So -- What's Keeping You ( In the Field)

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Comments (12)

dtill in Massachusetts

79 months ago

I seem to be at a crossroads here- as I am sure many of you are. The LTC arena has changed since 1991,and not allof the changes have been positive. It seems I spend a great deal of time compiling reports for various corporate VPs- They all ask for the same info in diferent formats. Why can't they all just get together and read the same report!! Not to mention the growing number of mandatory corporate conference calls where Admins are beaten over the head AGAIN with mandates to cut costs- grow census etc etc. The regulatory climate is brutal and we are being expected to do more with less everyday. The line staff are complaining and rightly so- given the PPD we are working with. I love my residents and truly believe in the work that we do everyday. After 15+++ years in the field I am starting to have my doubts. So what's the verdict- stay and continue to wage the wars with corporate greed, gung ho surveyors and militant unions or look for greener pastures elsewhere?? Is there a better career path out there for a tired NHA?? I would love to hear your thoughts.

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admin in Columbus, Indiana

78 months ago

When I first started I spent most of my time trying to please the "man" or should I say the "posse" at the top until the day I realized that I was never going to be able to. I have stopped looking at my computer all day and started getting out on the floor more. I put a response on my computer saying "I only check messages at 9:00 and 4:00 the hours between are dedicated to residents, families, and community. I really haven't been bothered as much since then and I remind those who all the time want things that the priority is local not in the land of Oz as I refer to it. Surprisingly most of the posse have respected it.

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Phil in Milwaukee, Wisconsin

77 months ago

PPD-----OK Here you go. This what happens when a CFO who has never had to recieve or give care gets too much power in an organization. PPD is an assessment tool not a management style and is certainly not an indicator of how work of mouth advertising is going. Word of mouth advertising has a direct effect on your census, unfortunately this does not translate into PPD so your companies CFO does not understand it. If you cut staff YOU WILL NEVER HAVE A FULL CENSUS.
Owners need to understand there are more competitors now than ever and more comming (home health, assissted living, supportive living, professional caregivers, etc.) Owners today have 2 choices:
1. Spend the money on CNAs and people to monitor them and train them in creating customer satisfaction, and provide care in single rooms. This produces private pay, and good referring docs.
2. Go for all homeless, Mentally Ill, public aid residents and cram them into rooms, have surveyors hate you, and wait a year for public aid to pay a small percentage of what you are owed.

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Mark Slaughter in Paint Rock, Texas

77 months ago

dtill in Massachusetts said: I seem to be at a crossroads here- as I am sure many of you are. The LTC arena has changed since 1991,and not allof the changes have been positive. It seems I spend a great deal of time compiling reports for various corporate VPs- They all ask for the same info in diferent formats. Why can't they all just get together and read the same report!! Not to mention the growing number of mandatory corporate conference calls where Admins are beaten over the head AGAIN with mandates to cut costs- grow census etc etc. The regulatory climate is brutal and we are being expected to do more with less everyday. The line staff are complaining and rightly so- given the PPD we are working with. I love my residents and truly believe in the work that we do everyday. After 15+++ years in the field I am starting to have my doubts. So what's the verdict- stay and continue to wage the wars with corporate greed, gung ho surveyors and militant unions or look for greener pastures elsewhere?? Is there a better career path out there for a tired NHA?? I would love to hear your thoughts.

As I once told an AIT...Start drinking...start now...and never quit.! Who the hell could do this sober?

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Kathleen McKinney in Bandera, Texas

77 months ago

amen to that!!! small enough home in a very small group is the only answer I know. Big companies use the money to pay for the losing homes with the money the others make, result. Everyone loses.

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Lance Michaels in Lansing, Michigan

73 months ago

dtill: Have you discovered anything more through this discussion or in your quest in other arenas?

Does this sound familiar?

I have 18 years of experience as an administrator, mostly in turnaround situations – a niche that I came upon accidentally, but then learned to embrace. A demonstrated track record with census building through marketing to referral sources paired with managing in-house census and providing excellent care have been an important part of my past successes. Considerable turnaround of net income have been just one of the significant results of improved care, census, and expense management. I am proud of the improved results that have been realized in my past assignments, not just with financial operations, but especially with the improved clinical and regulatory outcomes – and improvements in employee and resident/family satisfaction and ccommunity perceptions.

