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With Steven Buck, CEO of Care Providers Oklahoma

Steven Buck, CEO of Care Providers Oklahoma

Every year since 1965, millions of taxpayer dollars have gone towards Medicare-and-Medicaid-funding, and in 2020, that monetary value grew more than nine percent. Despite this, so many Medicare-and-Medicaid-funded long-term care facilities still find themselves struggling to afford enough employees, equipment and resources that are needed to provide quality care for their residents. At the end of February 2022, The Biden Administration announced a new set of reforms that they say will improve the safety and quality of nursing home care.


Ensure that every nursing home provides a sufficient number of staff who are adequately trained to provide high-quality care.

Hold poorly performing nursing homes accountable for improper and unsafe care and require them to immediately improve their services or cut them off from taxpayer dollars.

These two specific new reforms announced by The Biden Administration left many long-term care owners and operators, like CEO and Founder of Voyage Long Term Care, Brad Underwood, in disbelief. “I am totally disappointed with the recent Biden Administration reforms,” Underwood said. “It is almost insulting to all the hard work done by our frontline caregivers, despite the lack of support. To propose that they want to overly regulate and under-fund these mandates is an outrage.”

CEO of Care Providers Oklahoma (CPO), and business partner of Voyage Long Term Care,

Steven Buck, says that there is still more work that must be done before these reforms can be truly effective. “We have to find the right balance between knowing that our frontline workers are doing the absolute best they can to provide quality care in our facilities, and still holding the correct parties accountable when poor care is delivered,” Buck said.

In an email statement released by CPO to their members, Buck stated that he was also

disappointed in the administration’s lack of credit attributed to the long-term care industry’s frontline heroes and all the hard work that they have put into the past two years. “Our staff members have worked heroically and successfully to save many lives, and today, COVID-19 has largely been minimized – although not eradicated – in our facilities,” Buck said. “Rather than acknowledge these successes, President Biden is now proposing that nursing homes increase staffing levels without any additional financial support. It shows a complete lack of

understanding of the workforce and revenue challenges our facilities face.”

Buck said that based on feedback given by the hundreds of CPO members, like Voyage Long Term Care, the biggest issues facing long-term care include economic challenges, liability risks and one of the most significant of them all, the long-term care workforce shortage.


The Biden Administration’s new set of reforms are planning to ensure that every nursing home provides a sufficient number of staff who are adequately trained to provide high-quality care.

The long-term care industry faced labor shortages well before the 2020 pandemic, but now, several reports show that it is at an all-time low. According to a report done by the American Health Care Association (AHCA), and the National Center for Assisted Living (NCAL), nursing homes have lost over 240,000 caregivers since the start of the pandemic. The labor shortage has not been this low for more than 15 years.

According to the official fact sheet released by the White House, in regard to the new reforms, long-term care facilities, including nursing homes, will be held accountable if they fail to meet the minimum staffing level required.

Chief Operations Officer of Voyage Long Term Care, Kip McElwee, says that in her eight years of experience in long-term care, she’s seen the labor-force in its highs and lows, but the current workforce shortage is nothing like she’s seen before. “Healthcare staffing is always going to go up and down, ‘fully staffed’ has always been, and I think, always will be an uncommon phrase for us,” McElwee said. “For me, the sad part of all of this is that all of the attention we have to put towards keeping our homes fully staffed takes away from the attention we could be giving more to the residents. Employers have to now be more creative than ever before to find employees. These new reforms leave us wondering if they even understand what’s really happening.”


Buck said that, in his professional opinion, there are several key components that must come into play for the long-term care labor interest to increase. “We need a robust reimbursement

model,” Buck said. “In 2019, we saw a significant reset of the rate structure for Medicaid and Medicare delivered services in Oklahoma thanks to Senate Bill 280. That initiative fueled a better compensation model for our frontline workers and allowed us to pay a more attractive wage. However, Covid reset everything. We moved from a wage environment that was in the $11-$12 per hour bandwidth for frontline aides to now having to compete with hospitals who are paying all departments a $15-$16 per hour wage. No criticism towards the hospitals, but that is a market reality.”

Many long-term care professionals would agree that when working in long-term care, they are more motivated by passion rather than the pay. However, at the end of the day, Buck said that the pay rate is what matters most. “It is not always glamorous work,” Buck said. “It can be incredibly rewarding, but very challenging. So, when you have hospitals who pay frontline aides $15 an hour and places like Hobby Lobby paying their employees $18 an hour, and you’re somebody who is trying to make a living and provide for your family, you’re probably going to navigate to a higher paying job.”

