The 2010 hurricane season is predicted to be one of the worst in history. Across the entire Atlantic Basin for the six-month season, which began June 1st, there is a 70 percent probability that there will be 14 to 23 Named Storms (top winds of 39 mph or higher), including 8 to 14 Hurricanes (top winds of 74 mph or higher), of which 3 to 7 could be Major Hurricanes (Category 3, 4 or 5; winds of at least 111 mph). See the storm prediction article for more details.

“If this outlook holds true, this season could be one of the more active on record,” said Jane Lubchenco, Ph.D., under secretary of commerce for oceans and atmosphere and NOAA administrator. “The greater likelihood of storms brings an increased risk of a landfall. In short, we urge everyone to be prepared.”

Preparation is key to the best survival rates. It can make the difference between life and death, especially for the vulnerable nursing home resident population. Here are some important tips to keep in mind:

1. Every facility should have a weather radio. If you don’t have one, check out this link. HAM radios have also gotten a lot of good press lately for emergency situations — “works, when all else fails.” Check out this link.

2. Update your emergency preparedness manual and make sure every department head has a copy. Emergency contracts need to be current and able to meet regulations, but more importantly—your facility’s requirements. It’s just a worthless piece of paper unless you know it will workable solution in a time of crisis.

2a. Try out your contracts ahead of time as practice. Yes, this can be costly, but I bet you will be surprised how many of them will be unable to meet your needs. Transportation contracts often have these issues because of FEMA and other similar organizations that end up needing emergency assistance. Problem solve ahead of time by thinking out alternative strategies if something were to go awry.

2b. Consider developing relationships with churches in the area. They have been found to be quite reliable (CDL), and often go under the radar of available transportation during a disaster.

3. Practice, practice, practice! OK, we all know drills can be a bit hokey and tiresome. So try new ideas to keep your staff interested while at the same time reiterate the importance of these practice sessions. If your staff is goofing off—how will the react in a real emergency?

4. Be flexible! As we all know when a emergency occurs very rarely do things go as planned. If this were to happen at your nursing home, learn to adapt to the surroundings and think logically. This could prevent not only wasted time and energy, but possibly save someone’s life.

5. Last resort–relocation to another facility. While some may disagree, transporting nursing home residents to another facility can be more dangerous than the actual storm. From skin tears to death, uprooting fragile residents should be as stated, the last resort.

If anyone has any more tips to add, please comment on this post. Working together we can be better serve our residents!

One of the more helpful websites out there for prescription assistance is www.needymeds.org. This source accumulates multiple resources that offer free or discounted prescriptions. They also list coupons available.

For example, diabetic medication and supplies can be costly especially for individuals without insurance. Abbott Laboratories has a program that provides these things for FREE. Check out the links for more information.

Just a quick update on books that you may want to reference before taking the Nursing Home Administrator Exam (NAB Test):

1. My personal favorite: NAB Study Guide. I extensively used the 4th edition, and now there is a 5th edition. So far I haven’t had any experience with the newest version, but the older version was a “must buy.” However, don’t expect to get by with passing the exam just using this guide. It is just one of many tools to help prepare you. To purchase the new version, click on this link to the NAB website. Sometimes I was able to find used 4th editions of the “NAB Study Guide 4th Edition” at a better price.

2. Another one of my favorite books is “Principles of Health Care Administration” by Wilborn Davis and Joseph Townsend. Although it isn’t a study guide, I found that this book covered information essential to passing the NAB exam.

3. For all nursing home administrators (and future administrators), you will want to purchase “The Long Term Care Survey” which contains the latest CMS updates, regulations, and survey procedures. Go to the AHCA bookstore to purchase. The latest version is currently September 2009.

4. James E. Allen’s 5th Edition Study Guide is a helpful resource—not my preferred favorite but a useful tool nonetheless. He also has a Nursing Home Administration 5th Edition.

5. The Licensing Exam Review Guide in Nursing Home Administration: 1000 Test Questions in the Nation Examination Format on the 1996 Domains of Practice

Other Useful Resources:

1. One helpful management book for nursing home administrators is
“Effective Management of Long Term Care” by Douglas Singh.

2. “The Toyota Way to Healthcare Excellence: Increase Efficiency and Improve Quality with Lean (ACHE Management)” by John Black is another useful management book.

