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.
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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 So
