NAB NHA Exam 2023/2024 with Complete Solutions

the physical plant - ANSWER-all designed, constructed, equipped, and maintained to protect health and safety of residents, personnel, public Life Safety Code (LSC) - ANSWER-Entire construction plan and materials meet LSC standards|||CMS requires unless have waiver or exception. CMS grants waivers on SNFs; states on NFs (NFPA) - ANSWER-National Fire Protection Association ||established LSC Purpose of LSC - ANSWER-to provide reasonable degree of safety from fire. Waivers for Life Safety Code - ANSWER-If CMS finds a state fire and safety code adequately protects residents and personnel thenLSC does not apply. OLder facilities may obtain a waiver if they are and have been in compliance with an older addition of LSC as specified by CMS.||Before a nursing home may be built it must present architectural plant to State Medicaid or designated agency that approves construction. All major renovations, such as additional beds, change in utilization of space, and so on must receive approval. The state provides guidelines on what must be a approved. Upkeep and repairs do not require prior approaval. Blue Prints - ANSWER-keep as-built plans available for surveyors who do LSC inspection as well as for repair persons who may need prints for big jobs. LSC and other standards - ANSWER-Building and contact standards are set by LSC, CMS, ANSI/ADAAG - (dependent on which the state chooses) and state and local codes. ||- for handicapped|-follow which on specific state requires (ANSI/ADAAG) LSC and ANSI/ADAAG - ANSWER-LSC accepts both standards so they are essentially all LSC standards. Administrator does not need to know EVERY standard, but must keep a copy of the "LSC Handbook" as reference. The architect who designs the facility must know and incorporate all LSC and other standards, but it is advisable for the NHA to check his building to ensure compliance. LSC, ANSI/ADAAG, and CMS - ANSWER-**- building materials - fire-rate according to number of stories. 2 hour and 1 hour rating|**- sprinklers - new buildings have automatically activated by smoke/heat|- exits - no room more than 100 feet from exit. Lighted exit signs of specific size. |- walls extend continuously to roof deck of next floor. wall finish must meet flame-spread requirements ( have certificate of this)|- furnishings - curtains and carpet must meet fire rating|- rooms - CMS requirements - 4 residents to room MAX. 80 sq ft/resident (multi-resident room), 100 sq ft for single occupancy. requirement for rooms| - ANSWER-- direct access to corridor|- outside window (CMS) or door (LSC)|- privacy|- furnishing| separate bed, proper size and height| bedding appropriate to climate| individual closet space| bedside table| comfortable chair| enough overbid tables to meet needs of rsidents|- toilets (CMS, ANSI, ADA)|- bathing facilities (CMS)|- resident call system (CMS, LSC) 24/7 - back up system available|- temperature range (71-81 degree F) (three feet above floor), states set actual, A/C not required Doors - ANSWER-All 44" or more in new construction (41.5 opening)|outside doors open egress.|no locks on resident door except staff has key (LSC)||Bathroom door 32" (ANSI/ADAAG)||Fire Doors with automatic hold-open devices required in corridors||(over bed tables not required for patient) corridors - ANSWER-no dead-ends (LSC)||8 feet wide (CMS) Floors - ANSWER-at or above ground level. (LSC) |Fire rating if carpeted. (LSC)|Non-slip bath/toilet (ANSI, LSC)|Asphalt tile best Fire alarms - ANSWER-flashing and audible. |connect with local fire dept, if possible|must have NFPA 71 certification of fire alarm service| smoke detectors - ANSWER-approved detectors requried smoking - ANSWER-written regulations, enforced. |smoking ares with non-combustible ashtrays, metal containers with self-closing lids.|Prohibited areas include resident rooms and beds, oxygen, flammable liquid storage.|proper signs posted.|supervise non-responsible. ANSI/ADAAG(Americans with Disabilties Act Accessibility Guidelines) - ANSWER-Make building available to and usable by physically handicapped, no mental (blind, deaf, non-ambulatory, semi-ambulatory, uncoordinated). ADAAG = MAKE BUILDINGS AVAILABLE TO ADA'S. |State decides whether to apply ANSI or ADAAG standards to nursing homes accessible route - ANSWER-no incline more than 10% Wheelchair passage - ANSWER-32" bathroom doors||36" elsewhere parking - ANSWER-13 FEET||cannot block sidewalk; alley for 2 cars.|The number of handicap parking places is determined from a grid issued by ANSI. It MUST BE NOTED THAT FOR EVERY EIGHT (8) HANDICAP PARKING SLOTS, ONE MUST BE VAN ACCESSIBLE.||If the facility only has one handicapped place, it must be van accessible. ramps - ANSWER-maximum rise 30". Slope not more than 1:10 What items must be accessible to wheelchair residents?| - ANSWER-WATER FOUNTAINS, telephones (non-Braille), light switches Toilets and handrails - height - ANSWER-toilets (Also ADA for staff) seat **17" to 19" height;||hand rails/grab bars 33" to 36". |5% or more meet standards as determined by state and CMS||(easier to replace with handicapped toilet) Handrails - ANSWER-outside ramp, stairwell, bathroom required by ANSI, and specific height.||CMS requires in corridors.||ADAAG specifies all 34" to 38" in public places. |On stairwell must be 32" and MUST EXTEND 12" beyond last step. (ANSI| Monitored - ANSWER-monitored nationally the Office of Civil Rights monitors ANSI. States may assign to Fire Marshall, Medicaid Agency, other. |ADAAG is monitored by State Agency handling LSC and ANSI. Alarms - ANSWER-flashing alarms for deaf, sound alarms for blind, tactile warnings for blind to identify danger areas. Grating - ANSWER-No greater than one-half inch; openings perpendicular to travel rout, if elongated. Threshold - ANSWER-no more than 1/2 inch on entrance and exit doors, except exterior sliding door can be 3/4 inch in height GROUNDS and parking - ANSWER-Maintenance cost-mowing biggest. State decides on number of parking spaces per bed. Water - ANSWER-water must have backup source of supply. Temperature established by state. Automatic Control Valves. (surveyors will ask for contract) (110 degrees in GA) Ventilation - ANSWER-All areas ventilated to outside - window, mechanical ventilation, or combination. | a. good movement (state determines| b. acceptable humidity/temperature levels (state determines)| c. surveyor rating:| A= Good movement; acceptable temp/humidity/odor levels| B= Little movement; temp/humidity/odor levels less acceptable.| C= No movement; temp/humidity/odor levels unacceptable. Residents and staff apprea distressed due to levels. Pest control - ANSWER-PREVENTION PROGRAM BEST; use contractor and staff||no traps, poisons, sticky fly paper.||advantage - to use pest control service:||licensed and trained in use of all pesticides, how to rotate chemicals to prevent buildup of resistance. ||(close garbage bin: attracts pests) Space and Equipment - ANSWER-Facility must provide sufficient space and equipment for dining, healthcare services, recreation and rehabilitation. ||Sufficient means enough to enable staff to provide residents with needed services as identified in the plan of care.| - space large enough to accommodate usual number that use it; must be accessible.| - accommodate wheelchairs, walkers, other ambulatory devices.| - rehab areas have exercise equipment, storage for supplies and equipment. Monitoring - ANSWER-States decide who will monitor LSC and ANSI/ADAAG standards. the monitor may be the State Medicaid Agency, State Fire Marshall, or other. If it is an agency other than State Medicaid, the monitoring agency must coordinate its findings with the Medicaid agency. Preventative Maintenance definition. - ANSWER-checking all systems, including roof, on regular basis and documenting.