3. The “Eden Alternative” has become popular in recent years which involves transforming nursing homes into lively environments with gardens, animals, and children. The book, “Life Worth Living: How Someone You Love Can Still Enjoy Life in a Nursing Home – The Eden Alternative in Action” by William H. Thomas, M.D. explores ways to promote life and engage residents – a must read for administrators and/or nursing home staff.

4. For those of you who are visionaries, check out Beth Baker’s “Old Age in a New Age: The Promise of Transformative Nursing Homes.” In this book, Baker discovers ways to value staff and avoid high turnover, reduce dementia behavioral issues through the environment, and provide better care to residents without costing the nursing home more money.

5. To get a different perspective on resident care, here is a book written by a CNA, entitled “Nobody’s Home: Candid Reflections of a Nursing Home Aide.”

6. An old favorite that I still reference from time to time is Dale Carnegie’s, “How to Win Friends and Influence People.”

For more suggestions, check out my recommended books link.

My Father went to the same cardiologist for years. Because of Atrial Fibrillation and other related heart issues, he was a frequent visitor at his doctor’s office. In fact, Dad considered him his primary physician, despite his specialty being the heart.

This seemed to work quite well until one day Dad was exhibiting strange behavior. Instead of opening the car door as usual and getting in, he grabbed a hold of the car’s headlight and tried to open it. When Mom asked him what he was doing, he simply replied “I’m trying to get in the car.” This behavior was quite odd for my Father, and immediately we knew something was wrong. But, what was it? It was first thought that maybe he was experiencing a mini-stroke.

Since Dad did not want to go to the hospital that night, he decided to see his cardiologist the next day. The doctor couldn’t find anything wrong, but decided to do CAT scan anyway. After a week went by, they received a message from the doctor’s office that there was a small legion shown in the brain. They didn’t think it was of any great concern, but he should eventually go see a neurologist.

A couple weeks later, my Father experienced a similar episode again. Mom immediately rushed him into the hospital. And it was only then, the ER physician noted he had two cancerous brain tumors. Dad later died two weeks later from the cancer which had already spread throughout his body.

The reason why I tell this story is to help others realize the importance of a primary physician. If you have a cardiologist, that is wonderful! But, you should also have a primary physician who generally understands the whole body.

Here are some tips to live by:

• Don’t settle on a doctor you are unhappy with. Find a physician who will listen to your needs and address your concerns.
• It is also important to find a doctor that stays up-to-date in the medical field. Yes, continuing education is required for doctors. But the question is, do they apply it?
• Because your health has been “good” so far don’t assume that everything is perfect. Assumptions can be disastrous. Go in for yearly checkups. If you are notice a medical change, contact your doctor right away.
• Get educated. Read articles and attend lectures, so you can make informed decisions, especially if you are aware of a medical issue.
• No one knows you, like you. Verbalize your concerns to your doctor. Don’t expect he or she will notice something is wrong. Your physician may see hundreds of patients a week. Unless they know you personally, it is unlikely they will notice a change.

I encourage everyone to get involved with your medical care. If anything, it may save your life one day.

I haven’t posted in a while largely due to family health emergency. We learned a few months ago that one of our family members had Stage IV Small Cell Lung Cancer that metastasized to the liver and brain. We also found out he had two brain tumors.

This information was a lot to take in, especially since he entered the emergency room for mild confusion and dizziness. Up to a few weeks before this awful news, he was out golfing and mowing the yard on a regular basis.

I still remember that day vividly, when the ER doctor walked in and abruptly told us that he had Stage IV Cancer and he had only a few months to live. Not only did it catch us all off guard, there was no warmth or sentiment there. It was just cold hard facts. Even for me, someone who works in health care, I was stunned by how matter of fact this physician was with us. If I hadn’t been involved in the conversation I would have thought he was diagnosing a common cold or some other minor illness.

Shortly thereafter the physician referred us to a radiologist that met with this family member and his wife, who began the treatment process. Later the wife called and told me that she had a horrible experience. Supposedly, while her husband was working with the nurse, she had a candid discussion with the radiologist who admitted that there was a slim chance of recovery. This of course we already knew. However, he went on to say “you should be happy, because he has lived a long life.”

I was stunned when I heard this. Telling her that she should be “happy” that her husband has lived this long doesn’t make it any easier. In fact it came across that the radiologist wouldn’t be try as hard because of his age. Since cancer is more or less “expected” at the age of 85.

In the end, the cancer won over within less than three weeks from diagnosis. This period was emotionally draining on us all, especially the rapid decline. My very dear family member who was diagnosed with this dreadful disease had always been the rock of the family. But when the ER doctor came in that first horrific day and gave us the shocking news, it was the first time I had ever seen him cry.

