Attorney & Lobbyist Martha Gentry Addresses Legislative Issues in Tennessee
Lucas: Welcome to Bridge the Gap Podcast: The Senior Living Podcast. I’m here with my buddy Josh and this is Lucas and we have our esteemed guest today- Martha Gentry. She’s an attorney with a focus on senior living. Welcome Martha.
Martha: Thank you very much! It’s a pleasure to be here.
Lucas: Yeah, we’re excited. Give a little bit of a background to how you got involved in law and specifically how you’ve gotten involved in senior living and Argentum as well.
Martha: Well, thank you. Public policy has always been an interest to me as long as I can remember. I really was always fascinated by how government really impacts everything that we do- all politics is local. So, I was always very interested in how state and local government really impacted all areas of our lives.
I was always taught from an early age how important older people are in our lives and the care and respect for older people. So, when the opportunity came for me to represent Argentum, it was just a very natural fit and I was very excited to have the opportunity to work in what was a relatively new and very growing area and something I saw as an important need.
Josh: So, I had the opportunity to meet you back- I don’t even know how many years ago was. It’s probably been at least-
Martha: -a few.
Josh: Yes, several years. We won’t talk about how long ago was. But, probably similar but different story. You know, when I got into the industry I was very much: don’t like politics, don’t like how it impacts everything that we’re doing. As a young administrator, I was constantly feeling like I was responding to all the change that was around me and then finally a lightbulb moment it was like, you know what, I’ve got to quit responding to it. I’ve got to actually try to shape some of this.
I had no clue how to do that and was able to meet some folks like you and Megan Fraser and Anne Carr that kind of took me under your wing and taught me about how to approach legislators, the representatives- how to go about the proper channels to bring about positive change.
So, thank you for what you do. Fast forward fast now a little bit. What does your every day life look like and what are some of those challenges that are the big challenges that you’re facing right now in our senior housing industry?
Martha: Okay. Well, I think the important issue that everyone in the public policy in Tennessee is facing is we have a new governor that will be inaugurated on the 19th of January. We have a record number of new legislators that will take the oath of office when they come for organizational session in January and they organize on January 8, is the date required by the constitution for the new members to be sworn in.
Thirty-five is a lot of new people to get to know and- one thing I’ve learned in working with people is when you really sit down and get to know them and build a trust relationship with them, it takes time, but advocacy I think in the legislative arena is a people business and it is getting to know them. I hope we can talk more about that and how, as I said, all politics is local and a lot can be done in the communities that helps us at the state level when we need to work on policies- we can all work together and the members when they get to Nashville have a little bit of background in what’s going on in their individual communities.
Josh: So, Lucas, we talk a lot about this and it seems like no matter what topic we’re talking about- whether it’s recruiting of labor or today talking about maybe some legislative policy issues and things like that like we’re gonna talk about- it seems like it always boils down to relationships right? It seems like that’s what we’re always talking.
So, Martha, talk through (this). So, we’re talking about Tennessee today, right, because we’re here in Nashville where policy is made, where big decisions are made. You’re helping to represent organizations like Argentum that represents the senior housing industry but this is something that happens in every other state. It may look a little bit different but the principles we’re talking about today, they exist, but the timing is now in Nashville and in Tennessee.
So, as these new legislators come in and one of the things I heard you talking about when you were talking about relationships is that it does take time. So, let’s transition to talking practically speaking for those operators out there, for those people in senior housing that do want to be a voice. You know, what are some of the grassroots things that they can do that are small bites of that apple that are tangible?
Martha: Well, I think the single most important thing that any director at an assisted living community can do is to know who the elected representatives are for that community- the house member and the senate member.
What I have found is that in Tennessee, our legislature is part time so they spent a very limited amount of time in Nashville. They all have other jobs that they do. They don’t have a lot of staff and so they are very receptive to any amount of education (or) background information about your industry that you can provide them.
So, assisted living I really like the idea that you have residents and you have a community. Invite them into your community and show them what you’re community is all about. Who are your residents? How many of them are veterans? How many of them are former teachers? Give them that sense of community and let them know about what’s going on. And it doesn’t have to be fancy or formal- but invite them over. You just want to find out who they are, invite them over and begin that dialogue.
