Meeting the Leadership Challenge in Long-Term Care

What You Do Matters

By David Farrell, M.S.W., L.N.H.A., Cathie Brady, M.S., and Barbara Frank, M.P.A.

ISBN 978-1-932529-70-8
338 pages
6 x 9 papercover
© 2011

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What you do really does matter! This book is a must-read for nursing home administrators, directors of nursing, and others in leadership positions in long-term care. It offers practical, commonsense, easy-to-implement approaches that will yield immediate positive results. It also serves as a wake-up call to leaders who doubt their impact and as an affirmation to leaders who struggle daily to do a good job. Let Meeting the Leadership Challenge in Long-Term Care open the door to new possibilities and set your organization on a better course.

Too often long-term care leaders feel overwhelmed by regulatory, financial, and corporate constraints and succumb to the myth that staff turnover is an inevitable cost of doing business. The book debunks this myth, revealing the powerful link between staff satisfaction and successful organizational performance that delivers high quality, high census, good surveys, and a healthy bottom line.

Based on extensive on-the-ground experience with implementing and guiding hundreds of nursing homes through successful organization transformations, the authors offer advice and wisdom that can make your organization more successful, efficient, and stable, whether it is currently struggling or thriving. Just a few of the take-home lessons from this constructive guide include how to

  • Get and keep the right staff, including how to identify “triple crown winners”
  • Reduce staff stress and promote solid teamwork
  • Build a positive chain of leadership that brings out the best in the staff
  • Convert money now spent on turnover into resources to support stability
  • Improve corporate support with an instructive “Stop Doing List”
  • Use quality improvement and culture change practices to achieve high performance
  • Increase staff, family, and resident satisfaction
  • Make a meaningful impact as a leader

Watch these benefits unfold right before your eyes in one of the most unique features of this book: a journal documenting administrator David Farrell’s experience turning around a nursing home that was by all measures doing poorly. Through his difficulties, triumphs, tragedies, and everyday experiences, see how better outcomes are attainable by focusing on leadership practices that make a difference.

Widely recognized as experts in the long-term care field, the authors of Meeting the Leadership Challenge in Long-Term Care combine their years of experience in nursing home leadership and management to create a resource that can transform how long-term care facilities are run.

Format: E-book
e-ISBN 978-1-938870-17-0

E-book available through:

Also available through: Chegg, Baker and Taylor, OverDrive, Garnders, and Follett

About the Authors

The Touchstone of Nursing Home Quality: Managers’ Concerns for Caregivers
(V. Tellis-Nayak and Mary Tellis-Nayak)

A Note to Our Readers

PART I. Leadership

Journal: A Year in the Life of a Nursing Home Administrator
(David J. Farrell)

  1. Leadership: What You Do Matters

PART II. Practices for Stability

  1. Taking Time to Hire Right
  2. From Absenteeism to Attendance
  3. A Positive Chain of Leadership: Supervision
  4. Achieving Staff Stability: A Case Study

PART III. Moving the Flywheel

  1. The How of Change
  2. Moving the Flywheel—Getting Traction
  3. Memo to Corporate
  • Appendix A: What Are Your Financial Incentives?
  • Appendix B: Tracking Absenteeism

A Note About Our Sources

Meeting the Leadership Chal… by on Scribd

David FarrellDavid Farrell, M.S.W., L.N.H.A., is a licensed nursing home administrator who has spent over 30 years in the healthcare profession. He started as a certified nursing assistant in order to earn extra money while attending college. That experience inspired him to pursue a Master’s degree in Social Work with a concentration in gerontology and administration from Boston College. Throughout his career in various leadership positions, David has advocated for patient-centered care using quality improvement practices. A nationally recognized leader in the field, he has traveled the country to deliver inspiring presentations to health care executives at conferences and training events. Currently, David is the Vice President of Subacute Services at Telecare Corporation located in Alameda, California.

