Assisted Living Administration: The Knowledge Base, 2nd Edition

561 Pages·2004·35.82 MB·English

by  James E. Allen MSPH PhD CNHA

Assisted Living
Administration
The Knowledge Base
Second Edition
ii
James E. Allen, PhD, MSPH, CNHA is
Associate Professor (retired) of Health Policy and Administration in the
Department of Health Policy and Administration
School of Public Health
University of North Carolina at Chapel Hill
He is a licensed North Carolina nursing home administrator.
The UNC-CH Long Term Care Administration Teaching Resources Program
This program makes available to students and course instructors relatively complete sets
of materials for classroom use and for preparation for becoming a nursing home
administrator.
Five key elements for this preparation are:
1. The text, Nursing Home Administration,
4th. ed, Springer Publishing Company, 2003.
2. Nursing Home Federal Requirements: Guidelines to Surveyors and Survey
Protocols., 5th. ed., Springer Publishing Company, 2003
user friendly rendering of the Health Care Finance Administration's State
Operations Manual, Provider Certification.
3. The Licensing Exam Review Guide in Nursing Home Administration, 4th ed.,
Springer Publishing Company, 2003 - 864 practice questions.
4. The Five-Step Administrator-in-Training Internship Program
plus AIT Self-Assessment Tool available through the national association of state
boards.
Instructor's Guide -- 20 case studies plus several hundred questions for classroom use
available to course instructors. Instructors: write to the author, James E. Allen.
Correspondence courses for licensure preparation - used by over a dozen state licensing
boards.
For further information write to the above address,
Or call 1-800-458-8125 or fax [phone].
alrcf outline © Springer Publishing Company
Assisted Living
Administration
The Know/edge Base
Second Edition
James E. Allen, PHD, MSPH, CNMA
Springer Pubiishing Company
iv
Copyright 2004 by Springer Publishing Company, Inc.
All rights reserved.
No part of this publication may be reproduced stored in a retrieval system, or transmitted
in any form or by any means, electronic, mechanical, photocopying, recording, or
otherwise, without the prior permission of Springer Publishing Company, Inc.
Springer Publishing Company, Inc.
536 Broadway
New York, NY 10012-3955
Cover design by Joanne Honigman
Acquisition Editor: Sheri Sussman
Production Editor: Jeanne Libby
04 05 06 07 08 15 4 3 2 1
Library of Congress Cataloging-in-Publication Data
Allen, James E. (James Elmore), 1935-
Assisted living administration : the knowledge base / James E. Allen. -2nd ed.
p.; cm.
Includes bibliographical references and index.
ISBN 0-8261-1516-0
1. Congregate housing—United States—Administration. 2. Older people—Home care—United States.
3. Older people—Housing—United States. 4. Community health services for older people—United
States. I. Title.
HD7287.92.U5A44 2204
362.16'0973»dc22
2004008870
OP
Printed in the United States of America by Integrated Book Technology
alrcf outline © Springer Publishing Company
V
Contents
List of Figures ix
List of Tables xi
Introduction tiii
Part One Assisted Living Industry Overview Management, Leadership 1
1.0 The Assisted Living Industry: Overview 3
1.0.1 Defining Assisted Living 3
1.0.2 Prevalence of Assisted Living Facilities 5
1.0.3 Forces Creating the Need for Assisted Living Facilities 11
1.0.4 Clouds on the Horizon
1.1 Administrative Tasks That Must Be Performed by the Assisted Living
Administrator 20
1.1.1 Levels of Management 24
1.1.2 Line - Staff Relationships 25
1.2 Forecasting 26
1.3 Planning 28
1.3.1 Why Plan? 28
1.3.2 Steps in Planning 29
1.4 Organizing 32
1.4.1 Description of the Organization as a System 33
1.4.2 Identifying Systems 38
1.4.3 Additional Characteristics of Systems 38
1.5 Staffing 42
1.6 Directing 42
1.6.1 Policy Making 43
1.6.2 Making a Decision 46
1.6.3 Leading 47
1.6.4 Power and Authority 54
1.6.5 Communication Skills 57
1.6.6 Organizational Norms and Values 60
1.6.7 Related Concepts 63
1.7 Comparing, Controlling Quality 67
1.8 Innovating 69
1.9 Marketing the Assisted Living Facility 70
1.9.1 The Turn to Marketing 70
1.9.2 The "Marketing" of the Assisted Living Facility 71
1.9.3 Developing a Marketing Strategy 72
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Part Two Assisted Living Facility Organizational Patterns; Human Resources
91
2.0 Organizational Patterns of the Assisted Living Facility 93
2.1 Identifying the Personnel Functions 127
2.2 Planning Employment Needs: Writing Job Descriptions 127
2.3 Forecasting Future Employment Needs 129
2.4 Recruiting Employees 130
2.5 Hiring Staff 134
2.6 Training Staff 148
2.7 Retaining Employees 154
2.7.1 What the Facility Needs From the Employee 154
2.7.2 What Employees Need From the Facility 154
2.7.3 Strategies Available 156
2.8 Evaluating Employees 170
2.9 Paying Employees 175
2.10 Disciplining Employees 178
Part Three Assisted Living Facility Financing, Business Operations 185
