Ethics and practice: The connection

In a day when, in the mind of some people, anything goes, the field of long-term care administration suffers seriously when people don’t seem to know or appreciate the concepts of right and wrong, good and evil. This has adversely affected the profession to the point where fewer people want to be administrators because of the risk of being criticized for what they allegedly do not do in providing care for loved ones.

This situation, coupled with the flourishing challenges of litigation and poor survey outcomes, seems to be telling bright people that long-term care administration is not the future for them.

In thinking about nursing home administration and how it has been impacted by the coming of Medicare/Medicaid in the 1960s and the creation of licensure laws for administrators, it stands to reason that ethics should be affirmed through regulation in the various states and jurisdictions. In 2006 the West Virginia Nursing Home Administrators Licensing Board began looking at its standards to ascertain the degree of emphasis they placed on ethics. It was determined that more needed to be done to strengthen the Board’s policies.

Initial consideration focused on developing an established code that would be embraced by the long-term care profession. In the end the one adopted was the Code of Ethics developed by the American College of Health Care Administrators (ACHCA) and recommended by the National Association of Long Term Care Administrator Boards (NAB). With this as a guide, provisions were included in West Virginia’s regulations defining professional misconduct or unprofessional conduct, leading to written rules addressing what happens when a licensee fails or refuses to comply with the principles of right and wrong. Furthermore, provisions were placed in the rules indicating that licensed administrators who knew of ethical violations and failed to report them to the Board could place their licenses in jeopardy.

In doing so, the licensure Board wanted to deal with direct ethical violations and put the licensed administrator community on notice to watch for any infractions. In the Board’s opinion, such self-monitoring was necessary to put “eyes” in the field that hopefully would one day aid in improving public perception of nursing home practice in West Virginia.

The process of moving the proposed rule from conception to public hearing to legislative action took the better part of two years. The good news is, effective March 31, 2008, those licensed in West Virginia to practice nursing home administration came under revised expectations pertinent to ethics and ethical practice.

In the spring 2008, Hugh Heaton of The Compliance Store, LLC, Boaz, Alabama, was able to complete research to determine the pervasiveness of ethical expectations found in licensure rules for nursing home administrators throughout the United States. Based on his research, only 20 states and jurisdictions including West Virginia had statements of any kind in their rules at that time. The majority dealt with medical ethics rather than the ethics of practice. This would suggest opportunities abound for licensure boards in all states and jurisdictions to review their rules governing personal practices and initiate a process to strengthen or build into regulations the state’s expectations for ethical practice.

There is little doubt in the public’s mind that long-term care’s reputation is not good. Based on belief, research, and work accomplished through the West Virginia Board, we believe that significant steps can be taken to enhance public appreciation for what administrators do and, at the same time, create new expectations for those in the field. They should know that ethics and character count. We believe that as time goes by, if more people who have the duty to credential administrators buy into our thinking, the perception of nursing home administration can be enhanced. This can have a positive effect toward decreasing negative outcomes of litigation and complaints registered through the regulatory process.

If anyone in other states would like to explore the language and mechanics used in West Virginia for incorporating desired ethical changes into our rules, let us know. Contacts can be made with Mrs. Alberta Slack, Director, West Virginia Nursing Home Administrators Licensing Board, P. O. Box 522, Winfield, WV 25213. What we have learned, we will be happy to share. When we are able to demonstrate across America that nursing home administrators are doing their part to maintain a clean profession, increased public respect and esteem for the field is likely.

Daniel W. Farley, PhD, CNHA is President/CEO of the GlenWood Park Retirement Village, Princeton, West Virginia, and Chair of the West Virginia Nursing Home Administrators Licensing Board. For further information, phone (304) 425-8128 or email

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