||roof protects all other assets. (log or cards) 3 points of Preventative Maintenance - ANSWER-1. Value:| Everything safe and operative for resident care (#1)| saves downtime| small reparis cost less than complete breakdown| equipment and systems last longer|2. personnel - major error in hiring|3. work orders environmental quality - clean, attractive, home. - ANSWER-1. housekeeping - procedures for floors, rooms, aseptic cleaning, storage of materials, ODOR CONTROL, role in infection control, equipment care, safety|2. homelike - residents brings own belongings as long as it does not interfere with staff work or infringe on other residents' rights. de-emphasize institutional look. | a. sound - comfortable, does not interefre with hearing. background noise under resident control. Level not require staff to raise voices. consider differences in room assignments.| b. lighting - adequate for resident/staff to perform. comfortable - minimize glare, GIVE RESIDENT CONTROL. environmental design - ANSWER-now part of all new construction. Must be designed to provide most attractive, comfortable, usable environment. | a. landscaping - all grounds, nursing home sign.| b. choice of colors.| c. room size- too small?, adequately designed?| d. medical records storage| e. parking - inconspicuous| f. functional equipment - not just fancy. linen supply and laundry - ANSWER-clean linens in good condition, not ragged, stained. what resident clothing will launder?| a. monitoring costs - bulk soap, temperatures, overloading/under loading, overydrying, filters| GUIDELINES- after 10 years of use, maintenance cost usually justify replacement of equipment| b. Theft| Occupational Safety and Health Administration (OSHA) - ANSWER-programs OSHA falls under U.S. Department of Labor safety and infection control program - - ANSWER-complete procedures for all staff to follow best infection control. committee may be desirable. universal precautions - ANSWER-checked by OSHA; includes|-CDC HAND WASHING procedures. NOW recommend use of alcohol-based solution to cleanse hands (except dietary employees)|-SOILED LINENS and bedclothes means used linens.|-Contaminated linen is soiled by blood or other potentially infectious materials. Mishandling is most frequent exposure to communicable materials. OSHA requires contaminated to be containerized at location. aseptic cleaning of isolation area. |OSHA APPROVED SPILL KITT*** CMS STANDARDS for infection control - ANSWER-investigate, control, prevent infections|set up procedure for entire program|document incidents and correctivev action|isolate infected resident|no employee with communicable diseases or skin lesions can have contact with food or residents|hand washing after each direct resident contact|handle, process, store, and transport linens in manner to prevent spread of infection blood born pathogens (BBP) - ANSWER-focused on AIDS and Hepatitis B. (OSHA) Training for BBP - ANSWER-all staff trained in how to handle| 1. blood spills and materials that may be infected, and | 2. exposure incidents PERSONAL PROTETIVE EEQUIPMENT (PPE) - ANSWER-FACILITY MUST PROVIDE GLOVES, GOWNS, LAB COATS, FACE SHIELDS, EYE PROTECTION, MOUT PIECES, AND RESUSCITATION BAS, POCKET MASKS, OR OTHER VENTILATION DEVICES. TRAINED TO USE Disposal - ANSWER-of sharps and other contaminated materials (OSHA) must have container in nursing, laundry, etc. and policy on emptying container (med carts: check levels)| regulated waste - ANSWER-contaminated sharps, blood, pathological waste, etc. Have written procedures for handling. Needlestick Safety and Prevention Act - ANSWER-follow OSHA standards|engineering controls - shield, retracting needles, shielded catheters, needles housed in protective covering, and jet injections. NOW required to USE SAFETY SYRINGES.|Law requires employee input on what works best. isolation room procedures - ANSWER-single occupancy|toilet|hand washing faciltities|vented to outside|sign when in use| HBV requirements - ANSWER-vaccine offered free to all employees (OSHA) Employee with lesions - ANSWER-never works in kitchen or patient care area post-exposure procedures - ANSWER-must have written plan for evaluation and follow-up. individuals involved tested (consent may be gained-OSHA says not required)-test blood of exposed person documentation - ANSWER-every exposure incident. facility should have "OSHA Compliance and Exposure Control Plan Checklist" in order to know if incompliance reporting communicable diseases to: - ANSWER-state agency SAFETY mandated by CMS, OSHA: Goals - ANSWER-1. reduce work-related illness, injury, death in staff.|2. reduce accidents, injuries among resident, families, visitors. programs - ANSWER-procedures to cover preventive measures, investigating of accidents, documentation, corrective action, reporting. committee may be useful - not required identify potential hazards - ANSWER-BED RAILS, wheelchairs, walkers (misuse or poor maintenance|WET FLOORS mopping, spills|HOT WATER-temperature set by state. Automatic control valves|extension cords|frayed electrical wires|unattended cleaning carts (medication carts)|restraints|adapters (cheaters) accidents - ANSWER-unintentional damage to object or injury to person. two causes: |(1) unsafe behavior|(2) unsafe working or living conditions investigate - ANSWER-every accident, document, corrective measures - identify patterns, discuss with dept. head. document - ANSWER-on OSHA forms log (FORM 300***) only inventory staff, not residents. need copy of "what every employer needs to know about OSHA Record-keeping . keep records for 5 years. non-recordable- - ANSWER-if only first aid unconscious reportable - ANSWER-accidental death, and 5 or more hospitalized (within 8 hours report) POSTER - ANSWER-required by OSHA HCP - ANSWER-Hazard Communication Program ||Mandated by OSHA Purpose of HCP - ANSWER-all chemicals are evaluated and information concerning hazard communicated to employer and employees. HCP Program written: - ANSWER-a. list of all hazardous chemicals (anything with a warning label)|b. label all chemical containers|c. prepare and distribute MSDS (any chemical)|d. develop and implement employee training label must: - ANSWER-a. identify product|b. identify hazardous chemicals|c. contain appropriate warning|d. show name and address of manufacturer|e. sometimes pH content-7 is norm Includes - ANSWER-cleaning compounds, clorox, furniture polish, pine oil, detergents, etc. Anything with WARNING label on it. lockout/tagout - ANSWER-control hazardous energy.|| purpose of lockout/tagout - ANSWER-to require employers to establish program using lockout or tagout devices on energy isolating devices and to disable equipment and machines to prevent unexpected energizing, start-up, or release of store energy in order to prevent injury. lockout device - ANSWER-lock (key or combination) that will hold device in safe position so it will not energize. where to keep key? maintenance person tagout device - ANSWER-used when evergy source cannot be locked out - tag or warning device NOT to use. Right to know laws RE: - ANSWER-hazardous materials in some states. OSHA recognizes only in sates with OSHA approved programs OSHA penalties - ANSWER-OSHA can FINE facilities|amounts based on severity of the deficiencies, GIVE CITATIONS and IMPRISON|CONSULTANTS - OSHA does trial run - no penalties SMDA - ANSWER-Safe Medical Devices Act of 1990 Medical devices - ANSWER-Medical devices - "Any apparatus, implement, chanine, implant, or related article intended for use in diagnosing, treating, curing, or preventing disease or intended to affect the body's function or structure, which achieves its intended purposes without chemical or metabolic action within the body.