One might think that an organization with thousands of members and many varied ideologies might require a leader who manages with a stern voice and an iron fist.

In the case of LeadingAge, the organization of nonprofit aging services providers chose to go in another direction at the turn of the century, and it couldn’t have been happier. 

Instead of hiring someone who enjoyed a bully pulpit and a booming voice, the group chose a Southern gentleman who actually trained for the religious pulpit and dispensed folksy stories that brought far more grins and adherence than any tedious boardroom bureaucracy ever would do.

This is the way of Larry Minnix, who came on in 2001 as president and CEO of the organization that then called the American Association of Homes and Services for the Aging. The Georgia native retired in 2015 with the full gratitude of a group that then named after him the long-term care leadership academy he founded.

Minnix continually implored nursing home and assisted living providers to tell “their stories” to anyone who would listen, a mantra that has since been adopted by other senior living and care organizations. He typically told the best tales of all, often regaling groups with stories of his Cousin Bubba and other colorful relatives, many of whom are prominent players in his candid 2018 self-published book, “Hallowed Ground: Stories of Successful Aging.”

Anyone who deems Minnix a naive yokel, however, is gravely mistaken. During his tenure, he pursued numerous new initiatives, including establishing the Center for Aging Services Technologies, or CAST. And although the effort ultimately was unsuccessful, he led a years-long charge to have Congress enact the Community Living Assistance Services and Supports Act, or CLASS Act, which called for a new public insurance fund for long-term care.

A leader for 28 years at Wesley Woods near Atlanta, the last decade of that time as its executive director, he also coined the now-popular motivational phrase, “In the future, there will be two kinds of nursing homes: The excellent and the out-of-business.” 

“Whether pushing for reforming the way we pay for long-term care or strengthening leaders and leadership in our field, Larry never hesitated to challenge the status quo and develop creative solutions,” observed Katie Smith Sloan, both the top executive Minnix hired to assist him and the one who succeeded him as president and CEO. “He did this with humor, compassion and an unwavering commitment to allowing older adults to live their best lives, wherever they called home.”

Minnix continues to consult on operational and strategic matters and remains a much sought-after speaker and writer on aging issues. A career of more than four decades in long-term care extends even further.

OBRA ’87, the landmark federal law that greatly enhanced the regulation of nursing homes, marked a turning point for long-term care. Paul Willging, Ph.D., who led the American Health Care Association when OBRA ’87 took effect, helped the field transition to this new era of federal oversight.

Willging, now deceased, is among those who have been “the right people at the right time in the evolution of the sector and association,” commented industry veteran Steve Chies, who is president of North Cities Health Care in Coon Rapids, MN, and a former AHCA board chairman.

Although the sector could have mounted a fierce resistance against the legislation, “Willging convinced us this was a good thing and where things should be moving,” said Chies, who at the time served on several task forces organized by Willging to help members understand how to move forward. “He was pushing rather than waiting for something to happen.”

Following the implementation of the Omnibus Reconciliation Act of 1987 in 1990, Willging was instrumental in helping the field pivot to an outcomes-based measurement of quality, said Dave Kyllo, vice president of Insurance and Member Programs at AHCA.

“That’s the way we now strive for quality,” said Kyllo, who during Willging’s tenure was just starting his career at AHCA. “At the time, it was brand new.”

Willging, who had served as the deputy administrator of the Health Care Financing Administration (now the Centers for Medicare & Medicaid Services) before joining AHCA, left his imprint in other ways. Among them was the creation of the National Center for Assisted Living, now a significant advocacy group.

Considered personable and a strong communicator, Willging did not stop working on behalf of senior care when he left AHCA. After 16 years at the group’s helm, he served as a senior associate at Johns Hopkins University’s Bloomberg School of Public Health and as associate director of the university’s Center on Aging and Health.

“Paul was a resounding voice for long-term care, paving the way for the future of the profession while spearheading a focus on quality care for our nation’s seniors,” noted Mark Parkinson, president and CEO of AHCA/NCAL, following WIllging’s death in 2011.

