PACS COO Touts ‘New School’ Nursing Home Administrator Training, Decries Survey Backlog 

Behind the success of PACS Group’s (NYSE: PACS) high-growth model is the nursing home giant’s principle of entrusting its early career administrators with greater autonomy. In rejecting the traditional path, PACS allows administrators in training the opportunity to step into their roles with greater independence much earlier.

Enabling new leaders to make crucial decisions and creating an environment open to more autonomy out the gate is something the nursing home sector needs to embrace but hasn’t really adopted, Josh Jergensen, COO of PACS Group, told Skilled Nursing News. 

In a broad ranging interview with SNN, in which Jergensen discussed hot topics such as surveys, staff makeup and retention, he also outlined the company’s wins with its unique administrator-in-training (AIT) program. The program has been key in reducing burnout among its leaders, he said.


In contrast, the “old school approach” sets AITs up for middle management and burnout, Jergensen said, which is why PACS has attempted something fresh.

The traditional approach for training of administrators involves a very formal two-year program for AITs on average. AITs embed with various departments to understand how the business works. And then, a lot of AITs also typically get their certified nurse aide (CNA) licenses, something helpful to understand as an administrator, but not necessary for preparing future leaders, he said.

Meanwhile, PACS’ “new school approach” shrinks the time commitment of the AIT program to about half a year, enabling AITs to closely shadow a current administrator to determine how the administrator is handling difficult situations, how they’re interacting with key stakeholders and their community.


That means less time shadowing other departments in favor of a more focused understanding of how the administrator role impacts housekeeping, food service, clinical teams and other departments.

In its 11 years of existence, PACS has hired 205 AITs through its program. About 157 of them still work at PACS. That translates to a remarkable 77% retention rate for administrators over the course of those years, he said.

In discussing his views on surveys, another problem facing the sector, Jergensen said that while he is all for the survey process in ensuring quality at nursing homes, survey backlogs have created confusion.

“They’re misinforming consumers,” he said of the delayed surveys. “If they can’t catch that process up, they may need to rethink the 5-star ranking system to keep consistency.”

The following conversation has been edited for length and clarity. 

How does the administrator-in-training program need to change for the future?

We have to improve the talent that’s coming into the program. If they’re coming from other industries or they’ve never been career people, that’s fine. If they’re young people, that’s fine. Probably the majority of our AITs we hire straight out of college. We’re looking for individuals with those certain leadership skills and characteristics that we believe will eventually make good administrators.

The individuals need to get better and the only way that you get the best individuals is to create a platform that’s attractive for them. So like I mentioned, autonomy, the ability to run the business, it’s attractive to those young entrepreneurial individuals who are trying to start their careers. There aren’t a lot of careers that can offer that.

Any other aspects need to change or be discussed?

We have to get compensation right. Maybe not super high as an AIT but eventually as an administrator we have to see and understand what that right compensation might be, and help people see that potential. And then they have to see what other professional opportunities exist. Professional growth and advancement, what does that mean for them? Can they take a challenged facility and make it better and then transition to maybe a bigger facility, or maybe overseeing multiple facilities if the state allows it, or maybe regional leadership? And then we have to see what other professional opportunities exist that we are competing with and make sure we’ve leveled up.

The only way to get the best talent is to create the vision of what leadership in this industry looks like so that talent is attracted to the entry level position, which is the AIT.

How might staff makeup change in the future, given the mandate and physician, physiatry groups expanding in the sector?

In general, good leadership, good individuals at each facility will understand those dynamics, which are different in every local market. Some may be RN rich, some may be LPN rich. Some may have unique programs for their communities. A decentralized model where decision making is located in those individual areas will allow them to adjust their business model to adjust to a changing environment.

As we look at where the space is going, more acuity is being pushed from the hospitals to the post-acute settings and thus your ability to provide care efficiently while also getting great clinical outcomes is going to drive census and skilled mix. If you don’t get care right and you’re not an exceptional performer in your community for that, you’ll struggle forever.

Anything you’d like to say about the survey backlog?

The survey process is so far behind that the star rankings pushed to the public are an inaccurate reflection of the current care being provided. If they can’t catch that process up, they may need to rethink the 5-star ranking system to keep consistency.

It’s not reflective. They’re misinforming consumers based on how far behind they are. That can be positive or negative. Facilities that look great may not have had a survey in three years, they may have deteriorated. Facilities that are doing great in new hands, they’re performing better, may not have had a survey to prove it. I would say that’s a key component.

It sounds like surveys can be a boon to operators, depending on consistency.

I know people have said the survey process is more stringent and more punitive. If there’s a tag or deficiency they’re going to write it as a tag, and to me that’s fair. I know it’s inconsistent from region to region, which needs to get cleaned up, but if you’re a good provider and you’re doing it right and there are consistent surveys, it will allow you the ability to show each year that you’re better than you were last year and it will be reflected to the consumer.

Any comments on the five-claim probe currently being conducted across all nursing homes?

We understand as a company that the industry is heavily regulated. We knew that before we got into it and we knew it as we were growing as an organization. We’re not fearful of people coming in to check our results. We feel we proactively do a lot of that ourselves. When the surveys get behind, when they’re unclear and inconsistent from the regulatory bodies, that’s when it becomes frustrating.

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