Buck also said that the healthcare industry as a whole is lacking the level of advocacy needed to continue a robust health careers continuum of work. “We need to speak passionately to our high school students and early college individuals about how rewarding this career can be by talking about the merit of healthcare careers,” Buck said. “We also

need to think strategically about how we can help these individuals progress through the jobs with continuous education. All in all, we need to be able to pay our long-term care employees a wage that is respectful of what they are doing to change people’s lives and give our seniors the high-quality care that they deserve in their final days on this earth.”

Currently, Voyage Long Term Care requires 17 licensed staff per 100 residents for day shift, 11 for evening shift, and seven for night shift. “I’d like to think that we strive to be innovative when it comes to filling positions within our homes,” Underwood said. “It’s important to put focus on recruiting new employees, but I think it’s just as important to focus on keeping them too, and we try to do that with competitive pay, rewards, and educational support. However, we have to have the funding to do that, too.”


Amongst the set of new reforms set by The Biden Administration, one reform states that it will ensure that poorly performing nursing homes are held accountable for improper and unsafe care.

There are more than 1.4 million Americans who currently live in over 15,500 Medicare-and-

Medicaid-certified nursing homes across the nation. These individuals are amongst the

highest risk for serious complications due to COVID-19. State health departments across the country have worked to appoint health inspectors to visit the home once a year, or as needed, to ensure that long-term care facilities are in compliance with state regulations. This section of The Biden Administration’s new set of reforms plans to enhance funding and resources towards Centers for Medicare & Medicaid Services (CMS) inspections by implementing a 25 percent increase in funding.

With this, CMS, and The Biden Administration plan to “beef-up” scrutiny and expand financial penalties for poorly performing nursing homes and explore the possibility of making per-day penalties as the default penalty for non-compliance, instead of the current one-time fine policy that was put in place by The Trump Administration. “We do have an obligation to protect our seniors,” Buck said. “I agree that there has to be accountability when poor care is delivered. I don’t suggest a system of leniency. I believe that our government regulators have the responsibility to be our partner in care and help the entire system improve, but I get

concerned about a ‘gotcha’ mentality. When you find something that needs to be held

accountable, it’s got to be held accountable, but we should all be in the business of lifting the quality of care to our seniors together.” Underwood said he agrees and believes that legislators must take a deeper look into the reality of long-term care. “Our healthcare system is made up of many parts,” Underwood said. “Long-term care continues to receive unjust punishment, over regulatory practice, and unfair treatment at the state and federal levels. Until legislators take an active role in reviewing the practices of these individuals, seniors, and senior living, will suffer.”

Millions of dollars in penalties are paid towards CMS every year, and with the administration’s new per-day penalty policy plan, numbers will skyrocket by taking the dollar limit on per-instance financial penalties from $21,000 to $1,000,000. “I would love to say that we’re going to significantly progress care in every building in the country,” Buck said. “I think that is an

outstanding goal. I just don’t think we can get there by ratcheting down on the buildings

who are coming up on the hills of a catastrophic pandemic. This is a time for new learning

and new opportunities.”


How CPO and Voyage Long Term Care plan to mitigate possible negative outcomes of the new reforms for their nursing homes

Since the administration’s release of the new set of reforms, many long-term care

communities are fearful of what it may mean for their residents, residents’ families and

employees. “For Oklahoma, if there is an expectation for a minimum staffing ratio without

a significant advancement in reimbursement structure, we will have buildings close,” Buck

said. “In many rural parts of the state, the long-term care home is usually the largest private

employer in that community, and if they are unable to meet the workforce requirements,

the buildings will close.” Underwood has faith that Voyage Long Term Care will rise above the rest throughout the year. “During the hardest days of Covid I witnessed our people perform the most heroic tasks imageable,” Underwood said. “They risked their own lives to care for our senior residents. I have faith that Steve and CPO will bring that fact to our regulators in a clear and effective manner.”

Advocacy plays a large factor in CPO’s goal to better the environments of their members

and nursing homes across the state. Buck has confidence that CPO can, and will, continue

to communicate with state policy makers to ensure that the new reforms will only help

Oklahoma’s long-term care industry move forward. “Is it meritorious to add more staff,” Buck said. “Absolutely, but to get there, we have to be able to pay a rate that can attract more staff. Is it meritorious to increase standards and expectations? Yes, but the way to get there is through a collaborative manner with the appropriate investments, as opposed to hard sanctions and disrespecting the hard work of the men and women who have served so capably in this field.”


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