||i.e. catheters, thermometer, pacemakers, contact lenses, hearing aides, restraints, blood glucose monitors, WCs, gerchairs, beds, infusion and feeding pumps, whirlpool suction machines. policies and procedures - ANSWER-facility required to establish policies/procedures for programs of staff training, of reporting incidents, illnesses, and injuries, and of action taken. monitoring - ANSWER-the Food and Drug Administartion (FDA) monitors reportable incidents - ANSWER-events that reasonable suggest a medical device caused or contributed to a serious illness or injury, or to the deat of a resident - includes user error. serious illness or injury: - ANSWER-a. life threatening|b. results in permanent impairment to body structure or functioning|c. needs immediate medical or surgical intervention to prevent permanent illness or injury. ||extent determined by a physician training - ANSWER-staff must be trained annually on commonly used medical devices and on reporting. trained as necessary on infrequently used devices. include step by step procedure for staff to use in handling and reporting. Reporting - ANSWER-a. designated person - incident covered by SMDA are reported to a specified person within a specified time.|b. deaths - designated person reports deaths to FDA and the manufacturer of the device within 10 days.|c. serious injuries and illness - reported to the manufacturer, if known; if not, to the FDA within 10 days|d. Annual (summary) reports - filed with FDA inJanuary and July . Use form FDA 3375 TEST. ANNUAL REPORTS NOT REQUIRED IF NO INCIDENT. Reports include:| facility | device-serial number and//or lot number| manufacturer| incident description||Referred to as Medical Device Reports|| Security - ANSWER-Broad term that applies to protection of residents, staff and visitors, theft, etc. Location - ANSWER-determines security needs, i.e. high crime areas entrances - ANSWER-Entrances - lock from outside alarm devices - ANSWER-for wanders and elopers drug abuser - ANSWER-threat- narcotic key local police - ANSWER-relationships materials security - ANSWER-program of purchasing, receiving, storage, issuing, inventorying. Administrator monitor Fire prevention & control - - ANSWER-CMS requires program, LSC gives specifics (NFPA Guidelines) classes of fires and control - ANSWER-a. paper, wood-water (class A extinguisher) no more than 75' apart|b. grease, liquids-dry chemicals, hood (class b extinguisher)|c. electrical-dry chemicals (class b or c extinguisher)| B&C no more than 50' apart.| K-Kitchen extinguisher prevention - ANSWER-fire-rated building material and furnishings||have designated smoking areas and monitor. preventative maintenance - ANSWER-regular inspections (firemen), reports|a. kitchen hood-semiannually|b. fire alarms|c. exit lights|d. auxiliary generator|e. automatic fire doors|f. smoke detectors|g. smoking procedures|h. sprinkler system|i. fire extinguishers (show dates) Identify risk areas - ANSWER-NUMBER 1 CAUSE OF NURSHING HOME FIRES ACCORDING TO THE NFPA IS GREASE FIRES IN THE KITCHEN| FIRE CONTROL - ANSWER-planned program with local firemen who learn facility layout, hookups, cutoffs.. Alarm systems - ANSWER-regulated by ANSI and LSC Highest ranking person on duty in charge. Follow RACE: - ANSWER-R - Remove (rescue) endangered resident|A - sound Alarm|C - Contain fire (known which extinguishers to use.)|E - Evacuate if necessary (blind) or extinguish Doors - ANSWER-automatic fire doors; door to room closed training and drills - ANSWER-all staff trained before go on job. Drill required quarterly on each shift by LSC. Document....Not ENOUGH. How many per year? documentaiotn|||Specific duties of each employee. Supervisor will question. Other Disaster planning depends on location - ANSWER-1. main highway/railroad - chemical spills|2. factories - explosions|3. hurricanes, tornadoes, floods, wildires, snow storms, earthquakes, other natural disasters Preparedness program and training - ANSWER-transfer of casualties, records-transportation|shelter agreements|evacuation routes|care when evacuated --medications|special emergency procedures for cardiac cases|backup sources -water, power emergency power - ANSWER-required by CMS if have life support equipment, state may require all. supply power to: (LSC) alarm system, life supports, nurse's station, med. prep area, boiler room, communications (call system). CMS omits resident call system, BUT says follow LSC|| power transfer- 10 seconds| cranked weekly| tested full load 30 minutes/month| document battery backup - ANSWER-(if no generator) for fire, life safety, alarm system; all entrances and exits. NO waiver. Auditing and reporting - ANSWER-review program regularly - check all equipment, accident log, maintenance log, infection control measures, security practices, reports of theft.||conduct and observe drills wil firemen||review documentation ||ask each employee "duty?" reporting - ANSWER-of fires to fire marshall required in most states. also to medicaid agency atmosphere - ANSWER-1. physical - pleasant buildings, rooms, surroundings, change colors.|2. social - make eye contact every time see a person and call name and smile. never ignore any person you pass in the facility. be friendly.|3. show warmth, interest in individual.|4. eden alternative Governing Body - ANSWER-REQUIRED by CMS, whether sole proprietorship, partnership, or corporation corporations - ANSWER-are required by state to have Articles of Incorporation that specify officers, board, membership. closely held corporation - ANSWER-less shareholders, most are 5 or less, less formal organization. Public Corporation - ANSWER-many shareholders, very structured, bylaws make up - ANSWER-may be one person or many - there is not typical board structure in NFs Duties of Corp - ANSWER-Mission Statement - what facility is to do (major duty)|Board establishing measurable goas|Employ agent (NHA). Required by CMS|Establishing and implementing policies and procedures. CMS says legally responsible for operations|Approve budget|Evaluate administrator's mangement|Board does not get into day-to-day operations Bylaws - ANSWER-mostly by corporations. Rules to govern corporation itself. Not too specific. Tells WHAT cop oration will do.Includes duties of Board, officers, committees. Prepared by corporate members. Used as basis for writing policies and procedures for each unit of corp. Tells HOW activities to be carried out. Usually prepared by administrator, and approved by board. Governing body/administrator relationship - ANSWER-NHA only person reporting directly to GB, usually through the chain of command, e.g. regional director, VP of operations, etc. Represents his/her staff in best light-accurate, objective, factual. Reports to GB as requested - census, personnel, financial reports, regulation changes. (keep fully informed, otherwise grapevine gets to them.) Directives/policies/procedures .