While attending a nursing home industry event more than a year ago, Jamie Sanford came to a startling realization: Sanford, 37, was the youngest one there. By far.
“It was intimidating – the age gap was so significant,” Sanford said, recalling the room full of nursing home administrators who all appeared to be at least 20 years old than her.
Since attending that meeting, Sanford has become an
administrator herself, overseeing Linn Health & Rehabilitation in East Providence, an 84-bed facility owned by Aldersbridge Communities. But her experience meeting other managers illustrates a looming problem in the nursing home sector:
Many industry leaders in Rhode Island say that most administrators of nursing homes are over the age of 55 and approaching retirement. Recruiting – and retaining – the next generation of administrators hasn’t been easy.
While homes have been an epicenter of the coronavirus crisis, the last nine months have put a spotlight on the difficulties of working inside facilities that are caring for society’s most frail and elderly. And any major recruitment effort might have to be put on hold while a new wave of COVID-19 cases hits the state.
James Nyberg, director of LeadingAge RI, which represents 14 nonprofit facilities that offer care for the state’s aging population, said he’s worried that the pandemic will have negative effects on developing a workforce that was already unstable before COVID-19.
And the issues go beyond hiring administrators. Staff members lower on the ladder have become more difficult to find, too.
“It’s not seen as a desirable place to work, until they become part of the workforce and become close with residents,” Nyberg said recently.
Labor training officials are trying to set the groundwork for a recovery after COVID-19.
Skills for Rhode Island’s Future, a nonprofit that offers job-search support, career-enhancement services and free training for unemployed and underemployed Rhode Islanders, is working to recruit and train staff for nursing homes.
Spokesman Josh Singer said the program, in collaboration with the R.I. Department of Labor and Training, launched a dispatch service for congregate care settings in April. As of Dec. 1, 140 nurses and nursing assistants have been “dispatched” to 1,220 shifts, earning a per diem “surge wage.”
In addition, Skills for RI started an emergency certified nursing assistant training program that provided a temporary, 90-day license to participants. More than 110 people completed the training, and of those, 68 have worked in congregate care centers through the dispatch program.
Marianne Raimondo, Rhode Island College professor and director of RIC’s health care administration department, founded the long-term care administration certificate program nearly five years ago after she heard from industry leaders about the dire need for a pipeline to replace administrators approaching retirement.
“[Being an administrator] does require experience and knowledge of complex rules and regulations, complex reimbursement systems [such as] Medicaid and Medicare, managing a very difficult resident population, and the provision of complete care,” said Raimondo, who is Gov. Gina M. Raimondo’s sister. “Financial management is difficult due to low reimbursement rates – it is very difficult to equitably and adequately compensate the workforce, especially front-line certified nursing assistants, which results in turnover and difficulty recruiting staff.”
She added, “I feel that it is one of the most difficult and challenging jobs in health care.”
Richard Gamache, Aldersbridge Communities CEO, teaches health care administration at RIC. His students have various post-graduation goals, whether they want to work inside hospitals or clinics, or be inside the corporate offices of health systems. But he said many want to become nursing home administrators, which “astounds” him, calling the job “thankless,” “underpaid” and “under-respected.”
Gamache said most aspiring administrators have to earn a related degree with specific courses, complete an internship that is usually unpaid and pass an exam just to enter a job market with limited opportunity and a high burnout rate.
“I tell my students on the first night of class that the last ‘nursing homes’ have been built in this country,” Gamache said. “There will be no more new ones. That ship has sailed. Nursing homes are dinosaurs just waiting on the meteor.”
He said the future of congregate-care facilities can be seen in places such as the Saint Elizabeth Community in East Greenwich, which uses a “greenhouse model” consisting of four houses, each with 12 residents. It’s meant to provide both privacy and community, but still have around-the-clock care.
“These models are nothing like the traditional, 125-bed cinder-block institutions that were built in the 1970s. All those buildings are falling apart,” said Gamache.
And while Medicaid is a primary source of revenue for nursing homes, Raimondo said administrators are finding that the reimbursements are barely covering costs. In turn, some administrators such as Sandford say they are having a hard time recruiting and retaining their own staff.
“In all positions, the work is hard,” Sanford said. “If you’re offered a dollar or two more somewhere else, why would you stay in a nursing home?”
Alexa Gagosz is a PBN staff writer. Contact her at Gagosz@PBN.com.
