Section 4 - Physical Environment



NURSING HOME ADMINISTRATOR LICENSURE

EXAM REVIEW COURSE | |

(National Exam ◘ MODULE 4

FORM B

referencsect

Administration

Speed Reader

Examination 1

Examination 2

Examination 3

Examination 4

Stan Mucinic, LNHA

Legal Notices

Students enrolled in the “National Nursing Home Administrator Licensing Course” are purchasing the professional knowledge of the instructor to assist the student to prepare for the national licensure exam administered by the National Association of Boards of Examiners (NAB).

This is a 5-week intensive independent study program designed to provide students a unique personalized and structured learning environment where progress is monitored by the instructor through email to help students maintain focus and complete scheduled assignments timely.

THE INSTRUCTOR MAKES NO EXPRESS OR IMPLIED WARRANTY OR REPRESENTATION OF ANY KIND THAT COMPLETION OF THIS OR ANY LICENSURE PREPARATION COURSE OFFERED BY INSTRUCTOR WILL GUARANTEE A PASSING SCORE ON ANY LICENSING EXAM.

An individual’s ultimate success in passing the licensure exam is dependent on an individual’s professional experience, academic preparation, and the time and energy the individual can commit to exam study and preparation. A student’s work schedule or other commitments may require more time to prepare for an exam than allotted. The student is solely responsible for licensing exam registration/testing and retesting fees.

HOW TO USE THE STUDY GUIDES

Step 1 – VERY IMPORTANT - The personalized test organizer that comes with the program is the key to your success and sets this program apart from any other. It is critical you follow the instructions and score each exam, and file the completed exams into your binder. Try to keep to the schedule and email your test results to the instructor to stay focused.

Step 2. - Speed Reader – Read the speed reader for each module once or twice before taking the module exam(s). Read the speed reader over and over again until you familiarize yourself with its contents. THE MORE TIMES YOU LOOK IT THE MORE LIKELY YOU ARE TO REMEMBER IT.

Step 3 – Exam Packet - The exam packet contains questions designed to measure your comprehension and retention of the material you read. Take each exam over and over again until you score 100%. Make sure you score each exam and record the results in your organizer or you will not be able to gauge your progress.

The exam questions are cross referenced to the speed reader to allow you to quickly find and review material you missed on the exam as follows:

Thus, the specific material would be found on page 2 of the speed reader, section 1.8, subparagraph 13.

Contact Information

Email Stan Mucinic at smucinic@ with any questions and after you score each practice exam

Administration - Table of Contents

|1 |Quality of Care |4 |

|2 |Measures of Quality |4 |

|3 |Federal and State Standards |4 |

|4 |Management Information Systems |5 |

|5 |Medical Staffing Model |5 |

|6 |Management Functions Model |5 |

|7 |Important Trends – Forecasting |5 |

|8 |Important Trends – Organizing |5 |

|9 |Important Trends – Planning |5 |

|10 |Important Trends – Staffing |6 |

|11 |Important Trends – Directing |6 |

|12 |Important Trends – Evaluating |7 |

|13 |Important Trends – Controlling Quality |7 |

|14 |External Forces |7 |

|15 |Important Trends – Innovating |7 |

|16 |Important Trends – Marketing |7 |

|17 |Marketing Strategy |8 |

|18 |Marketing Challenges |8 |

|19 |Marketing and Public Relations |8 |

|20 |Consumer Decision Model |8 |

|21 |Decision to Enter Facility |8 |

|22 |Marketing Tools |9 |

|23 |Buyer Readiness States |9 |

|24 |Consumer Satisfaction Surveys |9 |

|25 |Conflict Resolution |9 |

|26 |Grievance Procedures |9 |

|27 |Oral/Written Communication |9 |

|28 |Barriers to Communication |10 |

|29 |Tailor Communication to Individual |10 |

|30 |Formal/Informal Communication |10 |

|31 |Flow of Communication |10 |

|32 |Communication Technology |10 |

|33 |Risk Management |10 |

|34 |Survey and Licensure Process |11 |

|35 |Survey Process |11 |

|36 |Quality Indicator Reports |11 |

|37 |Online Survey Certification Reports (OSCAR) |11 |

|38 |Survey Outcomes |11 |

|39 |Severity Levels of Non-Compliance |11 |

|40 |Scope of Deficiencies |12 |

|41 |Substandard Quality of Care |12 |

|42 |Remedies of Non-compliance |12 |

|43 |Informal/Formal Dispute Resolution |12 |

|44 |Accreditation Organizations |12 |

|45 |Organizational Concepts |12 |

|46 |Systems Theory |13 |

|47 |Policies and Procedures |13 |

|48 |Leadership Theories |13 |

|49 |Management Theories |14 |

|50 |Systems Theory |16 |

|51 |Norms, Values and Employee Motivation |15 |

|52 |Delegation of Authority |17 |

|53 |Command Concepts |17 |

| | | |

| |Administration - Table of Contents (Cont’d) | |

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|54 |Line vs Staff Authority |17 |

|56 |Management Levels |17 |

|57 |Nursing Home Management |17 |

|58 |Departments Functions |18 |

|59 |Facility Organization Chart |19 |

|60 |Governing Body Duties |19 |

|61 |Administrator Duties |20 |

|62 |Federal Rules |20 |

|63 |Nurse Aide Education/Training |20 |

|64 |Professional Organizations |21 |

|65 |OBRA ‘87 |21 |

|66 |Survey Deficiencies |22 |

|67 |Resident Care |22 |

|68 |Ownership Patterns |22 |

|69 |Payor Sources |22 |

|70 |Legislation |22 |

|71 |Occupancy Statistics |23 |

|72 |Demographics |23 |

|73 |Technology |23 |

|74 |Medical Director |23 |

|75 |Quality Assessment and Assurance Committee |23 |

|76 |CMS Quality Standards |23 |

|77 |Demming |24 |

|78 |Technological Support |24 |

|79 |Miscellaneous |31 |

|80 |Financial terms | |

Administration

|Section 1 - Quality of Care |

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|1.1 - Quality of Care |

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|EVERY FACILITY USES SOME QUALITY IMPROVEMENT MODEL |

|Must monitor quality indicators, identify problems and fix them |

|Quality of care indicators: |

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|Resident rights |

|Quality of life |

|Financial performance |

|Consumer satisfaction |

|Infection rates |

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|Various Quality Improvement Models: |

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|Performance Improvement Model |

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|Least involved and effective model |

|Involves making small changes |

|Is not a comprehensive or interdisciplinary approach |

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|Quality Assurance Model |

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|Has its roots in quality assurance committee |

|Focused mainly on clinical issues |

|Not typically comprehensive or interdisciplinary |

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|Continuous Improvement Model |

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|Requires involvement of senior managers |

|Focuses on continuously improving consumer satisfaction |

|Involves an interdisciplinary effort |

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|Total Quality Management Model (TQM) |

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|Most effective and comprehensive |

|Comprehensive, interdisciplinary approach to continuously improve all facets of operations and consumer satisfaction |

|Takes 5-10 years to implement |

|Requires total involvement of management |

|Empowers frontline staff |

|Requires intensive training of staff |

|Objective is to exceed customer expectations |

|Must improve quality totally, continuously and forever |

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|Section 2 - Measures of Quality |

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|2.1 - Measures of Quality |

