More long-term care leaders say they’re being well paid for the work they do, but a higher salary still remains the No. 1 item on their work satisfaction wishlist.
That’s according to 723 administrators, directors of nursing, assistants and other topline staff who responded to the 2024 McKnight’s Mood of the Market survey.
Administrators were the most satisfied of the group, with two-thirds (66.4%) saying they were “very well paid” or “somewhat well paid.” That’s compared to 57.4% among nurse leaders.
Among all respondents in this year’s survey, 62.2% reported positive feelings about their pay — an 8 percentage point gain over last year’s 54% rate.
Correspondingly, the share saying they were “not so well paid” or “not at all well paid” dropped to 11.3% this year, down from 17.5% in 2023.
Now in its sixth year, the survey was distributed by email from late July to mid-August.
So why the big shifts? It comes down to changing culture and a changing economy, experts told McKnight’s Long-Term Care News.
The allure of remote jobs and COVID-era pay in other sectors put a damper on how those in long-term care viewed their salaries and workplace demand for several years, according to Esther Shain, a skilled nursing recruiter in the New York tri-state area.
But an economic slowdown fueled by high interest rates — and the drying up of jobs in other markets where people appeared to being cashing in so easily — has ushered in a reset, she said.
“After the pandemic, so many people were building all of these interesting businesses and working remotely and getting paid crazy money,” said Shain, director of recruitment for Alvin Kahn & Associates, in an interview with McKnight’s last week. “In that honeymoon period, for a good two years … people [in other jobs] were getting crazy salaries. When you’re an administrator and you’re working so hard and you’re watching, literally, people make money overnight from all of these other things, pay satisfaction is obviously not going to be No. 1 in nursing homes.”
But with skilled nursing’s “recession-proof” nature, she said she now often has unemployed workers calling from real estate, tech businesses and other sectors looking for a way in.
There isn’t necessarily always going to be one, she says, with fewer vacancies in some of the top buildings or regional leadership roles she recruits for. That hews with a national trend, as the Bureau of Labor Statistics reported last week that July ended with the fewest job openings in the US labor market since January 2021.
Fewer options, it seems, makes the jobs and the paychecks that current nursing home leaders have more appealing, said Shain, who illustrated the point in an entertaining LinkedIn post last month.
Money dominates, still
Nursing home leaders do continue to receive healthy raises, even if not on par with some of the spikes seen during the pandemic’s worst years. The 47th Annual Nursing Home Salary & Benefits published in August found administrators enjoyed another bump of 3.8%, to an average salary of $135,744, while DONs’ average pay jumped 3.75% to hit $117,754.
“When some folks were getting 5% increases, sometimes that was going to the non-exempt employees and these people were kind of getting the short end of the stick because there just wasn’t as much money to pay the higher-end people,” said Matt Leach, principal and senior compensation consultant with Total Compensation Solutions.
Now, even modest raises given to building leaders may be viewed more favorably, given a steady decline in the US inflation rate since March.
“When inflation is at 5 or 6%, even if you’re getting 4 to 5%, you’re not even treading water,” Leach added. “Now I think that at least people’s perception of inflation, of those we talk to, it seems like it has at least moderated so that you’re actually getting ahead.”
Mark Prifogle is vice president of operations at BHI Senior Living, with 10 life plan communities in Indiana, Michigan and Ohio. He oversees the Indiana market, where he says labor demands have “eased considerably.”
Administrators, in particular, may find their pay more fair now than a year or two ago, both because providers have done a good job of increasing pay for building leaders and because fewer nursing colleagues are out-earning them thanks to extensive overtime availability.
“First their staff were getting double-digit increases, and then all of the sudden, nurses are working as much as they want,” said Prifogle, chair-elect of the American College of Health Care Administrators. “We’ve had to be very deliberate about addressing that, and some organizations did it better than others.”
It’s also critical that owners and operators stay ahead of trends as large-scale raises start to dissipate, Prifogle told McKnight’s.
“We live in a world of finite resources. That kind of cadence isn’t going to last forever,” he said.
How to make them happy
Even with more than 65% of leaders thinking they’re well paid, there still appears to be room for improvement.
Some 44.4% of all respondents said higher salary is one of two changes that would most improve their job satisfaction.
Pay has topped that wishlist four out of six years the survey has been conducted, with notable exceptions for “more staff” in 2021 and 2022 — when more than 400,000 workers had left long-term care due to COVID-19’s effects.
But where it has often been chosen by more than half of respondents, salary was not just a less cited option this year; the gap between it and other factors narrowed.
Among all respondents, more staff remains the No. 2 choice at 31.5%, but better health insurance and benefits came in a close third at 30.7%. Among administrators, benefits were the No. 2 selected option at 31.2%, with more staff just behind that at 30.3%.
Prifogle said that reflects the demographics of workers in those roles, who often have their own health concerns or growing families to care for. When BHI reconsidered its health insurance options, it maintained a PPO but also added a lower-premium plan that might make sense for other employees. The company also makes those benefits available to staff working as little as 30 hours weekly, which is seen as a “huge bonus,” Prifogle said.
That’s a reflection of the company’s efforts to be as flexible as possible with scheduling, which 13.7% of survey respondents said would improve their job satisfaction.
Making valuable contributions
Despite wanting more from their employers, most survey respondents (78.6%) continue to feel their contributions at work are valued by their colleagues “a great deal” or “a moderate amount.” That’s down slightly from 2023’s combined share of 81.9%.
Still, nearly a quarter of nurse leaders told McKnight’s their contributions were only valued “a little.”
Administrators also outrated nurses when it came to opportunities their companies provide to advance their careers. While the overall share calling their opportunities “excellent” nearly doubled for 2024, up to 29.1% from 15.8% in 2023, nearly one-third (32.8%) still described opportunities as “poor” or “fair” this year. Among nurses, an even higher 34.3% rated advancement opportunities “poor” or “fair” this year
That paints a “pathetic” picture of the sector, said Denise Boudreau, president of Drive, which helps senior living and healthcare companies address workplace culture.
She suggested more providers consider how they can give their top building leaders more opportunities, even if it’s through mentorship or additional training or certification, rather than a promotion that requires them to move to another site.
“Could I grow in some way in my leadership role?” Boudreau mused. “Direct care staff, some of them say, ‘I want to stay a nursing assistant. I don’t want to be a nurse.’ But they become an expert in onboarding other people as a peer mentor or they become an expert in dementia. We could do the same thing for administrators and directors of nursing.”
This is the second article in a four-part series. Later this week, McKnight’s examines workplace flexibility and concerns about increasing regulatory burden. In Part 1, we explored long-term care’s quitting problem and its apparent slowdown.
