‘Nothing more in the tank’: With administrators mired, skilled nursing industry will struggle to recover and scale

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Administrators and executives with decades of experience believe that leadership in the skilled nursing space has fundamentally changed.

A reactionary mindset has taken hold among care home administrators, affecting facility morale and slowing progress in the sector.

According to Thomas Annarella, Administrator of Valley Hi Nursing & Rehabilitation in Illinois, it is incredibly difficult to look at overall recovery and get a broader perspective when there is such a high level of burnout. There is “nothing left in the tank”, that is, there is no energy to look beyond everyday problems.

This mindset is problematic when it comes to implementing seismic changes to industry through the Biden reforms, calls to action the report of the National Academies of Sciences, Engineering and Medicine (NASEM) or otherwise.

The staffing crisis and ever-changing regulatory requirements are the main causes of this mindset, according to Annarella.

It’s “survival mode” for many administrators at this point, he said, as leaders try to get ahead of multiple issues, including cost inflation and vendor capacity issues. to provide goods and services in a timely manner.

The sheer volume of director turnover — and new reports of that turnover in the Payroll-Based Journal (PBJ) — also make newcomers to the role feel reactionary.

“If you’re not on the job for a long time, you don’t have systems in place, you’re in a constant state of change, you’re looking for staff and trying to stay clear of regulatory issues” , said Annarella. “I see a lot more of this, than it is [a response to] covid.”

According to Bob Lane, president and CEO of the American College of Health Care Administrators (ACHCA), these headwinds affect new and seasoned administrators alike.

“You have it on both sides. You have the young leaders who are not necessarily driven out of the profession, but are being asked to do twice what they expected when they arrived,” Lane said. “Then you have the others who have been through quite a few battles over the years and that’s just the straw that broke the camel’s back, so to speak.”

Debbie Meade, CEO of Health Management in Georgia, said it had had seven administrators in the past year and a half across its four buildings, with burnout and lack of resources making it difficult to keep people in the role. and watch them grow. as leaders.

SNF operators are lucky to keep administrators in a building for three to five years, she said. It’s a different career ladder than 25 years ago when an administrator stayed in one building for their entire career.

“My last director who retired from the building had worked with the company for 20 years. I can’t find that person anymore,” Meade said.

Industry Consolidation and Administrator Leadership

The changing profile of directors is also driven by industry consolidation, as industry leaders strive for regional positions at larger companies with more resources, Meade said.

There is a dissonance between what independent or smaller operators see in administrator revenue versus operational giants like The Ensign Group (Nasdaq: ENSG) with a pipeline 30 to 40 administrators in training for facility recovery projects.

Once administrators are actually in place, larger companies can provide constant guidance when it comes to regulatory updates, Meade said. Since this level of support is not readily available to administrators of independent or smaller operators, they need to be more self-sufficient and confident in their abilities.

That translates to higher compensation, Meade said, another big challenge for smaller operators with limited resources.

“You have to pay for that experience, that experience that they have,” Meade added.

Leadership and culture with “nothing in the tank”

When administrators are overloaded, the entire institution can be negatively affected.

“One of the things I’ve noticed with many administrators and even higher level employees in buildings is the level of burnout. It’s almost like they’re numb to what’s going on around them and that’s a really, really scary position,” Annarella added.

Such situations impact the morale of direct care staff and middle managers, Meade said.

“Employees don’t quit their job, they quit the boss. You need a good leader to acquire skills, retain staff and recruit new employees. This position is powerful and very important,” she said.

It’s a 24-hour, 365-day-a-year job, Meade added, with an “enormous amount of time” spent away from family. This aspect of the job has only become more difficult in light of pandemic-related changes, with remote posts in other sectors allowing people to spend more time with their families.

“It is probably the negative impact of the Covid in our profession for this profession; you can’t do this job from home. You have to be in your building,” Meade said.

Local administrators

Self-motivation and motivated people are what it takes, she said, and those types of people are usually found within the company. Or, they are introduced to the sector from an early age.

That’s where preceptorship programs come in handy, said Meade, who began planning the program earlier this year.

“Georgia has a pre-designed preceptor program…they have a good format and [regulations] that you need to follow. It’s a different format and we hope it produces a good leadership team for the company,” Meade noted.

Annarella said Valley Hi is very committed to who gets selected for admin tracks or leadership career paths in general — most of her team have worked with Valley Hi for 13 years, starting as universal workers through through high school programs and eventually earning clinical certifications before ending as administrators.

“They’ve done that all through Valley Hi and they recognize that; they want to stay with us, they know everyone here,” he added. Universal workers are usually students from neighboring school districts who follow direct care workers and help with tasks in the facility.

Meade said her four buildings have a similar partnership with the local school district, for people to get licensed as certified practical nurses (CNAs). The program is part of a career academy that places students in apprenticeship programs.

“They see the benefits and the value of working with elders, and they learn things from working with these people,” Meade said. “What job is better than when you get to make a difference in someone’s life every day?”

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