​

Everyone has a different story about how they came to work in long term and post-acute care. One thing they all have in common, however, is their passion for what they do.

The stories are as unique as the people. Some feature shows of strength to follow one’s inner compass against great odds, while others show turning points when a team member becomes inspired by another. What is certain is that the individuals that pave their career path in the profession do so with a great deal of commitment and drive, backed up with a strong support system provided by their employers, families, and friends.

LaTecia Rhoden, RN, has a story that spans 23 years. She started at Rehab Select in 1997 with getting her certified nurse assistant (CNA) certification. It was challenging. She was a single mother, and her children were small at the time. 

“My kids went to day care during the day, and I worked first shift,” she says. “I would get home, try to cook, clean up, and get them to bed. And then when they would go to bed, I took as many online classes as I could, and I would take evening classes for the ones that I couldn’t take online.”

Getting her basic courses completed early was key for Rhoden. “When I first graduated high school, I had taken a lot of my basic college courses and got those out of the way,” she says. “I went for education, so I went back and took the courses for nursing.”

But Rhoden’s path wasn’t always so clear. Early on, she had doubts. “During my first week here [at Rehab Select] I thought, ‘Oh no, I’m not going to do this. I can’t do this,’” she says. 

One person changed her mind. “I had this one patient,” says Rhoden. “I was in her room, helping her get dressed, and she told me, ‘You must have been raised by your grandparents.’ And I asked, ‘Why would you say that?’ And she said, ‘Because you are so nice and so respectful. Being here, I can tell you are one of those people who were meant to do this.’”

Rhoden says that comment made her feel good, and from that point on, she tried every day to make it her business to show other patients and residents that kind of respect. “I wanted to let them know that I was there for their best interest, and that I wanted to do everything to make sure that they were all right,” she says.

“I was 19 then, and now I’m 41. I want to make sure that every patient is seen in that manner.” In long term and post-acute care, it is natural to form close relationships with patients and residents, and especially those who don’t “have anyone,” says Rhoden. She points out she is able to see this from different perspectives as a CNA, a licensed practical nurse (LPN), and as a nurse manager.

Rhoden set her sights on continuing to build her clinical skills by becoming an LPN. She waited until her son got old enough to watch her daughter, and then she went back to school. Her sister also moved in with her and helped with the kids. 

She worked different shifts while completing her education and training. While attending class she worked as a charge nurse, starting on the night shift in the long term unit. And then she went back to the day shift and worked on the long term unit. It wasn’t long before she decided to pursue her registered nurse (RN) degree and changed units again to accommodate her class schedule.

Rhoden then worked part-time at Rehab Select for six months, picking up a position at a hospital that would help her get a clinical nurse manager role at Rehab Select later on. She then came back and worked full-time as a staff development nurse, where she did the orientation for all new hires. She was also responsible for nurse training and all the education for staff members. 

She was also put in charge of infection control, reviewing infection rates in the building, arranging meetings with physicians, staff, and state health department staff, communicating about outbreaks when necessary.

Keeping her laser focus on her next move, Rhoden enrolled in Jacksonville State University in Jacksonville, Ala., where she completed her bachelor’s of nursing degree. She took a job as a clinical nurse manager of the rehab unit at Rehab Select. Upon finishing her bachelor’s degree, she enrolled in a nurse practitioner program.

Today, Rhoden has just completed her first year of the program. “It is eight semesters, so I have seven more to go until I have my master’s degree as a nurse practitioner,” she says. “And then I will go an additional four semesters to get a doctorate of nursing.”

Rhoden caught the attention of her colleagues early on. “She’s got great clinical assessment skills,” says Suellen Tobler, administrator at Rehab Select. When an LPN says something is going on with a resident, Rhoden as a nurse manager doesn’t miss a beat. “She goes in already knowing what needs to be looked at,” says Tobler. “She knows she’s got to have the vitals, she looks at their medicines and when they last took them, etc.”

It’s about knowing the residents well enough to know that something is wrong. “Sometimes a resident can’t tell you that something is wrong, but she knows them well enough to know that something is off as soon as she walks in,” says Tobler. “It’s about using her intuition and her skill sets.”

It’s also about character, says Tobler. “She can tell a joke and have a straight face; you think for a second she’s being serious, but then you get it was a joke.” Tobler describes Rhoden as personable and fun, skills she uses while mentoring CNAs. “She herself enjoys mentoring our CNAs, and she helps those going to school to be an LPN,” says Tobler. “She is an awesome teacher and a mentor to a lot of these girls.”

Much like Rhoden, Tobler’s own childhood experiences with the elderly had an effect on her career path. While she attended high school, she volunteered to visit elders in local nursing centers.

Tobler has been a nursing center administrator since 2011, and she started out as a social worker in 2002. Someone at the company asked if she would be interested in going through the company’s administrator in training (AIT) program. Tobler had just finished her master’s degree in counseling, and after some reflection decided to pursue her AIT and stay in long term and post-acute care.

