Fill - Free fillable National Association of Long Term Care Administrators Boards PDF form

National Association of Long Term Care

Administrators Boards (NAB)

And

American College of Health Care

Administrators (ACHCA)

National Administrator-in-Training

Program Manual

Special Appreciation to the

AIT & Preceptor Task Force

Phil DuBois and Lisa Hahn (Co-Chairs)

ACHCA Representatives

Becky Reisinger (Staff)

Sue Anagnostou

CC Andrews

Denise Boudreau-Scott

Melanie Eaton

Michael Hotz

Mary Helen McSweeney-Feld

Kristen Simas

NAB Representatives

Taylor Stephen (Staff)

Donald Aldridge

Donna Alexander

Jane Baker

Jennifer Johs-Artisensi

Margaret McConnell

Steve Nash

Gaylord Z. Thomas

Deborah Veley

National AIT Program Manual Authors:

Donald Aldridge

Jane A. Baker

Lisa R. Hahn

Katrina G. Magdon

Gaylord Z. Thomas

Editors: Lisa R. Hahn, Michelle Grachek, Jason Silberberg

Design and Development: Josh Dobbs

No part of this manual may be reproduced in any form, by photostat, microfilm, xerography, or any other means, or

incorporated into any information retrieval system, electronic or mechanical, without the permission of the copyright owner.

All inquiries should be addressed to:

National Association of Long Term Care Administrator Boards

1444 I Street NW #700

Washington, DC 20005

Table of Contents

Introduction .......................................................................................................... 4

Chapter 1: Guidelines for Designing an Administrator-in-Training Program ........ 5

Required Activity Area .................................................. 5

Inventory of Knowledge: Self-Assessment Instrument . 6

Other Activities .............................................................. 6

Length of Program ........................................................ 6

Training Schedule ......................................................... 7

Administrator-in-Training Program Approval ................. 7

Chapter 2: The Phases of the AIT Program ......................................................... 8

Phase 1: Application and Interview Process ................. 8

Phase 2: Self-Assessment Instrument ......................... 8

Phase 3: AIT Program Design ...................................... 9

Phase 4: The AIT Experience ..................................... 10

Phase 5: Program Completion ................................... 10

Chapter 3: AIT Model Standards covering Domains of Practice ........................ 11

Domain 10-Customer Care, Support, and Services .... 11

Domain 20-Human Resources ................................... 16

Domain 30-Finance .................................................... 19

Domain 40-Environment ............................................. 21

Domain 50-Management and Leadership .................. 23

Chapter 4: Preparation for the National Examination ........................................ 29

Appendices

Appendix 1: Knowledge and Skills

Appendix 2: AIT Sample Learning Activities

Appendix 3: Self Assessment Instrument for AITs

Appendix 4: Glossary

Appendix 5: Prefixes

Appendix 6: Suffixes

Appendix 7: Abbreviations

Appendix 8: Therapeutic Actions

Appendix 9: Common Diagnoses

Appendix 10: Forms and Flashcards

The National Administrator-

in-Training Program

An Administrator-in-Training (AIT) Program is a supervised internship during

which the AIT works under the guidance and supervision of a preceptor, who is a

licensed administrator meeting the qualifications established for preceptors by

their respective states. The internship is a unique phase of education consisting

of the supervised practice of long term care administration in the Nursing Home

(NHA), Assisted Living (RCAL) and/or Home and Community Based Services

(HCBCS) environment.

In this manual, we will refer mostly to the AIT Program for the Nursing Home

Administrator. However, the manual, forms and Self-Assessment Instrument can

be applied to all service lines, with minor modifications.

The purpose of the AIT Program is to spur and enhance the professional develop-

ment of the AIT in the field of long term care (LTC) administration. It equips the

AIT with the tools and knowledge for when they become an administrator. A

significant portion of the program involves observing and participating in activities

associated with administration or resident/patient care.

Many college health care administration programs have incorporated an intern-

ship/AIT program into their curricula. All National Association of Long Term Care

Administrator Boards (NAB) accredited schools have an AIT component built into

their programs. There have been several research studies that have validated the

importance of the AIT experience towards a successful LTC administrator career.

The goal of this manual is to help to provide the AIT with a solid foundation in

the exciting field of long term care. Another objective is to encourage state

licensing boards to adopt this manual for their AIT programs. The more states

that use the Model AIT Program, the more consistent our AIT training and our

requirements become.

Chapter 1

Guidelines for Designing

an Administrator-in-

Training Program

The AIT Program is designed by both the Preceptor and the AIT. It is developed

specifically for the AIT based upon education, experience, knowledge, skills and

abilities. The Preceptor and AIT are expected to exercise considerable initiative in

planning and implementing the training program in order for the AIT to succeed.

The AIT program must conform to the number of AIT hours required by your State

Board. Please be advised that, in addition to the following guidelines for designing

the program, there may be a requirement in your state to submit the proposed

Administrator in Training Program to the appropriate state board for approval prior to

the beginning of the AIT Program. State boards typically have standard forms to use.

However, sample forms can be found in Appendix 10 for your review and use.

Required Activity Areas:

The AIT Program should be based on the five domains of practice, which are cov-

ered in the various departments found in a long term care facility. The tool presents

the departments as modules and rotations; it is through these departments/modules

that the program should be designed, so that the individual AIT can meet an appro-

priate and tailored amount of time in each of the domains as appropriate. These

modules include:

• Administration

• Human Resources

• Nursing

• Business Ofce/Financial Management

• Diet

• Rehabilitation

• Medical Records

• Activities

• Social Services/Admissions

• Housekeeping/Laundry

• Environmental Management/ Maintenance

The AIT must complete a rotation in each of these areas. The preceptor and the

AIT may work together to determine the order in which these modules are

undertaken, and the amount of time allocated to each. For example, if the AIT’s

background experience is in nursing, he/she would ideally spend less time in

nursing, and more in other areas. However, each activity area, including those

in which the

AIT has prior experience, must be included in the training program.

The AIT should, through a combination of observation and participation, become

familiar with all aspects of each activity area, including its purpose, the services

it provides, stafng, and any problem areas. They should try to gain an under-

standing of the roles of the front line staff in that area, the role of its department

manager, and the administrator’s perspective on how to oversee that area. They

should also understand how that area interacts with other areas in the provision of

care and services.

Inventory of Knowledge: Self-

Assessment Instrument

The preceptor and AIT are encouraged to develop an inventory of the AIT’s

knowledge in each of these areas to determine where the AIT Program should

be focused. To help with this process, we have included a Self-Assessment

Instrument for the AIT to complete at the initiation of the AIT Program. Once this

instrument is completed, the Preceptor will have a better indication of the AIT’s

strengths and weaknesses. Self-Assessment Forms are included in this manual.

We also recommend that this Self-Assessment be completed again, either mid-way

or at the end of the program, to indicate the progress of the AIT.

Other Activities:

Since state licensing regulations differ in terms of the number of AIT Program hours

required, the AIT experience must be customized to individual needs based upon the

state’s particular licensing requirements. The tool we provide enables the preceptor to

make such customization.

The preceptor is strongly encouraged to either arrange for the AIT to visit or con-

duct research to become familiar with state licensing agencies and professional

associations, such as the state afliates of the American Health Care Association

(https://www.ahcancal.org/), Leading Age (http://www.leadingage.org/), and

American College of Health Care Administrators (http://www.achca.org/), as well

as the National Association of Long-Term Care Administrators Boards

(http://www.nabweb.org/). The purpose of such visits is to provide the broadest

possible experience for the AIT. Membership in and attending meetings of

relevant industry associations and/or professional organizations should also be

encouraged.

Length of the Program:

Since state licensing regulations differ in terms of the number of Administrator in

Training Program hours required, the AIT experience must be customized to the

AIT’s needs based upon the state’s particular licensing requirements and the tool

provided will enable the preceptor to make such customization.

NAB recommends a minimum of 1,000 hours for a Nursing Home Administrator’s

AIT Program. Some state boards require 2,000 hours for an NHA AIT, but there

are also states that require less than 1,000 hours. Some state boards award credit

based upon education and supervisory experience. NAB includes state-by-state

board requirements on its website at http://www.nabweb.org/state-licensure-

requirements for reference.

Guidelines for Designing

an Administrator-in-

Training Program

Training Schedule:

Typically, it is expected that the AIT will work a full-time (40 hours/week) schedule.

The AIT can be completed on a part-time basis unless your state precludes this type

of schedule.

The AIT generally works a usual day shift of the facility where the training is taking

place. However, it is strongly suggested that each program also include some

coverage of night and weekend shifts to familiarize him/her with the unique aspects

of facility administration during those times. The schedule should be individualized

for each AIT. It is expected that the preceptor and AIT develop a schedule that

maximizes exposure to new and previously unfamiliar aspects of the facility.

Administrator in Training Program

Approval

Once the preceptor and the AIT have developed a program outline, it may be

required to be sent to the state board for approval, using the appropriate form

that the board requires. In some states, the program may not begin without such

approval.

We have developed sample forms for the state boards to utilize, if they so choose.

These forms were created by reviewing many of the state’s current forms.

The Administrator in Training Program Forms can be located in the Appendix 10:

Forms and Flashcards section of the manual.

Guidelines for Designing

an Administrator-in-

Training Program

Chapter 2

NAB recommends the following Process for use by the Preceptor and the AIT

Phase 1: Application and Interview Process

This partnership can be advantageous to both parties. The Preceptor can provide

valuable training to the AIT, and both the AIT and the facility will benet as a result

of the AIT completing quality improvement projects and other activities. It is ulti-

mately the Preceptor’s decision if the AIT is a good t for the profession. Through

this experience, it may be determined that the AIT may be better suited for other

career options.

The AIT must carefully select his/her Preceptor, and should be someone from

whom the AIT feels they can learn. It is very important that you select someone you

respect and who is willing to share information with you that will ensure a quality

internship that will prepare you for a successful career in long term care

administration. Therefore, prior to committing yourself to an internship, it is very

important to spend time with a potential preceptor in their building to learn their

management style; how they relate to staff, residents, and families; to what extent

they are professionally involved; and their longevity with the corporation. The AIT

should also be familiar with other information about the preceptor’s corporation.

From visiting with the potential preceptor, you should be able to recognize the

personality of the community. The quality of the facility is based on the leadership

of the community, which takes on the personality of its leader.

If you are having difficulty finding a Preceptor, you might want to arrange an infor-

mational interview with a corporation and share the AIT Sample Learning Activities

which is included in Appendix #2 of this manual. It is a comprehensive list of projects

that an AIT could perform and will hopefully help to demonstrate how valuable the

AIT could be to their organization.

In most cases, the AIT Program is initiated with an interview between the Preceptor

and the AIT. Prior to the interview, the AIT should provide a resume to the Preceptor

and a follow up call to meet with the Preceptor. The interview should center on the

AIT’s prior work experience, educational background and professional goals. It is

very important for the AIT to make the very best impression on the Preceptor at this

initial interview.

The learning environment is most important to your success. You want to feel

welcomed, accepted, and a part of the organization. Office space, access to a

computer and telephone are contributing factors to a solid learning environment. A

preceptor that provides a strong learning environment sends a positive message to

the AIT and to a successful internship.

Phase 2– Self-Assessment Instrument

Once the Preceptor and the AIT commit to the AIT Program, the Preceptor should

have the AIT complete the Self-Assessment Instrument.

The Self-Assessment Instrument helps establish a foundation of what the AIT thinks

he or she already knows. It is important for the AIT to be honest and open in this self-

assessment; it is not a test but a guideline instrument to help the Preceptor develop

a quality plan of action for the AIT. The self-assessment includes various tasks that

the AIT scores numerically based on their own knowledge and skills in each of the

five Domains of Practice. This provides the Preceptor the ability to tailor the AIT

program in order to make the most of the experience based on the AIT’s strengths

and weaknesses. The Preceptor will see areas that may need more or less focus and

can design the program accordingly.

AIT Program Process

The Self-Assessment Instrument is where the Preceptor determines how much time

the AIT should expect to spend in each of the various Domains. For example, if the

AIT has a nursing background, we would expect less time devoted to Domain 10

(Customer Care) and perhaps more somewhere else such as Human Resources or

Finance. On the other hand, if the AIT has an accounting background, they would

likely need to spend more time in Customer Care and less in Finance. This tool

assists the Preceptor and AIT in making these determinations.

This tool can be found in Appendix 3: Self Assessment Instrument for AITs

We also recommend the use of NAB’s Practice Examinations during the beginning

phase of the AIT and at the conclusion of the AIT program. Taking this examination

in the beginning will provide a good assessment of the areas of strength and

weakness, and also help inform the candidate of their areas of competency and

where they need further development, even prior to completing the self-assessment.

The information on the Practice Examinations can be found at http://www.nabweb.

org/practice-exams. The results of the practice examination will include your overall

score and will provide the percentage of passage within each domain.

Phase 3 – AIT Program Design

The next phase is designing the AIT Program using the Self-Assessment Instrument.

The Preceptor should input the number of state mandated AIT hours in the Self-

Assessment Instrument. Once the required hours are entered, it will self-populate

a suggested number of hours in each sub-task and domain. The Preceptor and AIT

should go through this tool together to determine modications that would individu-

alize this program for the AIT, as previously addressed.

Creation of the AIT Professional Development Plan involves determining activities

that are designed to meet the objectives of each subtask. There are sample activi-

ties included in the Self-Assessment Instrument as well as the Manual, but they are

not exhaustive but rather should be used as a sort of “brainstorming” platform by

the Preceptor in designing the plan of study. The goal is to design an “AIT Plan” that

works both for the Preceptor and advances the AIT’s development. For the first-time

Preceptor, a master template should be saved so it can set the foundation for future

AITs. It will allow the Preceptor to fine-tune these activities and improve at teaching

and demonstrating the objectives. Another advantage of using this tool is that it

helps the Preceptor to communicate with the department heads (who also spend

considerable time with the AIT) exactly what the objectives are and how the team

intends to get that message across. For that reason, it is also a good idea to include

the department heads in the development of the plan and the design of the activities

that will help teach the objectives.

NAB recommends all AITs go through CNA (Certied Nurse Aide) training if the

AIT does not have a nursing background. These hours can count towards your

AIT program.

Incorporated in the appendices are several tools—including a glossary and

flashcards--to assist the AIT in a successful AIT Program completion and passage of

the national examination. Additionally, NAB’s Nursing Home Administrators

Examination Bibliography References and the Assisted Living Administrators

Examination Bibliography References can be found at http://www.nabweb.org/exam-

references.

AIT Program Process

Phase 4 – The AIT Experience

Research has shown that Preceptors play a signicant role in inuencing the AIT’s

success.

The learning environment is also very important to the success of the AIT.

Making the AIT feel welcomed, providing adequate ofce space including a computer,

name badge and an email address will help the AIT to feel a part of the organization.

Phase 5- Program Completion

Once you have completed your AIT program, submit the required forms to

your state board. We have included sample NAB AIT Forms in case the state

board wishes to utilize them.

The following Forms are included on the NAB website at www.nabweb.org:

NAB 101-Nursing Home Administrator-In-Training Application

NAB 102-Nursing Home Administrator-In-Training Proposed AIT Program

NAB 103-Nursing Home Administrator-In-Training Monthly Report

NAB 104-Nursing Home Administrator-In-Training Completion AIT Program Form

NAB 105-Nursing Home Administrator-In-Training Documentation of Completion Form

If your state board utilizes these forms, we recommend that you initially submit

the AIT Application along with the Proposed AIT Program to your state board. If

your state board requires monthly reports, we have included a sample for your

usage. At the conclusion of your program, we recommend that you complete and

submit both the Completion AIT Program Form and the Documentation of

Completion Form.

AIT Program Process

Johs-Artisensi, J. & Olson, D. (2012). Advancing Practices to Enhance the Field

Experience of Developing Long Term Care Administrators, White Paper, New

York City/Washington DC: The Commonwealth Fund and NAB Foundation.

AIT Model Standards Covering

the Domains of Practice

We have incorporated NAB’s 2014 Professional Practice Analysis, which applies to

NHA, RCAL and HCBS. This manual will refer to the AIT Program for the Nursing

Home Administrator. However, the manual, forms and Self-Assessment Instrument

can be applied to all service lines with some small modifications. Suggested AIT

Activities and Assignments for each of the Domains of Practice follow each section.

These can also be found in the Self-Assessment Instrument.

Domain 10 - Customer Care, Support,

and Services

10.01 - Establish care recipient service policies and procedures that comply with

applicable federal and state laws, rules, and regulations.

This task requires the Administrator to create policies and procedures that follow

federal and states laws rules and regulations.

10.02 - Ensure plans of care are evidence- based, established, implemented, updated,

and monitored based on care recipient preferences and assessed needs.

This task requires the Administrator to ensure that staff implements a plan of care

for each resident, based on the individuals needs and preferences, under the

direction of a physician. This includes a comprehensive assessment of each

resident/recipient. The comprehensive assessment should include (but not limited

to) assessments for nutrition (to include diet, texture, weight, swallowing), therapy,

mobility, fall risk, skin/wound management, medications and contraindications,

cognitive abilities, behavior, mental health, etc.

10.03 - Ensure the planning, development, implementation/execution, monitoring, and

evaluation of admission/move in process, including pre-admission/pre-move in

information, to promote a quality experience for care recipients.

This task requires the Administrator to ensure that the admission process is

comprehensive and is resident-centered. This includes obtaining all available

documentation at the time of admission to include, but not limited to: power of

attorney for health care and financial, resident identification cards, insurance

information, doctor and all other orders related to the resident to include hospital/

doctors/clinic records pertaining to the residents stay at the facility or services

provided by the organization.

10.04 Ensure the planning, development, implementation/execution, monitoring, and

evaluation of discharge/move out process to promote a quality experience for care

recipients.

This task requires the Administrator to ensure that resident care is appropriate for

the level of care they require and that an interdisciplinary team continually moni-

tors the resident’s progress and recommends the best care environment need to

maximize the resident’s quality of living.

10.05 - Ensure the planning, development, implementation/execution, monitoring, and

evaluation of programs to meet care recipients psychosocial needs and preferences.

This task requires the Administrator to ensure that residents are properly evaluated

and cared for based on their psychosocial needs and preferences.

10.06 Ensure the planning, development, implementation/execution, monitoring, and

evaluation of care recipient’s activities/recreation to meet social needs and preferences.

This task requires the Administrator to ensure activities, events, and programs are

resident centered and designed to meet the needs and preferences of each resident.

Chapter 3

AIT Model Standards Covering

the Domains of Practice

10.07 - Ensure the planning, development, implementation/execution, monitoring,

and evaluation of a health information management program to meet documentation

requirements in compliance with federal and state regulations.

This task requires the Administrator to ensure all resident specic documentation is

protected and follows state, federal, and HIPAA regulations.

10.08 - Ensure the planning, development, implementation/execution, monitoring, and

evaluation of medication management that supports the needs of the care recipient.

This task requires the Administrator to ensure that doctors’ orders are strictly

followed and that policies and procedures are in place to assure compliance.

10.09 - Ensure the planning, development, implementation/execution, monitoring, and

evaluation of a rehabilitation program to maximize optimal level of functioning and

independence for care recipients.

This task requires the Administrator to provide individualized rehabilitative services

to recipients that will help them meet their baseline and allow residents to be as

independent as possible.

10.10 - Ensure the planning, development, implementation/execution, monitoring, and

evaluation of systems for coordination and oversight of contracted services.

This task requires the Administrator to ensure that services are available to meet

the needs of each recipient from qualied vendors that meet city, state, and

federal requirements.

10.11 - Ensure the planning, development, implementation/execution, monitoring,

and evaluation of policies and procedures for responses to care recipient incidents,

accidents, and/or emergencies.

This task requires the Administrator to ensure that policies and procedures are

written and followed to prevent incidents and accidents and to prepare staff to act

appropriately when incidents, accidents, and emergencies occur.

10.12 - Ensure the planning, development, implementation/execution, monitoring, and

evaluation of housekeeping and laundry services for care recipients.

This task requires the Administrator to ensure a clean, safe, and sanitary environment.

10.13 - Ensure the planning, development, implementation/execution, monitoring, and

evaluation of education intended for care recipients and their support networks.

This task requires the Administrator to ensure that the care recipient and/or their respon-

sible party is informed of their care, condition, and treatment as much as practical.

10.14 - Ensure the planning, development, implementation/execution, monitoring, and

evaluation of nutritional needs and preferences of care recipients.

This task requires the Administrator to ensure that the care recipient’s nutritional

needs are met in accordance with their individualized needs and preferences while

simultaneously meeting all physicians prescribed orders.

10.15 - Ensure the planning, development, implementation/execution, monitoring and

evaluation of dining experience that meets the needs and preferences of care recipients.

This task requires the Administrator to ensure that dining services are resident-cen-

tered and meet the nutritional needs paralleled with the recipient preferences.

10.16 - Ensure care recipients rights and individuality with all aspects of care.

This task requires the Administrator to ensure all staff are trained and follow

state and federal guidelines related to resident rights. Attention must be made

to issues related to abuse, neglect, misappropriation of resident property and

mistreatment of residents.

AIT Model Standards Covering

the Domains of Practice

10.17 - Integrate support network’s perspectives to maximize care recipients quality

of life and care.

This task requires the Administrator to ensure that measures are taken to review

Quality Improvement Measures and to strategize how each team member inu-

ences quality measures and how they each help to improve quality based on

recipient, responsible party, and team members input. Attention must be made to

issues related to meeting the care recipient’s individualized needs

10.18 - Ensure transportation options are available for care recipients.

This task requires the Administrator to ensure adequate transportation to recipients.

The facility should identify transportation that is available and the costs (if any) for

the services and inform recipients and their responsible parties of availability and

cost. The facility/entity must be available to help coordinate transportation services

based on the recipients preference and available funding.

10.19 - Ensure the provision of a customer service culture that leads to a quality

experience for care recipients.

This task requires the Administrator to promote a resident centered experience that

serves each recipient according to their choices and preferences as much as practical.

Knowledge of:

K01 Applicable federal and state laws, rules, and regulations

K02 Government programs and entities

K03 Ethical decision-making

K04 Interpersonal relationships, dispute resolution, and group dynamics

K05 Psychosocial aspects of aging

K06 Physiological aspects of aging

K07 Basic principles and concepts of nursing

K08 Basic medical terminology

K09 Basic pharmaceutical terminology

K10 Basic principles and regulations for medication management/administration

K11 Basic principles and concepts of restorative/wellness programs

K12 Basic principles of rehabilitation

K13 Basic principles of acute and chronic diseases

K14 Basic principles of infection control

K15 Basic principles of pain management

K16 Basic principles of fall prevention

K17 Basic principles of elopement prevention

K18 Basic principles of creating a safe environment for care recipients

K19 Basic understanding of mental health issues

K20 Basic understanding of cognitive impairments

K21 Basic principles of behavior management

K22 Basic principles of restraint usage and reduction

K23 Basic elements of a social services program

K24 Basic elements of a therapeutic recreation/activity program

K25 Basic principles of nutrition including specialized diets

K26 Basic principles of dietary sanitation, food storage, handling, preparation,

and presentation

K27 Basic principles of hospice and palliative care

K28 Grieving process

K29 Death and dying

AIT Model Standards Covering

the Domains of Practice

K30 Person-centered care concepts

K31 Diversity of care recipients

K32 Care recipients’ support network interests, needs, and values

K33 Care recipient Bill of Rights

K34 Resident Assessment Instrument (RAI) and interdisciplinary care plan

requirements and process

K35 Care recipient assessment instruments (OASIS) and interdisciplinary care

plan requirements and process

K36 Care recipient assessments and care plans other than RAI and OASIS

K37 Admission/move-in, transfer, and discharge/move-out requirements

K38 Bed-hold requirements (NHA only)

K39 Roles, responsibilities, regulation and oversight of contracted providers

and services

K40 Services and resources available across the continuum of care (such as

community, social, nancial, spiritual)

K41 Care recipient specic legal matters (such as power of attorney, guardianship,

conservatorship, code status, Advance Directives)

K42 Activities of Daily Living (ADLs) and Independent Activities of Daily Living (IADLs)

K43 Role of Medical Director

K44 Role of healthcare partners and clinical providers

K45 Medical services, specialties and equipment (such as oxygen, durable

medical equipment, podiatry)

K46 Emergency medical services and techniques (such as CPR, rst aid,

Heimlich maneuver, AED)

K47 Center for Medicare and Medicaid Services (CMS) quality indicators

and measures

K48 Quality assurance and performance improvement processes as related to

care and services

K49 Techniques for auditing care recipient services and outcomes

K50 Signs and symptoms of abuse, neglect, and exploitation

K51 Mandatory reporting requirements for incidents and adverse events

K52 Medical record content, format, and documentation requirements

K53 Condentiality, disclosure, and safeguarding medical record information

requirements

K54 Transportation options for care recipients

K55 Environmental services (such as housekeeping and laundry)

K56 Hospitality services

K57 Basic technological advances in healthcare

I. Possible Activities/Assignments related to Domain 10: Customer Care,

Support and Services

A. Quality of Care/Nursing

1. Develop a rounding sheet with the administrator and director of nursing that is

resident- centered; initiate implementation.

2. Observe nurse peer review on administration of medications.

3. With director of nursing, ensure medications are not expired.

4. Develop resident satisfaction surveys and make recommendations for implemen-

tation as necessary.

AIT Model Standards Covering

the Domains of Practice

B. Rehabilitation

1. Organize and implement a follow-up program for discharged residents

to the community.

2. Develop audit for equipment inventory and complete audit; report.

C. Medical/Resident Records

1. Conduct admission audit of current in-house resident population, analyze data

and report. Assist with recommendations, as needed.

2. Conduct audit of u vaccination response variables, analyze data and report.

Assist with recommendations, as needed.

3. Conduct audit of admission and annual required vaccines, analyze data and

report. Assist with recommendations, as needed.

4. Conduct medical records audit with appropriate staff.

D. Activities

1. Develop and implement a volunteer program

2. Develop/enhance Life Enrichment/Person Centered Care program

a. Interview residents and families and analyze information to ensure that

desired activities are planned and implemented as necessary

b. Working with Directors of Activities and other personnel as needed, help

develop in-service for Life Enrichment/Person Centered Care; assist appro-

priate staff with delivering in-services.

E. Social Services/Admission

1. Conduct an audit of admissions documents (per regulations and organization

policy), analyze and report.

2. Complete an audit of resident preferences, such as time to eat, rise and retire,

bath/showers, time of therapy, etc. Make recommendations as necessary

3. Develop and implement an outreach program that communicates regularly with

residents and/or families post discharge.

F. Dietary

1. Develop a questionnaire for residents related to dietary satisfaction including

variables such as taste, temperature, timeliness, presentation, etc; implement,

analyze and report; make recommendations.

2. Meet with the dietician and dietary manager to learn how menus are developed,

followed, and implemented; conduct an audit to conrm residents are receiving

correct foods, drinks and adaptive devices.

3. Understand nutritionally compromised concerns and how weights are monitored.

4. Audit purchasing and storage of dietary supplies and food; report to dietary

manager and administrator.

