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

A reactionary mindset has taken hold among nursing home administrators, affecting morale within facilities and slowing the evolution of the sector.

It’s incredibly difficult to look at overall recovery and have a wider perspective when there’s such a high level of burnout, according to Thomas Annarella, administrator at Valley Hi Nursing & Rehabilitation in Illinois. There’s “nothing more in the tank” — that is, no energy to look beyond day-to-day problems.

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

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

It’s “survival mode,” for a lot of administrators at this point, he said, as leadership tries to get ahead of multiple issues, including cost inflation and issues with vendors being able to provide goods and services in a timely manner.

The sheer amount of turnover in administrators – and new reporting on such turnover in the Payroll-Based Journal (PBJ) – makes newcomers to the role reactionary, too.

“If you’re not in a position for a long period of time, you don’t have systems in place, you’re in a constant state of change, you’re chasing staffing and trying to stay out of regulatory trouble,” said Annarella. “I see a lot more of that, than it being [a response to] Covid.”

These headwinds are affecting new and seasoned administrators alike, according to Bob Lane, president and CEO of the American College of Health Care Administrators (ACHCA).

“You’ve got it on both ends. You’ve got the younger leaders who aren’t necessarily being driven out of the profession, but they’re being asked to do twice as much as they had expected when they first came in,” said Lane. “Then you have the others that have been through quite a bit of battles over the years and this is just the straw that broke the camel’s back, so to speak.”

Debbie Meade, CEO of Health Management in Georgia, said she has had seven administrators in the past year-and-a-half among her four buildings, with burnout and lack of resources making it difficult to keep people in the role and see 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 compared to 25 years ago, when an administrator would stay at one building for the entirety of their career.

“My last administrator that retired from the building had worked with the company for 20 years. I’m not finding that person again,” said Meade.

Industry consolidation and administrator leadership

The changing profile of administrators is also being driven by industry consolidation, as leaders in the space strive for regional positions in larger companies with more resources, Meade said.

There’s a dissonance between what independent or smaller operators are seeing in administrator turnover compared to operating giants like The Ensign Group (Nasdaq: ENSG) with a pipeline of 30 to 40 administrators-in-training for facility turnaround projects.

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

That translates to more pay, Meade said, another tall order for smaller operators with limited resources.

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

Leadership and culture with ‘nothing in the tank’

When administrators are overburdened, the entire facility can be negatively affected.

“One of the things that I noticed with a lot of administrators and even just senior level employees within 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 to be in,” added Annarella.

Such situations are impacting the morale of direct care staff and middle management, said Meade.

“Employees don’t leave jobs, they leave the leader. You have to have a good leader in order to gain the competence and retain the staff and recruit new staff. That position is powerful and very important,” she said.

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

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

Homegrown administrators

Self-motivation, purpose-driven people are what’s needed, she said, and those types of people are usually found within the company. Or, they’re introduced to the sector from an early age.

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

“Georgia has a preceptor program already designed … they have a good format and [regulations] that you have to follow. It’s a different format and hopefully will produce a good leadership team for the company,” noted Meade.

Annarella said Valley Hi is very purposeful in who is selected for administrator tracks, or leadership career paths in general – most of his team has been with Valley Hi for 13 years, starting as universal workers through high school programs and eventually getting clinical certifications before ending up as administrators.

“They did that all through Valley Hi and they recognize that; they want to stick with us, they know everyone here,” he added. Universal workers are usually students from nearby school districts who shadow 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 nursing assistants (CNAs). The program is part of a career academy that places students into apprenticeship programs.

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