It’s no exaggeration to say that Mary Ousley, a leading expert in nursing home quality and the regulatory system, has improved the lives of thousands — if not millions — over her 40-year career as a leader in long term care.
A registered nurse, nursing home operator and patient advocate, Ousley was among a select group of tacticians tapped to craft OBRA 1987, the landmark nursing home reform law, which set care standards and rights for nursing home residents in the United States.
“It was the honor of my life to be a part of developing this quality and regulatory framework that has pretty much stood the test of time and is still the platform that guides post-acute and long-term care operators,” says Ousley. The core goal of their work, she says, was to improve quality of life for patients through more personalized care, a mission central to the Center for Innovative Medicine, where she serves on the International Advisory Board.
“With so many innovations in medicine, we can certainly enable individuals to live longer — but if their lives are not giving them meaning, then what have we accomplished?” she says.
In the years since OBRA, she has continued to lead quality improvement initiatives, as chair of the American Healthcare Association (which represents long-term care providers in the United States), and as a strategic leader for companies including Horizon, Marriott, Sunbridge and PruittHealth. Given her expertise and breadth of experience, Ousley has frequently been tapped as a spokesperson in congressional hearings and for national policy discussions. This year she will be honored with McKnight’s Pinnacle Awards Career Achievement Award.
What varied perspectives have you brought to the table when it comes to quality improvement in long-term care?
I realized early on, when we met to develop a regulatory framework for OBRA, that you can have a beautiful set of regulations, but they are useless if it’s impossible for nursing facility operators to implement them and for accrediting agencies to determine whether providers, including hospitals and skilled nursing facility, are in compliance. The real challenge is: How will they work in the real world?
As an individual who has owned and operated nursing centers, I bring the operations perspective as well as experience with the financing model. And of course, as a nurse, I know the clinical side of working with patients and families. I think this clinical side is the most important; bringing a practical, real-life voice to policy-making is so valuable.
“With so many innovations in medicine, we can certainly enable individuals to live longer — but if their lives are not giving them meaning, then what have we accomplished?” – Mary Ousley
The ongoing nursing shortage is a key challenge facing both hospitals and nursing care facilities today. What do you see as the best way forward?
I’m convinced that simply focusing on producing more nurses is not the whole solution. We need to give young people a reason for choosing a nursing career, whether in hospitals, nursing centers or home health positions. That requires continuing to change the culture to give nurses a leadership voice in the team-based health care model. After all, the nurse is the “patient-centered” in the patient-centered care model and nurses are integral to coordinating care, across all aspects of the healthcare system.
In your role on the board of CIM, you’ve encouraged increased representation of nurses, including funding the first nurse as a CIM Scholar, Martha Abshire Saylor.
Yes! I remember that soon after I joined the board, I looked around the room at all the physicians and whispered to my sister, Dana Case, a fellow nurse who was also joining the board: Where are all the nurses? My observation resonated with CIM Director David Hellmann, and I so appreciate that since that time he has concentrated on making sure the nursing voice is really heard. I’ve been thrilled to see more nurses leading and attending CIM Seminars, for example. When it came time for me to choose a nurse to sponsor as the first nurse CIM Scholar, Martha was a natural, given her clinical and research work in helping patients better cope with heart failure and her recognition that taking care of the whole patient means giving equal attention to the caregivers who are providing care and support for the patient.
I am thrilled to see Martha taking a central role in CIM’s Center for Humanizing Medicine. She is bringing her expertise regarding the impact of caring to the patient and family experience. No doubt Martha was humanizing medicine before we gave it a name. She is the first nurse CIM Scholar and I sincerely hope she is not the last!
Looking ahead, what worries you about the future of health care in the U.S. — and where do you find optimism?
Funding in all areas of health, of course, is a tremendous challenge, particularly in the wake of the federal legislation passed last July that included large reductions and restrictions affecting Medicaid. We need to advocate and speak out for the individuals who need health care. This is the idea, which CIM advances so powerfully, that medicine is a public trust. To me that means that health care is a human right and must be highly reliable. And we need to make sure our elected leadership understands what needs to happen.
I’ve devoted my career to post-acute and long-term nursing care, trying to ensure that every single facility in the U.S. is providing the highest quality of care. That said, older adults and disabled people also seek alternatives — and there are many available today to assist those wishing and able to stay in their homes, for as long as possible.
Johns Hopkins clinicians innovated the idea of “hospital at home.” I would love to see that model used to provide skilled nursing at home. Medicare currently pays most costs for up to the first 20 days in a skilled nursing facility and with a copay for the remaining 80 days up to the full 100-day benefit period. Why couldn’t we fund that same care in the home? Different groups are now working on this idea; it doesn’t exist right now, but I really think it should.
