Nursing home administrator hiring and retention challenges aggravate industry labor struggles

Staffing issues continue to strain skilled nursing facilities, and not just at the caregiver level. Operators are acutely aware that once a long-serving administrator decides to leave the building, other staff members may follow.

It also takes time to fill the position — often more than a caregiver role — because, depending on the state, administrators must have several years of education under their belt.

Add to that the fact that candidates are scarce for almost all positions, even outside the long-term care sector, and it creates a tricky situation.

Operators need to find new and innovative ways to keep administrators engaged in their role – whether that’s increasing salaries, subsidized housing, facilitating a better work-life balance or better benefits , among others.

A recent Pulse survey conducted by Skilled Nursing News provided a window into the current landscape of administrator hiring and retention. Although unscientific and relatively small in size, the survey showed that skilled nursing operators do not believe it will be any easier to recruit and ultimately retain administrators in 2022.

Among survey respondents – 116 in total from small, medium and large operators – 58.6% expected the hiring climate for administrators to become more difficult, followed by 40% who believed it would stay the same.

About 65.2% of survey respondents said they also expected director retention to become more difficult, followed by 31.9% who thought it would stay the same.

Kevin Mulhearn, chief financial officer of Hillcrest Health Services, told Skilled Nursing News that while their facilities have had “really good administrators,” it can be quite difficult to fill vacancies.

Hillcrest owns three nursing homes and operates two others in the Omaha, Nebraska market, in addition to its adult day services, assisted living, palliative care, independent living, memory care and Home Care.

“It’s hard to find these people right now,” Mulhearn said, adding that it takes time to train and develop less experienced administrators.

Because there is usually only one administrator at an institution, this offers leaders the ability to use very personalized and specific retention strategies, according to Eboni Green, faculty member of the Doctor of Administration program. Health Care from Walden University.

The same idea also applies on the recruiting side.

The Path to Hiring and Keeping an Administrator

The three most common avenues that operators have taken to try to attract directors are increasing salaries (56.4%), facilitating a better work-life balance (38.4%) and offers more benefits (12.8%).

On the retention side, respondents indicated increasing wages (52.6%) and work-life balance (36.8%), in addition to offering more paid time off (11.8%) and organize appreciation days/events (11.8%).

Green told Skilled Nursing News that while work-life balance can be an extremely important factor to consider, it can be difficult for an administrator to step away from their job — even mentally — and especially during the pandemic. of COVID-19.

“I think a lot of times administrators get so involved in what’s going on in the facility that it’s really hard to even mentally get them away from the organization,” said Green, who is also a registered nurse. and Certified Long-Term Care Administrator.

More than 48% of respondents indicated that one of the main reasons director retention has become more difficult is due to pandemic-related burnout and current operational challenges.

This was followed by leaving for other skilled nursing or health care providers (13.5%), high turnover in other institutional positions (9.8%), leaving for other industries (9.8%) and failure to meet salary and/or benefits expectations. (6.1%).

About 7.4% of respondents said that retaining directors had not become more difficult.

A director can set the tone and make a difference in how a long-term care facility is perceived both in the community and from a regulatory standpoint, according to Green.

“Admins are really the backbone of the services we provide to communities, and it’s not an easy thing because you have to wear so many hats,” she said.

Wanda Hose, who served as the administrator of the Bay at Eastview Health and Rehabilitation Center in Antigo, Wisconsin for 25 years, told Skilled Nursing News that having “membership” in a facility can make all the difference.

Hose is actively involved in managing the workforce, developing pay scales, and feels comfortable talking about what she needs to take her establishment “to the next level,” among her many other responsibilities.

“If the administrator has the membership, I think it’s very easy to get your staff to have it as well,” she said.

Hose started as an overnight RN at Eastview in 1992 before serving as a staff educator for two years and then a CNA instructor. She has been the head of Eastview since obtaining her license in 1997.

She also stressed the need for work-life balance, especially at a time when she thinks administrators in particular have been impacted due to the 24/7 nature of their jobs.

“It has a lot to do with the team that the admin facility can put together so that they don’t feel like they’re alone at the top of the mountain, because there are other options so that you can actually take a vacation,” she said. noted.

As part of Eastview’s recruiting efforts, the facility offers fully paid health insurance for administrators and other senior-level positions, according to John Vander Meer, director of business development for operating company Champion Care.

The operator currently has 13 nursing homes and one assisted living facility across the state of Wisconsin.

Champion Care also partners with the University of Wisconsin-Eau Claire and its healthcare administration program, to help grow the carrier’s pipeline of administrators.

About 32.5% of respondents indicated that the insufficient number of qualified candidates was the main reason why hiring directors was increasingly difficult.

This was followed by competition from other NFCs or healthcare providers (24.4%), competition for workers from other industries (10.4%), availability of unemployment benefits and pandemic assistance (3.4%) and workers staying at home to care for family members (1%).

About 11% of respondents said it had not become more difficult to hire administrators.

The keys to being a good administrator

It wasn’t until Green met a nurse who had a background in long-term care at an Iowa convention center that she knew what the role of administrator even entailed.

She said the lack of understanding and awareness of the role puts the industry at a disadvantage, especially given the negative attention care homes have received during the pandemic.

“I think we need to do a better job of highlighting the benefits and the relationships and that this is actually an area of ​​interest for individuals, and continue to build on the requirements for education so we can better share best practices and encouraging each other to stay and stick to it,” she said.

Some of the best directors are those who understand the regulatory process, have good leadership and communication skills, and have a lot of patience, Green said. What may be even more important, she says, is the ability to step back and pause occasionally.

It is ultimately a question of delegation.

“It really means that we identify people who are going to do their job well, and we’re here to provide them with the resources and support they need to thrive,” Green said.

Skilled nursing facilities should focus on promotion from within and delegate a task or two to people who have expressed an interest in becoming an administrator or have those leadership-type skills, she said.

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