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OVERVIEW Nursing home administrators are responsible for the management of nursing homes. Their duties are wide ranging, covering everything from keeping track of financial accounts, to making sure the facility is up to code, to greeting residents at social events. In addition, administrators supervise managers throughout the residence Nursing home managers head different departments of a facility, such as housekeeping, dietary, human resources, and they report any problems or needs to the nursing home administrator, who then addresses the situation. Administrators work closely with the medical director and nursing staff to ensure proper medical treatment for all residents. They also act as the nursing home’s representative during interactions with residents’ families, government agencies, and the community. HISTORY Institutions for the elderly have not always been clean and cheery places. Nevertheless, such institutions have existed in the United States dating back to colonial times, before the country even became the United States. One institution in use was the poor house, modeled after the English almshouse. Elderly people without means of support or families to care for them often ended up living their final days in these dismal places. Religious institutions, such as convents, also offered places for the old and sick to stay. And, of course, families provided care for their senior members, often with several generations living in one household. It was not until the 20th century, however, that the long-term care of seniors became organized into a business. According to the American Health Care Association, the first nursing homes in the United States came into existence around 1900. Originally these homes were boarding houses, places where people paid rent that covered rooms and meals. As boarding house residents aged, some became physically unable to care for themselves and needed help with everyday activities. In addition, those without other family members, who otherwise would take care of them, sought places that offered basic medical care in addition to meals and lodging. Boarding house owners recognized the need to provide housing and medical services for these older residents. Those who began to supply these services became the first people to run nursing homes and were, essentially, the first nursing home administrators. By 1920, state health departments developed licensure programs for nursing homes within their jurisdiction to better regulate facilities and their services. The 193 Os saw the development of the Social Security and Old Age Assistance programs, government programs designed to give the elderly financial support that they could use for their care. In 1965 the programs Medicare and Medicaid were added to the Social Security Act. These two programs paid providers of care services directly and helped to spur the growth of the long-term care industry. Today, as the country’s senior population expands, as medical and technological advances are made, and as lifestyles change, the need for well-managed, comfortable, clean, and affordable long-term care for the elderly is greater than ever. THE JOB The term “nursing home” usually makes people think of what are called skilled nursing facilities. These facilities provide 24-hour nursing care, meals, and living space to residents. Many nursing home administrators work at skilled nursing facilities. However, other types of nursing or care facilities also exist. For example, intermediate-care facilities, which provide residents with meals and shelter and may also provide regular medical care, although not on a 24-hour basis, employ administrators. And administrators work at residential care facilities, also called assisted living facilities. These facilities provide residents with meals and living space but offer only limited medical supervision and care. In addition to these three distinctions (skilled nursing, intermediate care, and residential care facilities), nursing homes can also be grouped into three categories based on their ownership. Not-for- profit nursing homes are run by voluntary organizations, such as fraternal or religious groups. Proprietary facilities are those run for profit by individuals, partnerships, or corporations. And government facilities are run, of course, by the government and include such places as veterans’ homes and state-run nursing homes. However, no matter what type of facility they work for and no matter who owns the facility, all nursing home administrators are responsible for every aspect of maintaining and operating that home. Their many duties range from management of personnel to public relations. Depending on the size of the facility, administrators may have one or more assistants to help with the daily responsibilities. If the nursing home is part of a large corporation, then the administrator must meet with the governing board or other administrators from different facilities within the company. They take an active role in helping plan budgets and programs. For example, if staff resources are low or new equipment or remodeling is needed, then the administrator must explain the situation to the corporate office in order to get proper funding for the project. They may also help set fee schedules for patient services. Lynn Cecconi is a nursing home administrator. Her facility is one of many owned and operated by a health care group in the Chicago area. “I have a monthly meeting with corporate to explain the numbers,” says Cecconi, referring to the facility’s budget. If the nursing home