Effective Leadership in Long Term Care

Introduction

The LTC is constantly changing and so are the training requirements as demanded by federal regulatory agencies. For example, traditional skilled nursing facilities have become more medically complex and specialized. Further, assisted living centers, serving as an alternative to nursing homes, now deliver more care and services while at the same time providing privacy and flexibility to seniors. Senior living facilities focus primarily on providing a safe living environment and convenience services for able-bodied seniors. Community-based organizations focus on home care designed to serve the frail older adults who desire to remain in their homes as they age.

There are several credentialing programs for administrators that are required to hold specific licenses. Licensing requirements vary according to state and healthcare setting. In any case, effective healthcare administrators and staff should be diligent in addressing the following two challenges:

1. Healthcare administrators and management staff must be proactive and diligent in understanding, planning, and executing person-centered change. This requires them to gain comprehensive knowledge of the issue so that they can overcome barriers, objectively analyze their effectiveness, and remain focused on regulatory compliance and personal control.

2. Assisted living administrators and management staff need to successfully balance the sometimes competing priorities of marketing their facility and providing exemplary patient care. Additionally, they need to construct and institutionalize systems primarily focused on effective quality management in order to satisfy-and hopefully exceed- customer expectations. Continually practiced, this skill will help to ensure compliance with regulatory requirements.

The servant-leadership model places emphasis on developing vision (conceptualization, foresight, building community); instituting change (persuasion, commitment to the growth of people); communication (listening); visible presence (empathy, awareness, healing) and stewardship. Positive culture change is ineffective when leadership is limited to the ideas of a controlling minority. When the LTC administrator and management staff act in the capacity of stewardship, they are delivering service rather than demonstrating control over others. It is fundamental that everyone participate to define the purpose and culture of the organization, and then incorporate these elements into the program.

The effective administrator, manager or leader can effectively structure the quality management system to align with common sense goals as opposed to extrinsic requirements or incentives. The successful LTC administrator demonstrates great enthusiasm and passion for delivering exemplary customer service. Of course, this passion drives them far beyond their need to have to comply with specific regulations and standards. As they progress, they continue to grow and develop effective leadership traits and skills. They continuously share in the mission of the facility, which is patient-centered and built around the provision of quality care. They also foster a culture that empowers employees and residents alike, supports innovation, and agility and yields concrete, attainable results.

Developing an Effective Leadership Program

It is prudent for LTC facilities, nursing homes, assisted living homes and home care organizations to allocate resources designated specifically for the development of a systematic and objective leadership development program, including identifying the skill-set(s) needed for managers effectively lead and motivate staff. There are three categories of skills that all LTC administrators must master: technical skills, relational skills and conceptual skills.

Technical skills relate to the ability to perform the job at hand. Low-level managers require more technical skills than do senior managers, because they are in charge of the actual operations Relational skills can also be thought of as interpersonal skills. These are important for administrators of all levels, in order to lead, motivate and develop their team members, as well as to successfully engage in negotiations for resources and influence stakeholders. Conceptual skills include those related to sound judgment, foresight, intuition, creativity, effective planning, problem solving and coordination of the various organizational functions, and are essential for senior managers.

In many instances, LTC leaders and managers are promoted from within the ranks of current employees. Without proper training, these new leaders can demonstrate inexperience or incompetence, marked by poor decision-making and ineffectual business practices. Leadership training should include topics such as work-flow design, conflict resolution, performance evaluation, communication styles and interpersonal skills, problem-solving methodologies, and coaching and mentoring.

Even without a formal leadership position, in a successful LTC environment, all staff should demonstrate a willingness and preparedness to lead under certain circumstances or in certain situations. Interestingly, some individuals are unaware of their leadership potential until the opportunity presents itself. Management can inspire the development of leadership traits in their staff by:

• developing new habits to guide their behavior;
• learning the principles, skills and techniques related to leadership;
• translating new knowledge into meaningful activities and actions.

Addressing Cultural Competency

There have been many incidents of abuse, neglect and mistreatment of residents in LTC facilities over the years. Cultural differences within the facilities can significantly impact the perceived quality of care delivered. As such, development of programs that are sensitive to residents’ needs should focus on identifying and mitigating cultural differences between residents and staff in order to make a positive impact and increase patient satisfaction and staff morale.

It is important for administrators and staff to recognize cultural differences, to understand patient needs and values on an individual level, and to construct an environment that will foster cultural comprehension and respect for differences. The following themes impact cultural sensitivity in LTC facilities: language barriers, cultural assimilation, and patent privacy.

The incorporation of cultural themes, traditions, and customs into LTC activities and events permit residents and staff to experience shared cultures. Administrators and management staff, for example, can offer traditional foods, or allow for dress that conforms to certain rituals or traditional customs, thus encouraging cultural exchange.

Development of a language program or diversity of reading program can be developed. Volunteers from ethnic organizations serving as guest lecturers will certainly help to promote cultural similarities and appreciation. Cultural diversity should be fully embraced as an asset in nursing homes and other LTC facilities, to build the reputation of the facility and encourage cultural acceptance.

Populations with special needs are group of individuals that require assistance for various types of disabilities or developmental delays in behavioral, cognitive, emotional, physical, scholastic, or social skills. Special needs can be classified as physical or mental. Physical disabilities include blindness, chronic illness, congenital disorders, deafness, and orthopedic and traumatic injuries, while mental disabilities includes autism spectrum disorder (ASD), bipolar disorder, depression, dementias including Alzheimer's disease, manias, phobias and schizophrenia. In 1990, the Americans with Disabilities Act (ADA) was signed into law to protect those with special needs against discrimination in public and private spaces such as at work, in school, while using public transportation, and more.