5. Audit to ensure foods are served and maintained at proper temperatures and in

accordance with the Food Code.

G. Housekeeping/Laundry

1. Conduct weekly audits, evaluating such variables as dust, oors, toilet, showers

of designated public areas; track, trend and report accordingly.

2. Audit resident rooms for housekeeping variables;track, trend and report

accordingly.

3. Audit residents to determine if laundry is clean and received promptly.

4. Audit infection control, safety and cross contamination procedures and make

recommendations as necessary.

5. Follow the linen distribution system from soiled to clean and report accordingly.

6. Observe resident clothing management

AIT Model Standards Covering

the Domains of Practice

Domain 20 - Human Resources

20.01 - Ensure that human resource management policies and programs comply with

federal and state rules and regulations.

This task requires the Administrator to create policies and procedures that follow

federal and states laws rules and regulations.

20.02 - Establish the planning, development, implementation, monitoring, and evalua-

tion of recruitment, selection, and retention practices.

This task requires the Administrator to ensure the facility has systems in place that

will provide for a consistent, fair, and predictable method of job development, job

hiring, job training, employee evaluation, and continuing education. These systems

should follow the standards of the Fair Labor Standards Act (FLSA).

20.03 - Establish the planning, development, implementation, monitoring, and evalua-

tion of employee training and development programs.

This task requires the Administrator to have policies and procedures in place to train

managers/leaders to follow and design basic and continuing education programs

aimed at evaluating individual employee performance and training programs that

can meet the basic, continuing, or potential educational needs of the employee.

20.04 - Establish the planning, development, implementation, monitoring, and evalua-

tion of employee evaluation programs.

This task requires the Administrator to ensure that policies and procedures are

in place that clearly provide instruction to managers/leaders to regularly monitor

employee performance and to timely inform employees of when their performance

or adherence to procedures does not meet standards. This should include timely

formal evaluations of the employee to communicate areas of poor performance and

areas in which the employee meets and exceed facility standards.

20.05 - Establish the planning, development, implementation, monitoring, and evalua-

tion of compensation and benet programs.

This task requires the Administrator to ensure that policies and procedures are in

place for employee compensation and benets programs. This includes a formal

method of informing employees of their employee benets and compensation.

20.06 - Establish the planning, development, implementation, monitoring, and evalua

tion of employee health and safety programs.

This task requires the Administrator to ensure that policies and procedures are in

place to prevent employee injury and encourage employee wellness. This includes

having an effective workers compensation or group retro program and providing

a health/wellness program that gives employees the opportunity to attain health,

dental, vision, accident, pharmacy, and life insurance programs.

20.07 - Establish the planning, development, implementation, monitoring, and evalua-

tion of employee satisfaction and organizational culture.

This task requires the Administrator to ensure policies and procedures are in

place to measure employee satisfaction and that results are taken seriously and

considered. This task also requires the Administrator to develop an organizational

chart/diagram that will clearly communicate to employees the organization

structure.

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20.08 - Establish the planning, development, implementation, monitoring, and evalua-

tion of employee disciplinary policies and procedures.

This task requires the Administrator to have policies and procedures in place that

will set standards to objectively measure employee performance. When employee

performance or behavior does not meet standards, employees are made aware of

an allegation, and given an opportunity to give an explanation of their performance

or behavior (give their side of the story), offer witnesses or evidence that will

support their statement, and/or provide a written statement. The procedure should

include that the employee will be made aware if an investigation will be done, if the

employee will be suspended pending investigation, and that no discipline will be

applied until a thorough investigation is completed.

20.09 - Establish the planning, development, implementation, monitoring, and evalua-

tion of employee grievance policies and procedures.

This task requires the Administrator to have policies and procedures in place to

clearly communicate with the employee a formal grievance procedure in which

the employee,

without fear of retaliation, can communicate areas of frustration,

abuse, mistreatment, or concerns with the understanding that a formal response

will follow.

20.10 - Establish the planning, development, implementation, monitoring, and evalua-

tion of leadership development programs.

This task requires the Administrator to develop leadership development pro-

grams not only for managers and leaders but for all employees. This may be in

the form of a formalized program designed by a corporation, outside vendor, or

the Administrator.

20.11 - Promote a safe work environment (such as safety training and employee

risk management).

This task requires the Administrator to ensure effective policies and procedures are

in place to create an awareness of safety throughout the workplace that include

reporting accidents, safety monitoring, fire drills, water, gas, and electric shut off

valves, and that emergency generators are regularly tested.

20.12 - Promote a positive work environment (using techniques such as conict

resolution, diversity training, and staff recognition programs).

This task requires the Administrator to ensure that policies and procedures are

in place to assure that the employees are provided a workplace that allows them

to communicate concerns and grievances in a safe environment. It also includes

training programs in diversity, conflict resolution, continuing education, and staff

recognition programs.

20.13 - Facilitate effective written, oral, and electronic communication among manage-

ment and employees.

This task requires the Administrator to ensure policies and procedures are in place

to direct managers and employees on how to formally and informally communicate

with each other. These procedures should include requirements to managers on

effective leadership ensuring employees are aware and trained in their respective

job duties and tasks. Supervisors should also be held accountable for validating

performance and communicating with employees that progress.

20.14 - Ensure employee records and documentation systems are developed

and maintained.

This task requires the Administrator to ensure employee records and

correspondence are protected and secure from other employees, residents, and

unauthorized individuals.

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20.15 - Establish a culture that encourages employees to embrace care recipients rights.

This task requires the Administrator to create a culture that ensures that all resident

rights are followed. and to develop policies and procedures on reporting violations

of resident rights.

Knowledge of:

K01 Applicable federal and state laws, rules, and regulations

K02 Licensure requirements and scopes of practice

K03 Service provider stafng requirements

K04 Employee position qualications, job analysis, job descriptions

K05 Employee recruitment, selection, interviewing, reference and background checks

K06 Employee orientation, training and continuing education requirements,

and resources

K07 Compensation and benet programs (such as employee assistance pro-

grams, insurance, salary, retirement)

K08 Human resource policies and procedures (such as employee grievance, work-

place rules, discipline, absenteeism, turnover, classication, exemption status)

K09 Diversity training

K10 Performance evaluation procedures

K11 Safety and injury prevention training

K12 OSHA rules and regulations

K13 Workers compensation rules, regulations, and procedures

K14 Drug-free workplace programs

K15 Methods for assessing, monitoring, and enhancing employee satisfaction

K16 Employee recognition, appreciation, and retention programs

K17 Leadership development

K18 Types and methods of communication

K19 Conict resolution and team dynamics

K20 Information technology safeguards related to such issues as data security,

social media, e-mail, voicemail, computer software, cell phones, photography,

video, texting

K21 Union/management and labor relations

K22 Employee record-keeping requirements and procedures

K23 Mandatory reporting requirements

II. Possible Activities/Assignments related to Domain 20: Human Resources

A. Conduct an employee file audit per regulations and organizational policy.

B. Collect annual turnover rates for last few years, and develop a strategic plan

with activities, timeframes, etc. for identified changes.

C. Develop an employee satisfaction questionnaire, administer it and analyze

data;develop a subsequent plan.

D. Develop, organize and implement several employee activities.

E. Track absentee information, such as shift, day of week, reason, frequency;

analyze and report the findings.

F. Audit external health care providers (e.g., physicians, dentists, podiatrists)

to determine current

licenses, liability insurance, etc.; analyze and report the

findings.

G. Study and analyze recruiting plans/staffing patterns and offer ideas to

improve current processes to ensure that the needs of the residents cared

for are met.

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H. Review and understand the facility’s employee handbook to ensure accuracy

and that all federal/state guidelines are followed and make recommendations

as necessary.

I. Review and evaluate payroll plans, compensation plans, and benefit packages

J. Participate in a complete employee hiring and orientation process ( interview,

background check, etc.).

K. Conduct a staff meeting and an in-service training program.

L. Participate in a disciplinary/grievance procedure and an employee

counseling session.

M. Understand and have knowledge of National Labor Relations Board (NRLB)

as it relates to the facility.

N. Review and evaluate the unemployment compensation record of the facility

and attend an unemployment compensation hearing as necessary.

O. Review and report on ways to encourage and support professional develop-

ment of team members.

Domain 30 - Finance

30.01 Ensure that financial management policies, procedures, and practices comply

with applicable federal and state regulations.

This task requires the Administrator to create policies and procedures that follow

federal and state laws, rules, and regulations, including those specific to NHA,

RCAL or HCBS.

30.02 - Develop, implement, and evaluate the service provider’s budget.

This task requires the Administrator to have knowledge of the budget process and

have systems in place to accurately set budgets based on income, expense, capital

improvements, and required tasks of the organization.

30.03 - Oversee the billing and collections process and monitor the accuracy of

charges and timely collection of accounts.

This task requires the Administrator to have procedures in place to timely and

accurately bill for resident care and services to appropriate parties, insurances, or

state and federal agencies as appropriate. Systems should be in place to make

sure each recipient knows and understands their bill so that timely payments can

be made to the facility.

30.04 - Negotiate, interpret, and implement contractual agreements to optimize nan-

cial viability.

This task requires the Administrator to ensure the facility/organization has written

agreements and contracts that include duration of contract, liability insurance required

and assured for each party, language that includes duties of each party and what steps

are required to notify each party of any breach of service and details of how to dissolve

agreements for poor service or choice to use another vendor/contractor.

30.05 - Develop, implement, monitor, and evaluate nancial policies and procedures

that comply with Generally Accepted Accounting Principles (GAAP).

This task requires the Administrator to ensure policies and procedures are in place

to direct staff on the steps to accurately perform their duties. Direction must be given

for employees in the areas of payroll, accounts receivable, billing, accurate record

keeping, internal controls, trust accounts, HIPAA, etc.

30.06 - Monitor and evaluate the integrity of nancial reporting systems and

audit programs.

This task requires the Administrator to ensure that internal controls are in place to

validate systems, audit and verify information, and ensure proper supervision to

protect theft.

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An example way to monitor theft would be to never allow the person who prepares

a deposit make the deposit. There should be checks and balances in place to allow

for the person making the deposit to check the prepared paperwork by a different

individual to ensure no errors were made. Another example would be to have a

place where the administrator of designee can access all passwords in case of

emergency or to validate access when a person may be unavailable.

30.07 - Establish safeguards for the protection of the service provider’s assets (such

as insurance coverage, risk management)

This task requires the Administrator to have knowledge and provide leadership in

risk management, internal controls, workers compensation, and to prevent unnec-

essary insurance/legal claims.

30.08 - Develop, implement, monitor, and evaluate systems to improve financial

performance.

This task requires the Administrator to use critical thinking to understand financial

viability and to respond to the financial needs of the facility/organization.

30.09 - Manage and adjust expenses with fluctuations in census/occupancy/care

recipient levels (such as staffing rations).

This task requires the Administrator to have systems in place that will effectively

make adjustments in labor, supplies, and resources as needed to ensure

continued financial performance.

30.10 - Monitor and address changes in the industry that may affect financial viability.

This task requires the Administrator to stay knowledgeable of the changes of all

financial resources to include but not limited to Medicare, Medicaid, insurance

companies, and other payor sources. In addition, the Administrator must be

knowledgeable of any city, state, and federal changes that may affect the financial

performance of the facility/organization and make changes as needed.

Knowledge of:

K01 Applicable federal and state laws, rules, and regulations

K02 Operational and capital budgeting and forecasting methods

K03 Financial statements and reporting requirements for not-for-prot and for-

prot service providers

K04 Service-related sources of revenue/reimbursement

K05 Reimbursement methods across the continuum of care

K06 Alternative sources of revenue

K07 Integration of clinical and nancial systems

K08 Billing, accounts receivable, and collections

K09 Accounts payable procedures and management

K10 Revenue cycle management

K11 Internal controls

K12 Contracts and agreements

K13 Financial analysis (such as ratios, protability, debt covenants, revenue mix,

depreciation, forecasting)

K14 Financial statements (such as income statement, balance sheet, statement

of cash ows)

K15 Financial measures (such as operating margin, daily cash on hand, stafng,

expense analysis)

K16 Risk management

K17 Insurance coverage (such as property, liability)

K18 Inventory control and management

K19 Payroll procedures and documentation

K20 Purchasing process and supply chain management (such as request for

proposals, pricing, ordering, receiving, group purchasing organization [GPO])

K21 Resident trust accounts for personal funds

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III.Possible Activities/Assignments related to Domain 30: Finance

A. Assist the administrator with all budget (capital, cash, operating, etc.) develop-

ment and submission.

B. Understand and assist with accounts payable processing.

C. Analyze and understand how aged accounts work.

D. Understand the facility’s bad debt and write-off policy; determine avenues

for improvement.

E. Understand triple-check systems for private pay and all third party payors.

F. Describe and review regularly produced financial reports to determine if fiscal

issues have arisen and make recommendations as necessary

G. Review and describe the chart of accounts, bookkeeping procedures,

income and expense statements and balance sheets; make

recommendations as necessary.

H. Understand the financial audit process utilized by third party payors to ensure

billings are in accordance with services provided.

I. Analyze and understand third party payor cost reporting systems.

Domain 40 - Environment

40.01 - Ensure that physical environment policies and practices comply with applicable

federal, state, and local laws and regulations.

This task requires the Administrator to create policies and procedures that follow

federal and state laws, rules, and regulations, including those specific to NHA,

RCAL or HCBS.

40.02 - Ensure the planning, development, implementation, monitoring, and evaluation

of a safe and secure environment.

This task requires the Administrator to have policies and procedures in place that

ensure

the physical plant, systems, equipment, and resources are properly used

and appropriate for the facility/organization. It is required that the Administrator

understands, promotes, directs, and requires supervision to maintain all equipment

and resources and continually validate the physical plant to include (but not limited

to) the facility, grounds, equipment, tools, emergency systems, fire systems,

sprinklers, etc.

40.03 - Ensure the planning, development, implementation, monitoring, and evaluation

of infection control and sanitation.

This task requires the Administrator to have policies and procedures in place to effec-

tively assure that infection control and sanitation are properly planned, implemented,

and validated. This would include, but not limited to, training of personnel, assuring

proper supplies and resources are available and effective communication through the

facility/operation/agency of reporting violations and areas of concern.

40.04 - Ensure the planning, development, implementation, monitoring, and evaluation

of emergency and disaster preparedness program, including linkage to outside emer-

gency agencies.

This task requires the Administrator to have specific policies and procedures in place to

assure that an effective disaster preparedness program is in place. It is extremely

important that the plan includes regular training of staff related to re drills, emergency

shut off valves, re evacuation routes, where to nd ashlights, extension cords, emer-

gency phone, etc. In addition, the plan needs to include regular testing of emergency

systems such as sprinklers, re alarm, systems, emergency generators, and all safety

and emergency equipment. It requires having agreements made with outside vendors

for equipment testing and maintenance, transportation in the event of an emergency,

and transfer agreements with resources that can help provide care and service to

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relocate residents when necessary. In the event of relocation, provisions for moving

resident charts, medications, blankets, food, and other items need to be planned and

implemented.

40.05 - Ensure the planning, development, implementation, monitoring, and evaluation

of environmental services, housekeeping, and laundry.

This task requires the Administrator to ensure that policies and procedures are

in place to provide a comprehensive plan that assures all environmental, house-

keeping, and laundry services department meet and/or exceed all local, state,

and federal requirements. This task includes infection control, proper

temperatures and temperature logs, proper use of chemicals and products used

per Material Safety Data Sheets (MSDS), preventative maintenance, systems to

validate compliance, etc.

40.06 - Ensure the planning, development, implementation, monitoring, and evaluation

of maintenance services for property, plant and all equipment, including preventative

maintenance.

This task requires the Administrator to ensure that policies and procedures are in

place to provide a comprehensive plan that assures all maintenance services meet

or exceed all local, state, and federal requirements. This task includes infection

control, proper temperatures and temperature logs, proper use of chemicals

and products used per MSDS, preventative maintenance, systems to validate

compliance, etc.

40.07 - Ensure the planning, development, implementation, monitoring, and evaluation

of appropriate HIPAA complaint technology infrastructure.

This task requires the Administrator to ensure HIPAA compliance by developing

technology infrastructures, safeguards (e.g., backup systems, external data

storage areas, preventative maintenance for computer hardware and software) and

ongoing validation surveys.

40.08 – Establish, maintain, and monitor a physical environment that provides clean,

safe, and secure home-like surroundings for care recipients, staff, and visitors.

This task requires the Administrator to ensure policies and procedures are in place

to create a clean, home-like environment that supports the well-being and safety

of all recipients. This task includes creating a resident-centered culture that

promotes choice, comfort, and cleanliness.

40.09 – Identify opportunities to enhance the physical environment to meet changing

market demands.

This task requires the Administrator to regularly maintain the physical environment

of the facility/organization and to evaluate and monitor trends within the market or

community to keep the facility/organization current. This task includes creating a

chart or schedule for the normal life of equipment and furnishings, using qualified

professionals to assess the interior/exterior design of facility/organization, and

developing annual and capital budgets to prepare for predicted capital spending.

40.10 – Establish, maintain, and monitor an environment that promotes choice, com-

fort, and dignity for care recipients.

This task requires the Administrator to ensure policies and procedures are in place

to create a clean, home-like environment that supports the well-being and safety

of all recipients. This task includes creating a resident-centered culture that

promotes choice, comfort, and cleanliness.

40.11 – Assess care recipients’ environment for safety, security, and accessibility and

make recommendations for referral or modification.

This task requires the Administrator to ensure that each recipient’s personal

environment and accessibility is individually evaluated and accommodations are

made to provide the most independent, comfortable, and safe environment possible.

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Knowledge of:

K01 Federal, state and local standards, codes and regulations for building,

equipment, maintenance, and grounds

K02 Environmental principles that promote care recipient rights

K03 HIPAA compliance

K04 Community resources, programs and agencies available to meet the care

recipients’ home needs

K05 Design principles that create a safe, secure, and home-like atmosphere

based on the needs of the individuals served

K06 Safety and security procedures

K07 Physical plant security principles

K08 Preventative and routine maintenance for building, grounds and equipment

K09 Contracted services for mechanical, electrical, plumbing, laundry

and IT systems

K10 Compliance matters related to provision of contracted services

K11 Infection control and sanitation regulations/standards of practice

K12 Pest control programs

K13 Handling and disposal of potentially hazardous materials

K14 Disaster and emergency planning, preparedness, and recovery

K15 Community resources available in the event of emergency or disaster

K16 The use, storage, and inspection of required emergency equipment

K17 Policies and procedures for housekeeping, maintenance, and laundry services

K18 Technology infrastructure

IV. Possible Activities/Assignments related to Domain 40: Environment

A. Audit preventative maintenance logs per regulations and company policy;track

and trend such variables as time of day, season, staff member, etc.

B. Audit resident rooms, utilizing audit tools to evaluate such items as electrical

outlet plates, call bells, water temperatures and beds; track, trend and report

accordingly.

C. Review emergency generator and life safety regulatory requirements according

to state, local, and federal laws specific to your building(s) and prepare a com-

pliance report.Conduct audit of past year of the log; develop/revise preventative

maintenance log with maintenance supervisor.

D. Conduct an audit of the past year’s log; develop and/or revise preventative

maintenance logs with the maintenance supervisor.

E. Assist the administrator and maintenance supervisor with developing and

implementing an emergency plan.

F. Develop a rounding sheet with the administrator and maintenance supervisor

that is environmental and safety centered; initiate its implementation.

G. Audit Log Out/Tag Out procedures to ensure compliance.

Domain 50 – Management and Leadership

50.01 - Ensure compliance with applicable federal

and state laws, rules, and regulations.

This task requires the Administrator to create policies and procedures that follow

federal and states, laws, rules, and regulations, including those specific to NHA,

RCAL or HCBS.

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50.02- Promote ethical practice throughout the organization.

This task requires the Administrator to create policies and procedures to ensure

that a system is in place to direct the facility/organization related to ethical topics/

situations that arise. This task would include developing an ethics committee or the

creation of an ad hoc ethics committee when necessary.

50.03 – Develop, implement, monitor, and evaluate policies and procedures that

comply with directives of governing body.

This task requires the Administrator to know and understand the governing body

and all directives, policies, and procedures. This task also requires the adminis-

trator to recommend changes or additions to policies and procedures and make

recommendation to the governing board to change/add policies and procedures

when necessary.

50.04 – Develop, communicate, and champion the service provider’s mission, vision,

and values to stakeholders.

This task requires the Administrator to develop a process to train stakeholders to

communicate the mission, vision, and value of the organization. This includes

creating positive and effective ways to not only share the mission, vision, and

values of the organization but to create an atmosphere of confidence and

execution of the mission, vision, and values.

50.05 – Develop, implement, and evaluate the strategic plan with governing

body’s endorsement.

This task requires the Administrator to develop a strategic plan that reflects the

facility/organizational values, mission, and policies that will direct the facility/

organization to conduct effective business practices with the endorsement of the

governing body. The strategic plan must include how the plan will be

implemented, validated, and evaluated in a timely manner.

50.06 – Promote and monitor satisfaction of the care recipient’s and their support

networks.

This task requires the Administrator to develop a system to monitor resident

satisfaction. This can be done by the Administrator being visible through onsite

visits with residents and family. This can also be done with satisfaction surveys

and mock inspections. The successful administrator will generally perform a

combination of onsite visits, surveys, and daily interaction with staff in the form

of a stand up meeting.

50.07 - Identify, foster, and maintain positive relationships with key stakeholders.

This task requires the Administrator to determine who key stakeholders are and

develop a working relationship/understanding with each of them. This task includes

creating an atmosphere of trust and understanding. This should be tempered with

providing necessary information to work jointly on projects and systems that benefit

the organization. At no time should the impression be given that any key

stakeholder is asked to assist in leading the facility/organization.

50.08 – Educate stakeholders on services provided, regulatory requirements, and

standards of care.

This task requires the Administrator to develop a strategy to provide instruction and

resources to help the stakeholder to understand facility, state, and federal

requirements. It is also important for stakeholders to understand facility protocols,

standards, and services that are provided to meet residents needs and create a

home like environment to ensure resident safety and choice are paramount.

50.09 – Solicit information from appropriate stakeholders for use in decision making.

This task requires the Administrator to set up protocols/standards of practice to

use all available input from trusted resources to make effective,fair and timely

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decisions. The Administrator must have the ability to weigh the situation/circum-

stance and the time used to make decisions. While the Administrator is account-

able for the decisions he/she will make, it is important for the Administrator to

know that sometimes a good decision is better than the best decision when time

or the lives of others is a factor.

50.10 – Manage the service provider’s role throughout any survey/inspection process.

This task requires the Administrator to develop a protocol/practice to use for any

unannounced survey or inspection. The protocol should include reporting the sur-

veyors’/inspectors’ presence to all key management teams. In addition, the protocol/

practice should include providing needed information to surveyors and inspectors,

keeping copies of any documents the surveyor/inspector reviews (as known), coop-

erating with the inspection, being visible, supporting staff throughout the survey/

inspection, responding quickly to surveyor/inspector requests, and fire marshal

inspection. The Administrator should strive to be ready for a survey any day of the

year by training his/her staff to do all that is right year round.

50.11 – Develop and implement an intervention(s) or risk management program(s) to

minimize or eliminate exposure.

This task requires the Administrator to develop a risk management program that

is designed to prevent problems before they occur. The program should start

with the identication of key risk areas and a system or protocol to prevent them.

This includes specic protocols to educate staff on reporting incidents, events or

situations that occur timely, who to report to, and what steps to take to reduce

liability. This program requires effective communication from the Administrator and

her/his designees.

50.12 – Identify and respond to areas of potential legal liability.

This task requires the Administrator to create a plan that identifies, responds, and

prevents any current or potential legal liability. This includes communicating with

staff, residents, and responsible parties when issues arise and proactively

responding to concerns before they become a liability. In addition, Administrators

should have systems in place to ensure best practices are done and documentation

occurs for any change of condition or abnormal action, event or activity. The plan

should also clarify when legal representation is necessary and describe the process

to retain an attorney.

50.13 – Implement, monitor, and evaluate information management and technology

systems to support service providers operations.

This task requires the Administrator to meet all federal, state and community

requirements for information management of health records, financial information and

HIPAA. Safeguards to employee, patient, resident and client information must be in

writing and show evidence of training/competency of all employees. In addition, the

Administrator must ensure there is a process in place to protect access to informa-

tion, secure and track passwords, and to back up and protect all data in the com-

munity servers. Attention must also be given to ensure all technology is designed to

save employees time and allow more time for patient/resident/client care.

50.14 – Develop, implement, and monitor comprehensive sales, marketing, and public

relations strategies.

This task requires the Administrator to develop an effective marketing strategy

designed to help the consumer, resident or responsible party, and staff to know

about the features, benefits, and amenities of the community/organization. The

community/organization should have clear policies, standards, and protocols to

build consumer confidence.

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The Administrator should also have clear policies and procedures on how to

communicate emergency and disaster situations within and outside the community.

The Administrator must also ensure that a marketing plan reflects and

communicates what the community does/stands for/has achieved in the form of

writing/action/advertisement/brochure/word of mouth.

50.15 – Ensure that written agreements between the care recipient and the service

providers protect the rights and responsibilities of both parties.

This task requires the Administrator to assure that all written agreements reflect

the services provided to the resident and meets federal and state guidelines. This

may include having legal representatives review the written agreements

on a regular basis to ensure they meet the most current regulations at the time and

protect the facility/community/resident. In relation to a resident agreement/service

plan/admission/financial agreement/etc., it is always wise to have the agreements

reviewed by an attorney. Service provider/vendor agreements should be carefully

reviewed by the Administrator, a designated financial person and, when necessary,

an attorney.

50.16 – Develop, implement, and evaluate the organization’s quality assurance and

performance improvement programs.

This task requires the Administrator to develop an effective QAPI (Quality Assurance

and Performance Improvement) program. This includes following CMS guidelines

related to QAPI and establishing specific procedures, policies, and systems to

perform an effective QAPI program. This also includes ensuring the program is

designed to meet the ever-changing needs of the facility/organization.

50.17 – Lead organizational change initiatives.

This task requires the Administrator to demonstrate leadership by carefully

assessing the facility needs, strategically developing effective methods to meet

these needs, and then communicating the need for change(s) to the individuals

affected. All changes should include providing clear and concise purposes related

to the change and then to effectively train, validate, and celebrate those who

participate in the change.

50.18 – Facilitate effective internal and external communication strategies.

This task requires the Administrator to develop methods of effective communication,

internally and externally. The administrator must establish a hierarchy of individuals

who communicate with each other via an organizational chart. The chart should be

available to residents, families and staff so that it is clear who is responsible and

has the authority to provide information. This includes creating clear and concise

messages so that all staff are aware of how and what is to be communicated and

when the need for assistance in communication is necessary. No employee should

ever feel that the total weight of providing information rests on them. Training and

strategies should include not only verbal and written communication but also

electronic media such as Facebook, blogs, and Twitter.

50.19 – Promote professional development of all team members.

