LeadingAge Magazine · July/August 2016 • Volume 06 • Number 04

Understanding Competencies for a New Generation of Leaders

July 13, 2016 | by Gene Mitchell

Understanding Competencies for a New Generation of Leaders

As the aging-services field works to overcome the challenge of shortages in direct-care workers, the hunt for new management talent is just as important. Demand for services is growing while at the same time a generation of aging-services leaders—baby boomers—is beginning to retire.

Randy Lindner, president and CEO of the National Association of Long Term Care Administrator Boards (NAB), has a front-row seat for these changes. NAB represents regulatory boards and agencies responsible for licensure of long-term care administrators in all 50 states and the District of Columbia. These agencies license approximately 35,000 of the people who run organizations providing long-term services and supports for U.S. seniors.

NAB has recently conducted a professional practice analysis to identify and update the competencies required to lead organizations in our field, learning some interesting things about the overlap between administration of skilled nursing, assisted living and home and community-based services.

The commonalities among those 3 lines of service are such that NAB is preparing to offer a new “Health Services Executive” (HSE) qualification, beginning in 2017.

LeadingAge spoke with Lindner for more detail on what NAB has learned, and why he believes the HSE qualification can encourage the development of new generations of leaders for our field.

LeadingAge: How many people in the long-term care field are currently licensed by NAB members?

Randy Lindner: We don’t know exactly because every state keeps its own records, but my best guesstimate would be that, among licensed nursing home administrators, there are about 25,000 keeping an active license.

There are probably about 10,000 assisted living administrators that could be licensed at this time. We have one state, Oklahoma, that started requiring licensure of adult day service managers, so that could be another couple of hundred people, though that’s just a guess.

LeadingAge: NAB has recently launched a professional practice analysis to “identify the domains of practice, tasks performed, and knowledge and skills used by individuals responsible for leadership in organizations that provide long-term services and supports.” What was the purpose of this effort and what outcomes does NAB expect?

Randy Lindner: We started this about 3 years ago with a strategic visioning session to look at our existing programs, and recognized that the field of long-term care administration was rapidly changing and expanding. We felt we needed to take a look at how people are prepared and credentialed in the profession of long-term care.

The federal mandate to license long-term care administrators started in 1970, and at that time most long-term care was provided in the nursing home. Since then things have changed dramatically and now there are many choices and lines of service. But our regulation and licensure and how we prepare people has remained focused on skilled nursing. Back in the late 1990s a few states started licensing assisted living administrators and NAB responded … by supporting states that were mandated to license assisted living by developing a national licensure program for [it].

We looked at the 2 programs and recognized that under the surface there seemed to be a high degree of commonality in the competencies between skilled nursing home administrators and assisted living administrators.

The purpose of the professional practice analysis was first to look at those 2 lines of service and update the practice analysis to assure they are contemporary; that’s something we’ve always done every 5 to 7 years. At the same time we saw the emergence and rapid growth of home and community-based services and we decided to also look at the competencies of the people who are responsible for leadership and management in [that] area. We commissioned a study and assembled a task group that represented subject matter experts from all of those lines of service, and did an 18-month study, and the results of it validated what we expected. We found the core competencies were about 82% common across all of the lines of LTSS.

When you think about it it makes sense because the people in this profession are not clinicians, they are leaders and managers and responsible for finances and marketing and managing bricks-and-mortar communities or, in the case of home and community-based services, providing services in someone else’s environment. The skill sets and knowledge base have a high level of commonality. The biggest differences are probably coming from the level of the medical model in NHs, and federal regulations have unique differences in that [area], and in assisted living there’s more of a hospitality model. In home and community-based services we found that leadership and management probably involves even a higher level of skill and knowledge because you’re managing a workforce working outside of a bricks-and-mortar environment.

Based on what we found, we wanted to be sure we were preparing people coming into the profession to work in today’s environment, knowing that many administrators don’t stay in the same line of service, or find that they are responsible for multiple lines of service because of the way the [field] has restructured. We wanted to develop a pathway to prepare and recognize those individuals who have demonstrated competencies to work in multiple lines of service.

LeadingAge: Is this where the new Health Services Executive (HSE) qualification, which you are planning to launch in 2017, comes into play?

Randy Lindner: Yes. From our perspective we’re positioning ourselves as a body that will issue a qualification for someone who has demonstrated they have the experience, knowledge and skills of a health services executive. We’ll not be issuing any credentials but NAB will be the body that verifies the HSE qualification.

We’re asking the states to do one of two things: First, through the rules and regulations they adopt, we’re calling for licensure by equivalency, meaning that someone who’s been verified as HSE-qualified by NAB would meet the licensure equivalencies to practice as a nursing home administrator, an assisted living administrator, or in the area of home and community-based services.