The McKnight’s brand may be familiar to many in the field today. That’s somewhat ironic, as the man behind it never expected to be a publisher.

Boiled down, the late William M. “Bill” McKnight Jr. was a gregarious, smart salesman with a keen eye for opportunity. While working for American Hospital Supply Corp. (now Baxter), he saw an unmet need: Medical distributors were having a difficult time finding useful industry information.

So along with his wife, Dede, he launched Medical Product Sales magazine in 1969. That was followed by monthly publications for hospital purchasers and pharmaceutical sales reps. Finally, a publication for the nursing home field made its debut in 1980.

The rest may be history, but that history hardly was a smooth ride — especially early on, when his nursing home magazine’s future was very much in doubt. For years, Today’s Nursing Home was the proverbial runt of a four-magazine litter. The publication was rebranded as McKnight’s Long-Term Care News in 1990 and struggled for several more years but eventually gained its momentum and secured its spot atop the market.

As the decade progressed, the brand’s reputation as an honest broker and an early adopter began paying dividends. McKnight’s Long-Term Care News took the lead in surveying readers, offering webcasts, daily news and more, while also earning scores of publishing and journalism honors. Readers and advertisers took notice. By around 1996, it had already become the market’s big dog. McKnight’s now also has a footprint in the senior living, clinical care and home care sectors.

Bill McKnight died peacefully in 2012, following a quiet retirement spent between his homes in Illinois and Arizona.

He left an enviable publishing legacy: media brands that deliver impartial, fair and accurate reporting on matters that matter. It’s a standard that those of us who follow in his footsteps endeavor to meet each day.

The American Seniors Housing Association traces its roots back to the early days of the senior living industry, beginning in 1991 under the auspices of the National Multifamily Housing Council. In 2000, as the senior living industry continued to grow, the group became a separate, independent association.

David Schless, ASHA’s president, has led the organization every step of the way for the past 30 years.

“You can’t separate ASHA from David and David from ASHA, because he’s been there the whole time,” says Senior Lifestyle co-founder and Chairman Bill Kaplan, who has also been active since the beginning and was the association’s chairman in 2002-2003.

Schless joined the NMHC in 1991 to head its seniors housing committee after having served on the staff of the National Association for Senior Living Industries for two years, having gained aging services-related knowledge through studies leading to a Bachelor of Science degree from the University of Connecticut and a Master of Science degree from the University of North Texas.

Kaplan described him as a “wealth of knowledge and information” and “driven.”

“I have a lot of respect for David,” he said. “He’s a consummate professional.”

In the beginning, Kaplan added, ASHA “gave us a voice. It gave us a purpose, and it gave a place for us as industry members to be able to meet with our peers and our associates at one single place.”

Over the years, Schless has built up membership and fostered relationships with other associations serving operators. In addition to offering forums where members can exchange information, ASHA also funds research, publishes reports and advocates for providers.

Along the way, ASHA formed the Seniors Housing PAC, the first political action committee of its kind, to maintain a strong, unified voice on federal issues affecting the industry.

More recently, in 2016 ASHA launched a consumer campaign, Where You Live Matters, to educate older adults and their families about housing options that are available to help them age well. Two years later, the association launched the ASHA Senior Living Hall of Fame to recognize visionaries in the industry. Six people were inducted in 2018, three in 2019 and four in 2020.

Over the decades, Schless has ridden the ups and downs of the industry along with the association’s members. During the coronavirus pandemic this year, ASHA has advocated for financial aid and testing for senior living operators to battle COVID-19 as well as priority for senior living residents and staff members when a vaccine becomes available.

“He’s taken hold of the things that were necessary as an association for our industry and really stepped up his game,” Kaplan said of Schless.

“He’s one of the good guys.”

Arnold Whitman is a towering figure, both figuratively and literally, in the world of skilled nursing and senior living investing. The founder, president and CEO of Formation Capital has become as well-known for his billion-dollar deals as he has for promoting the long-term care sector itself.