spends more than the budget allowed, Cecconi must explain where and how the funds were allotted. If the nursing home spends less than the budget allowed, that too must be explained. “I am accountable for everything.” Administrators oversee every department in the nursing home from dietary to medical records. Some departments may have their own managers, but these managers must report to the administrator. Many times, administrators interview and hire department managers; they also have a voice in how staff members are trained and supervised. Administrators also work with the medical director and nursing director to plan medical policies and procedures that will ensure the, best health care for all the residents. They also work with the activities director in planning recreational events, holiday parties, and other year-round entertainment for the residents. Administrators are responsible for dealing with different government agencies that monitor health care. Nursing homes must meet strict guidelines before becoming Medicare and/or Medicaid certified by the federal agency Centers for Medicare and Medicaid Services (CMS). Without CMS approval, Medicare and Medicaid will not pay for any services rendered at the facility. In addition, every nursing home facility undergoes an annual inspection by the state’s health department. Any discrepancies or violations found are directed to the administrator for explanation. Many nursing homes also participate in voluntary quality assurance programs that measure the performance of the facility and its staff. If there are problems with the staff, or complaints regarding a client’s treatment or well-being, the administrator must intervene. A good administrator should be able to listen, assess the situation, and act accordingly. Administrators should not only be visible to patients and their families, but be approachable as well. For Cecconi, the most important duty of a nursing home administrator is “assuring positive resident outcome.” She works closely with her staff to make sure every resident is well cared for and happy. Cecconi finds that if the resident is treated well, then the families are satisfied. REQUIREMENTS High School Nursing home administrators are business managers. Thus, classes such as accounting, business management, and computer science will help pre pare you for the business side of this job. Quantitative skills are needed to excel in this career, so make sure you take as many math classes as possible. Science and health classes are important to take and will pre pare you for college. High school classes in sociology, psychology, and social studies can provide you with a background for understanding a variety of people. And, because you will be working with so many different people and must give directions, take English, speech, and foreign language classes to hone your communication and leadership skills. Postsecondary Training Most nursing home administrators have a college degree in health administration, business, human resources, or another related field. A few states do allow licensing for administrators who hold an associate’s degree and have a certain amount of experience. It is recommended, however, that you get a bachelor’s degree. One reason for this is that requirements for professional certification stipulate that anyone licensed after 1996 must also hold a bachelor’s degree to be eligible for certification. In addition, most employers insist on hiring only those with at least a bachelor’s degree. Many colleges and universities across the United States offer bachelor’s degrees in health care administration, health service administration, or long-term care administration with concentrations or minors in nursing home management. The Association of University Programs in Health Administration (AUPHA) certifies undergraduate programs that meet the organization’s standards; the National Association of Boards of Examiners of Long Term Care Administrators grants academic approval to undergraduate programs in long-term care administration. For information on certified and approved programs, contact these organizations (see the end of this article for addresses and websites). The Accrediting Commission on Education for Health Services Administration is the accrediting body for graduate programs in health administration education. Information on these graduate programs is also available from the AUPHA. Graduates of advanced-degree programs usually have a master’s of science in health administration or a master’s in business administration in health care management. Courses you are likely to take as an undergraduate cover subjects such as health law, gerontology, medical terminology, and health care financial management. In addition, expect to take classes such as accounting, marketing, computer science, and organizational theory. Some programs also require students to complete an internship, also called an administrator-in-training program. Certification or Licensing Professional certification is available from the American College of Health Care Administrators. Requirements for becoming certified include having a bachelor’s degree, having two years of professional experience as a nursing home administrator, completing a certain amount of continuing education, and passing the certification exam. Candidates who meet all requirements receive the designation certified nursing home administrator (CNHA). Certification demonstrates an administrator’s level of experience and professionalism and is recommended. All nursing home administrators must be licensed. All states and the District of