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|STRUCTURE – STAFF, BUILDING EQUIPMENT |

|Process – Policies and procedures |

|Outcome – Quality of life of residents (pressure sores, dehydration) |

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|Section 3 - Federal/State Standards |

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|3.1 - Federal/State Standards |

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|FEDERAL/STATE STANDARDS SUPERSEDE CORPORATE POLICIES |

|Survey and inspections are an important form of external feedback on quality |

|Section 4 – Management Information Systems |

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|4.1 - Management Information Systems |

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|MUST HAVE A SYSTEM TO ORGANIZE AND PRIORITIZE FLOW OF INFORMATION IN FACILITY |

|Must determine what information to receive, where it comes from, the priority and process to receive it. |

|Section 5 - Facility Medical Staffing Models |

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|5.1 - Facility Medical Staffing Models |

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|OPEN STAFF MODEL – ANY PHYSICIAN CAN ATTEND RESIDENTS (MOST USED) |

|Closed Staff Model – Only approved group of doctors can see residents – used in facilities with hundreds of patients |

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➢ Section 6 - Management Functions Model

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|6.1 - MANAGEMENT FUNCTIONS MODEL |

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|FORECASTING – PROJECT TRENDS AND NEEDED RESOURCES AND SERVICES |

|Planning – Identify objectives and desired outcomes |

|Organizing – Determine the structure of the organization and ensure work is done without duplication |

|Staffing – Hiring the right people for the right job |

|Directing – Explain what needs to be done and help staff accomplish it |

|Evaluating – Compare actual results to planned results |

|Controlling Quality – Taking necessary corrective action |

|Innovating – Constantly improving the ways things are done |

|Marketing – Attracting people to the facility |

|Section 7 - Important Trends – Forecasting |

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|7.1 - Important Trends – Forecasting |

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|PRIOR TO 1987 AND THE SHIFT TO THE PROSPECTIVE PAYMENT SYSTEM, CHANGE WAS SLOW AND GRADUAL |

|Retrospective payment Is based on actual expenses and produced huge profits for nursing facilities |

|Rapid changes can be expected now and in the future |

|During 70’s and 80’s, administrators could make long term decisions and plans |

|Today, change happens too quickly to know what reimbursement rates be tomorrow |

|Lifespan of new technology is 18 months |

|The core business of long term care may be entirely different in 2020 |

|Nursing staff is experiencing culture shock |

|Mankind’s knowledge is expected to double every 5 years |

|Survival tomorrow is based on accurately forecasting trends |

|Must change constantly to adapt to changes in environment |

|If you don’t fix it all the time, it will break |

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|Section 8 - Important Trends – orgANIZING |

1. Ensuring work gets done

2. Breaks work into tasks to be handled by one person

3. Ensures no duplication of work

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|Section 9 - Important Trends – Planning |

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|9.1 - Important Trends – Planning |

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|PLANNING EXPRESSES ORGANIZATIONAL GOALS |

|Planning involves an integrated decision system |

|Planning aids managers in coping with uncertainty |

|Planning makes possible comparing expected results with actual results |

|Strategic planning is critical to survival |

|Planning forces an assessment of what services the market will need tomorrow |

|Planning moves from the general to the specific |

|Section 10 - Important Trends – Staffing |

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|10.1 - Important Trends – Staffing |

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|STAFFING INVOLVES HIRING THE RIGHT PERSON FOR THE RIGHT JOB |

|A job interview is not a predictor of future performance |

|Adequate staffing is critical to success in a nursing home |

|Resident interaction with staff determines resident quality of life |

|Resident acuity level determines staffing needs |

|Must hire department heads with expertise because of the complexity of regulations |

|The number of registered nurses is key to quality care |

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|Section 11 - Important Trends – Directing |

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|11.1 - Important Trends – Directing |

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|DIRECTING INVOLVES COMMUNICATING TO EMPLOYEES WHAT NEEDS TO BE DONE |

|Directing involves developing policies and procedures that allow employees to make the same decisions given the same circumstances |

|It is possible to develop policies and procedures to direct employee behavior 24 hours a day and communicate exactly what management expects |

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|section 12 - Important Trends – Evaluating |

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|12.1 - Important Trends – Evaluating |

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|MUST COMPARE EXPECTED RESULTS TO ACTUAL RESULTS |

|Policies and plans of action are the guidelines to compare outcomes to expectations |

|Policies are broad statements of goals |

|Guidelines are step-by-step instruction on how to do something |

|A plan of action has specific procedures to implement a policy |

|Benchmarking involves: |

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|Comparing current business practices with the “best practices” of other organizations |

|Benchmarking process involves: |

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|Deciding what to benchmark |

|Forming a team |

|Selecting partners |

|Collecting and analyzing info |

|Implementing new methodologies |

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|Should adapt the “best practices” of other organizations and must not adopt them in total since they may not work the same way for your organization |

|(different culture) |

|Enablers are practices leading to exceptional performance |

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|Controlling quality has always been an elusive aspect of successful management |

|Organizational pathology deals with illnesses that affect an organization |

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|Key quality indicators of a nursing home: |

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|The number of registered nurses |

|The nursing process itself |

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|section 13 - Important Trends – Controlling Quality |

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|13.1 - Important Trends – Controlling Quality |

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|CONTROL IS THE ACT OF TAKING CORRECTIVE ACTION AFTER EVALUATING EXPECTED TO ACTUAL RESULTS |

|Control involves modifying policies and processes |

|Need to provide clear and accurate info to employees |

|Corrective action must be taken consistently and timely |

|Make clear what is relevant and what can be discarded |

|Control mechanisms must be seen as legitimate and relevant |

|Managers who avoid confrontation fail to take action |

|section 14 - External Forces |

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|14.1 - External Forces |

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|OPPORTUNITIES IN THE ENVIRONMENT INCLUDE AN AGING POPULATION AND MANAGED CARE CONTRACTS |

|Constraints in the environment include government regulation |

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|section 15 - Important Trends – Innovating |

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|15.1 - Important Trends – Innovating |

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|IF YOU DON’T FIX IT ALL THE TIME, IT WILL BREAK |

|The administrator does not need to be the innovator but must foster change and be an agent of change |

|Do not make policies but give employees a sense of direction |

|Do not make policies that inhibit change |

|Make policies that foster innovation |

|Tom peters - Innovation is critical to success and must be continual |

|Government standards are now considered maximal standards as opposed to minimal standards |

|Staff will only become agents of change if they believe changes are necessary |

|Implement both good and bad employee suggestions |

|Must make changes even if staff is not ready (change is not a comfortable process) |

|section 16 - Important Trends – Marketing |

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|16.1- Important Trends – Marketing |

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|MUST ATTRACT HIGHER PAYING CUSTOMERS |

|Must market services that customers need and are willing/able to pay for |

|When a facility reaches premium status – staff tends to slack off and the facility falls to the bottom of the pack |

|In 1997, the U.S. supreme court ruled illegal the self imposed advertising ban on nursing homes |

|Competition is when 2 or more organizations seek to serve the same customer |

|Average occupancy rate was 82% in 1992; a facility needs 90% occupancy to break even |

|Market sharing – Fighting for a slice of an existing market |

|Market creation – Creating new services not offered by anyone else |

|Medicaid is the largest payor for long term care |

|Private pay is the second largest payor source for long term care |

|section 17 - Marketing Strategy |

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|17.1 - Marketing Strategy |

