10 Deadly Sins of the Nursing Home Administrator

nursing home administrator rio pic

So you want to become a great nursing home administrator?

But you find yourself not quite attaining the level of success you aspire to.  Have you asked yourself one simple question:  What am I doing wrong?

You want to accomplish great things in this long term care industry we call home.  Here are 10 points to consider.  If you’re doing any of  these, it could very well be the roadblock on your highway to success.

1.  Not Putting Care First: Your number one priority everyday, day in and out, should be the care of your residents.  There should be no waffling over whether to pay all that money to rent an air mattress for your resident who was admitted with serious wounds.  Put the care first and mark this sin off your list.

2.  Failing to Make Rounds:  I hate being an “office administrator.”  Granted, there are many responsibilities, conference calls, reports, phone calls, and emails that tie you to an office, but the successful administrator makes time to get out and about checking residents and rooms, and interacting with frontline staff members.  Otherwise, how do you really know what’s going on out there.

3.  Failing to Build a Functional and Cohesive Team: If you have negative team members, they will destroy the progress you’re trying to make.  Team members who are always complaining, always ready to criticize others, always finding the faults or weaknesses of any task or project you’re working on – well, these people are a disease.  They have to go.

4.  Lack of Emotional Control: I’ve said it before, if you can’t manage your emotions, you can’t be your most successful.  Lack of emotional control leads to bad decisions, stress, and team breakdown.  We’ve got to grow up and get it together to be successful as a nursing home administrator.

5.  Financial Incompetence: Know your financials.  Know how they work.  What expenses hit what GL (general ledger) accounts.  Cost out risky referrals.  Eliminate unnecessary overtime.  Make sure people work their schedule.  Keep department expense budgets in line.  Push Medicare and Managed Care.  Collect your money.  Adjust your staffing to in-house census.

6.  Not Knowing Your Regs: Your watermelon book is your key to survival in a survey as well as in your daily operations.  You have to know the regs to know how to react to situations that arise.

7.  Over-promising to Family Members: Your staff will love you for this one! (Sarcasm). A lesson that should be learned from Day 1 is under-promise and over-deliver.  When a family member comes to rip you a new one because they found their mother wet, the best response isn’t, “It will never happen again!”  Because it will happen again.  Because the resident is incontinent.  Because the staff find her wet 12 times a day and the family just found her this time before we did.  It will happen again.  The best answer in situations like this is:

  • Letting them know that you’re sorry they found her that way.
  • Being realistic since she is incontinent, telling them that you can’t promise they’ll never find her like that again, but that you can promise as soon as you’re aware of it that your staff will get her taken care of.  They shouldn’t find her like that daily, obviously.
  • Explore what options are available – scheduled toileting program?  More frequent incontinence checks?  Anything going on clinically that can be addressed and is contributing to the incontinence?

8.  Failure to Support and Drive Facility Marketing Programs:  Many old-school administrators just don’t get this one.  They operated in a different environment with less competition and a less savvy consumer.  Nowadays, make no mistake – you are in fierce competition for your referrals!  Marketing is just as important as any other aspect of the nursing home business.  Without proper marketing, your facility loses community recognition, referrals decline, and soon, your census suffers which in turn affects revenue.  With lower revenue, you have to make it up somewhere, so expenses are cut and then you are running less staff, you can’t purchase needed equipment, your supplies budgets are affected, and a vicious cycle begins.

9.  Failure to Give Positive Reinforcement: Your staff need it.  If your making rounds as we talked about in #2, you have the perfect opportunity to catch people doing something right.  Let’s get started.  Your staff morale will benefit greatly.

10. Trying to Manage Your Friends: Many times, insecure nursing home administrators, in an effort to “fit in”, make friends with their employees, their direct reports – hanging out with them after work and the like.  I’m not saying that it’s necessarily wrong to make friends at work.  I’m saying it’s difficult to manage friends and you shouldn’t put yourself in that position.  You have to make a decision.  Are these people friends or employees first?  What happens when one of them does something that needs to be addressed or requires disciplinary action?  Most people will avoid addressing the issue.  Meanwhile, the rest of your facility staff are watching to see what you’re going to do.  “Playing favorites” has no place in our facilities and can be destructive to your team-building efforts.  Your staff will lose respect for you if they see you playing favorites and then you’ve lost control of your facility.  Instead of being buddy-buddy with subordinates, just be respectful, consistent, and supportive.  Draw some lines between your personal life and your work.

