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Pushing the senior care field


Texas college struggles to entice students into nursing home careers

Boston Globe (07/07/2003)
By Esther M. Bauer

LATONIA, Texas — Despite a nationwide shortage in nursing home managers, Southwest Texas State University is unable to entice many undergraduates to consider a career in caring for the elderly, so it is turning to military retirees and other midlife career-changers to save its academic program.

Although the graduate certificate program at the university, located in San Marcos, is the largest of its kind in the state and the only Texas curriculum accredited by the National Association of Boards of Examiners of Long Term Care Administrators, it enrolled 17 students this spring -- down from 30 in the late 1990s. Still, this crop is better than the crop in the fall 2001, when seven students enrolled.

“We had to get really aggressive about trying to attract career changers,” said Beth Knox, director of the program. “At first, we practically had to look under rocks. It was a matter of keeping the program afloat; other programs throughout Texas were closing.”

The program was saved by a combination of “divine intervention’’ and a curriculum designed to “attract the older student wanting a career change,” she said.

The program includes 15 credit classroom hours and a 1,000-hour internship required by the state. Classes are held on weekends and the graduate level curriculum offers more prestige than the undergraduate curriculum it replaced.

Monte Hengst, 53, an alumnus of Southwest Texas State University's program for long-term care administration, is one of its most successful career-changers. A retired Army major, Hengst is regional vice president of operations for Fountain View Inc., a California-based chain of nursing homes that operates 50 centers across the Southwest. Twenty-two are in Texas.

Hengst oversees management at nine of them, including Oak Manor Nursing Center, one of the largest employers in this south-central Texas town of about 1,375 residents. He also is serving as its onsite administrator until he can fill the vacancy. Hengst’s search for an administrator and the university’s efforts to attract students to the program are two indicators of a looming health care crisis affecting Texas and many other states.

The number of licensed nursing home administrators is declining. Reasons range from strict regulatory environments and litigation and personal liability risks, to low Medicaid reimbursement and the unglamorous nature of the career. In Texas, the 1,000-hour, usually unpaid internship also is cited as an additional deterrent for potential students, compared with most other states where 400 to 600 hours are common.

“'Medicaid reimbursement is a major key; we are expected to take care of a nursing home resident 24 hours a day for less money than you and I would spend in 24 hours to travel, get a night in a midpriced hotel, and eat three meals,” said Marian Upchurch, coordinator of internships for the Southwest Texas State program.

Texas ranks among the lowest-paying states for Medicaid reimbursement. The reimbursement at Oak Manor, where two-thirds of the residents are on Medicaid, could range from $72 to $154 per day.

Litigation also is key, said Lori Proctor, a Houston-based defense attorney for long-term care facilities.

Although a new Texas law caps jury awards against such facilities at $1.5 million plus medical expenses, fear of litigation has dissuaded many individuals from choosing the profession, Proctor said.

Nationally, the administrator shortage is reflected in the decreasing number of candidates taking nursing home licensure exams, a test developed by the National Association of Boards of Examiners and used in every state. Only 2,314 candidates took the exam last year, nearly a 40 percent decline since 1997, according to the Washington-based association. In Texas, a sharp drop in candidates occurred when the state nearly doubled the required number of internship hours. In 1998-’99 an average of 169 candidates took the exam, but the average has dropped to 82 candidates since 2000, when the internship requirement was extended to 1,000 hours.

Although Texas has 1,176 licensed long-term care facilities — second only to California -- and 2,103 licensed administrators, nobody knows how many of the individuals are actually in practice, said Renee Clack, director of enforcement and professional services for Long-Term Care Regulatory, a division of the Texas Department of Human Services.

The decline is most apparent in school enrollments, she added.

'“Let’s just be honest. Nursing facilities have so long been associated with a place you go to die; it’s not something that appeals to young people.”