Longtime long-term care exec turns eye to advocacy

Charles Perry started at the top of his field.

His first job in long-term care? General manager and administrator of a skilled-nursing center in his Mississippi hometown.

Nor has Perry looked back: He's held executive positions throughout his career, developing and operating skilled-care and rehabilitation centers in the South and in Southern Nevada.

Today, following detours that included a stint in the state Legislature and an attempt at retirement, Perry helms the Nevada Health Care Association, a trade group for skilled-nursing centers, rehabilitation facilities and assisted-living homes. Perry's task is to educate the public and help consumers and center operators alike as they negotiate what he called the second-most regulated American sector after the nuclear industry.

Question: How did you get into the long-term care sector?

Answer: A family friend had gotten into the business of providing long-term care in my hometown back in Mississippi, and he owned the biggest licensed nursing home in the state. He approached me to go to work for him, and when I was evaluating his offer, it seemed to me that we were basically standing at the threshold of something in the country that was brand new, and that was going to take hold. I saw it as a great opportunity.

Question: Why did you think it would be big?

Answer: By 1967, we already had the legislation passed that created Medicare and Medicaid. States were moving from where the counties were essentially responsible for paying for indigent care to vendor programs. It was obvious that there would be a pay source for care that hadn't been there before. States also were beginning to receive federal funding to pay for these services. It was a brand new day.

Question: What has been your favorite part of the job?

Answer: Long-term care or skilled-nursing care is a lot different in that you normally get to know the folks you're taking care of. People in and out of hospitals never get to know the administrators of the hospital. All they know is the nurse or doctor who comes in to see them. They're there a few days and then back home. In this segment of health care delivery, you actually get to know the people you're taking care of, and you get to know their families. It's a relationship you don't have in other realms of health care delivery. I've enjoyed getting to know folks, visiting and sitting down with people who were our residents and patients, and getting to know their families.

Question: What led you into advocacy?

Answer: When you are an administrator or owner of a skilled-nursing facility, part of the job is advocacy. You are advocating more on behalf of your own business interest -- the facility you represent, and the people who are there. But, to be a successful administrator of a skilled-nursing or rehabilitation facility, that advocacy is part of the job you need to do. The move from being a day-to-day administrator in a facility to being the executive director of an association is different, because now you're advocating for your members, for the entire profession in whatever jurisdiction you're in. It's much broader in scope.

Question: What do you like about it?

Answer: I get a lot of calls from people looking for answers from, "Do you know where I can find a facility for my parents?" And my members call me frequently with situations that involve some intervention on my part, with one or more regulatory agencies, and helping them maneuver through the bureaucracy they need to get through to be in compliance. So it's still customer service. It's just customer service on a different level.

Question: You also served a term in the Nevada Assembly in 1982. Why did you join the Legislature?

Answer: So much of what governs what we do, and so much of the regulatory system that we have to comply with, comes out of the Legislature. I had been going to the Legislature, meeting with legislators and testifying before committees, and it occurred to me someone might have better success trying to make an impact on those bodies from the inside.

Question: What laws did you work on?

Answer: The biggest thing that happened while I was in the Legislature was, we passed legislation that allowed Citibank to come to Nevada. Prior to that, there was no interstate banking in the state. It was all intrastate. We passed legislation that introduced interstate banking to Nevada. We also had a pretty severe economic crisis on our hands in the '83 session. It was not anything close to what we have now, but looking back, for the time, we were in pretty dire straits. That session also was the first expansion of the Legislature, where the Assembly went to 42 seats and the Senate to 21.

Question: How important was that Citibank law?

Answer: I think it shined a light on Las Vegas and gave Las Vegas more legitimacy. Up until that time, we were looked on by the national banking community as small potatoes. We had some fairly large state banks, but we didn't have any national banks. The legislation helped to open up Nevada, and particularly Las Vegas, to the rest of the country.

Question: What issues are you most into right now?

Answer: The biggest thing facing the state in the next legislative session is the overall budget situation we're facing. I think that's the 1,000-pound gorilla in room. The next big thing the Legislature has to take on in 2011 is redistricting and reapportionment from the 2010 Census. And most of us who have been around this process for a long time are basically holding our breath until 2011 gets here, and we see what else we're going to be confronted with that we don't know about right now.

Question: How will those big issues affect you?

Answer: So much of what we do is publicly funded. Skilled-nursing facilities basically derive 80-85 percent from two sources, Medicare or Medicaid, with Medicaid probably being the majority of public funding we get. We're under fire right now. In the special session we just had, there was a proposal to reduce skilled-nursing facilities' Medicaid reimbursement by a flat $10 per person a day. It would have really been severe. We wouldn't have been able to survive with that type of reduction. And we were only facing an $887 million deficit. Now we're facing a deficit of at least
$3 billion. It's going to be brutal.

Question: What's your proudest accomplishment?

Answer: Being able to contribute to the growth of this profession, to get out there and let people know what nursing homes are, and that there is a place for people. Everybody that has anything to do with paying for health care, the first thing they want to do when someone is in the hospital is get them out as soon as possible. Where do those people go? To skilled-nursing and rehab facilities, until they can get home. We are the safety net and safety valve for hospitals. If you've got folks stacked up in hospitals, you're cutting off access to others, and it's a lot more expensive to provide services in the hospital than to get them into a skilled-nursing or rehab facility. That's the story we've got to tell. We're not just a place for old people. We're not just a place where people go to live out their lives. A lot of good things are going on in skilled-nursing and rehab facilities. We're getting people out of the hospital and up on their feet, back at home and out with their families, and I've been able to participate in it all.

Question: Where do you see health care going in Nevada, especially with insurance reform?

Answer: We certainly need more doctors. We need more nurses and more health care infrastructure than we have now. I don't know that we're going to get there through health care reform. We've got to have more to offer people to get them to come here and live here than just good weather and low taxes. We're lacking in so many of the social amenities you find in other communities. We just don't have that infrastructure for folks. What do people do when they don't play golf or when they don't go to a casino or a buffet? We've got to have things for people to do and we've got to have services for them.

We have the second-most severe shortage of registered and licensed nurses in the U.S. We have a lot of gaps in physician services. We need more doctors in family health and primary care. And we've got vast stretches between Las Vegas and Reno with a lot of small communities where there's not a whole lot going on, and doctors don't want to go there. We need to resolve that. We need things that will make it attractive for people to come here and bring their families and educate their children.

Question: What are your goals going forward?

Answer: I've thoroughly enjoyed being part of this community. I'm grateful I had an opportunity to be in this business, and that I've had an opportunity to make somewhat of an impact. I just hope to keep doing that as long as I can. I tried retirement from 1993 to 1999, but decided I needed to go back to work. I'd like to stay here as long as they think I'm effective.

Contact reporter Jennifer Robison at jrobison
@reviewjournal.com or 702-380-4512.