This task requires the Administrator to purposefully assess team members’ training

and experience and to facilitate an environment that allows employees opportunities

to grow professionally. This would include internal and external opportunities for

employees motivated to develop themselves professionally.

Knowledge of:

K1 Applicable federal and state laws, rules, regulations, agencies and programs

K2 Code of ethics and standards of practice

K3 Components and purpose of mission, vision and value statements

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K4 Stakeholder roles, responsibilities and limitations

K5 Roles and responsibilities of owners and governing bodies

K6 Services available along the healthcare continuum

K7 Provider’s role along the healthcare continuum

K8 Methods for assessing, monitoring and enhancing care recipient satisfaction

K9 Provider’s certications and licensing requirements

K10 Regulatory survey and inspection processes, including the plan of

correction process

K11 Grievance procedures

K12 Procedures for Informal Dispute Resolution (IDR)

K13 Compliance programs

K14 Reportable outcome measurements

K15 Risk management principles and processes

K16 Provider’s legal and criminal scope of liability

K17 Internal investigation protocols and techniques

K18 Strategic business planning

K19 Management information systems

K20 Technology to support operations

K21 Sales and marketing techniques

K22 Public relations, including media relations

K23 Volunteer programs

K24 Elements of contracts and agreements

K25 Care recipient’s rights and responsibilities

K26 Role of care recipient advocates and advocacy groups

K27 Mandatory reporting requirements

K28 Quality assurance and performance improvement techniques and models

K29 Organizational change management

K30 Organizational structures

K31 Leadership and management principles and philosophies (such as planning,

organizing, directing, delegating, motivating and evaluating)

K32 Personality and leadership styles

K33 Diversity awareness (such as culture, ethnicity, race, sexual orientation,

gender, religion and language)

K34 Workforce planning and education

K35 HR management theory and principles

K36 Governmental relations and advocacy

K37 Functions of all departments and services

V. Possible Activities/Assignments related to Domain 50: Management

& Leadership

A. Review policy and procedure manuals to determine if they are appropriate

and timely, per regulations and organization policy and make recommenda-

tions for change as necessary.

B. Develop and assist the administrator with an annual strategic planning

meeting.

C. Review current internal and external contracts and agreements for accuracy,

efficiency and timeliness; organize and make recommendations as necessary.

D. Review and become comfortable with federal regulations and state specific

regulations; assist with educating department leaders, if needed.

E. Assist with writing a Plan of Correction and/or identified regulatory violations.

F. Review and update the facility’s organizational chart and job descriptions.

G. Review short-term and long-term goals of the organization for appropriateness.

H. Study the bylaws/mission statement/vision of the governing body and how

decisions and policies are made within the organization. Analyze

the authority

throughout the facility.

I. Plan and attend internal and external meetings and prepare reports for the

organization, as necessary.

AIT Model Standards Covering

the Domains of Practice

J. Review the facility marketing plan and make recommendations for change as

necessary based upon facility dynamics and community needs.

K. Review and understand the facility’s media publicity efforts, including (but not

limited to) writing news releases, facility publications, newsletters, etc.

L. Organize and write a report to include competitive information, such as

description of services and amenities, survey history, CMS 5-Star rating and

community involvement.

M. Review the facility’s corporate compliance program to ensure all appropriate

rules and regulations are followed.

N. Review and describe how the facility’s risk management program minimizes

legal liability.

O. Review and analyze facility’s information management system, including

technology, to ensure safeguards are in place to provide resident confidential-

ity, data security, social media, cell phones, etc.

P. Review and analyze the facility’s quality improvement programs.

Q. Review the facility’s customer satisfaction program, including resident rela-

tions initiatives, reception/concierge duties and resident/family surveys.

R. Transitional Care: understanding the various regional lines of service and how

they relate, as well as initiatives to ensure continuous delivery of safe and

quality care as consumers transition between the different lines of service.

The Following are the Necessary Skills:

S01 Creating and communicating a vision

S02 Communicating effectively

S03 Cultivating effective relationships

S04 Inspiring and motivating

S05 Demonstrating empathy

S06 Group facilitation, consensus building and team building

S07 Delegating, leading, and empowering

S08 Coaching, teaching, counseling and mentoring

S09 Negotiating, collaborating and resolving disputes

S10 Problem solving

S11 Analyzing and interpreting information/data

S12 Informed decision making/critical thinking

S13 Recognizing and ensuring care recipients’ holistic needs are being met

S14 Assessing and recognizing safety concerns and needs

S15 Allocating and optimizing resources and programs

S16 Writing and evaluating policies and procedures

S17 Developing and evaluating systems

S18 Protecting and promoting nancial viability

S19 Managing regulatory and accreditation surveys, inspections and audits

S20 Prioritizing and managing time

S21 Utilizing technology

S22 Utilizing social media

Preparation for the

NAB Examination

Chapter 4

As you prepare for the NAB examination, you will want to keep in mind the approxi-

mate distribution of questions that will come from each of the Domains.

NHA RC/AL

Customer Care, Supports, and Services 35% 34%

Human Resources 13% 14%

Finance 14% 14%

Environment 13% 13%

Management and Leadership 25% 25%

TOTAL 100% 100%

The NAB is an entry level examination. You need to familiarize yourself with the

type of questions that you will find on the examination. Don’t forget that there are

NAB practice examinations available that may help you become more comfortable

with the examination and build confidence with the content. Please familiarize

yourself with the tools that are included in this manual to assist in preparation for

the national examination. Some of these tools, such as the Flashcards and

Glossary items can be found in the Appendices in the Self-Assessment

Instruments. Additionally, NAB’s Nursing Home Administrators Examination

Bibliography References and the Assisted Living Administrators Examination

Bibliography References can be found at http://www.nabweb.org/exam-references.

We wish you the best of luck and a successful career in long term care!

KNOWLEDGE AND SKILLS

Before accessing the sample learning activities it is recommended that you review the information

below. Questions

on the NAB exams are developed from these items. A helpful preparatory activity

would be if you asked yourself how you would write questions to “test” each of these items if you were

an exam item writer?

SKILLS (applicable to ALL Domains)

S01 Creating and communicating a vision

S02 Communicating effectively

S03 Cultivating effective relationships

S04 Inspiring and motivating

S05 Demonstrating empathy

S06 Group facilitation, consensus building, and team building

S07 Delegating, leading, and empowering

S08 Coaching, teaching, counseling, and mentoring

S09 Negotiating, collaborating, and resolving disputes

S10 Problem solving

S11 Analyzing and interpreting information/data

S12 Informed decision making/critical thinking

S13 Recognizing and ensuring care recipients’ holistic needs are being met

S14 Assessing and recognizing safety concerns and needs

S15 Allocating and optimizing resources and programs

S16 Writing and evaluating policies and procedures

S17 Developing and evaluating systems

S18 Protecting and promoting nancial viability

S19 Managing regulatory and accreditation surveys, inspections, and audits

S20 Prioritizing and managing time

S21 Utilizing technology

S22 Utilizing social media

KNOWLEDGE - Domain 10 - Customer Care, Supports, and Services

Knowledge of:

K01 Applicable federal and state laws, rules, and regulations

K02 Government programs and entities

K03 Ethical decision-making

K04 Interpersonal relationships, dispute resolution, and group dynamics

K05 Psychosocial aspects of aging

K06 Physiological aspects of aging

K07 Basic principles and concepts of nursing

K08 Basic medical terminology

K09 Basic pharmaceutical terminology

K10 Basic principles and regulations for medication management/administration

K11 Basic principles and concepts of restorative/wellness programs

K12 Basic principles of rehabilitation

K13 Basic principles of acute and chronic diseases

K14 Basic principles of infection control

K15 Basic principles of pain management

K16 Basic principles of fall prevention

K17 Basic principles of elopement prevention

K18 Basic principles of creating a safe environment for care recipients

K19 Basic understanding of mental health issues

K20 Basic understanding of cognitive impairments

K21 Basic principles of behavior management

K22 Basic principles of restraint usage and reduction

K23 Basic elements of a social services program

K24 Basic elements of a therapeutic recreation/activity program

K25 Basic principles of nutrition including specialized diets

K26 Basic principles of dietary sanitation, food storage, handling, preparation, and presentation

K27 Basic principles of hospice and palliative care

K28 Grieving process

K29 Death and dying

K30 Person-centered care concepts

K31 Diversity of care recipients

K32 Care recipients’ support network interests, needs, and values

K33 Care recipient Bill of Rights

K34 Resident Assessment Instrument (RAI) and interdisciplinary care plan requirements and process

K35 Care recipient assessment instruments (OASIS) and interdisciplinary care plan requirements and process

K36 Care recipient assessments and care plans other than RAI and OASIS

K37 Admission/move-in, transfer, and discharge/move-out requirements

K38 Bed-hold requirements (NHA only)

K39 Roles, responsibilities, regulation and oversight of contracted providers and services

K40 Services and resources available across the continuum of care (such as community, social, nancial, spiritual)

K41 Care recipient specic legal matters (such as power of attorney, guardianship, conservatorship, code status,

Advance Directives)

K42 Activities of Daily Living (ADLs) and Independent Activities of Daily Living (IADLs)

K43 Role of Medical Director

K44 Role of healthcare partners and clinical providers

K45 Medical services, specialties and equipment (such as oxygen, durable medical equipment, podiatry)

K46 Emergency medical services and techniques (such as CPR, rst aid, Heimlich Maneuver, AED)

K47 Center for Medicare and Medicaid Services (CMS) quality indicators and measures

K48 Quality assurance and performance improvement processes as related to care and services

K49 Techniques for auditing care recipient services and outcomes

K50 Signs and symptoms of abuse, neglect, and exploitation

K51 Mandatory reporting requirements for incidents and adverse events

K52 Medical record content, format, and documentation requirements

K53 Condentiality, disclosure, and safeguarding medical record information requirements

K54 Transportation option for care recipients

K55 Environmental services (such as housekeeping and laundry)

K56 Hospitality services

K57 Basic technological advances in healthcare

KNOWLEDGE - Domain 20 - Human Resources

Knowledge of:

K01 Applicable federal and state laws, rules, and regulations

K02 Licensure requirements and scopes of practice

K03 Service provider staffing requirements

K04 Employee position qualifications, job analysis, job descriptions

K05 Employee recruitment, selection, interviewing, reference and background checks

K06 Employee orientation, training and continuing education requirements, and resources

K07 Compensation and bene

t programs (such as employee assistance programs, insurance, salary, retirement)

K08 Human resource policies and procedures (such as employee grievance, workplace rules, discipline,

absenteeism, turnover, classification, exemption status)

K09 Diversity training

K10 Performance evaluation procedures

K11 Safety and injury prevention training

K12 OSHA rules and regulations

K13 Workers compensation rules, regulations, and procedures

K14 Drug-free workplace programs

K15 Methods for assessing, monitoring, and enhancing employee satisfaction

K16 Employee recognition, appreciation, and retention programs

K17 Leadership development

K18 Types and methods of communication

K19 Conict resolution and team dynamics

K20 Information technology safeguards related to such issues as data security, social media, e-mail, voicemail,

computer software, cell phones, photography, video, texting

K21 Union/management and labor relations

K22 Employee record-keeping requirements and procedures

K23 Mandatory reporting requirements

KNOWLEDGE - Domain 30 - Finance

Knowledge of:

K01 Applicable federal and state laws, rules, and regulations

K02 Operational and capital budgeting and forecasting methods

K03 Financial statements and reporting requirements for not for prot and for profit service providers

K04 Service-related sources of revenue/reimbursement

K05 Reimbursement methods across the continuum of care

K06 Alternative sources of revenue

K07 Integration of clinical and financial services

K08 Billing, accounts receivable, and collections

K09 Accounts payable procedures and management

K10 Revenue cycle management

K11 Internal controls

K12 Contracts and agreements

K13 Financial analysis (such as ratios, profitability, debt covenants, revenue mix, depreciation, forecasting)

K14 Financial statements (such as income statement, balance sheet, statement of cash flows)

K15 Financial measures (such as operating margin, days cash on hand, staffing, expense analysis)

K16 Risk Management

K17 Insurance coverage (such as property, liability)

K18 Inventory control and management

K19 Payroll procedures and documentation

K20 Purchasing process and supply chain management (such as request for proposals, pricing, ordering,

w receiving, group purchasing organization (GPO)

K21 Resident trust accounts for personal funds

KNOWLEDGE - Domain 40 - Environment

Knowledge of:

K01 Federal, state and local standards, codes and regulations for building, equipment, maintenance, and grounds

K02 Environmental principles that promote care recipient rights

K03 HIPAA compliance

K04 Community resources, programs and agencies available to meet the care receipients’ home needs

K05 Design principles that create a safe, secure, and home-like atmosphere based on the needs of the

individual served

K06 Safety and security procedures

K07 Physical plant security principles

K08 Preventative and routine maintenance programs for buildings, grounds, and equipment

K09 Contracted services for mechanical, electrical, plumbing, laundry systems, IT

K10 Compliance matters related to provision of contracted services

K11 Infection control and sanitation regulations/standards of practice

K12 Pest control programs

K13 Handling and disposal of potentially hazardous materials

K14 Disaster and emergency planning, preparedness, and recovery

K15 Community resources available in the event of emergency or disaster

K16 The use, storage, and inspection of required emergency equipment

K17 Policies and procedures for housekeeping, maintenance, and laundry services

K18 Technology infrastructure

KNOWLEDGE - Domain 50 - Management and Leadership

Knowledge of:

K01 Applicable federal and state laws, rules, and regulations, agencies, and programs

K02 Code of ethics and standards of practice

K03 Components and purpose of mission, vision, and value statements

K04 Stakeholders roles, responsibilities, and limitations

K05 Roles and responsibilities of owners and governing bodies

K06 Services available along the healthcare continuum

K07 Provider’s role along the healthcare continuum

K08 Methods for assessing, monitoring, and enhancing care recipient satisfaction

K09 Provider’s certications and licensing requirements

K10 Regulatory survey and inspection processes, including the plan of correction process

K11

Grievance procedures

K12 Procedures for Informal Dispute Resolution (IDR)

K13 Compliance programs

K14 Reportable outcome measurements

K15 Risk management principles and processes

K16 Providers legal and criminal scope of liability

K17 Internal investigation protocols and techniques

K18 Strategic business planning

K19 Management information systems

K20 Technology to support operations

K21 Sales and marketing techniques

K22 Public relations including media relations

K23 Volunteer programs

K24 Elements of contracts and agreements

K25 Care recipient’s rights and responsibilities

K26 Role of care recipient advocates and advocacy groups

K27 Mandatory reporting requirements

K28 Quality assurance and performance improvement techniques and models

K29 Organizational change management

K30 Organizational structures

K31 Leadership and management principles and philosophies (such as planning, organizing, directing, delegating,

motivating, evaluating)

K32 Personality and leadership styles

K33 Diversity awareness (such as culture, ethnicity, race, sexual orientation, gender, religion, language)

K34 Workforce planning and education

K35 HR management theory and principles

K36 Governmental relations and advocacy

K37 Functions of all departments and services

SAMPLE LEARNING ACTIVITIES

Sub-

Domain

Task Sample Learning Objective(s)

- adjust/tailor (these are by no means

comprehensive or perfect)

Sample Learning Activities -

brainstorming ideas only (may not be

properly placed/aligned with tasks)

10.01

Establish care recipient service policies

and procedures that follow federal and

state laws, rules, and regulations. This task

requires the Administrator to create policies and

procedures that follow federal and state laws,

rules and regulations.

The AIT will be able to...

• list applicable laws, rules, regulations.

• identify existing applicable policies.

Review applicable rules, laws, and

regulations, review existing policies in the

host facility; propose changes to update

existing policies. Create a list of existing

rules, laws, regulations and policies.

Review care related survey tags. Re-

view nursing job descriptions and policy/

procedure manuals. Learn scheduling

techniques/stafng patterns. Review the

nursing in-service training session - attend

a session. Observe quality of interactions

between nursing staff and residents. Re-

view infection control procedures. Identify

major standards and regulations required

for the facility. Determine how compliance

is tracked and evaluated.

10.02

Ensure plans of care are evidence-based,

established, implemented, updated,

and monitored based on care recipient

preferences and assessed needs. This task

requires the Administrator to ensure that staff

implement a plan of care for each resident,

based on the individual needs and preferences,

under the direction of a physician. This task

includes a comprehensive assessment of

each resident/recipient. The comprehensive

assessment should include (but not limited

to) assessments for nutrition (to include diet,

texture, weight, swallowing), therapy, mobility,

fall risk, skin/wound management, medications

and contraindications, cognitive abilities,

behavior, mental health, and etc.

The AIT will be able to...

• create and update care plans.

• describe the MDS.

• summarize required information to be

included in resident’s records, how they

are updated, etc.

Attend care planning meetings; assist

with records reviews. Attend CNA training

(become a CNA) - highly recommended

for most AITs. Review facility policies

governing the role of the physician. Study

procedures and practices for emergency

medical care. Study a random sample of

3-4 resident medical charts - review physi-

cians’ orders, nursing notes, etc.

Below are examples of Sample Learning Activities that you may consider using in your Plan of Study. These

activities are a sample list and may be tailored to meet each individual AIT experience. You may wish to copy

and paste, edit and add to or delete from this list to tailor it to your own style when you’re creating your “Plan of

Study” for your AIT.

Before you review these sample learning activities, it is recommended that you review the information in the “Knowledge

and Skills” section (Appendix 1). Questions from the NAB exams are developed from these items. Ask yourself how you

would write questions to “test” each of these items if you were an exam item writer.

10.03

Ensure the planning, development,

implementation/execution, monitoring

and evaluation of admission/move-in

process, including pre-admission/pre-

move in information, to promote a quality

experience for care recipients. This task

requires the Administrator to ensure that the

admission process is comprehensive and is

resident centered. This task includes obtaining

all available documentation at the time of

admission to include (but not limited to): power

of attorney for health care and nancial, resident

identication cards, insurance information,

doctor and all other orders related to the

resident to include hospital/doctors/clinic records

pertaining to the residents stay at the facility or

services provided by the organization.

The AIT will be able to...

• describe the admission/move in

process.

• list the admission requirements and

required documentation.

Observe an admission process; assist and/

or conduct an admission. Research and

list document requirements at the facility.

Review the contents and organization of a

standard medical record. Using a checklist,

analyze a sample of 4-5 medical records

for completeness and currency of informa-

tion (audit records). Attend a meeting of

the committee assigned to monitor quality

of care. Become familiar with resident as-

sessments and care plans. Identify quality

measures used by the facility. Review

the social worker’s job description and

job duties. Determine facility’s philosophy

regarding social services for residents and

their families. Participate in a resident care

planning meeting. Assist Social Services

Director with a special project as needed

(e.g., record review, resident satisfaction

survey, etc.). Conduct an admission

audit of current in-house resident pop-

ulation, analyze data and report (assist

with recommendations as needed). Audit

admissions documents. Complete an audit

of resident preferences, such as time to

eat, rise and retire, bathe, and time of

therapy (make recommendations). Develop

and implement an outreach program that

communicates regularly with residents and/

or families post discharge.

10.04

Ensure the planning, development,

implementation/execution, monitoring and

evaluation of discharge/move out process

to promote a quality experience for care

recipients. This task requires the Administrator

to ensure that resident care is appropriate

for the level of care they require and that an

interdisciplinary team continually monitors the

resident’s progress and recommends the best

care environment needed to maximize the

resident’s quality of living.

The AIT will be able to...

• explain the discharge/move out

process.

• describe the discharge requirements,

restrictions, and required

documentation.

Observe a discharge. Observe an inter-

disciplinary team meeting discussing a

possible discharge. Assist with a discharge

10.05

Ensure the planning, development,

implementation/execution, monitoring

and evaluation of programs to meet

care recipient’s psychosocial needs

and preferences. This task requires the

Administrator to ensure residents are properly

evaluated and cared for based on their

psychosocial needs and preferences.

The AIT will be able to...

• demonstrate how residents are cared

for and evaluated.

• describe psychosocial needs/

preferences.

• summarize how resident care meets the

psychosocial needs/preference of the

resident.

Attend CNA training (become a CNA)

(highly recommended). Develop a “rounds”

checklist with the Administrator and DON

that is resident-centered; initiate imple-

mentation. Develop resident satisfaction

surveys and make recommendations for

implementation as necessary.

10.06

Ensure the planning, development,

implementation/execution, monitoring

and evaluation of care recipient’s

activities/recreation to meet social needs

and preferences. This task requires the

Administrator to ensure activities, events,

and programs are resident centered and

designed to meet the needs and preferences

of each resident.

The AIT will be able to...

• observe how the activities director

learns the preferences of the residents.

• describe the challenges associated with

planning activities to meet the various

needs/preferences of each resident.

Interview residents to learn what they are

interested in doing; assist to plan activities/

events/programs; review related survey

tags. Explore the Activities Director’s

philosophy of service. Review and eval-

uate the activity calendar for variety and

appropriateness. Participate in a variety of

activities with residents. Work one-on-one

with a resident in an activity (e.g., BINGO

Buddy).

10.07

Ensure the planning, development,

implementation/execution, monitoring

and evaluation of a health information

management program to meet

documentation requirements in compliance

with federal and state regulations. This task

requires the Administrator to ensure all resident

specic documentation is protected and follows

state, federal and HIPAA regulations.

The AIT will be able to summarize HIPAA

requirements

Review HIPAA requirements; review and

observe HIPAA related policies and prac-

tices; suggest changes to HIPAA related

policies and practices; review related

survey tags. Conduct audit of u vaccina-

tion response variables, analyze data and

report (assist with recommendations as

needed). Conduct audit of admission and

annual required vaccines, analyze data

and report (assist with recommendations

as needed). Conduct medical records audit

with appropriate staff.

10.08

Ensure the planning, development,

implementation/execution, monitoring, and

evaluation of medication management that

supports the needs of the care recipient.

This task requires the Administrator to ensure

that doctor’s orders are strictly followed and

that policies and procedures are in place to

assure compliance.

The AIT will be able to explain require-

ments for medication management to

include documentation requirements,

storage requirements, destruction require-

ments, etc.

Observe med passes/documentation;

observe expired med destruction; review

med storage policies/practices; review

related survey tags. Learn the policies

covering drug orders, receiving drugs, drug

storage, disbursement of medication and

drug destruction. Observe the procedures

and techniques used in the administration

of medications. Observe nurse peer review

on administration of medications. With

DON, ensure medications are not expired.

10.09

Ensure the planning, development,

implementation/execution, monitoring and

evaluation of a rehabilitation program to

maximize optimal level of functioning and

independence for care recipients. This

task requires the Administrator to provide

individualized rehabilitative services to

recipients that will help them meet their

baseline and allow residents to be as

independent as possible.

The AIT will be able to...

• describe rehabilitation programs.

• recognize declines in the range of

motion, etc. that helped with

rehabilitation.

Observe rehabilitation; observe range of

motion measurements; observe assess-

ments for rehabilitation. Determine how

the facility provides rehabilitation services

to residents (direct staff, contract, etc.).

What types of rehabilitation specialists are

used by the facility (PT, OT, Speech, etc.)?

Visit with one of the rehabilitation special-

ists about his/her services. Observe, if

possible, rehabilitation treatments. Orga-

nize and implement a follow-up program

for discharged residents to the community.

Develop audit for equipment inventory and

complete audit report.

10.10

Ensure the planning, development,

implementation/execution, monitoring and

evaluation of systems for coordination

and oversight of contracted services. This

task requires the Administrator to ensure that

services are available to meet the needs of each

recipient from qualied vendors that meet city,

state and federal requirements.

The AIT will be able to...

• interpret the process required to

coordinate necessary services.

• list items to avoid when preparing a

facility contract.

• provide examples of required services

that must be contracted within various

facility types.

Review existing contracts; assist to estab-

lish a new contract or renew an existing

one. Summarize required services that

have to be offered within the facility.

10.11

Ensure the planning, development,

implementation/execution, monitoring

and evaluation of policies and procedures

for responses to care recipient incidents,

accidents, and or emergencies. This task

requires the Administrator to ensure that policies

and procedures are written and followed to

prevent incidents and accidents and to prepare

staff to act appropriately when incidents,

accidents, and emergencies occur.

The AIT will be able to...

• describe reporting requirements and

the administrator’s role in reporting

interventions that follow an incident.

• list the steps in conducting a proper

investigation.

• share expected reactions to incidents.

Assist to prepare incident report(s). Dis-

cuss/recommend interventions. Observe/

conduct/assist with an investigation. Partic-

ipate in post-incident counseling

10.12

Ensure the planning, development,

implementation/execution, monitoring and

evaluation of housekeeping and laundry

services for care recipients. This task requires

the administrator to ensure a clean, safe, and

sanitary environment.

The AIT will be able to...

• compare the overlap of infection control

with housekeeping requirements.

• identify the challenges/concerns of the

housekeeping and laundry staff.

Review related survey tags. Assist with

housekeeping daily chores. Assist with

laundry procedures. Review housekeeping

and laundry policies

10.13

Ensure the planning, development,

implementation/execution, monitoring and

evaluation of education intended for care

recipients and their support networks. This

task requires the Administrator to ensure that

the care recipient and/or their responsible

party is informed of their care, condition, and

treatment as much as practical.

The AIT will be able to...

• explain the requirements for informing

residents and/or their responsible party

of their care, condition, and treatment.

• describe what constitutes a signicant

change.

Become a CNA (attend training). If CNA

training is completed, it is advised to

complete the self assessment again and

realign hours as needed.

10.14

Ensure the planning, development,

implementation/execution, monitoring

and evaluation of nutritional needs and

preferences of care recipients. This task

requires the Administrator to ensure that the

care recipient’s nutritional needs are met in

accordance with their individualized needs and

preferences while simultaneously meeting all

physician-prescribed orders.

The AIT will be able to...

• identify geriatric nutritional needs that

encompass various diet requirements.

• describe requirements related to

signicant weight change, etc.

Become certied to feed residents; assist

in feeding. Assist with weigh-in proce-

dures Assist with preparation and storage

of food. Assist with delivery of meals to

residents. Review physician prescribed

dietary requirements for various residents.

Review job description of the Food Service

Director, cooks and other staff. Learn how

the dietary department is organized and

how staff is scheduled. Review policies

and procedures regarding key issues in

food service (e.g., hand washing, tempera-

tures, waste management, etc.) Review

and discuss menu preparation with Food

Service Director and/or Dietician.

10.15

Ensure the planning, development,

implementation/execution, monitoring and

evaluation of dining experience that meets

the needs and preferences of care recipients.

This task requires the Administrator to ensure

that dining services are resident centered and

meet the nutritional needs paralleled with the

recipient preferences.

The AIT will be able to describe culture

change issues as they relate to dining.

Visit another facility that delivers/serves

meals in a different way (e.g. from a menu or

a la carte). Review culture change. Interview

residents to learn what they desire (variables

in taste, temperature, timeliness, presenta-

tion, etc). Meet with Dietician and Dietary

Manager to learn how menus are developed,

followed and implemented. Audit to conrm

residents are receiving correct diets, drinks

and adaptive devices. Understand nutrition-

ally compromised concerns and how weights

are monitored. Audit purchasing and storage

process. Audit food temperatures.

