The Management Library for Executive Directors BOOK 1

Transcription

1 The Management Library for Executive Directors V2.1 BOOK , Senior Living University. All rights reserved. Reproduction or translation of any part of this work, by whatever means, beyond that permitted by Section 107 or 108 of the United States Copyright Act without permission of the copyright owners is unlawful. Inquiries regarding permission for use of material contained in this publication should be addressed to: Senior Living University, 830 Cherry Drive, Hershey, PA

2 The Management Library for Executive Directors V 2.1 / BOOK ONE The Management Library for Executive Directors Thanks and acknowledgment for contributions to this publication are offered to the following: Jennifer Noonan, Author/Senior Editor Kelly Wallask, Editor Kathleen Anderson, Co-Author Doug Baynham, Co-Author Maureen Boyle, Co-Author Kathleen Cameron, RPh, MPH, Co-Editor Deborah Carlson, R.N.C., M.S.N., Co-Author Jerry Cooper, Co-Editor Trudy Couch, Ph.D., Co-Editor Diane Doumas, M.S., Co-Editor Carol Edelstein, Co-Editor Colleen Endsley, Co-Editor Lloyd Fossey, Co-Author Scott Haille, Co-Editor Christine Hurley, Co-Author Rose Lochman, Co-Author/Co-Editor Karen Love, Co-Editor John E. Lyncheski, JD, Co-Editor David McNair, Co-Editor Susan McPherson, California-RCFE, BEHNA, Co-Editor Ethel Mitty, EdD, RN, Co-Editor Patti O Neill, RN, Co-Editor Mary Sue Patchett, Co-Editor Jackie Pinkowitz, Co-editor Deb Price, R.N.C., M.S.N., C.S., Co-Author/Co-Editor Robert Rouse, Co-Author Rachel Smith, Co-Author Katherine Will, Ph.D., Co-Author David D. Peete, Publisher David M. Goldberg, Publisher i

3 The Management Library for Executive Directors V 2.1 / BOOK ONE Contents Content Overview 1 Key Topics 2 SECTION 1 AN INTRODUCTION TO ASSISTED LIVING 3 Chapter 1: An Introduction to Assisted Living 5 Chapter Overview 6 Key Topics 6 Senior Care Options 7 What Is Assisted Living? 8 A Definition of Assisted Living 8 A State-Regulated Environment 9 Terms Used Synonymously With Assisted Living 10 How Is Assisted Living Paid for? 10 Where Are the Residents? 10 The Core Principles of Assisted Living 11 The Changing Senior Living Culture The Culture Change Movement Pioneer Network Quality First 16 In Summary 17 Chapter 2: The Assisted Living Resident 19 Chapter Overview 20 Key Topics 20 The Assisted Living Resident 21 Resident Acuity Level 22 What Kind of Assistance Does an Assisted Living Resident Need? 22 What Are Assisted Living Residents Giving Up? 23 What Do Residents Gain From Assisted Living? 23 Reasons for Leaving an Assisted Living Residence 24 The Philosophy of Person-Centered Care 25 Is Assisted Living Here to Stay? 25 In Summary 26 Chapter 3: Residents Rights 27 Chapter Overview 28 Key Topics 28 An Overview of Residents Rights 29 The Executive Director s Role in Residents Rights 31 Teaching Your Employees About Residents Rights 31 The Right to Privacy 32 The Right to Choice 32 The Right to Exercise Autonomy 34 Residence-Specific Rights 35 When Is a Right Not a Right? 35 In Summary 36 iii

4 SECTION 2 LEADERSHIP AND CULTURE 37 Chapter 1: An Introduction to Your Role as Executive Director 39 Chapter Overview 40 Key Topics 40 Effective Leadership and Management 41 Are You a Leader? 44 Are You a Manager? 45 Horizontal Management 46 Continuous Quality Improvement Practices (CQI) 47 Implementing CQI in Your Residence 47 Basic Principles of CQI 48 Building a Culture of Quality 48 Creating a Culture of Integrity 50 Your Community s Mission 50 What Is a Mission Statement? 51 Developing a Mission Statement 54 Your Quality First Covenant 55 Ethics Committee Consultation 58 Administration 24/7 59 Ensuring Appropriate Supervision 60 Weekend Administration 61 In Summary 62 SECTION 3 PEOPLE 63 Chapter 1: HR Basics 65 Chapter Overview 66 Key Topics 66 What Is Human Resources? 67 HR Is About Leadership 67 The Executive Director s Role in HR 68 Building Community Amongst Your Employees 68 Upholding the Dignity of Assisted Living Employees 69 Personnel Policies 71 Developing HR Policies 71 Key HR Terms and Definitions Implied Contract At Will Employment Just Cause Negligent Retention 76 Prevent Charges of Negligent Retention Protected Category 79 Laws That Govern Employment Practices 79 The Cost of Illegal Employment Practices 85 The Role of State Regulations in HR 86 State Labor Resources 87 In Summary 88 iv

