Administrator training for assisted living; the Mountain Shadows way.

This assisted living provider came at it from a different and enlightening - angle

As a growing number of nursing homes position themselves to take advantage of the rapid growth in the assisted living market, some type of cross-training is becoming a necessity. There is no doubt that nursing home administrators are among the best candidates for positions as administrators of assisted living facilities. But simply "dropping" an LTC administrator into an assisted living setting - as the industry now seems to be doing - is setting up the field for less than optimal outcomes.

The set of skills needed to operate a nursing home is different from that required to run an assisted living facility. Specifically, the latter requires additional (or different) business and marketing acumen, a change in focus from the medical to the residential model and, most important, redirectional techniques and tools for dealing with the behaviors of assisted living residents. Our company has decided to address this problem in its own way.

When Mountain Shadows, Inc. of Escondido, CA decided to enter the assisted living arena (called residential facilities for the elderly (RCFE) in California), we wanted to apply the philosophy of care employed at our Mountain Shadows Care Center - 16 residential facilities for persons with developmental disabilities (ICF/MR). That philosophy centers around a holistic, residential model, rather than a medical one, and an approach to care aimed at enhancing quality of life, while achieving and maintaining the highest possible level of functioning for our residents. Under OBRA, these goals have become regulations for nursing homes; for assisted living facilities, these are essential business factors.

We were motivated in this direction when I first visited our two new assisted living sites, The Manse (48 residents) and Sierra Vista Retirement Center (62 residents). I felt the services we were providing leaned more toward "babysitting" than toward the interactive care program we're used to on the developmental disability side. This observation, coupled with a desire to challenge my existing administrators with opportunities for career growth, ultimately led to the development of our Mentor Program. In it, our Care Center administrators (Qualified Mental Retardation Professionals (QMRP/Administrators)) voluntarily cross-train at our assisted living facilities to become certified assisted living administrators. This combination of qualifications and training shed considerable light on the requirements all administrators in this field will face.

The Mentor Program

This four- to six-month training program is divided into several components which, as a whole, are designed to provide the candidate with hands-on exposure to every aspect of assisted living administration. Central to the program is the team of mentors from Mountain Shadows, Inc. (MSI), our assisted living facilities, and Focus Teaching Systems, a health care provider-training company that works closely with MSI.

Each member of the team provides mentoring in his or her area of expertise, and is required to "sign off" on the component when the candidate has mastered the material. Depending on the topic being addressed and the needs of the candidate, the substance of any given component is mentored using modeling, direct observation, hands-on participation, or with educational media. For example, while focusing on areas related to resident and family interaction, the candidate may be asked to attend actual meetings with residents' families to observe the techniques used. During the component dealing with staff development, the candidate may initially sit in on interviews of perspective employees, participate in the interview process at a later date and, ultimately, conduct an interview under the supervision of the mentor.

A sample of the components developed for the Mentor Program designed for the candidate at Sierra Vista Retirement Center is presented in Table 1. Since no two people come to a training program with the same level or scope of skills, the time spent on any one component and, indeed the components themselves, are modified according to the candidate's needs, as well as those of the facility in which they are scheduled to work. For example, a candidate with a strong business background may spend less time on the "Business Acumen/Free Enterprise" component, but may require more intensive exposure to components dealing with resident and family interaction.

The components of the program run both concurrently and consecutively, i.e., candidates may work on several areas simultaneously or, at other times, focus on a single component. At some point during the program, the candidates are sent to complete their required 40 hours of course work at Community Education, a Vista, CA-based company that trains and certifies assisted living administrators, after which they take their state certification exam. Other requirements for successful completion of the program may include additional course work or serving as "administrator of the day."

To date, one candidate has completed the program and is now a relief/on-call assisted living administrator, and two more are in the process. As we expected, the Mentor Program is allowing us to develop quality administrators who are both motivated and well prepared to work in the assisted living field. An added benefit is the additional administrative-level presence, especially during "off hours", at our assisted living facilities.

Care Planning

Our Mentor Program became the catalyst for the development of additional programs at our assisted living facilities. We realized, for example, that we needed to develop an assessment tool that would allow us to assess the needs of our residents from a holistic, rather than strictly medical, perspective. That tool would require interdisciplinary team and family involvement, and would allow us to develop a "contract of care" that identifies our residents' expectations of us and ours of them. To some extent, this resembles the well-known (to nursing homes) Minimum Data Set, but with a different twist. In short, we drew from our developmental disabilities experience and adapted a tool called the Individualized Service Plan (ISP) for use at our assisted living facilities. The basic components of the ISP are listed in Table 2.

The ISP is essentially an in-depth assessment of an individual's physical and cognitive capabilities and impairments, social needs and behaviors. The assessment is followed by active programming which is measured and quantified against ISP goals set by the interdisciplinary team (including residents and their families). In this way, what was once essentially intuitive is now being carefully documented and monitored. If OBRA is any indication, this is something that will certainly be required if assisted living facilities are Federally regulated.

Once we had the ISP process in place, we saw a need for an effective way to train our direct care staff to provide the kind of interactive, proactive care needed to satisfy it. Ultimately, we turned to Focus Teaching Systems, the firm mentioned previously. Their Focus Teaching and Redirectional System (see "Principles of Staff Training,") has already been fully implemented in our centers caring for persons with developmental disabilities and is now in the initial implementation stages in our assisted living facilities.

Nursing Homes Invited

We are now discussing the feasibility of offering our training program to other companies with qualified would-be assisted living administrators. This type of arrangement would be mutually beneficial: Mountain Shadows would have the benefits of the services of the candidate during training, following which that candidate would return to his or her home company as a trained, certified assisted living administrator.

While the Mentor Program originally targeted our QMRP/Administrators for cross-training, the program can be tailored to accommodate qualified candidates from other backgrounds, ie, nursing home administrators. A case in point is our most recent candidate who is not a QMRP/Administrator but has sufficient background in related areas to make him an excellent candidate for training as an assisted living administrator. In fact, within three to six months of completing the Mentor Program, he will become administrator of Sierra Vista. (The present administrator will turn her full attention to her additional duties as MSI's Director of RCFE Marketing).

Practical experience and guidance in these areas - whether through a program like ours or another avenue with probably similar ingredients - will provide nursing home administrators with an additional "layer" of expertise. In this era of redefining, repositioning and diversification of long-term care services, who among us couldn't use that added layer?

Doug Cook is President and CEO of Mountain Shadows, Inc. in Escondido, CA. For further information, write to Doug Cook at Mountain Shadows, Inc., 2067 W. El Norte Parkway, Escondido, CA 92026, or call (619)-747-3289