10.16

Ensure care recipients rights and

individuality with all aspects of care. This

task requires the Administrator to ensure all

staff are trained and follow state and federal

guidelines related to resident rights. Attention

must be made to issues related to abuse,

neglect, misappropriation of resident property

and mistreatment of residents.

The AIT will be able to...

• dene, in detail, resident rights.

• analyze issues such as abuse, neglect,

misappropriation, and mistreatment.

Study resident rights; present an in-service

regarding aspect(s) of resident rights.

Present an in-service regarding abuse, ne-

glect, misappropriation of resident property

and/or mistreatment of residents. Review

the residents rights statements used by the

facility - evaluate them for completeness,

accuracy, timeliness. Review methods of

disseminating resident rights information

to residents and families. Evaluate the

extent to which resident rights are being

addressed by staff.

10.17

Integrate support network’s perspectives

to maximize care recipients quality of life

and care. This task requires the Administrator

to ensure that measures are taken to review

Quality Improvement Measures, and to

strategize how each team member inuences

quality measures and how they each help to

improve quality based on recipient, responsible

party, and team members’ input. Attention must

be made to issues related to meeting the care

recipient’s individualized needs.

The AIT will be able to evaluate needs of

residents to maximize care and quality

of life and determine the means to meet

these goals.

Review Quality Improvement Measures;

interview residents/responsible parties

and employees to see how the facility is

progressing. Develop and implement a

Volunteer Program. Develop/Enhance Life

Enrichment/Person Centered Care Pro-

gram - interview residents and families to

ensure desired activities are planned and

implemented. Develop in-service alongside

Activities Director for Life Enrichment/

Person Centered Care; assist to present

in-services.

10.18

Ensure transportation options are available

for care recipients. This task requires the

Administrator to ensure adequate transportation

to care recipients. The facility should identify

transportation that is available and the costs

(if any) for the services and inform recipients

and their responsible parties of availability and

cost. The facility/entity must be available to help

coordinate transportation services based on the

recipients preference and available funding.

The AIT will be able to list requirements to

provide transportation to residents.

Explore additional options not currently

used. Review existing policies.

10.19

Ensure the provision of a customer service

culture that leads to a quality experience

for care recipients. This task requires the

Administrator to promote a resident centered

experience that serves each recipient

according to their choices and preferences as

much as practical.

The AIT will be able to...

• understand the culture of customer

service.

• describe the administrator’s role as a

leader.

• dene customer service from a care

recipients perspective.

Interview residents to learn their choices/

preferences. Study “customer service”

in another setting (e.g. restaurant, hotel)

and compare it to how this facility denes

customer service. Conduct an in-service

on the importance of customer service.

Recognize employees who are good

examples of customer service. Determine

how resident care policies and procedures

are developed and disseminated in the

facility. Determine the extent to which staff

knows relevant resident care policies. Au-

dit/do rounds for dust, clean oors, toilets,

showers, etc. Audit laundry. Audit infection

control, safety and cross-contamination

procedures. Follow the linen distribution

system from soiled to clean.

20.01

Ensure that human resources management

policies and programs comply with federal

and state rules and regulations. This task

requires the Administrator to create policies and

procedures that follow federal and state laws,

rules and regulations.

The AIT will be able to interpret the require-

ments relating to HR from the federal and

state levels.

Review federal and state HR requirements;

review/update facility policies. Review fa-

cility policy on cultural diversity and cultural

competence; determine how staff is being

trained in these areas. Conduct employee

le audit per regulations and organizational

policy. Review/understand employee hand-

book - look for accuracy and compliance;

make recommendations.

20.02

Establish the planning, development,

implementation, monitoring, and evaluation

of recruitment, selection, and retention

practices. This task requires the Administrator

to ensure the facility has systems in place

that will provide for a consistent, fair, and

predictable method of job development, job

hiring, job training, employee evaluation,

and continuing education. These systems

should follow the standards of the Fair Labor

Standards Act (FSLA).

The AIT will be able to...

• explain the limitations of hiring practices

and interview question restrictions.

• describe turnover rate issues and

methods available to address this.

• Define the NRLB and provide examples

of how this organizational entity affects

the facility.

Participate in job interviews; interview em-

ployees to nd out why they stay; conduct

exit interviews to understand why employ-

ees are leaving. Review the process of

interviewing prospective staff (who does it?

What techniques are used, etc.?). Collect

annual turnover rate for last few years

and develop strategic plan with activities,

timeframes, etc., for identied changes.

Participate in a complete employee hiring

and orientation process (i.e., interview,

background check, etc.).

20.03

Establish the planning, development,

implementation, monitoring, and evaluation

of employee training and development

programs. This task requires the Administrator

to have policies and procedures in place to

train managers/leaders to follow and design

basic and continuing education programs

aimed at evaluating individual employee

performance and training programs that

can meet the basic, continuing, or potential

education needs of the employee.

The AIT will be able to list the require-

ments for evaluating individual

employee performance.

Review policies and procedures to train

managers/leaders regarding evaluation

of employees. Conduct an in-service for

managers/leaders. Conduct a staff

meeting and in-service training program.

20.04

Establish the planning, development,

implementation, monitoring, and evaluation

of employee evaluation programs. This

task requires the Administrator to ensure

that policies and procedures are in place

that clearly provide instruction to managers/

leaders to regularly monitor employee

performance and to timely inform employees

of when their performance or adherence to

procedures does not meet standards. This

should include timely formal evaluation of

the employee to communicate areas of poor

performance and areas that employee meets

and exceed facility standards.

The AIT will be able to describe perfor-

mance evaluation standards and how

and why to enforce them.

Review performance evaluation require-

ments. Review status of performance

evaluations. Study correlation of turnover

with evaluation reports. Develop employee

satisfaction questionnaire; administer it and

analyze data; develop plan.

20.05

Establish the planning, development,

implementation, monitoring, and evaluation

of compensation and benet programs.

This task requires the Administrator to ensure

that policies and procedures are in place for

employee compensation and benet programs.

This includes a formal method of informing

employees of their employee benets and

compensation.

The AIT will be able to explain the Admin-

istrator’s role in the compensation and

benet program.

Brief new employees at a new employee

orientation regarding their benets. Review

facility recognition programs and proce-

dures. Examine how performance reviews

are conducted and by whom. Conduct an

assessment of turnover rates and iden-

tify major factors that contribute to staff

turnover. Review employee benet policies

and plans (Employee Manual). Determine

how compensation and benets policies and

programs are developed and implemented.

Conduct a compensation analysis using

state, regional or national comparative data.

Study and analyze recruiting plans and staff-

ing patterns - offer ideas to improve. Review

and evaluate payroll plans, compensation

plans, and benets packages.

20.06

Establish the planning, development,

implementation, monitoring, and evaluation

of employee health and safety programs.

This task requires the Administrator to ensure

that policies and procedures are in place

to prevent employee injury and encourage

employee wellness. This includes an effective

workers compensation or group retro program

and providing a health/wellness program that

gives employees the opportunity to attain health,

dental, vision, accident, pharmacy, and life

insurance programs.

The AIT will be able to describe the

importance of employee health and safety

programs

Review policies and procedures relating

to the health and wellness of employees.

Review facility safety policies and pro-

grams. Attend a safety committee meeting.

Study OSHA regulations that pertain to

the facility. Review workers compensation

policies and procedures. Track absentee

information by shift, days of week reasons,

frequency; analyze and report.

20.07

Establish the planning, development,

implementation, monitoring, and evaluation

of employee satisfaction and organizational

culture. This task requires the Administrator to

ensure policies and procedures are in place to

measure employee satisfaction and that results

are taken seriously and considered. This task

also requires the Administrator to develop an

organization chart/structure that will clearly

communicate the organization structure to

employees.

The AIT will be able to...

• give examples of ways to measure

employee satisfaction.

• illustrate the organizational structure.

Review policies and procedures relating to

the measurement of employee satisfaction.

Review organization chart.

20.08

Establish the planning, development,

implementation, monitoring, and evaluation

of employee disciplinary policies and

procedures. This task requires the

Administrator to have policies and procedures

in place that will set standards to objectively

measure employee performance. When

employee performance or behavior does not

meet standards, employees are made aware of

an allegation, and given an opportunity to give

an explanation of their performance or behavior

(give their side of the story), offer witnesses or

evidence that will support their statement, and/or

provide a written statement. Procedures should

state that the employees will be made aware if

an investigation will be done, if the employee

will be suspended pending investigation, and

that no discipline will be applied until a thorough

investigation is completed.

The AIT will be able to explain the

importance and limitations of employee

disciplinary policies and procedures.

Review employee disciplinary policies

and procedures. Participate in counsel-

ing. Participate in incident investigations.

Participate in and interview of employee

regarding performance or behavior issue.

Review and evaluate the unemployment

compensation record of the facility and

attend an unemployment compensation

hearing as necessary.

20.09

Establish the planning, development,

implementation, monitoring, and

evaluation of employee grievance policies

and procedures. This task requires the

Administrator to have policies and procedures in

place to clearly communicate with the employee

a formal program/grievance procedure in

which the employee, without fear of retaliation,

can communicate areas of frustration,

abuse, mistreatment, or concerns with the

understanding that a formal response will follow.

The AIT will be able to explain the impor-

tance of employee grievance policies and

procedures.

Participate in grievance procedures.

20.10

Establish the planning, development,

implementation, monitoring, and evaluation

of leadership development programs. This

task requires the Administrator to develop

leadership development programs not only for

manager/leaders but also for all employees.

This may be in the form of a formalized program

the Administrator.

The AIT will be able to describe their

knowledge of leadership and leadership

principles, including mentoring skills.

Conduct in-service for employees focusing

on leadership. Study a new leadership

principle. Learn about “empowerment” and

teach a department head. Learn about del-

egation and teach it. Review and report on

ways to encourage and support profession-

al development of team members.

20.11

Promote a safe work environment (such

as safety training and employee risk

management). This task requires the

Administrator to ensure effective policies and

procedures are in place to create an awareness

of safety throughout the workplace that include

reporting accidents, safety monitoring, re drills,

water, gas and electric shut off valves, and that

emergency generators are regularly tested.

The AIT will be able to...

• describe the need for safety training

and risk management.

• explain the importance of emergency/

disaster drills, incident reporting, and

knowledge of the facility.

Conduct and evaluate an emergency/

disaster drill. Review emergency/disaster

plans. Create a “cheat sheet” for the facility

to show where all important shut-off valves/

switches are located. Participate in the

testing of emergency generators; conduct

an in-service. Brief new employees on

the details and importance of emergency

procedures. Audit external health care pro-

viders to determine current license, liability

insurance, etc.

20.12

Promote a positive work environment (using

techniques such as conict resolution,

diversity training, and staff recognition

programs). This task requires the Administrator

to ensure that policies and procedures are in

place to assure that the employees are provided

a workplace that allows them to communicate

concerns and grievances in a safe environment.

This also includes training programs in diversity,

conict resolution, continuing education, and

staff recognition programs.

The AIT will be able to...

• identify techniques for conict

resolution.

• provide examples of diversity issues.

• explain the importance and methods of

staff recognition.

Participate in conict resolution; test

theories, methods. Study conict resolution

techniques. Attend diversity sensitivity

training. Propose ideas to recognize staff

performance; spontaneously recognize

(informally) staff performance.

20.13

Facilitate effective written, oral, and

electronic communication among

management and employees. This task

requires the Administrator to ensure policies

and procedures are in place to direct managers

and employees on how to formally and

informally communicate with each other. These

procedures should include requirements to

managers on effective leadership ensuring

employees are aware and trained in their

respective job duties and tasks. Supervisors

should also be held accountable for validating

performance and communicating with

employees their progress.

The AIT will be able to explain the im-

portance of effective formal and informal

communication.

Review communication policies and pro-

cedures. Review performance evaluations.

Examine the methods administrators use to

communicate with employees (e.g., newslet-

ters, bulletin boards, social media, etc.).

20.14

Ensure employee records and

documentation systems are developed

and maintained. This task requires the

Administrator to ensure employee records

and correspondence are protected and

secure to other employees, residents and

unauthorized individuals.

The AIT will be able to explain the require-

ments for protecting private employee

information, data and correspondence.

Review laws, rules, regulations relating;

review facility policies relating; observe the

practice of protecting employee records

(conduct an exercise to attempt to violate a

faux record?)

20.15

Establish a culture that encourages

employees to embrace care recipients rights.

This task requires the Administrator to create a

culture that ensures that all resident rights are

followed and to develop policies and procedures

on reporting violations of resident rights.

The AIT will be able to demonstrate

expertise concerning the rights of care

recipients.

Conduct an in-service involving residents

rights. Conduct an orientation brieng that

covers residents rights for new employees/

volunteers. Review existing policies and

procedures.

30.01

Ensure that nancial management policies,

procedures, and practices comply with

applicable federal and state regulations.

This task requires the Administrator to create

policies and procedures that follow federal and

states laws, rules and regulations.

The AIT will be able to describe federal and

state laws, rules and regulations relating to

nancial management.

Review laws, rules, regulations, and

facility policies.

30.02

Develop, implement, and evaluate the

service provider’s budget. This task requires

the Administrator to have knowledge of the

budget process and have systems in place

to accurately set budgets based on income,

expense, capital improvements, and required

tasks of the organization.

The AIT will be able to...

• explain how a budget is developed,

how it is followed, and what it implies to

various departments.

• describe the chart of accounts,

bookkeeping procedures, income/

expense statements, and balance sheets.

Participate in establishing a new contract

or renewing an existing one. Review

existing contracts; discuss details of

existing contracts with attorney (if possi-

ble). Participate in the process to dissolve

an agreement (if the opportunity presents

itself); discuss how/why you would dissolve

an agreement. Review regularly produced

nancial reports and make recommenda-

tions if necessary.

30.03

Oversee the billing and collections process

and monitor the accuracy of charges and

timely collection of accounts. This task

requires the Administrator to have procedures

in place to timely and accurately bill for

resident care and services to appropriate

parties, insurances, or state and federal

agencies as appropriate. Systems should be

in place to make sure each recipient knows

and understands their bill so that timely

payments can be made to the facility.

The AIT will be able to...

• describe the billing and colle

ction

process.

• explain how aged accounts work.

• understand billing charges.

• explain third party payor processes to

ensure billings are in accordance with

services provided.

Assist with billing. Assist with collection.

Study billing charges (accounts payable).

Review bad-debt and/or write-off policy;

determine avenues for improvement.

30.04

Negotiate, interpret, and implement

contractual agreements to optimize

nancial viability. This task requires the

Administrator to ensure the facility/organization

has written agreements and contracts that

include duration of contract, liability insurance

required and assured for each party, language

that includes duties of each party and what

steps are required to notify each party of

any breach of service, and details of how to

dissolve an agreement for poor service or

choice to use another vendor/contractor.

The AIT will be able to...

• describe the process required to

coordinate necessary services.

• list items that should be avoided in a

contract.

• list required items that must be provided

in a contract for various facility types.

Participate in establishing a new contract or

renewing an existing one. Review existing

contracts; discuss details of existing con-

tracts with attorney (if possible). Participate

in the process to dissolve an agreement

(if the opportunity presents itself); discuss

how/why you would dissolve an agreement.

Review the facility’s union contracts (if appli-

cable). Study a sample consultant contract

and reimbursement paperwork.

30.05

Develop, implement, monitor, and

evaluate nancial policies and procedures

that comply with Generally Accepted

Accounting Principles (GAAP). This task

requires the Administrator to ensure policies

and procedures are in place to direct staff on

the steps to accurately perform their duties.

Direction must be given to employees in the

areas of payroll, accounts receivable, billing,

accurate record keeping, internal controls, trust

accounts, HIPAA, and etc.

The AIT will be able to...

• dene GAAP.

• describe internal controls and record

keeping.

• list trust account requirements.

Study GAAP. Study internal controls.

Review established internal policies

and procedures. Assist in trust account

execution (disbursement, documentation,

etc.). Review accounting documents.

Review and understand facility nancial

statements. Determine how nancial state-

ments are monitored and how variances

are addressed. Discuss the latest facility

audit with relevant staff.

30.06

Monitor and evaluate the integrity of nancial

reporting systems and audit programs.

This task requires the Administrator to ensure

that controls are in place to validate systems,

audit, and verify information, and ensure proper

supervision to protect theft. An example way to

monitor theft would be to never allow the person

who prepares a deposit make the deposit. There

should be checks and balances in place to allow

for the person making the deposit to check the

prepared paperwork by a different individual

to ensure no errors were made. Another

example would be to have a place where

the Administrator or designee can access all

passwords in case of emergency or to validate

access when a person may be unavailable.

The AIT will describe the internal controls

of the facility.

Study the internal controls used; review

policies. Establish the back-up plan for

passwords in case of emergency or plan

to validate access when someone is not

available. Determine the facility’s revenue

sources and how they are managed.

Review billing and accounts receivable

procedures. Review Medicaid and/or

Medicare billing process, if applicable.

30.07

Establish safeguards for the protection of the

service provider’s assets (such as insurance

coverage, risk management). This task

requires the Administrator to have knowledge

and provide leadership in risk management,

internal controls, workers compensation, and to

prevent unnecessary insurance/legal claims.

The AIT will explain risk management. Review insurance policies. Review risk

management policies and procedures.

Proactively identify an issue in the facility

that could be addressed more strongly.

Study other risk management procedures

(e.g., security systems).

30.08

Develop, implement, monitor, and evaluate

systems to improve nancial performance.

This task requires the Administrator to use

critical thinking to understand nancial viability

and to respond to the nancial needs of the

facility/organization.

The AIT will describe financial perfor-

mance measures and the variables that

contribute to them.

Review nancial documents; identify

opportunities and strengths.

30.09

Manage and adjust expenses with

uctuations in census/occupancy/care

recipient levels (such as stafng ratios). This

task requires the Administrator to have systems

in place that will effectively make adjustments

in labor, supplies, and resources as needed to

ensure continued nancial performance.

The AIT will explain census/occupancy

issues and how they affect nancial perfor-

mance.

Perform calculations for the administrator

to assess performance. Review systems

that adjust labor requirements, supplies

and resources based on census/

occupancy rates.

Determine the extent to

which the facility provides inservice

training to staff on financial issues.

Develop a training module on some aspect

of financial man-agement for staff; provide

the training and evaluate its effectiveness.

30.10

Monitor and address changes in the

industry that may affect nancial viability.

This task requires the Administrator to stay

knowledgeable of the changes of all nancial

resources to include, but not limited to:

Medicare, Medicaid, insurance companies,

and other payor sources. In addition, the

Administrator must be knowledgeable of any

city, state, and federal changes that may

affect the nancial performance of the facility/

organization and make changes as needed.

The AIT will describe the impact of the

various pay sources and how changes

to those pay sources affect the facility/

organization.

Study pay sources and rates. Study how

these sources change.

40.01

Ensure that physical environment policies

and practices comply with applicable federal,

state and local laws and regulations. This

task requires the Administrator to create policies

and procedures that follow federal laws, rules

and regulations.

The AIT will define the Life Safety Code and

describe all app

licable federal, state, and

local laws that apply to the facility.

Participate in a mock survey. Make rounds

to nd issues in the facility. Study applica-

ble federal, state, local and facility rules,

laws, regulations, policies and procedures.

Review job descriptions of maintenance

staff. Determine the facility’s policies and

procedures to monitor compliance with

environmental regulations and standards.

Compile a list of all federal, state and local

standards and regulations that govern the

facility. Review the content of these items

and determine how they are managed

within the facility.

40.02

Ensure the planning, development,

implementation, monitoring, and evaluation

of a safe and secure environment. This task

requires the Administrator to have policies and

procedures in place that ensure the physical

plant, systems, equipment, and resources are

properly used and appropriate for the facility/

organization. It is required that the Administrator

understands, promotes, directs, and requires

supervision to maintain all equipment and

resources and continually validate the physical

plant to include (but not limited to) the facility,

grounds, equipment, tools, emergency systems,

re systems, and sprinklers.

The AIT will be able to evaluate the facil-

ity’s environment for violations and safe

working equipment.

Review policies and procedures; determine

how these are developed and updated.

Determine how policies and procedures

are monitored and evaluated. Make

rounds; participate/conduct and evaluate

drills. Learn the facility’s system for repair

orders. Study the preventive maintenance

system. Accompany a staff member on

a preventive maintenance assignment.

Audit preventative maintenance logs per

regulations and company policy - track and

trend related variables such as time of day,

season, staff members, etc. Audit resident

rooms to evaluate such items as electrical

safety, call lights operating properly, water

temperatures, beds properly functioning,

etc. Review emergency generator and

life safety code requirements. Audit and

analyze previous year’s maintenance logs

with Maintenance Supervisor. Develop

a “rounds” sheet with Administrator and

Maintenance Supervisor that is envi-

ronmental and safety centered; initiate

implementation.

40.03

Ensure the planning, development,

implementation, monitoring, and evaluation

of infection control and sanitation. This task

requires the Administrator to have policies and

procedures in place to effectively assure that

infection control and sanitation are properly

planned, implemented, and validated. This would

include, but not be limited to, training of personnel,

assuring proper supplies and resources are

available and effective communication through

the facility/operation/agency of reporting violations

and areas of concern.

The AIT will explain infection control

and sanitation

Review policies and procedures.

Make rounds.

40.04

Ensure the planning, development,

implementation, monitoring, and evaluation

of emergency and disaster preparedness

program, including linkage to outside

emergency agencies. This task requires the

Administrator to have specic policies and

procedures in place to assure that an effective

disaster preparedness program is in place. It

is extremely important that the plan includes

regular training of staff related to re drills,

emergency shut off valves, re evacuation

routes, where to nd ashlights, extension

cords, emergency phone, etc. In addition, the

plan needs to include all safety and emergency

equipment. Also included in this task is

supervising agreements made with outside

vendors for equipment testing and maintenance,

transportation in the event of an emergency,

and transfer agreements with resources that

can help provide care and service to relocate

residents when necessary. In the event of

relocation, provisions for moving resident charts,

medications, blankets, and food, etc. need to be

planned and implemented.

The AIT will describe the critical im-

portance of disaster preparedness and

associated drills/exercises.

Conduct and analyze exercises/drills.

Review the various disaster plans (e.g. tor-

nado, hurricane) and test various aspects

of them randomly. Study the re and evac-

uation plans and participate in a re drill if

possible. Review the facility’s emergency

management plan. Help update the plan/

validate agreements if needed.

40.05

Ensure the planning, development,

implementation, monitoring, and

evaluation of environmental services,

housekeeping and laundry. This task

requires the Administrator to ensure that

policies and procedures are in place to

provide a comprehensive plan that assures

all environmental, housekeeping, and laundry

service departments meet or exceed all local,

state and federal requirements. This task

includes infection control, proper temperatures,

temperature logs, proper use of chemicals and

products used per Material Safety Data Sheets

(MSDS), preventative maintenance, and

systems to validate compliance.

The AIT will describe the roles of house-

keeping, laundry personnel and mainte-

nance personnel

Review policies and procedures. Take

random temperatures (water and air);

create a temperature log. Determine

which systems need preventative main-

tenance and schedule the maintenance.

Participate in mock survey or partial

mock survey. Review job descriptions

for housekeeping and laundry. Review

the stafng patterns and determine how

staff is scheduled. Review how resident

laundry is managed. Determine resident

satisfaction with the laundry services.

40.06

Ensure the planning, development,

implementation, monitoring, and

evaluation of maintenance service

for property, plant and all equipment,

including preventative maintenance. This

task requires the Administrator to ensure

that policies and procedures are in place to

provide a comprehensive plan that assures

all maintenance services meet or exceed

all local, state, and federal requirements.

This task includes infection control, proper

temperature and temperature logs, proper use

of chemicals and products used per MSDS,

preventable maintenance, and systems to

validate compliance.

The AIT will describe all federal, state

and local requirements for the plant and

equipment.

Review federal, state and local require-

ments, policies and procedures. Audit log

out/tag out procedures for compliance.

40.07

Ensure the planning, development,

implementation, monitoring, and

evaluation of appropriate HIPAA compliant

technology infrastructure. This task

requires the Administrator to ensure that

HIPAA compliance is assured by developing

technology infrastructures, technology

safeguards (i.e., backup systems, external

data storage areas, preventative maintenance

for computer hardware and software) and

ongoing validation surveys.

The AIT will describe the HIPAA compliance

requirements and necessary safeguards.

Review HIPAA requirements; review

technology safeguards in place; study other

options available.

40.08

Establish, maintain, and monitor physical

environment that provides clean, safe, and

secure home-like surroundings for care

recipients, staff, and visitors. This task

requires the Administrator to ensure policies

and procedures are in place to create a clean,

home-like environment that supports the

well-being and safety of all recipients. This task

includes creating a resident centered culture that

promotes choice, comfort, and cleanliness.

The AIT will be able to identify expectations

to create a home-like environment.

Review policies and procedures; conduct

rounds to nd issues. Interview residents to

discover their desires and needs. Review

the facility’s safety program and proce-

dures. Attend a safety committee meeting.

40.09

Identify opportunities to enhance the

physical environment to meet changing

market demands. This task requires the

Administrator to regularly maintain the physical

environment of the facility/organization and to

evaluate and monitor changing trends within

the market community to keep the facility/

organization current. This task includes

creating a chart/schedule for the normal life

of equipment and furnishings, using qualied

professionals to assess the interior/exterior

design of facility/organization, and developing

annual and capital budgets to prepare for

predicted capital spending.

The AIT will evaluate the importance of the

many aspects of the environment.

Survey age of furnishings and project life

expectancy of these items. Create projected

major replacement schedule for furniture

items. Study innovations in the industry.

Conduct rounds and inspect furniture.

40.10

Establish, maintain, and monitor an

environment that promotes choice, comfort,

and dignity for care recipients. This task

requires the Administrator to ensure policies

and procedures are in place to create an

environment that ensures color, accessibility,

design, temperature, and square footage are

appropriately appointed based on the residents

who reside in the care setting. Resident rooms

should allow residents the ability to decorate

it based on their preferences and creativity

as long as the room meets federal and state

safety requirements.

The AIT will be able to...

• state methods to discover the needs

and desires of care recipients.

• analyze the importance of listening to

the care recipients.

Interview care recipients to discover

their desires and needs. Interview family

members.

40.11

Assess care recipients’ environment

for safety, security, and accessibility

and make recommendation for referral

or modication. This task requires the

Administrator to ensure that each recipient’s

personal environment and accessibility is

individually evaluated and accommodations

are made to provide the most independent,

comfortable, and safe environment possible.

The AIT will be able to describe safety,

security and accessibility requirements of

care recipients.

Make rounds and survey/inspect rooms.

Participate in a mock survey. Study

OSHA regulations that pertain to the

facility. Attend a safety meeting. Examine

the extent to which resident rights are

assured by the facility’s environmental

policies and practices.

50.01

Ensure compliance with applicable federal

and state laws, rules, and regulations.

This task requires the Administrator to create

policies and procedures that follow federal and

state laws, rules and regulations.

The AIT will interpret the applicable laws,

rules and regulations.