The AIT program at Rehab Select starts out with participants taking a class to be a CNA. “If you can’t take care of somebody, how can you lead a group to take care of people?” says Tobler. That’s the first step. After that, students learn every department. “You work in dietary and housekeeping, for example,” she says. “Eventually you become a floor administrator, where you are in charge of hall, along with a nurse supervisor.”

After going through these steps, the student takes the licensing test and becomes an administrator. Rehab Select’s program usually has anywhere from three to five students participating.

Scholarships are a big part of Rehab Select’s CNA program, says Tobler. “When they start, we encourage CNAs to apply for scholarships. We have a scholarship [toward earning an] LPN degree. So CNAs can use the scholarship to become an LPN.” Then after they get their LPN degree, the company has scholarships to help staff earn their RN degree, she says.

“We are constantly recruiting and promoting talent,” says Tobler. “If we see a CNA who is really good, we ask them, ‘Have you thought about becoming an LPN?’ We encourage it. Our company really encourages advancement within the company.”

Seeing applicants who want to work at Rehab Select, Tobler says that she can recognize who will be a “keeper” early on. “If they come in just looking for a job, you can tell by their demeanor and the way they act that they just want a paycheck,” she says. But one can see the compassion and excitement in the people who really want to work taking care of people, she says.

“Even just taking them down the halls to the office, you can see if they interact with people, with the residents,” says Tobler. “Did they say hello, did they smile, do they really have that caring type of personality?”

The keepers in long term care, those who last, love it, she says. If a person doesn’t love long term care, they will not survive it; they will leave it. 

“There’s no medium, you either like it or you don’t,” she says.

Stacey Merritt Hord said she would never work in long term care. During her early college years, she volunteered at a local nursing center because she thought it would be good for her. 

“They handed me a bunch of letters and said, ‘Go read these to people,’” she says. It was her first time in a nursing center, and she felt uncomfortable trying to communicate with residents who seemed to not follow what she was saying.

Then she saw a resident who made her feel differently. “I remember communicating with a lady who was nonverbal,” she says. “It was a wonderful experience. She communicated with facial expressions, and I was able to read to her, and that was good.”

Soon after, Hord found herself as a speech language pathologist in Hueytown, Ala. She covered two nursing centers, one with 50 beds and one with 150 beds. The smaller facility had a direct connection to her heart, she says. “I went in there, and I was able to connect with the residents and the DON [director of nursing], and people made me feel like I made a difference. 

“I loved working with the residents, and I found a purpose and a calling. I knew it was all about the people.”

Early thoughts about her career path focused on education, since her mother was an educator. “My career path before I became a speech language pathologist was that I wanted to be a teacher,” she says. “And it’s funny now because I am a teacher but in a different kind of way. In Alabama, I fell in love with it, and it changed my life.”

After stints as an administrator, she became a rehab director, and that led to positions at different centers. “I was running therapy at a center, and we had about 25 therapists, and I was in charge of restorative nursing,” Hord says. 

“Then PPS [the prospective payment system] hit, and we had a major workforce reduction.” She continued managing the therapy department and restorative nursing and oversaw and managed two nursing units.

Hord then got a job as an assistant administrator at a small locally owned nursing center company, which she says helped set her on her career path when her boss approached her about being the administrator. 

So she decided to become an AIT while she was pregnant with her first child. She also became a CNA.

“I maintained that for 10 years as an active CNA while I was running centers as a nursing home administrator,” she says. “Along that path, the owner of the company I worked for was very involved with the American Health Care Association/National Center for Assisted Living National Quality Award Program, which is based on the Baldrige Performance Excellence Program.” 

When someone suggested she read about the criteria, she did, and it made sense to her. Since then she has applied the criteria to several aspects of her career path. 

While she enjoyed the multiple roles that came with working at a small center, she realized there was not much room for growth, because turnover was so low. So she left the company and took a job as an administrator with a multifacility company. With the Baldrige criteria on her mind, she soon decided that she wanted to go on a quality path in her career. 

“I set up a job alert on Indeed.com for ‘vice president of quality,’” she says. “I had no idea if the job existed, I just knew that this is my job, though, and it’s what I need to do.”

Six months later, the job alert showed an open position. Hord applied but the company was looking for a candidate with more corporate experience than she had. Another six months passed, and another job alert came up for a vice president of quality position. A recruiter referred her to the senior vice president of quality, and she was later hired.

Working in a corporate office was much different from working in a nursing center. “I was used to walking around the center every day, making laps around the center, talking to staff, looking at linens, checking breakfast,” says Hord. “I went from doing that every morning to walking in an office in Atlanta. So it was very different, a different purpose.” 