5 The Management Library for Executive Directors V 2.1 / BOOK ONE Chapter 2: Recruiting and Hiring the Best 89 Chapter Overview 90 Key Topics 90 Creating an Effective Recruitment Plan 91 Step 1: Write Your Hiring Goals 91 Step 2: Develop a Survival Plan 92 Step 3: Identify Your Advertising Options 92 Step 4: Select an Interview Format 93 Step 5: Outline a Process for Background Checks and References 93 Step 6: Define Hiring Timelines and Accountability 93 Step 7: Determine How Final Decisions Will Be Made 94 Screening Applications and Resumes for Star Performers 95 Screening Resumes and Applications 95 Identifying Red Flags 96 Looking for Flexibility 97 Gaps in Employment 97 Conducting Phone Pre-Screens and Interviews 101 The Telephone Screening Interview 101 Conducting Effective Interviews Pre-Interview Planning 103 The Interview Checklist The Interview Post-Interview Evaluation 106 Avoid Questions That Discriminate 106 Creating an Offer 108 Confirm Your Offer in Writing 108 Sample Offer Letter Salaried Employee 109 Example Offer Letter Hourly Employee 110 Promoting Company Benefits 111 Communicating Enrollment Periods 111 Conducting Reference Checks 112 Questions to Ask 112 Make a Note of It 113 Conducting Criminal Background Checks 116 In Summary 118 Chapter 3: Retaining Your Staff 119 Chapter Overview 120 Key Topics 120 Developing a Retention Strategy 121 Retaining Your Employees What Do They Need? 121 Employee Orientation 124 Involve Your Team in Orientation 128 Motivating Employees 128 Help Employees Become Goal-Oriented 128 Employee Recognition Programs 131 Employee Distress 132 Common Causes of Employee Distress 133 In Summary 134 v

6 Chapter 4: Staffing Workload 135 Chapter Overview 136 Key Topics 136 The Staff Planning Process 137 Three Common Staffing Models 138 In Summary 142 Chapter 5: Training Your Staff 143 Chapter Overview 144 Key Topics 144 Staff Development and Training 145 Adult Learning Styles 145 Global Versus Sequential Learning 150 How Do We Help Global and Sequential Learners? 151 Learner-Focused Training Methods 152 Creating In-Service Lesson Formats 156 A 30-Minute Lesson Format 156 In Summary 158 Chapter 6: Evaluating and Managing Performance 159 Chapter Overview 160 Key Topics 160 Performance Evaluations 161 Why Evaluate Your Employees? 161 Why Do Performance Evaluations Sometimes Fail? 162 Evaluating the Probationary Period 163 Creating an Open Dialogue 164 Self-Appraisals 164 The R-A-P Model 165 Tips for Successful Appraisal Meetings 167 Appraisals and Civil Lawsuits 168 Why Some Managers Fail to Discipline 169 Managers Fear Conflict 169 Managers Fear Legal Action 169 Anti-Discrimination Laws 170 Strategies for Managing Performance 171 Strategy #1 Cultivate a Reputation as a Fair Employer 171 Strategy #2 Establish Clearly Defined House Rules 172 Strategy #3 Document, Document, Document 172 Strategy #4 Use Performance Improvement Plans 175 Method 1 Verbal Warning 176 Method 2 Written Warning 177 Method 3 Suspend and Conduct an Internal Investigation 180 Strategy #5 Terminate for Just Cause 182 Preventing Wrongful Discharge Claims 183 Voluntary Resignations 183 Disciplining for Poor Attendance and Lateness 184 Writing Performance Notes Related to Absenteeism/Tardiness 186 The Employee Grievance Process 187 State Unemployment Laws 188 Responding to an EEOC Charge 189 In Summary 190 vi

7 The Management Library for Executive Directors V 2.1 / BOOK ONE Chapter 7: Promoting a Healthy Workforce 191 Chapter Overview 192 Key Topics 192 Managing Diversity 193 Culture: What Is It? 193 Six Steps to Cultural Understanding 194 Communications 197 Sexual Harassment 197 Sexual Harassment Policies 198 Reporting Sexual Harassment 198 Investigating Sexual Harassment 199 Include Sexual Harassment Training and Orientation 199 Vaccinations 200 Workers Compensation 201 Preventing Employee Accidents 201 Enforce Employee Safety Guidelines 202 Promoting Employee Safety 204 Two Approaches to Promoting Safety 204 In Summary 205 vii

8 The Management Library for Executive Directors V2.1 BOOK , Senior Living University. All rights reserved. Reproduction or translation of any part of this work, by whatever means, beyond that permitted by Section 107 or 108 of the United States Copyright Act without permission of the copyright owners is unlawful. Inquiries regarding permission for use of material contained in this publication should be addressed to: Senior Living University, 830 Cherry Drive, Hershey, PA