Josh: So, one of the things I found out- again I’m sure you probably thought many times when I’ve called you that I was just asking the most stupid questions. I remember, thinking back, I didn’t even know who my legislators were. You know, having multiple communities, there’s kind of multiple interests there because there’s where I live and then there’s where the communities are located.
So, talk us through for maybe that group out there that this is totally foreign like I know it is to a lot of, especially maybe, the mom-and-pop operators that are at one or two communities and they want to be involved. How does someone go about finding out who their legislator is, who their legislators are, and how they contact them?
Martha: We have a very good website for the state of Tennessee and if you go to the Tennessee General Assembly website, there is a location on there that says find my legislator. You can put in your zip code and it will give you everything that you need to know including their email address or telephone number or the name of their staff person. Most all legislators read their emails so you can start with an email saying I’m an operator of such and such community and I’d like to sit down and talk to you.
Josh: And, you know, I’ll tell you one of things I was shocked at is when you told me about that, I even found out that there was an app. Woah, go figure, there’s an app for that. I don’t know if that’s the case in every state but I know that’s becoming a very popular thing where it’s very easy to find your legislator.
Honestly, I was shocked that a lot of these legislators that I didn’t know, some of them you introduced me to and that was always at a very easy open door. But, many of them, I would email just a short simple email introduction and they were very responsive. They want to talk to you, they want to know the issues. So, to build that relationship so that when a tough issue does arise that you need help and that you need to bring about positive change, it’s not starting the relationship at that point. So, starting the relationship before there’s an actual problem that needs to be tackled.
But, with that said, there’s all kinds of issues. So, talk through- what are some of the issues in Tennessee that maybe you’re working with legislators right now or you know are problems on the horizon that our senior living industry either is rallying around or needs to rally around from your perspective?
Martha: I think the issue that I see both from a personal standpoint being in and out of communities as well as from talking to people in the industry is labor is an issue. While the state of Tennessee does not impose labor regulations like the federal government does, we provide a workforce and the workforce needs to be trained.
So, one of the things that our new governor has talked about in his campaign is that we need good jobs, we need good education and we need safe communities. And I think we all agree and support that. He has committed to taking a deeper look at technical education and I think a lot of the training that we need, like for medication aids, we’ve been working on training programs to train workers to work under the supervision of a licensed nurse so that they can assist with medication administration.
We are very hopeful that we can move the ball down the field, if you will, and have greater access to that education so that it increases the available workforce and communities.
Josh: Sure. So, when we start talking about these tough issues, you mentioned medication aid, we’re talking about labor challenges and things like that that, you know, as I understood it- and you continually amaze me with your understanding of the law making, legislative processes, how to bring about positive change there- but then there’s this other side of the equation that impacts all licensed healthcare facilities in any state but in the state of Tennessee where we are state regulated industry. I’ve had the opportunity to kind of work indirectly with you on kind of a different side of the fence with the regulatory board.
Talk our listeners through how, you know, there’s decisions and influence at the legislative level and then there’s this whole regulatory body. What’s the difference between the two and how do you get involved in that? What’s that composition?
Martha: Well, we’ll go back to our civics 101. There are three branches of government and, as I said, we have a new governor and the governor appoints his cabinet. The Department of Health has a division called Health Related Boards and the board for licensing healthcare facilities in that division of regulatory boards. As the executive branch, they administer the laws that the legislative branch enacts. So, they’re separate branches with separate functions and then if for some reason there is a problem in the administrative branch, then you can appeal to the judicial branch. So, you get your three branches of government.
Another important reason for our communities to know their legislators is at times and the governor appoints the members to all these different regulatory boards. So, if the governor has a position to fill on a regulatory board, it’s likely that he or someone on his staff might talk to some legislators and say, hey, I need someone from your area to fill this position, can you make a recommendation? And when you’ve got a dialogue and a legislator knows that the assisted living community’s gonna be regulated, then the legislator very well could make that recommendation. They could get you on a board. That is so important because the division of health facilities regulation, they regulate all licensed healthcare facilities and so assisted-living is just one.