A fiercely competitive former collegiate and post-collegiate basketball player, he brings the same determination that helped him complete numerous marathoners to the boardroom.

“Four words occur to me when I think of Arnie,” said Robert Kramer, the co-founder of and current senior adviser to the National Investment Center for Seniors Housing & Care, who has worked with Whitman for approximately 30 years. “He’s a big-picture thinker, which is not common in the industry. He’s a visionary, a trailblazer and a risk-taker.”

A combination of those traits was fully apparent when he went counter trend in the early 2000s and bought up Florida facilities when others were fleeing under a contentious legal and regulatory climate.

“Arnie figured out a strategy and bought in Florida. He said, ‘These homes are needed, and the care is needed, and I’m going in,’ ” recalled Kramer, who founded Nexus Insights earlier this year and is the organization’s president. About five years into the strategy, Formation sold six portfolios, including 186 nursing homes, to GE Healthcare Financial Services for an eye-popping $1.4 billion. He followed that quickly with a $620 million purchase of Tandem Health Care.

Like any risk-taker, Whitman also is known for some of the deals that didn’t go down as hoped. In 2005, a hostile takeover attempt of then-giant Beverly Enterprises fell flat. Not long after, however, Formation won the bid for Genesis HealthCare.

Whitman has been a big proponent of NIC from the start. Its board chairman once in the 1990s and again in the 2000s, the irrepressible 6-foot-4 executive is known for his candor and outreach.

Operations-wise, he was far ahead of peers when it came to understanding quality metrics and outcomes. In recent years, he has expanded Formation more into healthcare technology ventures.

“He’s had a transformative impact that goes beyond just the dollars they themselves have invested, which have been huge and significant. It goes way beyond that,” Kramer noted. “He’s always looking to see where the puck’s going. He’s not just doubling down on where he’s been.”

Numerous top-flight academic researchers delve into nursing home care and policy, but few, if any, approach the track record of Vince Mor.

Currently a professor of health services, policy and practice and the Florence Pirce Grant University Professor in the Brown University School of Public Health, Mor has been the principal investigator of more than 40 National Institutes of Health-funded grants during his 40 years at the university.

His vast impact on federal standards is directly reflected in the many academic and professional honors he has received.

One of the fathers of the Minimum Data Set Resident Assessment Instrument, he currently is undertaking a massive study coordinated with other Ivy League researchers on the effect of Medicaid policies. A developer of federal quality standards for nursing homes, he also is considered an expert on hospitalizations analysis, cancer care, and age and racial discrimination in care treatments.

For Mor, who holds a Ph.D. from Brandeis University, it always has been about making data more readily accessible and improving industry standards.

“Vince is a rock star,” said Steven Littlehale, a nationally respected gerontological nurse specialist who is among the dozens of top-flight long-term care professionals who call Mor a mentor. “He has a unique ability to translate scientific insights into interdisciplinary practical change that shapes policy.”

Most recently, Mor also has been a widely quoted researcher and expert on COVID-19 and nursing homes.

One of his more ambitious ongoing projects will test and evaluate interventions for Alzheimer’s disease and other dementias. He and long-time collaborator Susan Mitchell, M.D., MPH, of Hebrew SeniorLife received a five-year grant from the National Institute on Aging worth $53.4 million for it. Aimed at “revolutionizing” Alzheimer’s care, It is one of the largest federal grants ever awarded for Alzheimer’s care.

In 2014, the American Health Care Association/National Center for Assisted Living donated $1 million to team with Mor’s Brown School of Public Health to create the Long Term Care Quality and Innovation Center at the university.

“His enthusiasm is infectious and his analytic understanding of data is amazing,” David Gifford, M.D., AHCA/NCAL’s quality chief and a protege of Mor’s, told McKnight’s Long-Term Care News in 2014. “He’s moving so fast. He’s always thinking long-term.”