| - ANSWER-of GB interpreted properly, whether agree or not. Let Employees gripe, but support GB GB listen - ANSWER-to employee complaints but refer them to supervisor or NHA. Inform NHA Role confusion - - ANSWER-GB members usually successful in another field. Not have same, clearly defined solutions Duty of obedience partnership - ANSWER-partner owes his partners a duty to act in obedience to the partnership agreement on all business decisions. Personally liable if does not. Corporation - ANSWER-Directors and officers must act within the authority granted them - usually in bylaws and articles of incorporation. Can be held liable for any unauthorized actions. duty of diligence - ANSWER-Partners, board members, and administrators must discharge duties in good faith, with care and prudence, i manner she/he believes is inbest interest of organization. Adminstrtaor must exercise knowledge and skill he/she professes to have as a licensee. Management - ANSWER-Creating and maintaing an environment within an organization that makes it possible for staff to work together toward common goals. Getting work done with and through others. Functions of Managers (supervisors): Planning - ANSWER-setting goals, establishing PPR's, programs, budgets, etc. that determine what, how, when, where and by whom work is to be done. CENTRAL TASK is planning as it permeates all other functions. Purpose - ANSWER-primary focus on obtaining goals |offsest uncertainty and change|develop economical operations, and|facilitate control| Primary value - ANSWER-Administrator is charge whether she/he is present or not Types of plans: mission - ANSWER-basic task assigned to an enterprise by society. In nursing homes the mission is LTC goals or objectives - ANSWER-end results or product toward which all effort is directed||a. short range|b. long range|c. goal oriented needed||(These SHOULD STIMULATE action) Strategies - ANSWER-general plan that focuses on long range goals. ||What will facility be like, look like, feel like, sound like, and react like, in the future policies - ANSWER-broad general statements to guide decision making and to some extent action in achieving goals. allows flexibility in judgment. procedures - ANSWER-step by step means by which tasks are performed. allows less flexibility in decision making rules - ANSWER-specific, authoritative guides that require an action be taken or not taken. allows no flexibility in decision making. employees can use no judgment, so should have few as possible. programs - ANSWER-summations of goals, PPR's, budgets, work and space assignments, and resources. budgets - ANSWER-plan expressed in numerical terms that outline expected results evaluating effectiveness of policies and procedures. Are they: - ANSWER-written|differentiated|taught/understood|monitored to be sure they are followed|help meet goals|flexible - if don't help, change|reviewed and updated regularly organizing - ANSWER-grouping activities and people, assigning roles, delegating authority. Setting up department, shifts, work teams. purpose of organizing - ANSWER-allows for growth and expansion; seeks to reduce friction and unsought consequences. departmentalization - ANSWER-makes it possible for the organization to expand.** chart of organization - ANSWER-shows lines of authority and communication, formal organization.||hierarchy. top to bottom scalar chain - ANSWER-used almost entirely. || 0| I|__|I I|0 0 Span of management - ANSWER-How many employees a supervisor can effective supervise. Usually 8-12 at line level. |DEPENDS:|- difficulty of task|- clearness of policies/procedures|- training|- how well supervisor communicates|- experience|- closeness of control required Unity of command - ANSWER-employee has only one supervisor insofar as possible. need clear authority lines - promotes job satisfaction, teamwork. staffing (HR) - ANSWER-recruiting, interviewing, hiring, training, promoting, demoting, terminating, retiring employees. (terminate early in week) Directing (leading) - ANSWER-influence of employees todo their work according to stander - who?when? how? invoves leading, motivating, communicating, giving instructions, goal setting, decision making, representing, coordinating, managing conflicts. Leadership NH success depends on NHA's ability and willingness to lead. Basic characteristics of leaders: - ANSWER-visibility- out and about in facility out in front, not office-bound. (ghost can't lead)|decisive - must use authority and be accountable for what happens.|listening - hears what people say - good communicator with everyone.|pitches in - when needed, rolls up sleeves and helps.|understanding - gives staff right to be angry, non-judgmental.|goal oriented - quality resident care is foremost. plans so all know the NH goals|Competitive - wants his/her NH to be the best|knowledge base - broad knowledge base of all NH ape rations and of total health care. Duties of leaders. duties are diverse. they include: - ANSWER--goal setting - points teh way. good planner|-decision making - high priority, as it includes problem solving. makes decisions when needed - no - procrastination. uses his/her authority.|-giving instruction - types: specific or general, formal or informal, written or oral. Gives instructions of type staff best responds to.|-Listening - problems of staff, residents, families, and public. Good at crisis intervention. |-Representing - his staff in best light.|-Coordinating- People have different approach to work - slow and fast, interested or not, apply self fully or not, etc. He/She must coordinate those differences and still get job done. Superior/subordinate relationship - ANSWER-gives rise to jealousy and anger; trouble begins. Some people DO NOT WANT TO WORK or be told what to do. Authority - ANSWER-right to act or require action of others- instruct, approve/disapprove, veto action, change action, reward/withold. Line - ANSWER-over all under one's direction - hire, instruct, monitor, discipline, fire staff - ANSWER-advisory, recommend, teach. cannot enforce decisions- consultants. functional - ANSWER-authority over a function (hiring, purchasing..) but not over person who carries it out. used in larger organizations. delegation - ANSWER-effective when lowest person in echelon who is authorized and capable is making a given decision. key to effective management. leadership style - ANSWER--laissez-faire - give instructions and leave alone, easy going and supportive. May work for professional staff, and for highly motivated, capable staff.||democratic- allow employee input on how things are done. majority rules. a factor in TQM. administrator must retain veto power, cannot be 1005 democratic.||paternal, sympathetic, parenting - you do your job- i'll take care of leave, raises, benefits.||autocratic- dictatorial, threatening, intimidating. no confidence in staff; he knows all. "don't care if he likes me or not-just so work gets done"||situational- leaders adapt their style at times to meet circumstances in which they are working and/or the type of employee they are leading. controlling - ANSWER-measuring of the work performance to determine if it follows guidelines, and correction of any errors in performance. requires good policies and procedures. purpose of controlling - ANSWER-maintain harmony between plans and work performance. ||purpose of correcting erros is to improve work performance. **three steps in correcting errors: - ANSWER-review how work was to be done - begin with mutual agreement.