Study applicable rules, laws and regula-

tions. Determine the KEY federal, state

and local rules and regulations governing

the facility; examine the procedures and

practices for maintaining compliance with

these factors.

50.02

Promote ethical practice throughout

the organization. This task requires the

Administrator to create policies and procedures

to ensure that a system is in place to direct the

facility/organization related to ethical topics/

situations that arise. This task would include

developing an ethics committee or the creation

of an ad hoc ethics committee when necessary.

The AIT will be able to dene ethics and

describe how it relates to the facility/

organization.

Present an in-service related to ethics.

Make an orientation brieng related

to ethics. Attend an ethics committee

meeting. Review existing ethics policies

and procedures. Determine what

outcomes are routinely measured by

the facility (e.g., turnover rates, nancial

gains.). Determine how variances are

addressed and followed up on.

50.03

Develop, implement, monitor, and evaluate

policies and procedures that comply

with directives of governing body. This

task requires the Administrator to know

and understand the governing body and

all directives, policies, and procedures.

This task also requires the administrator to

recommend changes or additions to policies

and procedures and make recommendations

to the governing board to change/add policies

and procedures when necessary.

The AIT will explain the role of the

governing body.

Review policies and procedures inuenced

by governing body. Attend a governing

body meeting. Determine the type of

ownership of the facility (e.g., for prot, not

for prot, governmental, etc.).

50.04

Develop, communicate, and champion the

service provider’s mission, vision, and

values to stakeholders. This task requires

the Administrator to develop a process to train

stakeholders to communicate the mission,

vision, and values of the organization. This

includes creating positive and effective ways to

not only share the mission, vision, and values of

the organization but to create an atmosphere of

condence and execution of the mission, vision

and values.

The AIT will identify the mission, vision and

values of stakeholders

Identify stakeholders. Discuss the mission,

vision and/or values at an orientation and/

or in-service. Review mission, vision and

values. Write an example mission/vision

statement and dene values.

50.05

Develop, implement, and evaluate the

strategic plan with governing body’s

endorsement. This task requires the

Administrator to develop a strategic plan that

reects the facility/organizational values,

mission, and policies that will direct the facility/

organization to conduct effective business

practices with the endorsement of the governing

body. The strategic plan must state how the plan

will be implemented, validated, and evaluated in

a timely manner.

The AIT will be able to recognize the

importance of the strategic planning process.

Participate in a strategic planning process.

Determine how the facility educates

the governing body on compliance and

regulatory requirements. Develop a brieng

on new regulations or rule change for the

preceptor to share with the governing body.

Review the facility’s strategic planning

process. Evaluate the facility’s governing

ideas (vision, mission, values) for clarity

and effectiveness.

50.06

Promote and monitor satisfaction of

the care recipient’s and their support

networks. This task requires the

Administrator to develop a system to monitor

resident satisfaction. This can be done by

the Administrator being visible through onsite

visits with residents and family. This can

also be done through satisfaction surveys

and mock inspections. The successful

Administrator will generally perform a

combination of onsite visits, surveys, and

daily interaction with staff in the form of a

stand up meeting.

The AIT will identify methods to monitor

resident satisfaction.

Conduct rounds. Conduct interviews with

residents and/or staff. Conduct and/or

participate in mock surveys. Participate in

stand up meeting(s). Participate in care plan

meetings with family members, etc. Review

results of past resident/family satisfaction

surveys. Assist preceptor in developing,

administering and analyzing a new survey.

Review Policy and Procedure manuals to

determine if appropriate and current per

regulations and organization policy - make

recommendations as necessary.

50.07

Identify, foster, and maintain positive

relationships with key stakeholders. This

task requires the Administrator to determine

who key stakeholders are and develop a

working relationship/understanding with

each of them. This task includes creating an

atmosphere of trust and understanding. This

should be tempered with providing necessary

information to work jointly on projects and

systems that benet the organization. At no

time should the impression be given that any

key stakeholder is asked to assist in leading

the facility/organization.

The AIT will identify key stakeholders

and describe methods/techniques for

developing a working relationship with

each of them.

Discuss various key stakeholders and

their needs/competing needs; discuss the

relationship issues with each.

50.08

Educate stakeholders on services provided,

regulatory requirements, and standards of

care. This task requires the Administrator to

develop a strategy to provide instruction and

resources to help the stakeholder to understand

facility, state, and federal requirements. It is also

important for stakeholders to understand facility

protocols (e.g. standards and services) that are

provided to meet residents needs and create a

home like environment to ensure resident safety

and choice are paramount.

The AIT will identify the educational needs

of each of the stakeholders.

Participate in an educational opportunity

for a stakeholder.

50.09

Solicit information from appropriate

stakeholders for use in decision making.

This task requires the Administrator to set

up protocols/standards of practice to use

all available input from trusted resources to

make effective/fair/timely decisions. While the

Administrator is accountable for the decisions

he/she will make, it is important for the

Administrator to know that sometimes a good

decision is better than the best decision when

time or the lives of others is a factor.

The AIT will examine the importance of

timely decision making.

Discuss decision making; participate in

decision-making. Determine how the facility

ensures that resources are available as

needed. Review resource budgeting process.

50.10

Manage the service provider’s role

throughout any survey/inspection process.

This task requires the Administrator to

develop a protocol/practice to use for any

unannounced survey/inspection. The protocol

should include reporting the surveyors/

inspectors presence to all key management

teams. In addition, the protocol/practice

should include providing needed information

to surveyor/inspector, keeping copies of any

documents the surveyor/inspector reviews

(as known), cooperating with the inspection,

being visible, support staff through survey/

inspection, respond quickly to surveyor/

inspector requests, and re marshal

inspections. The Administrator should strive

to be ready for a survey any day of the year

by training his/her staff to do all that is right

year round.

The AIT will know how to prepare/stay

prepared for a survey and how to interact

with surveyors during a survey.

Participate in a survey/mock survey. Review

survey protocol policies/procedures.

Conduct an in-service regarding survey/

inspection. Review/update survey

preparation materials. Determine the

process for providing administrative

oversight for the survey process. Review

the last 2-3 licensing or certication surveys.

Study how the facility addressed any issues

noted in the surveys.

50.11

Develop and implement an intervention(s)

or risk management program(s) to minimize

or eliminate exposure. This task requires the

Administrator to develop a risk management

program to prevent problems before they occur.

The program should start with the identication

of key risk areas and a system/protocol to

prevent them. This includes specic protocols

to educate staff on reporting incidents/events/

situations that occur timely, whom to report to,

and what steps to take to reduce liability. This

program requires effective communication from

the Administrator and her/his designees.

The AIT will be able to...

• dene risk management.

• demonstrate effective communication

skills.

Review/update existing risk management

policies/procedures. Review insurance

policies. Conduct relevant in-service brief-

ings. Review the facility’s training plan for

disseminating compliance and regulatory

information to key parties. Participate in a

training session.

50.12

Identify and respond to areas of potential

legal liability. This task requires the

Administrator to create a plan that identies,

responds to, and prevents any current

or potential legal liability. This includes

communicating with staff, residents, and

responsible parties when issues arise

and proactively responding to concerns

before they become a liability. In addition,

Administrators should have systems in place

to ensure that best practices are done and

documentation occurs for any change of

condition or abnormal action/event/activity.

The plan should also delineate when legal

representation is necessary and clarify the

process to retain an attorney.

The AIT will be able to:

• identify legal liability issues.

• demonstrate effective communication

skills.

Discuss legal liability issues. Conduct

in-service regarding relevant issue(s).

Develop a system to analyze current

practices and improve on them. Discuss an

issue with the preceptor and identify areas

of potential legal liability with the facility.

Observe how the preceptor manages

various areas of risk.

50.13

Implement, monitor, and evaluate

information management and technology

systems to support service providers

operations. This task requires the Administrator

to meet all federal/state/community requirements

for information management of health

records, nancial information, and HIPAA.

Safeguards to employee, patient, resident,

and client information must be in writing and

show evidence of training/competency of

all employees. In addition, the Administrator

must ensure there is a process in place to

protect access to information, secure and track

passwords, and back up and protect all data in

the community servers. Attention must also be

given to ensure all technology is designed/set up

to save employee time and allow more time for

patient/resident/client care.

The AIT will be able to:

• identify information management

requirements and note any restrictions.

• evaluate methods to protect

information appropriately.

Review information management

processes; analyze strengths/weaknesses

of current processes; recommend

improvements, if necessary. Study the

facility’s information management system;

suggest improvements to the system from

a user’s perspective.

50.14

Develop, implement, and monitor

comprehensive sales, marketing, and public

relations strategies. This task requires the

Administrator to develop an effective marketing

strategy designed to help the consumer,

resident or responsible party, and staff to

know the features, benets, and amenities of

the community/organization. The community/

organization should have clear policies,

standards, and protocols build consumer

condence. The Administrator should also

have clear policies/procedures on how to

communicate emergent/disaster solutions within

and outside the community. The Administrator

must also ensure that a marketing plan reects

and communicates what the community does/

stands for/has achieved in writing/action/

advertisement/brochure/word of mouth.

The AIT will be able to:

• identify numerous stakeholders.

• develop and effective marketing strategy,

• demonstrate familiarity with policies/

procedures relating to disaster scenarios.

Review policies,

procedures, brochures.

Draft needed changes to update policies,

procedures, brochures. Meet with

stakeholders. Draft a “mock” press release

following a disaster exercise. Study the

facility’s marketing plan. Evaluate the

effectiveness of various aspects of the

plan in marketing the facility to the public.

Determine facility practices in media

relations. Review the facility’s public

relations and marketing budget. Explore the

types and degree of interaction between the

facility and various community resources.

Attend a community meeting with your

preceptor. Make a list of local, state and

federal political representatives for the

facility. With approval from your preceptor,

compose a letter to a local or state

representative regarding some aspect of

legislation or regulation affecting the facility.

50.15

Ensure that written agreements between

the care recipient and the service providers

protect the rights and responsibilities

of both parties. This task requires the

Administrator to assure that all written

agreements reect the services provided to

the resident and meets Federal and State

guidelines. This may include having legal

representatives review the written agreements

on a regular basis to ensure they meet the

most current regulations at the time and protect

the facility/community/resident. In relation to

a resident agreement/service plan/admission/

nancial agreement, the service provider/vendor

agreements should be carefully reviewed by the

Administrator, designated nancial person and,

when necessary, an attorney.

The AIT will model appropriate

conversations about resident rights and

applicable guidelines and agreements

Review and update written agreements.

Review federal and state guidelines.

Review provider/vendor agreements.

50.16

Develop, implement, and evaluate the

organization’s quality assurance and

performance improvement programs.

This task requires the Administrator to develop

an effective QAPI (Quality Assurance and

Performance Improvement) program. This

includes following CMS guidelines related to

QAPI and to establishing specic procedures,

policies, and systems to perform an effective

QAPI program. This also includes ensuring the

program is designed to meet the ever changing

needs of the facility/organization.

The AIT will be able to:

• summarize QAPI concepts.

• establish procedures, policies, and

systems to perform an effective QAPI

program.

Participate in quality assurance meetings.

Design a program to meet a current need

of the facility; implement with the aid of the

preceptor/staff.

50.17

Lead organizational change initiatives. This

task requires the Administrator to demonstrate

leadership by carefully assessing the facility

needs, strategically developing effective

methods to meet these needs, and then

communicating the need for change(s) to the

individuals affected. All changes should include

providing clear and concise purpose related

to the change and then to effectively train,

validate, and celebrate those who participate in

the change.

The AIT will demonstrate leadership abilities. Develop and assist with annual strategic

planning meeting. Identify a program

that needs to be advanced and lead the

initiative to make those changes. By

leading this change initiative the AIT will

demonstrate their ability to:

• manage a program.

• lead individuals to make the change(s)

that are necessary

• secure buy-in to make the changes.

etc.).

50.18

Facilitate effective internal and external

communication strategies. This task requires

the Administrator to develop methods of effective

communication, internally and externally. The

Administrator must establish a hierarchy of

individuals who communicate with eachother

via an organizational chart. The chart should

be available for residents/families/staff so

that it is clear who is responsible and who

has the authority to provide information. This

includes creating clear and concise messages

so that all staff are aware of how and what is

to be communicated and when the need for

assistance in communication is necessary. No

employee should ever feel that the total weight

of providing information rests on them. Training

and strategies should include not only verbal

and written communication but also electronic

media such as Facebook, blogs, and Twitter.

The AIT will identify the “chain of

command” and explain how to use it.

Review the organizational chart.

Participate in resolving issues. Participate

in various internal media. Discuss key

management and leadership skills

necessary for effectiveness. Evaluate the

leadership and management styles of key

management staff. Review current internal

and external contracts/agreements for

accuracy, efciency and timeliness - make

recommendations as necessary.

50.19

Promote professional development of

all team members. This task requires the

Administrator to purposefully assess team

members’ training and experience and to

facilitate an environment that allows employees

opportunities to grow professionally. This would

include internal and external opportunities

for employees who are motivated to develop

themselves professionally.

The AIT will describe the importance of

professional development

Participate in counseling. Assist the admin-

istrator to write a performance evaluation.

Identify several possible professional

development activities and ask the precep-

tor to sponsor you for one or more events

(e.g., local seminars, meetings, profession-

al groups, etc.).

The following skills apply to all Domains of Practice:

Creating and communicating a vision

Communicating effectively

Cultivating effective relationships

Inspiring and motivating

Demonstrating empathy

Group facilitation, consensus building, and team building

Delegating, leading, and empowering

Coaching, teaching, counseling, and resolving disputes

Problem solving

Analyzing and interpreting information/data

Informed decision making/critical thinking

Recognizing and ensuring care recipients’ holistic needs are being met

Assessing and recognizing safety concerns and needs

Allocating and optimizing resources and programs

Writing and evaluating policies and procedures

Developing and evaluating systems

Protecting and promoting nancial viability

Managing regulatory and accreditation surveys, inspections, and audits

Prioritizing and managing time

Utilizing technology

Utilizing social media

SELF ASSESSMENT INSTRUMENT FOR

ADMINISTRATORS-IN-TRAINING

Step 1. Have the AIT take the Self-Assessment on page 57.

For each sub-domain, there are tasks that an administrator

performs. The AIT needs to rate themselves based on the

sub-domain presented. To complete the rating response,

select the box and click on the arrow in the lower right

hand corner. This data feeds directly into the rest of the

worksheet. It should be saved (when they start) with a new

name that the preceptor will recognize as the AIT’s self

assessment.

Step 2. Review the AIT’s assessment and see how it

translated into the Modules (departments). Please visit

page 82 to weigh their assessment against the typical

number of hours in each domain, the NAB percentages in

each domain and their self-assessed weaknesses/

strengths. This will create worksheets for the Preceptor to

design that will suit the AIT in the various modules. Those

percentages are the weighted areas of the NAB Exam.

Step 3. The Preceptor should consult with their depart-

ment heads to design activities for the AIT to do in each

of these areas. The Preceptor will need to either print and

allow the AIT to handwrite their plan of study or collaborate

to complete the plan electronically. By completing an

electronic plan, it can be used with future AITs.

This tool is an instrument to use to help the Preceptor design a plan of study for the AIT. It will require the AIT

to complete the self-assessment rst and will assist the Preceptor to determine the areas in which the AIT

would like to concentrate on and compare this to the NAB suggested times. The Preceptor can adjust the times

as they see t in any area.

Instructions: Rate yourself on the following items. Please be honest as this self-assessment will be kept condential and

used only by your Preceptor to design a plan of study. For additional instructions, please reference the previous page.

This will help the Preceptor prepare an analysis of their strengths and weaknesses…and will translate into helping dene

your needs for the number of hours in each AIT Program Module. Below is the scale that will be used throughout the

self-assessment.

4 - I feel that I am fully competent in this area.

3 - I am quite knowledgeable or skilled in this area.

2 - My knowledge or skill level is about average in this area.

1 - I believe that my knowledge or skill level is decient here.

0 - I know nothing about this, or do not have this skill.

Domain 10: Customer Care, Supports and Services

Subdomain Task Item Self Perception

10.01

Establish care recipient service policies and procedures that

follow federal and state laws, rules, and regulations. This task

requires the Administrator to create policies and procedures that follow

federal and state laws, rules and regulations.

10.02

Ensure plans of care are evidence-based, established,

implemented, updated, and monitored based on care recipient

preferences and assessed needs. This task requires the

Administrator to ensure that staff implement a plan of care for each

resident, based on the individual needs and preferences, under

the direction of a physician. This task includes a comprehensive

assessment of each resident/recipient. The comprehensive

assessment should include (but not limited to) assessments for

nutrition (to include diet, texture, weight, swallowing), therapy, mobility,

fall risk, skin/wound management, medications and contraindications,

cognitive abilities, behavior, mental health, and etc.

10.03

Ensure the planning, development, implementation/execution,

monitoring and evaluation of admission/move-in process,

including pre-admission/pre-move in information, to promote

a quality experience for care recipients. This task requires the

Administrator to ensure that the admission process is comprehensive

and is resident centered. This task includes obtaining all available

documentation at the time of admission to include (but not limited to):

power of attorney for health care and nancial, resident identication

cards, insurance information, doctor and all other orders related to

the resident to include hospital/doctors/clinic records pertaining to the

residents stay at the facility or services provided by the organization.

10.04

Ensure the planning, development, implementation/execution,

monitoring and evaluation of discharge/move out process

to promote a quality experience for care recipients. This task

requires the Administrator to ensure that resident care is appropriate

for the level of care they require and that an interdisciplinary team

continually monitors the resident’s progress and recommends the best

care environment needed to maximize the resident’s quality of living.

10.05

Ensure the planning, development, implementation/execution,

monitoring and evaluation of programs to meet care recipient’s

psychosocial needs and preferences. This task requires the

Administrator to ensure residents are properly evaluated and cared

for based on their psychosocial needs and preferences.

10.06

Ensure the planning, development, implementation/execution,

monitoring and evaluation of care recipient’s activities/recreation

to meet social needs and preferences. This task requires

the Administrator to ensure activities, events, and programs

are resident centered and designed to meet the needs and

preferences of each resident.

10.07

Ensure the planning, development, implementation/execution,

monitoring and evaluation of a health information management

program to meet documentation requirements in compliance with

federal and state regulations. This task requires the Administrator

to ensure all resident specic documentation is protected and follows

state, federal and HIPAA regulations.

AIT’s NAME

Self-Assessment

Choose one...

10.08

Ensure the planning, development, implementation/execution,

monitoring, and evaluation of medication management that

supports the needs of the care recipient. This task requires the

Administrator to ensure that doctor’s orders are strictly followed and

that policies and procedures are in place to assure compliance.

10.09

Ensure the planning, development, implementation/execution,

monitoring and evaluation of a rehabilitation program to

maximize optimal level of functioning and independence for

care recipients. This task requires the Administrator to provide

individualized rehabilitative services to recipients that will help

them meet their baseline and allow residents to be as independent

as possible.

10.10

Ensure the planning, development, implementation/execution,

monitoring and evaluation of systems for coordination

and oversight of contracted services. This task requires the

Administrator to ensure that services are available to meet the needs

of each recipient from qualied vendors that meet city, state and

federal requirements.

10.11

Ensure the planning, development, implementation/execution,

monitoring and evaluation of policies and procedures for

responses to care recipient incidents, accidents, and or

emergencies. This task requires the Administrator to ensure that

policies and procedures are written and followed to prevent incidents

and accidents and to prepare staff to act appropriately when incidents,

accidents, and emergencies occur.

10.12

Ensure the planning, development, implementation/execution,

monitoring and evaluation of housekeeping and laundry services

for care recipients. This task requires the administrator to ensure a

clean, safe, and sanitary environment.

10.13

Ensure the planning, development, implementation/execution,

monitoring and evaluation of education intended for care

recipients and their support networks. This task requires the

Administrator to ensure that the care recipient and/or their

responsible party is informed of their care, condition, and treatment

as much as practical.

10.14

Ensure the planning, development, implementation/execution,

monitoring and evaluation of nutritional needs and preferences

of care recipients. This task requires the Administrator to ensure that

the care recipient’s nutritional needs are met in accordance with their

individualized needs and preferences while simultaneously meeting all

physician-prescribed orders.

10.15

Ensure the planning, development, implementation/execution,

monitoring and evaluation of dining experience that meets the

needs and preferences of care recipients. This task requires the

Administrator to ensure that dining services are resident centered and

meet the nutritional needs paralleled with the recipient preferences.

10.16

Ensure care recipients rights and individuality with all aspects

of care. This task requires the Administrator to ensure all staff are

trained and follow state and federal guidelines related to resident

rights. Attention must be made to issues related to abuse, neglect,

misappropriation of resident property and mistreatment of residents.

10.17

Integrate support network’s perspectives to maximize care

recipients quality of life and care. This task requires the

Administrator to ensure that measures are taken to review Quality

Improvement Measures, and to strategize how each team member

inuences quality measures and how they each help to improve

quality based on recipient, responsible party, and team members’

input. Attention must be made to issues related to meeting the care

recipient’s individualized needs.

10.18

Ensure transportation options are available for care recipients.

This task requires the Administrator to ensure adequate transportation

to care recipients. The facility should identify transportation that is

available and the costs (if any) for the services and inform recipients

and their responsible parties of availability and cost. The facility/entity

must be available to help coordinate transportation services based on

the recipients preference and available funding.

10.19

Ensure the provision of a customer service culture that leads

to a quality experience for care recipients. This task requires

the Administrator to promote a resident centered experience that

serves each recipient according to their choices and preferences

as much as practical.

Domain Total or

Choose one...

Domain 20: Human Resources

Subdomain Task Item Self Perception

20.01

Ensure that human resources management policies and

programs comply with federal and state rules and regulations.

This task requires the Administrator to create policies and procedures

that follow federal and state laws, rules and regulations.

20.02

Establish the planning, development, implementation,

monitoring, and evaluation of recruitment, selection, and

retention practices. This task requires the Administrator to ensure

the facility has systems in place that will provide for a consistent, fair,

and predictable method of job development, job hiring, job training,

employee evaluation, and continuing education. These systems

should follow the standards of the Fair Labor Standards Act (FSLA).

20.03

Establish the planning, development, implementation,

monitoring, and evaluation of employee training and

development programs. This task requires the Administrator to

have policies and procedures in place to train managers/leaders to

follow and design basic and continuing education programs aimed at

evaluating individual employee performance and training programs

that can meet the basic, continuing, or potential education needs of

the employee.

20.04

Establish the planning, development, implementation,

monitoring, and evaluation of employee evaluation programs.

This task requires the Administrator to ensure that policies

and procedures are in place that clearly provide instruction to

managers/leaders to regularly monitor employee performance

and to timely inform employees of when their performance or

adherence to procedures does not meet standards. This should

include timely formal evaluation of the employee to communicate

areas of poor performance and areas that employee meets and

exceed facility standards.

20.05

Establish the planning, development, implementation,

monitoring, and evaluation of compensation and benet

programs. This task requires the Administrator to ensure that policies

and procedures are in place for employee compensation and benet

programs. This includes a formal method of informing employees of

their employee benets and compensation.

20.06

Establish the planning, development, implementation,

monitoring, and evaluation of employee health and safety

programs. This task requires the Administrator to ensure that

policies and procedures are in place to prevent employee injury and

encourage employee wellness. This includes an effective workers

compensation or group retro program and providing a health/wellness

program that gives employees the opportunity to attain health, dental,

vision, accident, pharmacy, and life insurance programs.

20.07

Establish the planning, development, implementation,

monitoring, and evaluation of employee satisfaction and

organizational culture. This task requires the Administrator to ensure

policies and procedures are in place to measure employee satisfaction

and that results are taken seriously and considered. This task also

requires the Administrator to develop an organization chart/structure

that will clearly communicate the organization structure to employees.

20.08

Establish the planning, development, implementation,

monitoring, and evaluation of employee disciplinary policies and

procedures. This task requires the Administrator to have policies

and procedures in place that will set standards to objectively measure

employee performance. When employee performance or behavior

does not meet standards, employees are made aware of an allegation,

and given an opportunity to give an explanation of their performance

or behavior (give their side of the story), offer witnesses or evidence

that will support their statement, and/or provide a written statement.

Procedures should state that the employees will be made aware if an

investigation will be done, if the employee will be suspended pending

investigation, and that no discipline will be applied until a thorough

investigation is completed.

Choose one...

20.09

Establish the planning, development, implementation,

monitoring, and evaluation of employee grievance policies and

procedures. This task requires the Administrator to have policies

and procedures in place to clearly communicate with the employee a

formal program/grievance procedure in which the employee, without

fear of retaliation, can communicate areas of frustration, abuse,

mistreatment, or concerns with the understanding that a formal

response will follow.

20.10

Establish the planning, development, implementation,

monitoring, and evaluation of leadership development

programs. This task requires the Administrator to develop leadership

development programs not only for manager/leaders but also for all

employees. This may be in the form of a formalized program designed

by a corporation, outside vendor, or the Administrator.

20.11

Promote a safe work environment (such as safety training and

employee risk management). This task requires the Administrator

to ensure effective policies and procedures are in place to create an

awareness of safety throughout the workplace that include reporting

accidents, safety monitoring, re drills, water, gas and electric shut off

valves, and that emergency generators are regularly tested.

20.12

Promote a positive work environment (using techniques such

as conict resolution, diversity training, and staff recognition

programs). This task requires the Administrator to ensure that

policies and procedures are in place to assure that the employees

are provided a workplace that allows them to communicate concerns

and grievances in a safe environment. This also includes training

programs in diversity, conict resolution, continuing education, and

staff recognition programs.

20.13

Facilitate effective written, oral, and electronic communication

among management and employees. This task requires the

Administrator to ensure policies and procedures are in place to

direct managers and employees on how to formally and informally

communicate with each other. These procedures should include

requirements to managers on effective leadership ensuring

employees are aware and trained in their respective job duties and

tasks. Supervisors should also be held accountable for validating

performance and communicating with employees their progress.

20.14

Ensure employee records and documentation systems are

developed and maintained. This task requires the Administrator

to ensure employee records and correspondence are protected and

secure to other employees, residents and unauthorized individuals.

20.15

Establish a culture that encourages employees to embrace care

recipients rights. This task requires the Administrator to create a

culture that ensures that all resident rights are followed and to develop

policies and procedures on reporting violations of resident rights.

Domain Total or

Choose one...

Domain 30: Finance

Subdomain Task Item Self Perception

30.01

Ensure that nancial management policies, procedures, and

practices comply with applicable federal and state regulations.

This task requires the Administrator to create policies and procedures

that follow federal and states laws, rules and regulations.

30.02

Develop, implement, and evaluate the service provider’s budget.

This task requires the Administrator to have knowledge of the budget

process and have systems in place to accurately set budgets based

on income, expense, capital improvements, and required tasks of

the organization.

30.03

Oversee the billing and collections process and monitor the

accuracy of charges and timely collection of accounts. This task

requires the Administrator to have procedures in place to timely

and accurately bill for resident care and services to appropriate

parties, insurances, or state and federal agencies as appropriate.

Systems should be in place to make sure each recipient knows

and understands their bill so that timely payments can be made to

the facility.

