1. National Association of Boards of Examiners of Long Term Care Administrators American Public Health Association October 23, 2001

2. Nursing Home Administrators: A Vanishing Profession Third Year Decline And Increasing Need May Signal a Crisis-in-the-Making  Introduction  History of Licensure  Current Profile of NHAs  Current Situation  How We Are Responding

3. Introduction Randy Lindner, MHSA, CAE Executive Director  National Association of Boards of Examiner of Long Term Care Administrators (NAB) Member - Board of Directors (FARB)  Federation of Associations of Regulatory Boards Member- Board of Directors (CLEAR)  Council on Licensure, Enforcement and Regulation Member  Interprofessional Workgroup on Health Care Regulatory Reform Member - Advisory Committee  Wertlieb Educational Institute for Long Term Care Management, George Washington University Member (ACHCA)  American College of Healthcare Administrators

4. Introduction National Association of Boards of Examiners of Long Term Care Administrators (NAB) Mission – Public Protection Members

5. History National Legislation for Licensure  Amendment to the 1965 Social Security Act in 1967  States obligated to have licensure program in effect by July 1, 1970 NAB Formed – 1970 Responsible for nationally recognized Long-Term Care Administrators exams  Nursing Home Administrator  Assisted Living Managers

6. Other Support Programs Academic accreditation Continuing educational approvals Disciplinary reporting Standards of practice Reciprocity development Model regulations and standards

7. OBRA 86 Raised the Bar CMS (a.k.a. HCFA) released proposed administrator standards in 1987*  Baccalaureate Degree  All but 14 states currently meet standard  12 week (480 hour) internship program  All but 7 states require 250 – 2000 hours  Standardized Examination  Full compliance  20 Hours of CE annually  All but 4 states require 15-30 hours *Regulation still pending

8. Demographics for NHA Candidates (2000) 65% Female Age Cohort – 25 to 35 College graduate – Emphasis on long term care  50% Baccalaureate, 27% Master’s Completed AIT Program Experienced in long term care

9. Number of NHA Candidates Average – 1988 to 1997: 3778 Range: 3351 to 4572 1998: 3324 1999: 2975 2000: 2423 2001: (Projected) 2000  Revised Projection as of August 2001 (2,400)

10. NHA Exam Candidates 1988-2000 36.5% Decline -- 1997-2000

11. Reports of College Programs Decline in enrollments Decline in graduations Decline in candidates sitting for exam

12. Reasons Given for Enrollment Declines Unpaid internships (AIT) Lower salaries than other sectors Increased competition from Assisted Living Negative image of profession Perception of high stress job Lack of knowledge of career options

13. Anecdotal Reports of Declines in Renewals States are reporting a decline in the renewal rate of currently licensed NHAs Recruiters report increased demand and supply shortage in some areas of the country NAB desires to further quantify these reports and the reasons for the decline

14. Possible Reasons for Decline Punitive Regulatory Environment Labor/staffing shortages Compensation Alternate attractive career options Litigious environment Industry Financial distress Negative image of industry

15. How Have States Responded? NAB conducted survey to quantify decline and response on the state level:  Experiencing a decline (58% new, 38% endorsement)  Relaxed educational requirements (17%)  Relaxed AIT requirements (32%)  Relaxed requirements for reciprocity (29%)

16. 58% of Reporting States, Reported a Decline in New NHA Applicants

17. NAB’s Response Partnership efforts with Academia, Industry, Government, Professional & Trade Assns Summit on the Decline in Recruitment and Retention of LTC Administrators Establishment of Marketing Task Force  Career Brochure Development  PR Campaign National Practice Act Registry of Profession Research

18. Closing Remarks Recommendations to NAB State Licensure Boards and/or Agencies, Academia, Government and Associations  Raise Awareness of the Profession  Improve the image of the Profession  Elevate Visibility of the Problems  Eliminate Unnecessary Barriers to Licensure  Work as Coalitions to Address Problems

19. Contact Information