2024, one of the strengths he brought was his experience in the long term care industry. Porter knows what it’s like to work in direct care and shares a passion for giving residents the best care possible.
Formerly AHCA/NCAL’s senior vice president of government relations, Porter has spent his career advocating for caregivers and the elderly: during the COVID-19 pandemic, he helped secure billions in resources for the long term care sector, and he was named one of The Hill’s Top Lobbyists 2023. As he prepares to face the challenges ahead, he’s more than ready to meet them head-on.
The Importance of Genuine Human Contact
Porter’s 35-year career began when he was a teenager volunteering at nursing homes through a church outreach program. In college, he decided to pursue a degree in health care management with a focus in long term care, and he began working as an administrator soon after graduating. He credits his former boss Liz Kail, the administrator of a facility in Lynchburg, Virginia, with giving him his first job in 1989.
“I got in my car, drove from Richmond, and asked her if I could be her administrator in training, and she gave me the chance,” he recalled. “She was my very first mentor.”
Looking back to those early years, Porter said that a number of lessons stuck with him throughout his career. One of the most important is that there’s no substitute for what he calls genuine human contact.
“One thing that stuck with me is the fact that the residents so enjoyed seeing us,” he said. “You got to know them. They got to know you. They looked forward to seeing you. You got big smiles. It’s just important to take the time to engage with them, and doing that makes a big difference. I still carry that with me today.”
From Administrator to Lobbyist
Porter made the leap from operations to policy, as he described it, “quite by accident.” In the early 1990s, he was managing a group of facilities in the Atlantic region when Maryland began planning to transition its Medicaid program to managed care.
“Based on our portfolio, it would have eviscerated the business,” he recalled. “We had to do something about it.”
There was just one small problem: Maryland’s legislative session lasts only 90 days. This meant that Porter and the operators he was working with had a very brief window to develop an alternative proposal and convince lawmakers to support it—which is exactly what they did. “It was quite the amateur hour,” Porter said. “But we consulted with some people, got to work, figured out a solution, and we won.”
This caught the attention of the chief operating officer of ManorCare at the time, Keith Weikel, who offered Porter an opportunity to build up the operator’s government affairs department. “I said, ‘I’m not a lobbyist. I don’t know what I’m doing,’” Porter recalled.
Weikel disagreed, telling Porter that what mattered were his skills as an administrator. “He said, ‘You can learn the ins and outs of lobbying,’” Porter explained. “‘I can’t teach a lobbyist our business.’”
Porter took the job, moved to Toledo, Ohio, with his family, and spent the next decade building ManorCare’s lobbying arm. “It was learning by doing,” he recalled, though he had a little help from his friends at other organizations. Perhaps the most important among them was Larry Lane, then the head of government affairs at Genesis Healthcare, who advised him on how to structure ManorCare’s approach. He also shared a bit of wisdom that Porter never forgot: “He said, ‘In operations, we’re competitors, but in government affairs, there are no competitors. We’re all on the same team.’”
There’s one other team that’s supported Porter throughout his career: his family. “I’ve got a wife of 35 years and three kids that are now grown,” he said. “From snowstorms and natural disasters, to not having enough staff, to having to move to Toledo, to all the things that have been my career, they’ve been super supportive. I wouldn’t be able to have the success that I have without them.”
Meeting the Demands of the Future
A few months into his new role, Porter’s top priority is staying committed to AHCA/NCAL’s mission. “Providing solutions to problems is core to our mission, and at the end of the day, we have to be laser-focused on that,” he said.
That means not only listening to the organization’s membership in a broad sense, but also spending ample time in facilities themselves. “I spent the first 16 years of my career in buildings, so I think it’s important for all of us—particularly the leadership team—to make sure that we’re spending time in facilities and understand what the issues are.”
Naturally, he’s also deeply concerned with the unfolding caregiver crisis. Solving it will require close collaboration with lawmakers, as well as leaders in other health care sectors who are facing the same problems and will benefit from common solutions.
“If we’re going to be able to meet the demands of the future—and they are significant—none of it matters if we don’t have the workers to take care of this burgeoning demand,” Porter warned. “And right now, America really does not have a plan to provide the supply of workers that are needed. It doesn’t exist.”
To that end, he’s hopeful about the two pieces of legislation AHCA/NCAL has been working on with Congress. One would create an apprenticeship-like program for nursing assistants; the other would augment facilities’ own nursing assistant training programs.
“I think it’s going to be an incremental battle,” he said of the workforce shortage. “It’s our goal to continue to offer solutions and at least incrementally move the bar.”
Another focus area will be the development of what he called a more “rationalized” regulatory system: in short, one that leads to quality improvement and facilitates a positive, rather than punitive, relationship between regulators and operators. “We need to have a regulatory system that keeps providers that shouldn’t be in the business out of it, and that supports providers that are doing a good job or intend to do a good job,” he said.
At the same time, Porter takes solace in the belief that policymakers have finally come to recognize the industry as a central service, one that will become increasingly important as the population of people ages 85 and older grows. “I’m excited to see how the government works with us in the future to meet that demand,” he said. “It gives us a great opportunity to get additional support to do all the things we want to do.”
Rising Up, Learning, and Overcoming
While there may be challenges ahead, Porter believes the long term care industry has proven itself more than able to navigate crises great and small—and he’s excited to work closely with AHCA/NCAL’s members to solve the problems facing them.
“It’s the resilience of our members that excites me,” he said. “Every time we face a challenge, I always say to myself, ‘They’re underestimating our people once again. We know how to rise up, learn, and overcome. It’s just the nature of who we are.’”
Steve Manning is a freelance writer from New York City.