9 The Management Library for Executive Directors V 2.1 / BOOK TWO Contents SECTION 4 RESIDENT PROGRAMS AND CARE 1 Chapter 1: The Resident Move-In Process 3 Chapter Overview 4 Key Topics 4 Pre-admission Needs Assessment 5 The Move-In Packet 13 Completing the Move-In Packet 13 The Contents of the Move-In Packet 14 Helping Residents Cope With Transition 21 Resident and Family Orientation 23 In Summary 24 Chapter 2: Tools for Managing Resident Care 25 Chapter Overview 26 Key Topics 26 The Individualized Service Plan 27 What Is the Individualized Service Plan? 27 Who Creates the Service Plan? 27 The Service Plan Meeting 29 Shared Risk Agreements 38 What the Shared Risk Agreement Does 37 When Do You Need to Initiate a Shared Risk Agreement? 38 Shared-Risk Review 39 Advance Directives 40 Informed Consent 40 Discussing the Advance Directives With Your Residents 43 In Summary 44 Chapter 3: Care Management 45 Chapter Overview 46 Key Topics 46 The Care Management Process 47 The Five Steps of Care Management 47 The Executive Director s Role in Care Management 49 Identifying Community Resources 49 In Summary 50 Chapter 4: The Nurse s Role in Assisted Living 51 Chapter Overview 52 Key Topics 52 Nurses Play an Integral Role 53 The Responsibilities of the Nurse 53 Nurse Roles in Assisted Living 54 Regional Nurse 54 Nurse Consultant 55 On-Staff Nurse 55 Nurse Delegation 56 Hiring a Nurse for Your Community 57 iii

10 The Executive Director s Role in Nursing 58 What the Nurse Should Report to the Executive Director 58 Managing the Expectations of the Customer 59 Private Personal Aides and Others 60 In Summary 61 Chapter 5: Resident Wellness 63 Chapter Overview 64 Key Topics 64 An Overview of Resident Wellness 65 Normal Physical Changes in the Body 65 Common Signs and Symptoms of Illness 69 When Signs and Symptoms Indicate an Emergency 72 Training Your Staff to Recognize, Respond to, and Report Signs and Symptoms of Illness 73 Common Emotions Expressed by Assisted Living Residents 74 The Resident s Emotional and Social Needs 76 Change and Loss Affect the Resident 77 Family Members Have Emotional Needs, Too 77 Sexual Activity and Companionship 78 Creating Policies and Guidelines Related to Sexual Activity 79 Infection Control 80 Ensuring Good Infection Control 80 In Summary 81 Chapter 6: Activities of Daily Living (ADLs) 83 Chapter Overview 84 Key Topics 84 Encouraging Independence Through ADLs 85 Providing ADLs as Abilities Decline 86 Upholding Three Key Principles of Assisted Living 87 In Summary 91 Chapter 7: Medication Management 93 Chapter Overview 94 Key Topics 94 An Overview of Medication Management 95 Laws Governing Medication Management 95 State Guidelines for Medication Management 96 With Which Medications Can Caregivers Assist? 98 Communicating About Medication Management 98 Categories of Medications Over-the-Counter Medications Herbal Medicines Prescription Medications 101 Medication Classifications and Names 102 Drugs Not Recommended for Use by Seniors 105 Top 10 Drug-Drug Interactions 105 Controlled Medications 106 Special Note on Psychotropic Medications 108 Improper Use of Psychotropic Drugs 108 Assisting a Resident With Self-Administration 110 An Assessment of the Resident s Ability to Self-Administer Medications 111 The Role of the Caregiver in Self-Administration 112 Recording, Documenting, Reporting 115 The Six Rights of Medication Administration 117 The Resident Who Is Unable to Self-Administer Medications 118 iv

11 The Management Library for Executive Directors V 2.1 / BOOK TWO Documentation: Using the Medication Record 119 Documenting in the Resident s Chart 123 Medication Orders Via Telephone 125 Transcribing a New Prescription 125 Medication Review 127 Storing Medications 128 Types of Medication Packages 128 Safe Medication Storage 129 Disposal and Destruction of Unused Medications 130 Returning Medication to the Pharmacy 130 Disposing of Medication in Your Residence 131 Medication Disposal Record 131 Decreasing Medication Errors 133 Pharmacy Relations 134 What to Look for in a Pharmacy 134 Medications Delivered by the Pharmacy 135 In Summary 135 Chapter 8: Meeting Other Resident Needs 137 Chapter Overview 138 Key Topics 138 Managing Incontinency 139 What to Look for 139 Incontinence Treatment 140 Reducing Resident Falls 142 Risk Factors for Falls 142 Fall Prevention 143 Resident Incidents 144 The Resident Incident Checklist 148 In Summary 150 Chapter 9: Disabilities and Mental Illness 151 Chapter Overview 152 Key Topics 152 Residents With Disabilities 153 Programs for the Developmentally Disabled 154 Meeting the Special Needs of Residents With Physical Disabilities 155 Mental Illness in the Elderly 156 Depression 160 Causes and Signs of Depression 160 Signs of Improvement 161 Assessing, Documenting, and Managing Mental Illness 162 Managing Mental Illness in the Assisted Living Setting 162 In Summary 164 Chapter 10: Resident Abuse and Neglect 165 Chapter Overview 166 Key Topics 166 Resident Abuse 167 Physical Abuse 168 Emotional Abuse 168 Sexual Abuse 169 Neglect 169 Possible Solution 171 v