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|MARKET AUDIT – INVOLVES GATHERING DATA FROM THE EXTERNAL ENVIRONMENT TO ASSESS THE FACILITY’S NEEDS AND INCLUDES: |

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|Performing a demographic breakdown |

|Identifying services in demand |

|Assessing environmental constraints |

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|Potential market – Customers express some interest in services |

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|Potential Market – All potential customers who express some interest in a product offering |

|Available Market- Those have an interest but lack the money to buy your product |

|Qualified Available Market – Those that have an interest but additionally the money and access to buy the product or service offered |

|Served market – Those who a facility made an effort to attract to the facility |

|Penetrated market- Actual customers who have bought your products |

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|Market Segmentation – Involves slicing the market into subgroups – income, age and demographics |

|Market Mix – Choose which services to market |

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|Product mix – Various product lines |

|Product line – Mix of product items |

|Product item – Single service or product |

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|Implement and evaluate marketing plan – Create awareness among consumers |

|Creating a new service not offered by competitors is called market creation |

|section 18 - Marketing Challenges |

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|18.1 - Marketing Challenges |

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|INTANGIBILITY – CUSTOMER CANNOT EXPERIENCE SERVICES BEFORE ENTERING A FACILITY |

|Inconsistency – Quality of services vary from shift to shift, and from day to day |

|Inseparability – Cannot separate perception of poor service by one employee from other services provided by facility |

|Inventory – Each unoccupied bed bears costs |

|section 19 - Marketing and Public Relations |

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|19.1 - Marketing and Public Relations |

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|MUST HAVE A MARKETING AND PUBLIC RELATIONS PLAN AND UPDATE IT ANNUALLY |

|Marketing is promoting the sale and distribution of a service |

|Public relations is communicating information about the facility to the community and consumers |

|Section 20 - Consumer Decision Making Model |

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|20.1 - Consumer Decision Making Model |

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|PROBLEM RECOGNITION |

|Information search |

|Alternate evaluation |

|Post purchase evaluation |

|section 21 - Decision to enter facility |

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|21.1 - Decision to enter facility |

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|A DECISION TO ENTER A FACILITY IS BASED ON THE BELIEF THAT THE FACILITY CAN MEET THE RESIDENT’S NEEDS |

|Subliminal perceptions from a facility tour is the key to deciding whether to enter a facility |

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|section 22 - Marketing Tools |

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|22.1 - Marketing Tools |

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|KEY REFERRAL SOURCES |

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|Doctors and hospital discharge planners |

|Word of mouth |

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|Most effective advertising – Word of mouth |

|Least effective advertising – Radio/TV |

|Most effective marketing tools – Tour of the facility |

|Paid media (TV/newspaper ads) are impersonal forms of advertising |

|section 23 - Buyer Readiness States |

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|23.1 - Buyer Readiness States |

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|COGNITIVE – CONSUMERS AWARE OF THE FACILITY |

|Affective – Consumer selects a facility after comparing it with others |

|Behavioral (Consumer is convinced choice was right) |

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|Section 24 - Survey Consumer Satisfaction |

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|24.1 - Survey Consumer Satisfaction |

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|SHORT TERM RESIDENTS – SHOULD SURVEY SHORT TERM RESIDENTS OF SATISFACTION WITHIN 30 DAYS AFTER DISCHARGE |

|Long term residents – Should interview short term resident satisfaction annually |

|Families focus on food quality |

|Discharge planners focus on rehab |

|Physicians focus on their relationship with nursing staff |

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|section 25 – Conflict Resolution |

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|25.1 - Conflict Resolution |

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|FIRST CLARIFY THE ISSUE |

|Identify what each person wants |

|Identify a solution |

|Negotiate a solution |

|Confirm the agreed upon solution with the parties |

|Any resolution should have positives for both sides |

|section 26 - Grievance Procedure |

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|26.1 - Grievance Procedure |

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|DOCUMENT ALL GRIEVANCE COMPLAINTS |

|Respond to grievances as quickly as possible |

|Use the resident council for feedback |

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|section 27 - Oral/Written Communication |

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|27.1 - Oral/Written Communication |

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|COMMUNICATION IS THE TRANSMISSION OF MEANING |

|A message must be sent and received, decoded and understood for communication to take place |

|Communication is power and so is withholding information |

|The closer to the center of power, the more important the communication |

|Active listening is listening intently, with empathy and acceptance |

|Communication is the heart of the management process |

|section 28 - Barriers to communication |

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|28.1 - Barriers to communication |

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|AGENDA CARRYING – EMPLOYEES SKEW INFORMATION BASED ON PERSONAL NEEDS |

|Selective Hearing - Employees filter unpleasant information (incapable of understanding) |

|Differences in Knowledge – People perceive information differently based on knowledge |

|Filter Effect – Tells manager only what they think the manager wants to hear |

|Subgroup Allegiance – A subgroup demands allegiance from its members (nurses, kitchen staff) |

|Status difference – Staff hesitant to approach a member of a higher status – nurse aide to doctor |

|Language barrier –Staff does not understand technical jargon |

|Self protection- Staff withholds information that reflects negatively on themselves |

|Information overload - Too much information and staff shuts down |

|Section 29 - Tailor communication to individual |

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|29.1 - Tailor communication to individual |

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|WRITTEN INFORMATION REINFORCES ORAL COMMUNICATION |

|section 30 - Formal/Informal Communication |

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|30.1 - Formal/Informal Communication |

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|FORMAL COMMUNICATION – COMMUNICATING THROUGH MEMOS, MEETINGS AND FOLLOWS LINES OF THE ORGANIZATION CHART |

|Informal Communication – Staff chatting informally in the break room |

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|section 31 - Flow of Communication |

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|31.1 - Flow of Communication |

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|DOWNWARD COMMUNICATION – COMMUNICATION FROM A SUPERIOR DOWN TO A SUBORDINATE |

|Upward Communication – Communication from a subordinate up to a superior |

|Horizontal Communication – Communication between peers |

|Grapevine – The company rumor mill |

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|section 32 - Communication Technology |

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|32.1 - Communication Technology |

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|EMAIL – ELECTRONIC COMMUNICATION THROUGH INTERNET OR INTRANET |

|Firewire – Transfers video recorded on a camcorder to a computer |

|Blue tooth – Connects cell phones and keyboards to a computer (wireless communication) |

|4. High frequency radios (i.e., walkie talkies) |

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|Section 33 – Risk Management |

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|33.1 - Risk Management |

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|RISK MANAGEMENT INVOLVES MANAGING THE RISKS OF NEGATIVE OUTCOMES IN THE WORKPLACE |

|Risk is an event that could lead to financial loss or damage |

|The main focus is to prevent injury, theft, malpractice and negligence |

|The Federal Employer Liability Act holds employers directly financially responsible for injuries to employees |

|A facility usually has a risk management committee |

|The facility is responsible for damage caused by employees to others under “Respondeat Superior” (The employer must answer for the acts of their employees) |

|The facility is not responsible for acts of independent contractors |

|Assault and battery is the leading cause of lawsuits (includes providing treatment without informed consent) |

|Effective Risk Management Program includes: |

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|Early intervention |

|Completed incident reports and tracking trends |

|An active safety committee |

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|The U.S. tort system is ineffective because malpractice drains money from resident care and doctors order unneeded tests and practice “defensive medicine” |

|section 34 - Survey and Licensure Process |

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|34.1 - Survey and Licensure Process |