30.04

Negotiate, interpret, and implement contractual agreements to

optimize nancial viability. This task requires the Administrator to

ensure the facility/organization has written agreements and contracts

that include duration of contract, liability insurance required and

assured for each party, language that includes duties of each party

and what steps are required to notify each party of any breach of

service, and details of how to dissolve an agreement for poor service

or choice to use another vendor/contractor.

30.05

Develop, implement, monitor, and evaluate nancial policies and

procedures that comply with Generally Accepted Accounting

Principles (GAAP). This task requires the Administrator to ensure

policies and procedures are in place to direct staff on the steps to

accurately perform their duties. Direction must be given to employees

in the areas of payroll, accounts receivable, billing, accurate record

keeping, internal controls, trust accounts, HIPAA, etc.

30.06

Monitor and evaluate the integrity of nancial reporting

systems and audit programs. This task requires the Administrator

to ensure that controls are in place to validate systems, audit, and

verify information, and ensure proper supervision to protect theft.

An example way to monitor theft would be to never allow the person

who prepares a deposit make the deposit. There should be checks

and balances in place to allow for the person making the deposit to

check the prepared paperwork by a different individual to ensure no

errors were made. Another example would be to have a place where

the Administrator or designee can access all passwords in case of

emergency or to validate access when a person may be unavailable.

30.07

Establish safeguards for the protection of the service provider’s

assets (such as insurance coverage, risk management). This task

requires the Administrator to have knowledge and provide leadership

in risk management, internal controls, workers compensation, and to

prevent unnecessary insurance/legal claims.

30.08

Develop, implement, monitor, and evaluate systems to improve

nancial performance. This task requires the Administrator to use

critical based thinking to understand nancial viability and to respond

to the nancial needs of the facility/organization.

30.09

Manage and adjust expenses with uctuations in census/

occupancy/care recipient levels (such as stafng ratios). This

task requires the Administrator to have systems in place that will

effectively make adjustments in labor, supplies, and resources as

needed to ensure continued nancial performance.

30.10

Monitor and address changes in the industry that may affect

nancial viability. This task requires the Administrator to stay

knowledgeable of the changes of all nancial resources to include,

but not limited to: Medicare, Medicaid, insurance companies,

and other payor sources. In addition, the Administrator must be

knowledgeable of any city, state, and federal changes that may

affect the nancial performance of the facility/organization and make

changes as needed.

Domain Total or

Choose one...

Domain 40: Environment

Subdomain Task Item Self Perception

40.01

Ensure that physical environment policies and practices comply

with applicable federal, state and local laws and regulations. This

task requires the Administrator to create policies and procedures that

follow federal laws, rules and regulations.

40.02

Ensure the planning, development, implementation, monitoring,

and evaluation of a safe and secure environment. This task

requires the Administrator to have policies and procedures in place

that ensure the physical plant, systems, equipment, and resources

are properly used and appropriate for the facility/organization. It is

required that the Administrator understands, promotes, directs, and

requires supervision to maintain all equipment and resources and

continually validate the physical plant to include (but not limited to) the

facility, grounds, equipment, tools, emergency systems, re systems,

and sprinklers.

40.03

Ensure the planning, development, implementation, monitoring,

and evaluation of infection control and sanitation. This task

requires the Administrator to have policies and procedures in place

to effectively assure that infection control and sanitation are properly

planned, implemented, and validated. This would include, but not

be limited to, training of personnel, assuring proper supplies and

resources are available and effective communication through the

facility/operation/agency of reporting violations and areas of concern.

40.04

Ensure the planning, development, implementation, monitoring,

and evaluation of emergency and disaster preparedness

program, including linkage to outside emergency agencies.

This task requires the Administrator to have specic policies and

procedures in place to assure that an effective disaster preparedness

program is in place. It is extremely important that the plan includes

regular training of staff related to re drills, emergency shut off

valves, re evacuation routes, where to nd ashlights, extension

cords, emergency phone, etc. In addition, the plan needs to include

all safety and emergency equipment. Also included in this task is

supervising agreements made with outside vendors for equipment

testing and maintenance, transportation in the event of an emergency,

and transfer agreements with resources that can help provide care

and service to relocate residents when necessary. In the event

of relocation, provisions for moving resident charts, medications,

blankets, and food, etc. need to be planned and implemented.

40.05

Ensure the planning, development, implementation, monitoring,

and evaluation of environmental services, housekeeping and

laundry. This task requires the Administrator to ensure that policies

and procedures are in place to provide a comprehensive plan that

assures all environmental, housekeeping, and laundry service

departments meet or exceed all local, state and federal requirements.

This task includes infection control, proper temperatures, temperature

logs, proper use of chemicals and products used per Material Safety

Data Sheets (MSDS), preventative maintenance, and systems to

validate compliance.

40.06

Ensure the planning, development, implementation, monitoring,

and evaluation of maintenance service for property, plant and

all equipment, including preventative maintenance. This task

requires the Administrator to ensure that policies and procedures

are in place to provide a comprehensive plan that assures

all maintenance services meet or exceed all local, state, and

federal requirements. This task includes infection control, proper

temperature and temperature logs, proper use of chemicals and

products used per MSDS, preventable maintenance, and systems to

validate compliance.

40.07

Ensure the planning, development, implementation, monitoring,

and evaluation of appropriate HIPAA compliant technology

infrastructure. This task requires the Administrator to ensure

that HIPAA compliance is assured by developing technology

infrastructures, technology safeguards (i.e., backup systems, external

data storage areas, preventative maintenance for computer hardware

and software) and ongoing validation surveys.

Choose one...

40.08

Establish, maintain, and monitor physical environment that

provides clean, safe, and secure home-like surroundings for care

recipients, staff, and visitors. This task requires the Administrator

to ensure policies and procedures are in place to create a clean,

home-like environment that supports the well-being and safety of all

recipients. This task includes creating a resident centered culture that

promotes choice, comfort, and cleanliness.

40.09

Identify opportunities to enhance the physical environment

to meet changing market demands. This task requires the

Administrator to regularly maintain the physical environment of the

facility/organization and to evaluate and monitor changing trends

within the market community to keep the facility/organization current.

This task includes creating a chart/schedule for the normal life of

equipment and furnishings, using qualied professionals to assess the

interior/exterior design of facility/organization, and developing annual

and capital budgets to prepare for predicted capital spending.

40.10

Establish, maintain, and monitor an environment that promotes

choice, comfort, and dignity for care recipients. This task

requires the Administrator to ensure policies and procedures are

in place to create an environment that ensures color, accessibility,

design, temperature, and square footage are appropriately

appointed based on the residents who reside in the care setting.

Resident rooms should allow residents the ability to decorate it

based on their preferences and creativity as long as the room meets

federal and state safety requirements.

40.11

Assess care recipients’ environment for safety, security,

and accessibility and make recommendation for referral or

modication. This task requires the Administrator to ensure that

each recipient’s personal environment and accessibility is individually

evaluated and accommodations are made to provide the most

independent, comfortable, and safe environment possible.

Domain Total or

Choose one...

Domain 50: Leadership and Management

Subdomain Task Item Self Perception

50.01

Ensure compliance with applicable federal and state laws, rules,

and regulations. This task requires the Administrator to create

policies and procedures that follow federal and state laws, rules

and regulations.

50.02

Promote ethical practice throughout the organization. This task

requires the Administrator to create policies and procedures to ensure

that a system is in place to direct the facility/organization related to

ethical topics/situations that arise. This task would include developing

an ethics committee or the creation of an ad hoc ethics committee

when necessary.

50.03

Develop, implement, monitor, and evaluate policies and

procedures that comply with directives of governing body.

This task requires the Administrator to know and understand the

governing body and all directives, policies, and procedures. This

task also requires the administrator to recommend changes or

additions to policies and procedures and make recommendations

to the governing board to change/add policies and procedures

when necessary.

50.04

Develop, communicate, and champion the service provider’s

mission, vision, and values to stakeholders. This task requires the

Administrator to develop a process to train stakeholders to communicate

the mission, vision, and values of the organization. This includes

creating positive and effective ways to not only share the mission,

vision, and values of the organization but to create an atmosphere of

condence and execution of the mission, vision and values.

50.05

Develop, implement, and evaluate the strategic plan with

governing body’s endorsement. This task requires the Administrator

to develop a strategic plan that reects the facility/organizational values,

mission, and policies that will direct the facility/organization to conduct

effective business practices with the endorsement of the governing

body. The strategic plan must state how the plan will be implemented,

validated, and evaluated in a timely manner.

50.06

Promote and monitor satisfaction of the care recipient’s and their

support networks. This task requires the Administrator to develop

a system to monitor resident satisfaction. This can be done by the

Administrator being visible through onsite visits with residents and

family. This can also be done through satisfaction surveys and mock

inspections. The successful Administrator will generally perform a

combination of onsite visits, surveys, and daily interaction with staff

in the form of a stand up meeting.

50.07

Identify, foster, and maintain positive relationships with key

stakeholders. This task requires the Administrator to determine

who key stakeholders are and develop a working relationship/

understanding with each of them. This task includes creating an

atmosphere of trust and understanding. This should be tempered

with providing necessary information to work jointly on projects and

systems that benet the organization. At no time should the impression

be given that any key stakeholder is asked to assist in leading the

facility/organization.

50.08

Educate stakeholders on services provided, regulatory

requirements, and standards of care. This task requires the

Administrator to develop a strategy to provide instruction and

resources to help the stakeholder to understand facility, state,

and federal requirements. It is also important for stakeholders to

understand facility protocols (e.g. standards and services) that are

provided to meet residents needs and create a home like environment

to ensure resident safety and choice are paramount.

50.09

Solicit information from appropriate stakeholders for use

in decision making. This task requires the Administrator to set

up protocols/standards of practice to use all available input from

trusted resources to make effective/fair/timely decisions. While the

Administrator is accountable for the decisions he/she will make, it

is important for the Administrator to know that sometimes a good

decision is better than the best decision when time or the lives of

others is a factor.

Choose one...

50.10

Manage the service provider’s role throughout any survey/

inspection process. This task requires the Administrator to develop a

protocol/practice to use for any unannounced survey/inspection. The

protocol should include reporting the surveyors/inspectors presence to

all key management teams. In addition, the protocol/practice should

include providing needed information to surveyor/inspector, keeping

copies of any documents the surveyor/inspector reviews (as known),

cooperating with the inspection, being visible, support staff through

survey/inspection, respond quickly to surveyor/inspector requests, and

re marshal inspections. The Administrator should strive to be ready

for a survey any day of the year by training his/her staff to do all that is

right year round.

50.11

Develop and implement an intervention(s) or risk management

program(s) to minimize or eliminate exposure. This task requires

the Administrator to develop a risk management program to prevent

problems before they occur. The program should start with the

identication of key risk areas and a system/protocol to prevent

them. This includes specic protocols to educate staff on reporting

incidents/events/situations that occur timely, whom to report to, and

what steps to take to reduce liability. This program requires effective

communication from the Administrator and her/his designees.

50.12

Identify and respond to areas of potential legal liability.

This task requires the Administrator to create a plan that identies,

responds to, and prevents any current or potential legal liability. This

includes communicating with staff, residents, and responsible parties

when issues arise and proactively responding to concerns before they

become a liability. In addition, Administrators should have systems

in place to ensure that best practices are done and documentation

occurs for any change of condition or abnormal action/event/activity.

The plan should also delineate when legal representation is necessary

and clarify the process to retain an attorney.

50.13

Implement, monitor, and evaluate information management and

technology systems to support service providers operations.

This task requires the Administrator to meet all federal/state/

community requirements for information management of health

records, nancial information, and HIPAA. Safeguards to employee,

patient, resident, and client information must be in writing and show

evidence of training/competency of all employees. In addition, the

Administrator must ensure there is a process in place to protect

access to information, secure and track passwords, and back up and

protect all data in the community servers. Attention must also be given

to ensure all technology is designed/set up to save employee time and

allow more time for patient/resident/client care.

50.14

Develop, implement, and mon

itor comprehensive sales,

marketing, and public relations strategies. This task requires the

Administrator to develop an effective marketing strategy designed to

help the consumer, resident or responsible party, and staff to know

the features, benefits, and amenities of the community/organization.

The community/organization should have clear policies, standards,

and protocols build consumer confidence. The Administrator should

also have clear policies/procedures on how to communicate emergent

disaster solutions within and outside the community. The

Administrator must also ensure that a marketing plan reflects and

communicates what the community does/stands for/has achieved in

writing/action/advertisement/brochure/word of mouth.

50.15

Ensure that written agreements between the care recipient and

the service providers protect the rights and responsibilities of

both parties. This task requires the Administrator to assure that all

written agreements reect the services provided to the resident and

meets Federal and State guidelines. This may include having legal

representatives review the written agreements on a regular basis to

ensure they meet the most current regulations at the time and protect

the facility/community/resident. In relation to a resident agreement/

service plan/admission/nancial agreement, the service provider/

vendor agreements should be carefully reviewed by the Administrator,

designated nancial person and, when necessary, an attorney.

Choose one...

50.16

Develop, implement, and evaluate the organization’s quality

assurance and performance improvement programs. This task

requires the Administrator to develop an effective QAPI (Quality

Assurance and Performance Improvement) program. This includes

following CMS guidelines related to QAPI and to establishing specic

procedures, policies, and systems to perform an effective QAPI

program. This also includes ensuring the program is designed to meet

the ever changing needs of the facility/organization.

50.17

Lead organizational change initiatives. This task requires the

Administrator to demonstrate leadership by carefully assessing the

facility needs, strategically developing effective methods to meet

these needs, and then communicating the need for change(s) to the

individuals affected. All changes should include providing clear and

concise purpose related to the change and then to effectively train,

validate, and celebrate those who participate in the change.

50.18

Facilitate effective internal and external communication

strategies. This task requires the Administrator to develop methods of

effective communication, internally and externally. The Administrator

must establish a hierarchy of individuals who communicate with

eachother via an organizational chart. The chart should be available

for residents/families/staff so that it is clear who is responsible and who

has the authority to provide information. This includes creating clear

and concise messages so that all staff are aware of how and what is to

be communicated and when the need for assistance in communication

is necessary. No employee should ever feel that the total weight of

providing information rests on them. Training and strategies should

include not only verbal and written communication but also electronic

media such as Facebook, blogs, and Twitter.

50.19

Promote professional development of all team members. This

task requires the Administrator to purposefully assess team members’

training and experience and to facilitate an environment that allows

employees opportunities to grow professionally. This would include

internal and external opportunities for employees who are motivated to

develop themselves professionally.

Domain Total or

Choose one...

HOURS CONVERSION

The assessments will help the Preceptor adjust the hours for each module by individual task based on strengths and

weaknesses in the various domains. A score of 0 or 1 may indicate that additional hours are needed within a specic area

while a 4 may suggest that the recommended hours can be reduced.

Preceptor: You can adjust the applicable reference column hours to what you think is typical for each of these topics for

instructing the

AIT. Understand that the changes in hours have a ripple effect on other hours.

* NOTE: This is based on the 700 hour program and might need to be adjusted accordingly. For example, if it only takes an hour to show something (regardless

of whether it’s in a 560 or 1000 hour program), you would need to adjust and use that time elsewhere.

Hours Conversion

PRECEPTORS: THIS IS YOUR

COLUMN

Self-

Assessment

Typical Pro-

gram Hours

in many

states

Variable

Default Variable hours are set to 700 hours -

Preceptors may change these hours. This number

goes forward into the Plan of Study… Please note:

Edits may occur in the white number columns only.

ADMINISTRATION

Preceptor Assigned Hours

10.01

Establish care recipient service policies and

procedures that follow federal and state laws, rules, and

regulations. This task requires the Administrator to create

policies and procedures that follow federal and state laws,

rules and regulations.

10.11

Ensure the planning, development, implementation/

execution, monitoring and evaluation of policies and

procedures for responses to care recipient incidents,

accidents, and or emergencies. This task requires the

Administrator to ensure that policies and procedures are

written and followed to prevent incidents and accidents and to

prepare staff to act appropriately when incidents, accidents, and

emergencies occur.

10.16

Ensure care recipients rights and individuality with all

aspects of care. This task requires the Administrator to ensure

all staff are trained and follow state and federal guidelines

related to resident rights. Attention must be made to issues

related to abuse, neglect, misappropriation of resident property

and mistreatment of residents.

10.17

Integrate support network’s perspectives to maximize

care recipients quality of life and care. This task requires

the Administrator to ensure that measures are taken to review

Quality Improvement Measures, and to strategize how each

team member inuences quality measures and how they each

help to improve quality based on recipient, responsible party,

and team members’ input. Attention must be made to issues

related to meeting the care recipient’s individualized needs.

10.19

Ensure the provision of a customer service culture that

leads to a quality experience for care recipients. This task

requires the Administrator to promote a resident centered

experience that serves each recipient according to their

choices and preferences as much as practical.

1000

700

7.14

5.00

20.08

Establish the planning, development, implementation,

monitoring, and evaluation of employee disciplinary

policies and procedures. This task requires the Administrator

to have policies and procedures in place that will set standards

to objectively measure employee performance. When employee

performance or behavior does not meet standards, employees

are made aware of an allegation, and given an opportunity to

give an explanation of their performance or behavior (give their

side of the story), offer witnesses or evidence that will support

their statement, and/or provide a written statement. Procedures

should state that the employees will be made aware if an

investigation will be done, if the employee will be suspended

pending investigation, and that no discipline will be applied until

a thorough investigation is completed.

20.12

Promote a positive work environment (using techniques

such as conict resolution, diversity training, and

staff recognition programs). This task requires the

Administrator to ensure that policies and procedures

are in place to assure that the employees are provided

a workplace that allows them to communicate concerns

and grievances in a safe environment. This also includes

training programs in diversity, conict resolution, continuing

education, and staff recognition programs.

20.13

Facilitate effective written, oral, and electronic

communication among management and employees.

This task requires the Administrator to ensure policies and

procedures are in place to direct managers and employees on

how to formally and informally communicate with each other.

These procedures should include requirements to managers

on effective leadership ensuring employees are aware and

trained in their respective job duties and tasks. Supervisors

should also be held accountable for validating performance and

communicating with employees their progress.

20.15

Establish a culture that encourages employees to embrace

care recipients rights. This task requires the Administrator to

create a culture that ensures that all resident rights are followed

and to develop policies and procedures on reporting violations

of resident rights.

30.06

Monitor and evaluate the integrity of nancial reporting

systems and audit programs. This task requires the

Administrator to ensure that controls are in place to validate

systems, audit, and verify information, and ensure proper

supervision to protect theft. An example way to monitor theft

would be to never allow the person who prepares a deposit

make the deposit. There should be checks and balances in

place to allow for the person making the deposit to check

the prepared paperwork by a different individual to ensure

no errors were made. Another example would be to have a

place where the Administrator or designee can access all

passwords in case of emergency or to validate access when a

person may be unavailable.

30.08

Develop, implement, monitor, and evaluate systems

to improve nancial performance. This task requires

the Administrator to use critical thinking to understand

financial viability and to respond to the financial needs of

the facility/organization.

30.09

Manage and adjust expenses with uctuations in

census/occupancy/care recipient levels (such as

stafng ratios). This task requires the Administrator to

have systems in place that will effectively make adjustments

in labor, supplies, and resources as needed to ensure

continued nancial performance.

7.14

5.00

3.57

2.50

1.79

1.25

3.57

2.50

10.71

7.50

7.14

5.00

7.14

5.00

30.10

Monitor and address changes in the industry that may

affect nancial viability. This task requires the Administrator

to stay knowledgeable of the changes of all nancial resources

to include, but not limited to; Medicare, Medicaid, insurance

companies, and other payor sources. In addition, the

Administrator must be knowledgeable of any city, state, and

federal changes that may affect the nancial performance of the

facility/organization and make changes as needed.

40.01

Ensure that physical environment policies and practices

comply with applicable federal, state and local laws and

regulations. This task requires the Administrator to create

policies and procedures that follow federal laws, rules and

regulations.

40.04

Ensure the planning, development, implementation,

monitoring, and evaluation of emergency and disaster

preparedness program, including linkage to outside

emergency agencies. This task requires the Administrator

to have specic policies and procedures in place to assure

that an effective disaster preparedness program is in place. It

is extremely important that the plan includes regular training

of staff related to re drills, emergency shut off valves, re

evacuation routes, where to nd ashlights, extension cords,

emergency phone, etc. In addition, the plan needs to include

all safety and emergency equipment. Also included in this

task is supervising agreements made with outside vendors for

equipment testing and maintenance, transportation in the event

of an emergency, and transfer agreements with resources that

can help provide care and service to relocate residents when

necessary. In the event of relocation, provisions for moving

resident charts, medications, blankets, and food, etc. need to

be planned and implemented.

40.09

Identify opportunities to enhance the physical environment

to meet changing market demands. This task requires the

Administrator to regularly maintain the physical environment of

the facility/organization and to evaluate and monitor changing

trends within the market community to keep the facility/

organization current. This task includes creating a chart/

schedule for the normal life of equipment and furnishings, using

qualied professionals to assess the interior/exterior design of

facility/organization, and developing annual and capital budgets

to prepare for predicted capital spending.

40.10

Establish, maintain, and monitor an environment that

promotes choice, comfort, and dignity for care recipients.

This task requires the Administrator to ensure policies and

procedures are in place to create an environment that ensures

color, accessibility, design, temperature, and square footage

are appropriately appointed based on the residents who reside

in the care setting. Resident rooms should allow the ability to

decorate it based on preferences and creativity as long as the

room meets federal and state safety requirements.

50.01

Ensure compliance with applicable federal and state laws,

rules, and regulations. This task requires the Administrator

to create policies and procedures that follow federal and state

laws, rules and regulations.

50.02

Promote ethical practice throughout the organization.

This task requires the Administrator to create policies and

procedures to ensure that a system is in place to direct the

facility/organization related to ethical topics/situations that arise.

This task would include developing an ethics committee or the

creation of an ad hoc ethics committee when necessary.

5.36

3.75

7.14

5.00

10.71

7.50

14.29

10.00

10.71

7.50

14.29

10.00

10.71

7.50

50.03

Develop, implement, monitor, and evaluate policies and

procedures that comply with directives of governing

body. This task requires the Administrator to know and

understand the governing body and all directives, policies,

and procedures. This task also requires the administrator to

recommend changes or additions to policies and procedures

and make recommendations to the governing board to

change/add policies and procedures when necessary.

50.04

Develop, communicate, and champion the service

provider’s mission, vision, and values to stakeholders.

This task requires the Administrator to develop a process to

train stakeholders to communicate the mission, vision, and

values of the organization. This includes creating positive and

effective ways to not only share the mission, vision, and values

of the organization but to create an atmosphere of condence

and execution of the mission, vision and values.

50.05

Develop, implement, and evaluate the strategic plan with

governing body’s endorsement. This task requires the

Administrator to develop a strategic plan that reects the facility/

organizational values, mission, and policies that will direct the

facility/organization to conduct effective business practices with

the endorsement of the governing body. The strategic plan

must state how the plan will be implemented, validated, and

evaluated in a timely manner.

50.07

Identify, foster, and maintain positive relationships with

key stakeholders. This task requires the Administrator to

determine who key stakeholders are and develop a working

relationship/understanding with each of them. This task includes

creating an atmosphere of trust and understanding. This should

be tempered with providing necessary information to work

jointly on projects and systems that benet the organization.

At no time should the impression be given that any key

stakeholder is asked to assist in leading the facility/organization.

50.09

Solicit information from appropriate stakeholders for use

in decision making. This task requires the Administrator to

set up protocols/standards of practice to use all available input

from trusted resources to make effective/fair/timely decisions.

While the Administrator is accountable for the decisions he/

she will make, it is important for the Administrator to know that

sometimes a good decision is better than the best decision

when time or the lives of others is a factor.

50.10

Manage the service provider’s role throughout any survey/

inspection process. This task requires the Administrator

to develop a protocol/practice to use for any unannounced

survey/inspection. The protocol should include reporting

the surveyors/inspectors presence to all key management

teams. In addition, the protocol/practice should include

providing needed information to surveyor/inspector, keeping

copies of any documents the surveyor/inspector reviews

(as known), cooperating with the inspection, being visible,

support staff through survey/inspection, respond quickly to

surveyor/inspector requests, and re marshal inspections. The

Administrator should strive to be ready for a survey any day of

the year by training his/her staff to do all that is right year round.

50.11

Develop and implement an intervention(s) or risk

management program(s) to minimize or eliminate

exposure. This task requires the Administrator to develop a

risk management program to prevent problems before they

occur. The program should start with the identication of key

risk areas and a system/protocol to prevent them. This includes

specic protocols to educate staff on reporting incidents/events/

situations that occur timely, whom to report to, and what steps

to take to reduce liability. This program requires effective

communication from the Administrator and her/his designees.

10.71

7.50

10.71

7.50

14.29

10.00

10.71

7.50

7.14

5.00

21.43

15.00

7.14

5.00

50.12

Identify and respond to areas of potential legal liability.

This task requires the Administrator to create a plan

that identies, responds to, and prevents any current

or potential legal liability. This includes communicating

with staff, residents, and responsible parties when issues

arise and proactively responding to concerns before they

become a liability. In addition, Administrators should have

systems in place to ensure that best practices are done

and documentation occurs for any change of condition

or abnormal action/event/activity. The plan should also

delineate when legal representation is necessary and clarify

the process to retain an attorney.

50.16

Develop, implement, and evaluate the organization’s

quality assurance and performance improvement

programs. This task requires the Administrator to develop

an effective QAPI (Quality Assurance and Performance

Improvement) program. This includes following CMS guidelines

related to QAPI and to establishing specic procedures,

policies, and systems to perform an effective QAPI program.

This also includes ensuring the program is designed to meet

the ever changing needs of the facility/organization.

50.17

Lead organizational change initiatives. This task requires

the Administrator to demonstrate leadership by carefully

assessing the these needs, strategically developing effective

methods to meet facility needs, and then communicating the

need for change(s) to the individuals affected. All changes

should include providing clear and concise purpose related to

the change and then to effectively train, validate, and celebrate

those who participate in the change.

50.18

Facilitate effective internal and external communication

strategies. This task requires the Administrator to develop

methods of effective communication, internally and externally.

The Administrator must establish a hierarchy of individuals

who communicate with eachother via an organizational

chart. The chart should be available for residents/families/

staff so that it is clear who is responsible and who has the

authority to provide information. This includes creating clear

and concise messages so that all staff are aware of how and

what is to be communicated and when the need for assistance

in communication is necessary. No employee should ever

feel that the total weight of providing information rests on

them. Training and strategies should include not only verbal

and written communication but also electronic media such as

Facebook, blogs, and Twitter.

Module Total

7.14

5.00

14.29

10.00

14.29

10.00

7.14

5.00

275.00

192.50

HUMAN RESOURCES

Self-

Assessment

Typical Pro-

gram Hours

in many

states

Variable

Preceptor Assigned Hours

20.01

Ensure that human resources management policies

and programs comply with federal and state rules and

regulations. This task requires the Administrator to create

policies and procedures that follow federal and state laws, rules

and regulations.

