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Managing the Long-Term Care Facility: Practical Approaches to Providing Quality Care

Managing the Long-Term Care Facility: Practical Approaches to Providing Quality Care

Rebecca Perley (Editor)

ISBN: 978-1-118-65498-9

Feb 2016, Jossey-Bass

600 pages

$72.99

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.

Related Resources

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