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|THE GOVERNMENT LICENSURE PROCESS HELPS THE NURSING HOME INDUSTRY TO MAINTAIN STANDARDS AND QUALITY, AND TO REDUCE LAWSUITS |

|All facilities must be licensed by the state |

|Medicare and Medicaid facilities must be certified to receive reimbursement |

|The inspection process focuses on OUTCOMES (quality of resident life) |

|Before OBRA 1987, the focus was “process” |

|The federal survey program has 5 different survey types |

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|section 35 - Survey Process |

|35.1 - Survey Process |

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|TASK 1 – OFFSITE PREP (REVIEW OSCAR, COMPLAINTS, OMBUDSMAN REPORTS, WAIVERS) |

|Task 2 – Entrance Conference (meet with staff, discuss survey) |

|Task 3 – Initial Tour (walk through facility) |

|Task 4 – Sample Selection (collect targeted resident records) |

|Task 5 – Info Gathering (collect findings from survey team) |

|Task 6 – Info Analysis (review findings of the team and violations) |

|Task 7 – Exit conference (discuss survey finding with facility staff) |

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|section 36 - Quality Indicator reports from CMS |

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|36.1 - Quality Indicator reports from CMS |

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|FACILITY CHARACTERISTICS |

|Facility quality indicator profile |

|Resident level summary |

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|section 37 - Online Survey Certification Reports (OSCAR) |

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|37.1 - Online Survey Certification Reports (OSCAR) |

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|REPORT #3 = FACILITY COMPLIANCE HISTORY |

|Report #4= Last survey report |

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|section 38 - Survey Outcomes – Report to Administrator |

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|38.1 - Survey Outcomes – Report to Administrator |

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|NOTICE OF ISOLATED DEFICIENCIES (MINIMAL PROBLEMS, NO PLAN OF CORRECTION NEEDED) |

|Form 2567 (non compliant deficiencies, plan of correction required, maybe resurvey) |

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|Section 39 - Severity levels of Non-Compliance |

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|39.1 - Severity levels of Non-Compliance |

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|LEVEL 1 - NO MORE THAN MINOR NEGATIVE IMPACT |

|Level 2 - Minimal physical, mental or psychosocial discomfort |

|Level 3 – Compromised the resident’s ability to maintain highest practical level of functioning |

|Level 4 – Risk of immediate injury, harm or impairment or death to a resident |

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|Section 40 - Scope of Deficiencies |

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|40.1 - Scope of Deficiencies |

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|ISOLATED – AFFECTS A LIMITED NUMBER OF INDIVIDUALS/LOCATIONS |

|Patterned – Affects more than a limited number of individuals/locations |

|Widespread – Entire population of facility is impacted |

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|Section 41 - Substandard Quality of Care |

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|41 - Substandard Quality of Care |

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|THE FACILITY WILL BE CITED FOR SUBSTANDARD CARE IF CITED FOR NON-COMPLIANCE FOR RESIDENT BEHAVIOR, FACILITY PRACTICES, QUALITY OF LIFE AND QUALITY OF CARE |

|STANDARDS |

|There must be evidence of immediate jeopardy of injury or death |

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|41.2 - Letter coding on F Tags Tags G and above are substandard care – actual harm |

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|NO ACTUAL HARM BUT POTENTIAL FOR HARM |

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|A - no harm  no potential harm   just a few affected |

|B - no harm no potential harm - more than a few affected |

|C - no harm- no potential harm  most affected |

|D - no harm -potential harm  just a few affected |

|E - no Harm - potential for harm- more than a few affected |

|F - no harm - potential or harm - most people affected |

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|SUBSTANDARD CARE – ACTUAL HARM |

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|G -actual harm-  just a few affected-  no immediate Jeopardy |

|H - actual Harm - more than a few affected- not IJ |

|I - actual harm - most people affected- no IJ |

|J - actual harm - limited affected - IMMEDIATE JEOPARDY |

|K- actual harm - More than a few- IMMEDIATE JEOPARDY |

|L  Actual Harm - Most affected - IMMEDIATE JEOPARDY |

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|Section 42 - Remedies for Non-Compliance |

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|42.1 - Remedies for Non-Compliances |

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|LEVEL 1 REMEDY – A) DIRECTED PLAN OF CORRECTION, B) STATE MONITOR, C) REQUIRED IN-SERVICE |

|Level 2 Remedy – a) Denial of payment of new admissions and b) Daily fine of $3000-$5000 |

|Level 3 Remedy – a) Temporary receiver, b) Termination of contract and c) Daily fine $3050 -$10,000 |

|Section 43 - Informal/Formal Dispute Resolution |

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|43.1 - Informal/Formal Dispute Resolution |

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|INFORMAL DISPUTE RESOLUTION– APPEAL BY WRITING A LETTER TO CHALLENGE SURVEYOR FINDINGS |

|Formal dispute resolution – Request a hearing before an administrative judge |

|Section 44 - Accreditation Organizations |

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|44.1 - Accreditation Organizations |

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|JCAHO – A PRIVATE VOLUNTARY ORGANIZATION WHICH ACCREDITS NURSING HOMES, HOSPITALS AND OTHER FACILITIES, CONDUCTS INSPECTIONS EVERY 3 YEARS, AND IMPOSES MONEY |

|FINES FOR NON-COMPLIANCE, FACILITIES ACCREDITED BY JCAHO ARE EXEMPT FROM STATE INSPECTION |

|CARF – Commission on Accreditation of Rehabilitation facilities accredits rehab and therapy facilities |

|Membership in both attracts managed care contracts and is a seal of high quality |

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|Section 45 – Organizational Concepts |

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|45.1 - Organizational Concepts |

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|ORGANIZATIONAL GROWTH IS UNLIMITED |

|Entropic Process – All organisms move toward death |

|Negative Entropy – Re-energizes an organization with life and money |

|Organizations must grow by bringing in more resources than they expend |

|Unrestricted resources foster unrestricted growth (i.e. Medicare dollars) |

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|As they grow, organizations force the world around them to accommodate their needs |

|Organizations tend to resist change |

|Arteriosclerosis is organizational hardening of the arteries resulting from resistance to change |

|A company on top today can quickly find itself fall tomorrow because of a deep reservoir of outmoded attitudes |

|and policies |

|Organizations commonly respond to change by: |

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|Firing employees who agitate for change |

|Maintaining the status quo |

|Ignore signs for the need to change |

|Buying out the competition |

|Policies and procedures are sacred cows and cannot be changed |

| |

|The following promote positive outcomes for troubled organizations: |

|Decreasing costs but not value |

|Putting the right person in the right job |

|Out position the competition |

|Section 46 - Systems Theory |

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|46.1 - Systems Theory |

| |

|COMPANIES START OUT SIMPLE AND THEN BECOME COMPLEX; I.E. CHAIN MERGERS |

|It is difficult to predict how companies will react |

|Systems theory gives managers tools to understand the relationship between an organization and its environment |

|Administrators tend to resist change and instead embrace outmoded polices and attitudes |

