9780763764500

Table of Contents


	New to this Edition	xv
	Foreword	xvii
	Preface	xix
	About the Author	xxiii
PART I	INTRODUCTION: THE CHANGING LONG-TERM CARE SCENE	1
Chapter 1	Long-Term Care Today: Turbulent Times	3
	Learning Objectives	3
	Introduction	3
	Defining the Long-Term Care System	5
	How the Long-Term Care System Came About	6
	The Components of the Long-Term Care System	12
	The Argument Over Institutional versus Noninstitutional Care	19
	Long-Term Care as Part of a Continuum	21
	Strengths and Weaknesses in the Long-Term Care System	23
	Summary	31
	Vocabulary Terms	32
	Discussion Questions	32
	Bibliography	33
Chapter 2	Toward an Ideal System	35
	Learning Objectives	35
	Introduction	35
Criterion 1	The Long-Term Care System should be Based on Recognition of the Needs, Rights, and Responsibilities of Individuals	37
Criterion II	The Long-Term Care System should be Easily Accessible	42
Criterion III	The Long-Term Care System should Coordinate Professional, Consumer, Family, and Other Informal Caregiver Resources	45
Criterion IV	The Long-Term Care System should be an Integral Part of the Health and Social System to Promote Integration, Efficiency, and Cost-Effectiveness	47
Criterion V	The Long-Term Care System should be Adequately and Fairly Financed	54
Criterion VI	The Long-Term Care System should Include an Education Component to Create Informed Consumers, Providers, Reimbursers, and Regulators	60
	Summary	63
	Vocabulary Terms	64
	Discussion Questions	64
	Bibliography	65
PART II	LONG-TERM CARE SERVICE PROVIDERS	67
Chapter 3	Nursing Facilities	69
	Learning Objectives	69
	Introduction	69
	How Nursing Facilities Developed	70
	Philosophy of Care	73
	Ownership of Nursing Facilities	75
	Services Provided	75
	Special Care Units	75
	Consumers Served	78
	Market Forces Affecting Nursing Facilities	79
	Regulations	81
	Financing Nursing Facilities	83
	Staffing and Human Resource Issues	83
	Legal and Ethical Issues	86
	Management of Nursing Facilities	88
	Significant Trends and their Impact on Nursing Facilities	89
	Summary	91
	Nursing Facilities Case: Mary	92
	Vocabulary Terms	94
	Discussion Questions	95
	Bibliography	95
Chapter 4	Subacute and Postacute Care	97
	Learning Objectives	97
	Introduction	97
	What is Postacute Care?	98
	What is Subacute Care?	98
	What is the Difference Between Postacute Care and Subacute Care?	98
	Postacute Care	98
	Subacute Care	101
	Market Forces Affecting Subacute Care	108
	Regulations	109
	Accreditation	111
	Financing Subacute Care	112
	Staffing and Human Resource Issues	114
	Legal and Ethical Issues	116
	Management of Subacute Care Units	117
	Significant Trends and their Impact on Subacute Care	120
	Summary	122
	Subacute Care Case	122
	Vocabulary Terms	124
	Discussion Questions	124
	Bibliography	125
Chapter 5	Assisted Living	127
	Learning Objectives	127
	Introduction	127
	Assisted Living Workgroup	129
	How Assisted Living Developed	129
	Philosophy of Care	130
	Ownership of Assisted Living Facilities	131
	Services Provided	132
	Consumers Served	134
	Market Forces	136
	Regulations	137
	Accreditation	139
	Financing Assisted Living	139
	Staffing/Human Resource Issues	141
	Legal and Ethical Issues	142
	Management of Assisted Living	144
	Management Challenges and Opportunities	146
	Significant Trends and their Impact on Assisted Living	147
	Summary	148
	Assisted Living Case	149
	Vocabulary Terms	150
	Discussion Questions	150
	Bibliography	151
Chapter 6	Senior Housing	153
	Learning Objectives	153
	Introduction	153
	What is Senior Housing?	154
	Philosophy of Care	156
	Services Provided	157
	Ownership	159
	Consumers Served	160
	Accreditation	161
	Financing	161
	Staffing	163
	Management	163
	Significant Trends and their Impact on Senior Housing	163
	Summary	164
	Senior Housing Case	164
	Vocabulary Terms	166
	Discussion Questions	166
	Bibliography	167
Chapter 7	Community-Based Services	169
	Learning Objectives	169
	Introduction	169
	Origins and Development	171
	Philosophy of Care	172
	Ownership	175
	Services Provided	176
	Consumers Served	180
	Informal Caregivers	181
	Market Forces Affecting Community-Based Services	182
	Regulations	184
	Accreditation and Certification	185
	Financing of Community-Based Services	186
	Staffing and Human Resource Issues	189
	Legal and Ethical Issues	191
	Management	193
	Management Challenges and Opportunities	194
	Significant Trends and their Impact on Community-Based Services	196
	Summary	198
	Cases	198
	Home Healthcare Case: Joan and Jerry	198
	Hospice Case: Pierre	200
