HCAD 635 Long-Term Care Administration

HCAD 635, Long-Term Care Administration

Week one: Why We Are Here?

Let us begin by exploring the “big picture” view of Long Term Care (LTC). Seventy percent of people 65 and over will need some form of LTC service during their lifetimes. Take some time to review these two sites listed in the class schedule: Genworth 2017 Cost of Care and 2018 Alzheimer’s Association Facts and Figures.

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What are your initial impressions? Discuss why understanding LTC is an important aspect of healthcare leadership. Support your opinions with valid references.

Week 2. Independent Living/Residential Care

Digging Deeper
Answer one of the following questions and comment on the responses of your peers.
1. How do technology, the political environment, and the general economy impact the delivery of services in assisted living facilities? What about in independent living settings?
2. Independent living or retirement facilities do not offer clinical services. Discuss why you believe each is included as a part of the LTC continuum.
3. Both formal and informal processes can be used to carry out environmental scanning. Watch Environmental Scanning (4:23)(https://www.youtube.com/watch?v=LN03WRRlHwc). Discuss two types of formal and two types of informal means that a LTC facility administrator can use to identify important environmental trends.
4. An International Perspective: watch the video “China’s Demographic Problem” (6:54) (https://www.youtube.com/watch?v=G_VPKGewapI). Why should the United States be concerned about China’s aging population?

Week 3. Assisted Living
"Where do we go from here, now that all our children have grown up?"
What are the recent trends in Assisted Living, and why are they important to caring for the elderly with disabilities?
Consider the Alternatives Contains unread posts
What is the philosophy of care in assisted living? How does this differ from other housing options, such as independent living and continuing care retirement communities? What is the Beacon Hill Village; how prevalent is this concept?
Week 4. Nursing Homes
Disability Care
What roles do nursing homes play in providing rehabilitation and extended care for functionally disabled persons? Is the optimal approach, or can you suggest a different model based on current trends?
Placing Mom or Dad in the Home
Under what circumstances is it appropriate to consider nursing home placement for an elderly parent or guardian? Is placement in assisted living or in home care always a superior choice?
Week 5. Hospice and Palliative Care
This week’s discussions focus on palliative care and hospice care. Please respond to the following questions in the class conference created for this purpose. Aim for a very good paragraph for each question. You are highly encouraged to respond to the posts of others in the class as well.
End of Life Options
How does hospice and palliative care differ from the traditional medical model of health care delivery? What are the benefits to patients who elect these services in lieu of traditional medical care?
The Hospice Model
What are the benefits of interdisciplinary team management of patient care as practiced in hospice and palliative care? Are there potential lessons learned for improving the quality of traditional medical care?
Week 6. Quality of Care – Nursing Home Survey Process

Assessing Quality of Care
What are the major strengths and weaknesses of the nursing home survey process in assuring that residents have high levels of quality of care and quality of life?
Beyond the Four Walls
What do you consider to be the key areas for developing quality metrics in home and community based care? Which ones are easier to measure than others?
Ethics & Legal Issues in LTC Administration — Individual Case Study Selection
This is where you indicate your preference for the research paper addressing the legal and ethical issues of long term care administration, which is due by the end of Week 7. You may select from two case studies posted in the Course Content folder for this week.
1. The first option is entitled “End-of-life and the Family.”
2. The second option is entitled “Refusing Treatment.”
As noted in the syllabus, I reserve the right to reassign you to a case that you have not selected (so the earlier you indicate your choice the better). I will do my best to honor your preference.
Week 7. Legal Issues and Ethics
Please respond to the following questions in the discussion created for this purpose.
Try to extend the observations already made in the lecture and include what you found doing your paper.
I look forward to a very productive dialog this week
Advanced Directives Case Study

1. To ensure that all questions are answered, not more than FOUR students may answer a given question. That means check what others wrote before you answer!
2. Indicate which question you are answering in the subject line so that it will be easy for other students to quickly determine how many people have answered each question.
3. Post your response as a NEW TOPIC.
Use the RESPOND choice only when commenting on someone else’s post

Read One Patient, 34 Days in the Hospital, $7,000 Syringes and a $5.2 Million Bill (found in Class Content). Answer One (1) of the following questions:
1. What factors would influence your thought process early in the decision-making; why did the doctors proceed with the treatment? Comment on the nurse’s statement “there’s a lot of waste.” Provide your concluding thoughts.
2. Should his family have been consulted? Should his age have impacted the decisions? What about the fact that his use of services limited access for others? Provide your concluding thoughts.
3. What did you find incredible to believe or accept? What would you do differently? What are the health policy implications? Provide your concluding thoughts.
4. Following the motto, “an inquiry delayed is an admission lost,” outline the main areas that the administrator should address when establishing procedures for handling inquiries about their facility and its services.
5. You have been hired as a consultant to the city government to conduct a survey of caregivers. Who will you define as a caregiver? How will you pick your sample? What will you ask? What are the salient issues that you will want to cover?
6. As a nursing home administrator who wishes to establish a value-based partnership with a community-based agency, what are some of the main points you need to carefully think through before discussing a proposition with the potential exchange partner?
7. Watch http://www.ted.com/talks/eric_topol_the_wireless_future_of_medicine (16:58)). What innovations are being developed in health care and how might these innovations change the current long-term care landscape?
Week 8. Person Centered Care