|point out error|indicate remedy guidelines to correcting (4) - ANSWER--correct first error, soon as possible, in private|-objective, specific, factual-no exaggeration|-make no excuse, be serious|-do not threaten that will watch to see| management types - ANSWER-most effective now considered to be TQM and MBWA TQM - ANSWER-builds employee interrelationships through work teams; utilizes employee knowledge. requires open communication, trust, mutual respect among employees and management. focus on improving - ANSWER-skills and quality of output. concerned with productivity, safety, cost, resident satisfaction. how can improve quality of work, and their knowledge and skills. result in continuous quality improvement (CQI) - ANSWER-greater job satisfaction, motivation, teamwork, growth of staff. MBWA - ANSWER-NHA regularly visits all departments and observes performance and environment. sends out strong messages:||- interested, available|- expects quality|- monitoring|- provides opportunity to:| - reinforce good work| - prevent some problems| - enhance communication employee centered management - ANSWER-is interested in needs and interests of employees. promotes positive work atmosphere, improves performance. (TQM and MBWA) organization communication - ANSWER-- process of tansmitting information among two or more people. occurs when message received with understanding. direction of organization communication- - ANSWER-upward, downward, horizontal (lateral) diaganonal process of organization communication - ANSWER-ideation|encoding|transmitting|receiving|decoding|understanding|feedback key to communication is listening - ANSWER-40% of the time. |active listening - hearing message and the feelings behind it.| best form of organizational communication - ANSWER-face to face - as secure immediate feedback by expressions, questions.. barriers in organizational communication - ANSWER-poorly worded -use language of receiver|inattention - tune out and think of something else|transmission barriers- noise, poor hearing, stuttering, etc.|distrust of sender|fear of consequences|poor retention - 30% or less is retained|premature evaluation - give answer before problem is presented|upward communication barrier- filtering out some info before passing it along|over/under - more than need to make decision. purpose of communication - ANSWER-usually CHANGE - schedule, procedure, new skill, further training. | timing of communication - ANSWER-tell assistants first, department heads, supervisors, then workers. usually several days before implementation. never tell staff at once. written communication preferred when: - ANSWER-info must pass thru several mgt. levels|employees not well trained|involves significant change |provides guidelines of long duration|supervisor tends to forget what has told employees computerized information - ANSWER-learn basic terminology. value- provides quicker, more accurate, greater amount of information for decision making. especially useful in financial management, inventory control, etc.MIS needed in nursing homes| a. online survey certification and reporting (OSCAR) system. All NH's must input assessment and care plan information. surveyors use in planning focus of survey.| b. extensively used in accounting, assessment, care plans.| c. internet - much information for NH survey results| d. FAX| e. voice response| f. e-mail informal organization and communication - ANSWER-grapevine - tends to be used and depended on more than officia communication; tends to be believed and acted on. CANNOT destroy. learn to use.||offset by open, frequent, official communication. supervisors trace rumors.||coffee cliques and other informal groups talk about work, procedures, changes, how they will react. undue influence on performance privileged communication - ANSWER-between physician/patient, attorney/client, nurse/patient, husband/wife. NONE in child abuse cases| change - ANSWER-causes work slow-down or stoppage until employees learn how it affects them timing of change - ANSWER-announce before start, allow time to adjust, get off chest. ask for reactions, promote discussion - how affects you?||avoid 2 words: effective immediately no change - ANSWER-no change in any unit until all others evaluate impact principals of reciprocal action - ANSWER-no change can occur in any unit of an organization without affecting all other departments directly or indirectly||(don't ask why: employees get defensive. "i understand you were late, what are the reasons" motivation - process by which administrators initiate and direct employee behavior - ANSWER-1. Maslow's needs hierarchy - needs in acending order of importance from biological (food, clothing, shelter) to self-actualization. ||2. motivation primarily internal - employees wants to be seen as capable, competent||3. well motivated employees identify with facility goals, see as their own. ||4. money seldom motivates over period of time. employees must know raises depend on performance. may motivate if sizable in terms of what accustomed to.||5. rewards - important to job satisfaction types of rewards - ANSWER-organizational approval - pay increases, benefits, longevity pins, letters of recommendations, parking space, good supervisor relationship.||social environment - important. work with pleasant, cooperative employees - co-worker recognition.||work itself - interesting, stimulating, satisfying. risk management - ANSWER-program to reduce occurrences (incidents) that may lead to action damaging to facility and its reputation. economic loss through tort action -civil suit. primarily to protect facility, but also to protect residents, staff, and visitors. risk factors - ANSWER--administration - PPRs, staff qualification, follow-up of complaints, accidents, insurance...|-nursing - restraints, PRN orders, medications, lack of proper assessment and care plan. #1 are of concern|-environment - LSC, ANSI, ADA, OSHA - poor security and preventive maintenance, inadequate safety and infection control. Housekeeping safety.|-Dietary-infection control, spoilage, food taste and appearance, garbage disposal.|-tools for developing good program:| proper plans for each dept| adequate insurance| training| documentation| quality assurance and assessment| monitored by NHA (MBWA) Marketing - ANSWER-act of offering services or product in the marketplace. managing flow of goods between producer and consumer. developing sales potential open market - ANSWER-ordered by court. Cannot restrict advertising health services and prices research - do market opportunity analysis first. gives info on: - ANSWER-a. needs of elderly|b. nature and effect of competition|c. structure and relations of current services.|start no new service, or expand, until research shows it's economically feasible.| market opportunity - ANSWER-depends on demand for service, size, nature.. success depends on this| marketing attitude. - ANSWER-all marketing oriented to meeting consumer needs. number one goal; starting point advertising - ANSWER-emphasize unique aspects of your service. false advertising - such as "we meet and exceed all state an federal standards" is prime ammunitions for lawyers strategy - ANSWER-plan of action used to meet goals. marketing program lists strategies in sequence to be carried out, who , when, etc. punlic relations - ANSWER-managing communications between organization and its many publics. difference: marketing focused on potential user, PR focus on all people. overall goal - ANSWER-interpret facility to public and public to facility.|bonds and involve th two in an interrelationship. | a. earn respect and pproval of community. image building - ANSWER-major means of meeting goals is to sponsor fund raising event, donate proceeds to a charity - show interest in community. Tour of facility usually best method. Others:| wellness fair| be geriatric resource center| educate public officials on needs| respite care| serve on boards, committees of community organizations| speaking engagements| handling nursing home telephone use of news media - ANSWER-featured articles. negative rumors - work with reports newsletters* - ANSWER-inform public of facility services, inform residents/family of comment resources. send to agencies, civic organizations, local government, health care organizations. educational institutions - ANSWER-participate in HS career days, involve student groups (social studies classes, clubs). inform of what nursing home industry involves professional training - ANSWER-train AITs, interns from colleges. encourage professors to have students visit, do term paper on aging, LTC, facility operations. written program - ANSWER-public relations program should be written. show the role of employees, residents, ramify, volunteers, and administrator in improving relationships within facility (staff/residents, staff/family, staff/staff, staff/community) legislative issue - ANSWER-1. work with state health care associations and state and other health care groups|2. keep local legislators informed of LTC needs and issues.