Rethinking the Role of the Nursing Home CEO

Doing away with large, multi-layered corporate structures, as some of the largest skilled nursing operators have done in recent months, has given companies both big and small the opportunity to assess — and in some cases — rethink the role of the company’s top executive.

Iowa-based Accura HealthCare CEO Ted LeNeave purposely placed himself at the bottom of the organizational chart, effectively turning it upside down.

Doing so allows staff members to “be the experts in their own area.”

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“It just seemed that people always go to the top of the chart and they either assume that those are the people that make the decisions or they’re the ones you need to get to know, and I said, ‘Well if the most important people in the business world think that the top of the chart are the most important people, then that’s why we flipped it upside down,” LeNeave told Skilled Nursing News during an interview at the AHCA/NCAL conference in Nashville.

Those at the top of the organizational chart include residents, families and direct care staff.

“I am not the piece that makes this company run, it is everyone at the top of the chart,” he said.

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Accura HealthCare operates 34 communities across four states: Iowa, Minnesota, Nebraska and South Dakota.

Previously seen as skilled nursing giants, Genesis HealthCare and Consulate Health Care have both gone from operating hundreds of facilities each to downsizing and leaning into a regional focused, market model strategy. 

Consulate currently manages 60 centers across five states and Genesis has roughly 250 skilled nursing facilities across 17 markets.

The regional and local market model has been embraced by other operators as well, with the top 50 largest providers on average operating in six states. Of those 50 providers, many tend to focus on one or two states in terms of local density, according to a Stifel analysis of recently released Centers for Medicare & Medicaid Services (CMS) data.

I work for you’

For Consulate CEO Jeron Walker, the company’s smaller footprint has allowed him to not only visit facilities more frequently, but to also empower each administrator or executive director to bring ideas to the table on what is needed to succeed in their respective markets.

“I go around when I’m visiting our centers and I tell our executive directors all the time: I work for you. I am a shovel, put me to work,” he previously told SNN. “This is the approach that I take and it’s allowing our centers within each market to share what they need to be successful, and then let me and my team work on those areas so they can focus on quality and connection within the center.”

LeNeave also stressed the importance of being a resource to staff. The CEO doesn’t have to be the smartest person in a particular area such as finance, law, technical skills or human resources, rather, “it really needs to be a person that can build a team, provide trust and a vision.”

“A lot of CEOs might say, ‘This is my team, they are a resource to me to elevate the company.’ I don’t see it that way. In an organizational chart that is upside down, whoever is above you, they are the ones leading and we are a resource to them,” LeNeave added.

Kennett Square, Penn,-based Genesis has created a “small, smart structure” made up of a “macro president,” or administrator, a clinical lead, an MDS coordinator, human resources and business development positions per market, according to Melissa Powell, executive vice president and COO.

“We talk now about buildings first, the building needs to run the care. They need to be supported by a national structure or market structure,” Powell previously told Skilled Nursing News. “We kind of took down those barriers of almost like how do we support the building, not do it for the building … and that’s the perfect mix.”

That support, according to LeNeave, comes in the form of some of the basic responsibilities a nursing home CEO should take on, including being a leader and building a team that can go out and can perform, measure expectations, set goals and reevaluate.

“As a CEO you do that by leadership and then you provide a vision. The vision has to be there but you can’t create that vision by yourself. Our vision is created as we work as a team and we try to see what is our purpose … Our purpose is to care for others,” he said.

The role of the CEO can depend somewhat on the size of the company, LeNeave said, especially given that leaders of smaller companies have likely been wearing multiple hats during over the last two-plus years.

Ultimately big or small, a nursing home CEO needs to not only lead by example but also let people who know their job to do their job, according to Bartley Healthcare President and CEO Philip Scalo.

“If a CEO doesn’t communicate and that culture isn’t there, you’re not going to have the level of care that you want, you’re not going to have the level of satisfaction from your employees that you want and it’s going to be difficult,” he said.

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