I sometimes wonder if the situation could have been better if his doctor had been more empathetic. Maybe not…I don’t know. However, I do feel that more attention should be given to a patient and family when delivering such a significant blow. Because I can attest, he was never the same after he heard those few abrupt words.

On a more personal note, I would like to share that this family member was my Father, who is and always will be deeply missed.

Worker’s compensation is one of the tasks I work with on a routine basis. Accidents unfortunately happen, and employees can get injured. I rarely stumble across a claim that seems bogus. However, there are on occasion such situations that call in to question whether a employee truly did get injured on the job.

There is a lot of trust involved with caring for another human being, especially in the home health care field. Employees are sent out to client’s homes and are expected to provide quality service. I believe home health companies need even greater screening of staff because of the lack of daily supervision. In a nursing home, there are many “eyes” watching over employees including the director of nursing and the nursing home administrator.

This week I was given a web address for the Florida Worker’s Compensation Claims. On this website, you can type in the name of a person (even the way it sounds) and it will give any previous compensation history of a person living in Florida. You may ask why is this important? As I mentioned earlier, there is a lot of trust between management and staff to provide quality care to residents and/or clients. The more you know about a person’s work history the better.Check out this website.

It’s been a little while since I have last written. Work these days has been extremely busy…which by all means, is wonderful. However, it’s moments such as these that something gets sacrificed because there is only so much time. Depending on the day, I might be missing out on adequate amounts of sleep, quality meals, or time spent TRULY listening to others.

After a long day, some nights I come home practically comatose to the world. On these occasions, there are times when my husband may start a conversation. Suddenly, midway through I realized I only caught parts of what he was trying to tell me. Some people may call this typical to married life. Ha. Anyway, this got me thinking about how often this happens everyday….to many people. It reminds me how valuable a person who truly listens.

When I was a Masters in Social Work Intern in Austin, Texas, I had my own clients assigned within a couple of nursing homes. A lot of time was spent with each one of my clients, since I didn’t have other work related obligations. As a result, I knew their intimate frustrations, worries and fears, and was able to better assist them with this knowledge.

Some of my clients had no family, or if they did, they were rarely in contact. Often after having an hour session, they would want to continue longer. These individuals were by far the most likely to develop signs and symptoms of depression. However, it was noticeable by their reaction that having someone that would listen, meant the world.

Nursing home staff, family and friends of nursing home residents, also have hectic lives. Often it may inhibit them from being able to slow down long enough not to miss every other word of a story. It’s extremely hard to always be an active listener. For me, it is a work in progress….but, an effort that’s truly worth making.

When I was studying for the NAB exam (not too long ago), I tried to find a free exam that could test my knowledge. Despite my efforts, I didn’t find one and for this reason, I designed this simple 20 question exam.

This test is only a snapshot of what the Nursing Home Administrator (NAB) exam will cover. It should ONLY be considered supplemental to the many resources available–books written by individuals that know the NAB exam far better than I do. (Check out my other recent post on recommended books for NAB exam). These questions may not even be similar to the ones you receive, but it is my hope that it assists you with learning this vast amount of material.

The NAB Exam Study Questions & Answers (at the end):

1. When the power at your facility goes out, the emergency generator needs to reestablish it in:
a. 10 seconds
b. 1 minute
c. 20 seconds
d. 2.5 minutes

2. A major issue in malnutrition is a result of:
a. Poor tasting food
b. Poor dentition
c. Lack of assistance
d. Meal times

3. The daughter of a female resident tells a CNA about a male resident who supposedly has been sexually harassing her mom. Who should the CNA report this incident to?
a. Charge Nurse
b. Administrator
c. Activity Director
d. Social Worker

4. Definition of working capital is:
a. All assets less all liabilities
b. Fixed assets less fixed liabilities
c. All current and fixed assets
d. Currents assets less current liabilities

5. A full time social worker is required when there is:
a. 120 residents
b. 121 residents
c. 60 residents
d. 61 residents

6. The main components of the risk management program are:
a. Liability control
b. Preventative measures and case management
c. Unionization
d. All of the above

7. Type A Fire Extinguisher assists with what type of fire:
a. Chemical/Flammable liquids, no residue
b. Electrical
c. Metals
d. Materials that burn to ash

8. A facility must not serve morning meals more than ___ hours after the evening meal.
a. 12 hours
b. 13 hours
c. 14 hours
d. 15 hours

