Programs to cultivate leaders in the nursing home space, including the administrator-in-training program (AIT), are being challenged by rapid turnover and the need for better reimbursement and support systems.

But, a focus on company culture, offering of diverse pathways for those seeking leadership positions, and a willingness to show prospective leaders a behind-the-scenes look, makes for a program that can retain leaders while inviting others to grow into positions with more responsibility.

And many operators – faced with the dire consequences of losing leaders – are putting a lot of effort behind developing administrators.

Massachusetts-based EF Senior Care, for one, has graduated 11 AITs in four years, with a focus on both clinical and financial management. EF Senior Care started out as a consulting company and has placed these administrators in their own building or in client buildings, said CEO Michael Nickolaus. He views it as investing in the industry, since EF Senior Care owns just two nursing homes in Massachusetts.

“When we rotate them through the departments, we really now put a heavy focus on the clinical and the nursing side and on the financial and the back office side,” said Nickolaus. “In today’s environment, if you can’t manage those areas extremely well, you’re going to struggle.”

Nickolaus discussed where leadership programs are headed and what is working right now, along with Ariana Moreau, director of clinical services for Georgia-based A.G. Rhodes, at a recent panel discussion hosted by Skilled Nursing News.

Moreau placed an emphasis on company culture and how it plays a major role in building up leaders from within an organization. Staff are already vested in the culture, and in the case of A.G. Rhodes, that culture has been evolving for 120 years.

“I think that’s why we are as strong as we are today, because that culture, that mission, is woven into everything that we do,” said Moreau. “Whatever culture you have – whatever you want your message to be in your organization, your beliefs, your mission – you have to make sure you’re weaving that in at all levels.”

A.G. Rhodes has a director of culture position, and there’s a focus on diversity, equity and inclusion right from orientation and via committees, Moreau said.

“There’s so much depth to those types of programs,” Moreau said. “[Such a position] really transforms the culture and allows your associates and employees to show up as their authentic selves.”

Tailormade leadership programs

The Georgia nonprofit’s leadership program could lead to administrator licensure, Moreau said, along with a multitude of other leadership positions including director of nursing. It’s open to any staff member that has been with the company for a year.

“We partner with some external resources … it’s really about building that leadership foundation for people who want to grow in the industry,” said Moreau. “Maybe it’s that CNA who wants to be a [medication technician], or it’s a business office manager or admissions director who wants to be an administrator. It’s really all different levels of career ladders.”

The diversity of the program, and an unabashed look behind the scenes for certain departments that make a facility function, have helped A.G. Rhodes’ leadership program flourish, Moreau said.

“I think it’s really eye opening for them, because it changes the perspective of what it takes to run an organization, to make it successful,” she said.

Meanwhile, EF Senior Care’’s AIT curriculum is tailored to each individual in terms of timeline, noted Nickolaus.

“One of the expectations we set with AITs is, we retain the right to extend that another three months, particularly if there’s an area or two where we feel like they still need development,” he said.

On the other hand, there are candidates with unique backgrounds – a doctor or registered nurse would likely have a shortened AIT curriculum with EF. Massachusetts doesn’t have a prescribed AIT curriculum like other states, Nickolaus said. EF was able to present a six-month curriculum to prepare AITs for their licensure exam.

Roadblocks to building leaders

Dealing with adverse situations is an important part of administrator training as well.

The Massachusetts-based EF Senior Care introduces its trainees to stressors in the last months of their program. If there’s an unhappy family member, an AIT may be asked to take the lead while also dealing with employee issues and terminations.

Since the pandemic,the administrator role has changed and ill-equipped administrators can be a huge roadblock to a nursing home organization’s growth, he said. Since Covid, leaders are physically and emotionally drained. There are infection control challenges, admissions declines, staffing issues, and financial stress, to name a few burdens.

“A lot of insiders are exhausted, and so we really struggle to find new ways to motivate them, right? We all saw a lot of people leave the industry [during the pandemic], particularly some of the more seasoned ones,” said Nickolaus.

For those looking to enter the nursing home sector, Nickolaus said operators can do a better job of educating people, especially college graduates, on what the industry has to offer.

“There’s the joy of caring for people, job security, and it’s a well compensated position,” Nickolaus said of the administrator role. “We need to do a better job of promoting that, to develop that sort of pipeline of people who might look at it and consider it.”

For Moreau, another major roadblock to building leaders is the cost associated with it, and making it a priority when there are so many other challenges facing the sector.

“Reimbursement is so tight these days in our industry. That’s something as an industry we have to work to address on a higher federal level so that we do have the funds and resources to do this,” Moreau said of building up leadership programs.