Columbia require candidates to pass a national licensing exam given by the National Association of Boards of Examiners of Long Term Care Administrators. In addition, many states require candidates to pass a state exam as well as to fulfill certain requirements, such as having completed an administrator-in-training pro gram of a certain length and completing a certain number of continuing education hours. Since these state requirements vary, you will need to check with the licensing board of the state in which you hope to work for specific information. Other Requirements Nursing home administrators must have a keen sense for business and enjoy managing people, budgets, and resources. They should be able to work well with a wide variety of people, from government official to residents’ families. But just as important as having a feel for business nursing home administrators must have a special interest in helping people, especially the elderly. Administrators need to be aware of the emotional and physical challenges their residents face and be able to figure out ways to make their facilities accommodating. Administrators need to have a positive attitude and to be committed to lifelong learning, since continuing education is an essential part of this work. EXPLORING To explore the field of nursing home administration, try contacting a nursing home in your area and make an appointment to speak with the administrator or assistant administrator about this work. They should be able to answer any questions you may have about the job, as well as give you a feel for their workday. Hands-on experience is also important to get, so volunteer at a local nursing home or assisted living residence. You can help conduct activities such as bingo and arts and crafts, plan holiday celebrations, read aloud to the sight impaired, or simply keep lonely seniors company. Most, if not all, facilities welcome volunteers. In addition, there may be opportunities for paid part-time or summer jobs at these facilities. Even if you end up only working in the kitchen, you will still get a good feel for the structure of the business.
EMPLOYERS There are approximately 17,000 nursing homes located throughout the United States. Each nursing home, depending on its size, needs administrators and assistant administrators to oversee its operation. Not-for-profit groups, corporations, and government agencies employ administrators in a variety of settings: at skilled nursing, intermediate care, and residential facilities. No matter what the facility is, however, each needs administrative leadership to ensure successful operation. Do job opportunities vary from state to state? According to the 2000 census conducted by the U.S. Census Bureau, California had the largest number of residents age 60 and over, with approximately 4.7 million. Alaska, on the other hand, ranked at the bottom with approximately 53,000 residents in this age group. It makes sense to conclude that opportunities for nursing home employment are most plentiful in areas with high concentrations of older residents. STARTING OUT A nursing home administrator is considered a high executive position, so it is quite rare to land this job directly after graduation. Working as an assistant administrator is a more realistic mid-level management position. It is not uncommon for administrators to have one or more assistants responsible for different aspects of running the nursing home, especially at larger facilities. For example, one assistant administrator may be in charge of human resources and benefits, while another is assigned to keeping inventory and purchasing supplies. The administrator oversees the work of each assistant. As a starting point for the career of administrator, however, you may begin as an activity director or, depending on the size of the facility, as an assistant to the activity director. Nursing home patients look forward to a variety of diversions to help make their stay pleasant and enjoyable. Coordinating weekly patient entertainment, such as bingo, arts and crafts, holiday parties, and other celebrations, are some of the duties of an activity director. Other routes into this field include jobs that familiarize you with government agencies and case management. In Lynn Cecconi’s situation, her past experience working as a discharge planner and as a public aid caseworker gave her valuable training in working with both Medicare and Medicaid. Her ability to navigate through these two complicated government agencies and their policies gave Cecconi an edge over other candidates. ADVANCEMENT It is hard to identify a typical route of advancement for the nursing home administrator, since this is already considered an executive position. Experienced administrators might choose to work for a larger nursing home with a bigger staff. If employed by a chain, administrators may advance by being transferred to other nursing home locations or promoted to the corporate office. Administrative positions at hospitals, health maintenance organizations, pharmaceutical companies, or national associations, such as the Red Cross, are other options for advancement. The skills and experience nursing home administrators possess, such as management and budgeting, can be easily applied to other areas of the corporate world. EARNINGS The 2004 - 2005 Nursing Home Salary and Benefits Report, published by the Healthcare and Hospital Compensation Service, reports that nursing home administrators made a median annual salary of $72,761 in 2004. This represented an almost 4 percent increase from the previous year. Median salaries differed