Long-Term Living posted an interview online on Dec. 3, 2009 with a former administrator who has written a book about his career as an administrator in Maryland nursing homes. Elliott D. Cahan, a retired administrator, gives in his book, A Place Like Home, candid reflections on running facilities for for-profit and not-for-profit operators in Maryland. Below are just a few of the excerpts from the interview where he admits that corporate control of the budget, concern about proftis, and quality of staff cause problems in trying to run a nursing home. Cahan elaborated on all of these points in an interview with Richard L. Peck, former Long-Term Living Editor-in-Chief.
Peck: Your comments in your book, though, present quite a mixed picture—principally, that the administrator’s job is a juggling act. Would you elaborate?
Cahan: All the disparate parties involved in resident care—residents, families, staff, regulators, owners—come at it from different angles, but ultimately, it’s the administrator who is holding the bag for providing the care. Put it another way, it’s like a stack of cards and you’re never quite sure which card is holding up the stack—take away the DON, the nursing assistant, the RN, and will the whole thing collapse? It’s a precarious business. And yet I always found it interesting that Maryland had no requirement for a state surveyor to have worked in a long-term care facility. It’s a job that is more difficult than many people think.
Peck: Would you say that an administrator’s principal focus would be on staff?
Cahan: I think a principal role for the administrator is to clear the way of all red tape and roadblocks so that staff will have an environment for success. If you do this, they will provide good care. You can’t pay the highest wages, although they should be competitive, but basically if you provide an environment where staff feel appreciated and want to show up every day, good care will result. Specifically, that means giving them the supplies, the equipment, including maintenance and repair, and in general eliminating frustration from their daily work.
Peck: By the same token, what do administrators need?
Cahan: They need to be empowered by the owner, the board, and the corporate office. They need more than “sometimes” authority—for example, having no control of the budget but being held accountable for spending nine bucks for doughnuts at a staff meeting.
Peck: Among the more controversial statements you make in your book is that, from a quality standpoint, not-for-profit facilities are preferable to for-profit facilities. Would you discuss that?
Cahan: That probably is the most controversial statement in my book. But I can only go by personal experience. I’ve heard for-profit management of one chain admit that it was all about the quarterly share price, not the residents. At least they were honest. In general, the for-profit chains thought that they would create efficiencies through centralization but it never happened. Also, they went through a period when they bought provider companies at crazy prices, with huge mortgages that operations could never support. It made me wonder whether investors really understood the field, but this had a bearing on quality. I’m not saying this is a hard-and-fast rule—there were for-profit facilities in inner city neighborhoods that offered much better environments than was available at home, and I’ve seen not-for-profits that provided low quality of care. I was just addressing the overall situation with that comment.