To make effective decisions for its organization, it is important that any board includes a complement of skills among its members that meet the needs of the organization and its stakeholders at any given time. These needs may be unique to each organization and its sector. For these reasons, we were curious to learn if elderly care expertise and experience are common skills found among long-term care organization board members. 70% of our survey participants (n=46) reported that their board has at least one member with that expertise, and 64% reported at least two members, indicating that most respondents identified representation of skills in elderly care on the board.
It is not clear why 30% did not identify any elderly care expertise on the board, or why the response rate to this question was low. It is possible that non-board members (the majority of the respondent group) were not knowledgeable about the skills represented on the board, that some participants had varying thresholds or levels of understanding for considering someone on the board to have expertise (we did not define the term for participants), that expertise in elderly care is in fact not represented at the board level, or that other skills (such as medical knowledge and experience) are present and may overlap with expertise in elderly care.
In our interviews, participants offered some insights. We asked interviewees to identify the top 2-3 skills needed on their boards. Elderly care expertise was not specifically mentioned by anyone. However, experience in health care was discussed. As one CEO summarized, “There’s always at least one nurse on the board". Several participants discussed a shift in priorities, away from representation- or sponsor-based recruitment, towards a focus on the qualifications of potential candidates. “In the last few years”, shared one interviewee, “we started moving towards a skills-based recruitment method”. This may suggest that the identification and disclosure of skills is a work-in-progress for some long-term care organization boards.
We were also curious to learn how the board interprets quality care reports or resident satisfaction surveys, without the presence of elderly care expertise on the board. One CEO shared that the board finds ways to fill skills gaps—when possible—by relying on staff with specific expertise to assist in discussions. “We’re missing healthcare background”, they disclosed, “but we supplement it with having staff like the Director of Medical attend meetings to interpret clinical realities”. While information flow between staff and the board is essential to ensure effective and informed oversight, over reliance on staff to fill in knowledge gaps could increase risk around the board’s abilities to ask challenging questions and make informed decisions.
“We’re missing healthcare background [on the board], but we supplement it with having staff like the Director of Medical attend meetings to interpret clinical realities”
(CEO, long-term care organization)
Interview participants also identified the benefits of having expertise on the board that is specific to the circumstances of their organization. For example, one of our participants identified an understanding of a specific religious tradition and mission as a meaningful and important characteristic for board members at their faith-based non-profit long-term care home. Participants also discussed the importance and benefits of having a broader range of expertise that is unique to the sector generally, including experience in healthcare, government relations, and real estate development, in addition to more traditional or standard board skills, such as strategic thinking and planning, leadership, and financial literacy. Although our survey findings suggest that non-profit organizations are more likely to have a board of directors (or that their administrators are more familiar with or knowledgeable about the board), interviewees from non-profit organizations highlighted unique challenges with non-profit board recruitment. 6 out of 12 interviewees from non-profit organizations identified difficulties attracting appropriately skilled and suitable volunteers to sit on the board. “[It is] hard to find qualified board members”, shared one participant; “The most difficult thing the board has is to recruit new members”, disclosed another.
The varied interview responses above highlight some of the complexities of long-term care corporate governance, including board recruitment and skills.