3.0 Overview: Position of the Assisted Living Industry 187
3.0.1 Evaluating the Financial Strength of the Assisted Living Provider 191
3.0.2 Cost of Assisted Living Services 195
3.0.3 Sources of Funding to the Assisted Living Industry 197
3.0.4 Pricing Assisted Living Services 198
3.1 The Administrator's Role as Financial Manager 200
3.2 Generally Accepted Accounting Principles 203
3.3 Two Approaches to Accounting 204
3.4 The Two Main Steps in the Accounting Process 206
3.5 Putting Financial Statements to Work 220
3.6 Additional Accounting Procedures that Help the Administrator Maintain
Control Over the Facility 226
3.7 The Concept of Depreciation
3.8 Using "Costs" in Managerial Decisions 245
3.8.1 Two Types of Costs: Variables and Fixed 246
3.8.2 Additional Types of Costs: Indirect Costs and Direct Costs 248
3.9 Budgets and Budgeting 252
3.9.1 Two Methods of Budget Preparation 253
3.9.2 Five Steps in the Budgeting Process 254
3.10 Finance 259
3.10.1 Sources of Laws 259
3.10.2 The Court Systems 260
3.10.3 Legal Terminology 261
3.10.4 Risks Assumed by the Operation of an Assisted Living Facility 267
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3.10.5 Business-Related Concepts and Terms 273
3.10.6 Insurance Terms 292
3.10.7 Terms Associated with Wills and Estates 293
Part Four The Assisted Living Facility Environment:
The Long Term Care Continuum Laws and Regulations 297
4.1 The Long Term Care Continuum 299
4.1.1 Origins 299
4.1.2 The Care Continuum 310
4.2 The Social Security Act: Medicare / Medicaid 316
4.3 Older Americans Act of 1965 324
4.4 Labor and Management: Laws and Regulations 329
4.4.1 Early Management-Labor Relations 329
4.4.2 Major Legislation Affecting Employer-Employee Relationships 330
4.4.3 Regulation of Compensation 343
4.4.4 Workers' Compensation 346
4.4.5 Unemployment Compensation 347
4.4.6 Retirement 348
4.4.7 Work-Place Safety: The Occupational Safety and Health Act 349
4.5 Fire Safety: The Life Safety Code 354
4.6 Americans with Disabilities Act of 1990 Accessibility Guidelines for Facilities 365
4.7 Nationally Recommended Operating Standards 395
Part Five Assisted Living Facility Resident Care 409
5.0 The Assisted Living Environment 411
5.1 The Aging Process 417
5.1.1 Overview of Some Appearance and Functional Changes Believed to Be
Asociated with Aging 419
5.2 Theories of Aging 421
5.3 The Aging Process As It Relates to Diseases Common to the Assisted Living Facility
Population 424
5.3.1 Blood Circulation 425
5.3.2 Respiratory System 435
5.3.3 Nervous System 440
5.3.4 Digestive System 449
5.3.5 Nutrition 453
5.3.6 External and Internal Defense Mechanism 458
5.3.7 Musculoskeletal System 465
5.3.8 Genitourinary (Renal) System 469
5.3.9 Reproductive System 474
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5.3.10 Emotional and Mental Weil-Being 476
5.4 The Scope of Care Issue: Data From 50 States 480
5.5 Resident Care Policies: Establishing and Maintaining Quality of Care 486
5.6 Health Care Records 509
5.7 Pharmaceutical Services 514
Final Observations
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ix
List of Figures
1.1 Conceptual Depiction of the Management Functions
of the Assisted Living Facility Administrator
1.2 Simplified Systems Model
1.3 Range of Decision-Making Strategies Open to the Manager
1.4 Three Levels of Skill Requirements for Managers
2.1 (A) Organizational Pattern of the 60-Unit Jordan Lake Assisted Living Facility
2.1 (B) Organizational Pattern of the 100-Unit Kerr Lake Assisted Living Facility
2.2 Maslow's Hierarchy of Need Concept
3.1 Lakeside Assisted Living Billing Journal
3.2 Source Documents, Support Records, Journal, Ledger
3.3 The Financial Statements
3.4 Resident Census Report
3.5 Resident Ledger Card
3.6 Recommendation for Write-off of Uncollectible Account
3.7 Accounts Receivable Receipts Journal
3.8 Perpetual Inventory Record
3.9 Page from Payroll Journal
3.10 Resident Trust Funds Trial Balance
3.11 Cost Allocation Between Two Support and Two Revenue Centers
4.1 U.S. Population Group Aged 85 and Over From 1900 to 2050
4.2 Need for Institutional and Community-Based Long Term Care, 1995
4.3 Definitions of Activities of Daily Living and Instrumental Activities of Daily Living
4.4 Sources of Payment for Long Term Care Costs, 1995
4.5 Medicaid and Medicare Long Term Care Expenditures, Fiscal Years 1989 - 1993
4.6 Overview of the Long Term Care Continuum
4.7 Building Section View Illustrating Grade Line and Story Designation
4.8 Minimum Clear Width for Single Wheelchair
4.9 Minimum Clear Width for Two Wheelchairs
4.10 Wheelchair Turning Space
4.11 Minimum Clear Floor Space for Wheelchairs
4.12 Forward Reach
4.13 Side Reach
4.14 Accessible Route
4.15 Protruding Obj ects
4.15a Walking Parallel to a Wall
4.15b Walking Perpendicular to a Wall
4.15c Freestanding Overhanging Objects
4.15cl Overhead Hazards
4.15d Overhanging Objects
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