There you have it – the 10 Deadly Sins of the Nursing Home Administrator.  Now that you can recognize them, you will be able to avoid these pitfalls and keep yourself on the path to becoming a great administrator!

Thanks and tell me what you think. Let me know if there’s anymore nursing home administrator “sins” you’d like to see added to the list.


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15 Responses to “10 Deadly Sins of the Nursing Home Administrator”

  • David Smeltzer on

    I agree with all of the above, but just as important as knowing the financials and knowing the regs is knowing quality indicators, measuring them regularly, and managing this process to improve care. If you don’t measure it, you’re not managing it.

    Our faith-based, not-for-profit organization runs 3 nursig homes in western NY. This is the area that always causes me the greatest concern.


  • Mark on

    Absolutely! Great point, David.

  • Hey, Mark, this is a terrific post. Shared Sin #8 on CaringForward.com: http://caringforward.typepad.com/home/2010/03/todays-focus-the-8th-deadly-sin-for-nursing-home-administrators.html

    Enjoy your blog, learn a lot from it.

  • Mark on

    Hey, thanks, Doug! I checked out CaringForward.com and really liked what I saw. Good stuff! I’ll be following it regularly.

  • Calvin on

    I agree with everything but the being friends with employees. I personally have a great working relationship with my employees and also have a great relationship with many of them outside of work. We have a rule that we do not discuss our personal relationship at work and we do not talk about what we do outside of work. Some of my best employees have been the best of friends. I choose them wisely!

  • Mark on

    Hi, Calvin. Thanks for your comment! I think some of us would struggle if we ever had to discipline a friend, so that’s the reason for that. However, it sounds like you have a nice balance with the rules you’ve implemented. Nice job!

  • Gina Basham on

    I really enjoyed this article. I am seeking a masters in health care administration and still have several years to go but since I have worked as an aide I have noticed a lot of obvious neglect and realized in knowing how the nursing staff interacts and thier little “secrets” that this would be a great fit. I know finacials are a big priority in all LTC. I need more stuff like this so keep posting!!!

  • Mark on

    Will do, Gina. Thanks and good luck!

  • Tim on

    Hi. I really enjoyed the article. As someone whom has worked in long term care before, I am studying for my NH exam. My Mother is a NHA as is my stepfather. I hear struggles they face every day including staff not charting at all until the end of shift. I am seeking a software platform that can manage patient care. Especially since all doc needs to be electronic by 2010. If it is not currently available, I want to create it so that the system is a “tickler” system that places time constraints on incontinence checks, bathing, and fluids in/waste out. Every hospital that I visit my own patients at has this system. CNA’s and nurses roll around portable wireless computers on stands. If I have it my way, I will remove every nurses station in the facilities I work with. As a former rehab therapist, I have seen nurses sit for their entire shift and not see a single patient face to face. This of course, tempered against rising nursing salaries and shortage. But time can be given away from floors in a structured fashion, so that nurses and aids view the job as equitable in terms of break times. Casinos around here work employees for two hours on and one hour off the floor paid. The employees have access to computers, big screen tv’s and medication and massage therapy services at really low rates. They can get an online college degree in the time they have at work, when they are off the floor. The medical model has been far too unkind to employees and relied on the physician heirarchy for too long!

  • Mark on

    Great comment, Tim! Thanks for dropping in. I would love to see a model like you described. The problem lies with the regulatory requirements and how to meet them with the financial constraints our government has imposed upon us. If someone could find an answer to that while revamping the LTC care model, that person will change the nursing home landscape forever.

