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The Disappearing Administrator:Results of a National Survey

April 1, 2002
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The NAB asked state licensing boardsfor their observations and recommendationsBy John R. Pratt, MHA, FACHE
The Disappearing Administrator:
Results of a National Survey
What are the state licensing boards seeing? And what are they doing about it? By John R. Pratt, MHA, FACHE Over the past several years, there has been a disturbing decrease in the number of new skilled nursing facility administrators entering the profession. That decline, as measured by the number of individuals taking the national licensing exam, has been well documented in several articles in professional publications.

The exam, which is required of all would-be administrators, is developed and administered under the aegis of the National Association of Boards of Examiners of Long-Term Care Administrators (NAB).

NAB, whose mission is "to enhance the effectiveness of state boards of long term care administrators in meeting their statutory and regulatory duties and responsibilities to protect the health, safety, and welfare of the public," has expressed concern over the decline and is taking a number of steps to address it. One such effort involved a survey of all NAB member jurisdictions (50 states and the District of Columbia) to ascertain the extent to which they are experiencing the decline and what they are doing to reverse it.

The survey was conducted during the spring and summer of 2001. It was not intended as empirical research, but rather as an attempt to get input into the discussion from the member boards. Much of the information gathered was anecdotal, and as such might be more valuable than simple statistics. Forty-eight responses to the survey were received (47 states and D.C.). For one reason or another, three state boards did not respond. The following summarizes the findings:

Extent of the Decline

Survey participants were asked if they had seen a decline in new applications for licensure and/or applications for endorsement (the process by which an administrator with a license in one jurisdiction applies to transfer that license to another) from administrators already licensed in other states. More than half (56%) of respondents reported experiencing a decline in new licensure applicants and nearly a third (33%) experienced a decline in endorsement applicants, confirming that there is a problem.

The survey results were searched to identify possible regional trends. As Figure 1 shows, several large groups of states are experiencing a decline. However, in numerous instances, neighboring states responded differently. For example, of the six New England states responding, three answered yes to a decline, and three answered no. Similarly, Oregon and Idaho said yes, while Washington said no.

Quantifying the Decline

While some boards were not able to accurately quantify the amount of decline, particularly in the case of endorsement applicants, most could. The extent of the decline ranged from 23 to 75% over the past several years, with many in the 50% range. This further strengthens the impression that the problem has been felt largely on a state-by-state basis. It also speaks to the variation in the boards' ability to uniformly document trends.

Reasons for the Decline

Respondents were asked why they thought the number of new licensure applicants had dropped off so dramatically. Reasons offered included a punitive regulatory environment, lack of compensation commensurate with responsibility, long hours, staffing shortages, a good economy offering many attractive career options, growth of the assisted living industry as an option, need for industry career path development programs, funding shortages, industry financial distress and negative press.1

What Are They Doing About It?

The remainder of the survey focused on jurisdictional licensing boards' activities to address the decline, as well as their views on what national organizations such as NAB can do. Answers tended to fall into two general categories: regulatory changes and outreach efforts.

Regulatory changes. A number of the jurisdictions have changed their education requirements or were contemplating doing so to make them more flexible. There was heavy sentiment expressed that they should not decrease the education requirements in any way, but rather should make them more adaptable to ap-plicants with a variety of backgrounds.