Educational institutions are courting long-term care students harder than ever, with an eye toward creating a better future.

You don’t have to preach to Jolene Roberts about the state of professional development in long-term care.
“It’s behind,” she says matter-of-factly. “The kinds of services and products an administrator has to deliver are much more complex than they were 15 years ago when I started. Your decision making requires a higher level of critical thinking ability.”
But Roberts isn’t just wringing her hands about what she sees as a sad state of affairs. She’s putting her money where her mouth is.
The president and CEO of Hillcrest Health Systems in Bellevue, NE, Roberts requires managers at her two communities and seven associated businesses to have at least a bachelor’s degree.
“I’m interviewing for a vice president of operations right now, and I can tell you I will lean toward a master’s prepared person,” said Roberts, who holds master’s degrees in gerontology and social work from the University of Nebraska-Omaha herself.
“It all boils down to the fact our clientele are more demanding, and their clinical and complex needs are greater,” Roberts said. “Long-term care is more of a business. What I find even in my administrators, which is typical nationally, is you promote with technical skills because there’s not a lot of degree-prepared administrators out there.”
One also doesn’t have to impress upon Dr. Ed Hackman the importance of an education. He’s director of the healthcare administration programs at Bellevue University in Omaha, NE, where available programs are attracting numerous long-term care professionals.
His goal is to create a more finely tuned degree that meets the requirements of The National Board of Long-Term Care Examiners (NAB) for licensure. His school is launching a major study of the profession and higher education to determine what degree offerings would be most appropriate.
“We’re looking at a great deal of opportunity to help the long-term care industry get to where they need to be education-wise, and to prepare for what’s coming – the baby boomers,” he said. “A lot of people are watching us.”
One of the biggest hurdles to creating a one-stop NAB-approved, license-ready degree is states’ varying requirements. Some states don’t even mandate a bachelor’s degree for nursing home administration licensure, and requirements for training hours or work experience can vary greatly.
“You’d almost have to make (courses) customized to each state,” Hackman said. “There are challenges but also a great deal of opportunity. As an industry, long-term care has lagged behind the hospital industry in keeping up with their levels of education for their administrators and managers. Maybe as an education industry we haven’t done a good job of showing that.”
Hackman would know about these things. He’s overseen operations at a hospital and a nursing home.
“Running a nursing home is not easier than running a hospital. In many ways, it’s a lot more difficult,” said the former administrator at the Saunders County Healthcare Facility, about 30 miles west of Omaha. “It is episodic at an acute-care facility. At a nursing home, you have to understand the aging process and how that affects quality of life. You have to deal with families a lot more. It’s a different animal.
“The assumption is if you can run a hospital, you can run a nursing home. I don’t agree with that. If anything, you need a broader degree of knowledge.”

Credits, costs
Bellevue started offering its healthcare administration degrees in the early 1990s and has graduated about 1,000 students with them since. About 300 of Hackman’s students are long-term care oriented at any one time, he said.
The few LTC-oriented degree programs available at U.S. colleges or universities vary in the finer details of core requirements and teaching methods. But they also carry similar characteristics when it comes to number of credits needed and, in some respects, price.
Bellevue, for example, requires 127 credit hours to earn a bachelor’s degree. That includes a 36-hour LTC core; credit may be given for prior experience. But students also have to start with at least 60 credit hours (an associate’s degree roughly) to embark on what is typically a 15-month program.
The master’s program requires 39 credit hours and takes about a year and a half to complete, Hackman noted. Tuition charges for the master’s total about $13,000, while a bachelor’s degree is closer to $12,000. As with most schools, financial aid is available.
Courses may be taken online; in fact, last year, Bellevue’s online revenues eclipsed the in-person revenues for the first time, Hackman said. Online courses and discussions are largely conducted with the help of message boards so very little “live” attendance is needed, he added.
Hackman said he’s heard long-term care operators commonly grouse about probably having to pay higher salaries to administrators with better education credentials.
“That is so short-sighted,” he said. “I say it’s more likely they’ll run off if you don’t encourage (higher education). My experience as a nursing home administrator was when I provided more education, they got more loyal.”