20.02

Establish the planning, development, implementation,

monitoring, and evaluation of recruitment, selection, and

retention practices. This task requires the Administrator to

ensure the facility has systems in place that will provide for a

consistent, fair, and predictable method of job development,

job hiring, job training, employee evaluation, and continuing

education. These systems should follow the standards of the

Fair Labor Standards Act (FSLA).

20.03

Establish the planning, development, implementation,

monitoring, and evaluation of employee training and

development programs. This task requires the Administrator

to have policies and procedures in place to train managers/

leaders to follow and design basic and continuing education

programs aimed at evaluating individual employee performance

and training programs that can meet the basic, continuing, or

potential education needs of the employee.

20.04

Establish the planning, development, implementation,

monitoring, and evaluation of employee evaluation

programs. This task requires the Administrator to ensure

that policies and procedures are in place that clearly

provide instruction to managers/leaders to regularly monitor

employee performance and to timely inform employees of

when their performance or adherence to procedures does

not meet standards. This should include timely formal

evaluation of the employee to communicate areas of poor

performance and areas that employee meets and exceed

facility standards.

20.05

Establish the planning, development, implementation,

monitoring, and evaluation of compensation and benet

programs. This task requires the Administrator to ensure

that policies and procedures are in place for employee

compensation and benet programs. This includes a formal

method of informing employees of their employee benets

and compensation.

20.06

Establish the planning, development, implementation,

monitoring, and evaluation of employee health and safety

programs. This task requires the Administrator to ensure that

policies and procedures are in place to prevent employee injury

and encourage employee wellness. This includes an effective

workers compensation or group retro program and providing a

health/wellness program that gives employees the opportunity

to attain health, dental, vision, accident, pharmacy, and life

insurance programs.

20.07

Establish the planning, development, implementation,

monitoring, and evaluation of employee satisfaction and

organizational culture. This task requires the Administrator

to ensure policies and procedures are in place to measure

employee satisfaction and that results are taken seriously

and considered. This task also requires the Administrator

to develop an organization chart/structure that will clearly

communicate the organization structure to employees.

7.14

5.00

28.57

20.00

7.14

5.00

7.14

5.00

7.14

5.00

7.14

5.00

7.14

5.00

20.08

Establish the planning, development, implementation,

monitoring, and evaluation of employee disciplinary

policies and procedures. This task requires the Administrator

to have policies and procedures in place that will set standards

to objectively measure employee performance. When employee

performance or behavior does not meet standards, employees

are made aware of an allegation, and given an opportunity to

give an explanation of their performance or behavior (give their

side of the story), offer witnesses or evidence that will support

their statement, and/or provide a written statement. Procedures

should state that the employees will be made aware if an

investigation will be done, if the employee will be suspended

pending investigation, and that no discipline will be applied until

a thorough investigation is completed.

20.09

Establish the planning, development, implementation,

monitoring, and evaluation of employee grievance policies

and procedures. This task requires the Administrator to have

policies and procedures in place to clearly communicate with

the employee a formal program/grievance procedure in which

the employee, without fear of retaliation, can communicate

areas of frustration, abuse, mistreatment, or concerns with the

understanding that a formal response will follow.

20.10

Establish the planning, development, implementation,

monitoring, and evaluation of leadership development

programs. This task requires the Administrator to develop

leadership development programs not only for manager/

leaders but also for all employees. This may be in the form of a

formalized program designed by a corporation, outside vendor,

or the Administrator.

20.14

Ensure employee records and documentation systems

are developed and maintained. This task requires the

Administrator to ensure employee records and correspondence

are protected and secure to other employees, residents and

unauthorized individuals.

50.19

Promote professional development of all team members.

This task requires the Administrator to purposefully assess

team members’ training and experience and to facilitate an

environment that allows employees opportunities to grow

professionally. This would include internal and external

opportunities for employees who are motivated to develop

themselves professionally.

Module Total

7.14

5.00

7.14

5.00

3.57

2.50

3.57

2.50

14.29

10.00

107.14

75.00

NURSING DEPARTMENT/

HEALTH CARE SERVICES

Self-

Assessment

Typical Pro-

gram Hours

in many

states

Variable

Preceptor Assigned Hours

10.02

Ensure plans of care are evidence-based, established,

implemented, updated, and monitored based on care

recipient preferences and assessed needs. This task

requires the Administrator to ensure that staff implement a

plan of care for each resident, based on the individual needs

and preferences, under the direction of a physician. This

task includes a comprehensive assessment of each resident/

recipient. The comprehensive assessment should include (but

not limited to) assessments for nutrition (to include diet, texture,

weight, swallowing), therapy, mobility, fall risk, skin/wound

management, medications and contraindications, cognitive

abilities, behavior, mental health, and etc.

10.03

Ensure the planning, development, implementation/

execution, monitoring and evaluation of admission/

move-in process, including pre-admission/pre-move

in information, to promote a quality experience for

care recipients. This task requires the Administrator to

ensure that the admission process is comprehensive and is

resident centered. This task includes obtaining all available

documentation at the time of admission to include (but not

limited to): power of attorney for health care and nancial,

resident identication cards, insurance information, doctor

and all other orders related to the resident to include hospital/

doctors/clinic records pertaining to the residents stay at the

facility or services provided by the organization.

10.04

Ensure the planning, development, implementation/

execution, monitoring and evaluation of discharge/move

out process to promote a quality experience for care

recipients. This task requires the Administrator to ensure that

resident care is appropriate for the level of care they require

and that an interdisciplinary team continually monitors the

resident’s progress and recommends the best care environment

needed to maximize the resident’s quality of living.

10.05

Ensure the planning, development, implementation/

execution, monitoring and evaluation of programs to meet

care recipient’s psychosocial needs and preferences.

This task requires the Administrator to ensure residents

are properly evaluated and cared for based on their

psychosocial needs and preferences.

10.08

Ensure the planning, development, implementation/

execution, monitoring, and evaluation of medication

management that supports the needs of the care recipient.

This task requires the Administrator to ensure that doctor’s

orders are strictly followed and that policies and procedures are

in place to assure compliance.

10.11

Ensure the planning, development, implementation/

execution, monitoring and evaluation of policies and

procedures for responses to care recipient incidents,

accidents, and or emergencies. This task requires the

Administrator to ensure that policies and procedures are

written and followed to prevent incidents and accidents and to

prepare staff to act appropriately when incidents, accidents, and

emergencies occur.

10.13

Ensure the planning, development, implementation/

execution, monitoring and evaluation of education

intended for care recipients and their support networks.

This task requires the Administrator to ensure that the care

recipient and/or their responsible party is informed of their

care, condition, and treatment as much as practical.

10.16

Ensure care recipients rights and individuality with all

aspects of care. This task requires the Administrator to ensure

all staff are trained and follow state and federal guidelines

related to resident rights. Attention must be made to issues

related to abuse, neglect, misappropriation of resident property

and mistreatment of residents.

42.86

30.00

21.43

15.00

21.43

15.00

21.43

15.00

10.71

7.50

7.14

5.00

3.57

2.50

3.57

2.50

10.19

Ensure the provision of a customer service culture that

leads to a quality experience for care recipients. This task

requires the Administrator to promote a resident centered

experience that serves each recipient according to their

choices and preferences as much as practical.

20.11

Promote a safe work environment (such as safety training

and employee risk management). This task requires the

Administrator to ensure effective policies and procedures

are in place to create an awareness of safety throughout the

workplace that include reporting accidents, safety monitoring,

re drills, water, gas and electric shut off valves, and that

emergency generators are regularly tested.

40.03

Ensure the planning, development, implementation,

monitoring, and evaluation of infection control and

sanitation. This task requires the Administrator to have

policies and procedures in place to effectively assure

that infection control and sanitation are properly planned,

implemented, and validated. This would include, but not be

limited to, training of personnel, assuring proper supplies

and resources are available and effective communication

through the facility/operation/agency of reporting violations

and areas of concern.

40.07

Ensure the planning, development, implementation,

monitoring, and evaluation of appropriate HIPAA

compliant technology infrastructure. This task requires the

Administrator to ensure that HIPAA compliance is assured by

developing technology infrastructures, technology safeguards

(i.e., backup systems, external data storage areas, preventative

maintenance for computer hardware and software) and ongoing

validation surveys.

40.11

Assess care recipients’ environment for safety, security,

and accessibility and make recommendation for referral or

modication. This task requires the Administrator to ensure

that each recipient’s personal environment and accessibility

is individually evaluated and accommodations are made

to provide the most independent, comfortable, and safe

environment possible.

50.06

Promote and monitor satisfaction of the care recipient’s

and their support networks. This task requires the

Administrator to develop a system to monitor resident

satisfaction. This can be done by the Administrator being

visible through onsite visits with residents and family. This

can also be done through satisfaction surveys and mock

inspections. The successful Administrator will generally

perform a combination of onsite visits, surveys, and daily

interaction with staff in the form of a stand up meeting.

50.08

Educate stakeholders on services provided, regulatory

requirements, and standards of care. This task requires the

Administrator to develop a strategy to provide instruction

and resources to help the stakeholder to understand facility,

state, and federal requirements. It is also important for

stakeholders to understand facility protocols (e.g. standards

and services) that are provided to meet residents needs and

create a home like environment to ensure resident safety

and choice are paramount.

Module Total

7.14

5.00

3.57

2.50

7.14

5.00

3.57

2.50

3.57

2.50

21.43

15.00

14.29

10.00

192.86

135.00

REHABILITATION DEPARTMENT

Self-

Assessment

Typical Pro-

gram Hours

in many

states

Variable

Preceptor Assigned Hours

10.09

Ensure the planning, development, implementation/

execution, monitoring and evaluation of a rehabilitation

program to maximize optimal level of functioning and

independence for care recipients. This task requires the

Administrator to provide individualized rehabilitative services

to recipients that will help them meet their baseline and

allow residents to be as independent as possible.

Module Total

MEDICAL/RESIDENT RECORDS

Self-

Assessment

Typical Pro-

gram Hours

in many

states

Variable

Preceptor Assigned Hours

10.07

Ensure the planning, development, implementation/

execution, monitoring and evaluation of a health

information management program to meet documentation

requirements in compliance with federal and state

regulations. This task requires the Administrator to ensure all

resident specic documentation is protected and follows state,

federal and HIPAA regulations.

Module Total

ACTIVITIES DEPARTMENT

Self-

Assessment

Typical Pro-

gram Hours

in many

states

Variable

Preceptor Assigned Hours

10.06

Ensure the planning, development, implementation/

execution, monitoring and evaluation of care recipient’s

activities/recreation to meet social needs and preferences.

This task requires the Administrator to ensure activities,

events, and programs are resident centered and designed to

meet the needs and preferences of each resident.

Module Total

14.29

10.00

14.29

10.00

28.57

20.00

28.57

20.00

28.57

20.00

28.57

20.00

SOCIAL SERVICES/

ADMISSIONS DEPARTMENT

Self-

Assessment

Typical Pro-

gram Hours

in many

states

Variable

Preceptor Assigned Hours

10.03

Ensure the planning, development, implementation/

execution, monitoring and evaluation of admission/

move-in process, including pre-admission/pre-move

in information, to promote a quality experience for

care recipients. This task requires the Administrator to

ensure that the admission process is comprehensive and is

resident centered. This task includes obtaining all available

documentation at the time of admission to include but not

limited to: power of attorney for health care and financial,

resident identication cards, insurance information, doctor

and all other orders related to the resident to include hospital/

doctors/clinic records pertaining to the residents stay at the

facility or services provided by the organization.

10.04

Ensure the planning, development, implementation/

execution, monitoring and evaluation of discharge/move

out process to promote a quality experience for care

recipients. This task requires the Administrator to ensure that

resident care is appropriate for the level of care they require

and that an interdisciplinary team continually monitors the

resident’s progress and recommends the best care environment

needed to maximize the resident’s quality of living.

10.13

Ensure the planning, development, implementation/

execution, monitoring and evaluation of education

intended for care recipients and their support networks.

This task requires the Administrator to ensure that the care

recipient and/or their responsible party is informed of their

care, condition, and treatment as much as practical.

10.18

Ensure transportation options are available for care

recipients. This task requires the Administrator to ensure

adequate transportation to care recipients. The facility should

identify transportation that is available and the costs (if any) for

the services and inform recipients and their responsible parties

of availability and cost. The facility/entity must be available to

help coordinate transportation services based on the recipients

preference and available funding.

Module Total

14.29

10.00

14.29

10.00

5.36

3.75

7.14

5.00

10.00

3.75

5.00

41.07

28.75

BUSINESS OFFICE/

FINANCIAL MANAGEMENT

Self-

Assessment

Typical Pro-

gram Hours

in many

states

Variable

Preceptor Assigned Hours

10.10

Ensure the planning, development, implementation/

execution, monitoring and evaluation of systems for

coordination and oversight of contracted services. This

task requires the Administrator to ensure that services are

available to meet the needs of each recipient from qualied

vendors that meet city, state and federal requirements.

30.01

Ensure that nancial management policies, procedures,

and practices comply with applicable federal and state

regulations. This task requires the Administrator to create

policies and procedures that follow federal and states laws,

rules and regulations.

30.02

Develop, implement, and evaluate the service provider’s

budget. This task requires the Administrator to have

knowledge of the budget process and have systems in place

to accurately set budgets based on income, expense, capital

improvements, and required tasks of the organization.

30.03

Oversee the billing and collections process and monitor

the accuracy of charges and timely collection of accounts.

This task requires the Administrator to have procedures

in place to timely and accurately bill for resident care and

services to appropriate parties, insurances, or state and

federal agencies as appropriate. Systems should be in

place to make sure each recipient knows and understands

their bill so that timely payments can be made to the facility.

30.04

Negotiate, interpret, and implement contractual

agreements to optimize nancial viability. This task requires

the Administrator to ensure the facility/organization has written

agreements and contracts that include duration of contract,

liability insurance required and assured for each party, language

that includes duties of each party and what steps are required

to notify each party of any breach of service, and details of

how to dissolve an agreement for poor service or choice to use

another vendor/contractor.

30.05

Develop, implement, monitor, and evaluate nancial

policies and procedures that comply with Generally

Accepted Accounting Principles (GAAP). This task requires

the Administrator to ensure policies and procedures are in place

to direct staff on the steps to accurately perform their duties.

Direction must be given to employees in the areas of payroll,

accounts receivable, billing, accurate record keeping, internal

controls, trust accounts, HIPAA, and etc.

30.07

Establish safeguards for the protection of the service

provider’s assets (such as insurance coverage, risk

management). This task requires the Administrator to have

knowledge and provide leadership in risk management, internal

controls, workers compensation, and to prevent unnecessary

insurance/legal claims.

40.07

Ensure the planning, development, implementation,

monitoring, and evaluation of appropriate HIPAA

compliant technology infrastructure. This task requires the

Administrator to ensure that HIPAA compliance is assured by

developing technology infrastructures, technology safeguards

(i.e., backup systems, external data storage areas, preventative

maintenance for computer hardware and software) and ongoing

validation surveys.

7.14

5.00

7.14

5.00

21.43

15.00

21.43

15.00

14.29

10.00

14.29

10.00

14.29

10.00

3.57

2.50

50.13

Implement, monitor, and evaluate information

management and technology systems to support service

providers operations. This task requires the Administrator

to meet all federal/state/community requirements for

information management of health records, nancial

information, and HIPAA. Safeguards to employee, patient,

resident, and client information must be in writing and

show evidence of training/competency of all employees. In

addition, the Administrator must ensure there is a process

in place to protect access to information, secure and

track passwords, and back up and protect all data in the

community servers. Attention must also be given to ensure

all technology is designed/set up to save employee time and

allow more time for patient/resident/client care.

50.14

Develop, implement, and monitor comprehensive

sales, marketing, and public relations strategies. This

task requires the Administrator to develop an effective

marketing strategy designed to help the consumer, resident

or responsible party, and staff to know the features,

benets, and amenities of the community/organization.

The community/organization should have clear policies,

standards, and protocols build consumer condence. The

Administrator should also have clear policies/procedures on

how to communicate emergent/disaster solutions within and

outside the community. The Administrator must also ensure

that a marketing plan reects and communicates what the

community does/stands for/has achieved in writing/action/

advertisement/brochure/word of mouth.

50.15

Ensure that written agreements between the care

recipient and the service providers protect the rights

and responsibilities of both parties. This task requires the

Administrator to assure that all written agreements reect the

services provided to the resident and meets Federal and State

guidelines. This may include having legal representatives

review the written agreements on a regular basis to ensure they

meet the most current regulations at the time and protect the

facility/community/resident. In relation to a resident agreement/

service plan/admission/nancial agreement, the service

provider/vendor agreements should be carefully reviewed

by the Administrator, designated nancial person and, when

necessary, an attorney.

Module Total

DIETARY DEPARTMENT

Self-

Assessment

Typical Pro-

gram Hours

in many

states

Variable

Preceptor Assigned Hours

10.14

Ensure the planning, development, implementation/

execution, monitoring and evaluation of nutritional needs

and preferences of care recipients. This task requires the

Administrator to ensure that the care recipient’s nutritional

needs are met in accordance with their individualized needs

and preferences while simultaneously meeting all physician-

prescribed orders.

10.15

Ensure the planning, development, implementation/

execution, monitoring and evaluation of dining experience

that meets the needs and preferences of care recipients.

This task requires the Administrator to ensure that dining

services are resident centered and meet the nutritional needs

paralleled with the recipient preferences.

Module Total

10.00

14.29

10.00

14.29

10.00

146.43

102.50

28.57

20.00

10.00

14.29

10.00

42.86

30.00

HOUSEKEEPING/

LAUNDRY DEPARTMENT

Self-

Assessment

Typical Pro-

gram Hours

in many

states

Variable

Preceptor Assigned Hours

10.12

Ensure the planning, development, implementation/

execution, monitoring and evaluation of housekeeping and

laundry services for care recipients. This task requires the

administrator to ensure a clean, safe, and sanitary environment.

40.05

Ensure the planning, development, implementation,

monitoring, and evaluation of environmental services,

housekeeping and laundry. This task requires the

Administrator to ensure that policies and procedures are

in place to provide a comprehensive plan that assures all

environmental, housekeeping, and laundry service departments

meet or exceed all local, state and federal requirements.

This task includes infection control, proper temperatures,

temperature logs, proper use of chemicals and products

used per Material Safety Data Sheets (MSDS), preventative

maintenance, and systems to validate compliance.

40.08

Establish, maintain, and monitor physical environment

that provides clean, safe, and secure home-like

surroundings for care recipients, staff, and visitors.

This task requires the Administrator to ensure policies

and procedures are in place to create a clean, home-like

environment that supports the well-being and safety of all

recipients. This task includes creating a resident centered

culture that promotes choice, comfort, and cleanliness.

Module Total

ENVIRONMENTAL MANAGEMENT/

MAINTENANCE DEPARTMENT

Self-

Assessment

Typical Pro-

gram Hours

in many

states

Variable

Preceptor Assigned Hours

20.11

Promote a safe work environment (such as safety training

and employee risk management). This task requires the

Administrator to ensure effective policies and procedures

are in place to create an awareness of safety throughout the

workplace that include reporting accidents, safety monitoring,

re drills, water, gas and electric shut off valves, and that

emergency generators are regularly tested.

40.01

Ensure that physical environment policies and practices

comply with applicable federal, state and local laws and

regulations. This task requires the Administrator to create

policies and procedures that follow federal and laws, rules

and regulations.

40.02

Ensure the planning, development, implementation,

monitoring, and evaluation of a safe and secure

environment. This task requires the Administrator to have

policies and procedures in place that ensure the physical plant,

systems, equipment, and resources are properly used and

appropriate for the facility/organization. It is required that the

Administrator understands, promotes, directs, and requires

supervision to maintain all equipment and resources and

continually validate the physical plant to include (but not limited

to) the facility, grounds, equipment, tools, emergency systems,

re systems, and sprinklers.

40.06

Ensure the planning, development, implementation,

monitoring, and evaluation of maintenance service for

property, plant and all equipment, including preventative

maintenance. This task requires the Administrator to

ensure that policies and procedures are in place to provide

a comprehensive plan that assures all maintenance services

meet or exceed all local, state, and federal requirements.

This task includes infection control, proper temperature and

temperature logs, proper use of chemicals and products

used per MSDS, preventable maintenance, and systems to

validate compliance.

7.14

5.00

7.14

5.00

10.71

7.50

25.00

17.50

7.14

5.00

3.57

2.50

7.14

5.00

10.71

7.50

40.08

Establish, maintain, and monitor physical environment

that provides clean, safe, and secure home-like

surroundings for care recipients, staff, and visitors.

This task requires the Administrator to ensure policies

and procedures are in place to create a clean, home-like

environment that supports the well-being and safety of all

recipients. This task includes creating a resident centered

culture that promotes choice, comfort, and cleanliness.

40.09

Identify opportunities to enhance the physical environment

to meet changing market demands. This task requires the

Administrator to regularly maintain the physical environment of

the facility/organization and to evaluate and monitor changing

trends within the market community to keep the facility/

organization current. This task includes creating a chart/

schedule for the normal life of equipment and furnishings, using

qualied professionals to assess the interior/exterior design of

facility/organization, and developing annual and capital budgets

to prepare for predicted capital spending.

40.10

Establish, maintain, and monitor an environment that

promotes choice, comfort, and dignity for care recipients.

This task requires the Administrator to ensure policies and

procedures are in place to create an environment that ensures

color, accessibility, design, temperature, and square footage

are appropriately appointed based on the residents who reside

in the care setting. Resident rooms should allow the ability to

decorate it based on preferences and creativity as long as the

room meets federal and state safety requirements.

Module Total

Recomended Above

CROSS-CHECK OF TYPICAL AGAINST NAB

PERCENTAGES…

Domain%s

YOUR HOURS for

this AIT

Your Do-

main %s for

this AIT

PPA %

(NAB -

NHA)

Domain 10 Hours 35%

Domain 20 Hours 13%

Domain 30 Hours 14%

Domain 40 Hours 13%

Domain 50 Hours 25%

Total

100%

(does not include “Other” module in percentage)

Compare and Consider self-assessment. Is it logical for this AIT?

OTHER

Self-

Assessment

Typical Pro-

gram Hours

in many

states

Variable

Preceptor Assigned Hours

As required/desired - shore up weaker than assessed

areas (aka "slop factor"?)

Module Total

14.29

10.00

5.36

3.75

7.14

5.00

55.36

38.75

42.86

30.00

42.86

30.00

1000

700

344.64

241.25

36.01%

241.25

36.01%

119.64

83.75

12.50%

83.75

12.50%

123.21

86.25

12.87%

86.25

12.87%

126.79

88.75

13.25%

88.75

13.25%

242.86

170.00

25.37%

170.00

25.37%

957.14

670.00

100.00%

670.00

100%

Professional Development Plan

Module/

Department

Sub-

Domain

Task Proposed

Hours

Learning Activities

Administration (list as many/few as necessary for

the hours proposed)

10.01

Establish care recipient service policies

and procedures that follow federal and

state laws, rules, and regulations. This task

requires the Administrator to create policies and

procedures that follow federal and state laws,

rules and regulations.

Also in Nursing Module 10.11

Ensure the planning, development,

implementation/execution, monitoring

and evaluation of policies and procedures

for responses to care recipient incidents,

accidents, and or emergencies. This task

requires the Administrator to ensure that policies

and procedures are written and followed to

prevent incidents and accidents and to prepare

staff to act appropriately when incidents,

accidents, and emergencies occur.

Also in Nursing Module 10.16

Ensure care recipients rights and individuality

with all aspects of care. This task requires

the Administrator to ensure all staff are trained

and follow state and federal guidelines related to

resident rights. Attention must be made to issues

related to abuse, neglect, misappropriation of

resident property and mistreatment of residents.

10.17

Integrate support network’s perspectives to

maximize care recipients quality of life and

care. This task requires the Administrator to

ensure that measures are taken to review Quality

Improvement Measures, and to strategize how

each team member inuences quality measures

and how they each help to improve quality

based on recipient, responsible party, and team

members’ input. Attention must be made to

issues related to meeting the care recipient’s

individualized needs.

Also in Nursing Module 10.19

Ensure the provision of a customer service

culture that leads to a quality experience

for care recipients. This task requires the

Administrator to promote a resident centered

experience that serves each recipient

according to their choices and preferences as

much as practical.

Please reference Appendix 2 for ideas of activities for each sub-domain.

5.00

20.08

Establish the planning, development,

implementation, monitoring, and evaluation

of employee disciplinary policies and

procedures. This task requires the

Administrator to have policies and procedures

in place that will set standards to objectively

measure employee performance. When

employee performance or behavior does not

meet standards, employees are made aware of

an allegation, and given an opportunity to give

an explanation of their performance or behavior

(give their side of the story), offer witnesses or

evidence that will support their statement, and/or

provide a written statement. Procedures should

state that the employees will be made aware if

an investigation will be done, if the employee

will be suspended pending investigation, and

that no discipline will be applied until a thorough

investigation is completed.

20.12

Promote a positive work environment (using

techniques such as conict resolution,

diversity training, and staff recognition

programs). This task requires the Administrator

to ensure that policies and procedures are in

place to assure that the employees are provided

a workplace that allows them to communicate

concerns and grievances in a safe environment.

This also includes training programs in diversity,

conict resolution, continuing education, and staff

recognition programs.

20.13

Facilitate effective written, oral, and electronic

communication among management and

employees. This task requires the Administrator

to ensure policies and procedures are in place

to direct managers and employees on how

to formally and informally communicate with

each other. These procedures should include

requirements to managers on effective leadership

ensuring employees are aware and trained in

their respective job duties and tasks. Supervisors

should also be held accountable for validating

performance and communicating with employees

their progress.

20.15

Establish a culture that encourages

employees to embrace care recipients rights.

This task requires the Administrator to create a

culture that ensures that all resident rights are

followed and to develop policies and procedures

on reporting violations of resident rights.

30.06

Monitor and evaluate the integrity of nancial

reporting systems and audit programs.

This task requires the Administrator to ensure

that controls are in place to validate systems,

audit, and verify information, and ensure proper

supervision to protect theft. An example way to

monitor theft would be to never allow the person

who prepares a deposit make the deposit. There

should be checks and balances in place to allow

for the person making the deposit to check the

prepared paperwork by a different individual to

ensure no errors were made. Another example

would be to have a place where the Administrator

or designee can access all passwords in case of

emergency or to validate access when a person

may be unavailable.

30.08

Develop, implement, monitor, and evaluate

systems to improve nancial performance.

This task requires the Administrator to use

critical thinking to understand nancial viability

and to respond to the nancial needs of the

facility/organization.

5.00

2.50

1.25

2.50

7.50

5.00

30.09

Manage and adjust expenses with uctuations

in census/occupancy/care recipient levels

(such as stafng ratios). This task requires the

Administrator to have systems in place that will

effectively make adjustments in labor, supplies,

and resources as needed to ensure continued

nancial performance.