9. The comprehensive MDS assessment is required within ___ days of admission:
a. 7
b. 10
c. 15
d. 14

10. Who established Theory Z:
a. Dr. William Ouchi
b. W. Edwards Deming
c. Dr. James E. Allen
d. Dr. Roberta Greene

11. To operate a fire extinguisher, you must:
a. Pull, Aim, Squeeze, Sweep
b. Pull, Aim, Squeeze, Spray
c. Push, Aim, Squeeze, Spray
d. Push, Point, Release, Sweep

12. Person who implements resident care policies and coordinates the medical care in the facility is the:
a. Administrator
b. Director of Nursing
c. Medical Director
d. Social Worker

13. A facility should conduct a minimum of ____ fire drills annually:
a. 15
b. 12
c. 10
d. 14

14. The theory “hierarchy of need” was founded by:
a. Douglas McGregor
b. William Ouchi
c. A.H. Maslow
d. Dr. David Snowdon

15. A 3rd party used to advise or counsel in the negotiation process is considered:
a. Arbitration
b. Conciliation
c. Mediation
d. Total Quality Management (TQM)

16. Hematology is the study of:
a. Diseases of the blood and blood-forming organs
b. Disorders in the endocrine system and its specific secretions
c. A “holistic” approach to medical care
d. Disorders of the rectum

17. If an employee works 52 hours in a 7 day work week and is paid $10.00 per hour for regular time, the employee should be paid a total weekly income of :
a. $333
b. $580
c. $520
d. $780

18. In September, a facility had a total of 99 employees. Then, in October they had a total of 98 employees. By the month of December there were 100 employees. Over this 3-month time span, 10 employees were hired, fired, or laid off. What was the turnover ratio for the quarter?
a. 10%
b. 50%
c. 18%
d. 20%

19. A federally required screening for all future nursing home residents, to determine if they are mentally ill or mentally retarded:
a. MMSE
b. MAR
c. PASARR
d. HIPAA

20. Therapeutic diets are prescribed by a _____ and approved by a ________.
a. Physician and Dietician
b. Dietician and Physician
c. Nurse and Dietician
d. Dietician and Pharmacist

Scroll Down for the Answer Key
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_
_
_
_
_
_
_
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Answer Key:

1. A
2. B
3. A
4. D
5. B
6. B
7. D
8. C
9. D
10. A
11. A
12. C
13. B
14. C
15. C
16. A
17. B
18. A (Turnover ratio: # of employees who left divided by total # of employees in a given period)
19. C
20. A

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This time of year always passes quickly, with all that is expected from buying gifts, spending quality time with friends & family, company parties, cooking, and of course work responsibilities. Most of you probably have similar agendas.

The other day I was talking to a friend who shared that he becomes depressed around the holidays. Over the years, he has lost many family members and friends. Growing up he celebrated Christmas with extended family–approximately 40-50 relatives. It has now dwindled down to a few people. Some family married or moved away, but the foundational members that originally brought everyone together, have long since died.

Holidays often remind people of the past. Some may be excited about the changes that have occurred in their lives, while others may wish to return to a happier time. One of my previous clients, often talks about her parents around the holidays. At 88, she still longs to return to the “good ole days” when she lived in Ohio and rode her sled on snowy days. These were happier times…before she and her parents had a falling out, and then she moved far away.

This client is one of many that have spoken out about their depression, especially around the holidays. Most older adults have lost some type of significant relationship over the years. Unfortunately,this is a normal part of growing older….for any age.

After talking at length to my friend about his “holiday depression,” we agreed on one point. The only way to manage the losses incurred, is to be open to new experiences. As he ages, he may one day be a foundational figure in his family. Where new family members come together, and spend quality time over the holiday season. One day his future grandchildren may look back at these times (like my previous client) as the “good ole days.” Happy Holidays to you all!

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Yesterday the oldest person, Edna Parker died at age 115. She outlived her husband who died in 1939, and her two sons. Staying active long after most slow down, Edna Parker pushed wheelchairs for others in the nursing home to keep busy. When asked, she attributed education to her longevity.

I know quite a few people who begin to slow down in their fifties and sixties, especially after they retire. Sometimes then their health begins to deteriorate. What if retirement was only the halfway point? For Edna Parker at age 55, she hadn’t even lived half of her life. She truly is an inspiration to us all–proving there doesn’t have to be age limitations.

The full article can be found by clicking on this link.

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