Assisted Living Administration and Management: Effective Practices and Model Programs in Elder Care

Contents
......Page 8
Contributors
......Page 14
Foreword
......Page 16
Preface
......Page 20
Acknowledgments
......Page 24
List of Figures
......Page 26
List of Tables
......Page 28
INTRODUCTION......Page 30
Long-Term Care......Page 31
Need for Long-Term Care......Page 32
Long-Term Care Providers......Page 33
HISTORICAL EVOLUTION OF ASSISTED LIVING......Page 36
DEFINING ASSISTED LIVING......Page 37
General Resident Profile......Page 43
Length of Stay and Reasons for Leaving......Page 44
Quality of Care and Safety Concerns......Page 45
Quality Improvement Efforts......Page 46
REFERENCES......Page 47
INTRODUCTION......Page 50
The Challenge......Page 51
Medicaid Reimbursement......Page 52
Labels......Page 53
Philosophy......Page 54
Regulatory Models......Page 55
Unit Requirements......Page 58
Resident Agreements/Contracts......Page 59
Pre-Admission Disclosures......Page 62
Admission and Retention......Page 63
Resident Rights......Page 65
Services......Page 67
Operator/Administrator Requirements......Page 68
Direct Staff Requirements......Page 69
Medication Administration......Page 70
Quality Assurance Efforts......Page 72
Americans With Disabilities Act......Page 73
Civil Rights Act of 1991......Page 74
Rehabilitation Act of 1973......Page 75
Family and Medical Leave Act......Page 76
Fair Labor Standards Act (FLSA)......Page 77
Occupational Safety and Health Act......Page 78
REFERENCES......Page 79
INTRODUCTION......Page 82
Aging in Place - A Consideration......Page 83
SERVICE MODELS......Page 84
Hospitality Model......Page 85
Specialized Dementia Care Model......Page 86
ORGANIZATIONAL PATTERNS BY SIZE AND MODEL......Page 87
Non-Profit Investors......Page 88
Administrator’s Objective......Page 91
SPECIFIC AFFILIATIONS......Page 92
Ethnic......Page 93
Gender......Page 94
 Lesbian/Gay/Bisexual/Transgender......Page 95
REFERENCES......Page 96
INTRODUCTION......Page 98
Challenges of Workforce Recruitment......Page 99
Pay and Benefits......Page 100
THE RECRUITMENT PROCESS......Page 101
Job Requirements......Page 102
Job Descriptions......Page 111
Internal Sources......Page 112
Screening......Page 113
Legal Aspects......Page 114
Background Verification......Page 115
CONCLUSIONS......Page 119
REFERENCES......Page 120
INTRODUCTION......Page 122
The Importance of Staff  Training......Page 123
Direct Care Staff  Training Requirements......Page 124
Direct Care Issues......Page 133
Safety and Emergency Issues......Page 135
Direct Care Staff Training: Model Education and Training Programs......Page 136
FACILITATING STAFF TRAINING THROUGH  LEARNING CIRCLES:  A MODEL FOR TRAINING......Page 137
REFERENCES......Page 140
Workforce Retention in Assisted Living:  A Critical Issue......Page 142
Defining Staff  Turnover......Page 143
Calculating Turnover Rates......Page 144
Identifying Risk of Staff  Turnover......Page 145
RETENTION STRATEGIES......Page 146
Sick Time......Page 148
Meetings With the Administrator......Page 159
Supplies/Equipment......Page 149
Recognize the Value of Each Employee......Page 150
Employee of the Month......Page 151
Self-Scheduling......Page 152
Supportive Management......Page 153
Skills for Personal Growth......Page 154
Career Ladders......Page 155
Treats......Page 156
Staff Empowerment......Page 157
Input on Policies and Procedures......Page 158
REFERENCES......Page 160
CONTINUING EDUCATION......Page 162
Methods for Delivering Continuing Education......Page 163
Continuing Education:  What Administrators Say......Page 164
REGULATORY REQUIREMENTS......Page 166
MODEL CONTINUING EDUCATION PROGRAMS......Page 170
Online Continuing Education......Page 174
REFERENCES......Page 178
INTRODUCTION......Page 180
Scientific Management......Page 181
Theory X and Theory Y......Page 182
Deming Management Method......Page 183
Total Quality Management (TQM)......Page 184
Reengineering or Business Process Reengineering (BPR)......Page 185
Management by Objective (MBO)......Page 186
MANAGEMENT METHOD AND STYLE......Page 187
Top-Down or Non-Participatory......Page 188
Participatory......Page 189
MANAGEMENT AND ORGANIZATIONAL STRUCTURE......Page 190