  • William straub on

    The best QA software ive encountered is the Abaqis system which models the Qs survey. It provides some very good ongoing feedback into how youre doing with your quality measures

  • Lynn Jones on

    Great post!It validates that I have been doing all the right things in every building I have been in. Unfortuntely though, I have been fired from all of 6 positions because “I was not a good fit” Never a counseling notice, but told I am doing a great job just weeks prior to the terminiation in every case. What I have learned is that these companies don’t care about administrators. If bad employees are angry because they are being asked to do their job nd held accountable,all they have to do is complain, and some good administrator is fired, and labeled unemployable because they obviously are not good administrators because they were fired from position(s). Nothing could be further from the truth. In many cases, NHA who are friends with employees, engage in gossip and other inappropriate behaviors with employees, holding no one accountable, seem to have longevity in their positions. When I was an ANHA, a NHA for the company, accused me of threatening to take her position. This was a total lie, but I was fired! In 3 positions, I was mistreated by my superiors, and fired for no reason. It makes me wonder if this industry is where I need to be. It seems surreal to me.

  • Mark on

    Hi, Lynn. Thanks for your comment. I hate to hear you’ve had such a rough ride in this industry, but you are not alone. I think many of us, myself included, have worked for individuals who were less than equipped to handle the role and, as a result, made mistakes that ended up with us seeking other employment.

    A company is neither good nor bad. Companies instead are made up of individuals. It’s the mix of individuals you work for that determines whether you’ll be treated fairly or not. It’s the type of industry we’re in. And, yes, there have been some I simply walked away from because I felt like their ship was sinking and that I deserved to work for a better organization and for higher quality individuals that had values more in line with my own.

    Sometimes one is just not a good fit. I have had a few where I wasn’t a good fit. I remember one facility where I had about 6 corporate hotline calls in a 2 month period – all over BS. I used to get concerned over those things, but that’s not even a bump in the road anymore. People are going to complain, but as long as I’m doing what I believe is the right thing for my residents, my facility, and my company, I’m not going to let that bother me. I follow the BASICS memo day in and day out and my staff understand that I will take care of my residents with them, without them, or through them. Obviously, the goal is to build a supportive staff around you and start growing leaders that share your goals.

    I have many times considered getting completely out of this industry – I was mentally exhausted and didn’t play company politics well – only to come back stronger than ever and take on challenges that no one else wanted to touch. I’ve learned to be stronger than my detractors, stronger than my peers, and, when necessary, stronger than some superiors. I’ve had to learn how to manage staff, manage consultants, manage surveys, and manage upward when I have to. Now, that’s not saying all my directors have been terrible. I’ve had several great bosses (and just a few that should never work for a nursing home company again).

    My advice: don’t worry about labels. Usually the person labeling someone else isn’t qualified to label anyone. There’s always a facility somewhere that is in need of a strong administrator who is going to make sure the residents are treated with kindness and that quality care is being delivered. It takes a strong person to overcome the adversity one faces in this industry. I’ve learned to accept the fact that I have a bullseye on my back – sometimes with families, staff, surveyors, local media, and yes, even my own company in some instances. That’s ok. I’m here for a higher purpose.

    I could care less about those pot-stirrers that have never run a nursing home (or run it well) or did everything they could to move up and out so they didn’t have to continue doing it. You see, I’m still here doing it. I’m still in the heat of the battle everyday. I’m going to still be producing great outcomes for my residents when the detractors have faded away. And I know I can do this for the company I’m with or for someone else if the one I’m with becomes intolerable. Regardless of what anyone else thinks, one can prove their successes with survey outcomes, resident satisfaction, financials, etc. When you do the right thing, you’ll build a good reputation and people will want you to work for them. There’s always a company who will appreciate someone who produces great survey results and millions of dollars in revenue.

    Don’t give up.

    Good luck!

  • Mike on

    This article describes the administrator at the long term care facility to which I am currently employed. She is an “office administrator,” relying on cameras and her “inner circle” of friends and family members to tell her what is going on. There is absolutely no positive reinforcement. Morale among the good workers is at an all time low. She practices nepotism and favoritism and it discourages good workers from wanting to work there. The most unfortunate thing is, we can’t tell anyone. The shareholders choose to take her side nearly every single time and it is so disheartening. The good workers have no voice.

  • Mark on

    Over time, her style will be her downfall. Dissatisfied employees and low morale do not equal superior results. It will catch up to her.


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