Opinion: Why Paying Administrators-in-Training Makes Sense (and How to Pay for It)

Administrator-in-Training (AIT) programs are an essential component of leadership development in the long-term care (LTC) sector and a requirement, in most states, as a prerequisite to sitting for licensure exams. These structured learning opportunities immerse aspiring administrators in the daily operations of skilled nursing and assisted living facilities, providing comprehensive exposure to budgeting, staffing, regulatory compliance, and quality initiatives. Despite the substantial responsibilities assigned to trainees, many AIT programs remain unpaid—an arrangement that can not only impose financial hardship on participants but also undermine the LTC industry’s leadership pipeline. Below is a professional analysis of why these programs warrant fair compensation, supported by empirical research and real-world data.

Recognizing the Tangible Contributions of AITs

Substantive Organizational Responsibilities Rather than purely shadowing licensed administrators, AITs frequently assist with resident chart reviews, compliance audits, and staff scheduling (American College of Health Care Administrators [ACHCA], 2020). Their involvement addresses genuine operational needs and often parallels tasks conducted by fully compensated administrative staff.

Innovation and Problem-Solving Trainees often bring new perspectives to entrenched challenges. By collaborating with established leaders, they propose solutions that can enhance operational workflows and policy adherence (Castle & Lin, 2010). Offering compensation for these tangible contributions reflects the organizational value that AITs provide.

Broadening Access to a Skilled and Diverse Talent Pool

Mitigating Financial Barriers Unpaid AIT programs can deter individuals who cannot forgo a regular income during what may be an extended training period (U.S. Department of Labor [DOL], 2018). Recent graduates also have a narrow window before their student loan payments begin, generally 6 months after graduation, creating a new barrier. Providing compensation fosters a more inclusive recruitment process, attracting candidates from varied socioeconomic backgrounds who might otherwise be unable to participate.

Responding to Market Demands The Bureau of Labor Statistics (BLS) projects a 28 percent growth in employment for medical and health services managers from 2021 to 2031, a rate significantly above the national average (BLS, 2022). In this competitive environment, offering remuneration to AITs can strengthen LTC’s appeal, ensuring that high-quality candidates choose to pursue administrative roles within the sector.

Strengthening Retention and Organizational Stability

Cultivating Loyalty and Commitment Facilities investing in their trainees foster greater loyalty and long-term engagement. By covering living expenses or providing a stipend, organizations signal confidence in trainees’ potential, thereby enhancing the likelihood that they will remain post-licensure (Donoghue & Castle, 2009).

Reducing Turnover-Related Disruptions Leadership continuity is critical in long-term care, where staff and residents often develop trusting relationships with facility administrators. Unpaid AIT programs may inadvertently raise the risk of trainees seeking immediate paid positions elsewhere. Conversely, fair compensation helps solidify stability in leadership structures and minimize the disruptions associated with frequent turnover.

Elevating Standards of Professionalism and Quality

Accountability and Performance Paid positions typically come with higher expectations and more rigorous performance metrics. In this sense, compensating AITs aligns their role with that of other healthcare professionals, reinforcing a culture of accountability and results-driven practice (Castle & Lin, 2010).

Parity with Comparable Healthcare Residencies In other health-related fields, such as hospital administration or clinical fellowships, compensation during training is standard. Adopting a similar model in long-term care underlines the sector’s commitment to professional equity and underscores the indispensable nature of LTC administrators (ACHCA, 2020).

Preparing for Future Demands in Long-Term Care

Growing Need for Experienced Leaders As the population ages, LTC facilities require capable administrators who can address complex resident needs, regulatory requirements, and resource constraints. Paid AIT programs enable trainees to dedicate their full attention to developing competencies, rather than seeking additional employment to fund their training (BLS, 2022).

Enhancing Organizational Competitiveness Facilities that offer paid AIT placements position themselves as forward-thinking and supportive employers. This advantage can attract particularly motivated candidates who might otherwise consider alternative careers in the broader healthcare sector.

