Staffing challenges continue to strain skilled nursing facilities, and not just at the caregiver level. Operators are acutely aware that once a long-time administrator decides to leave the building, other staff may follow.
It also takes time to fill the position – often more than a caregiver role – because depending on the state, administrators are required to have multiple years of education under their belt.
Couple that with the fact that applicants are in short supply for almost every position, even outside the long-term care industry, and it creates a tricky situation.
Operators are having to find new and innovative ways to keep administrators engaged in their roles – whether it be increased wages, subsidized housing, facilitating better work-life balance or better benefits, among other things.
A recent Pulse survey conducted by Skilled Nursing News gave a window into the current administrator hiring and retention landscape. Though unscientific and relatively small in size, the survey showed that skilled nursing operators do not believe it’s going to get any easier to bring on and ultimately keep administrators in 2022.
Among the survey’s respondents – 116 in all ranging from small, mid- and large-size operators – 58.6% expected the administrator hiring climate to get harder, followed by 40% who felt it would stay the same.
Roughly 65.2% of survey respondents said they also expected retaining administrators would get harder, followed by 31.9% who believed it would stay the same.
Kevin Mulhearn, chief financial officer at Hillcrest Health Services, told Skilled Nursing News that while their facilities have had some “very good administrators,” filling open spots can be quite difficult.
Hillcrest owns three nursing homes and operates two others in the Omaha, Nebraska market, in addition to its adult day services, assisted living, hospice, independent living, memory care and in-home care.
“Finding those individuals is tough right now,” Mulhearn said, adding that it takes time to train and develop less experienced administrators.
Because there is typically only one administrator in a facility, this provides an opportunity for leadership to use very personalized, specific retention strategies, according to Eboni Green, a faculty member at Walden University’s Doctor of Healthcare Administration program.
The same idea also applies on the recruiting side.
The path to hiring and keeping an administrator
The three most common paths operators reported taking when trying to attract administrators are increased wages (56.4%), facilitating better work-life balance (38.4%) and offering more health benefits (12.8%).
On the retention side, respondents indicated raising wages (52.6%) and work-life balance (36.8%), in addition to offering more paid time off (11.8%) and hosting appreciation days/events (11.8%).
Green told Skilled Nursing News that while work-life balance can be an incredibly important factor to consider, it can be hard for an administrator to step away from the job – even mentally – and especially during the COVID-19 pandemic.
“I think oftentimes administrators are so involved in what’s going on at the facility, it’s very hard to even get them to mentally get away from the organization,” said Green, who is also a registered nurse and licensed long-term care administrator.
More than 48% of respondents indicated that one of the biggest reasons why administrator retention has gotten harder is due to burnout related to the pandemic and the current operating challenges.
That was followed by leaving for other skilled nursing or health care providers (13.5%), turnover being high at other positions in facilities (9.8%), leaving for other industries (9.8%) and being unable to meet wage and/or benefit expectations (6.1%).
Approximately 7.4% of respondents said retaining administrators has not gotten harder.
An administrator can set the tone and make a difference in how a long-term care facility is viewed both in the community and from a regulatory standpoint, according to Green.
“Administrators are really a linchpin for the services that we provide to communities, and it is not an easy thing because you do have to wear so many hats,” she said.
Wanda Hose, who has been the administrator at The Bay at Eastview Health and Rehabilitation Center in Antigo, Wis. for 25 years, told Skilled Nursing News that having “buy-in” at a facility can make all the difference.
Hose is actively involved in managing labor, developing wage scales and feels comfortable speaking up about what she needs to take her facility “to the next level,” among her many other responsibilities.
“If the administrator has buy-in I think it’s very easy to lead your staff to have buy-in as well,” she said.
Hose started out as a night shift RN at Eastview in 1992 before serving as the staff educator for two years and then CNA instructor. She has been the leader of Eastview since getting her license in 1997.
She also highlighted the need for work-life balance, especially at a time when she believes administrators in particular have been impacted due to the 24-7, on-call nature of their jobs.
“That has a lot to do with the team that the administrator’s facility can build so that they don’t feel like they’re on top of the mountain alone, because there are other options so that you can actually take a vacation,” she said.
As part of Eastview’s recruiting efforts, the facility offers fully paid health insurance to administrators and other higher level positions, according to John Vander Meer, director of business development for operations company Champion Care.
The operator currently has 13 nursing homes and one assisted living facility throughout the state of Wisconsin.
Champion Care also partners with the University of Wisconsin-Eau Claire and its health care administration program, to help cultivate the operator’s administrator pipeline.
About 32.5% of respondents pointed to not enough qualified applicants being the biggest reason why hiring administrators has been increasingly challenging.
That was followed by competition from other SNF or health care providers (24.4%), competition for workers from other industries (10.4%), availability of unemployment benefits and pandemic assistance (3.4%) and workers staying home to take care of family members (1%).
Roughly 11% of respondents said it has not gotten 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 a convention center in Iowa that she knew what the administrator role even entailed.
She said the lack of understanding and awareness of the role puts the industry at a disadvantage, especially given negative attention nursing homes 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 focus for individuals, and continue to build on the education requirements so that we can do a better job of sharing best practices and encouraging one another to stay and to stick with it,” she said.
Some of the best administrators are those who understand the regulatory process, possess good leadership and communication skills, and have a lot of patience, Green said. What may be even more important, she said, is the ability to take a step back and occasionally take a break.
It’s ultimately about delegation.
“It really means that we identify folks who are going to be good at their jobs, and we’re there to provide them the resources and support that they need to flourish,” Green said.
Skilled nursing facilities should focus on promoting from within and delegate one or two tasks to individuals who have expressed interest in being an administrator or possess those leadership type skills, she said.
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