When pivotal programs are put into place, it becomes easy to forget there was a time without them.

Such could be said for the American Health Care Association/National Center for Assisted Living’s National Quality Award Program, which is designed to provide a path to performance excellence for senior living and skilled nursing providers.

Dale Thompson, the current board chair for the Evangelical Lutheran Good Samaritan Society and former CEO of the Benedictine Health System, was instrumental in starting this highly respected program in the 1990s.

“His perspective on quality really has radiated through AHCA,” said Steven Chies, who served as an executive under Thompson at Benedictine and considers Thompson a “40-year friend.”

Beyond instituting change at the nation’s largest long-term care trade association, Thompson made an impact on quality in the industry in other ways. Among them: He chaired the Quality Improvement Organization in Minnesota and a veterans advisory commission established by the Gopher State governor.

During his 10-year stint at Benedictine (2003–2013), Thompson set a high bar. Among his contributions: leading the organization through a decade of positive financial performance; enabling the company to achieve three levels of recognition by the Minnesota-based Performance Excellence Network; and establishing numerous partnerships, including those with HealthEast, Allina Health, Mayo Health, Steele County and many others.

Thompson did not set out to make a name for himself in long-term care. He began his career as a math teacher. But through the United States Junior Chamber, a leadership and civic organization, he met his future business partner, Robert Sundberg, who installed Thompson as an administrator at one of his facilities. Sundberg then sold Thompson one of his facilities, and that acquisition evolved into Health Dimensions, which Benedictine later purchased.

Thompson has continued his success at Good Sam. He played a key role in the affiliation with Sanford Health and the development of the institutional special needs plan, or I-SNP, for the organization.

No doubt, quality continues to be Thompson’s guide.

“His mantra is, ‘We can’t rely on regulations to get good outcomes. We need systems to do it,’ ” Chies noted.

Those hoping to get a sneak peek into the future of senior living might consider studying the playbook of Toledo, OH-based Welltower.

The $40 billion real estate investment trust, which consistently earns spots at the top of the American Seniors Housing Association’s ASHA 50 ranking of largest senior living owners and Argentum’s list of biggest REITs, has displayed innovative thinking under Thomas J. “Tom” DeRosa, who has been CEO since April 2014.

Assisted living and memory care “may become more consequential” in the healthcare system, he said in mid-2018, pointing to the complex deal that in part saw Welltower become an owner of HCR ManorCare and its Arden Courts memory care communities as “the best example that one can point to” of how that system is changing.

The deal came almost three years after publication of an academic study funded by Welltower, two other REITs and six senior living companies found that “new integrated payment and delivery models targeting residential care facilities might prove fruitful,” given the high rates of chronic illness, functional dependence and healthcare use among residents.

Since that study, Welltower has announced an effort to further position senior living as a low-cost care setting of choice within the nation’s healthcare system through a collaboration with CareMore Health in some of the senior living communities in its portfolio. And earlier this year, Welltower announced what it said was a first-of-its-kind partnership between the REIT and a major academic health system, in which Thomas Jefferson University and Jefferson Health clinicians will work to address social determinants of health for older adults by managing senior living residents’ full continuum of care.

Welltower-commissioned efforts sought to establish quality standards for assisted living and memory care and found that city-dwelling baby boomers want to stay there as they age. Acting on the findings of the latter study, the REIT has developed two senior living high-rises in Manhattan with Hines and has another New York City project with Atria Senior Living, Related and Spitzer.

On the forefront of another industry trend, Welltower launched a middle-market 55-plus brand, welltowerLiving, earlier this year. The REIT also has prioritized efforts related to environmental, social and corporate governance. 

Now, even with what he termed a “pronounced” financial effects of the pandemic, DeRosa remains optimistic about the future of senior living.

“Many questions remain unanswered as to the duration and ultimate impact of COVID-19. However, what we can say with great certainty is that the long-term drivers of our business remain firmly intact,” he said on the REIT’s most recent earnings call. “The population is growing older. The need for value-based healthcare is as important as ever, and addressing social determinants of health will only grow in relevance.”