Long-time presence
Thanks in part to an original infusion of spirit and wisdom from a co-founder who was a giant in the long-term care industry, Herbert Shore, degree programs in the University of North Texas’ aging studies programs have had a long-term care emphasis for 40 years.
Alumni from the master’s degree program alone number about 800 and included national and state association leaders around the country, said Richard Lusky, chairman of the applied gerontology department.
“We’re a bit unusual – we don’t use a purely business model but a social model,” Lusky said.
While he acknowledged a master’s degree is not the right track for everyone, many would benefit more than they realize, he said. He also feels the value of a bachelor’s degree would be hard to deny.
More general knowledge “doesn’t always do full service any more,” he added.
“Part of the master’s degree is not just to teach you what’s current today but also to give you the kind of skill that will allow you to be able to remain current in the future.”
The 14-year-old long-term care program at St. Joseph University in Maine also continues to grow at a steady rate — while the more general healthcare administration track has withered a bit, according to director John Pratt. Although there has been a drop-of in long-term care related certificate earners, the number of single-course students has grown because of out-of-state referrals to the continually rolling online curriculum, Pratt added.
A bachelor’s degree requires 128 credit hours. Of these, 36 hours must be from a long-term care core. Undergrad costs are $260 per credit hour, or $780 per course. A master’s degree requires 42 credits hours (at a cost of $340 each). Students may start a course at any time, Pratt said.
As a leader of NAB’s education committee, Pratt is very aware of degree offerings existing for long-term care administrators. And how hard it is to serve the population.
“Until there’s some uniformity in state requirements (for licensure), I’m not sure it will clear up,” Pratt said. According to a 2005 state-by-state breakdown, 12 states did not require their licensed nursing home administrators to have at least a bachelor’s degree. Some require an associate’s degree, and all mandate varying hours of administrator-in-training experience – with greater amounts for those without degrees.
The biggest resistance to mandated degree requirements comes from smaller operations, especially those in rural areas, said Roberts, who operates in Nebraska, one of the 12 exception states.
“Their biggest fear is their business will be in jeopardy if they have to have a degreed person and they can’t get them,” she explained.

Nationwide standard
In June 2005, NAB’s board of governors approved a “principles of interstate licensure endorsement.” Twenty states have endorsed the document, which would set the minimum requirement of a bachelor’s degree for licensure.
St. Joseph’s Pratt says some facilities are lucky existing laws were never enforced: “OBRA ’87 (the massive reform bill) had a section requiring a bachelor’s degree and administrator-in-training program. But it was never implemented.”
One institution is implementing especially strong attention-getting tactics in the long-term care and seniors services arena lately: the Erickson School of Aging Studies at the University Maryland, Baltimore County. Founded two years ago, it plans to eventually offer a full range of aging and long-term care courses.
More than 150 executives have trained thus far in extended conferences. Directors hope a master’s program will be approved in time for fall 2007 enrollment.
“We launched the first undergraduate major of its kind in the country this fall, management of aging services,” said Kevin Eckert, the school’s dean.
Despite having only a few months to promote the new degree program, more than 40 students already have declared it as a major, and more than 100 are taking introductory classes, Eckert said. Thus far, all courses are offered only in-person and, unlike others catering to the long-term care crowd, Eckert is hoping to draw younger, traditional college students into the profession.
Employers should accelerate the employee education wave, he said.
“Part of this is investing in their education and advancement,” Eckert said. “The companies who do that will get the best results, the most knowledgeable workers and people dedicated to them because they’ve invested in them. We’ve seen it happen in other sectors.”

What’s the difference?

Degree: An academic title awarded by a college or university to a student who has completed an extended course of study at the undergraduate (associate’s or bachelor’s) or graduate (master’s or Ph.D.) level.

Licensure: The legal right to practice a recognized profession. Granted by state boards, licensure generally requires successful completion of a degree from an accredited college or university, passing a required examination, and successfully completing a supervised internship.

Certification: An educational process that requires a learner to complete prescribed course of training and to pass an assessment with a minimum acceptable score.

Continuing education: Ongoing formal education required of certified and licensed professionals. Includes approved educational programs or university courses designed to enhance professional knowledge and/or skills. Participation is frequently measured in “Continuing Education Units” (CEUs) reflecting 10 contact hours of instruction.

Certificate: An award documenting attendance at an educational program. The training may or may not apply toward licensure, certification, a degree or continuing education requirements.

Source: University of North Texas Department of Applied Gerontology, 2006