Our readings from the Informational Guide on Person Centered Care identified the following nine structural elements needed to support assisted living:
1. Core Values and Philosophy
2. Relationships and Community
3. Senior Management–Owner– Governance
4. Leadership
5. Workforce
6. Services
7. Meaningful Life
8. Environment
9. Accountability
Your task this week is to discuss and identify two of the above structural elements. How do they help or hinder Person Centered Care? And when you answer this topic, please try to pick elements that have not be identified by other students. That means look at others before you dive in!
The Social, Political, and Safety Environments
Answer one of the following questions. Again, check to see what others have written/given as their answer on a public interest group or answer the same question.
1. Other than AARP, discuss one public interest group, aging service, or professional organization that you believe has or can have the most influence on political decisions related to LTC? Why do you believe this?

2. Research one public interest group and one professional organization that focus on LTC issues. Determine the three highest-ranking issues on their political agendas. Are their focus areas similar?

3. Laws regulating skilled nursing facilities and assisted living facilities vary by state. However, most states’ regulations address emergency and disaster preparedness, fire safety, staff training, medication management, resident privacy, and background checks. Choose two states and research their statutes and regulations regarding LTC facilities. What do the regulations in these states say about one of these issues? Where do you see the greatest differences in regulations? To what do you attribute this?

4. In recent years, we have witnessed unprecedented shifts in societal values, some of which can offer challenges to organizational operations. Watch Gray Gays: Aging as an LGBT adult (5:56). What are two unique challenges facing the elderly GLBT population? How can the typical nursing home or assisted living facility address the unique needs of this population?

5. Select one of the following ethical and legal issues in long term care and comment on the challenges inherent for long term care administrators in effectively responding to them. Select one topic for a residential setting (i.e., assisted living or nursing home) and select a different topic for home and community based care. How can an ethics committee can help a LTC administrator effectively deal with these issues?
a. Discrimination
b. Abuse
c. Privacy
d. Malpractice
e. Wrongful Termination
f. Patient Rights
g. Informed consent
h. Advanced Directives
Week 9. Strategic Marketing
Tell me Why…
Locate the websites of 3 different providers of assisted living facilities, adult day care services, or a CCRC. No nursing homes. You should have three websites for the same type of provider/facility. Pick the area you live in or someplace you would like to live! Review what others have presented and do not repeat the same areas!
1. Compare and contrast the relevant aspects of the websites.
2. Discuss how well or how poorly the facility has done with its web-based marketing tactics. What should they add or remove from their website?
3. If you were the decision-maker tasked with choosing one of these providers based solely on their website, which one would you choose? Why?
Be sure to include a link for each of the three websites in your post. Avoid using the same websites as others in the class.
The Price is Right
Every discussion of Long Term Care eventually arrives at the subject of cost. In preparation for Week 10, test your knowledge on Medicare and Medicaid! They are fun!
Long term care providers (actually, anyone in US healthcare) need to have a handle on the differences!
• KFF Medicaid Quiz
• KFF Medicare Quiz
After testing your knowledge, review Medicare at 50 – Origins and Evolution. What insights did you gain?

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Week 10. LTC Finance
Patient Accounting
Your task as the nursing home administrator is determine the method for tracking and managing the patient account fund. What protocols would you have in place? Lastly, what type of human resources personnel would you hire for this key activity?
Money Makes the World Go Around
Locate and post an article from any source and published during the last 12 months, that discusses a financial issue related to adult day care, assisted living, or home health care financing (NO articles on nursing homes). Try to choose an article that has practical implications.
The article should not be one assigned in the class or one chosen by another student. Do not post a link to the UMUC library, but attach the article to your response or post a link that anyone can use to access the article. Provide a brief summary of the article and answer each the following questions:
1. How does this tie in with your research to date?
2. How can the average long-term care manager use this information in day-to-day decision-making?
3. What is the “take home” message?
* Be sure to copy and paste the question before each of your answers to add clarity.
Week 11. Case Studies
Many function within healthcare are driven by peer review. For example, grant applications submitted to the federal Health Resources and Services Administration (HRSA, a component of HHS) are reviewed and scored by a panel of independent healthcare executives convened by HRSA.

Assume the recommendations of the group were accepted by the health system, and that content used to submit a certificate of need (CON) application to the commonwealth for approval of the recommended services. That CON will be reviewed by a panel of healthcare executives who will provide their assessment of the merits of the proposal. As individuals, review the other groups’ submissions. Does each make a compelling case? Would you approve the projected services?
This is not an exercise in criticism, but rather an insight into peer review. Civil, constructive review is expected. Remember, your own work is being reviewed at the same time.
Week 12. The Future and Final Comments

The Future of Long Term Care

Post your thoughts on the impact of Lecture 12 and on the future of long term care and health administration.

Final Course Reflections
Please post your comments about the class.
1. Using 50 words or less, how would you summarize this course to others?
2. What was the most surprising thing you learned in this course? What was the most important?
3. What did you like and not like about the course?
4. What advice would you give to students planning on taking this course in the coming semester?

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