Archive for the ‘Nursing Home’ Category

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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NAB exam, Nursing Home Administrator, malnutrition, working capital, social worker, risk management, MDS assessment, fire extinguisher

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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Edna Parker, wheelchairs, nursing home

Tonight I was going over my journal from a few years ago. It brought to mind the disastrous day when it took three hours for only eight nursing home residents to vote.

The odd part was that we had a voting precinct available in our building. General public could vote, but we were registered at a elementary school across the street.

Learning of this problem, the nursing home looked into voting electronically, where a hand held device could be brought to each resident. After trying this machine out with one resident, we found out the device was defective. The only other option we had was to get the facility van and gather together all the residents.

Despite this inconvenience and waiting over two hours, some of the residents were still willing to wait so they could vote. However, as time continued to pass, more and more residents became tired and fatigued. In the end, we waited three hours and only eight of the seventeen residents who wanted to vote were able to sustain the process.

I also have a close friend who lives in a nursing home. She discussed on several occasions that she would like to vote, but did not know how to go about it. I assumed the nursing home would help with this process. After the election, I happened to ask her if she had voted. To my surprise the facility did nothing to assist her.

According to an article in USA Today, approximately 10% of the population live in nursing homes. So imagine if every facility had a similar issue. This would lead to a large percentage of people who did not get to exercise their right as Americans.

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For those of you who have asked…here, finally is my recommendation for taking the nursing home administrator exams. Not to sound overly confident, but I had no trouble with either test (NAB or state). Of course, I listened to some very wise people in deciding what to do. At the time my preceptor said, “don’t even attempt” to take these exams without a review course. She claimed books and study guides were insufficient on their own.

For the most part, I would agree with her. The material I received from the review courses was by far the most relevant. Originally, I looked into a lot of different avenues. For example James E. Allen has a long term care administration online review course which runs about $600 for both parts. At the time, I was student and this was far more than I could afford. So instead I bought a few books that had been recommended, and decided to sign up for a local review course, which cost me about $150 each.

Below I have listed out a few books, I would recommend to those taking the NAB exam. The most relevant is the NAB Nursing Home Administrators Examination. I read this book several times, and each time I found more relevant material. When taking the exam, it seemed many questions came directly from this text.

Whatever you do, take your time to review all material so you feel prepared. Know your weaknesses, and properly study for them. If you need any help or have questions, don’t hesitate to contact me.

Recommended Books & Study Guides:

NAB Nursing Home Administrators Examination

Principles to Health Care Administration

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

The Licensing Exam Review Guide in Nursing Home Administration: Fifth Edition

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nursing home administrator, James E. Allen, long term care administration

I recently read an article on unique living environments entitled “Finding the Perfect Niche” by Maureen Hrehocik. This article discusses the more recent popularity of niche housing for older adults needing long-term care.

One of the fastest growing senior housing niche markets are for gay, lesbian, bisexual, and transgender individuals (GLBT). A member of the new GLBT community points out that she feels “more at home with people who share her (my) values.” This is especially so for those abandoned or disowned by family due to their sexuality. With the rising popularity of these communities, individuals who are gay, lesbian, bisexual, or transgender now have somewhere to live and grow old with their peers.

Another area on the move is university-based retirement communities (UBRC). While living in Austin, the University of Texas was making plans to open one of these facilities on campus. Currently, there are about three dozen university based retirement communities (UBRC) open in the United States. Most of the UBRCs meet the following criteria:

- The community must be located within a mile of the main campus.
- At least 10% of residents are expected to have affiliation with the University, whether as alumni or retired faculty.
- The community should be a Continuing Care Retirement Community (CCRC) providing all types of care, whether it’s independent, assisted, Alzheimer’s and/or skilled nursing.

Various cultures have also created niches for themselves. For instance, one Asian American nursing facility in California has two stone lions marking their entrance. No where in this facility will you find the number “4″, which signifies death to some Asian Americans. Also, the color blue is absent from the decor, because it is considered “undesirable.” These facilities have gained popularity because some prefer to be among those that have similar beliefs or customs.

Some seniors choose more non-traditional methods of retirement living. Since the year 2000, Bea Muller has been living on the Queen Elizabeth 2 cruise ship. Her “assisted living” choice runs about $100,000 dollars per year. This cruise ship visits twenty-five countries per year. A study done by the American Geriatric Society (2003) discovered that the average cruise ship only costs around $11 dollars more per month than an a assisted living facility.