So, you’ve got to have some folks on that board who really understand the industry and how- it may seem like a simple regulation like the width of a hall and where you place your chairs. But, if you’ve got somebody from assisted living, they can explain why that’s important and why you wanna hall to be a certain width.
Josh: Well, you know, you and I have experienced that and sometimes great intentions bring about some not so favorable unintended consequences when things aren’t really well thought out and well vetted.
I think back to a couple years ago when a real challenge that was just a practical example is when a life safety code rule was changed. It brought about a nurse call U.L underwriting that for a new code and the problem was that there was no grandfathering or anything like that. So, what happened is this new code came out and all these new projects were in development and hadn’t been opened yet. The new code came out and these nurse call systems, there was no nurse call system that had been created yet that had been approved by this code that had just been enforced.
So, that was a practical example of that really wasn’t… the intentions were good It wasn’t well thought out.
So, talk about- you mentioned a little bit of board composition. Right now, in the state of Tennessee, the board that I serve on, we have, I think it’s now 19 members. It was 18 members. It’s a very diverse group of people. As we start talking about senior living, it’s hard to believe that, I think, I’m the only one that is an assisted living operator on the board. There’s only one chair out of the 19 to, basically, bring about the regulatory oversight so to speak from a board’s position that understands senior housing.
We formed a subcommittee or a standing committee called the Assisted Care Living Facility. So, help our audience from your perspective because I see you out there in the public representing Argentum and representing others. How do your average person that wants to get in front of the board, that wants to have a voice at the regulatory level- what are some of the steps that they need to take from your perspective to get in front and bring about positive change?
Martha: On the website for the Board for Licensing Health Care Facilities is always the agenda, the schedule of the meetings (and) the meetings are always livestreamed so if you want to follow a particular issue, you can get on and see what’s going on.
One things that I think is important- if you want to make a comment on a particular topic, many times they’ve got conference call available so if you can’t come to Nashville to be there in person, you can present on the telephone. You would need to contact the executive director, identify the topic that you wanted to speak on and make arrangements ahead of time.
But, I think that the board is very good about accepting comments and input. Particularly, there is a rule making process when a statute is passed and the board has the authority for administering that particular statute, they will enact rules and regulations as guidelines as to how they interpret that. They have to be published ahead of time and there has to be public comment.
The members of the board are very receptive to comments that are filed. You can read the rules and they’ll give you a deadline of when the comments are due. You can file written comments if you don’t want to make a presentation and then those are reviewed and responded to in the rule making process.
Josh: So, before I transition to another topic- what do you think? The rules are constantly changing, in particular for assisted living it seems like there’s constantly either a new interpretative guideline which is- it’s not really the rules, it’s like this set of-
Martha: -the transition.
Josh: Yes, it’s the transition to rules, many times. So, there’s that. There’s all these rules. What do you think is the most important part of that regulatory process in rule that senior living providers really need to be paying close attention to?
Martha: Well, from my experience, one thing that I have seen (is) everybody likes to read the rules and complain about maybe this is too stringent. But I have found what gets communities in trouble the quickest is there is a rule that requires each community to have their own set of policies and procedures that outlines their responsibilities to their residents.
It’s very, very important not only to know what those policies and procedures are, but to follow them because if there is a policy and you decide that maybe it’s not relevant to your residents anymore and so you’re just going to cross it out, if a surveyor comes and sees that that’s a policy and you’re not abiding by your own policy, that is just as much of a violation as if you had violated a rule. So, you can get a deficiency for not following your own policy. A lot of communities don’t realize that and get a little slack about their own policies and I think that’s a very important thing that we always need to be vigilant about.
Josh: So, I don’t know if you and I have even talked much about this, but over the past couple of years, fairly new, especially here in Tennessee and new to assisted living was this idea of civil monetary penalties. Those seem to be on the rise. The quantity and it seems like the amount… that it is being assessed to senior living providers.