|Section 47 - Policies and Procedures |

| |

|47.1 - Policies and Proceduress |

|7UJ |

|Policies are written by upper and middle management |

|Procedures are written at the middle and lower management levels |

|Staff must follow all policies and procedures |

| |

|Section 48 - Leadership Theories |

| |

|48.1 - Leadership Theories |

| |

|PASSION MAKES AN EXCEPTIONAL LEADER AND FOSTERS EMPLOYEE COMMITMENT |

|Leadership continuum |

| |

|Dictatorial – Manager issues edicts to employees |

|Democratic – Manager leads by consensus |

|Laizze Faire – Manager sets the big picture and delegates details to staff |

| |

|Effective Leaders: |

| |

|Mediate temper |

|Promote loyalty |

|Care and respect employees |

|Share decision making power |

|Behave in different leadership styles |

| |

|Successful managers make right decisions and no disastrous ones |

|Great Leadership Theory – History is shaped by great leaders |

|Charismatic Leadership theory- charismatic leaders have a magical presence, their decisions are unexamined and people have strong confidence in that person |

|Management and leadership are not the same |

|Leaders change while managers merely adapt |

|Management focuses on performance and results |

|Managers must take external action when required |

|Home health care is the fastest growing sector in the health care industry |

|Leaders challenge the status quo and inspire staff by vision |

|The key role of an administrator – make decisions |

|Primary focus of decisions – resident care and welfare – not profits |

|All managers use some theory of management |

|Managers believe they can manage anything |

|Need administrators because plans go awry and someone needs to respond |

|Any employee can sabotage a company by following policies to the letter |

|Once hired, employees turn to co-workers for knowledge of what to do |

| |

|Section 49 – Management Theories |

| |

|49.1 - QUALITATIVE/QUANTITATIVE MANAGEMENT |

| |

|Quantitative management method – managing through reports |

|Qualitative management method – motivating, empowering and challenging staff |

|49.2 - Management By Walking Around (MBWA) |

|WALK AROUND EACH DAY AND OBSERVE – DO NOT MAKE ANY CHANGES ON THE SPOT |

|Naïve listening |

|See first hand how things are working |

|Maintain the chain of command |

|Gather info and pay attention to detail |

|49.3 - Management by Objectives |

|OBJECTIVES DEFINED BY THE BOTTOM AND THEN MOVED TO THE TOP DECISION MAKERS |

|Purpose is to get buy-in from staff with upper management making final decision |

|Focus is on setting clear goals with definite timeframes |

| |

|49.4 - Management by Exceptions |

|1. RESPOND ONLY TO EXCEPTIONS AND VARIANCES |

| |

|49.5 – PERT (Program Evaluation and Review Technique |

| |

|1. Shows relationship of elements in a project (renovating a wing/Gantt chart) |

| |

|49.6 - Scientific Management Theory |

| |

|1. Using time and motion studies to improve efficiency |

| |

|49.7 - Human Relations Management Theory |

| 1. RECOGNIZE THE NEED TO MEET EMPLOYEE PSYCHOLOGICAL AND SOCIAL NEEDS AND THE POWER OF SOCIAL GROUPS |

|49.8 - Computer Management Theory |

| |

|Use computer software to analyze data and manage facility systems (MDS, Budgeting) |

|49.9 - Efficiency/Effectiveness Concepts |

| |

|Efficiency is producing results with minimum expense |

|Effectiveness is producing quality work in relation to the effort expended |

|Increasing number of staff (cost) will not necessarily produce better outcome (effectiveness) as staff divides work to ease burden on them all -not exert |

|greater effort |

|Must achieve balance between efficiency and effectiveness, cannot focus on one at the expense of the other |

| |

| |

| |

| |

| |

| |

| |

| |

|49.10 - Maslow’s Hierachy of Needs |

| |

|Five levels of need: |

| |

|Food-water-air |

|Safety and security |

|Love-acceptance |

|Power-worth-recognition |

|Fulfill potential |

| |

|Cannot motivate employees with higher needs (acceptance) unless they have food to feed their family (must meet primary needs first) |

|Relationships between co-workers is a key motivating factor |

|49.11- McGregor’s X-Y Theory |

| |

|Theory X – (X = No/Negative response) |

| |

|The manager believes workers naturally dislike work |

|The manager uses fear and punishment to motivate workers |

| |

|Theory Y – (Y=yes/positive response) |

| |

|The manager views workers as responsible and want to do a good job |

|The manager uses positive rewards and reinforcement to achieve goals |

|49.12 - Herzbergers Two Factor Theory |

| |

|Hygiene factors – causes only dissatisfaction does not foster satisfaction/retention |

| |

|Attractive work environment |

|Necessary computer and work tools |

|Clean and safe environment |

|Basic benefits |

|Motivators – fosters job satisfaction |

| |

|Recognition of work efforts |

|Promotions |

|49.13 - Theory Z |

| |

|Worker motivation dependent on shifting societal values |

|Workers in a facility placed in moratorium for dangerous resident care may feel shame and dissatisfaction in working for the facility and leave the job |

|49.14 - Tom Peters Theories (Developed Management by Walking Around) |

| |

|4 key management functions |

| |

|Care of customers |

|Constant innovation |

|Turned on people |

|Leadership |

| |

|Critical factors to superior performance |

| |

|Exceptional care and constant innovation |

| |

|A facility sells excellent customer service and not good financial reports |

|Key management attributes |

| |

|Blinding flash of the obvious |

|People skills and common sense |

| |

| |

| |

| |

| |

|49.15 - Kreigel’s Theories |

| |

|The time to change is when you don’t have to |

|Be totally committed to the job and burn with a passion |

|Constantly push limits and challenge everyone |

|Do not wait to effect change when staff is ready |

|Expect to wipeout (fail) several times each day (don’t play it safe) |

|Take nothing for granted |

|Prepare for the unexpected |

|Look for the waves on the horizon (opportunities in the future) |

|If it ain’t broken today it will be tomorrow |

|Don’t get lost in dealing with today’s problems |

|There may be bigger and better opportunities on horizon; don’t limit options |

|Stay ahead of changes and anticipate opportunities ahead |

|Never surf alone because you need people to succeed |

|The future belongs to those who welcome change |

|Change is a continuous process |

|Resisting change and innovation will allow you to survive but not thrive |

|49.16 - Peter Drucker’s Theories |

| |

|No area offers more rich opportunity for success for innovation than the unexpected |

|The unexpected (change) cannot be controlled |

|You can only change your attitude and expectations |

|Accept change is integral to living, and embrace it and use it to your advantage |

| |

|49.17 - Tannenbaum’s Theory |

| |

|Managers must be able to react to employees appropriately, and should not have a fixed response to all situations |

|49.18 - Types of Power |

| |

|Legitimate power – Is conferred by title, rank and the org chart |

|Reward power – Motivates behavior through promotions/bonus |

|Punishment power – Uses demotions, terminations, and suspensions to motivate workers |

|Referent power – Is based on liking, respecting or identifying with another person |

|Expert power - Recognition and respect is based on a manager’s perceived skills and knowledge |

|Expert and Referent power should be used most often by managers and are also available to workers as well |

|Section 50 – Systems Theory |

| |

|Systems Theory |

| |

|PROVIDES A MODEL FOR THE DAILY MANAGEMENT OF A FACILITY |

|A system is an organized or complex whole |

|Allen uses a model with the following elements |

| |

|Inputs – Are people, money, patients, supplies |

|Processors – Work actually accomplished by facility – patient care, clean floors, meals |