Ensuring Compliance with Evolving Labor Guidelines

Alignment with Labor Regulations The U.S. Department of Labor offers clear guidance regarding internship and training programs (DOL, 2018). When trainees perform tasks that substantially benefit an organization, they generally should be paid. Providing fair compensation helps avoid potential legal challenges and maintains transparent labor practices.

Promoting Ethical Standards Equitable compensation reinforces a culture of professionalism and integrity in LTC. By formally acknowledging the responsibilities and contributions of AITs, facilities uphold ethical best practices that further strengthen public trust and institutional reputation (ACHCA, 2020).

Potential Funding Sources

Many organizations, even when motivated to compensate AITs, may find themselves unable to fund another leader salary within existing budgets. Numerous potential, external sources exist for those with a little creativity.

1. Government-Funded Grants: Apply for federal, state, or local grants (e.g., Workforce Innovation and Opportunity Act, state workforce development funds) specifically aimed at healthcare workforce training.
2. Medicaid Reinvestment and Wage Pass-Through Programs: In states that channel a portion of Medicaid reimbursements toward staffing or training, use these dedicated funds to support AIT compensation.
3. CMP (Civil Monetary Penalties) Funds: Submit proposals to use fines collected from non-compliant facilities (administered by CMS and state agencies) for resident-focused quality initiatives—potentially including AIT program costs.
4. Public-Private Partnerships: Collaborate with academic institutions, healthcare suppliers, or local businesses. Such partnerships may involve shared grants, sponsorships, or in-kind resources to fund AIT salaries.
5. Professional Organization Scholarships/Programs: Tap into scholarships, stipends, or grants offered by groups like the American College of Health Care Administrators (ACHCA) or LeadingAge to underwrite AIT compensation.
6. Corporate and Philanthropic Sponsorships: Seek funding from foundations, charities, or healthcare-related corporations interested in promoting workforce development; arrange sponsorships to offset AIT expenses.
7. Regional Consortium or Multi-Facility Cost-Sharing: Multiple LTC facilities pool resources to pay for a shared AIT program, reducing the per-facility financial burden while expanding collective benefit.
8. In-Kind Contributions: Offer housing, meals, or travel stipends in lieu of full salaries, or split costs between the facility and a partner organization to make AIT positions more sustainable.
9. Community Fundraising or Crowdfunding: Engage local nonprofits or use online platforms to raise funds for AIT salaries, highlighting the impact on resident care and community well-being.Administrator-in-Training programs are central to nurturing the next generation of long-term care leaders. In many instances, however, these programs impose real professional responsibilities on trainees without fair remuneration. Such an approach can undermine both the trainees’ financial stability and the broader mission of attracting and developing highly skilled administrators.

By compensating AITs, facilities expand access to a more diverse pool of talent, minimize turnover, and encourage a greater commitment to excellence. Given the growing complexity of long-term care—driven by demographic shifts and evolving healthcare standards—investing in AITs is a strategic imperative. In recognizing both the ethical and practical dimensions of fair payment, organizations affirm their commitment to operational resilience, staff morale, and, ultimately, the well-being of the residents they serve.

References

American College of Health Care Administrators (ACHCA). (2020). Administrator-in-training program guidelines. Retrieved from https://www.achca.org

Bureau of Labor Statistics. (2022). Occupational outlook handbook: Medical and health services managers. U.S. Department of Labor.

Castle, N. G., & Lin, M. (2010). Top management turnover and quality in nursing homes. Health Care Management Review, 35(2), 161–174.

Donoghue, C., & Castle, N. G. (2009). Leadership stability in nursing homes: The influence of top management turnover on staff turnover and quality. The Gerontologist, 49(5), 629–638.

U.S. Department of Labor (DOL). (2018). Fact Sheet #71: Internship programs under the Fair Labor Standards Act. Retrieved from https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/whdfs71.pdf