Organizing Principles......Page 191
System as the Basis for Organization, Management, and Evaluation......Page 192
Planning Framework......Page 193
Evaluation Systems and Quality Control......Page 196
Evaluation and the Change Process......Page 198
THE BUSINESS PLAN......Page 199
Business Plan Perspectives......Page 200
Business Plan Issues......Page 202
Business Plan Directions......Page 203
Implementation Strategy......Page 204
Resources:  Available Income and Input-Output Expectation......Page 205
INFORMATION AND TECHNOLOGY SUPPORT SERVICES......Page 211
Implementation Design......Page 206
Goals, Objectives, and Expectations......Page 207
Administration Example......Page 209
Schedule, Staffing, Resources, and Budget......Page 210
Records Systems......Page 212
Resident Records System......Page 213
Marketing Strategies......Page 214
Marketing Team and Activities......Page 215
Assessment of Marketing Effectiveness......Page 216
REFERENCES......Page 217
Financial Management in Assisted Living Facilities......Page 222
ACCOUNTING SYSTEMS......Page 223
Revenue......Page 225
Depreciation......Page 226
Sum of the years digit method......Page 227
ORGANIZATION......Page 228
Documentary Evidence for Internal and Independent Auditors......Page 234
Accountant......Page 235
Clerk......Page 236
Office Administrator......Page 237
Specialist......Page 238
USE OF ACCOUNTING AND FINANCIAL SOFTWARE......Page 239
Noncore Modules......Page 240
The Balance Sheet......Page 242
Owners’ Equity......Page 243
Basic Format of the Cash Flow Statement......Page 245
The Profit and Loss Statement (a.k.a. “The Income Statement”)......Page 246
Other Financial Reports......Page 248
Resident Accounts Receivable Report......Page 250
Vendor Accounts Payable Report......Page 251
Handling Accounts Payable Accounts......Page 252
Handling Resident Accounts Receivable......Page 253
Handling Credits and Collections......Page 254
Time and Earnings (T&E) Records......Page 255
Payroll Journal......Page 256
The Operating Budget......Page 257
Resident’s Accounts Receivable......Page 259
Current Ratio......Page 260
Asset Turnover......Page 261
Creditor Days......Page 262
Limitations of Financial Ratios in Financial Modeling......Page 263
RISK MANAGEMENT......Page 264
Liability Insurance......Page 265
Defense of Law Actions......Page 266
Additional Extended Property Coverage Endorsement......Page 267
 Accounts Receivable Insurance......Page 268
MOST COMMON ACCOUNTING TERMS AND DEFINITIONS......Page 269
REFERENCES......Page 270
Legal Concepts and Issues in Assisted Living Facilities......Page 272
Common Law, Statutes, and Regulations......Page 273
Remedies......Page 274
Duty of Care......Page 275
Care Plans......Page 276
Medication Management......Page 277
Resident Falls......Page 278
Resident Wandering and Supervision......Page 279
Causation......Page 280
Corporate Negligence......Page 281
Respondeat Superior......Page 282
Elder Abuse......Page 283
Tort Reform......Page 284
Elements of a Valid Contract......Page 285
Unconscionability......Page 287
Who May be Admitted......Page 288
Admission Agreement Elements......Page 289
Termination......Page 290
Negotiated Risk......Page 291
Arbitration Clauses......Page 292
Mobility Devices......Page 293
Locked-Door Care......Page 294
EVICTIONS......Page 295
Eviction Procedures......Page 296
Appeals......Page 297
Housing Discrimination Laws......Page 298
Wills......Page 299
Trusts......Page 302
Rep Payee......Page 301
Guardianships and Conservatorships......Page 307
Joint Ownership......Page 303
Right to Refuse Treatment......Page 304
Advance Directives......Page 305
SURROGATE DECISION-MAKING......Page 306
Unrepresented Residents......Page 308
CONCLUSIONS......Page 309
REFERENCES......Page 310
INTRODUCTION......Page 312
Americans With Disabilities Act of 1990......Page 313
Federal Emergency Management Agency......Page 314
International Code Council......Page 315
Accessibility Issues......Page 316
Fire Safety Issues......Page 317
Disaster Preparedness Issues......Page 319
Preparations for Disaster or Emergency......Page 320
Protection During Disasters......Page 321
Recovery......Page 322
Resources for Administrators......Page 323
CASE STUDY......Page 324
