Foreword   Philip S. Brown, ThM, MA, NHA

xi

Introduction

xiii

List of Figures

xvii

List of Tables

xviii

List of Case Studies

xix

The Nursing Home Administrator’s Challenge

xxi

PART 1

LEARNING HOW TO MANAGE THE HEALTH CARE ORGANIZATION

1.1

Management Functions

1

1.1.1

Levels of Management

5

1.1.2

Line-Staff Relationships

7

1.2

Forecasting

9

1.3

Planning

11

1.3.1

Why Plan?

11

1.3.2

Steps in Planning

12

1.4

Organizing

16

1.4.1

Description of the Organization as a System

17

1.4.2

Identifying Systems

21

1.4.3

Additional Characteristics of Systems

22

1.5

Staffing

26

1.6

Directing

26

1.6.1

Policy making

27

1.6.2

Making a Decision

32

1.6.3

Leading

33

1.6.4

Power and Authority

42

1.6.5

Communication Skills

45

1.6.6

Organizational Norms and Values

48

1.6.7

Related Concepts

52

1.6.8

History of the Concept of Management

55

1.7

Comparing and Controlling Quality

58

1.7.1

Some Requirements for Effective Control of Quality

59

1.7.2

Diagnosing/Organizational Quality

60

1.7.3

Quality of Care: 1993-2006

70

1.8

Innovating

73

1.9

Marketing the Long-Term Care Facility

75

1.9.1

The Turn to Marketing

75

1.9.2

The “Marketing” of Health Care

77

1.9.3

Developing a Marketing Strategy

79

PART 2

UNDERSTANDING THE DEPARTMENTS AND MANAGING HUMAN RESOURCES

2.1

Organization of the Nursing Facility and Its Staff

91

2.1.1

The Administrator’s Office

94

2.1.2

Medical and Allied Health Functions

95

2.1.3

Dental Care

97

2.1.4

Foot and Eye Care

98

2.1.5

Pharmaceutical Services

99

2.1.6

Physical Therapy/Occupational Therapy/Speech Therapy

100

2.1.7

Laboratory and Other Diagnostic Services

101

2.1.8

Nursing Services

102

2.1.9

The Business Office

107

2.1.10

Medical Records

108

2.1.11

Dietary Department

108

2.1.12

Social Services and Admissions

112

2.1.13

Activities/Recreation

115

2.1.14

Housekeeping

119

2.1.15

Laundry

120

2.1.16

Maintenance Department

120

2.2

Identifying the Human Resources Functions

122

2.3

Planning Employment Needs: Writing Job Descriptions

124

2.4

Forecasting Future Employment Needs

126

2.5

Recruiting Employees

128

2.6

Hiring Staff

133

2.7

Training Staff

146

2.8

Retaining Employees

151

2.8.1

What the Facility Needs from the Employee

151

2.8.2

What Employees Need from the Facility

151

2.8.3

Strategies Available to the Facility to Both Meet Its Own and the Employees’ Needs

153

2.9

Evaluating Employees

165

2.10

Paying Employees

170

2.11

Disciplining Employees

173

PART 3

LEARNING TO MANAGE THE ORGANIZATION’S FINANCES

3.1

The Administrator’s Role as Financial Manager

179

3.2

Generally Accepted Accounting Principles

183

3.3

Two Approaches to Accounting; Cash Accounting and Accrual Accounting

185

3.4

The Two Main Steps in the Accounting Process: Recording Transactions and Preparing Financial Statements

187

3.5

Putting Financial Statements to Work: Working Capital, Ratio Analysis, and Vertical Analysis

201

3.6

Additional Accounting Procedures That Help the Administrator Maintain Control Over the Facility