|Outputs – Results of work performed – prevention of bedsores, tasty meals, odor free |

|Control of quality – Action taken to correct deficiencies |

|Plans of action and policies- Guidelines used to compare actual results to planned results |

|Feedback – External response to outputs (resident council, annual survey) |

|Environment – All external forces affecting the facility (opportunities such elderly people moving into surrounding community) and constraints (mandated min |

|staffing) |

| |

|Output from one system become the input for another system |

| Output Input |

| Patient released from hospital Admitted to nursing home for rehab |

| Resident released from SNF Home health care agency provides in-home services |

| |

|Section 51 – Norms, Values, Employee Motivation |

| |

|51.1 – Norms, Values, Employee Motivation |

| |

|VALUES (VAGUE IDEAL) ARE GENERAL OR VAGUE STATEMENTS REGARDING EXPECTED BEHAVIOR (I.E. , RESPECT RESIDENT’S DIGNITY) |

|Norms are specific standards of specific behavior (address residents by name at all times in a normal calm voice) |

|Norms and values are used to develop employee loyalty to a facility and to control behavior |

|An administrator must have zero tolerance for less than excellent resident care; uncompromising |

|An administrator must lead by example and workers will follow their example |

|Visions and dreams are more inspiring than slogans and goals |

|Motivating statements should come from facility staff not the corporate office |

|Corporate culture is overall manner facility staff interact with each other |

|Cannot expect employees to give their job undivided attention |

|Problems outside the job have an impact on worker morale and their focus on their jobs (partial inclusion/segmental involvement described employees focused on |

|other parts of life beside their job) |

|Workers can’t split personal and work lives |

|The bond between workers is critical to motivating them |

|Workers view a facility from the narrow perspective of their own work area |

|Employees usually have no contact with upper management |

|Section 52 - Delegation of Authority |

| |

|52.1 - Delegation of Authority |

| |

|DECISIONS SHOULD BE MADE AT THE LOWEST APPROPRIATE LEVEL |

|Authority is mostly delegated to middle and lower managers |

|Should delegate authority to people with the most knowledge and best judgment |

|The administrator is still ultimately responsible for all actions of their subordinates |

|The main problem with delegation is that employees can make wrong decisions |

|Section 53 - Command Concepts |

| |

|53.1 - Command Concepts |

| |

|SPAN OF CONTROL – THE MAXIMUM NUMBER OF PEOPLE ONE MANAGER CAN MANAGE |

|Short Chain of Command – The maximum levels of command |

|Balance Concept – The balance between departments re: standardized polices, scope of duties |

|Unity of Command – Each worker should be responsible to only one supervisor |

|Section 54 - LiNE vs Staff Authority |

| |

|Line Authority – Any individual empowered by the administrator to make decisions on behalf of the facility- i.e., the DON, asst administrator, and department |

|heads |

|Staff /advisory function– Staff with no authority to act for a facility – housekeeper, nurse aide, charge nurse, dietician, medical director – have staff or |

|advisory role |

|Section 55 – Emergency Line Authority |

| |

|Ordinarily, corporate staff have only an advisory status while in a facility, but in emergency, corporate officers can exercise line authority and give staff |

|direct orders |

| |

|Section 56 - Management Levels |

| |

|Upper management – The administrator is the upper management level |

| |

|Interacts with the governing board/owner |

|Makes policy that affects all employees |

| |

|Middle Management – the DON and department heads |

| |

|Policies only impact employees in their own department |

|Reports to upper management |

|Needs good communication skills to deal with upper and lower management |

| |

|Lower management – Charge nurse and front line supervisors |

| |

|Direct supervisory role over direct care staff |

| |

|Section 57 - Nursing Home management |

| |

|57.1 - Nursing Home management |

| |

|THE ADMINISTRATOR’S AUTHORITY IS CONSTRAINED BY THE PRESENCE OF LICENSED PERSONNEL IN A FACILITY |

|Power is the ability to control others |

|Administrators have real power |

|Power is a complex concept in our society |

| |

|100 bed facility typically has |

| |

|17 departments |

|8-9 department heads |

| |

|200 bed facility and larger will have: |

| |

|Six mid-level managers |

| |

|An assistant administrator has line authority |

|An administrative asst to the administrator has no line authority |

|The nursing home administrator: |

| |

|Develops budgets |

|Leads staff |

|Is responsible for quality of care |

|Section 58 – Departments/Functions |

| |

|58.1 – Departments/Functions |

| |

|ADMINISTRATION DEPARTMENT |

| |

|Monitors financial performance |

|Hires key staff |

|Develops the budget |

|Coordinates all work in the facility |

| |

|Advisory or allied health department includes the: |

| |

|Resident council |

|Medical director |

| |

|Medical records department is responsible to: |

| |

|Maintain clinical records |

|Must have a full-time records person |

| |

|Admissions |

| |

|Screen patients to determine medical condition |

|Consult with DON to verify if facility can meet needs of prospective new admission |

|Markets services to doctors and the community |

| |

|Dietary department is responsible to: |

| |

|Responsible for nutritious and appetizing meals |

|Long term residents tire of same food week after week |

| |

| |

|Social Services department is responsible to: |

| |

|Help residents adjust to facility life |

|Monitor resident’s psycho-social well being |

|Work closely with activities director |

| |

|Housekeeping department is responsible to: |

| |

|Maintain Infection control |

|Keeps facility clean and odor free |

| |

| |

|Laundry department is responsible to: |

| |

|Ensure linens, table cloths towels clean and good condition |

|Minimize spread of germs |

| |

|Maintenance department is responsible to: |

| |

|Ensure facility and equipment are maintained in good working order |

|To perform preventative maintenance |

| |

| |

|Business office is responsible to: |

| |

|Maintain payroll records |

|Maintain financial records (clinical records kept by nursing dept) |

|Maintain accounts receivable and payables |

|Generate financial reports |

| |

|Personnel/Human Resources department is responsible to: |

| |

|Maintain personnel records, resumes, references, background checks (no payroll records) |

|Section 59 - Facility Org Chart |

| |

|59 - Facility Org Charts |

| |

|EACH FACILITY MUST HAVE AN ORGANIZATION CHART |

|Solid lines indicate direct authority over an individual |

|A dotted line indicates an advisory role (dietician, medical director) |

| |

|Section 60 - Governing Body DUTIES |

| |

|60.1 - Governing Body |

| |

|A FACILITY MUST HAVE A GOVERNING BODY OR DESIGNATED PERSON TO ESTABLISH AND IMPLEMENT POLICIES TO OPERATE THE FACILITY |

|The governing body appoints a licensed administrator |

|The governing body is responsible to manage the facility |

|The governing body has legal responsibility for the operation of the facility (i.e., adopt policies and hire an administrator and to ensure proper operation of |

|the facility) |

|The governing body creates and adopts the mission statement |

|The governing body is ultimately responsible for the operation of the facility |

