NAB Documents Decline in NHA Licensure Candidates: A Response

Nursing Homes, August, 2001 by Annaliese Impink

I read with interest a recent article in the Winter 2001 edition of The Visionary--an article titled "NAB Documents Decline in NHA Licensure Candidates." According to the article, there is a documented decline in the number of individuals seeking to be licensed as nursing home administrators (NHAs). Our firm represents several NHAs across the nation in licensure actions before NHA boards. Many of these NHAs are actively seeking alternative employment opportunities, in large part because they fear they may lose their licenses or be subject to criminal liability based solely on the results of federal or state Medicare and Medicaid surveys. In some states, the shortage of NHAs is reaching a critical level.

It seems as though there is an article in the local newspaper on a weekly basis about federal and state government investigators of fraud and abuse allegedly committed by individual healthcare providers and large healthcare provider chains. The investigations often focus on improper claims for reimbursement from Medicare, Medicaid or other federal and state healthcare programs or, more recently, allegations of improper care or treatment of patients or residents. The government's commitment to eradicate healthcare fraud and abuse is commendable; however, often the aggressiveness by which these investigations are pursued is at best unsettling and oftentimes frightening. Today this is as true in the long term care (LTC) setting as it is in hospitals, home health agencies and individual physician practices. The net effect of the government's aggressiveness is a decline nationwide in the number of individuals entering the LTC profession.

Because we realize the essential role NHAs play in the successful operation of an LTC facility, we have developed the following strategies that should be considered as NHAs prepare to accept this challenging yet rewarding task. Specifically, NHAs should:

* Be intimately familiar with the Medicare and Medicaid Requirements of Participation and the State Operations Manual Guidance to Surveyors that is prepared and published by the Health Care Financing Administration--available at www.hcfa.gov.

* Be familiar with their resident populations and at least generally familiar with resident-specific diagnoses.

* Earn the respect of staff at all levels. Disgruntled staff, more often than not, generate complaints against NHAs.

* Make individual appointments with state surveyors, survey supervisors, the local LTC ombudsman and the local adult protective service staff to introduce themselves and explain their commitment to the residents they serve.

* Become familiar with residents' family and friends. Establishing strong relationships early will help to build trust and minimize family complaints.

* Develop strong and cooperative relationships with attending physicians and non-employee ancillary staff. These individuals often can be strong allies to NHAs.

* Establish friendly and professional relationships with local hospitals, emergency room staff and paramedics.

* Take an aggressive approach to survey management before, during and after actual surveys. NHAs should also involve staff in every phase of the survey process. Many problems can be resolved if they are caught early and addressed quickly.

* Become experts at compiling and maintaining documentation. Disciplinary actions can be avoided if NHAs can demonstrate, with appropriate documentation, that they and their staffs acted appropriately in certain instances.

* Periodically remind themselves that governmental entities often hold NHAs solely responsible for the success or failure of LTC facilities. Therefore, NHAs must establish themselves as leaders in the eyes of their staff and in the eyes of the community.

As our population ages, it is imperative that the LTC profession attract and retain strong and effective NHAs. These strategies may be useful stepping stones toward the development of a healthy and cooperative relationship between LTC providers and government regulators.

Annaliese Impink is a partner at the Law firm of Bianculli & Impink, PLC. in ArEinqtan, Va.

(*.) Reproduced with permission from The Visionary, the newsletter of The Wertlieb Educational Institute for Long Term Care Management, The George Washington University Medical Center School of Public Health and Health Services.

Statement from The WertLieb Educational Institute for Long Term Care Management

Unfortunately, the decline in the number of nursing home administrators and its potential impact have gone largely unnoticed in the policy and research, community. The George Washington University School of Public Health and Health Services (GWU SPHHS) Wertlieb Educational Institute for Long Term Care Management has begun to study the question We have been struck by the fact that little empirical research has clearly identified the specific causes of attrition as well as of the lack of new administrators who wish to enter the LTC field. Therefore, The Wertlieb Education al Institute, the GWU SPHHS's Center for Health. Services Research and Policy, the National Association of Boards of Examiners of Long Term Care Administrators (NAB) and the Center for Health Workforce Studies of the State University of New York at Albany are developing a collaborative research initiative to study, in depth, this impending crisis. We plan to investigate factors leading to the decline in NHA Licensure, identify the reasons adm inistrators; choose career in LTC, what keeps some administrators in LTC and, finally, what policy proposals should be developed to mitigate the LTC leadership crisis.