Skilled Nursing News: Administrator Losses are ‘Critical Issue’ for Nursing Home Workflow, Morale

By Amy Stulick | October 3, 2021

Focused Post Acute Care Partners CEO Mark McKenzie is starting to see burnout among his senior leaders take its toll on overall operations, with at least three of the operator’s administrators recently leaving the profession for other industries.

McKenzie said administrator and director of nursing loss has turned into a “critical issue” for the Burleson, Texas company; its highest compensated, highest educated team members, for the most part, and those with the greatest experience are leaving the industry altogether and it’s been difficult to recruit more.

“When you start to lose those [positions], other issues start to occur. Our industry continues to see a loss of team members within the industry itself, and you’re catching it on both ends,” said McKenzie, referring to a lack of people entering the industry coupled with an exodus of staff leaving.

Eboni Green, a faculty member at Walden University’s Doctor of Healthcare Administration program, says direct care workers and administrators are oftentimes inextricably tied to each other — when the administrator goes, there’s a string of certified nursing assistants, or licensed practical nurses that follow that person out the door.

“I’ve seen that happen a lot, because you build a relationship with the administrator, and sometimes it’s very personal,” said Green. “They understand what’s going on with your kids and your schedule … a change in leadership is not only going to impact patient care, but it’s going to impact the lives of the staff.”

Green is also a registered nurse and licensed long-term care administrator, and co-founder of Caregiver Support Services in Omaha, Neb.

High-stakes turnover

Regulatory penalties and finding the right replacement can make losing an administrator more devastating than other facility staff.

Every time an administrator leaves the operator needs to communicate that to the state — often triggering a survey, Green added.

“Staff are already doing extra shifts and trying to make sure that residents are getting their needs met, that they’re getting the care that they need, and now here we have to bring in this regulatory agency,” explained Green.

Having a regulatory agent on-site puts additional stress on caregiving staff, Green said, who are “hanging on by a string” in the first place.

Depending on the state, administrators are required to have multiple years of education before taking on the role, Green explained.

For example in Iowa, a prospective nursing home administrator must already have a bachelor’s degree in a related area like business or health care before entering a year-long administrator training program.

“This is more challenging because of the extensive education that you have to have on the regulations, whereas when we’re talking about frontline caregivers, nursing assistants, the training is usually 76 to 100 hours of training,” Green said.

Bringing in administrators from different industries is more feasible in assisted or independent living situations, she said, due to a less regulatory environment.

Money only goes so far

Despite a staggering number of incentives offered to bring administrators through the door at Texas facilities, there has been an underwhelming response from applicants, H2 Healthcare Managing Partner Reginald Hislop III said.

Sign-on bonus wars are reaching $50,000 in an attempt to attract staff to the Dallas, Texas metropolitan market, Hislop told Skilled Nursing News.

“As we’re seeing in Texas, it doesn’t matter how much you pay,” said Hislop. “Staff would rather work for each other than they would for, you know, a $25,000 sign-on bonus where they already know they’re going to be forced into mandatory overtime and 12, in some cases 24-hour shifts. You’re trying to fill shifts with money. It’s not going to work, you know, if your environment is hostile and people don’t like working there.”

Hislop said the industry is getting to a point in the staffing crisis where it doesn’t matter how much money is in the equation because there are too many other “fundamental problems.”

“They all said, I’ll watch the industry for when [pandemic case numbers] flatten back out,” said McKenzie, referring to early references of flattening the surge in COVID cases. “Since the pandemic, month over month, we continue to see people exit the industry job boards as opposed to coming in.”

Prior to the federal vaccination mandate, applicant flow to Focused Post Acute was 50% of what it was pre-pandemic, McKenzie said. Now, that statistic is even lower, coming in at 35-40% of what it was last February, after enjoying a brief uptick in June.

“At a certain point, no singular poke was the one that made you leave the industry, it was the collection of the pokes or the kicks in the shin or however you want to put it, to go, ‘today is the day that broke me,’” said McKenzie. “We’re starting to see more of those days over the last 60, 90, 120 days than we have on the front end [of the pandemic].”

Read the full article on Skilled Nursing News here.