|3. know applicable bills and let legislators know possible opposition.|4. contact all members of legislative committees that will handle LTC bill. do not wait until committee meets and try to educate them Omnibus Budget Reconcilation Act of 1987 (CMS) - ANSWER-provides Gederal Care Guidelines (42CFR) for all nursing facilities that are certified OBRA - licensed administrators - ANSWER-of all nursing facilities, except state may waive NHA for distinct part and swing beds. OBRA: ownership - ANSWER-all participating facilities file Disclosure of Ownsership. FOR CMS (1513). If party has 5% or more ownership, show|1. name and address|2. relationships between any two owners|3. any named person's 5% or more interest in any other participating facility||annual update by administrator OBRA: lab, radiology, other diagnostic - ANSWER-must have agreement with qualified sources transfer agreement - ANSWER-(written) with one or more hospitals. include transfer procedures, records. EXCEPTION document if no hospital will sign. ombudsman - ANSWER-programs required. Includes state advocacy agencies for MI and MR. established by Older Americans Act of 1965, as amended. Duties - ANSWER-primary: to investigate and resolve complains made by or on behalf of LTC residents. An ombudsman is an individual who protects and promotes the rights of individuals before, during, and after a placement into a NF, adduct care home, or other assisted living. the service is offered at no cost to the client and is confidients| ombudsman involved in - ANSWER-1. services that could adversely affect health, welfare, safety, or rights|2. facility notify of survey noncompliance findings|3. state notify of any action against facility.|4. must have access to residents; records only with written consent.|give resident the name, address, phone number of ombudsmen.|fed and state notify when give facility waiver.|state notify of urvey and allow to sit in on an exit interview, suggest residents and families to interview survey process: tasks surveyors perform - ANSWER-1. offsite prep Tasks surveyors perform - ANSWER-A. OFF-SITE PREPARATION - review CMS's Online Survey Certification and Reporting (OSCAR III and IV) system and QUALITY INDICATORS to determine areas survey is to focus on.||b. ENTRY CONFERENCE - request any records||C. Initial TOUR - may uncover new areas of concern which they list.||D. SAMPLE SELECTION AND INTERVIEWING- no longer look for light care and heavy care. Select residents according QI report. Administrator and DONs who study these reports have an insight on which residents the surveyors will be reviewing.||E. Information gathering||F. Information analysis||Exit interview|| Scope - ANSWER-how many residents involved:|- isolated: one or a limited number of residents affected; occurs occasionally in limited number of locations||- pattern: more than very limited number of residents are affected||- widespread: pervasive inf acility; systematic, affected large portion or all of the facility level of deficiency - ANSWER-level 1 - NO actualy harm with potential for minimal harm; minor negative impact on residents.||level 2 - no actual harm with potential for more than minmal harm; EXAMPLE: medication error rate, harm of short duration as falls, a laceration, etc. - easy to remedy.||level 3 - actual harm that is not IJ. A negative outcome that has compromised resident's ability to maintain or reach highest level of functioning. EXAMPLE: pressure sore of urinary tract infection occurring after admission.||Level 4 - IJ. Immediate or corrective action necessary because noncompliance in one or more requirements has caused or is likely to cause serious injury or harm, impairment, or death. EXAMPLE: nurse call system not functioning, severe staffing shortages. Exit Interview - ANSWER-includes resident and ombudsman. define areas not in compliance (not by Tag Number). ||PURPOSE: to inform facility of observation and findings. findings written and discussed (284) surveyors must revisit for deficiencies with a scope and severity rating of "G" or higher. They have the option on all citings below the "G" level. ||DOUBLE G's: CMS imposes denial of payment when provider is cited for actual harm deficiency, corrects, but is cited again within 9-15 months. POC (plan of correction) - ANSWER-Facility submits plan of correction showing:||a. HOW corrective action will be taken for residents affected by deficient practice.|b. HOW facility will identify other residents having potential tobe affected by the deficient practice.|c. WHAT measures or changes will be made to ensure non-recurrence.|d. HOW corrective actions to be monitored to ensure non-recurrence. No consolation can be given by surveyors or CMS.| 2567 - ANSWER-Statement of Deficiencies|referred to by its catalogue number.|Once the state sends this form to the facility it must be completed per instructions and returned to teh state agency within 10 days. the POC must be posted within the facility so anyone can review it. the facility must keep the past 3 consecutive years of POC's in-house.** Informal Dispute Resolution (IDR) - ANSWER-Facility may request informal resolution process. Must include in writing what findings (by Tag #s) you contest-time period specified by state remedies - ANSWER-imposed by CMS and the state remedies: category 1 remedies for "d" and "e" deficiencies - ANSWER-directed POC|state monitoring|directed in-service Category 2 - for deficiencies widespread with no actual harm but potential for minimum harm (f) - ANSWER-Denial of payment for new admits|denial of payment for all Medicare and Medicaid residents as imposed by CMS regional office|Civil money penalties of $50 to $3000 per day of noncompliance Category 3 - ANSWER-for cases of immediate jeopardy (level 4 deficiencies)|-temporary manager appointed|-terminated of provider agreement and/or|-CIVIL MONEY PENALTY OF $3,050 TO $10,000 PER DAY OF NONCOMPLIANCE|||||(QIS Survey being implemented in all states incrementally) Process of Financial Management - ANSWER-process of ensureing materials and other resources are bought and used efficiently and economically; attain goals. Value of Financial Management - ANSWER-Administrator has informatio to make decision and manage facility. Control device - measure performance against original plans. Administrator's role in Financial Mangement - ANSWER-owners hold administrator responsible for proper financial management of facility. Varies according to type of ownership. chain organizations may do budgeting, payroll, group purchasing - administrator may have little input. Smaller organizations usually have CPA to supervise accounting, make financial reports, handle payroll, etc. asset - ANSWER-a thing of value, things owned, such as cash, equipment, real estate. current asset - ANSWER-cash or other short-lived asset, i.e. A/R and CDs that are used up usually within 1 year. fixed or non-current assets - ANSWER-will not be used up within a year||i.e. building, equipment, etc. tangible assets - ANSWER-have physical characteristics, they can be SEEN and TOUCHED