12 Use of Restraints 172 Alternatives to Restraints 172 When Is a Restraint Justified? 174 Preventing Abuse 175 Take Immediate Action 175 In Summary 176 Chapter 11: Palliative and End-of-Life Care 177 Chapter Overview 178 Key Topics 178 Palliative Care 179 Pain Assessment and Management 180 Wong-Baker FACES Pain Rating Scale 181 Implementing Palliative Care in Your Residence 182 Hospice/End-of-Life Care 183 Identifying the End-of-Life Stage 184 Implementing Hospice in Your Residence 184 Dealing With Resident Death 185 Staff Experience Loss, Too 186 Employee Support Groups 186 A Tradition for Remembering the Resident 186 In Summary 187 Chapter 12: Resident Transfer and Move-Out 189 Chapter Overview 190 Key Topics 190 Supporting Aging-in-Place 191 Resident Move-Out 192 Involuntary Transfer 192 Involuntary Move-Out 193 Move-Out Due to Nonpayment 193 The Resident s Right to Appeal Move-Out 193 In Summary 195 ALZHEIMER S DISEASE AND RELATED DEMENTIA 197 Chapter 13: An Overview of Dementia 199 Chapter Overview 200 Key Topics 200 An Overview of Dementia 201 Irreversible and Reversible Types of Dementia 201 Signs and Symptoms of Dementia 202 Alzheimer s Disease 203 Risk Factors for Alzheimer's Disease 204 The Stages of Alzheimer s Disease The Early Stage The Middle Stage The Late Stage 208 Treatment of Alzheimer s Disease 209 In Summary 210 Chapter 14: Creating a Dementia-Capable Environment 211 Chapter Overview 212 Key Topics 212 Dementia Capability 213 What Does It Take to be Dementia-Capable? 214 vi

13 The Management Library for Executive Directors V 2.1 / BOOK TWO Developing Dementia Program Standards 215 Program Philosophy 215 Who the Program Serves 215 Approach to Care 216 How and by Whom Care Will Be Provided 216 The Program Location 216 What is "Special" About the Care Provided? 217 Communicate Your Commitment 218 Meeting the Residents Changing Needs 219 Assisting the Dementia Resident With Activities of Daily Living (ADLs) 220 Evaluating Your Physical Environment 221 In Summary 223 Chapter 15: Communicating With the Dementia Resident 225 Chapter Overview 226 Key Topics 226 Communication Is Key 227 Communicating With the Dementia Resident 228 In Summary 232 Chapter 16: Understanding and Managing Challenging Behaviors 233 Chapter Overview 234 Key Topics 234 An Overview of Challenging Behaviors 235 Types of Challenging Behaviors 235 Causes of Challenging Behaviors 236 When is a Behavior Considered to be Challenging? 237 Preventing Behavior Challenges 239 Solving Challenging Behavior 241 Wandering 243 Diversional Activities 244 In Summary 244 Chapter 17: Therapeutic Activities for Residents With Dementia 245 Chapter Overview 246 Key Topics 246 What Is Therapeutic Programming? 247 Therapeutic Programming Enhances Quality of Life 247 Therapeutic Programming Establishes Routine and Structure 248 Therapeutic Programming Involves a Four-Part Process 249 The Role of Staff in Therapeutic Programming 250 The Executive Director s Role in Therapeutic Programming 251 Developing an Individualized Program 252 Stage-Related Activities 256 Listening to Meet the Residents Needs 259 Small Groups for the Memory-Impaired 260 Evaluating Therapeutic Programming 261 In Summary 262 Chapter 18: Staffing Your Dementia Care Program 263 Chapter Overview 264 Key Topics 264 vii

