Guest Columns

Leadership in LTC: The diversity challenge

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Mary Helen McSweeney-Feld
Mary Helen McSweeney-Feld

As we celebrate Long Term Care Administrator's Week, which honors the important role that administrators play in providing leadership for the delivery of quality, we should look at resident-centered care and a supportive work environment for staff. While we may applaud today's accomplishments, work still remains to be done to address important issues in the administrator community.  Here are some of the highlights and challenges facing our long-term care leaders:

  • Administrators are getting older: In many states, practicing administrators are at or approaching retirement age. According to recent research, there are more administrators leaving the profession than entering it. Succession planning will be an increasingly important issue for many facilities in the future.
  • The number of individuals taking national administrator licensing exams is stagnant: Surveys by the National Association of Long-Term Care Administrator Boards (NAB) indicate a 40% decline in candidates seeking initial licensure since 1998, with only a slight increase in recent years. Barriers to entry include limited numbers of accredited educational programs that prepare candidates for long-term care administrator careers, a challenging and reactive regulatory environment, as well as other economic factors.
  • Administrator candidates are gender diverse: The NAB surveys indicate growing numbers of female candidates for the national NHA exam, but the majority of candidates are individuals currently working full-time in long-term care, and may be individuals currently employed in other capacities within long-term care facilities.
  • Limited information exists concerning the ethnic diversity of administrator candidates: A 2013 White Paper from the National Emerging Leadership Summit at George Washington University points to generational differences in administrator populations, with younger generations of administrators favoring greater work-life balance and use of technology in the work environment. The paper also acknowledged the need to reach a variety of populations in identifying, educating and mentoring future long-term care leaders.
  • Difficulties remain in obtaining administrator-in-training opportunities for administrator candidates, and entry-level administrator positions: The majority of states require completion of an administrator-in-training (AIT) program prior to licensure, but in many states, these opportunities have declined. Possible reasons may be the absence of a trained, state approved AIT preceptor within the facility, or the growing burden of compliance with new regulatory requirements leaving less time for supervision of administrator candidates. In addition, many organizations have eliminated their assistant administrator position as a cost-saving effort in light of declining reimbursement for long-term care services.
  • Administrators seeking career opportunity and growth are members of professional associations: Administrators seeking professional growth and development are increasing identified as members of long-term care organizations such as ACHA, ACHCA, and Leading Age, which have the agenda of working to improve the public image of long-term care administrators in the U.S.

The complexity of these workforce issues will only grow in the future with demographics increasing the potential number of consumers needing long-term care services in a variety of settings. Possible solutions include:

  • Establish facility training sites for long-term care administrators: In the same way that certain hospitals are designated as teaching hospitals for physicians, long-term care facilities could be designated as training sites for long-term care administrators through either an accreditation process or an application process developed by a consensus of professional associations. Reimbursement for services by payers could be enhanced if the sites met certain standards, maintained a certified preceptor and agreed to take at least one candidate a year for their AIT.
  • Provide CEU credit for AIT preceptors: Some state licensing boards offer CEU credit for any preceptor that agrees to supervise an AIT. If a stipend is not available to compensate a preceptor, CEU credits could be a valuable alternative.
  • Look at your CNA population for prospective administrator candidates: Many individuals start their careers in long-term care by working as nursing assistants, and some continue to work in this capacity as they finish their higher education. Mentoring potential candidates as well as offering some tuition assistance for training in administrative capacities may add to the diversity of your management team.
  • Revisit job descriptions for open administrative positions: Look at your available job opportunities, and if they are written to include minimum amounts of work experience within the position, consider whether a newly licensed administrator with less experience would be a good fit given the range of their recent AIT responsibilities.

Having a diverse administrative workforce requires new ideas on the process of training administrators and encouraging organizations to provide those training opportunities. Administrators who serve as preceptors have found the experience to be rewarding and challenging. In the meantime, a diverse group of administrator candidates, from returning veterans to job changers to recent graduates, waits at your doorstep for their chance to contribute to your organization and surrounding community.

Mary Helen McSweeney-Feld, Ph.D. is an Associate Professor in the Health Care Management Program, College of Health Professions, at Towson University in Towson, Maryland. She is a member of the American College of Health Care Administrators' Academy of Long-Term Care Leadership and Development, and a member of the National Association of Long-Term Care Administrator Boards' Education Committee

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