Growing the next generation of nursing home leaders is proving increasingly difficult for some skilled nursing operators — a sign, experts said, that the sector needs to make opportunities more welcoming to candidates looking to learn the ropes of skilled nursing administration.
Administrator-in-training programs have long been considered an ideal way to teach graduating college students, internal candidates and career changers how to manage a building’s clinical, operational, financial and regulatory requirements.
But distant site placements and funding issues can make it hard to match a would-be leader with a well-suited training ground. Barriers appear to be growing in some areas, with state policies, a lack of preceptors and distance to rural training sites called out by a variety of AIT observers. Cost is also an often-cited issue, even among some facilities that expect an opening due to retirement.
“It’s always been a challenge trying to find a location that wants to take you on,” said Steve Chies, a Minnesota operator and chair of the board at the Vision Centre, an organization dedicated to growing educational opportunities for nursing home and senior living leaders. “But the providers that really understand what the future of the organization and the sector needs are going to be open to hiring students and paying them … You can’t afford not to. We need to attract a couple of thousand people into the sector.”
The 2023-24 Nursing Home Salary & Benefits survey by HCS revealed 14.51% of providers reported top-level or executive vacancies earlier this year. There’s also a 28% turnover rate in the administrator ranks, and nearly 35% said they expected turnover to increase this year.
Against that backdrop, many rural and independent operators are struggling to recruit and train replacements. And some college and university advisors have reported fewer opportunities to place candidates close to their campuses.
Today’s AIT placements are often at regional and national chains whose leaders continue to invest in such programs to snag promising talent and build out a pipeline.
“If we want to truly be an industry that stands out with great outcomes — financial success, employee satisfaction, patient success outcomes — I just don’t see that there’s any other way to do it but by having really great local leadership and talent,” said Josh Jergensen, president and chief operations officer of PACS, a nursing home management group. “I believe that’s going to come from successful AIT programs.”
Attractive offers
A robust AIT program is a core part of PACS’ growth strategy. Over the last 10 years, the company has gone from two affiliated nursing homes to 206 nationally. With that explosive expansion, the quest for leaders has been constant. By this March, Jergensen said, PACS had trained 143 AITs, with 125 still with the company for an 88% retention rate.
The company offers competitive pay to its AIT candidates, recognizing that many could find paying work in an acute care setting or move to technology, investment or other sectors with healthcare administration degrees.
“You want to get top tier talent out of college and then you want them to come work for you for nine months with no pay? You’re not going to get them,” Jergensen said. “We want to make it an attractive position that is gonna stack up to other offers for top talent in both undergraduate programs and master’s programs across every state and university in our country.”
Chies says all providers need to take more of a long view and be willing to train workers for the sector’s future. Even a small salary might be enough to entice a candidate; a cooperative program run through the University of Wisconsin-Eau Claire pays AITs about $26,000 annually, an amount Chies said was a small fraction of the budget even for single-site, rural providers. Solid early training, he added, typically leads to a long-term commitment to the field. Strong nursing home leadership has also been linked to higher star ratings.
PACS employs a recruiter whose full-time job is to find people for its AIT program, individuals who are often from outside the healthcare industry.
Finding AIT candidates
Recruiting vibrant leaders from school or from other fields can still be a challenge for those who might only think of offering an AIT program. Sometimes it takes seeing leadership potential within a community and then building the infrastructure to retain and nurture that person.
At Baptist Senior Family in Pittsburgh, the latest AIT candidate landed in the 63-bed nursing home thanks to a staff member. A friend of her daughter needed an internship to complete his healthcare management and administration degree. That internship made it clear that the friend had an “instinct for good leadership that we wanted to be able to retain,” said Administrator Michelle Lobello.
The nonprofit organization brought Donald “DJ” Turner onboard as an assistant administrator in August, and then went about finding ways it could strengthen what would turn into an AIT program for him. Lobello knew she didn’t want his experience to mimic the “copy girl” training she’d had as a long-ago AIT.
Last week, Baptist Senior Family learned it will receive a $50,000 grant from LeadingAge PA to support those efforts.
“What the grant really does is, it allows us to have a much wider scope of experiences and education that perhaps we wouldn’t have been able to do on our own. It’s really just us positioning the next generation to take over once we retire,” said Baptist Senior Family President and CEO Tim Myers. “We’re going to … spend more time with DJ talking about the strategic piece, letting him into the decisions around why are we doing this or that, and how does it fit into the bigger picture. …. I think that ultimately, what is going to be great for him is seeing the big picture and being able to put all the pieces together, which when he becomes a leader, he’ll need to do.”
In addition to shadowing Lobello and a leadership team with decades of experience, Turner will be able to spend time at the organization’s affordable housing community too.
Though Turner is an employee like any other and not required to commit any specific time to Baptist Senior Family after his AIT is complete, he told McKnight’s he seems himself continuing on as a part of the community and helping to build bridges in the community and outside it.
“I had no idea how many jobs are within that this one facility … and how many people it takes to do something like, keep this running and running smoothly, to say the least,” said Turner, who before the internship and job at Baptist Senior Family thought he’d use his degree to become a medical device salesman. “The experience, it just opened my eyes a ridiculous amount.”
The grant funding that will make Turner’s experience a robust one can be critical for nursing homes looking to train leaders. But it’s not enough. Pennsylvania has about 700 nursing homes; the association gives out one AIT grant every two years.
Advocates are working behind the scenes with educational institutions and state leaders to promote better training opportunities. Vision Centre has an IT workgroup and calls those efforts a critical piece of its activity.
Along with the American College of Health Care Administrators, organizers are looking to elevate administrator training opportunities, in part by rebranding them as residencies to give them equal footing with similar clinical or acute care experiences.
ACHCA President and CEO Bob Lane encouraged more providers to train AIT cohorts, and to be willing to place those trainees in other communities after they complete their education.
And providers and students alike continue to grapple with hurdles in various states and at degree-granting institutions, observers noted. Those can range from the speed with which preceptors are approved, wide variation in the hours required for program completion; and a willingness to allow additional AIT programs if leaders think their state already has enough licensed nursing home administrators.
“I would say we need to look at it more from the standpoint of an investment, instead of viewing that the whole process is an expense,” Lane said. “Because that’s what it truly is: investing time and dollars into bolstering a field that is so important for the care of our elders now and going forward.”
For more on this issue, tune in Tuesday for a McKnight’s Newsmakers podcast on AIT challenges and opportunities.