14 Selecting the Right Staff 265 Attitude Is the Key 265 Does the Employee Have "the Attitude"? 266 Can the Employee Nurture Relationships? 266 Choose Employees Who Are CREATIVE 266 Staff Education and Training 268 Effective Training Topics 268 Staffing Patterns 269 The Team Approach to Dementia Care 269 Meeting the Residents Needs 270 Permanent Versus Rotational Assignments 270 Meeting the Needs of the Dementia Care Staff 272 Provide Ongoing Support 273 In Summary 273 ACTIVITIES AND RECREATION 275 Chapter 19: The Activities and Recreation Program Chapter Overview Key Topics 278 Activities Improve Quality of Life 279 Activities are Daily Events 279 Five Types of Activity 280 Formal Versus Informal Activities 281 Informal Activities 282 The Executive Director's Role in Activities 283 Building Community Through the Activities Program 283 The Activities Staff 284 Duties and Responsibilities of the Activities Staff 284 Meeting the Special Needs of Your Residents Social Needs Spiritual Needs Cultural Needs Personal Needs Educational Needs 287 Assessing Residents for Activities and Recreation 288 Leisure History 293 Gathering Information from Family Members 293 Ongoing Reassessment 294 In Summary 294 Chapter 20: Scheduling Activities Chapter Overview Key Topics 296 Activities Programs for Assisted Living 297 Group Activities 297 Individual Activities 297 Special Events 298 Caregiver Participation 298 Creating the Right Environment for Activities 299 Exercise and the Elderly Resident 300 The Benefits of Exercise 300 Designing an Exercise Program 302 The Risks of Participating in a Regular Exercise Program 302 viii

15 The Management Library for Executive Directors V 2.1 / BOOK TWO Community Outings 303 What Do Residents Want? 303 Public Transportation 304 Walking 304 Spiritual and Religious Activities 305 Intergenerational Activities 306 Creating Your Activities Calendar 309 In Summary 310 Chapter 21: Managing the Activities Program Chapter Overview Key Topics 312 Monitoring Resident Progress and Participation 313 Evaluating the Activities Program 316 State Requirements for Satisfaction Surveys 319 Budgeting for Your Activities Program 320 Capital Expenses 321 Creating and Managing a Volunteer Program 322 Who is Responsible for the Volunteer Program? 322 Recruiting Volunteers 323 Selection, Testing, and Other Requirements 323 Job Assignments and Descriptions 324 Orientation and Training of Volunteers 324 Supervising Volunteers 325 Tracking Volunteer Time 325 Evaluating Volunteer Performance 325 Volunteer Recognition 326 In Summary 326 Appendix: Potentially Inappropriate Medications 329 ix

16 The Management Library for Executive Directors V2.1 BOOK , Senior Living University. All rights reserved. Reproduction or translation of any part of this work, by whatever means, beyond that permitted by Section 107 or 108 of the United States Copyright Act without permission of the copyright owners is unlawful. Inquiries regarding permission for use of material contained in this publication should be addressed to: Senior Living University, 830 Cherry Drive, Hershey, PA

17 The Management Library for Executive Directors V 2.1 / BOOK THREE Contents SECTION 5 OPERATIONS 1 STATE, LOCAL, AND OTHER ACCOUNTABILITY AND OVERSIGHT 3 Chapter 1: An Overview of Licensure and Regulation 5 Chapter Overview 6 Key Topics 6 An Overview of Licensure and Regulation 7 Who Are Your State and Local Regulators? 8 Types of Licensure 9 The Role of State Regulators 10 Building Relationships With Your Regulators 12 Ownership and Legal Structure 14 Who Owns Your Residence? 14 Legal Structure of Your Residence 15 In Summary 16 Chapter 2: Regulatory Compliance 17 Chapter Overview 18 Key Topics 18 The Executive Director s Role in State Regulations 19 The Benefits of Regulatory Compliance 19 Regulated Areas of Care and Service 20 Staff Training Is Key to Regulatory Compliance 25 Preparing for the Licensing Survey 25 Top Five Commonly Cited Deficiencies and Complaints 26 Correcting a Deficiency or Grievance 26 Creating a Plan of Correction 27 Measuring Quality Through Satisfaction Surveys 28 Resident Satisfaction Surveys 28 Family Satisfaction Surveys 29 Staff Satisfaction Surveys 29 A Well-Written Survey Is Key 30 In Summary 31 Chapter 3: Federal Law and Requirements 33 Chapter Overview 34 Key Topics 34 Federal Initiatives That Influence Assisted Living 35 Medicare and Medicaid 39 Medicare 39 Medicaid 41 Health Insurance Portability and Accountability Act (HIPAA) 42 Long-Term-Care Ombudsmen 43 The Ombudsman and Conflict Resolution 43 In Summary 44 iii