My goal has always been to work for a facility or organization for the long term – but that dream has so far been elusive. Hard work, dedication, and long hours including evenings and weekends have somehow not been enough, and so I find myself at a crossroads.

Definition of insanity? Do I search and hold out for a long-term assignment – if I can find one – or figure out how to make interim assignments work – if I can find them. Or – is there a point when you give up on work that you truly enjoy – one that you consider a calling – and figure out something else to do to pay the bills.

If a totally new direction is the answer, what are the options for a licensed NHA?

I am very curious to learn if anybody else has experienced similar frustration, asked the same questions, and what they have done about it. Thank you for any ideas you might have to contribute!

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Dsimon in Grand Island, Nebraska

73 months ago

My first experience with a nursing home was as a prn nurse in 1976. I received my NHA license in 1991. At that time I was the DON I had just implimented all the OBRA 87 regulations and we were without an Admin. I've worked in For-Profit, Not-For-Profit, Community Operated, Religious Affiliate, Non Religious Affiliate, union and non-union facilities. The point is I've done pretty much all of it.

"What's keeping me in the field" are the people and the right people. The people are the residents. The right people are the right organization and the right staff.

Anyone in the industry over 9 months is in it for the intrinsic reward. Someone mentioned earlier it is a calling. Very true. The staff are your responsibility. Hire the right people. Set your standards and expectations high and hire the same. The care you give will be no better than your poorest performer.

The key is, did the people at the top join in answer to the call. Are they the right people. What is the TRUE mission? This is the one you operate by and use to base decisions. It may or may not be the one in print.

As the administrator you are the King of Relationships. Can you manage the relationships within the context of the TRUE mission.

I truly feel good about my job and what our organization are accomplishing. The trick was to find an organization whose TRUE mission aligned with mine.

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restlessintexas in Athens, Tennessee

54 months ago

dtill in Massachusetts said: I seem to be at a crossroads here- as I am sure many of you are. The LTC arena has changed since 1991,and not allof the changes have been positive. It seems I spend a great deal of time compiling reports for various corporate VPs- They all ask for the same info in diferent formats. Why can't they all just get together and read the same report!! Not to mention the growing number of mandatory corporate conference calls where Admins are beaten over the head AGAIN with mandates to cut costs- grow census etc etc. The regulatory climate is brutal and we are being expected to do more with less everyday. The line staff are complaining and rightly so- given the PPD we are working with. I love my residents and truly believe in the work that we do everyday. After 15+++ years in the field I am starting to have my doubts. So what's the verdict- stay and continue to wage the wars with corporate greed, gung ho surveyors and militant unions or look for greener pastures elsewhere?? Is there a better career path out there for a tired NHA?? I would love to hear your thoughts.

I just came across your comments. So what did you do? Are you still working as an administrator? I relate to you because after 21 years I'm ready to call it quits. I'd really like to get a masters in Social Work and work in long term care but I doubt many adminstrators would want to hire another NHA who would probably have much more experience. I too am 'tired'.

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bobmdelacruz in San Diego, California

54 months ago

Hi dtill, as Dsimon said the people and the right people unfortunately out of 415 SNF in Massachusetts, they all have 'people' very few have the 'right people'. I would expand Dsimon's 'right people' to include your direct reports and the corporations. If they're right for you then go for it.

As of 2008 total number of SNF is 15,531 in the US and it takes a few hours to find the answer who own them. I am sorry to say that what is publish on the owner's website is unfortunately not always align with their daily operations. The publicly traded corporation owners mostly too busy monitoring the company stock performance and the private companies are overly anxious waiting for their 'Regionals' to report what is going on.

Phil in Milwaukee brought up very important point about CNAs. That is really not a new finding but how many organizations really focus on it? The troubled building will get some here and there probably good enough to win some awards or get their picture taken with the Mayor for successful turnaround but those funds will be 'expensed' somewhere else in the organization - simple finance.

