Managing the Long-Term Care Facility Practical Approaches to Providing Quality Care
, by Perley, Rebecca
- ISBN: 9781118654781 | 1118654781
- Cover: Paperback
- Copyright: 2/23/2016
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.
REBECCA PERLEY is owner and CEO of AIT Exam Prep, a company that prepares administrators-in-training to pass the California and federal nursing home administrator licensure exams. She is a member of the Executive Faculty in the Health Care Administration Department of California State University, Long Beach and has been a guest lecturer for the State of California, Nursing Home Administrator Program.
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
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