18 DINING AND NUTRITION SERVICES 45 Chapter 4: An Overview of Dining and Food Service 47 Chapter Overview 48 Key Topics 48 What Is Dining and Food Service? 49 Teamwork Dining and Food Service 50 The Executive Director s Role in Dining and Food Services 54 Dining and Food Services Positions 55 Staffing Models for Dining and Food Services 57 Staff Training 58 Dining Services for the Memory-Impaired 59 Dining and Food Service Systems and Recordkeeping 60 In Summary Chapter 5: Menu Planning, Preparation, and Delivery 63 Chapter Overview 64 Key Topics 64 An Overview of Nutrition 65 The Signs of Good and Poor Nutrition 67 The Importance of Fluids in the Resident s Diet 69 Water as a Nutrient 69 The Signs and Symptoms of Hydration and Dehydration 70 The Resident s Dietary Profile 71 Menu Planning 73 The Cycle Menu 73 What Is Included in the Menu Plan? 74 Menu Language 74 Therapeutic Diets 76 Meal Presentation 78 The Effects of Aging on the Dining Experience 78 The Effects of Health on the Dining Experience 79 Meal Presentation Should Be Appealing 79 Meal Delivery 80 Dining Styles 80 Food Purchasing 83 Purchasing Guidelines 83 Food Costs 84 Tracking Food Costs 84 Controlling Food Costs 85 Food Inventory 86 Food Inventory Practices 86 In Summary Chapter 6: Food Safety, Sanitation, and Inspection 89 Chapter Overview 90 Key Topics 90 Food Handling 91 Keeping Food Areas Clean 94 Cleaning Schedules 94 Cleaning and Sanitizing Equipment and Utensils 96 Preventing Foodborne Illness 97 Dietary Audit 100 In Summary 105 iv

19 The Management Library for Executive Directors V 2.1 / BOOK THREE ENVIRONMENTAL AND PHYSICAL PLANT 107 Chapter 7: Housekeeping and Laundry 109 Chapter Overview 110 Key Topics 110 An Overview of Housekeeping 111 Housekeeping Helps to Manage Infection Control 111 The Structure of Housekeeping 112 The Goals of Housekeeping 113 Building Community Through Housekeeping 113 Housekeeping Responsibilities 114 Scheduling Housekeeping Duties 117 Housekeeping Procedures 118 Resident Move-In 118 Resident Move-Out Procedures 120 Inspection Procedures When a Resident Moves Out 120 Housekeeping Services for the Residence 122 The Importance of Cleaning Common Areas 122 Scheduling and Responsibilities 122 Guidelines for Cleaning Common Areas 123 Laundry 124 Staff Protection Against Contaminants 125 Managing the Laundry 125 Resident Laundry Preferences and Requests 126 In Summary 128 Chapter 8: Maintaining Your Physical Plant 129 Chapter Overview 130 Key Topics 130 An Overview of Facility Maintenance 131 How Is Facility Maintenance Organized? 131 The Purpose of Facility Maintenance 132 An Overview of the Maintenance Program General Maintenance Preventive Maintenance 133 Know Your State and Local Licensing Rules 133 In Summary 135 Chapter 9: Risk Management 137 Chapter Overview 138 Key Topics 138 An Overview of Risk Management 139 Loss Control 140 The High Cost of Accidents, Injuries, and Illnesses 140 Ten Risk-Management Strategies 141 A Typical Risk-Management Scenario 143 Preventing Mr. Levin s Fall 144 Risk-Management Policies and Procedures 146 Creating Safety Rules 146 Communicating With Your Insurance Company 147 Three Important Steps for Claims Management 147 In Summary 148 v

20 SAFETY 149 Chapter 10: Emergency Response and Security Systems 150 Chapter Overview 151 Key Topics 151 Life Safety Standards and Compliance 152 Disclosure of LIfe Safety Information 152 What Systems Do You Need? 152 Emergency Response Systems 153 Emergency Call Systems 153 Fire Alarm Systems 154 Security Systems and Programs 154 Planning for Safety Inspections 155 In Summary 156 Chapter 11: Emergency and Disaster Preparedness Plans 157 Chapter Overview 158 Key Topics 158 Emergency and Disaster Preparedness Plans 159 Contingency Plans 160 What Is an Emergency and Disaster Plan? 161 Severe Weather 164 Staff Responsibilities During Severe Weather 164 Power Outage 167 Staff Responsibilities During a Power Outage 167 Fire 170 Staff Responsibilities During a Fire 172 Planning for an Evacuation 174 In Summary 175 Chapter 12: Crisis Communications 177 Chapter Overview 178 Key Topics 178 Managing Crisis Communications 179 The First Steps for Responding to a Crisis Identify the Situation Notify the Appropriate People Enlist Your Response Team Uncover the Communication Issue 183 In Summary 184 Chapter 13: Other Environmental Issues 185 Chapter Overview 186 Key Topics 186 Residence Vehicles 187 Public Transportation 187 Smoking Policies 188 Lost or Stolen Property 188 Missing Property Incident 188 In Summary 189 vi