|The governing body has authority to make critical decisions for the facility |

|The governing body establishes the organization’s mission |

|The governing body establishes the basis for strategic planning |

|The governing body evaluates the facility and the administrator’s performance |

|The governing body has both express and implied authority |

| |

|Express authority– Conferred by statute or law |

|Implied authority – Conferred by corporate bylaws |

| |

|The governing body is not personally liable for the wrongs of employees |

|The governing body is specifically responsible for: |

| |

|Compliance with all state and federal laws |

|To ensure the administrator is licensed |

|Provide adequate staff and insurance |

|To ensure financial stability |

|To safeguard patient valuables |

|To require competitive bidding |

|Provide quality and timely treatment |

|Section 61 – Administrator DUTIES |

| |

|61.1 – Administrator/Governing Body DUTIES |

| |

|ADMINISTRATOR IS RESPONSIBLE FOR THE DAY-TO-DAY OPERATION OF FACILITY |

|Administrator carry out policies set by the governing body |

|Administrator’s authority is delegated by the board |

|Administrator fine tunes the boards strategic plans |

|The foundation of the organization is the Philosophy |

|Bylaws specify organizational structure and are the governance of a corporation – “by these laws we run this corporation” and specifies the |

| |

|Board composition |

|How the corporation is to be run and how to resolve common management issues |

|Place and time of board meetings |

|Number of shares of stock to be issued |

| |

|Section 62 - Federal Rules |

| |

|62.1 - Federal Rules |

| |

|MUST ADMINISTER THE NURSING FACILITY EFFICIENTLY AND EFFECTIVELY TO MAINTAIN RESIDENTS’ HIGHEST PRACTICABLE PHYSICAL, MENTAL AND PSYCHOSOCIAL WELL BEING |

|The facility must be licensed under state law and display all necessary licenses and permits to operate a facility |

|The facility must employ on a full-time, part-time or on a consultant basis, all staff needed to provide required services |

|Professional staff must be licensed or certified as required by law |

|If a facility does not employ any required professionals, they must contract to do so and assume full responsibility for the services performed by a contractor |

|Facilities that are Certified for Medicare and Medicaid must surveyed according to federal standards; facilities not certified for Medicare and Medicaid are |

|subject to state standards only |

| |

|Section 63 - Nurse Aide education/training |

| |

|63.1 - Nurse Aide education/training |

| |

|TO SERVE AS A NURSING ASSISTANT IN ANY NURSING HOME, A PERSON MUST BE EITHER A(N): |

| |

|Certified as a nursing assistant |

|Registered nurse or practical nurse |

|Applicant for nurse licensure permitted to practice nursing |

| |

|Temporary Service – 4 months or less |

| |

|Individuals who are not certified nursing assistants may be employed for 4 months if: |

| |

|The individual is enrolled in or has completed, a state-approved nursing assistant program; or |

|The individual is verified as actively certified and on the registry in another state with no findings of abuse, neglect, or exploitation in that state; or |

|The individual has preliminarily passed the state's certification exam. |

| |

|STATE CERTIFICATION MUST BE COMPLETED WITHIN 4 MONTHS AFTER INITIAL EMPLOYMENT |

| |

| |

|Aide Screening Requirements |

| |

|Must require each nursing aide to provide a complete employment history |

|The facility must verify employment history unless not possible |

|Background screening is required for all employees or prospective employees whose responsibilities may require them to: |

| |

|Provide personal care or services to residents; |

|Have access to resident living areas; or |

|Have access to resident funds or other personal property. |

| |

|Aides are required to have an annual performance review |

| |

|Nursing aides employed 12-months or longer must submit to a performance review every 12 months |

|Nursing aides must receive regular in-service education based on the outcome of such review each year |

| |

|Aides must have 16 hours of initial training to be certified in: (state certification course) |

| |

|Communication skills |

|Infection control |

|Safety and emergency procedures |

|Promote resident independence |

|Respect resident rights |

|Basic nursing and personal care skills |

|Mental health needs |

|Social services needs |

|Cognitively impaired residents |

|Resident rights |

|Restorative services |

| |

|Must have a minimum of 12 hours of in-service training each year to maintain certification |

|Must address areas of weakness identified in nursing assistant performance reviews and may address the special needs of residents as determined by the nursing home|

|facility staff. |

|State surveyors determine whether a nurse aide is competent |

|Nurse aides are supervised by RN’s and Lon’s |

|Volunteers, student nurses and private duty aides are not nursing aides and cannot be used as such. |

|Section 64 - Professional Organizations |

| |

|64.1 - Professional Organizations |

| |

|AMERICAN HEALTH CARE ASSOCIATION (AHCA) |

| |

|Represents 12,000 for-profit/non profit LTC facilities |

|Focuses on political and economic issues |

| |

|American Association of Homes and Services for the Aging |

| |

|Primarily represents non-profits |

| |

|American College of Health Care Administrators |

| |

|Represents long term care administrators |

|Section 65 – OBRA ‘87 |

| |

|65.1 – OBRA ‘87 |

| |

|OBRA 1987 ALSO KNOWN AS THE “NURSING HOME REFORM ACT” |

|OBRA 1987 dramatically decreased reimbursement to facilities via the Prospective Payment system |

|Retrospective payment is reimbursement of full costs after services provided |

|Prospective payment is a fixed amount based on acuity |

|OBRA 1987 set forth uniform licensing requirements for administrators |

|The American Academy of medicine did a study that documented poor care in nursing homes and lead |

|to enactment of OBRA 1987 |

|OBRA stands for Omnibus Budget Reconciliation Act |

|OBRA 87 switched focus of surveys from process to outcomes |

|Hundreds of hospitals closed in late 80’s due to OBRA 1987 |

|Section 66– Deficiencies |

| |

|66.1 – Deficiencies |

| |

|MAJOR CITATION FOR DIETARY WAS FOR UNSANITARY CONDITIONS |

|Only 3% of facilities are cited each year for resident rights violations |

|50% of residents are chair bound |

|Percentage of bed bound residents between 1993-1999 remained unchanged |

|Section 67 – Resident Care |

| |

|67.1 – Resident Care |

| |

|NEW RESIDENTS SEE PLACEMENT IN A NURSING HOME AS A LOSS OF INDEPENDENCE |

|40% of nursing home residents do not require nursing home care |

|Section 68– Ownership Patterns |

| |

|68.1– Ownership Patterns |

|SIZE AND TYPE OF OWNERSHIP HAVE NO IMPACT ON RESIDENT CARE |

|No expected increase in the number of new nursing homes over the next 5 years |

|More nursing home beds are in the north than the south |

|The expected rise in the elderly population does not mean a rise in demand for long term care |

|There are approximately1.6 million nursing home beds in U.S. |

|There are approximately 17,000 licensed nursing homes, 15,000 are certified |

|Approximately 1.5 million people live in nursing homes |

|56% of homes are chain owned |

|There was a large number of bankruptcies of nursing homes in 2000 |

|1.5 %of seniors 65 and older live in a nursing home |

|There are 1,570,000 certified Medicare nursing home beds |

|Section 69– Payor Sources |

| |

|69.1 – Payor Sources |

|MEDICAID PAYS 68% OF LONG TERM CARE |

|Private pay is second largest pay source for long term care |

|Medicaid beneficiaries must spend down all but $2000 of assets |

|Home health care is the largest growing sector in health care |

|Both Medicare Part A and B pay for home health care |

|Nursing homes must shift costs to private pay residents |

|Section 70 – Legislation |

| |

|70.1 – Legislation |

|THE HILL BURTON ACT PUMPED BILLIONS INTO BUILDING NEW HOSPITALS AND NURSING HOMES |

|The National Health Planning and Resources Act requires a Certificate of Need before building a hospital or nursing home |