Cathie BradyCathie Brady, M.S., has more than thirty years’ experience providing services and advocating for the elderly in a variety of settings, including serving as Executive Director of the Department of Aging Services for the city of Bristol, Connecticut, and for 10 years as the Regional LTC Ombudsman for Eastern Connecticut. Cathie has an M.S. in Organizational Management from Eastern Connecticut State University. She is co-founder (with her co-author Barbara Frank) of B&F Consulting, where she co-produced a Webcast for the Center for Medicare and Medicaid Services on “The How of Change: ‘What a difference management makes!’” Cathie directed the Connecticut Career Ladder and Culture Change Initiative. For 3 years, she worked with the New Orleans Nursing Home Staffing Project, which helped nursing homes recover from the aftermath of Hurricane Katrina. She co-produced a film with Louisiana Public Broadcasting called The Big Uneasy: Katrina’s Unsung Heroes. Cathie is a frequent speaker at state and national conferences and specializes in leadership development at all levels of an organization to assist nursing homes interested in being better places to live and work.

Barbara FrankBarbara Frank, M.P.A., began her career in long-term care by serving 16 years at the National Citizens’ Coalition for Nursing Home Reform in Washington, D.C., where she facilitated the Campaign for Quality, through which providers, consumers, practitioners, and regulators developed consensus on what became the OBRA 1987 legislation that overhauled nursing home regulations to require more individualized care. She has served as state ombudsman for Connecticut. Barbara facilitated the first Pioneer Network gathering in 1997, and in 2005, she facilitated the St. Louis Accord, a national gathering of providers, consumers, regulators, and quality improvement organizations that came together to improve clinical outcomes through culture change. Co-founder (with her colleague, Cathie Brady) of B&F Consulting, she works directly with individual nursing homes to improve their performance measures through workforce retention and culture change. Barbara led a team in the New Orleans Nursing Home Staffing Project, which helped nursing homes recover from the aftermath of Hurricane Katrina. She co-produced a film with Louisiana Public Broadcasting called The Big Uneasy: Katrina’s Unsung Heroes. She co-authored Nursing Homes: Getting Good Care There (1996) and has written extensively on efforts to improve care and outcomes in nursing homes. Barbara has an M.P.A. from the Kennedy School of Government.

11 reviews for Meeting the Leadership Challenge in Long-Term Care

  1. Administrator

    “This book lays it out loud and clear, Our leadership matters! The book travels down the road of daily nursing home life with dignity, respect, accountability, measurement and relationships full of humanity. It then frames out the practices and values that can make this the new reality of nursing homes. With great respect to Farrell, Brady and Frank who have walked this road, thank you for showing us the way.”
    Anna Ortigara, RN, MS, FAAN THE GREEN HOUSE Project

  2. Administrator

    “It is refreshing to read a book where the authors provide numerous pragmatic real-life examples of what it means for leaders of health care organizations to “walk the walk” and that “actions speak louder than words”. The authors show leaders how putting the resident and staff first will help you better achieve the goals of the organization. ”
    David R Gifford, MD, MPH, Director, Rhode Island Department of Health, Clinical Associate Professor of Medicine & Community Health, Warren Alpert Medical School of Brown University

  3. Administrator

    “We have numerous and substantial challenges in long-term care. Top managers of long-term care facilities are tasked with dealing with these challenges on a daily basis. Many suggestions and proposals exist to meet these challenges – but to be effective top management leadership is ‘the’ essential ingredient. In my opinion, the authors of this text aptly assert that what these top managers do really does matter!

