Just one more question

Like the great TV detective Columbo, Long-Term Living columnist Gary Tetz (Funny You Should Ask) always has one more question. In this bimonthly feature, he talks with long-term care leaders about anything that pops into his mind. He’s as surprised as you are that they’ll speak to him, and apologizes in advance for whatever inanity he might blurt out in the pressure of the moment.

He has written a long-term care textbook with a very weighty title—Long-Term Care: Managing Across the Continuum. His name is even on the cover, complete with middle initial. And since I have instant respect and admiration for anyone with the knowledge and focus to accomplish such a feat of strength and courage, I knew I had to talk to John R. Pratt.

Besides authoring what has become a standard part of healthcare curriculums nationwide, John is assistant program director for health programs at St. Joseph’s College of Maine. After 25 years in hospital administration, including 15 as a CEO, he’s spent the past 19 years creating distance learning programs for education-thirsty long-term care administrators.

Once he had reminded me where Maine was and assured me that geography would not be on the test, we moved on to other topics.

So you’re helping provide continuing education for administrators?

Yes, we’re one of the half dozen or so programs that are accredited by the National Association of Long Term Care Administrator Boards (NAB). What makes us quite different is we’re dealing almost exclusively with mid-career working adults, not the traditional college-age student.

And since you’re exclusively online, the beautiful thing is you never have to see these people.

(Laugh) Well, actually I do get to see them sometimes. And even though they’re online, I still get to know them a lot better than I ever knew that kid in the back of the classroom.

But that kid never showed up for class in his bathrobe. You’re not using Web cams, are you?

No, and now that I’m working at home as well, I’m very glad we aren’t.

You’ve been involved in healthcare pretty much your whole life.

Yes, I’ve been interested in this since I was 18. A lot of the folks I know in healthcare administration got into it by accident, but in my case, it was quite literal. During my freshman year in college, I was in a car crash and spent six months recovering in a hospital. That’s when I knew what I wanted to do.

Were you interested in the profession because you had a bad healthcare experience or a good one?

A good one. I was in the hospital a long time and got to know the administrator. I saw the satisfaction he got out of what he did, and decided I’d rather work with people than things. Before that, I had planned to become a mechanical engineer.

You used to be a hospital administrator, but now focus on long-term care. Why?

Unlike being the administrator of a large medical center, I found long-term care brought me a lot closer to the residents. I got to know them much better than I ever did the acute care patients who came and went.

Let’s talk about your book, Long-Term Care: Managing Across the Continuum. It’s a standard textbook in many programs.

Yes, as near as I know, 30 to 40 colleges are using it, and I get a lot of rewarding feedback. At this moment I’m updating it to a third edition.

What does the title mean? Are you referring to the time/space continuum?

At times when I was writing it, yes.

So you’re basically trying to describe the workings of long-term care at both the supergalactic and subatomic levels.

Actually, that says it very well. I found there were some good books out there that were very broad, sort of intergalactic. And there were some good ones that were very nuts and bolts, very subatomic. I wanted something in between, so I said to myself, “Shut up and write it.”

Given the book’s widespread use, that has to be a lot of pressure. If an administrator fails, is it your fault?

(Laugh) No, I’ve got a lot of built-in contingencies there. All I can do is give them the basic administration information. But the rewarding thing is that over the years in teaching and working with a lot of them, very few have failed. I don’t know that that has anything to do with me or my book, but it’s always gratifying.

Now, I’m not trying to discourage you, but your https://Amazon.com sales rank is 211,133.

Oh really? I’m not a bit surprised. When I wrote the book, I knew I wasn’t going to retire on my royalties.

But here’s the good news. Under the subheading of “caregiving,” and the descending subcategories of “books—science—medicine—physician and patient,” you’re number 58.

(Laugh) Okay, well that helps.

This book reflects your lifetime of experience in healthcare. How are the demands on an administrator different today than when you came into the field?

Oh, it’s much, much more complex. I sometimes say half-jokingly to my students that these days it’s a lot more fun teaching it than doing it. It’s become really difficult out there. The regulations are tougher. The folks who are paying for healthcare, both government and private, are scrounging for money to cover it. And because of that, more restraints are being imposed on the people providing it.

I was fortunate to grow up in the business when I did. I was first an assistant administrator in the ′60s, then an administrator during the ′70s and ′80s. It was a time when we were building facilities and coming up with new things, not making cutbacks and dealing with the regulations administrators face today. It was a lot more fun, although I certainly didn’t quit because I was tired of it.

What do you see now as the greatest challenge a new administrator faces in trying to be successful and effective?

Unfortunately, a lot of it is financial—balancing the costs while still providing a good quality product. Some of my colleagues don’t like me referring to healthcare as a product, but it is, and the challenge is to make enough money to keep it going. Even nonprofit agencies still have to meet payroll.

Doesn’t being an administrator today require a split personality? You have to be a great people person and motivator, but you also have to have that numbers side.