Intangible assets - ANSWER-are non-physical, such as COPYRIGHTS, patents and GOODWILL book value - ANSWER-is cost of a depreciable asset less accumulation depreciation ||depreciable asset - depreciation capital - ANSWER-is a term meaning funds to be used in business. Real esate, buildings and certain equipment can be included under certain conditions. | investment capital - ANSWER-cash used to purchase real estate and equipment, and to build - used to produce operational revenues. working capital - ANSWER-excess of CURRENT ASSETS/CURRENT LIABILITES. |A measure of company's ability to pay bills. capital expenditure - ANSWER-expenses of increasing book value of facility assets. contract for personal services - ANSWER-involves the offer of money, consideration, acceptance. Spell out duties, authority, time, remuneration, ESCAPE CLAUSE, other terms earnings - ANSWER-refers to generated revenues, or income. Gross erarnings are total revenues or income gross profit - ANSWER-net sales - cost of goods operating profit - ANSWER-gross profit - operating expenses net earnings (net profit) - ANSWER-revenues - expenses dividends - ANSWER-earnings distributed to owners retained earnings - ANSWER-earnings not distributed to stockholders, limited, or IRS will tax. equities - ANSWER-interest in or claims upon assets by the owners ||capital stock + retained earnings fixed expense - ANSWER-fixed expense remains constant without regard to volume of business||i.e. mortgage payments, leases, taxes variable expense - ANSWER-change with volume of business||i.e. food, medical supplies, utilities, etc. Often shown graphically. semi-variable expense. - ANSWER-Dr. Allen uses this term in reference to CNA wages. For example, if a facility census drops by 5 from one day to the nest, the administrator may send an aide home to keep within budgeted HPPD numbers, thus that employee's wage may be described as a semi-variable expense. gross income - ANSWER-total income from all services. Also, capital gains, interest on bonds, workers' compensation insurance benfits operating expense - ANSWER-those incurred in normal operations of business - salaries, benefits, utilities, materials, rents, etc. liabilities - ANSWER-debts or obligations owed. current liabilities - ANSWER-are debts usually due within one year,such as FICA taxes, FWT, notes payable and dividends Long-term liabilities - ANSWER-debts not due for a period usually more than one year, such mortgages, bonds, and property liens. lien - ANSWER-claim or charge on property for payment of obligations liquidity - ANSWER-denotes how quickly an asset can be converted to cash without appreciable loss marginal return - ANSWER-point at which revenues equal expenses, the break-even point mortgage - ANSWER-conditional transfer of title on property by a borrower to a lender to secure payment of a debt or loan net worth - ANSWER-total assets - total liabilities note - ANSWER-written promise to pay definite sum of money on a certain date usually with interest sole proprietorship - ANSWER-legally liable for business debts partnership - ANSWER-legally liable for business debts corporation - ANSWER-not generally liable for business debts, except payroll taxes. best for owner's protection against liabilities of business.| S corporation - ANSWER-no corporate tax, except some long-term capital gains. profits or losses claimed on individual tax returns limited liability corporation ( LLC) - ANSWER-combines characteristics of CORPORATIONS AND PARTNERHSIPS. more flexible management. profit and losses can be allocated regardless of how stockholders are invest in the company.||IRS will attach owners assets when corporation does not remit payroll taxes. fiscal year and budgeting - ANSWER-corporations choose any 12 months. partnerships generally use calendar year. sole proprietorships use calendar year. budget - ANSWER-plan expressed in numerical terms that is a forecast of revenues/expenditures for fiscal year. also budget other resrouces - allocating staff, space, equipment, supplies master budget - ANSWER-includes cash budget, capital budget, liquidity ratios, pro forma finanical statement CAPITAL BUDGET - ANSWER-INCLUDES REAL ESTATE, BUILDINGS, QUIPMENT, USALLY LIMITING FACTOR AS RE-COVERAGE FROM EXPENES TAKES LONG TIME, ||MEDICARE COUNTS $5000 OR MORE AS CAPITAL IF ITEM HAS USEFUL LIF IN RXCESS OF 1 YEAR (PREVIOUSLY $500 OR MORE) CASH BUDGET - ANSWER-FORECAST OF ALL CASH RECEIPTS AND DISBURSEMENTS. CONSIDERS SCHEDULE OF CASH INFLOWS AND PAYMENTS OF OBLIGATIONS. SHOWS AVAILABILITY OF CASH. value - ANSWER-makes possible plans to invest surplus and for periods when expenses exceed income OPERATING BUDGET - ANSWER-INCLUDES DETAILS OF ATINICPATED REVENUES (INCOME) BY SERVICE, AND ANTICIPATED EXPENDITURES BY CATEGORY. ||HELPS TO CONINUOUSLY STUDY AND CONTROL FINANCES|||(ROAD MAP TO FUTURE) INTEGRATED BUDGET - ANSWER-a document that projects all capital and operating costs, as well as all revenues, and consolidates this information methods - ANSWER-most chain organizations have computerized financial management. local facility computers linked with MAINFRAME COMPUTER IN CENTRAL OFFICE advantages of methods: - ANSWER-easier to access computer data, makes comparisons, etc. ||most budgets now prepared by central office in chain organizations, may ask for administrator input. some have administrator develop budget, send to central office, which negotiates with administrator. family owned facilities still depend on administrator to develop budget. timing of budget - ANSWER-begin well before beginning of fiscal year- biggest error is waiting too late. basis of budgeting - ANSWER-on past years' experience, historical trends, and future expectations forecasting budgets - ANSWER-begin with overall facility utilization forecasts-average daily census, resident days by payer, anticipated changes in needs, trends in economy, employment rates. reason for budgets - ANSWER-to determine reasonable costs and plan cost control departments in budgets - ANSWER-involve department heads in budgeting for own units. promotes cooperation. keep revenue cost in balance - ANSWER-no deficit budgeting zero-based - ANSWER-evaluated costs and benefits of all activities in comparison to alternative expenditures, rank and chose from alternatives in term s of how they fit overall priorities value of budget - ANSWER-a. it expresses in financial terms the goals and programs|b. it provides criteria for evaluation of performance|c. it serves as a control device Accounting - ANSWER-standards established by accountants and boards - GAAP. Nearly all facilities now use computerized. define accounting - ANSWER-includes bookkeeping, budgeting, reports, specials studies, auditing, designing systems bookkeeping - ANSWER-very mechanical, recording of business transactions. double-entry accounting - ANSWER-each transaction has equal debits, equal credits cash basis - ANSWER-revenues/expenditures recorded when actually received or paid out, except for depreciation expense. accrual basis - ANSWER-revenue/expenses recorded when incurred. Medicare REQUIRES Accounting records: account - ANSWER-summary of changes in assets, liabilities, stockholders equity, revenue, expense. each account given titles that describes nature of item included (equipment; utilities, auto expense...)