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Assisted Living Administrators
Profile of Assisted Living Administrators and Directors

Assisted living administrators

The Administrator of an assisted living facility has the greatest capacity to influence organizational culture and commitment, and quality of care given.

Each state regulates assisted living communities with little federal involvement or universal policies to adhere to. Because of the substantial variation, assisted living facilities come in different sizes, ownership, administrative philosophy, resident characteristics, disability levels, staff training, and employee job expectations.

A study conducted by the Design and Operation of the 2010 National Survey of Residential Care Facilities Program for the Department of Health and Human Services Centers for Disease Control and Prevention gained data on assisted living facilities that researchers and policymakers can apply to a wide variety of Long Term Care issues.

The Board of Directors for assisted living designates the person(s) legally responsible for the policies and procedures associated with the management and operation of the facility. This governing body, the Board of Directors, appoints the administrator who is responsible for the day-to-day management of the facility.

The Administrator's Role

  • Planning
  • Organizing
  • Staffing
  • Directing
  • Marketing
  • Budgeting

In larger assisted living homes, administrators hire department heads to oversee responsibilities that run the day-to-day operations. While the smaller homes depend solely on the administrator.

Common criticisms of facility administrators include lack of training in areas of bookkeeping, records management, and the interpretation and implementation of regulations.

In a survey of assisted living facility administrators shows that 83% of them earned training and certification in their field.

Does the director or administrator have a certificate or license related to managing facilities for older people?
Responses of don't know (< 1%), and not ascertained (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

Required Training

Three-quarters of the unlicensed staff personnel require some type of training or orientation which lasts between 1 and 16 hours; the remainder received on-the-job training or combination of pre-service and job training.

In most states the education requirements for the director or administrator role is out-dated. Yet in today's modern and larger residential care homes, it's the executive committees who warrant higher standards for their facilities and require higher education and training.

Despite the fact that training is a key component to quality assurance, ALF administrators and other staff are insufficiently trained to handle the growing social and medical needs of residents.

In the graph below, the highest grade or level of education the director or administrator completed are: Less than college - 16%; Some college - 22%, College graduate - 44%, and Post Graduate - 18%.

What is the highest grade or level of education the director or administrator completed?
Responses of don't know (< 1%), and not ascertained (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

Turnover

Changes in consumer preferences, growing quality expectations, human resource limitations, stressed finances, and competitive marketplaces have raised the bar for health and aging services administration.

These changes transition the ALF culture from regulatory-driven to person-centered values and principles. The good news is that by adopting a resident-centered care philosophy changes ALF leadership quality for the better, which has at its core a customer-driven focus.

The changing culture from the reactive, regulatory-driven profession takes extra effort and perseverance. Center for Medicaid and Medicare Services and the Quality Improvement organizations associate the high turnover of administrators and directors of nursing services with slow adoption to a quality service environment. These problems reflect the need for more effective leadership to allocate the necessary time and energy to embrace change.

In the following graph, most administrators remain at the same facility for 10 years or more, while 33% stayed less than 10 years.

How long, in total, have you worked at this and other residential care facilities or nursing homes in an administrative position (in years)?
Responses of legitimate skip (13%), and not ascertained (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

And that same group worked at the same facility and/or another residential care facility or nursing home in an administrative position for 25 plus years.

How long has the highest ranking administrator worked at this facility as the administrator or director (in years)? Please include the total time worked even if s/he has left the facility and then returned.
Responses of not ascertained (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

The research on staff turnover usually focuses on certified nurse assistants, professional caregivers and the non-professional staff because they give the most care. But a research study (Castle & Shugarman, 2005) shows that management turnover has a "destabilizing influence within the facility" (p. 187), but it can also alter employees' commitment to the workplace and erode quality of care. The longer tenure an administrator has within a facility, the better he or she can connect with staff and promote employee commitment.

Assisted Living Key Staff and Roles

Key staff at assisted living communities consist of Executive Director, Medical Director and Medical staff, Food and Nutrition staff, Activity Director, Administrators, and other staff members who help to create a nurturing environment. The size of the residence affects staff composition.

Administrators

Assisted living administrators and management staff begin to balance their focus on marketing and customer service with the need to develop and institutionalize effective quality management systems that consistently meet and exceed the expectations of the customers.

The changing effective quality management embraces goals and approaches to include:

  • A culture that portrays a sense of caring
  • Compassionate perspective for the needs of others
  • High touch, labor intensive environment
  • An extensive focus to lessen the barriers of high regulatory-driven organizations to a people-centric one

The 2010 National Survey of Residential Care Facilities Program for the Department of Health and Human Services Centers for Disease Control and Prevention also gathered demographic data on assisted living facilities and found that most administrators are female (76%), age 40 to 59 (59%), and Caucasian (70%). See the three graphs below. It's estimated that 5% of directors or administrators are of Hispanic, Latino, or Spanish origin, 12% are of African-American heritage, 16% are of Asian heritage, and 4% are Hawaiian or Alaskan.

What is the gender of the director or administrator?
Responses of don't know (< 1%), and not ascertained (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)
What is the age of the director or administrator?
Responses of refusal (< 1%), don't know (< 1%), and not ascertained (< 1%) and are not shown.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)
Which of these groups best describes the director or administrator?

Responses may include more than one category

The data in this chart has been rounded and simplified.
Source: 2010 CDC National Survey of Residential Care Facilities Survey (Facility Responses)

Executive Director

Staff and Roles
Staff and Roles

The Executive Director of an assisted living residence oversees all aspects of the life of the residents, ranging from medical needs to overseeing maintenance and upkeep of the facility.

The executive director is often the face of the residence, involved in everything from showing the facility to prospective residents to hiring staff. Ideally, the Executive Director has a background in Person-Centered Care and able to best facilitate an enriching environment for the residents. In small residences, the owner may serve as the Executive Director.

Activities Director

Activities Director - organizes and leads a variety of events to both entertain residents and keep them healthy and fit: in-house activities like exercise classes to trips to town for shopping, or the park for nature walks.

Another key role of an activity director is to find activities that residents want to do. The best one brings enthusiasm and knows how to keep residents engaged, happy and well-adjusted.

Medical Staff and Medical Director

Depending on the level of care given at the ALF, the medical staff oversees the healthcare activities. Medical Directors are usually nurse practitioners or other advanced practice skilled nurses and oversee a staff that consists of registered nurses, licensed practical nurses, nurses' aides and medical technicians.

Food and Nutrition Staff

Food ranks right up with health and fitness. The food and nutrition staff ensures residence eat healthy, nutritious food. They keep track of the dietary requirements based on preference, religion and medical needs of all residents.

In some cases, the residential homes contract out for the food planning and preparation rather than hiring a professional chef or food service. Each have a dedicated nutritionist or culinary director on staff.

Requirements for Background Checks on Staff Members

There are no federal laws governing the need for background checks for the staff of assisted living residences; however, a number of states require that checks before hiring. As of March 2012, Alaska, Florida, Kentucky, Michigan, New Hampshire, New Mexico, Oklahoma, and Rhode Island require background checks, while the state of Washington requires background checks for staff hired after January 1, 2012.

Most facilities run background checks on employees even though it is not required by law.

Carol Marak
Carol Marak

After seven years of helping her aging parents, Carol Marak has become a dedicated senior care writer. Since 2007, she has been doing the research to find answers to common concerns: housing, aging and health, staying safe and independent, and planning long-term.