10 Deadly Sins of the Nursing Home Administrator

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.

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 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!

Tell me what you think and let me know if there’s anymore “sins” you’d like to see added to the list.

Thanks!