	Adult Day Care Case: Wilma and Karen	201
	Vocabulary Terms	203
	Discussion Questions	203
	Bibliography	204
PART III	INTERACTION WITHIN THE CONTINUUM	207
Chapter 8	Competition, Cooperation, and Integration	209
	Learning Objectives	209
	Introduction	209
	The Environment	210
	Financing Changes	211
	Competition	212
	Cooperation	219
	Moving from Cooperation to Integration	221
	Integration	221
	Summary	234
	Vocabulary Terms	235
	Discussion Questions	235
	Bibliography	236
Chapter 9	External Control of Long-Term Care	237
	Learning Objectives	237
	Introduction	237
	Public (Government) Control Mechanisms	238
	Private Control Mechanisms	258
	Summary	263
	Vocabulary Terms	264
	Discussion Questions	264
	Bibliography	265
Chapter 10	Long-Term Care Reimbursement	267
	Learning Objectives	267
	Introduction	267
	Origins and Development	268
	Current Reimbursement Options	269
	Managed Care	282
	Significant Trends and their Impact on Long-Term Care Reimbursement	288
	Summary	294
	Vocabulary Terms	295
	Discussion Questions	295
	Bibliography	296
Chapter 11	Long-Term Care Quality	299
	Learning Objectives	299
	Introduction	299
	Defining Quality	300
	Total Quality Management/Continuous Quality Improvement	303
	Quality Initiatives	303
	Systemwide Quality Programs	304
	Provider-Administered Quality Improvement Programs	314
	Quality Teams	317
	Technology	318
	Summary	318
	Vocabulary Terms	318
	Discussion Questions	319
	Bibliography	319
Chapter 12	Ethical Issues in Long-Term Care	321
	Learning Objectives	321
	Introduction	321
	Emotional Impact on Consumers	322
	Access to Long-Term Care	324
	Autonomy	327
	Everyday Life Issues	341
	Restraints	345
	Abuse	346
	Other Long-Term Care Settings	348
	Management Ethics	348
	Summary	351
	Vocabulary Terms	352
	Discussion Questions	352
	Bibliography	353
PART IV	MANAGING IN THE LONG-TERM CARE SYSTEM	355
Chapter 13	Governance and Administration	357
	Learning Objectives	357
	Introduction	357
	Definitions	357
	Organization Types and Who Governs them	358
	Governing Body and Administration: Roles and Responsibilities	360
	Potential Problem Areas	370
	What�s Different About Long-Term Care?	372
	Summary	374
	Vocabulary Terms	374
	Discussion Questions	375
	Bibliography	375
Chapter 14	Leadership and Culture Change in Long-Term Care	377
	Learning Objectives	377
	Introduction	377
	Leadership	378
	Leaders: Who are They?	379
	Common Characteristics of Leaders	380
	Leadership Skills	382
	Influencing Others	382
	Providing Direction	385
	Getting Voluntary Acceptance	387
	Gaining and Improving Leadership Skills	392
	Culture Change	394
	Role of the Leader	397
	Summary	398
	Vocabulary Terms	398
	Discussion Questions	399
	Bibliography	399
Chapter 15	Technology in Long-Term Care	401
	Learning Objectives	401
	Introduction	401
	Applied Technology	403
	Information Technology	405
	Clinical Applications	405
	Administrative Applications	408
	Strategic Support Applications	409
	Networking Applications	410
	Systemwide Applications	411
	Privacy Concerns and H1PAA	415
	Cyber Security	417
	Benefits of IT	417
	Barriers to Use of IT	419
	Options for Acquiring IT	422
	Guidelines for Selecting an IT Vendor	423
	Summary	425
	Vocabulary Terms	425
	Discussion Questions	425
	Bibliography	426
Chapter 16	Marketing and Community Relations	429
	Learning Objectives	429
	Introduction	429
	Defining Marketing and Community Relations	430
	Organizing for Marketing	430
	Market Planning versus Strategic Planning	432
	The Planning Process	432
	Summary	447
	Vocabulary Terms	447
	Discussion Questions	448
	Bibliography	448
PART V	THE FUTURE: CONTINUING CHANGE	449
Chapter 17	Into the Future: Trends to Watch	451
	Learning Objectives	451
	Introduction	451
	Future Directions	453
	Changing Consumer Demographics	454
	Focus on Quality and Outcomes	458
	Changes in the Workforce	461
	Changes in the Organization and Delivery of Long-Term Care	463
	Technological Advances	465
	More and Better Clinical Applications	466
	Innovative Delivery Methods	466
	New Organizational Relationships	468
	Changes in Financing and Reimbursement	470
	Ethical Dilemmas	473
	Regulation	475
	Health System Reform	475
	Summary	476
	Vocabulary Terms	477
	Discussion Questions	477
	Bibliography	478
Chapter 18	Managing for the Future	481
	Learning Objectives	481
	Introduction	481
	Actions for Managers	481
	Actions for the System	490
	Summary	493
	Vocabulary Terms	493
	Discussion Questions	494
	Bibliography	494
Appendix A	Criteria for Designing or Evaluating a Long-Term Care System	495
	Index	499