Long-term care may be constantly changing. Still, some issues never seem to vanish.

Take uneven survey and enforcement practices. A recent problem? Hardly. In fact, it was one of Sheldon Goldberg’s chief concerns as executive vice president of the American Association of Homes and Services for the Aging (a position now called president and CEO at the organization now called LeadingAge), where he served for more than 17 years, beginning in 1982.

“This process is never uniform, consistent, or even fair,” he said during a 1997 interview.

Goldberg’s time at AAHSA aligns with some of the more challenging years the industry has ever faced. He was at the helm when a landmark federal nursing home law was passed and implemented. Nursing home quality was under constant scrutiny throughout his tenure. And Medicaid reimbursement levels in many states were at or near $100 a day when he began.

Goldberg earned a reputation as an honest broker. To be sure, members always were a top priority. But he was not afraid to speak out against operators who consistently failed to meet minimal quality standards, repeatedly stating they should be shut down.

He regularly testified before Congress about quality, reimbursement and caregiving issues.

But his greatest accomplishment may be that he helped build the organization into a long-term care juggernaut. In addition to quadrupling membership (largely through outreach efforts with state-based organizations), he helped put AAHSA on sounder fiscal footing. He also helped launch the AAHSA Development Corp., which made it easier for members to tap into sorely needed capital. His AAHSA years also saw the launch of the Continuing Care Accreditation Commission (acquired by the Commission on Accreditation of Rehabilitation Facilities [CARF] in 2003), which helped raise the quality of caregiving and other services.

Despite these and other notable accomplishments, Goldberg always was quick to credit others, especially members.

“They are extraordinary, the best people,” he said. By all accounts, the sentiment appears to have been mutual.

Clifton J. “Clif” Porter II doesn’t mind comparisons to Jackie Robinson, the great baseball pioneer. Porter doesn’t open with such comparisons or bank on them himself, but he’s not going to chase away anyone implying that he’s a highly valued performer doing groundbreaking work that cannot be confined by racial parameters.

Simply put, Porter has delivered a treasure map for how to start low and then knock the socks off the entire long-term care industry via deep study, hard work and effusive relationship building. The one-time nursing home volunteer now traverses the halls of Congress as the second-most influential lobbyist for the most powerful nursing home group in the country, the American Health Care Association, and its sister organization, the National Center for Assisted Living.

A native of the Washington, D.C., area, Porter is an earnest educator, intent listener and compelling story teller. All have served him well on his professional ascendance and command of issues over the past two decades.

It was Virginia Commonwealth nursing school Professor Emeritus Anthony DeLillis who 30 years ago first recommended nursing home administration to Porter, now AHCA/NCAL’s senior vice president of government relations. DeLellis also pointed out the paucity of Black leaders in the field to Porter, whom he labeled a pioneer and its “Jackie Robinson.”

Porter started impressively by improbably thriving at a 34-bed nursing home in Virginia. Taken under wing by HCR ManorCare Senior Executive VP / COO and Director Emeritus Keith Weikel, he eventually rose to regional vice president and then vice president of government relations for the 500-plus facility company.

At AHCA/NCAL for the past eight years, Porter has been hailed for building relationships with key legislators and staffs, while also injecting energy to AHCA/NCAL grassroots networking and advocacy efforts.

On the national scene, for example, he helped steer the nursing home industry from the public relations disaster sprouted from the conversion to RUGs-IV from RUGs-III. He pushed a SNF value-based purchasing system that averted a devastating $2 billion funding cut federal regulators were planning and then later sidetracked efforts to further pin skilled nursing providers into an unwelcome corner.

Name a major legislative issue facing long-term care operators today and Porter is extremely well-versed in it. He knows the key players well and vice versa.

Call it the byproduct of a trailblazer who lives every day by the motto: “You go out there and play.”