These days it’s not uncommon for cruise ships to have a “Bea Muller” type staying long-term. A cruise line called Residen Sea, has introduced “The World,” a ship that allows retirees to buy high-end apartments. Since cruise lines already have nurses and physicians on staff, it makes sense why some consider this type of retirement living.

With the large number of Americans retiring, it’s no wonder the options continue to grow. There is no doubt that Baby Boomers will reinvent the previously generic term “retirement.”

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Just a quick note to congratulate Jennifer Mikula who is Florida’s Nursing Home Administrator of the Year! I am proud to say she runs one of our local facilities, Palm Garden of Ocala.

Jennifer was nice enough to give me a tour of her facility a few months ago. With her visionary mindset, she has made many changes that have improved the quality of life of Palm Garden’s residents. For example, instead of having a standard hospital-like shower room, Palm Garden now has a Spa. These days residents who use to avoid bathing now line up to enjoy the beautiful tiled room with stained glass windows and a nail tech.

Palm Garden also has a quiet zone. In this silent area, residents can relax and enjoy the smell of fresh baked bread (also to eat), the sound of water flowing, and places to sit and nap if one so desires. According to Jennifer, residents who normally tend to be combative or act out, seem to change in this still and relaxing environment. In this comfy and cozy room, I don’t see how anyone could stay upset long.

For nursing home residents, I am glad to see these improvements and hope more Medicare/Medicaid nursing homes will join Jennifer in continuing to reinvest in their facilities.

Long-Term Living recently featured Palm Garden of Ocala in their magazine. To read this article, click on this link.

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Recently, I learned of a V.A. aid and attendants program available to veterans or their spouses. Under this program, a veteran can receive a maximum of $1673.00 per month in benefits, and a spouse can receive up to $869.00 per month.

To qualify for this program a veteran must have had 90 days or more of active duty, only one day of which was during wartime. It is not necessary that they saw combat. They must not have had a dishonorable discharge.

In addition, the veteran or spouse must be determined to be “permanently and totally disabled.” This includes but no limited to: trouble dressing/undressing him or herself, blindness, and mental or physical incapacity.

The veteran or spouse does not need to be house bound or considered helpless. You just have to prove the person is in need of aid and attendance on a regular basis. The V.A. will generally accept a letter from a physician, which should state that the person has an incapacity that requires care or assistance on a regular basis to live safely at home.

There is a net worth requirement for this program. This is something the V.A. could assist you with since it changes on a routine basis. The last known net worth cutoff was $80,000, not including your home.

In addition to the net worth requirement, there is also an income requirement. The veteran’s countable income should not exceed the maximum annual pension rate which is currently $1,673 (adjusted periodically), or $869.00 per month for the spouse. However, some items may be deducted from income in order to meet this criteria. For example: doctor and dental visits, co-payments, medical supplies, therapy, transportation to the doctor, ect.

It can take up to ninety days to receive approval. However, once approved payments are made retroactively from the first month after the month that you apply. So, funds you previously spent on home care may be reimbursed to you when the V.A. aid and attendants coverage starts.

This information was provided by Interim Healthcare Private Services (Ocala, Florida), which provides quality home care to veterans and others needing assistance. To view their website, click on the link: www.interimhealthcare.com

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Recently, I had a friend tell me about her grandfather who was left outside all day at a facility in the Ocala/Gainesville area. In Florida, it isn’t unusual to experience 100 degree days. Imagine being trapped outside without water, food, or a toilet. Where were the employees to assist him? The bigger question–why was he not missed? Unattended, this poor man suffered as a result of neglect.

There are many types of abuse such as: physical, mental, verbal, sexual, and intellectual/spiritual abuse. Neglect is considered a more passive form of abuse. For example, if your job was to change Mrs. Smith’s depends every evening, and you knowingly decided not to, and as a result she sat in urine for hours, you passively abused the rights of Mrs. Smith.

As with all types of abuse, they can eventually cause severe mental or physical damage. Sometimes the symptoms can be obvious such as a change in personality or physical evidence (i.e., severe bruising). One must be careful in making assumptions too quickly, because false claims could really damage the name of a reputable nursing home.

For example, one facility where I worked the family called the state to do a thorough investigation because their mother’s arms were severely bruised. Afterwards they found out that the bruising was mostly caused from taking her new medication, Coumadin.

If you believe your loved one or someone else is being abused, it is important to investigate it. Nursing homes have social workers, which can act as your advocate. Another option is your local ombudsman, which is unaffiliated with the nursing home. Information to finding the your nursing home ombudsman can be found at the facility.

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