Creating the national standard is no simple task.

By Steve Moran

I recently had a conversation with Randy Lindner, President and CEO of the National Association of Long Term Care Administrator Boards, better known as the NAB. NAB represents the 50 states and the District of Columbia as boards and agencies that license nursing home administrators in every jurisdiction, as well as assisted living administrators. NAB also offers home and community based services in the state of Oklahoma.

Where It All Began

“This all started with a federal mandate going back to 1970,” Randy explains, “in which the federal government — as an amendment to the Social Security Act — required that to be eligible for Medicare and Medicaid reimbursement, all skilled nursing facilities had to be licensed by the state and one of the conditions of licensure was that they have a licensed nursing home administrator in the building. That is where the federal licensure for nursing homes began. The federal government stopped short of setting specific standards for entry into the practice and left that to the states. As a result of that, we have 51 different practice acts right now for entering the profession.”

The Need for Consolidation

With 51 different practice acts currently in use, there is obviously a need for consolidation.

“We have struggled with that [consolidation] for the last 45 years,” Randy confirmed, “and really the only commonality across all the jurisdictions is the national examination, which is used by everyone. There are some elements of education, training and continuing education that are common. I would say on average maybe about half of the states require around a 1000-hour Administrator-in-Training (AIT) experience but then they go from 0, believe it or not, to as high as 2080 hours in some states. That presents a lot of challenges in today’s mobile environment, when people want to move across borders. They may find that even though they’ve practiced successfully for 10 years, once they move to another state, they suddenly don’t meet the AIT requirement and they have to go back into a training program.”

Creating A National Standard

How you create a national standard like this — without turning it into something that is going to be followed by regulation — is always tough. Of course, it’s one of the reasons why Argentum (formerly ALFA) has tackled this is the idea that you can set some standards that, hopefully, will actually slow down the regulatory process. Interestingly enough, I was in British Columbia last week, and in their senior living association, they’ve created a certification program for assisted living with a very specific goal of saying: ‘We understand the business better. We want to set the standards.’  So I kind of think when outside organizations like NAB are doing that — where it’s not regulatory — it creates the right mix. Randy clarified this point.

“I maintain that it’s not competition. But what I would hope and what I would really like to see happen is that if all of the players that have certification programs or licensure programs, if we could come together and agree on positioning the structure and commonality. Because I think right now, with all of the various certification programs that are developing, it’s creating the same mess we have at the licensure level. People are coming into the profession that don’t know where they should start: Which one is the right one? Will it be truly portable across states? Will it be recognized? But I think we still have the opportunity to sit down and say, ‘How can we make this work best for the profession and everybody benefit from it?”

To hear more from Randy Lindner and learn more about this topic, listen to the rest of the podcast below: