Main description:

Practical approaches to the operation of long-term care facilities Managing the Long-Term Care Facility provides a comprehensive introduction to the growing field of long-term care. Taking a continuum-of-care approach, the text covers every aspect of long-term care. Readers will develop a robust knowledge of the issues faced by people experiencing physical and or mental changes. Topics covered include the biological and psychosocial implications of ageing, marketing long-term care, facility operations, and information technology for health care, among many others. By integrating all aspects of long-term care, the book is an invaluable resource that will aid students and professionals in preparing for career advancement and licensure exams. The book is also is designed to help students prepare for the National Nursing Home Administrator exam. Pedagogical elements help guide readers through the content, and summaries and discussion questions to drive home lessons learned.
* Builds expert knowledge of all aspects of long-term care management, including operations, human resources, patient advocacy, and information systems * Emphasizes the latest understandings of the long-term care continuum and patient-centered care for diverse populations * Delivers practical approaches to providing quality care to individuals and making a positive impact on community wellbeing * Prepares readers for and National Nursing Home Administrator's licensure exam Managing the Long-Term Care Facility: Practical Approaches to Providing Quality Care provides real-world guidance for students in healthcare administration, health and human services, gerontology, nursing, business and medical programs, in both domestic and international markets. Nursing home administrators, administrators-in-training and preceptors will find this book an effective training tool in the nursing facility setting.

Contents:

List of Tables, Figures, and Exhibits xxiii Introduction xxvii Acknowledgments xxxiii About the Editor xxxv About the Contributors xxxvii Chapter 1 Public Policy: Historical Overview of Long-Term Care 1 Erlyana Erlyana, Jean Schuldberg, and Marian Last Key Demographic Trends of Older Americans 2 Demographic Bulge 2 Lower Acuity Among the Aging 3 Longevity and Healthier Lifestyles 3 Socioeconomic Status of Older Adults 3 Gender Imbalance 4 Diversity in Culture and Ethnicity 4 Same-Sex Marriage and LGBTQ+ Gender Identity 5 Impacts on Long-Term Care Continuum 5 Long-Term Care and Public Policy 6 What Is Long-Term Care? 6 What Is Public Policy? 7 Rationales (Goals) for Public Policy 7 Why Public Policies for LTC? 8 Highly Vulnerable Population 8 Negative Perceptions in Costs and Quality 9 Resources Are Limited Unaffordable and Limited Supply 11 Nonviable Financing Protection Mechanism, Both Public and Private Financing 13 Critiques of Public Policy 14 Key Historical Milestones and Major Long-Term Care Policies 15 Federal Policies 15 State and Local Government Policies 19 Important Policies Affecting LTC Professionals and Paraprofessionals 22 Examples of State-Specific Laws 24 The Patient Protection and Affordable Care Act (PPACA) and LTC 25 Summary 27 Key Terms 27 Review Questions 28 Case Study 28 References 29 Chapter 2 Long-Term Care Continuum 33 Marian Last, Jean Schuldberg, and Kenneth Merchant The Long-Term Care Continuum Defined 33 Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) 34 Medical Acuity 35 The Long-Term Care Continuum 35 Aging in Place 35 The Private Home Environment: Aging in Place 38 Informal Supports 38 Private-Duty Aide 39 Home Care 39 Home Health Care 39 Home Modifications 40 Federal Housing Programs 41 Shared Housing Programs 41 Congregate Housing 42 Veterans Affairs Supportive Housing (VASH) 42 Community Resident Environments 42 Continuing Care Retirement Community (CCRC) 42 Active Living Communities 43 Naturally Occurring Retirement Community 43 Community Support Programs 44 Adult Social Day Care 44 Adult Day Health Care 44 Hospice and Palliative Medicine 44 Intergenerational Caregivers 45 Respite Care Programs 45 Congregate and Home-Delivered Meal Programs 46 Other Community-Based Programs Organizations That Provide Assistance 46 Transitional Housing From Home Community to Formalized Home Care Facilities 50 Board and Care and Adult Care Homes 50 Intermediate Care Facilities (ICF) 51 Assisted Living Facilities 51 Twenty-Four-Hour Nursing Care 51 TheWorkforce in Care Facilities 53 Administrators 53 Physicians 54 Nurses 55 Licensed Versus Certified Healthcare Personnel 56 Therapeutic Specialists 58 Social and Quality of Life Specialties 58 Summary 59 Key Terms 60 Review Questions 64 Case Studies 64 Case Study #1: Community Care 64 Case Study #2: Skilled Nursing 65 References 65 Chapter 3 Resident Advocates, Diversity, and Resident-Centered Care 69 Ann Wyatt Where Does Quality Start? 70 Nursing 71 Housekeeping 73 Therapeutic Recreation 73 Volunteers 74 Dietary 75 Social Work 75 Other Disciplines and Departments 76 Quality Assurance and Performance Improvement 76 Resident Councils 77 Family and Friends 77 National Nursing Home Ombudsman Program 79 Advocacy Organizations 80 Diversity 81 Changing the Culture: Person-Centered, Person-Directed Care 83 Mount St. Vincent 83 The Live Oak Regenerative Community 84 The Eden Alternative 84 Wellspring 85 The Green House 85 The Household Model 86 Planetree 87 Advocacy and Dementia Care 87 The Pioneer Network 87 The Role of Philanthropy 88 The Language of Culture Change 88 Summary 89 Key Terms 89 Review Questions 90 Case Studies 91 Case Study #1 91 Case Study #2 92 Case Study #3 95 References 96 Acknowledgments 97 Chapter 4 Physical Environment of Long-Term Care 99 Andrew Alden, Jeffrey Anderzhon, and Sarah Moser History of Long-Term Care Design in the United States 99 Origins of the Acute Care Hospital and Aged Care 99 Governmental Oversight and Influence on Long-Term Care 102 The Medical Model of Aged Care 102 Traditional Nursing Home Components 103 Resident-Centered Care Model 104 Development of Contemporary Long-Term Care Environments 105 Exploded Corridor Floor Plans 105 Household Model Development 106 Contemporary Nursing Home Components 107 The Long-Term Care Culture Change Movement (Resident-Centered Care) 109 Technology of Long-Term Care 110 Behavioral Monitoring 111 Ambulatory-Assistance Devices 111 Communication Technology 111 Building Code Requirements 112 History and Importance 112 Americans With Disabilities Act 112 Going Beyond ADA 113 Fire-Resistance Rated Construction 113 State and Local Regulatory Agencies 114 International Building Code (IBC) 114 National Fire Protection Association and the Life Safety Code (LSC) 115 Authorities Having Jurisdiction (AHJ) 116 Occupational Safety and Health Administration (OSHA) 116 History and Importance 116 OSHA Components 116 Standards and Compliance Requirements for Administrators 117 Lockout/Tagout 117 Recordkeeping Rules 117 Citations and Penalties 118 Preventative Maintenance Programs 118 History and Importance 118 Useful Life 119 Maintenance Items 119 Preventative Maintenance Software 119 Infection Control Programs 119 Emergency Preparedness 120 History and Importance 120 Steps for Emergency Preparedness 121 Emergencies and Preparations 121 Egress Procedures 123 Assisted Evacuation 124 Testing 124 Training and Drills 124 Survey Process 125 Nursing Home Oversight 125 Summary 125 Key Terms 126 Review Questions 129 Case Studies 130 Case Study #1 130 Case Study #2 130 References 130 Chapter 5 Human Resources:Managing Employees in Long-Term Care 133 Sonja Talley and Carissa Podesta Core Human Resources Functions in Long-Term Care 133 Administrative Partner 134 Business Partner 134 Strategic Partner 134 Outsourcing Human Resources 134 Human Resources Challenges in Long-Term Care 135 Workforce Availability 135 Contingent Workforce 135 Turnover 136 Composition of Workforce 136 Managing Diversity 137 Workforce Planning 138 Direct Care Staffing 138 Recruiting 139 Job Descriptions 140 Referral Programs 140 Screening and Selection 140 Training 142 Orientation 143 Mandated Training 143 Employee Relations 146 Employee Communications 146 Employee Suggestion Program 147 Open-Door Policy 147 Legal Rights and Benefits 148 At-Will Employment 148 Union Organization 148 National Labor Relations Act (NLRA) Requirements 149 Occupational Safety and Health Act (OSHA) Requirements 150 Worker Safety Programs 151 AmericansWith Disabilities Act (ADA) Accommodation 152 Discrimination and Harassment 153 Retaliation 154 Summary 155 Key Terms 155 Review Questions 159 Case Studies 159 Case Study #1 159 Case Study #2 160 References 160 Chapter 6 Reimbursement in the Long-Term Care Environment 163 Robert Miller Payer Sources 164 Government Programs 164 Managed Care 171 Private Pay 173 Long-Term Care Insurance Plans 174 Supplemental Insurance Plans 175 Reimbursement Methods 175 Prospective 175 Retrospective 176 Resident-Related Items 182 Medicaid 182 Summary 188 Key Terms 189 Review Questions 196 Case Study 197 References 198 Acknowledgments 198 Chapter 7 Compliance and Risk Management 199 Rebecca Lowell Compliance Today 200 Overview of LTC Regulations 200 Federal LTC Statutes 200 State LTC Statutes 201 Who Does the Long-Term Care Provider Serve? 201 Compliance and Accountability 202 Government Tools 203 Surveys 203 Five-Star Incentives 203 Corporate Integrity Agreement 204 Corporate Compliance Program (CCP) 204 Whistle-Blower Litigation 204 Primary LTC Risk Areas 205 Criminal Prosecution 205 Regulatory Risks 205 Civil Litigation 206 Compliance Program Necessities 206 ACA Guidelines 206 2000 Office of Inspector General (OIG) Guidelines 207 2008 Supplemental Office of Inspector General Guidelines 209 Quality of Care 209 Submission of Accurate Claims 215 Anti-Kickback Statute (AKS) 217 Physician Relations 219 Anti-Supplementation 220 Medicare Part D 220 HIPAA 220 Effective Risk Management 221 Quality Assurance and Risk Management 221 Root Cause Analysis 224 Analyze the Data 224 Identify the Root Cause(s) 224 Recommend and Implement Solutions 225 Reassess to Determine Efficacy 225 Compliance Through Documentation 226 Medical Record 226 Employment Files 228 QA Studies and Audits (Often Referred to as Quality Assurance Performance Improvement or QAPI) 228 Billing Records 229 Incident Investigation/Reporting 229 ContractsWith External Resources 229 Summary 230 Key Terms 230 Review Questions 232 Case Studies 232 Case Study #1 232 Case Study #2 232 References 233 Chapter 8 Legal and Ethical Issues 235 Rebecca Lowell and Eduardo Gonzalez Health Care as a Business235 Payer Sources 236 Private Pay 237 Scope of Expectations 237 Legal Responsibilities 238 Initial State Licensure 238 ContractsWith Federal and State Governments 238 Other Federal Laws and Their Ethical Implications 239 Agencies 240 Department of Health and Human Services (DHHS or HHS) 240 State Health Departments 240 Department of Justice (DOJ) (Federal and State) 240 Office of Civil Rights (OCR) 241 Adult Protective Service (APS) 241 Long-Term Care Ombudsman (Ombudsman) 242 Privately Funded Agencies 242 Employees 242 Court of Public Opinion/Media 243 Principal Areas of Focus 243 Abuse and Neglect 243 Abuse/Neglect Investigation and Reporting 244 Residents Rights 246 Civil and Regulatory Ramifications 247 Health Insurance Portability and Accountability Act (HIPAA) 248 Physician and Vendor Relationships 249 Advance Care Planning 254 Other Important Issues to Consider 259 Practical Solutions to Complicated Problems 260 Policies, Procedures, and Protocols 260 Bioethics Committee 260 Training/Evaluation/Discipline 260 Reporting Process 261 Audit 261 Summary 262 Key Terms 262 Review Questions 265 Case Studies 265 Case #1 265 Case #2 266 References 266 Chapter 9 Marketing and Public Relations 269 Janice Frates and Susie Mix Assessing Local Demand for Long-Term Care Services 269 Public Perceptions and Public Relations 272 Naming and Vocabulary 272 Addressing Suspicions and Fears 273 Customers and Their Needs 273 Families 273 Third-Party Payers 275 Identifying Customer Needs 278 Market Segmentation 278 Competition 280 Positioning 280 Marketing Approaches 280 Collaboration 281 Referral Agents 281 Networking 282 Public and Private Oversight of Long-Term Care Services Providers 283 Customer Services and Retention 284 Preplacement Evaluation 284 Customer Service 285 Resident Ambassadors 285 Monitoring Customer Satisfaction 286 Marketing Plan 286 Return on Marketing Investment (ROI) 289 Customer Buying Behavior 289 Branding 290 Ethical Marketing 290 False Promises 291 Advertising and Promotional Activities 291 Social Media 291 Crisis Management 294 Summary 295 Key Terms 296 Review Questions 297 Case Studies 298 Case Study #1: SNF Marketing in a Post-ACA World: Memorial Hospital of Gardena (California) 298 Case Study #2: Skilled Nursing Facility Marketing in the Future 299 Case Study Review Questions 300 References 300 Acknowledgments 302 Chapter 10 Health Information Systems 303 Abby Swanson Kazley Prevalence of Use 304 Regulations, Laws, and Standards 305 Record Retention Requirements 308 Health Information Technology Applications 309 Advantages of Health Information Technology Use in Long-Term Care 313 Disadvantages of Health Information Technology Use in Long-Term Care 316 Electronic Devices 318 Implementation and Conversion to Health Information Technology 319 Staff Training 321 Summary 323 Key Terms 323 Review Questions 325 Case Studies 325 Case Study #1 325 Case Study #2 325 References 325 Acknowledgment 328 Chapter 11 Biological and Psychosocial Aspects of Aging: Implications for Long-Term Care 329 Barbara White Normal Physical ChangesWith Aging 329 Skin Changes 330 Sensory Changes 336 Immune System 338 Gastrointestinal System 340 Musculoskeletal System 341 Respiratory and Cardiovascular Systems 342 Frailty Syndrome 342 Urinary Tract 343 Neurological Changes 343 Health Promotion, Disease Prevention 345 Common Psychosocial Changes With Aging 345 Losses and Isolation 345 Depression 346 Anxiety 347 Sleep Pattern 347 Illness Presentations in Older Adults 348 Responses to Medications in Older Adults 349 Changes in Absorption, Distribution, Metabolism, Elimination, and Action 349 Inappropriate Drug Prescribing 350 Polypharmacy 350 Changes in Older Adult and Family Relations in Long-Term Care 350 Why Move to Long-Term Care Placement 350 Caregiver Burden 351 Suicide 352 Acquired Conditions as Consequences of Long-Term Care Placement 353 Interventions to Maintain Quality of Life After a Move to Long-Term Care 353 Initial Orientation/Transition 353 Personal Possessions 354 Staffing 354 Feelings of Self-Worth, Independence, and Choice 355 Assessment and Care Planning 355 Summary 356 Key Terms 357 Review Questions 363 Case Study 364 References 364 Acknowledgment 366 Chapter 12 Resident-Centered Clinical Operations 367 Paige Hector Clinical Operations 367 Role of the Administrator 367 Critical Thinking and Clinical Judgment 368 Federal and State Regulations 369 Policies and Procedures 369 Admission to Facility 370 Care Plan 371 Medical Record Audit 377 Rehabilitation 382 Evaluations 382 Treatment Plans 383 Supportive Devices 383 Documentation 383 Interdisciplinary Focus 384 Dos and Don ts 384 Subjective Versus Objective 385 Late Entry 386 Summarizing Event Entry 386 Complaints 387 Contributory Negligence 388 Resident, Patient, and Family Education 388 Documentation 389 Care Conference 389 Leave of Absence (LOA) 389 Community Survival Skills Assessment 390 Provider Order 390 Role of Payer Source 391 Summary 391 Key Terms 391 Review Questions 394 Case Study 394 References 395 Acknowledgment 395 Chapter 13 Facility-Centered Clinical Operations 397 Paige Hector Weekly Operations 397 Wound Rounds 397 Nutrition at Risk 398 Falls 398 Restorative Nursing 399 Monthly Operations 399 Medical Record Audit 400 Pharmacy 402 Recapitulation (Recap) 403 Nursing Assistant Flow Sheets 404 Quarterly Operations 404 Individual Discipline Summaries 404 Changes of Condition 405 Notifications 406 Alert Charting 406 24-Hour Report 406 Process 408 Shift Change 408 Stand-Up Meeting 409 Purpose 409 Color-Coding System 410 Part I General Issues 410 Part II Clinical Review 415 Challenges With Electronic Medical Records 423 Summary 424 Key Terms 424 Review Questions 425 Case Study 425 References 426 Acknowledgment 426 Chapter 14 Facility Operations and Performance Improvement 427 Rebecca Perley, Jim Kinsey, Paige Hector, and Jill Harrison Facility Operations 427 Role of the NHA 428 Daily NHA Rounds 430 Preadmission 431 Preadmission Screening and Resident Review (PASRR) 431 Financial Reimbursement for Treatment 431 Facility Tour 431 Documentation Required for Admission 432 Physician Order 432 Medication Administration Record (MAR) 432 Evidence of Being Free of Tuberculosis 432 History and Physical (H&P) 433 Discharge Summary 433 Admission Packet 433 Identification of Parties 433 Consent to Treatment 433 Resident Rights 434 Financial Arrangement 434 Transfers and Discharges 434 Bed Hold Policy 434 Personal Property and Funds 434 Photographs 435 Confidentiality of Medical Information 435 Facility Rules and Grievance Procedure 435 Admission Agreement 435 Resident-Directed Move-In 435 Orientation to the Facility 436 Resident s Adjustment, Grief, and Loss 436 Resident Assessment Instrument Process 436 Minimum Data Set (MDS) 437 Care Area Assessment (CAA)438 Care Plan 438 Care Plan Conference 438 Identifying and Honoring the Resident s Voice 439 Nursing 439 Dietary 439 Social Services 440 Activities 440 Performance Improvement 440 Quality Assurance (QA) 440 Performance Improvement (PI) 441 Quality Assurance and Performance Improvement (QAPI) 441 Five Elements of QAPI 441 Quality Assessment and Assurance (QAA) 442 Quality Measure/Indicator Reports 442 Program for Evaluating Payment Patterns Electronic Report (PEPPER) 443 Data Management 443 Process-Oriented Context 444 Run Charts Just Plot the Dots! 446 Variation 446 Strategies for Improvement: The Fun Stuff! 449 Surveys 453 Survey Management 453 Initial Certification Survey 454 Traditional Survey 454 Quality Indicator Survey (QIS) Process 456 Minimum Data Set (MDS) Survey 458 Exit Conference 458 Form 2567 458 Scope and Severity 459 Informal Dispute Resolution (IDR) 461 Summary 462 Key Terms 462 Review Questions 465 Case Study 466 References 466 Acknowledgment 468 Chapter 15 Financial Issues and Tools 469 Robert Miller Financial Issues and Financial Tools 470 Budgets 470 Budget Development 473 Profit or Loss 479 Staff 485 Revenue Enhancement 488 Level of Services Provided to Residents 490 Intensity of Services to the Residents 490 Future Directions 492 Level of Care 493 Affordable Care Act 493 Summary 494 Key Terms 495 Review Questions 502 Case Study 503 References 504 Acknowledgment 504 Chapter 16 International Comparisons and Future Trends in Long-Term Care 505 Erlyana Erlyana Growth of Elderly Population 506 Increase in Longevity and Disability 507 Increase in Long-Term Care Expenditure 508 International LTC Policies 510 Germany 510 Japan 511 Italy 512 South Korea 513 Future Trends of LTC in the United States 514 Anticipated Growth of LTC Needs 514 Trends in Supply and Use 515 Future Predictions for LTC 516 Summary 517 Key Terms 517 Review Questions 518 Case Study 518 References 519 Index 523