Confronted with an ever-worsening shortage of caregivers, the American Health Care Association enlisted Edelman Public Relations to create a campaign to raise awareness about the crisis facing long term care and to build congressional support for legislation to help recruit, train and retain frontline caregivers.  Edelman responded by designing a strategic earned media and grassroots campaign designed to target key federal legislators in their respective districts/states and to get them on record in support of a solution to the staffing crisis. 


At the outset of this year, the nation’s long term care community faced a mounting crisis:  800,000 critical caregiver jobs will need to be filled in just the next seven years, according to the General Accounting Office (GAO), the non-partisan research arm of the U.S. Congress.  At the current rate, the supply of caregivers entering the long term care field will not come close to keeping up with the demand for care as the baby boom generation reaches retirement age. 

While the issue of the nurse staffing crisis was prevalent in news reporting across the country, it generally referred to the shortage of Registered Nurses (RNs) in hospitals.  In nursing homes and assisted living facilities the crisis, although no less acute, is centered on a major shortage of “front-line caregivers” – the Certified Nursing Assistants and Resident Assistants who are responsible for 80 percent of the direct care of frail elderly and disabled patients.

Research, Planning Process and Objectives

While the GAO report rang alarm bells, the root causes of the staffing shortage were not well understood. The American Health Care Association conducted a study, “Staffing of Nursing Services in Nursing Homes: Present Issues and Prospects for the Future,” demonstrating the compounding impact of three factors: an aging nursing workforce, declining nursing school enrollments, and higher turnover rates in nursing homes as compared to hospitals.  The empirical foundation – nature of crisis and nature of solution – was in place for key messaging, including speaker talking points, press releases and opinion editorials. 

Our first step was to plan a route for the tour based on our Congressional targets:  those holding key committee assignments, heavily involved in health care issues, or otherwise viewed as potential champions for the cause. We then chose communities in those states/Congressional districts, which, because of size and demographic factors, seemed good prospects for extensive local media coverage.

The “Driving for Quality Care” National Petition Tour was aimed at three primary audiences:  (1) key federal legislators who would ultimately drive action on the issue and the content of relevant legislation; (2) their constituents, living in communities around the country chosen for tour visits, and (3) the local media whose coverage was critical to the activation of both audiences.
Because AHCA is a federation of 47 affiliated state nursing home associations, AHCA and Edelman worked closely with the affiliates representing tour-event communities to:
· Identify local spokespeople;
· Provide local skilled nursing and assisted living facility sites and state capitals for press conferences;
· Reach out to key state policymakers for support;
· Pitch established media contacts; and
· Contact state association members to attend press conferences/rallies. 

The “Driving for Quality Care” National Petition Tour was designed to advance four core objectives:
· Raise local awareness – via media coverage, of an acute long-term caregiver staffing shortage “in my own community”
· Translate that awareness into appeals – via petition signatures and letters to their members of Congress urging them to act
· Commit legislators to action – via remarks and appearances with the tour, and letters to the Congressional leadership
· Keep the heat on – via a database of thousands of petitioners, able to be mobilized strategically as needed.

Strategic Approach

Because our objectives focused heavily on localized awareness and action, AHCA and Edelman settled on the strategy of a “national tour visiting our community” as the primary driver. A boldly painted RV with a rollout petition attached to its side, seemed an ideal mechanism for “taking a cause to the people,” particularly when its intended beneficiaries were among Americans oldest and least mobile citizens.  We viewed the RV as (and it became) a traveling podium from which members of any age in any community could join thousands of likeminded Americans in calling on Washington to take action on a matter close to their hearts.

Campaign Execution

In 12 weeks: 66 events in 31 states:  From July 2 through September 11, 2001,  the “Driving for Quality Care” cross-country tour traveled some 15,000 miles. It resumed again briefly in October, ultimately holding at least one event in the district/state of every targeted member of Congress.

Online: Mindful of Internet–savvy Americans, we took our campaign online in July at  We invited site visitors to track the tour along with us by providing a map of our coast-to-coast route, an agenda of event dates and locations, copies of relevant studies, quotes from legislators in support of the tour, photos from previous events, local media coverage and a copy of the petition, which they could print, sign and mail to the American Health Care Association.  Also at this site, concerned citizens could add their names electronically to the traveling petition. 

Coordination back home:  While a rotating staff of two kept the tour going seven days a week, a team of four in Washington planned event details 4-10 days ahead. Local media were pitched using shortage statistics pertinent to each state.

Ending on a bipartisan note:  The tour officially ended at AHCA’s 52nd Annual Convention in Boston, October 15-19, where the RV was a central exhibit hall display.  To re-enforce the bipartisan nature of the long-term caregiver-shortage issue, among the very last petition signers were the Convention guest speakers, former House Speaker Newt Gingrich and former Massachusetts Governor and Democratic presidential candidate Michael Dukakis.

Summary of Results

Media coverage:  The Tour generated over 25 million media impressions with over 100 broadcast hits and 75 print hits including CNNfn, NBC, CBS, ABC, Fox, The Associated Press, Chicago Tribune, Arizona Republic, Las Vegas Review and Denver Post.

Petition signatures:  It collected more than 30,000 petition signatures at local events and through the Web site.
Congressional commitments:  We gathered 55 Congressional signatures on a letter urging action, addressed to the Congressional leadership and the President.

Congressional attendance:  Over 70 Congressional representatives or their staff attended local events and delivered highly supportive comments (please see a representative sampling in section nine of this awards submission).

Web site visits:  The site,, has registered approximately 200,000 hits to date.
Legislative action:  While the events of 9/11 have made conclusive legislative action on any domestic matter uncertain, on November 1 the Senate Health, Education, labor and Pensions Committee reported The Nurse Re-Investment Act and the Nurse Employment and Education Act with newly added provisions pertaining to front-line long-term caregivers in the nation’s nursing homes.