1. Presented at CLEAR’s 23rd Annual Conference Toronto, Ontario September, 2003 Research Based Policy Randy Lindner, MHSA, CAE Executive Director, National Association of Boards of Examiners of Long Term Care Administrators Sandra Greenberg, Ph.D. Vice President for Research & Development, Professional Examination Service

2. Presented at CLEAR’s 23rd Annual Conference Toronto, Ontario September, 2003 Agenda Introductions A Research - Based Search for Solutions (Case Study) Executive Summary Background The Products Expected Outcomes A Research Based Search for Solutions (Simulation Experience)

3. Presented at CLEAR’s 23rd Annual Conference Toronto, Ontario September, 2003 Case Study Executive Summary The Problem Unknown Implications Lack of Data Changes in Career Patterns Retention Factors Develop Recruitment & Retention Agenda

4. Presented at CLEAR’s 23rd Annual Conference Toronto, Ontario September, 2003 Background Emerging Crisis in Long Term Care Federal Legislation Impact of Pending Shortages Career Patterns (figure 1) National Summit Related Research Population Affected

5. Presented at CLEAR’s 23rd Annual Conference Toronto, Ontario September, 2003 Figure 1. Possible "Typical" Career Patterns for Recipients of State Licenses Fewer new applicants may not imply a shortage because previously licensed personnel may plan to return to AOR status after working in other positions. Many licensees accept non-consecutive positions as AOR in different facilities. There are frequent gaps in employment as AOR in many careers. Recurring Entry. Individuals receive license as part of a complex career that may include some positions as AOR and other positions that do not require licensure. Fewer new applicants implies potentially less serious shortage if nonadministrators are willing to serve as AORs with appropriate incentives. Many licensees never accept a position as AOR. Nonentry. Individuals receive license for reasons other than employment as an AOR, e.g., as a credential for government administration or for teaching long-term care management. Fewer new applicants implies potentially less serious impending shortage because former administrators may be willing to return as AOR if they receive appropriate incentives. Many licensees experience lengthy period between first and second positions as AOR. First AOR position usually accepted shortly after initial date of licensure. Intermittent Entry. Individuals receive license in anticipation of becoming AOR for a specific provider; they may return to an AOR position after working in another field (e.g., academia, assisted living management, state government, clinical practice, homemaker), Fewer new applicants implies less severe impending shortage because recently licensed administrators are waiting to receive their first position in a potentially long career as AOR. Many licensees experience lengthy period between date of license and first position as AOR. Licensees accept consecutive positions as AOR in different facilities. There are few gaps in employment as AOR in most careers. Delayed Entry. Individuals receive license in anticipation of an eventual life-long career as AOR. Entry into the field may be delayed because of a lack of available openings. Fewer new applicants implies severe impending shortage because licensed administrators do not typically return to AOR positions after they leave their first one. Many licensees either accept a single position as AOR shortly after licensure or never accept such a position. There are few gaps in employment as AOR in most careers. Single Entry. Individuals receive license in anticipation of becoming Administrator of Record (AOR) for a specific nursing home. They do not typically seek an AOR position with another employer after they leave the position. Implications for AOR ShortageEvidence From Career "Biographies"Career Pattern

6. Presented at CLEAR’s 23rd Annual Conference Toronto, Ontario September, 2003 The Project Collect Nationwide Data on Career Patterns Establish Set of Findings & Recommendations on Potential Crisis Propose Regulatory or Statutory Changes How the Work Will be Done

7. Presented at CLEAR’s 23rd Annual Conference Toronto, Ontario September, 2003 The Products Set of Findings Typical Career Patterns Factors Associated with Career Length & Satisfaction Implications of Factors on Recruitment & Retention Preliminary Set of Recommendations Communication/Dissemination State Governments Professional/Trade Association Session Presentations Policy State Briefings Publication Trade Press Scholarly Article for Peer-Reviewed Journal

8. Presented at CLEAR’s 23rd Annual Conference Toronto, Ontario September, 2003 Expected Outcomes Credibility Necessary to Shape Policy Criteria for Academic Programs State and Federal Regulatory Policy Influence Industry Practices Enhance Leadership and Management Skills Advance Interests of LTC Residents Public Protection Enhanced Services

9. Presented at CLEAR’s 23rd Annual Conference Toronto, Ontario September, 2003 Research-Based Decision Making (Simulation Experience)

10. Presented at CLEAR’s 23rd Annual Conference Toronto, Ontario September, 2003 Agenda Identifying the Questions Establishing Work Groups Implementing a Focus Group Reporting Back to the Group

11. Presented at CLEAR’s 23rd Annual Conference Toronto, Ontario September, 2003 Areas for Decision Making Eligibility Requirements Refining a Scope of Practice Renewal Requirements Transitioning to CBT Enhancing Consumer Protection Enhancing Practitioner Satisfaction Others ?

12. Presented at CLEAR’s 23rd Annual Conference Toronto, Ontario September, 2003 Establishing Work Groups Select a Topic of Interest to Your Agency Use Focus Panel Methodology to Refine Information Needs and Generate Solutions

13. Presented at CLEAR’s 23rd Annual Conference Toronto, Ontario September, 2003 Implementing a Focus Group Rules - Shared Responsibility for Work Product - No Rights/No Wrongs

14. Presented at CLEAR’s 23rd Annual Conference Toronto, Ontario September, 2003 Implementing a Focus Group (cont’d) Protocol - Define the Policy Decision You Need to Make -Identify the Key Stakeholders and Their Current Perspectives On the Policy -Identify the Information Needed to Inform the Decision -Brainstorm Ways to Gather Information -Develop a Plan for Collecting and Interpreting the Information (what are the +’s and –’s?) -Consider the Implementation Issues and the Ripples Caused by New Policies

15. Presented at CLEAR’s 23rd Annual Conference Toronto, Ontario September, 2003 Implementing a Focus Group (cont’d) Reporting - Select a Recorder to Report Back to the Group

16. Presented at CLEAR’s 23rd Annual Conference Toronto, Ontario September, 2003 Reporting Back to the Group Describe the Policy Decision Your Agency is Considering Outline Information Needed and Key Stakeholder Perspectives Describe the Plan to Collect Data and Interpret Results Identify Advantages/Disadvantages to Data Collecting Efforts Identify Obstacles to Overcome in Implementing the New Policy

17. Presented at CLEAR’s 23rd Annual Conference Toronto, Ontario September, 2003 Presentation Follow-up Please pick up a handout from this presentation -AND/OR- Please provide business cards to receive an e-mail of the presentation materials -AND/OR- Presentation materials will be posted on CLEAR’s website