A unit of young blood the industry faces aging leadership.

Jeremy Kiley still remembers his first day as a facility administrator, where he walked into the Alpina, Mich., nursing home's dining room, stood at the podium, greeted his staff and outlined his vision for the 152-bed long term care center.

Shortly after his speech, one of the nurses' aides--"a 45-year-old, kind of rough-around-the-edges sort"--raised her hand. "I don't want to be rude," she began, "but I swear I have pantyhose older than you."

Kiley, then an ancient 23 years old, could only laugh. "That was my christening into long term care," he said. "Here I am, the new boss, and I'm the second-youngest person working for the facility--the only person younger than me was the housekeeper, who was probably in high school. It was very intimidating."

Fast-forward to 2004, the now 31-year-old Kiley became the new administrator at Rutledge Home, a 66-bed nursing home in Chippewa Falls, Wis. He's older, wiser--and still a rarity in the administrative ranks. "These days, I don't get as many of the 'you look too young to be in this business' comments," he said. "But some people are still surprised at how long I've been in this role."

Like the American society it serves, the long term care industry is getting older. Douglas Olson, a professor with the Health Care Administration Program at the University of Wisconsin in Eau Claire, Wis., said people only have to make a visual survey at any of the industry conferences to see the graying of long term care leadership in progress. "A lot of people are interested in how we're going to engage young leadership to lead us through the next few decades," Olson said. "This is not just a state-specific or region-specific problem. It's a problem around the country."

A compilation of data from state organizations by Contemporary long Term Care in 2004 showed that 75.3 percent of 2,515 responding administrators were older than age 40. Breaking down the numbers in a different age group, 64.1 percent of respondents were ages 31 to 50.

In contrast, a report in 2003 by the National Association of Boards of Examiners of Long Term Care Administrators (NAB) showed that 56.7 percent of responding administrators were age 40 or younger. Almost 60 percent of respondents were within the survey's middle age groups of 31 to 40 and 41 to 50 years.

Both surveys reported the same median age, showing that roughly 30 percent of administrators are ages 41 to 50. But the difference comes in the number of older administrators in the field: whereas NAB's study placed the number of age 51 to 60 persons at 13 percent, CLTC's figures tallied at 34 percent.

Sandra White, education program manager for the American College of Health Care Administrators in Alexandria, Va., said her own association's study in 2003 of more than 900 administrators showed an average age of 45. "That (age) is representative of (nursing home administrators) in the nation today," White said. "Fewer young administrators are coming into the profession (while) many of the experienced, older NHAs are leaving."

Scaring them off?

Experts cited several reasons for the industry's gradual aging, including:

Too much negativity. After nearly 13 years in long term care, including the past eight as the administrator at Dove Healthcare Nursing and Rehabilitation in Eau Claire, Wis., 39-year-old Jim Deignan can only shake his head when he thinks about the attitude of his older peers in the profession. "Someone coming into the profession who wants to tap into the resources of their peers instead hears how nursing homes are tough places to work, they're short-staffed all the time, consumers expect too much out of them, that all anyone ever does is complain to the administrator," Deignan said. "The question to the new person becomes, 'Why did you ever go to school to do this?'"

Kiley said he heard the same grumblings from the older LTC community even while he was still in college. "Of the people from my own class (1996), there's only one or two out of the 20-something that graduated who are still in the business," he said. "I think they're scared away right from the start."

Attracting people to the profession isn't the problem. Olson noted that UW Eau Claire's program has grown steadily in recent years. "We've nearly tripled our enrollment in the past four years--from around 40 to 50, to 125 students this year," he said. He attributed much of the growth to the Center for Health and Aging Services (CHASE), a partnership among the university, other organizations, and the various industry associations.

The university is conducting a survey of alumni to determine industry retention rate, he said.

"We're as concerned about the situation as anybody," said Olson, who added that one area requiring increased investment is the transition into the workplace. "When you invest five years in a student--between his or her undergraduate curriculum and their one-year practicum--and then they go into the field and crash and burn two years later, it's a tragedy. We can do better."

Kiley said he encourages his staff to emphasize positive events, no matter how small, during the facility's morning meetings. "We've got a group now that talks about good things before I even have to ask," he said. "We have to be our own cheerleaders. When you're inundated every day by things that go wrong, it's really easy to feel down or get tired. When that happens, you start losing the energy to continue to improve."

Impatience about progress. Industry newcomers often don't want to stick around long enough to make gradual progress or growth in the business, Kiley said. Industry veterans need to encourage the younger, newer group of leaders to stick with it. "It's like a person who starts a workout program and isn't seeing all the results he wants to see immediately," he said. "It's only in the long haul when you can start to see improvements, when you can look back six months or a year and say, 'Wow, remember when it was like this? Look how far we've come.'"

Burnout. The high stress level of an administrator's job--including regulatory pressures and employee-related issues--tends to lead to job burnout, according to White. "The litigious environment administrators find themselves in these days can be quite a deterrent to entering the field or staying in it when more lucrative, less stressful jobs or retirement are beckoning," she said.

Burnout almost got to John Vrba, administrator at Manor Health Care Services in Hinsdale, Ill. He admitted he wasn't quite up to the emotional challenges of his position when he took over the facility in 1995 at age 27. "Residents would pass away, and for me it was like losing a grandparent, aunt or uncle every week or two," Vrba said. "That's what really almost pushed me away from the profession. I was so ready to bail."

But Vrba's opinion changed around the time he watched resident "Elizabeth" die as he held her hand. "I realized about quality of life," he said. "If someone passed, and you did it with respect, love and dignity, and family was with them, the dying experience could be a wonderful experience and not just a sad one:"

* Too many commitments. Younger administrators often try to juggle family duties with those of running facilities, according to Deignan. "It's a difficult thing," he said. "You're involved in the community, you're raising a family and you're trying to make a name for yourself and your facility. Everyone needs young blood, but there's only so many hours to go around."

Deignan, who is a district president of the Wisconsin Health Care Association, and the association's treasurer and chair of its public relations committee, estimated he spends 30 to 40 hours each month on outside activities on top of his usual workload at DHNR. "It's a pretty standard amount of time to spend and it adds up quickly," he said. "Fortunately, the owner of this company has given me his blessing. As long as I can get my work done, I can be on as many committees and associations that I want."

* The 'Stigma.' Olson said the industry needs to work on eliminating the stigma about a career in long term care: that's it's not the most glamorous job in the world. As a result, UW Eau Claire and industry associations have attempted to promote the job's more positive aspects through the CHASE program. "It was really about making sure we were thinking about this in terms of this being a noble profession," he said. "One thing we want to get across to younger people going into the field is that they are going to make a significant societal difference and touch the lives of individuals."