The second option, and this might be a little more difficult because it could require statutory changes, is to establish a new licensure category for the health services executive, or an HSE license, again based on a national qualification standard. Either way they go, it will mean a national standard based on being currently licensed, having a certain number of years’ experience, having a clean record, and having passed examinations which would include a core examination and specialty modules in the 3 lines of service. We are also revamping our academic accreditation program so that 4-year degree programs will reflect the HSE model and graduates of those NAB-accredited programs will automatically meet, upon graduation, the HSE qualification standards.

For states that adopt either of those 2 pathways, they are essentially agreeing that if people present themselves for licensure and are HSE-qualified, they will meet the licensure requirements in that state. It will be a portability model. It does not mean you only have to have one license in the country, it just means you won’t have to face what happens in many cases now, where you apply for licensure in another state and are told that your requirements from [the first] state don’t meet the requirements for the new one.

We’re getting a very high acceptance rate on this—and of course this is voluntary—but for those who want that broader-based recognition and who want that portability, the HSE qualification is an option.

Providers seem to like the model also, as it is not threatening, but it gives them an option for those who want to be able to move their administrators across state borders.

LeadingAge: Are you getting pushback from anyone?

Randy Lindner: We have not received any. Almost universally I get a reaction that “This is the right thing for us to do.” We have a great window of opportunity because of the changes in the field and the fact that this is positioned as voluntary.

We are planning to launch the new examination programs in July 2017, and are working on a couple of other initiatives to standardize the training of administrators and their preceptors. NAB and the American College of Health Care Administrators (ACHCA) have jointly funded and developed a model administrator-in-training (AIT) program, so the AIT has a consistent experience no matter the state. That is being pilot-tested now and we are hoping to launch in September of this year. It will have tools for the state, the AIT and the preceptor to model their experience and track and evaluate their experience in the program.

We’re also working on a model preceptor program with ACHCA, which mirrors the AIT program so the preceptor is well-trained and prepared to oversee the AIT experience based on the national model. Most states currently don’t require preceptor training.

We’re also repositioning our academic accreditation program. Now we have 11 accredited NAB programs at the bachelor’s level and 2 at the master’s level, and those programs will have to meet an HSE standard by 2021, so graduates will have that broader-based curriculum. We expect the majority of them to get there much sooner than 2021, and any new programs that come into the process will have to meet the HSE standards by 2018. There are about half a dozen programs in the pipeline now.

LeadingAge: Do you have any projections of how many individuals might pursue the HSE qualification?

Randy Lindner: Not yet. It’s not going to be for everybody, but the administrators I talk to now are excited about it. I think there will be a significant population that wants that extra recognition of a broader-based professional development, and another group that wants to be mobile, and there will be a part of the population that knows they’re at a time of life when they won’t be moving to another state and are happy doing what they’re doing. It will probably be of more interest, in terms of the mobility of moving through the profession and across states, to the younger demographics.

LeadingAge: Our field is focusing ever more intently on recruiting new leadership talent, partly as a result of growing demand for senior services and partly because there is a wave of retirements among leaders at our member organizations. From your perspective, are we doing enough to encourage new talent to enter our field?

Randy Lindner: We need to do a lot more. The leaders of trade and professional organizations need to think about what we can do, collectively, to attract young people to our field. One thing we need to look at is a research project to understand the demographics of this population to make better projections of what we need in the pipeline.

We need to think about how we can expand and improve our academic programs. The field really needs to be a partner working together with regulatory boards and with the academic community on both recruiting and supporting young people to be future leaders. A really good model is what’s happening in Wisconsin. The University of Wisconsin at Eau Claire established the CHAASE program, a very successful partnership with academia, providers and professional associations, and their degree program is highly successful. They’re turning out a great number of very bright young talented people.

If we’re going to bring young people into this field we need to enhance our image and find ways to support young talent both academically and through the AIT process. Every AIT that comes through the CHAASE program gets a stipend of $21,000 during their AIT—it’s not a big amount but the majority of AITs aren’t getting anything today.

Another thing to look at is how we support them when they start their careers once they’re licensed. We don’t have many opportunities any more for people to serve as assistant administrators. We throw them right into the fire. We hear from many young people who don’t have any experience and are frustrated because everyone wants 2 to 5 years’ experience, but if we don’t have those assistant administrator jobs, how do we provide that pathway for young people? If we don’t solve this it will hurt us in terms of bringing people into the field.

LeadingAge: What can associations and providers do to help?

Randy Lindner: Over the last couple of days, participants at the National Emerging Leadership Summit [NELS]* were asking what they can do to help. The whole NELS experience is [designed] to stimulate them to be involved as advocates for their profession. My response to them and to the field is, help us champion this and advocate for change in your state, so this national standard will be recognized. Our goals is to get 50 percent of states to adopt one of these two pathways, so by 2020 we have half the nation behind this and can keep working on the other half.

*LeadingAge spoke with Lindner immediately after the NELS, held in Washington, DC, June 21-23. The conference brings together health care administrators who have been in the field for less than 10 years. The NAB Foundation is a sponsor.