Why NAHC Wants to Become the NRA of Home Care

It’s not the ideal comparison, according to National Association for Home Care & Hospice (NAHC) President William Dombi.

But NAHC wants to be more like the NRA.

Regardless of how people feel about the National Rifle Association—the organization that’s often praised or blamed for stopping legislative efforts focused on gun ownership rights—its influence on Capitol Hill cannot be debated. Since launching nearly 150 years ago, the NRA has repeatedly swayed elections and shaped policy through deep pockets and the ability to effectively mobilize its members.


Its rolls reportedly total roughly 5 million members. That number that has been somewhat debated and came up last week when the group publicly stated it was facing deep financial troubles because of actions taken by the state of New York.

It is the NRA’s grassroots power NAHC is now striving to emulate, Dombi told Home Health Care News.

NAHC is not known to be experiencing financial troubles and its membership is, in fact, going up.


“When the NRA triggers grassroots advocacy in Washington, D.C., everybody listens,” he said. “You could be pro-Second Amendment, anti-Second Amendment or somewhere in between … but when the NRA speaks, it has reverberations throughout D.C.”

For these reasonsNAHC isn’t the only entity attempting to duplicate the NRA’s success. An official from the American Civil Liberties Union recently discussed how the organization was studying the NRA’s tactics in an interview with The New York Times Magazine.

NAHC is a not-for-profit industry association that represents more than 33,000 home care and hospice organizations. Founded in 1982, NAHC has grown into one of the largest and most active policy advocates for home-based providers throughout the country.

The association’s interest in the NRA comes as NAHC begins to pursue a major strategic realignment to better engage its base and operate in a more transparent manner than in the past.

The realignment, according to Dombi, has been christened NAHC 2.0.

“There had been growing concern that NAHC was not transparent, that people really didn’t know what was going on, how decisions were being made, how money was being spent,” he said. “We’ve got to get back to the basics.”

Home care’s untapped potential and the NRA

When the NRA started off, it was mostly a group for hunters, marksmanship aficionados and gun collectors. Over the years, however, it has steadily become more political, using its vast membership base and financial resources to pressure aspiring politicians and elected officials.

Reports filed with the Federal Election Commission, for example, show that the NRA, its political action committees and other affiliates spent a combined $54.4 million during the 2016 election period, according to Open Secrets, an online resource from the nonpartisan Center for Responsive Politics.

Yet money isn’t where the NRA gets its power from entirely, experts say.

Instead, the NRA has built its momentum by convincing followers that gun ownership is a way of life and fundamental to their American experience. It has done so not through detached messages sent via mainstream media, but rather through persistent and clear communications sent through its own channels, included multiple magazines, online forums, newsletters and NRATV, launched in 2016.

As a result of that dedicated engagement, the NRA has been able to mobilize its members on local, state and national levels seemingly at will, whether that means sending letters and placing phone calls to Congress or participating in public demonstrations.

“For me, the real political success of the NRA is not money, not that money is not important or doesn’t matter—it does,” Harry Wilson, a professor at Roanoke College, told HHCN. “The NRA’s real success comes from its membership and its ability to motivate its membership.”

Similar to other successful interest groups, the NRA does that by stoking fear, convincing its supporters that lawmakers are in a nonstop battle to take away their guns or infringe upon their rights. For the NRA, it’s always “the worst of times,” said Wilson, the author of multiple books on gun control and politics.

“For some period of time, gun control has been a divisive issue, much more so than home health or hospice,” he said. “In the grand scheme of things, this is one of the more divisive issues facing the country, and the [NRA] has sort of captured the market as the go-to group.”

NAHC may not have the same political clout as the NRA at the moment, but the potential for growth is there, largely because of the enormous scale of the home health, personal care and hospice industries and their respect workforces, according to Dombi.

There are more than 2 million U.S. home care workers, according to labor group PHI. That workforce is rapidly growing, too, doubling in size over the past decade as demand for long-term services and supports has risen.

As an association, NAHC plans to better connect with those workers through enhanced social media outreach and events. At the same time, it hopes industry leaders step up and take a more prominent role in getting their employees involved, Dombi said.

“We want the head of the home care or hospice company to filter things down to the staff level,” he said. “When you’re looking at one CEO of a company that employs 3,000 people, we would prefer get 3,000 messages sent to Congress rather than just one.”

Eventually, NAHC hopes to have something along the lines of a precinct captain in every single Congressional district. It also hopes to better engage the millions of Americans actually receiving home-based services as well, Dombi said.

“If we can just grab on to a small portion of that, we can be potent,” he said. “We can be really potent.”

Besides that untapped population, NAHC also has at least one key issue to rally people around, Wilson said: the wave of aging baby boomers. Whatever Congress and regulators actually do, NAHC can always make the case that home-based providers need even more support and even more resources, he said.

“They can sort of ring that bell,” he said. “Almost like the environmentalist appeal, saying we’ve got this impending disaster out there.”

Although it’s still refining its grassroots strategy, the home health, personal care and hospice industries have made obvious headway in terms of lobbying. In 1998, in-home care providers and interest groups representing them spent at least $2.3 million on combined lobbying activities, according to publicly available data under the Lobbying Disclosure Act. In 2017, they spent at least $6.9 million.

“Can we get to [the NRA’s] level of power? We can aspire to it,” Dombi said. “We can take steps toward it, but I certainly think we can be quite powerful.”

NAHC 2.0 prioritizing transparency

In addition to boosting its grassroots reach, NAHC is touting a newfound level of transparency as part of its strategic realignment.

That includes informing members on where finances are coming from, how money is being spent and whether membership is going up or down. In the past, some members have expressed concern that NAHC was too opaque, Dombi said.

As a display of that move toward transparency, Dombi revealed to HHCN how the organization sold a series of properties located in D.C. in April and May. Of note, the property included the D.C. home of famed statesman, orator and abolitionist Frederick Douglass, he said.

The property, purchased in the 1970s, had previously been used to hold gatherings and host dignitaries.

NAHC sold the property for about $4 million, according to Dombi.

“We thought it was better to liquidate that property,” he said. “As it turns out, it was a very solid financial investment.”

NAHC will invest that money into new services, including the hiring of additional staff to help members with case work and day-to-day issues.

Written by Robert Holly

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