207

3.7

The Concept of Depreciation

224

3.8

Using “Costs” in Managerial Decisions

227

3.8.1

Two Types of Costs: Variable and Fixed

227

3.8.2

An Additional Type: Semi-Variable Costs

228

3.8.3

Additional Types of Costs: Indirect Costs and Direct Costs

230

3.9

Budgets and Budgeting

234

3.9.1

Two Methods of Budget Preparation

234

3.9.2

Five Steps in the Budgeting Process

235

3.10

Finance: The Broader Context

240

3.10.1

Sources of Law

240

3.10.2

The Court Systems

242

3.10.3

Legal Terminology

242

3.10.4

Risks Assumed by the Operation of a Long-Term Care Facility

247

3.10.5

Business-Related Concepts and Terms

253

3.10.6

Insurance Terms

268

3.10.7

Terms Associated with Advanced Directives, Wills, and Estates

269

PART 4

LEARNING THE CONTINUUM OF LONG-TERM CARE

4.1

Origins, Overview, and Current Profile of the Nursing Home Industry

271

4.1.1

Origins: Long-Term Care—A 400-Year-Old Tradition

271

4.1.2

Overview/Context of the Nursing Home Industry

277

4.1.3

Nursing Homes

281

4.2

The Social Security Act: Medicare and Medicaid

299

4.2.1

The Social Security Act: Medicare

299

4.2.2

Title 19: Medicaid

306

4.3

Older Americans Act of 1965

311

4.4

Labor and Management: Laws and Regulations

315

4.4.1

Early Management-Labor Relations in the United States

315

4.4.2

Major Legislation Affecting Employer-Employee Relationships

316

4.4.3

Regulation of Compensation

329

4.4.4

Worker’s Compensation

331

4.4.5

Retirement

333

4.5

Workplace Safety: The Occupational Safety and Health Act

334

4.6

Fire Safety: The Life Safety Code

338

4.7

Americans with Disabilities Act of 1990 Accessibility: Guidelines for Facilities

349

4.8

Expanding Facility Services: Health Planning Regulations

376

4.9

Voluntary Operating Standards: Point Commission on Accreditation of Healthcare Organizations

378

PART 5

BUILDING YOUR RESIDENT CARE SKILLS

5.1

The Aging Process

383

5.1.1

Overview of Some Appearance and Functional Changes Believed to Be Associated with Aging

384

5.1.2

Somatic Theories of Aging

385

5.1.3

Resident Exercise and Fitness

388

5.2

Medical and Related Terms

389

5.2.1

Medical Specializations

389

5.2.2

Medications/Therapeutic Actions of Drugs

391

5.2.3

Abbreviations

397

5.2.4

Prefixes

400

5.2.5

Suffixes

404

5.3

The Aging Process as It Relates to Diseases Common to the Nursing Home Population

405

5.3.1

Blood Circulation

406

5.3.2

Respiratory System

416

5.3.3

Nervous System

422

5.3.4

Digestive System

438

5.3.5

Nutrition

443

5.3.6

External and Internal Defense Mechanisms

447

5.3.7

Musculoskeletal System

457

5.3.8

Genitourinary (Renal) System

462

5-3.9

Reproductive System

468

5.3.10

Emotional and Mental Well-Being

470

PART 6

PUTTING THE SYSTEM TOGETHER

6.1

Setting Policies for the Facility

481

6.1.1

Administration Policies

481

6.1.2

Personnel Policies

482

6.1.3

Dietary

485

6.1.4

Admissions Policies

485

6.1.5

Social Services Policies

486

6.1.6

Rehabilitation Policies

486

6.1.7

Resident Rights

487

6.1.8

Quality Assessment and Assurance

499

6.1.9

Dietary

500

6.1.10

Environmental Management

502

6.1.11

Infection Control

504

6.1.12

Physician Services

505

6.1.13

Dental Care

507

6.1.14

Nursing Requirements

507

6.1.15

Quality of Care Using the Resident Assessment Instrument

509

6.1.16

Pharmacy

512

6.1.17

Medical Records

514

6.1.18

Discharge Policies

514

6.2

Developing a Care Plan

515

6.3

The Survey

518

6.4

The Report Card

521

6.5

Getting Reimbursed for Care Given

522

6.6

A Glance at the Horizon

526

6.7

Final Observations on a Career in Nursing Home Administration

528

Appendix A

533

Appendix B

571

Index

579