    This text provides an essential resource for anyone interested in long-term care. I found the material to provide an exemplary framework for making progress. The information provided is a practical, and welcome, synthesis of what we know in other industries and how this applies to long-term care. I think this text will have a powerful influence.”
    Nicholas G. Castle, Ph.D., M.H.A., AGSF, Professor, Health Policy and Management, University of Pittsburgh

  4. Administrator

    Meeting the Leadership Challenge in Long-Term Care offers fresh insights about the critical role that leadership plays in improving workforce performance, and thereby, driving organizations toward excellence. The book provides descriptive information about the challenges that administrators face based on first-hand experiences grounded in actual case studies. This book applies core constructs about effective leadership to the context of performance improvement in long-term care and offers practical and actionable advice to owners, operators, researchers or others seeking effective strategies to improve service delivery.”
    Leslie A. Grant, Ph.D., Director, Center for Aging Services Management, University of Minnesota

  5. Administrator

    “David Farrell’s journal is gripping, compelling, sensitive and realistic. His and his co-author’s analysis of nursing home challenges and the ways to address them are compassionate and full of plain old common-sense. The authors have issued a serious call-to-action to every nursing home administrator and director of nursing. Should be required reading!”
    Carol Benner, Sc. M., National Director, Advancing Excellence in America’s Nursing Homes Campaign

  6. Administrator

    “Historically money has been an issue for nursing homes. This book provides a prescription for spending those scarce dollars differently and transforming the bottom line for residents, staff and corporations. Long-term care nurse leaders, who bear the burden of the present regulatory and corporate approach, will throw off those shackles by following the advice of these non-nurses, who have been able to look from outside the system, identify the challenges, and provide step-by-step solutions, based on real experience, to stabilizing staff. This book represents the intersection of nursing and culture change. Read it. Do it with, not for, your staff.”
    Sarah Burger, RN,C, MPH, FAAN, Gerontological Nurse Consultant

  7. Administrator

    “This book should be required reading for all who work in care settings and the text used for leadership and health care administration courses in colleges. The collective experience of the authors brings together the best of the best in terms of practical guidance and advice for being successful in many areas by providing meaningful lives for residents, meaningful work for staff, and financial stability for the care setting. Farrell’s personal journal is as compelling as a good novel, except it is nonfiction! You want to laugh, cry, scream and shout halleluiah.”
    Joanne Rader, RN, BSN, MN, Nurse Consultant, Rader Consulting

  8. Administrator

    “David, Barbara and Cathie have provided compelling and personal insight into the significance of today’s long-term care leadership. Their experiences and research clearly support the call for a new leadership model and spirit of service needed immediately to engage and support the workforce serving our elders. With the aging of baby-boomers, there is no time like the present to create a more effective model of leadership. This book serves as a roadmap that would be excellent in training new Administrators and revitalizing all long-term care leaders.”
    Jeff Jerebeker, CEO/ President, Pinon Manager, Board Member Pioneer Network

  9. Administrator

    “Long-term care is crying for leadership at all levels — and Cathie Brady, Barbara Frank and David Farrell know that the key to stabilizing your workforce is to Put the Person First! The authors — whom I have known and worked with for going on two decades — are leading voices in a growing national movement to change the culture of long-term care. They have drawn
    from the best sources and their own experiences to guide you. I predict the pages of this toolbox will be dog-eared from use. No more excuses! This works!”
    Rose Marie Fagan, Co-Founder and Founding Executive Director, Pioneer Network

  10. Administrator

    “Insightful, hopeful, informative and inspiring……..the authors certainly understand their intended audience; what is most needed and how to deliver it with humor and skill. Well thought out, well written and highly useful.”
    Barbara Bowers, PhD, RN, Helen Denne Schulte Professor, School of Nursing, University of Wisconsin-Madison

  11. Administrator

    “I was so excited to see this new book by my friends and colleagues Farrell, Brady and Frank. Nursing homes leaders from the bedside to the board room need a “field guide” to help them make critical decisions and this book fills the gap. The combination of journal writing and documentation of real world experiences have given life to the challenges that leaders face and the opportunities they have to “do the right thing”–from hiring right to ensuring long-term stability. What a terrific legacy for the late Dr. Susan Eaton who helped us to understand the role of leadership and management in making the nursing home a great place to live and work!”
    Robyn Stone, DrPH, Senior Vice President for Research, LeadingAge, Washington, DC.

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