What is- have you heard anything- I have heard some rumblings that there’s now going to be some kind of fund created from those civil monetaries that are going to be reinvested into quality improvement initiatives and things like that. Have you heard anything about that? We’re trying to dig in a little bit deeper.
Martha: I’m not really aware of that particular topic. I wouldn’t want to comment on that.
Josh: Yeah, so that’s something we want to follow because I think that’s a really good opportunity, you know, and something that we would want to be involved in.
And, along those lines, you know, every state that I’ve ever operated in has all these different member organizations and here Tennessee we’re no different. You’ve represented Argentum, probably other entities and organizations to the legislature, to the regulatory board. But it seems like what always has been the struggle- you and I talked about this- is that there’s always the challenge of circling the wagons, right, because you have these silos not only within our industry but even among the different membership organizations whether there’s an organization they’re basis is on your tax status and whether you’re a for-profit or nonprofit. One is based on, you know are you nursing home or are you assisted living or whatever.
So, what happens is you’ve got four or five membership organizations all kind of vying for the same basic group of membership and then getting them all to come to the table to have one loud voice to the legislature and to the regulatory body. So that you’re not confusing to either one of those groups, can you give us a little insight- you and I talked about maybe some of the ideas that you have for, as we like to say, bridging that gap to help unite people? Can you give us a little insider scoop?
Martha: Well, as I’ve said before, I think that the attention of legislators is very short. They have a lot of different topics that they have to regulate and hear from their constituents. So, for the senior living industry to be effective they need to have a very specific, direct message.
The challenge for me over the years in the public policy arena has always been taking a very diverse industry with a lot of different people and developing that very focused message. I think it’s something that we all need to continue to be aware of and to work on a working among ourselves to define what is the most important thing that we can do that will benefit our residents that will educate our policymakers and work on that one thing and try to bring everybody out of there silos so that we all work together. Developing legislation for educating medication aid is an example of how we did that successfully.
I think that when you see success at the legislature and at the regulatory level, it’s when everybody has come out of their silos and worked together as opposed to working individually on more minute things and the message because very blurred.
Josh: Well, I’m not going to squeeze it out of you yet but I know there’s some exciting announcements coming up maybe in the new year things that that you’re planning ahead to help unite our industry, to unite our member organizations, to bring a positive change. So, I’m excited about leadership you’ve provided there.
Lucas, my cohost, the number one senior living fan. I know you deal with a lot of these issues indirectly many times because you’re in the construction renovation, dealing with the senior homes, so you’re constantly hit with the changing life safety issues and having to manage that. So, I know he has a great appreciation working all over the Southeast. It’s been fun having you with us.
Martha: Thank you.
Lucas: Yeah and it’s a great example. A constant theme that we bring up on Bridge the Gap is this theme of being the bridge and there’s a lot of different aspects of that. So, to hit this legislative and regulatory and advocacy part of that connection is really, really important. We know that that’s added a lot of value back.
So, if there’s people in Tennessee and other states across the nation that are hearing this and there are inspired. They say hey, you know, I love what these people are doing, what you guys are doing, how do I get involved on some level? What would your admonition or encouragement to them be?
Martha: I would say that they need to find a group of people like of people like minded and get involved in a group where they can work on developing that message.
Lucas: That’s wonderful.
Josh: So, I know here in the state we have several awesome groups. We’re going to connect our listeners through our show notes. You always can follow us at Bridge the Gap and we’ll connect people and get them plugged in here in the state of Tennessee.
But, that’s a good encouragement for no matter what state you’re in- be the bridge, right? Get involved- you can bring about positive change.
Martha, thank you for educating me through the years, continuing to educate me (and) help me navigate the legislative body and the regulatory environment and it’s been fun, often times a big struggle, to feel like you’re making a little bit of a positive change. But, thank you for all that you do for the senior living industry.
Martha: My please. I enjoy it.
Lucas: Martha, Josh, I have a high respect for you guys. I’ve enjoyed listening in and learning alongside of our audience today on this. It’s inspiring to me. So, thank you all, everybody that’s been listening today to another great episode of Bridge the Gap.