This year, Skilled Nursing News held a magnifying glass to various roles within the nursing home as the sector continues to evolve – and receive mandated change from federal and state entities.

All the while, skilled nursing staff shortages fuel a reshaping of roles to take on more responsibilities and rely more on technology to fill the gaps.

Our stories examined positions from top executive roles to certified nursing assistants (CNAs), the backbone of the direct care workforce.

Leaders and those in each role shared their thoughts on how these positions have changed, expectations for the future, and how they’d like to see the roles shift to create a more streamlined workflow from the top down, and in turn deliver better care to residents.

Future of the CNA: Nursing Home Reform Efforts, Staffing Crisis Drive Changes in Key Role

Publication date: April 13, 2022

As the industry continued to grapple with the staffing crisis and expiration of crucial support in the form of temporary nurse aide waivers, operators called for not only more CNAs, but an expansion of their role in the nursing home to align more closely with value-based care.

The notion of specialized positions and legislation to support such positions among CNAs led the conversation, backed by calls for such change in the National Academies of Sciences, Engineering, and Medicine (NASEM) report.

Coupled with expansion will have to be trust, according to Lori Porter, co-founder and CEO for the National Association of Health Care Assistants (NAHCA).

“CNAs are the families’ experts,” said Porter. “Yet, facilities never want CNAs talking to families … trust has been a big issue, a big talking point throughout the pandemic. This is one of those reasons, one of those things that chips away from trust. Don’t talk to the surveyors. Don’t talk to the ombudsmen. Don’t talk to the families. Well, why not? They’re where we get our recognition.”

Staffing Shortages Lead Nursing Homes to Rethink MDS Coordinator Role

Publication date: May 15, 2022

Next up for our workforce series was the minimum data set (MDS) coordinator, a speciality position that ensures facilities get the appropriate amount of reimbursement and residents get the right level of care.

Regulatory headwinds and Medicare cuts have put enormous pressure on the MDS coordinator, who is oftentimes also a registered nurse (RN) for the facility. Former North Shore Healthcare CEO David Mills told SNN automation and more regional support has helped with the tug-of-war between direct care and MDS duties, but more needs to be done.

Mills said he wants to see more regional MDS coordinators and “floaters” to help when facilities face thinning frontline staff.

Why Skilled Nursing Providers Must Embrace the DON of Tomorrow

Publication date: May 19, 2022

Another North Shore Healthcare executive, this time Chief Clinical Officer Tina Belongia, said the director of nursing (DON) role has picked up dozens of additional responsibilities as a result of the staffing crisis.

Many have picked up shifts as a nurse, CNA, or even cooked meals for residents along with overseeing the clinical model at a facility. Education has become a huge piece of the DON role too, as nurses fresh out of school have less hands-on experience on account of the pandemic.

DONs have and continue to work with medical directorship companies to really refocus and redesign the care delivery system and positions within it. Stabilizing the workforce starts with stabilizing its leadership, Belongia said. Without that leadership, there’s a domino effect in turnover.

The Workforce Linchpin: Nursing Home LPN Role Weaves Together Resident Knowledge, Clinical Expertise

Publication date: August 3, 2022

Examining the licensed practical nurse (LPN) role in the nursing home was interesting and surprising – the position appears to be the “middle child” of clinical staff, indispensable and sometimes overlooked, especially by federal and state agencies as they draft staffing mandates.

The NASEM report didn’t spend too much time on the role either; Jasmine Travers, a researcher for the report, said it’s a potential hole in better understanding the nursing home workforce as a whole.

Those in the role say they straddle the line between direct care and leadership responsibilities, gaining the trust of fellow clinicians and coming up with solutions. Like the DON and CNAs, LPNs are racking up specializations like infection prevention or wound care all while striving to gain more leadership responsibilities at their facility and in some cases work toward RN certification.

Administrator’s Role Becomes More Hands-On Coming Out of COVID

Publication date: August 15, 2021

SNN ran the first of many stories examining the nursing home administrator role in 2021. This article and subsequent ones found those in this position have become more hands-on – and integral to building back census in the coming years in the wake of COVID-19.

Administrators started marketing themselves and their facilities a whole lot more through social media, updating websites and carefully cultivating the culture of a facility to draw in both staff and residents.

Building census through strengthening company culture proved to be a big responsibility for administrators, however. Fast forward just over a year, administrators new to the role and veterans in the field alike say they are burned out.

Turnover is fueled by mounting responsibilities and industry consolidation, as administrators seek out regional positions in larger companies with more resources at the ready.

Rethinking the Role of the Nursing Home CEO

Publication date: October 19, 2022

As nursing home giants like the Ensign Group (Nasdaq: ENSG) and Genesis HealthCare aim to make their business models less centralized around a singular corporate structure, many in the industry have had to rethink the CEO role.

CEOs need to think hyper-local as the sector is split by region – successful leaders in the role know their markets inside and out. A smaller footprint to oversee allows CEOs to visit facilities more frequently too, according to Consulate Health Care CEO Jeron Walker, and empower administrators and executive directors to bring their ideas to the table.

Accura HealthCare CEO Ted LeNeave stressed the importance of being a resource to staff too – successful nursing home CEOs recognize when they aren’t the smartest people in the room, and turn to learn from the best person on a given subject.

​​“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.