21 The Management Library for Executive Directors V 2.1 / BOOK THREE COMMUNITY AND FAMILY RELATIONSHIPS 191 Chapter 14: Effective Information Management 193 Chapter Overview 194 Key Topics 194 Effective Information Management 195 Creating the Resident s File 195 Maintaining Employee Documents 198 In Summary 200 Chapter 15: Building Community 201 Chapter Overview 202 Key Topics 202 What Are Families Experiencing? 203 A Family Member May Feel Anger 204 A Family Member May Feel Fear 204 A Family Member May Experience a Sense of Relief 205 A Family Member May Experience a Sense of Gratitude 205 Family Members Have Expectations 206 Supporting the Family Members of Your Residents 206 Quality Matters Most 206 Involving Families in Shared Risk 207 Review of Full Disclosure 208 Building Community Among Families 209 Involve Families Before Move-In 210 Involve Families After Move-In 210 Involve Families in Decision-Making 211 Foster Communication Between Residents and Families 211 Promote Convenience 213 Being a Good Community Neighbor 214 A Possible Solution 215 In Summary 216 Chapter 16: Resident and Family Councils 217 Chapter Overview 218 Key Topics 218 Supporting the Development of a Resident and/or Family Council 219 Working With the Resident Council 221 Purpose of the Resident Council 221 Role and Responsibilities of the Resident Council 222 The Executive Director s Role in the Resident Council 222 Building Community Through the Resident Council 222 Organizing Family Programs Family Support Groups Family Activity Clubs 225 Family-Friendly Assessment 226 In Summary 229 Chapter 17: Grievances and Conflict Resolution 231 Chapter Overview 232 Key Topics 232 Resident and Family Grievances 233 The Executive Director s Role in the Resident Grievance Procedure 234 Communicating Your Grievance Procedure 234 Training Your Employees to Handle Grievances 235 vii

22 Conflict Resolution 236 Seven Steps for Problem-Solving 237 Managing Challenging Families 239 One Possible Solution 241 In Summary 241 COMMUNITY INVESTMENTS 243 Chapter 18: Capital Expenditures 245 Chapter Overview 246 Key Topics 246 An Overview of Capital Expenditures 247 Six Steps for Creating a Capital Budget 248 Step 1: Identify Projects 248 Step 2: Obtain Estimates and Bids 250 Step 3: Consolidate the Budget 251 Step 4: Forecast Available Funding 251 Step 5: Prioritize Projects 251 Step 6: Gain Approvals 252 In Summary 253 Chapter 19: Providing Community Resources 255 Chapter Overview 256 Key Topics 256 Key Community Resources 257 Aging Services Network 257 Four Senior Advocacy Programs 257 The Area Agency on Aging (AAA) 259 Maintaining Relationships With the Area Agency on Aging 261 Community Healthcare Resources 262 The Benefits of Using Community Resources 262 In Summary SECTION 6 SALES AND MARKETING 267 Chapter 1: An Overview of Sales and Marketing 269 The Difference Between Sales and Marketing 271 The Executive Director s Role in Sales and Marketing 273 Building Community Among Your Sales and Marketing Team 273 What Is a Marketing Plan? 274 Three Benefits of the Marketing Plan 274 A Marketing Plan Answers Five Questions 275 The Four Components of an Assisted Living Marketing Plan 276 In Summary 277 Chapter 2: Situation Analysis: Research of the Marketplace 279 Chapter Overview 280 Key Topics 280 Defining Situation Analysis 281 Conducting the Situation Analysis 282 Situation Analysis Study 1: Marketplace Consumer Awareness 282 Using the Marketplace Awareness Study to Create Your Message 284 viii

23 The Management Library for Executive Directors V 2.1 / BOOK THREE Informal Consumer Research 285 Situation Analysis Study 2: Competitive Review 288 Who Is Your Competition? 289 How to Research Your Competitors 289 Three Methods for Conducting a Competitive Review 290 Situation Analysis Study 3: Internal Review 299 Situation Analysis Study 4: Target Audience Review 302 Situation Analysis Study 5: Pricing Review 304 Summarizing the Situation Analysis 307 Developing Your Product 312 The Situation Analysis Helps You Develop and Refine Your Product 312 In Summary 313 Chapter 3: Positioning Your Residence 315 Chapter Overview 316 Key Topics 316 Defining Product Positioning 317 The Assisted Living Position 317 The Unintended Position 318 Positioning Creates a Focused Marketing Strategy 318 Exercise: Create Your Residence s Positioning Strategy Assess Consumer Awareness of Assisted Living Understand the Decision-makers and Their Needs Determine Competitive Strengths and Weaknesses Identify Your Residence s Strengths and Weaknesses 321 Create Your Ideal Position 323 Review Your Realistic Position 323 Keeping Your Position Updated 324 In Summary 324 Chapter 4: Generating Leads and Referrals 325 Chapter Overview 326 Key Topics 326 Key Definitions 327 Four Advertising Mediums 328 The Benefits and Drawbacks of Advertising 328 Yellow Pages Advertising 329 Print Advertising 329 Print and Broadcast Advertising Working Together 330 Direct Mail Advertising 331 Public Relations 332 The Benefits of Public Relations 332 Stories That Interest Readers and Viewers 332 Networking With Professionals 334 Networking Versus Advertising 335 With Whom to Network? 336 Who Networks? 337 Creating a Contact List 338 How Many Contacts Is Enough? 343 Networking With Families 344 Positive Results of Family Networking 344 Two Reasons for Customer Dissatisfaction 346 Who Does the Dissatisfied Customer Talk to? 346 Networking With Families Affects Financial Results 347 ix

