Nursing home bill to get another look
A bill that would have eliminated the requirement that nursing home administrators possess a four-year degree failed to move to the Governor’s office last week, but likely will be considered again next session.
While the bill’s author Rep. Faught, R-Muskogee, says it would help put qualified people into care facilities in rural communities, aging advocates say it would diminish the quality of nursing home management.
The bill originally passed both the House and Senate, but was returned to the House for approval of amended language. The House adjourned before voting on the final bill but remains available for legislative action next year, according to Faught’s office.
Currently, nursing home administrators must have a bachelor’s degree, complete 560 hours of training through Administrator University at the Board of Examiners for Long Term Care Administrators and pass a state and national licensure exam.
In lieu of a four-year degree, House Bill 1551 would allow those with “10 years of supervisory experience, with five consecutive years of verified experience as a certified assistant administrator in an Oklahoma licensed nursing facility” to become an administrator.
“This was an idea from a supporter constituent who operates several nursing homes,” Faught said. “They have a hard time trying to fill that position. With them, they have lots of employees who have worked with them who can do the job but don’t have a four-year degree. It’s an alternate path for those (for whom) college is a roadblock.”
Faught said the intent of the bill is to stabilize leadership in rural nursing homes and guard against high turnover.
“They might hire someone right out of college who never worked in a nursing home and this person decides this isn’t where I want to be,” he said. “But if someone has worked in a nursing home for 10 years, they’re invested in the community. Let’s give them an option to advance their career.”
But Esther Houser, an aging advocate and former state long-term care ombudsman from 1979 to 2014, believes that the bill is unnecessary and will damage progress made in recent years.
“The bill isn’t needed. The Administrator University at the Board of Examiners often has a waiting list. These are all degreed people,” Houser said.
Houser cited a recent study supported by the Foundation of the National Association of Long Term Care Administrator Boards that concluded higher degree requirements and longer training requirements correlated with better facility outcomes.
“The research team found that better education and field training leads to better nursing home administrator exam scores,” said Jennifer JohsArtisensi, Ph.D. of the University of Wisconsin-Eau Claire in a news release. “It’s clear that education and training greatly impact the success of administrators, as well as quality of care, in a positive way.”
Houser said her experience as long-term care ombudsman echoed the study’s findings.
“The quality of services and the understanding of administrators regarding the rules and what’s required of them in statute and regulation have improved since this rule has taken place. That’s what my experience tells me,” Houser said. “I would rather see a person in charge of a facility who has shown that they are interested in learning and capable of critical thinking and understanding.”
Advocacy groups organized to fight the bill including AARP, Oklahoma Nurses Association, Oklahoma chapter of the American Medical Directors Association, the State Council on Aging and numerous others.
“For 15 years in Oklahoma, there has been a requirement for a fouryear degree for our longterm care administrators, those in charge of caring for our most frail and vulnerable citizens,” said a statement released by AARP. “During that time, Oklahoma has gone from the top 10 worst states in the country for nursing home deficiencies to 27th and we now rank below the national average in deficiencies. Most importantly, Oklahoma is not suffering a shortage of these administrators. The university that future administrators must attend is full to the point they have a waitlist. These exemptions are not necessary and, in fact, could be harmful.”
Another question raised was why a bill that establishes rules for the operation of nursing homes was passed in the Legislature without input from the board that provides nursing home oversight in Oklahoma.
While the Oklahoma State Board of Examiners for Long Term Care Administrators voted to support the new rule, many were surprised by the omission.
“The board has the sole authority to set the standards,” said Gaylord Z. Thomas, executive director of the state board. “When the legislature starts tinkering with standards, they are out of their lane. Ultimately that (should be) the board’s role.”
But supporters of the bill say this issue has been presented to the state board and the executive director for several years with no action, despite the organization’s pledge to develop an alternate path to licensure, according to information released by the Oklahoma Association of Healthcare Providers.
“Hospital administrators don’t have to have a four-year degree,” said Brett Coble, owner of several rural nursing homes and president of Oklahoma Association of Healthcare Providers. “There are parts of the state where it is harder to recruit licensed administrators. They are heavily concentrated in Oklahoma City and Tulsa.
“I’ve been in the position where I was recruiting and could not find someone who would come down to Waurika, Oklahoma, to be a nursing home administrator. I had people (who could have filled the position) working in the nursing home in leadership positions, but they hadn’t gone to college,” he said. “A basic four-year degree is not the end-all requirement for administrators.”
Coble also disagrees with the assertion that changing the requirement would diminish quality of care.
“What would be the incentive of hiring a less qualified administrator? This is a business. There are market principles at work. It’s not an incentive to provide substandard care,” he said.