Dtill, sorry that you have to go through this but unless you can afford a pay cut or finding the right organization you may have find a gig like Lance - turn them around and leave. Some of the bigger organization have quite a few of those troubled buildings and many recruiters making a living finding Administrators who are willing to do that. It will not be advertised as 'troubled' building unless you look at their survey performance or how many Administrators were kicked out prior. No offense to Lance but turning building around is not that hard provided everyone were 'aligned' - your boss included.

I am doing similar gig as what Lance is doing but there were times that I felt like I'm selling my soul to demon above me but unfortunately I am in it mostly because I have to financially - sorry Dsimon. But I can fake it really well :)

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Looking in Sweetwater in Loudon, Tennessee

53 months ago

restlessintexas in Athens, Tennessee said: I just came across your comments. So what did you do? Are you still working as an administrator? I relate to you because after 21 years I'm ready to call it quits. I'd really like to get a masters in Social Work and work in long term care but I doubt many adminstrators would want to hire another NHA who would probably have much more experience. I too am 'tired'.

I am looking into this field and am wondering from your comments if it is worth the effort. I see so many people wanting to become a NHA but if this is the life I have to ask Why?

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Lance Michaels in Lansing, Michigan

53 months ago

Looking in Sweetwater in Loudon, Tennessee said: I am looking into this field and am wondering from your comments if it is worth the effort. I see so many people wanting to become a NHA but if this is the life I have to ask Why?

To be an NHA, be successful, and maintain sanity, you really have to believe it to be as much a "calling" as a career. Twelve hour days can often be the norm - including weekends - and you are on call 24/7/365. (too funny - as I finished that sentence, it was 21:42 and the phone rang - it was "the home")

The regulators are nuts with their benchmark "substantial perfection;" there will always be at least one special resident or family member incapable of satisfaction; and pressure for performance comes not just from above you, but below you as well.

Having painted this picture, however, it is most important to stress that the rewards of your hard work can be tremendous: from satisfied and grateful residents and their families; appreciative staff; and supportive teams.

It is completely worth the effort and frustration if your aim is to serve people and work to improve their quality of life. The trick is to learn how to survive the politics and avoid burnout. It is often rare to have the alignment that bobmdelacruz suggests, making the management of even stable centers a challenge (the easy turnarounds are when a company floods a center with resources and consultants to magically create compliance - albeit temporary. While I have seen this happen to buildings, I haven't been in one where it happened. I have always done it independently and through leadership, team building, and culture change - the "not easy" way).

Administrators do not punch time clocks, leave their work behind them, and disengage. We live and breathe what we do. If you are someone that finds this prospect appealing, we'll always needs competent, CARING administrators. We do get some normal, stress-free workdays when things go well. ;)

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Looking in Sweetwater in Loudon, Tennessee

53 months ago

Lance Michaels in Lansing, Michigan said: To be an NHA, be successful, and maintain sanity, you really have to believe it to be as much a "calling" as a career. Twelve hour days can often be the norm - including weekends - and you are on call 24/7/365. (too funny - as I finished that sentence, it was 21:42 and the phone rang - it was "the home")

The regulators are nuts with their benchmark "substantial perfection;" there will always be at least one special resident or family member incapable of satisfaction; and pressure for performance comes not just from above you, but below you as well.

Having painted this picture, however, it is most important to stress that the rewards of your hard work can be tremendous: from satisfied and grateful residents and their families; appreciative staff; and supportive teams.

It is completely worth the effort and frustration if your aim is to serve people and work to improve their quality of life. The trick is to learn how to survive the politics and avoid burnout. It is often rare to have the alignment that bobmdelacruz suggests, making the management of even stable centers a challenge (the easy turnarounds are when a company floods a center with resources and consultants to magically create compliance - albeit temporary. While I have seen this happen to buildings, I haven't been in one where it happened. I have always done it independently and through leadership, team building, and culture change - the "not easy" way).

Administrators do not punch time clocks, leave their work behind them, and disengage. We live and breathe what we do. If you are someone that finds this prospect appealing, we'll always needs competent, CARING administrators. We do get some normal, stress-free workdays when things go well. ;)

Thanks for your reply. I do desire to have an impact on the lives of others but I have a young family and they come first. I cannot commit to living and breathing any career. I will just keep lookin

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