It takes a lot to run a skilled nursing, long term care, or assisted living facility. Several successful administrators and a trainer offer a window into the challenges and rewards of this unique line of work.

Samantha Vosloo, executive director, Palm Garden of Largo, Fla.: It is a 24-hour job. I don’t think you should necessarily be married to your building, I think that can be a little unhealthy in terms of work/life balance. But the building is definitely part of the family. You think about it all the time when you’re not there, and if something happens.

For example, we had a tornado that came through at midnight, and I was in my room on the phone with the television on making sure everybody is okay. It really is a 24/7 member of the family that you’re responsible for. It’s worth it to have that thing be so successful. It’s worth all of the time and energy you put into it.

Stacy Neubauer, administrator, Good Samaritan Society, Alma, Neb.: It’s very hard, it’s very challenging. There are lots of responsibilities. You really don’t get a taste of it until you actually have to do it. When you’re responsible for the lives of 40 people and their care—whether it be clinical, emotional, physical—if I don’t ensure they’re receiving the best care possible, we can get in trouble with the state, with their family.

That’s huge, because that can jeopardize our license to function as a nursing home. I’m very thankful for my many years in long term care, in many different roles, because I feel like that helps me in this role. I’ve also had lots of great role models along the way who help push me and help problem solve and have helped me.

Brenda Rice, administrator, Hebrew Home of Greater Washington, Md.: In order to provide the best possible care for residents, we need to understand how to innovate and create opportunities to grow. Meeting and exceeding the needs and expectations of residents and their families requires us to focus on how we can deliver person-centered care and make sure that the outcomes have the highest impact for each individual resident. 

Andrew Maas, administrator, Briarwood Health Care Center, Iowa City, Iowa: If I let myself get too excited or too happy, when I start having issues, I feel the helium got let out of the balloon, you feel deflated. Instead I look at it as there will always be ups and downs. You celebrate the good times, especially with the staff, and when you have times of concerns, you use that time to see what you can do for improvements.

Jennifer Pryor, co-director, Assisted Living Administration specialty, Virginia Commonwealth University, Richmond: [One] key technique that is very powerful is role model leadership. In its simplest terms that means always modelling the behaviors that the administrator wants others to emulate. And when things go wrong (as they inevitably will sometimes), it means owning the problem, involving others in the solution, and demonstrating that missteps are opportunities to learn and grow for everyone, the leader included.

Andrew Maas: I always try to do what’s right. If something is right—morally, ethically—and the decision I make is the right decision, then even if it ends up causing some kind of issue, I can still go home feeling good knowing that the decision I made was the right decision for me and for my staff.

The other day we had a discharge, and we had refunded the money left. And then we come to find out we had refunded one day too much. I was going to have to make a call to the family and say, ‘I know we refunded the money, but it was one day too much.’ I decided the right thing in this situation was to say, ‘I’m going to write that one day off, there’s no reason to call that family.’ The resident had passed away. There was no reason to call when they think everything is settled. I’m just going to let everything be settled.

Samantha Vosloo: Pride really has no place in what you do. My license is on the wall, and so everything is my responsibility. It doesn’t matter who did it or what happened, it’s my responsibility to correct it. If you can take the pride out of it and not get your feelings hurt when someone brings forward a concern or a process breaks, it allows you to be more clearheaded. You check your feelings and say, ‘Okay, where did the process break down?’ Or is it a people problem. There are really only two types of problems—people problems and process problems. If you can work at it with a clear head and fix it, you can be more successful than focusing on things like blame and pride.

Stacy Neubauer: We work with a different population. There are different diagnoses that go on in this population, like dementia. You can’t come into this field if you don’t have patience for that or understand that disease process. Because you’re going to get totally frustrated and hate what you do. You just have to know how to deal with it, behavior is a challenge. You have to be educated and understand.

Samantha Vosloo: I was at a wedding this weekend with people who I went to high school with, and some who I haven’t seen since high school. And when you tell them, “Oh, I’m a nursing home administrator,” they kind of look at you sideways. They don’t understand. For a lot of people their only familiarity is a Morgan and Morgan [law firm] commercial, so sometimes we don’t have the best reputation out there.

Having a mentor or being a mentor and having someone who knows what you do for a living is such a blessing. Besides a small business owner or a hospital administrator, there are not a lot of people out there who will fully understand what you do. So having that shoulder to lean on and get advice from your peers is so important.

Stacy Neubauer: This year I’m a mentor. We do a lot of reading of leadership books. We do a lot of getting together, going out to see each other in the field. It really helps you. When you’re in your building day after day, sometimes it’s hard to see something different. Just the networks that those events create with other administrators and executive directors, it’s been a great thing to be a part of.

Jennifer Pryor: Mentorship is an essential component of the professional preparation that emerging and new administrators need to be successful in their careers. To be a mentor is a wonderful way to give back and help to shape the future of the profession. Being an administrator is hard work, but the nature of this industry is service. To be truly holistic in serving others, we must make sure to not forget about service through mentorship. This includes mentoring managers and staff in various leadership roles within an administrator’s specific community, but also serving as a preceptor to mentor future administrators as they prepare for their new career.

I have heard from so many administrators and executive directors that it gets lonely being at the top of the organization. Therefore, having opportunities for mentorship and opportunities to connect with peers can help to relieve some of those feelings that administrators must go it alone. Throughout one’s entire career there are opportunities to be mentors and to have mentors, and we should all definitely take advantage of seeking these out.

Andrew Maas: A lot of facilities spend a lot of money on marketing and somebody to be in that position. I’d rather spend that money on direct-care staff and then let our reputation speak for itself. It’s done fairly well for us. I’ve talked to all staff. Everyone in the building is a marketer of our facility. You’re out and about, you have one of our shirts on, somebody is going to ask you about us. Or you see somebody coming into the building, don’t just let somebody stand there in the doorway looking like they don’t know what to do, go up to them. The staff do a very good job.

Even today, I was in a room with a new resident. There were two CNAs [certified nurse assistants] on that hallway, it was around shift change. The two new CNAs who came in at 2:00 p.m. made a point to come in and introduce themselves and let the residents know they’re the CNAs who are working on that hall today, and if they need anything to let them know. Making someone feel welcome is great.

Samantha Vosloo: You learn so much about so many different things. You have to know enough to know what you’re doing in terms of culinary, maintenance, nursing. I’m not a nurse, but you have to know how to read a referral or understand what they’re talking to you about a patient. Or when you’re facing challenges, it’s an opportunity to learn and grow.

For example, I’m putting in a parking lot now at the building, and I’m taking a crash course in engineering and permitting. You have to really not be afraid to ask questions and really focus in on knowledge, so the next time you have to deal with the permitting department, or the nurses or the doctors, you have a little bit of knowledge.