Another assault on education

Nursing home administrators edition

Bad legislation in Oklahoma is like a Russian nesting doll. Just when you think you’ve reached the last one, there’s another … and another … and another.

Which brings us to House Bill 1551, a blip on the otherwise polluted legislative horizon this session—as of this writing it’s already passed both chambers and is waiting for a conference to iron out the differences between the two versions. If signed into law, the Oklahoma State Board of Examiners for Long-Term Care Administrators (OSBELTCA) would be prohibited from requiring advanced degrees for those who operate the state’s nursing homes if they have 10 years of relevant experience.

Think about that for second. An administrator in a long-term nursing facility would be exempt from holding an advanced degree if he or she could demonstrate 10 years experience in such a facility. 

Let’s stop there.

Someone want to tell me who’s going to define what “experience” is in such cases—legislators, the administrators themselves, patients? And would it be limited to administrative experience, or would budgetary experience in the facility count, as well? How about public relations and marketing? Janitorial, perhaps? To put this another way: you want your neurosurgeon to have experience in brain surgery procedures or actually be certifiably trained and licensed—to have a mastery of standardized protocols—before he’s allowed to root around in your frontal lobe.

Admittedly, when you consider the legislature’s actions on HB 2177, which would bypass the Oklahoma Supreme Court decision on the Ten Commandments and allow them to be placed wherever legislators wanted to put them; its passage of HB 1482, which would rescind a state question already approved by voters on reclassifying some drug offenses; its whoring itself out to the payday loan industry on HB 1913, thankfully vetoed by Governor Fallin; its unconscionable consideration of HB 1270, which would burden even further those receiving state healthcare; and its inexplicable backing of HB 2132, which would allow Oklahoma municipalities to set up fiefdoms that would be beyond the purview of state law—HB 1551 is far from the worst thing out there, but it is a shining example of misguided and myopic legislative meddling. 

Who thinks of things like this, anyway?

These two: Republican State Senator Michael Bergstrom (District 1) and Republican State Representative George Faught (District 14). Faught, if you’re scoring at home—as we always suggest you do—is the same legislating canker sore who authored HB 1549, a horrendous detritus-filled pustule, which would prohibit women from seeking an abortion in the case of a genetic abnormality.

Faught also believes rape could be God’s will.

“Well, you know, if you read the Bible, there’s actually a couple circumstances where that happened,” Faught began. “The Lord uses all circumstances. I mean, you can go down that path, but it’s a reality unfortunately,” he said.

How do you not question this guy’s motivation on any bill to which he’s connected?

Anyway, here’s the money shot.

The Board shall not include a requirement for completion of a four-year degree for licensing or certification requirements for nursing facility administrators if such individuals possess ten years of experience at a nursing facility.

Hard to imagine what the motivation is here in lowering the bar on educational standards unless you believe, as seems to be their talking point, that there’s a shortage of such administrators in Oklahoma due to such requirements and this will allow for more of them.

Jim Jakubovitz, CEO/NHA of the Tulsa Jewish Retirement and Health Center here in Tulsa at Zarrow Pointe, parks this one about six rows deep.

“It just totally doesn’t hold water. And it’s been proved ad-nauseam to the contrary. There’s more than 700 nursing home administrators in Oklahoma and only 350 nursing facilities that require an administrator—and a licensed administrator is statutorily allowed to run three nursing homes if they’re in a 50-mile radius,” Jakubovitz said. 

Jakubovitz (full disclosure here: I’ve know him for years and my grandmother stayed at Zarrow 35 years ago) dismantles the argument that loosening the regulations will be good for the industry or that there’s a shortage of administrators because of the present guidelines. 

“Most professions have some sort of licensing body,” Jakubovitz explained. “Medical boards decide who physicians are, what they have to do, nurses have a board that determines whether you’re an RN or LPN, even cosmetology has a board that determines what the requirements are before you can cut hair. The Nursing Home Administrators Board is no different.”

Fifteen years ago, he said, OSBELTCA added a four-year degree requirement before one could become a nursing home administrator. About six years ago, the board created a certified assistant administrator position for people who had been in the industry for a while.

Now?

“The board has documented proof about why the care has been improved as a result of educating administrators. People came to the board with the proposed change to remove the education requirement and the board turned them down.”

And that’s when they went the legislative route. 

Here’s what the legislation says:

From Section One. 

No license or certification shall be issued to a person as a long-term care administrator unless:

1. The person shall have submitted evidence satisfactory to the Board that the person is:

a. not less than twenty-one (21) years of age, and

b. of reputable and responsible character; and

2. The person shall have submitted evidence satisfactory to the Board of the person’s ability to supervise the defined facility type in which he or she is licensed or certified to serve as a long-term care administrator.

Nice, huh? “Over twenty-one and … of reputable character.” Bartenders have higher standards.

All right, so what of the claim that facilities, especially in rural parts of the state, are closing? 

“They’re closing, yes,” says Jakubovitz, but not because there’s an educational requirement on administrators—they’re closing because there’s only 10 people in the facilities. And you can’t have an efficient business with 10 clients.”

More to the point, who lowers the bar in any profession, much less medical care, on the dubious assertion that you have an industry-wide shortage because of it? If you’re a hospital and need a neurosurgeon, you don’t hire a gastroenterologist because he’s the only one who’s available and will relocate to your little town. 

Jakubovitz admits he’s not objective here—and clearly he’s not—but for the love of Richard Webber, why are we having this conversation and why are elected legislators, many of whom wouldn’t know the difference between a breathing tube and a Shop-Vac, trying to strong-arm a professional licensing body to loosen its standards? Do they hate government regulation so much they can’t distinguish anymore between the sound and the
ridiculous?

Don’t answer that.

This one’s sound and should be left alone.

“This doesn’t belong on the legislators,” Jakubovitz told me. “This is an industry issue. The industry has spoken and it wants more education. And you can’t go back and forth and get into a pissing match about who’s qualified, who’s not. It’s not the legislators who should make that call.”

I remind him that he—not the GOP—is advocating for getting government out of the industry. 

“Yeah, I am, in this particular case. Every single profession has a licensing body,” he says again, “and they get to make the rules for their profession without a bunch of lawyers and representatives saying, ‘We know more about the nursing home administrator role than you and we don’t care what you think and we’re going to dictate the rules and requirements are.’ I mean, that’s just arrogant.”

No, that’s Oklahoma.

For more from Barry, read his article on the arrogant and ungrateful Republican Representative of Oklahoma’s 2nd District, Markwayne Mullin.