Let me go on the record here, I am not, nor have I ever been a long-term care administrator. As an operations manager, however, I spend a good part of my day talking to administrators. I grasp how difficult and complicated this profession can be and marvel at those who have pursued this path. 

But I do wonder: If one chooses this profession, why wouldn’t one wish to excel at it?

I recently took the time to read the National Association of Long Term Care Administrators Boards National Administrator-in-Training Program Manual. The volume of expertise that an administrator is required to have is staggering, as is the sheer scope of it – nursing, medication, environment, finance, laundry to dining, scheduling andvaccinations. Multiple domains of practice and in nearly every one, the first thing listed is demonstrated command of federal laws, rules and regulations.

So if administrators developed that level of understanding, how come so many can’t locate their State Operators Manual?

I’m not making that query sarcastically. The surveyors that I speak with have tale after tale of calling deficiencies and having administrators who are jaw-droppingly ignorant of the regulations. How is this possible when the first item in AIT programs is supposed to be demonstrated knowledge of those regulations? How is it possible when they all have those regulations available to them, right there in that SOM? What are we missing here?

I have a few suspicions. Many administrators have a business background and indeed, there is a great amount of business in the business. Finance and bottom lines are always at play in medicine in America. Long-term care is no exception.

But long-term care is still healthcare, and medical end of it has everything to do with quality outcomes. The bean counters may always have their say, but that matters little to Mrs. Smith whose uncontrolled diabetes is going to make her blind. An MBA didn’t prepare you for insulin protocols; did your AIT? Were all your ‘learning activities’ based on finance? Staff scheduling? Busy work your preceptor didn’t have time for? I genuinely want to know.

Administrator-in-Training requirements vary widely state by state. I commend NAB for aiming for some amount of uniformity in their manual. Of course, there is no mandatory compliance to their standards, and I’m still left wondering about how much time is dedicated to an understanding of the regulations? In an industry that loudly and robustly complains about regulations, there seems to be little understanding of those regulations at all. We hear horror stories about skilled nursing care every single day.

It’s time to ask if we are really over-regulated, or just not following the regulations we have. 

If this seems too tough, I can tell you about administrators with Five Star ratings. They use the SOM like a Bible, and have glowing surveys.  They use the SOM daily.

I wonder what makes these administrators different. What got them going in that direction? Was it a really great preceptor who mentored them? Was it just a deep drive to excel? What happened during their AIT or after that inspired them to learn more, to do more? How can our industry get more administrators to emulate them?

These questions aren’t rhetorical; I really want to know. Tell me about your AIT experiences. I want to know what helped, what was useless, how it worked for you.

Perhaps together we can transform LTC into the resident centered, life affirming profession that it should be. I can’t think of a nobler aspiration.

 Trish Rodriguez is the operations manager of SAVVY on the SOM, a subscription newsletter for skilled nursing on Medicare Regulations. She can be reached at ltrish@savvyonthesom.