| Chart of Accounts - ANSWER-completel list of all categories in the ledger - may include number - receivables and payables - like table of contents. journal - ANSWER-book of original ENTRY. CONTAINS al financial transactions in chronological order. tells where to post debits and credits. ledger - ANSWER-complete listing of all accounts and their balances, payable and receivable Financial Statements: trial balance - ANSWER-list of all accounts and their balances, except account with zero balance. made at an y time, used in preparing other statements balance sheet - ANSWER-summarizes assets, liabilities, and stock holders' equity. reflects SOLVENCY. made up at ANY TIME earning statement - ANSWER-compares revenues with expenses incurred to produce income. reflects PROFITABILITY. ALSO CALLED PROFIT AND LOSS STATEMENT. | retained earnings - ANSWER-explains changes in retained earning tha occur between balance sheet dates statement of changes in financial position - ANSWER-shows flows of funds into and out of the business. derived from and ties together b, c, and d in single report. bank statement - ANSWER-lists balances at beginning of month, deposits, checks paid, bank charges, interest, daily balances, and ending balance. RECONCILE immediately upon receipt monthly cash-flow statement - ANSWER-sometimes used to show cash receipts and disbursements leading to net change in cash in a given period. provides information to plan for short range, cash needs or able to pay obligations promptly three basic steps in accounting - ANSWER-Entries- transactions recorded as they occur in the journal. tells where to post.||posting - transfer of debits and credits from journal to ledger which is charts of accounts - payables and receivables||tabulate - account balances periodically. amortization - ANSWER-allocation of costs of non-current, intangible assets over a specified period of time. also, of debt-monthly payments depreciation - ANSWER-all assets costing $5000 or more and used more than one year are depreciated. allocation of costs of tangible assets over a specified period of time. cause of depreciation is decrease in value due to use, obsolescence, action of elements... straight-line depreciation method - ANSWER-distributes the same dollar amount of depreciation to expenses each year during the asset's assigned life. (required by medicare)||cost - salvage value|________________||assigned life accelerated depreciation - ANSWER-allocates larger amounts of depreciation in the early years of an asset's assigned life. DOUBLE-DECLINING is the type that allows applying the doubled rate each year. SUM-OF-THE-YEAR'S_DIGITS is another accelerated method that has high depreciation charges in the early years of an asset's life. PRODUCTION -UNIT, SERVICE-HOURS and others are not often used. accumulated depreciation - ANSWER-the total depreciated take to date on a depreciable assets salvage value - ANSWER-if there is a salvage value, subtract from cost before depreciating. adjusting entries - ANSWER-done by accountant if administration is concerned with PROFITABILITY. also done for discounts on purchasing, for uncollectable bills,and at the end of the year. | a. adjustment in basic bookkeeping is done in journal| b. error notedin audit is adjusted in ledger break-even analysis - ANSWER-determining break even point when income equals expenses- marginal return. |analyze variable and fixed expenses. value of break-even analysis - ANSWER-dcan study volume of service and expenses in integrated manner; expenses more closely controlled; decision on expansion can be carefully considered; easy-to-read report summarizing date contained in various income statements lower break-even: do 3 things - - ANSWER-1. reduce fixed costs, (mortgage)|2. increase prices where possible,|3. lower variable cost percent occupancy - ANSWER-determined by dividing the number of possible patient days into the number of actual patient days, multiplied by 100|||actual days |_________||possible days|||(possible days = # of bed x days in month) payback period for capital investments - ANSWER-original cost|__________||savings per year auditing - ANSWER-checking accounting records for accuracy. can have compliance audit nursing costs - ANSWER-cost of drugs $0.60 ppd. 100 beds with 90% occupancy. how much do you expect to spend in a 20 day month||100 beds x 90% occupancy = 90 pts|90pts x $0.60 cost ppd = $54.00 total cost/day|$54.00 total cost/day x 30 days = $1620.00 ratio analysis - ANSWER-analyzes strength and profitability, and efficiency of operations. done by determining relationships between certain items in balance sheet and earnings statement, and pairs of items of different statements ratio analysis: current or working capital - ANSWER-shows excess of current assets over current liabilities. expressed as 1.5:2. creditors interest in this ratio.||i.e. 25k/50k = 1.2 quick or acid test relates quick assets (cash, AR) to current liabilities (creditors and owners interest in this.)||acid test ratio = quick assets| __________| | current liabilites - ANSWER-... note on ratio analysis: - ANSWER-a current ratio of 1:1 indicates the facility can pay its debts and perhaps have a surplus. at first glade a ratio of 2:1 appears much better. however, there may be too much money tied up in current assets that are not liquid. in this case, a quick or acid test may be better. a quick ratio of 2:1 means the facility has adequate assets to meet its obligations with a surplus that can be possibly invested until needed. Accounts Receivable: reimbursement sources - ANSWER-medicaid|medicare|private pay|managed care|long-term care|||83% of residents pay in part or in whole by Medicaid/Medicare numbers to know for AR - ANSWER-3/30 qualifying stay within 30 days|20 100% first 20 days|80 co-pay days|100 days max on medicare|2 days notice before discharge|60 days break in care|5 days therapy/week AR audited - ANSWER-must show that made an effort to collect money before putting on bad debt Medicaid - - ANSWER-Title 19 program for medical assistance to the medically indigent - based on medical need. eligibility for Medicaid - ANSWER-possess no more than a home, car, and other resources up to an amount set by the state and approved by CMS.| CMS and Medicaid - ANSWER-State has official state Medicaid agency that administers program with CMS approval. Medicaid Services - ANSWER-include in-patient and outpatient hospital care, lab, x-ray, SNF and NF, home health, private duty nursing, dental, PT and OT, prescribed generic drugs and some other. Varies by state. medicaid - not covered - ANSWER-materials for personal care - tooth paste, tooth brushes, OTCs, etc. State provides full lsit of what NH must furnish residents on Medicaid. Medicaid billing - ANSWER-NH bills a fiscal intermediary chosen by the state. Nursing homes bill electronically on Form UB04 (failure to bill timely may result in forfeiture of that payment. Medicare Insurance Program - ANSWER-PPS Medicare Eligibility - ANSWER-Anyone over 65 who is eligible for social security is eligible for Part A. Others over 65 may join and pay a premium. Certain disabled also eligible without regard to age. Everyone pays premium for Part B. Medicare Services PPS for SNF - ANSWER-Part A covers in hospital in-patient, SNF, patient teaching (self-administration of medications, ostomy care, diabetic management, and rehab - PT, OT, ST. It does not cover respiratory therapy. Medicare Therapies - ANSWER-must be given 5 times weekly ; can be a comination of the therapy Length of stay (LOS) - ANSWER-in SNF up to 100 days - as long as making progress. Must have had three day hospital stay within 30 days of discharged if it is continued care for condition that arose in original stay. Medicare re-qualify - ANSWER-for another 100 days if there is a 60 day break in skilled services. this does not mean the person has to be discharged from nursing home, nor does it mean just because they were discharged from the nursing home that the spell of service has been broken.