Course HCA 621: Nursing Home Administration

*Make an argument for expectation setting when working with outside consultants.

For better or worse, I have had the opportunity to be the administrator for not-for profit corporations, for profit corporations, and government owned facilities. These are the three corporate entities that are able to operate nursing facilities in our country. To give you some idea of the breakdown of the types of ownership nationally:

For-profit facilities 65%

Not-for-profit 29%

Government 6%

The number of government owned facilities is on the decline and in the fast moving world of health care this is very good news. The decisions that need to be made quickly do not work well in the "cumbersome world" of civil service and political atmosphere of government owned facilities. This type of ownership, in my opinion, is the most difficult to be able to react in time enough to take advantage of the opportunities available. The decision making process has always been slow and in today's lightning fast business world of healthcare is a formula for failure.

With private ownership the opportunity to make decisions in order to compete in the modern day health care field can be accomplish . Remember that for-profit homes can be owned by a single person or more commonly for -profit chains, with many stockholders. As with the government owned facilities, the homes of for-profit corporations may have to go through a long chain of command or not, depending on the administrative structure. Not-for-profit homes can be a single facility, or a chain of homes, the opportunity to be able to react in a timely manner can occur with the correct administrative structure in these type of facilities.

Regardless of the type of ownership the nursing facility has, the administrators relationship with the owners/ board of directors is crucial. The administrator is acting on behalf of the owners/board, who have the ultimate responsibility to assure that the facility is being run in a proper ethical, moral, and legal manner. The owners/ boards most important decision is their selection of who will become the administrator. It is then the boards role to be one of policy oversight, represent the views of the community , and review and evaluate the administrator's performance. Day to day operational activities within the nursing facility need to be directed by the administrator without board or owner involvement or interference if the administrator is to be successful.

Thinking about these concepts as well as information provided in the Staffing, Directing, Comparing, Innovating, & Marketing activity, use Case Study 3 - The Owners' Directive and answer the questions at the end in a 1 - 2 page paper. While considering how you would respond to the owner's demands in the case study, explain how you maintain the legal and ethical standards required by your job while also determining if/how your response might differ depending on who runs your facility (a board of directors, a private owner, or the government).

Case Study 3: The Owners' Directive

1. Within the next month you are to reduce your staffing in nursing by 10%. You will be allowed to go back to regular staffing for the 2 months prior to State Surgery in order to help at that time. When the Surgery is done you are to revert to the 10% reduction in staffing.

2. You are to increase part-time staff by 5% across the board in order to save money on benefits that must be paid to full-time employees.

3. The food costs have been rising and you are to cut these costs by 10% in the next month.

4. Terminate the social work secretary immediately. She told the wife of one the owner's wives that the door she was exiting was for emergencies only. She then directed her to the proper exit. She then had to walk an extra 500ft. in the snow and cold to reach her car. This will let staff know ownership deserves privileges.

5. The facility does not have enough rehabilitations residents. Talk to the therapists and have them "loosen" their criteria for what qualifies ad rehabilitation so we can receive a higher rate of reimbursement.

Questions:

What should you do? How would you respond to these directives?