It’s a rare combination, and the ones who are successful out there recognize that they have strengths and weaknesses, and surround themselves with people who complement those. One of the first things I learned in graduate school was to hire a good numbers person, and then keep an eye on him or her.

With the price of food, healthcare, and transportation going through the roof, what magic tricks can an administrator use to keep staff focused and motivated when they have so many challenges at home?

No, no magic tricks. Good management and leadership is knowing your people as individuals. They don’t all get motivated by a key ring with the company logo on it. Some of them just want a thank you, others something more. But you really need to spend some time working and knowing who they are. And the other piece is to re-mind them from time to time why they’re there, and the satisfaction they get out of what they’re doing.

There’s not a lot most administrators can tangibly do about any of those hardships. So should they basically just admit the problem and listen?

Yes, that’s a lot of it. A lot of times what staff want is to know you really care about and recognize what they’re doing. If you can do something for them financially, that’s great. But if you can’t, as long as they understand you’ve done the best you can, you’d be surprised how much they’ll go along. There aren’t a whole lot of folks working in long-term care at any level who are doing it for the money.

In tough economic times like these, what kind of car should an administrator drive?

Preferably not a brand-new Cadillac. Back in my hospital days, I remember a physician who drove a real old beat-up car whenever it came to contract time.

Perhaps the administrator should leave the vehicle price information on the passenger window so at least the gossips are working with accurate information.

(Laugh) That’s not a bad thought.

If you had a bunch of young administrators sitting in front of you, what’s the best advice you could give?

Be sure of why you want to do it. Understand what you’re getting into and why. Then, if you think it’s still the right thing, go for it—and take advantage of every opportunity to learn along the way.

Do you recommend that administrators get caregivers involved in associations and send them to conferences?

Yes. Very much so. As much as they can. There will always be financial limitations, but yes, get them out. There are some studies that suggest that as long as people are receiving a level of pay relatively comparable to what they might get somewhere else, education is the one thing that will keep them there.

But in times of financial crisis, conferences are one of the first things to get cut.

Yes, and that’s unfortunate. One of the reasons you send people to conferences is to get them charged up a bit. Then they come back realizing that their facility isn’t the only one with a particular problem, and maybe they’re not doing so badly after all.

I noticed you’ve written a policy paper called, “Criteria for designing or evaluating a long-term care system.” Are you implying such a system actually exists? Because there’s some who would argue.

(Laughs) Yep, and I’m not one of those. In fact I get upset with those who love to call it a non-system. It’s a system—it’s just not unified or at times sensible. And even though that paper includes a lot of good information, if I knew how to create a perfect system, I’d be a lot richer than I am today.

But if you had the opportunity to design such a system, and then had to explain it in a 30-second presidential campaign-type shallow sound bite, what would you say?

(Laughs) Oh, God. That’s the last thing I’d want to do.

You’re not running for president, you understand. You’re just forced to answer as though you are.

I think the answer is that there’s no one out there, including me, who can do that. Everybody has his or her own axe to grind. We all want the best care at the lowest cost, and those two don’t necessarily go together. I learned a long time ago there are two kinds of healthcare—the kind I get that should be nothing but the best, and the kind you get that should be limited.

That’s a good answer, and you stayed within your allotted time.


But looking through that document made me want to go sit in a dark room for the rest of the day. Fixing the healthcare system seems so overwhelmingly difficult, if not impossible.

It’s easy to write things down, but not easy to do.

Have either of the candidates said anything about healthcare that made you optimistic for what can be achieved?

Not yet, and I’m not sure I see that happening in the near future. Back in the 1990s, when Senator George Mitchell was majority leader, he was pushing [then First Lady, now Senator] Hillary Clinton’s healthcare plan, and I was in one of several focus groups he met with. I asked him why long-term care wasn’t included, and he said, “We can’t afford it.” And my response was, and still is, “We can’t afford not to.”

From your vantage point in education, are young people getting more interest-ed in long-term care administration?

No, and we’re going to need a lot more than we have now. A lot of us are out there trying to beat the bushes, but I don’t find much interest among traditional-age young people. Those who are seem to have either had a family member who’s been involved, a bad experience they want to fix or a good one they want to emulate, or they grew up in the business. But for your average kid going to college today, they don’t know anything about it.

So if you were at a high school on career day, what would you tell the disinterested audience?

I’d tell them it’s good, it’s very rewarding, and to come out to a facility and take a look. Walk through and get a feel for what we’re doing for these people. Don’t be misled by the media. Get out and see for yourself. You’ll be inspired by the good things that are happening.

Have you always lived in Maine?

No, I grew up in Vermont, but I’ve lived in New England my whole life.

In your next book, perhaps you should use a New England metaphor, something about tapping the funding trees and watching the money drip, drip, drip into the bucket of long-term care. I don’t need credit for that idea, by the way.

No, that’s okay. You can keep that idea and go for it.

To send your comments to the author and editors, e-mail tetz1008@iadvanceseniorcare.com.

Long-Term Living 2008 October;57(10):84-88

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