The Administrator: An Endangered Species

There's been a great deal of talk of late (and it's about time!) about the nursing shortage-how young people are seeing the terrible pressures nurses work under in this managed care era and are saying "no thank you," and how the existing nursing force is shrinking by attrition. Not getting nearly as much attention, but just as alarming, has been the falloff in applicants for the NAB licensure exam for long-term care administrators. They've dropped by more than one-third in just the last couple of years. And more than a few existing administrators, according to anecdotal evidence, are seeking alternative employment.

What's the reason behind all this? I think it can be summarized in one word: fear.

Aggressive prosecution-and "prosecution" is the word-by plaintiffs' attorneys, state surveyors, Medicare/Medicaid antifraud units and U.S. Attorneys is zeroing in on the administrator as the "captain of the ship." Rising liability insurance rates and other costs, including increasing salary requirements for scarce staff, are laid at the administrator's doorstep. Meanwhile, as government reimbursement remains tight despite growing costs, financial relief seems to come only in the form of declining census-but that in itself is a black mark on the administrator.

In short, who in his right mind would want this job?

True, there are many positive steps administrators can take to improve their chances, such as developing their skills in documentation, resident care supervision, and relationships with families and government monitors. But the point I'd like to make here is this: It's time for society to back off just a bit and instead search for ways to support this crucial industry. As things stand, we are not building a strong long-term care industry to meet our society's growing needs by scaring off not only the bad apples, but the skilled, experienced, caring and dedicated leaders we now have. This is a species that should be protected. NH


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