|Title 20 of the Social Security Act of 1974 created a home health care benefit |

|OASAI – Old Age Survivors Disabled program was the precursor to the social security act |

|The Kerr Mills Act was the precursor to Medicaid – health benefits for the poor |

|Medicare and Medicaid passed in 1965 as an amendment to the Social Security Act |

|An amendment to the Social Security Act of 1967 required licensing of all administrators |

|Utilization review is done to determine if treatment provided to patients was effective and cost efficient |

|A Certificate of Need is issued if it is determined the community can absorb the additional beds – must avoid under and over capacity |

|The CMS stands for the Center for Medicare and Medicaid Services |

|Section 71– Occupancy Statistics |

| |

|71.1 – Occupancy StatisticS |

|OCCUPANCY RATES IN NURSING HOMES CONTINUE TO DROP |

|A facility needs a 90% occupancy rate to breakeven |

|Average occupancy in 1999 was 82% |

|Average Medicaid and private pay stay in nursing homes is 1000-1100 days |

|Average Medicare stay is 30 days |

|Total Medicare stays per year 971,967 days |

|Section 72– demographics |

| |

|72.1 – demographics |

|OLD AGE 85+ IS THE LARGEST GROWING SECTOR OF POPULATION |

|1 in 5 age 65 and older will spend sometime in nursing home |

|The average size of a nursing home facility is 104 beds |

|1 in 20 Americans between 65-74 reside in an institution |

|1 in 10 Americans between 75-84 reside in an institution |

|By 2030 18-20% of population will be 65 and older (1 in 5) |

|Most nursing home residents are female |

|Section 73 – technology |

| |

|73.1 – technology |

| |

|EVERY 10 YEARS 25% OF ALL KNOWLEDGE IS OUTDATED |

|Technology is outmoded every 18 months |

| |

|Section 74 - Medical Director |

| |

|74.1 - MEDICAL DIRECTORS |

| |

|THE MEDICAL DIRECTOR IS RESPONSIBLE TO IMPLEMENT RESIDENT CARE POLICIES |

|The medical director must ensure the residents’ medical needs are met |

|The medical director can substitute for an attending physician in an emergency |

|The medical director must counsel physicians not meeting federal, state and professional responsibilities |

|Medical director assists the DON in providing care |

| |

|Section 75 – Quality ASSESSMENT AND Assurance Committee |

| |

|75.1 – QUALITY ASSESSENT AND ASSURANCE COMMMITTEE |

| |

|MUST HAVE THE DON, A PHYSICIAN (MAYBE THE MEDICAL DIRECTOR), AND THREE MEMBERS OF STAFF ON THE COMMITTEE |

|The administrator is not required to be a member of the committee |

|The committee must meet at least quarterly |

|Must identify deficiencies with respect to resident care and resident services |

| |

| |

|SECTION 76 – CMS QUALITY STANDARDS |

| |

|76.1 – CMS QUALITY STADARDS |

| |

|QUALITY STANDARDS MANDATED BY THE CMS (CENTERS FOR MEDICARE AND MEDICAID SERVICES) ARE CONSIDERED DE JUERE (REQUIRED BY LAW)) |

| |

| |

| |

|Section 77 – Demming |

| |

|77.1 – DEMMING |

| |

|OPTIMIZE TEAM EFFORTS |

|Emphasize quality over price |

|Eliminate production quotas |

|Teach leadership skills |

| |

|Section 78 – Technological Support Systems |

| |

|78.1 – TECHNOLOGICAL SUPPORT SYSTEMS |

| |

|NURSING HOMES CAN USE TECHNOLOGICAL SUPPORT AND INFORMATION SYSTEMS TO TRACK |

| |

|Infection rates |

|Referral sources |

|Skin condition |

| |

|The administrator must analyze and use the quality data collected |

| |

|Section 79 – Miscellaneous |

| |

|79.1 – MISCELLANEOUS |

| |

|LONG TERM CARE INCLUDES |

| |

|Assisted living |

|Nursing home care |

|Continuing care communities |

| |

|Managing is a complex task that is not fully understood by the social sciences |

|An intentional act or threat causing fear in another with reasonable expectation of harm is called assault |

|Nursing home administrators should develop a culture of commitment |

|Administrators must use a combination of leadership and management skills |

|Administrators must focus on results and operations |

|Management and leadership are not the same |

|Administrators must handle daily operations ad take action when required |

|The current focus is to move individuals from institutional care to home health care which is less expensive |

|10 National Institute Occupational Safety and Health provides research for OSHA |

|11. Intentional touching of another person without their consent is called battery |

|12. Civil law focuses on torts and disputes between private individuals |

|13. The fundamental law of the U.S. that establishes the responsibilities and rights of federal courts is the |

|U.S. Constitution |

|14. The rate of increase in total nursing homes between 2005-2020 is likely to level out |

➢ SECTION 80 – KEY TERMS

|TERM |DEFINITION |

|DECENTRALIZATION |DECENTRALIZING DECISION MAKING IN AN ORGANIZATION INCREASES EFFICIENCY AND ALLOWS FOR |

| |GREATER EXPANSION AND GROWTH AS MIDDLE AND LOWER MANAGERS SHARE RESPONSIBILITY FOR MANAGING|

| |OPERATIONS |

|MINIMUM SQUARE FOOTAGE OF A |THE SQUARE FOOTAGE OF RESIDENT ROOM DOES NOT INCLUDE THE HALLWAY, VESTIBULE, CLOSET AND |

|RESIDENT ROOM |BATHROOM SINCE THIS IS NOT USABLE LIVING SPACE |

|PRACTICE CONTROL ACTS |STATE LAWS THAT CONTROL LICENSED NURSES |

|RESIDENT CHARTS |SURVEYORS ARE LESS CONCERNED WITH THE FREQUENCY OF CHARTING THAN THEY ARE WITH |

| |DOCUMENTATION OF SUFFICIENT PROGRESS IN CHART |

|RESIDENT RIGHTS |RESIDENT RIGHTS ARE SPELLED OUT IN OBRA 1987 AND ACTUALLY INCLUDE A RESIDENT BILL OF RIGHTS|

| |THAT SPECIFIES WHAT EVERY RESIDENT IN EVERY NURSING HOME IS ENTITLED TO (I.E. 80 SQ FEET |

| |PER PERSON IN A SEMI PRIVATE ROOM.) |

|SURVEY TYPES |STANDARD SURVEY - ANNUAL SURVEY (EVERY 15 MONTHS) ABBREVIATED |

| |STANDARD SURVEY - FOR A COMPLAINT SURVEY EXTENDED SURVEY - WHERE |

| |SUBSTANDARD CARE IS CITED IN AN ANNUAL SURVEY |

| |PARTIAL EXTENDED SURVEY - WHERE SUBSTANDARD CARE IS FOUND DURING A COMPLAINT SURVEY |

| |RESURVEY - WHERE THE SURVEY TIME RE-ENTERS AND VERIFIES CITATIONS WERE CORRECT FROM INITIAL|

| |SURVEY |

|WIDTH OF RESIDENT BEDROOM |THE WIDTH OF A BEDROOM IS DETERMINED BY THE STATE. HOW MANY RESIDENTS CAN BE PLACED IN A |

| |ROOM IS DETERMINED BY FEDERAL LAW. |

STUDY NOTES

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Section number

Page Number

2/1.8(13)

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