greatly according to geography, with those on the West Coast making a median salary of $84,000 a year, and those in the Midwest making $59,015. The report cites an increasing need for administrators and an increase in administrators’ year-end bonuses, with the average bonus being 13.59 percent of annual salary. It is important to note that not all nursing home administrators receive bonuses, but more and more nursing homes are offering them in order to compete for the best job candidates. The U.S. Department of Labor reports a median annual income of $64,930 in 2004 for medical and health services managers working at nursing and personal care facilities, a category including nursing home administrators. Ten percent of all medical and health services managers earned less than $41,450, and 10 percent earned more than $117,990 in 2004. These salaries do not include bonuses. Income also depends on the administrator’s experience, the size of the facility, its ownership, and its location in the country. Administrators receive added benefits such as health and life insurance, paid vacation and sick time, and retirement plans. WORK ENVIRONMENT Most administrators are scheduled for eight-hour workdays, although they often work longer hours, especially when there are a large number of admissions or if there is a problem that needs to be addressed. Administrators must be available at all hours to handle any emergency that may arise. Most keep a regular Monday through Friday work schedule; some work on weekends. Lynn Cecconi is often at the nursing home on important holidays, such as Thanksgiving or Christmas, to greet the residents and their families as well as the staff. Administrators usually have private offices, but the nature of their job takes them to every department and floor of the nursing home facility. If there is a problem in the dietary department, the administrator must go to the dietitian’s office or the kitchen. A resident’s complaint may take the administrator to that particular room. Most nursing home facilities do not enforce a dress code for non- medical staff. However, it is important to dress professionally and in a manner appropriate to the environment. OUTLOOK This is a field to watch. According to the U.S. Department of Labor, employment of health service managers is expected to grow faster than the average through 2012. Much of the anticipated employment opportunities will be at nursing homes and other residential facilities. One reason for this demand will be the increased number of seniors. The U.S. Census Bureau projects there will be approximately 70 million older persons, age 65 years or older, by 2030. This age group will grow dramatically beginning in 2010, when the baby boom generation (those born from mid-1940 to mid-1960) reaches senior status. People are also living longer than ever before due to improvements in medical care and healthier lifestyles. As life expectancies rise, many families are presented with the unique situation of caring for their elderly parents, and sometimes their grandparents, while raising their own young families. Another reason nursing home facilities and those who work in them will be in demand is our mobile society. People relocate today much more than in generations past, often moving away from their original homes for better employment opportunities. It is not uncommon for the elderly to have no immediate family members living close by. The primary reason many senior citizens enter nursing homes is their inability to care for themselves due to chronic illness or advanced age. According to a study conducted by Columbia University College of Physicians and Surgeons, the “typical” nursing home resident’s stay is two and a half years. As the number of people requiring round-the-clock medical attention increases, so will the need for more nursing home facilities. This, in turn, will fuel a demand for qualified nursing home administrators. FOR MORE INFORMATION For information regarding not-for-profit facilities, contact American Association of Homes and Services for the Aging 2519 Connecticut Avenue, NW Washington, DC 20008-1520 Tel: 202-783-2242 Email: info@aahsa.org For information on careers, certification, and licensure, contact the following organizations: American College of Health Care Administrators 300 North Lee Street, Suite 301 Alexandria, VA 223 14-2807 Tel: 888-882-2422 Email: education@achca.org American College of Healthcare Executives One North Franklin Street, Suite 1700 Chicago, IL 60606-3424 Tel: 312-424-2800 Email: GenInfo@ache.org For information regarding long-term health care and its facilities in the United States, contact American Health Care Association 1201 L Street, NW Washington, DC 20005 Tel: 202-842-4444 Contact the A UPHA for information regarding accredited academic programs in health administration. Association of University Programs in Health Administration (AUPHA) 2000 North 14th Street, Suite 780 Arlington, VA 22201 Tel: 703-894-0940 Email: aupha@aupha.org For information on licensing and undergraduate degree programs in long-term care administration, visit the following website: National Association of Boards of Examiners of Long Term Care Administrators 1444 I Street, NW Suite 700 Washington, DC 20005-6542 Tel: 202-712-9040 For career information, visit this website. Long Term Care Education.com http://www.longtermcareeducation.com For information on a career as a health care executive, visit Make a Difference -- Discover a Career in Healthcare Management http://www.healthmanagementcareers.comNext: Nursing
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