Hord was vice president of quality at Sava Senior Care, and from there she was recruited by Golden Living to work as vice president of quality and later vice president of operations. She was then recruited back to Sava Senior Care to be senior vice president of clinical. At that time the company had 175 centers in 19 states, and Hord oversaw nursing, clinical education, quality, electronic health records, nutrition, and more.

Today, Hord continues blazing her career path in a new area of focus for much of the long term and post-acute care world. 

About three months ago, she took a job in Alabama for a population health company. Her current role is chief quality and nursing relations officer for Senior Select Partners. The company has a Medicare advantage plan and an integrated care network called Alabama Select. 

“All this and I started out as a speech therapist,” says Hord. “I’m still licensed as a speech therapist. My path continues to just change based on the needs of our people. Our communities.”

And because she has done just about everything there is to do at nursing centers, Hord bridges a gap, she says. “I’ve mopped the floors, I’ve worked in the kitchen, I’ve been in the billing office. I’ve done a little of everything,” she says. “That’s what I bring to the population health world, I bridge the gap.”

Hord recalls a turn in her career path that didn’t work out. It was when she was an administrator and had her second child. “I decided to step back into the world of speech language pathology to be home more, but I could not do it,” she says. She remained in speech language pathology again for only six months until she decided she had to stop.

“I couldn’t unsee where my head was as an administrator working in a center. I fixed what I needed to fix, but because I was a speech therapist and not the authority, I didn’t necessarily have the authority to put change in place. So then I stepped back, and it wasn’t much longer before I was an administrator again.”

It was then that she realized she was missing something in her role. 

“I wanted to be able to help people,” she says. “I want to be able to have the autonomy to help people. And everybody sees things differently. “

Work-life balance is hard, but it’s vital, says Rhoden. “Even if it’s just setting aside some family time for a Sunday dinner together,” she says. “I make sure my husband and I never miss the opportunity to say we love each other daily even if it’s by phone. My son, although he’s 22 years old now, I make time once a week to enjoy a comedy movie or just have a talk at least weekly. With my 19-year-old daughter, I constantly create opportunities to encourage her; we have mother-daughter talks even if it’s by social media.” 

Rhoden says her family knows her work is a ministry of God and has always been very understanding and supportive in helping to form a balance.

Administrators, DONs, and other staff are naturally driven to make sure residents, their families, and staff are well taken care of, often at the expense of their own families, says Hord. And when it comes to work-life balance, watch out for the culprits known as Mom Guilt and Dad Guilt, which are very real and hard to navigate through.

“Mom Guilt has been especially hard for me over the years,” says Hord. “I was a working mom, and at times a single mom as many of us are. We have responsibility as parents and leaders for our families and also responsibility as primary financial provider for the family. Finding balance is hard.”

Staff work many hours so that their families have security and stability, but sometimes that means time away from their families. This is especially true during events such as an annual or follow-up survey, continuing education meetings, company meetings and training, and crisis management.

With three children, Hord has learned not to beat herself up if she cannot make it to every single event.

“Remind yourself that it is okay to miss some things and rely on your emotional bank account with your family,” she says. “If you have mostly emotional deposits, if you make a withdrawal because you have to work and miss one event, it will be okay,” she says. 

She also recommends using technology to bridge distance. “I have watched a basketball game in my hotel room via FaceTime with my husband,” she says. “I was not physically at the game, but I was still there, and my daughter knew that. Text, call, and FaceTime often. Those things keep everyone connected and engaged, even when you must be away.”

One of the biggest lessons Rhoden has learned is to check herself. “I try not to be judgmental of any facility,” she says. “Because I’ve worked in the hospital, and I’ve worked in a nursing home, and I know how nursing homes get a bad reputation.”

Often she has observed that many people outside the profession tend to believe that patients live in bad conditions in a center. “Now I see that people come to the nursing home in bad conditions,” she says. “And a lot of the times, we’re the ones helping them to get to their best condition.”

Another realization for Rhoden was that a lot of people, including students of health care, know very little about all services offered to patients in long term and post-acute care. When Rhoden does a tour of her facility, she makes sure to show all the departments at Rehab Select. 

“My classmates at Jacksonville in the program with me came to visit and saw some of the stuff we do here,” says Rhoden. “They said, ‘Wow, we didn’t know you all do that.’”

When Rhoden thinks of advice, she thinks of her daughter, who has just graduated from high school and is going into nursing. “I tell her to go ahead and get all her basic courses out of the way,” she says. “I would tell her to work part-time because I worked full-time with school, and that was really hard.”

She credits Rehab Select as being a place of support. “I grew up here,” she says. “What I really appreciate about this company is that they worked around my schedule, and I was able to take on a baylor shift, which is just a weekend. 

“And then when I would have clinicals on the weekend, I was able to swap with someone during the week and cover two of their shifts, and they’d cover my weekend.” Rhoden really appreciated that the company was flexible with her assignments. “So that was great that this company did that, and it worked out great for me,” she says. 

Read more: Climbing Ladders