24 Creating Your Family Networking Strategy Visiting Hospitalized Residents (ongoing) Service Plan Follow-up Calls (ongoing) New Resident Dinners (monthly) 348 Family Networking: Make It Happen! 349 Networking in Your Community 350 Community Education 350 Community Outreach 351 Offer Your Residence as a Community Resource 351 Create a Volunteer Network 352 Maintaining a Client Information Database 353 In Summary 353 Chapter 5: Creating a Marketing Plan 355 Chapter Overview 356 Key Topics 356 Five Steps to Creating a Marketing Plan 357 Step 1: Conduct or Update Your Competitive Analysis 357 Step 2: Create a Positioning Strategy for Your Residence 357 Step 3: Set Overall Objectives for Your Residence 357 Step 4: Write SMART Marketing Goals 358 Step 5: Choose Action Steps 361 Other Considerations for Your Marketing Plan 362 Measure the Effectiveness of Your Marketing Plan 368 In Summary 370 Chapter 6: Managing Your Marketing and Sales Staff 371 Chapter Overview 372 Key Topics 372 The Residence Marketing Team 373 Who Serves on the Marketing Team? 373 Responsibilities of the Marketing Team 374 The Marketing Team Meeting 374 Training Your Marketing Staff 375 Managing Through Sales Goals 378 What Are the Sales Goals for Your Residence? 378 Sales Goals for the Typical Assisted Living Residence 379 Applying the Sales Formula Two Examples 380 Focusing on Professional Contacts 382 Effective Lead Management 383 Tool 1: The Telephone 383 Making Time for Prospecting and Lead Management 384 Tool 2: A Lead-Management System 385 Classifying Leads 386 In Summary 388 SECTION 7 FINANCE AND ACCOUNTING 389 Chapter 1: An Overview of Accounting 391 Chapter Overview 392 Key Topics 392 Who Benefits From Profits? 393 Six Building Blocks of Accounting 394 x

25 The Management Library for Executive Directors V 2.1 / BOOK THREE The Benefits of Accounting and Financial Practices Manage by Fact, Not Feeling Use Information to Guide Strategy Manage Risk Support Continuous Process Improvement 401 Accounting Safeguards 402 Debt-Service Covenants 403 In Summary 404 Chapter 2: The General Ledger 405 Chapter Overview 406 Key Topics 406 An Overview of the General Ledger 407 Three Types of General Ledger Accounts 411 How the General Ledger Can Help You 412 In Summary 414 Chapter 3: The Revenue Cycle 415 Chapter Overview 416 Key Topics 416 An Overview of the Revenue Cycle 417 Segregation of Duties for the Revenue Cycle Cash Keeper Transaction Recorder Transaction Reviewer 418 The Executive Director s Role in the Revenue Cycle 420 Understanding the Billing Process 421 Handling Delinquent Accounts 421 In Summary 425 Chapter 4: Accounts Payable 427 Chapter Overview 428 Key Topics 428 What Is Accounts Payable? 429 The Executive Director s Role in Accounts Payable 429 An Overview of the Accounts Payable Process 430 Accounts Payable Input 431 The Processing Center 431 Vendor Contracts 432 Other Accounts Payable Functions 433 In Summary 436 Chapter 5: Budgeting 437 Chapter Overview 438 Key Topics 438 An Overview of Budgeting 439 Your Capital and Operating Budgets Should Work Together 441 A Budget is a Management Tool 441 Creating Your Operating Budget 443 How Long Does the Budget Process Take? 446 Budgeting Revenue 447 Ancillary Revenue 448 In Summary 449 xi

26 Chapter 6: Analyzing Financial Statements 451 Chapter Overview 452 Key Topics 452 Four Steps for Analyzing Financial Statements 453 Analyzing Cash Flow 458 Analyzing Operating Expenses 459 Three Tools for Analyzing Your Operating Expenses Same Period Comparisons Per Resident Day (PRD) Statistics Industry Statistics 461 Suggested Productivity Measures 461 In Summary xii