REFERENCES......Page 325
INTRODUCTION......Page 328
MODELS OF CARE IN ASSISTED LIVING FACILITIES......Page 329
Elements of the Medical Model of Care......Page 330
Roles of Residents and Families in the Medical Model of Care......Page 331
CULTURE CHANGES IN LONG-TERM CARE DELIVERY AND ASSISTED LIVING FACILITIES......Page 332
Pioneer Network......Page 333
Green House Model......Page 334
Roles of Staff and Administrators in the Green House Model......Page 335
Role of Community in the Green House Model......Page 336
Elements of the Eden Alternative......Page 337
Role of Elders and Families in an Eden Alternative......Page 338
Issues Related to the Green House Model of Care  in Assisted Living Facilities......Page 339
Best Practices in Implementation of Greenhouse Approach......Page 340
Issues Related to the Eden Alternative in Assisted Living Facilities......Page 341
CASE STUDY......Page 342
REFERENCES......Page 343
INTRODUCTION......Page 346
Definitions and Philosophy of Universal Design......Page 347
History of Universal Design......Page 348
Key Principles of Universal Design......Page 349
Strategies for Connecting Universal Design to Assisted Living Facilities......Page 351
AGING-IN-PLACE......Page 352
Definitions and Philosophy of Aging-in-Place......Page 353
Best Practices in Aging-in-Place......Page 355
Roles of Administrators, Staff, Residents, and Families  in Aging-in-Place......Page 356
Benefits Related to Universal Design......Page 357
Benefits Related to Aging-in-Place......Page 358
Challenges Related to Aging-in-Place......Page 359
Future Directions for Aging-in-Place......Page 360
CASE STUDY......Page 361
REFERENCES......Page 362
INTRODUCTION......Page 364
CONCEPTS OF CULTURE, ETHNICITY, AND HERITAGE CONSISTENCY......Page 365
Diversity and Cultural Groups......Page 366
African Americans......Page 374
Asian Americans......Page 375
Native Americans......Page 377
Gays and Lesbians......Page 378
DIVERSITY ISSUES......Page 373
CASE STUDY......Page 380
REFERENCES......Page 381
INTRODUCTION......Page 384
Age-Related Changes to the Respiratory System......Page 385
Age-Related Changes to the Muscular System......Page 386
Age-Related Changes to the Orthopedic System......Page 387
Age-Related Changes to the Gastroenterological System......Page 388
Age-Related Changes to the Genitourinary System......Page 389
Age-Related Changes to the Skin and Lymphatic System......Page 390
CASE STUDY......Page 392
Nutrition Issues......Page 393
Nutritional Assessment......Page 394
Mobility Issues......Page 397
Falls Prevention Issues......Page 399
Best Practices in Falls Prevention......Page 401
Sleep Issues......Page 402
Chronic Pain Issues......Page 405
CONCLUSIONS......Page 407
REFERENCES......Page 408
INTRODUCTION......Page 410
Neurologic Changes......Page 411
Memory and Cognitive Changes Associated With Aging......Page 412
Mini-Mental Status Examination......Page 413
Maintaining Memory Through Educational Programs......Page 414
Nutritional Supplements......Page 415
Best Practices......Page 424
Resources Available to Assisted Living Administrators......Page 420
Dementia Issues......Page 416
Dementia Assessment......Page 417
Alzheimer’s Disease......Page 418
Dementia Related to Alcohol and Drug Use......Page 419
Depression Issues......Page 421
Assessment of Depression in the Assisted Living Facility......Page 422
Strategies to Promote Optional Functioning  in Those With Depression......Page 423
Alcohol and Substance Abuse Issues......Page 425
Assessment for Alcohol Abuse in Assisted Living Facilities......Page 426
Factors Influencing Alcohol and Substance Abuse in Elders......Page 427
Strategies to Deal With Alcohol and Substance Abuse  in Assisted Living Facilities......Page 428
CASE STUDY......Page 429
REFERENCES......Page 430
INTRODUCTION......Page 432
PROTECTION OF CIVIL RIGHTS......Page 433
PROTECTION OF SOCIAL AND ETHICAL RIGHTS......Page 436
ISSUES RELATED TO RESIDENT’S RIGHTS......Page 437
Best Practices in the Area of Resident Rights......Page 439
PROFESSIONAL RESOURCES TO ADDRESS RESIDENT RIGHTS......Page 442
CASE STUDY......Page 444
REFERENCES......Page 445
Appendix A: Glossary of Financial Management Terms
......Page 446
Index
......Page 464