30.10

Monitor and address changes in the industry

that may affect nancial viability. This task

requires the Administrator to stay knowledgeable

of the changes of all nancial resources

to include, but not limited to; Medicare,

Medicaid, insurance companies, and other

payor sources. In addition, the Administrator

must be knowledgeable of any city, state, and

federal changes that may affect the nancial

performance of the facility/organization and

make changes as needed.

Also in MX module 40.01

Ensure that physical environment policies

and practices comply with applicable federal,

state and local laws and regulations. This

task requires the Administrator to create policies

and procedures that follow federal laws, rules

and regulations.

40.04

Ensure the planning, development,

implementation, monitoring, and evaluation

of emergency and disaster preparedness

program, including linkage to outside

emergency agencies. This task requires the

Administrator to have specic policies and

procedures in place to assure that an effective

disaster preparedness program is in place. It is

extremely important that the plan includes regular

training of staff related to re drills, emergency

shut off valves, re evacuation routes, where

to nd ashlights, extension cords, emergency

phone, etc. In addition, the plan needs to include

all safety and emergency equipment. Also

included in this task is supervising agreements

made with outside vendors for equipment testing

and maintenance, transportation in the event

of an emergency, and transfer agreements with

resources that can help provide care and service

to relocate residents when necessary. In the

event of relocation, provisions for moving resident

charts, medications, blankets, and food, etc. need

to be planned and implemented.

Also in MX module 40.09

Identify opportunities to enhance the physical

environment to meet changing market

demands. This task requires the Administrator to

regularly maintain the physical environment of the

facility/organization and to evaluate and monitor

changing trends within the market community to

keep the facility/organization current. This task

includes creating a chart/schedule for the normal

life of equipment and furnishings, using qualied

professionals to assess the interior/exterior

design of facility/organization, and developing

annual and capital budgets to prepare for

predicted capital spending.

Also in MX module 40.10

Establish, maintain, and monitor an

environment that promotes choice, comfort,

and dignity for care recipients. This task

requires the Administrator to ensure policies

and procedures are in place to create an

environment that ensures color, accessibility,

design, temperature, and square footage are

appropriately appointed based on the residents

who reside in the care setting. Resident rooms

should allow the ability to decorate it based on

preferences and creativity as long as the room

meets federal and state safety requirements.

5.00

3.75

5.00

7.50

10.00

7.50

50.01

Ensure compliance with applicable federal

and state laws, rules, and regulations.

This task requires the Administrator to create

policies and procedures that follow federal and

state laws, rules and regulations.

50.02

Promote ethical practice throughout

the organization. This task requires the

Administrator to create policies and procedures

to ensure that a system is in place to direct the

facility/organization related to ethical topics/

situations that arise. This task would include

developing an ethics committee or the creation of

an ad hoc ethics committee when necessary.

50.03

Develop, implement, monitor, and evaluate

policies and procedures that comply with

directives of governing body. This task

requires the Administrator to know and

understand the governing body and all

directives, policies, and procedures. This

task also requires the administrator to

recommend changes or additions to policies

and procedures and make recommendations

to the governing board to change/add policies

and procedures when necessary.

50.04

Develop, communicate, and champion the

service provider’s mission, vision, and

values to stakeholders. This task requires

the Administrator to develop a process to train

stakeholders to communicate the mission,

vision, and values of the organization. This

includes creating positive and effective ways

to not only share the mission, vision, and

values of the organization but to create an

atmosphere of condence and execution of the

mission, vision and values.

50.05

Develop, implement, and evaluate the

strategic plan with governing body’s

endorsement. This task requires the

Administrator to develop a strategic plan that

reects the facility/organizational values,

mission, and policies that will direct the facility/

organization to conduct effective business

practices with the endorsement of the governing

body. The strategic plan must state how

the plan will be implemented, validated, and

evaluated in a timely manner.

50.07

Identify, foster, and maintain positive

relationships with key stakeholders. This

task requires the Administrator to determine who

key stakeholders are and develop a working

relationship/understanding with each of them.

This task includes creating an atmosphere of trust

and understanding. This should be tempered

with providing necessary information to work

jointly on projects and systems that benet the

organization. At no time should the impression be

given that any key stakeholder is asked to assist

in leading the facility/organization.

50.09

Solicit information from appropriate

stakeholders for use in decision making.

This task requires the Administrator to set

up protocols/standards of practice to use

all available input from trusted resources to

make effective/fair/timely decisions. While the

Administrator is accountable for the decisions

he/she will make, it is important for the

Administrator to know that sometimes a good

decision is better than the best decision when

time or the lives of others is a factor.

10.00

7.50

10.00

7.50

5.00

50.10

Manage the service provider’s role throughout

any survey/inspection process. This task

requires the Administrator to develop a protocol/

practice to use for any unannounced survey/

inspection. The protocol should include reporting

the surveyors/inspectors presence to all key

management teams. In addition, the protocol/

practice should include providing needed

information to surveyor/inspector, keeping copies

of any documents the surveyor/inspector reviews

(as known), cooperating with the inspection,

being visible, support staff through survey/

inspection, respond quickly to surveyor/inspector

requests, and re marshal inspections. The

Administrator should strive to be ready for a

survey any day of the year by training his/her staff

to do all that is right year round.

50.11

Develop and implement an intervention(s)

or risk management program(s) to minimize

or eliminate exposure. This task requires the

Administrator to develop a risk management

program to prevent problems before they occur.

The program should start with the identication of

key risk areas and a system/protocol to prevent

them. This includes specic protocols to educate

staff on reporting incidents/events/situations that

occur timely, whom to report to, and what steps

to take to reduce liability. This program requires

effective communication from the Administrator

and her/his designees.

50.12

Identify and respond to areas of potential legal

liability. This task requires the Administrator

to create a plan that identies, responds to,

and prevents any current or potential legal

liability. This includes communicating with

staff, residents, and responsible parties when

issues arise and proactively responding to

concerns before they become a liability. In

addition, Administrators should have systems

in place to ensure that best practices are done

and documentation occurs for any change of

condition or abnormal action/event/activity.

The plan should also delineate when legal

representation is necessary and clarify the

process to retain an attorney.

50.16

Develop, implement, and evaluate the

organization’s quality assurance and

performance improvement programs. This

task requires the Administrator to develop

an effective QAPI (Quality Assurance and

Performance Improvement) program. This

includes following CMS guidelines related to

QAPI and establishing specic procedures,

policies, and systems to perform an effective

QAPI program. This also includes ensuring the

program is designed to meet the ever changing

needs of the facility/organization.

50.17

Lead organizational change initiatives. This

task requires the Administrator to demonstrate

leadership by carefully assessing the facility

needs, strategically developing effective methods

to meet these needs, and then communicating

the need for change(s) to the individuals affected.

All changes should include providing clear and

concise purpose related to the change and then

to effectively train, validate, and celebrate those

who participate in the change.

15.00

5.00

10.00

50.18

Facilitate effective internal and external

communication strategies. This task requires

the Administrator to develop methods of effective

communication, internally and externally. The

Administrator must establish a hierarchy of

individuals who communicate with eachother

via an organizational chart. The chart should

be available for residents/families/staff so

that it is clear who is responsible and who

has the authority to provide information. This

includes creating clear and concise messages

so that all staff are aware of how and what is

to be communicated and when the need for

assistance in communication is necessary. No

employee should ever feel that the total weight

of providing information rests on them. Training

and strategies should include not only verbal and

written communication but also electronic media

such as Facebook, blogs, and Twitter.

Human Resources

20.01

Ensure that human resources management

policies and programs comply with federal

and state rules and regulations. This task

requires the Administrator to create policies and

procedures that follow federal and state laws,

rules and regulations.

20.02

Establish the planning, development,

implementation, monitoring, and evaluation

of recruitment, selection, and retention

practices. This task requires the Administrator

to ensure the facility has systems in place

that will provide for a consistent, fair, and

predictable method of job development, job

hiring, job training, employee evaluation,

and continuing education. These systems

should follow the standards of the Fair Labor

Standards Act (FSLA).

20.03

Establish the planning, development,

implementation, monitoring, and evaluation

of employee training and development

programs. This task requires the

Administrator to have policies and procedures

in place to train managers/leaders to follow

and design basic and continuing education

programs aimed at evaluating individual

employee performance and training programs

that can meet the basic, continuing, or potential

education needs of the employee.

20.04

Establish the planning, development,

implementation, monitoring, and evaluation

of employee evaluation programs. This task

requires the Administrator to ensure that policies

and procedures are in place that clearly provide

instruction to managers/leaders to regularly

monitor employee performance and to timely

inform employees of when their performance

or adherence to procedures does not meet

standards. This should include timely formal

evaluation of the employee to communicate

areas of poor performance and areas that

employee meets and exceed facility standards.

20.05

Establish the planning, development,

implementation, monitoring, and evaluation

of compensation and benet programs.

This task requires the Administrator to ensure

that policies and procedures are in place for

employee compensation and benet programs.

This includes a formal method of informing

employees of their employee benets and

compensation.

5.00

20.00

5.00

20.06

Establish the planning, development,

implementation, monitoring, and evaluation

of employee health and safety programs.

This task requires the Administrator to ensure

that policies and procedures are in place

to prevent employee injury and encourage

employee wellness. This includes an effective

workers compensation or group retro program

and providing a health/wellness program that

gives employees the opportunity to attain health,

dental, vision, accident, pharmacy, and life

insurance programs.

20.07

Establish the planning, development,

implementation, monitoring, and evaluation

of employee satisfaction and organizational

culture. This task requires the Administrator

to ensure policies and procedures are in place

to measure employee satisfaction and that

results are taken seriously and considered.

This task also requires the Administrator to

develop an organization chart/structure that

will clearly communicate the organization

structure to employees.

20.08

Establish the planning, development,

implementation, monitoring, and evaluation

of employee disciplinary policies and

procedures. This task requires the

Administrator to have policies and procedures

in place that will set standards to objectively

measure employee performance. When

employee performance or behavior does not

meet standards, employees are made aware of

an allegation, and given an opportunity to give

an explanation of their performance or behavior

(give their side of the story), offer witnesses or

evidence that will support their statement, and/or

provide a written statement. Procedures should

state that the employees will be made aware if

an investigation will be done, if the employee

will be suspended pending investigation, and

that no discipline will be applied until a thorough

investigation is completed.

20.09

Establish the planning, development,

implementation, monitoring, and evaluation

of employee grievance policies and

procedures. This task requires the Administrator

to have policies and procedures in place to

clearly communicate with the employee a

formal program/grievance procedure in which

the employee, without fear of retaliation, can

communicate areas of frustration, abuse,

mistreatment, or concerns with the understanding

that a formal response will follow.

20.10

Establish the planning, development,

implementation, monitoring, and evaluation of

leadership development programs. This task

requires the Administrator to develop leadership

development programs not only for manager/

leaders but also for all employees. This may be

in the form of a formalized program designed by a

corporation, outside vendor, or the Administrator.

20.14

Ensure employee records and documentation

systems are developed and maintained.

This task requires the Administrator to ensure

employee records and correspondence are

protected and secure to other employees,

residents and unauthorized individuals.

5.00

2.50

50.19

Promote professional development of all team

members. This task requires the Administrator

to purposefully assess team members’ training

and experience and to facilitate an environment

that allows employees opportunities to grow

professionally. This would include internal and

external opportunities for employees who are

motivated to develop themselves professionally.

Nursing Department/Health Care Services

10.02

Ensure plans of care are evidence-based,

established, implemented, updated,

and monitored based on care recipient

preferences and assessed needs. This task

requires the Administrator to ensure that staff

implement a plan of care for each resident,

based on the individual needs and preferences,

under the direction of a physician. This task

includes a comprehensive assessment of

each resident/recipient. The comprehensive

assessment should include (but not limited

to) assessments for nutrition (to include diet,

texture, weight, swallowing), therapy, mobility,

fall risk, skin/wound management, medications

and contraindications, cognitive abilities,

behavior, mental health, and etc.

Also in Social Services

Module

10.03

Ensure the planning, development,

implementation/execution, monitoring

and evaluation of admission/move-in

process, including pre-admission/pre-

move in information, to promote a quality

experience for care recipients. This task

requires the Administrator to ensure that the

admission process is comprehensive and is

resident centered. This task includes obtaining

all available documentation at the time of

admission to include (but not limited to): power

of attorney for health care and nancial, resident

identication cards, insurance information, doctor

and all other orders related to the resident to

include hospital/doctors/clinic records pertaining

to the residents stay at the facility or services

provided by the organization.

Also in Social Services

Module

10.04

Ensure the planning, development,

implementation/execution, monitoring and

evaluation of discharge/move out process

to promote a quality experience for care

recipients. This task requires the Administrator

to ensure that resident care is appropriate

for the level of care they require and that an

interdisciplinary team continually monitors the

resident’s progress and recommends the best

care environment needed to maximize the

resident’s quality of living.

10.05

Ensure the planning, development,

implementation/execution, monitoring

and evaluation of programs to meet

care recipient’s psychosocial needs

and preferences. This task requires the

Administrator to ensure residents are properly

evaluated and cared for based on their

psychosocial needs and preferences.

10.08

Ensure the planning, development,

implementation/execution, monitoring, and

evaluation of medication management that

supports the needs of the care recipient.

This task requires the Administrator to ensure

that doctor’s orders are strictly followed and

that policies and procedures are in place to

assure compliance.

10.00

30.00

15.00

7.50

Also in Adm Module 10.11

Ensure the planning, development,

implementation/execution, monitoring

and evaluation of policies and procedures

for responses to care recipient incidents,

accidents, and or emergencies. This task

requires the Administrator to ensure that policies

and procedures are written and followed to

prevent incidents and accidents and to prepare

staff to act appropriately when incidents,

accidents, and emergencies occur.

Also in Social Services

Module

10.13

Ensure the planning, development,

implementation/execution, monitoring and

evaluation of education intended for care

recipients and their support networks. This

task requires the Administrator to ensure that

the care recipient and/or their responsible

party is informed of their care, condition, and

treatment as much as practical.

Also in Adm Module 10.16

Ensure care recipients rights and individuality

with all aspects of care. This task requires

the Administrator to ensure all staff are trained

and follow state and federal guidelines related to

resident rights. Attention must be made to issues

related to abuse, neglect, misappropriation of

resident property and mistreatment of residents.

Also in Adm Module 10.19

Ensure the provision of a customer service

culture that leads to a quality experience

for care recipients. This task requires the

Administrator to promote a resident centered

experience that serves each recipient

according to their choices and preferences as

much as practical.

Also in Adm and MX

Modules

20.11

Promote a safe work environment (such

as safety training and employee risk

management). This task requires the

Administrator to ensure effective policies and

procedures are in place to create an awareness

of safety throughout the workplace that include

reporting accidents, safety monitoring, re drills,

water, gas and electric shut off valves, and that

emergency generators are regularly tested.

40.03

Ensure the planning, development,

implementation, monitoring, and evaluation

of infection control and sanitation. This task

requires the Administrator to have policies and

procedures in place to effectively assure that

infection control and sanitation are properly

planned, implemented, and validated. This would

include, but not be limited to, training of personnel,

assuring proper supplies and resources are

available and effective communication through the

facility/operation/agency of reporting violations and

areas of concern.

Also in Bus Off Module 40.07

Ensure the planning, development,

implementation, monitoring, and evaluation

of appropriate HIPAA compliant technology

infrastructure. This task requires the

Administrator to ensure that HIPAA compliance is

assured by developing technology infrastructures,

technology safeguards (i.e., backup systems,

external data storage areas, preventative

maintenance for computer hardware and

software) and ongoing validation surveys.

40.11

Assess care recipients’ environment

for safety, security, and accessibility

and make recommendation for referral

or modication. This task requires the

Administrator to ensure that each recipient’s

personal environment and accessibility is

individually evaluated and accommodations

are made to provide the most independent,

comfortable, and safe environment possible.

5.00

2.50

5.00

2.50

5.00

2.50

50.06

Promote and monitor satisfaction of the care

recipient’s and their support networks. This

task requires the Administrator to develop a

system to monitor resident satisfaction. This

can be done by the Administrator being visible

through onsite visits with residents and family.

This can also be done through satisfaction

surveys and mock inspections. The successful

Administrator will generally perform a combination

of onsite visits, surveys, and daily interaction with

staff in the form of a stand up meeting.

50.08

Educate stakeholders on services provided,

regulatory requirements, and standards of

care. This task requires the Administrator to

develop a strategy to provide instruction and

resources to help the stakeholder to understand

facility, state, and federal requirements. It is also

important for stakeholders to understand facility

protocols (e.g. standards and services) that are

provided to meet residents needs and create a

home like environment to ensure resident safety

and choice are paramount.

Rehabilitation Department

10.09

Ensure the planning, development,

implementation/execution, monitoring and

evaluation of a rehabilitation program to

maximize optimal level of functioning and

independence for care recipients. This

task requires the Administrator to provide

individualized rehabilitative services to

recipients that will help them meet their

baseline and allow residents to be as

independent as possible.

Medical/Resident Records

10.07

Ensure the planning, development,

implementation/execution, monitoring

and evaluation of a health information

management program to meet documentation

requirements in compliance with federal

and state regulations. This task requires the

Administrator to ensure all resident specic

documentation is protected and follows state,

federal and HIPAA regulations.

Activities Department

10.06

Ensure the planning, development,

implementation/execution, monitoring and

evaluation of care recipient’s activities/

recreation to meet social needs and

preferences. This task requires the Administrator

to ensure activities, events, and programs are

resident centered and designed to meet the

needs and preferences of each resident.

15.00

10.00

20.00

Social Services/Admissions Department

Also in Nursing Module 10.03

Ensure the planning, development,

implementation/execution, monitoring

and evaluation of admission/move-in

process, including pre-admission/pre-

move in information, to promote a quality

experience for care recipients. This task

requires the Administrator to ensure that the

admission process is comprehensive and is

resident centered. This task includes obtaining

all available documentation at the time of

admission to include (but not limited to): power

of attorney for health care and nancial, resident

identication cards, insurance information, doctor

and all other orders related to the resident to

include hospital/doctors/clinic records pertaining

to the residents stay at the facility or services

provided by the organization.

Also in Nursing Module 10.04

Ensure the planning, development,

implementation/execution, monitoring and

evaluation of discharge/move out process

to promote a quality experience for care

recipients. This task requires the Administrator

to ensure that resident care is appropriate

for the level of care they require and that an

interdisciplinary team continually monitors the

resident’s progress and recommends the best

care environment needed to maximize the

resident’s quality of living.

Also in Nursing Module 10.13

Ensure the planning, development,

implementation/execution, monitoring and

evaluation of education intended for care

recipients and their support networks. This

task requires the Administrator to ensure that

the care recipient and/or their responsible

party is informed of their care, condition, and

treatment as much as practical.

10.18

Ensure transportation options are available

for care recipients. This task requires the

Administrator to ensure adequate transportation

to care recipients. The facility should identify

transportation that is available and the costs

(if any) for the services and inform recipients

and their responsible parties of availability and

cost. The facility/entity must be available to help

coordinate transportation services based on the

recipients preference and available funding.

Business Ofce/Financial Management

10.10

Ensure the planning, development,

implementation/execution, monitoring and

evaluation of systems for coordination and

oversight of contracted services. This task

requires the Administrator to ensure that services

are available to meet the needs of each recipient

from qualied vendors that meet city, state and

federal requirements.

30.01

Ensure that nancial management policies,

procedures, and practices comply with

applicable federal and state regulations.

This task requires the Administrator to create

policies and procedures that follow federal and

states laws, rules and regulations.

30.02

Develop, implement, and evaluate the

service provider’s budget. This task requires

the Administrator to have knowledge of the

budget process and have systems in place

to accurately set budgets based on income,

expense, capital improvements, and required

tasks of the organization.

10.00

3.75

5.00

15.00

30.03

Oversee the billing and collections process

and monitor the accuracy of charges and

timely collection of accounts. This task

requires the Administrator to have procedures

in place to timely and accurately bill for

resident care and services to appropriate

parties, insurances, or state and federal

agencies as appropriate. Systems should be

in place to make sure each recipient knows

and understands their bill so that timely

payments can be made to the facility.

30.04

Negotiate, interpret, and implement

contractual agreements to optimize nancial

viability. This task requires the Administrator

to ensure the facility/organization has written

agreements and contracts that include duration of

contract, liability insurance required and assured

for each party, language that includes duties of

each party and what steps are required to notify

each party of any breach of service, and details of

how to dissolve an agreement for poor service or

choice to use another vendor/contractor.

30.05

Develop, implement, monitor, and evaluate

nancial policies and procedures that

comply with Generally Accepted Accounting

Principles (GAAP). This task requires the

Administrator to ensure policies and procedures

are in place to direct staff on the steps to

accurately perform their duties. Direction must

be given to employees in the areas of payroll,

accounts receivable, billing, accurate record

keeping, internal controls, trust accounts,

HIPAA, etc.

30.07

Establish safeguards for the protection of the

service provider’s assets (such as insurance

coverage, risk management). This task

requires the Administrator to have knowledge and

provide leadership in risk management, internal

controls, workers compensation, and to prevent

unnecessary insurance/legal claims.

Also in Nursing Module 40.07

Ensure the planning, development,

implementation, monitoring, and evaluation

of appropriate HIPAA compliant technology

infrastructure. This task requires the

Administrator to ensure that HIPAA compliance is

assured by developing technology infrastructures,

technology safeguards (i.e., backup systems,

external data storage areas, preventative

maintenance for computer hardware and

software) and ongoing validation surveys.

50.13

Implement, monitor, and evaluate information

management and technology systems

to support service providers operations.

This task requires the Administrator to meet

all federal/state/community requirements for

information management of health records,

nancial information, and HIPAA. Safeguards to

employee, patient, resident, and client information

must be in writing and show evidence of training/

competency of all employees. In addition, the

Administrator must ensure there is a process in

place to protect access to information, secure and

track passwords, and back up and protect all data

in the community servers. Attention must also be

given to ensure all technology is designed/set up

to save employee time and allow more time for

patient/resident/client care.

15.00

10.00

2.50

10.00

50.14

Develop, implement, and monitor

comprehensive sales, marketing, and public

relations strategies. This task requires the

Administrator to develop an effective marketing

strategy designed to help the consumer,

resident or responsible party, and staff to

know the features, benets, and amenities of

the community/organization. The community/

organization should have clear policies,

standards, and protocols build consumer

condence. The Administrator should also have

clear policies/procedures on how to communicate

emergent/disaster solutions within and outside

the community. The Administrator must also

ensure that a marketing plan reects and

communicates what the community does/stands

for/has achieved in writing/action/advertisement/

brochure/word of mouth.

50.15

Ensure that written agreements between

the care recipient and the service providers

protect the rights and responsibilities of both

parties. This task requires the Administrator

to assure that all written agreements reect the

services provided to the resident and meets

Federal and State guidelines. This may include

having legal representatives review the written

agreements on a regular basis to ensure they

meet the most current regulations at the time and

protect the facility/community/resident. In relation

to a resident agreement/service plan/admission/

nancial agreement, the service provider/vendor

agreements should be carefully reviewed by the

Administrator, designated nancial person and,

when necessary, an attorney.

Dietary Department

Also in Adm and Nurs-

ing Modules

10.14

Ensure the planning, development,

implementation/execution, monitoring

and evaluation of nutritional needs and

preferences of care recipients. This task

requires the Administrator to ensure that the

care recipient’s nutritional needs are met in

accordance with their individualized needs and

preferences while simultaneously meeting all

physician-prescribed orders.

10.15

Ensure the planning, development,

implementation/execution, monitoring and

evaluation of dining experience that meets

the needs and preferences of care recipients.

This task requires the Administrator to ensure

that dining services are resident centered and

meet the nutritional needs paralleled with the

recipient preferences.

10.00

20.00

10.00

Housekeeping/Laundry Department

10.12

Ensure the planning, development,

implementation/execution, monitoring and

evaluation of housekeeping and laundry

services for care recipients. This task requires

the administrator to ensure a clean, safe, and

sanitary environment.

40.05

Ensure the planning, development,

implementation, monitoring, and

evaluation of environmental services,

housekeeping and laundry. This task

requires the Administrator to ensure that

policies and procedures are in place to

provide a comprehensive plan that assures

all environmental, housekeeping, and

laundry service departments meet or exceed

all local, state and federal requirements.

This task includes infection control, proper

temperatures, temperature logs, proper use

of chemicals and products used per MSDS,

preventative maintenance, and systems to

validate compliance.

40.08

Establish, maintain, and monitor physical

environment that provides clean, safe, and

secure home-like surroundings for care

recipients, staff, and visitors. This task

requires the Administrator to ensure policies and

procedures are in place to create a clean, home-

like environment that supports the well-being and

safety of all recipients. This task includes creating

a resident centered culture that promotes choice,

comfort, and cleanliness.

Environmental Management/Maintenance Department

20.11

Promote a safe work environment (such

as safety training and employee risk

management). This task requires the

Administrator to ensure effective policies and

procedures are in place to create an awareness

of safety throughout the workplace that include

reporting accidents, safety monitoring, re drills,

water, gas and electric shut off valves, and that

emergency generators are regularly tested.

40.01

Ensure that physical environment policies

and practices comply with applicable federal,

state and local laws and regulations. This

task requires the Administrator to create policies

and procedures that follow federal laws, rules

and regulations.

40.02

Ensure the planning, development,

implementation, monitoring, and evaluation

of a safe and secure environment. This task

requires the Administrator to have policies and

procedures in place that ensure the physical

plant, systems, equipment, and resources are

properly used and appropriate for the facility/

organization. It is required that the Administrator

understands, promotes, directs, and requires

supervision to maintain all equipment and

resources and continually validate the physical

plant to include (but not limited to) the facility,

grounds, equipment, tools, emergency systems,

re systems, and sprinklers.

5.00

7.50

5.00

2.50

5.00

40.06

Ensure the planning, development,

implementation, monitoring, and

evaluation of maintenance service

for property, plant and all equipment,

including preventative maintenance. This

task requires the Administrator to ensure

that policies and procedures are in place to

provide a comprehensive plan that assures

all maintenance services meet or exceed

all local,state, and federal requirements.

This task includes infection control, proper

temperature and temperature logs, proper use

of chemicals and products used per MSDS,

preventable maintenance, and systems to

validate compliance.

40.08

Establish, maintain, and monitor physical

environment that provides clean, safe, and

secure home-like surroundings for care

recipients, staff, and visitors. This task

requires the Administrator to ensure policies and

procedures are in place to create a clean, home-

like environment that supports the well-being and

safety of all recipients. This task includes creating

a resident centered culture that promotes choice,

comfort, and cleanliness.

40.09

Identify opportunities to enhance the physical

environment to meet changing market

demands. This task requires the Administrator to

regularly maintain the physical environment of the

facility/organization and to evaluate and monitor

changing trends within the market community to

keep the facility/organization current. This task

includes creating a chart/schedule for the normal

life of equipment and furnishings, using qualied

professionals to assess the interior/exterior

design of facility/organization, and developing

annual and capital budgets to prepare for

predicted capital spending.

40.10

Establish, maintain, and monitor an

environment that promotes choice, comfort,

and dignity for care recipients. This task

requires the Administrator to ensure policies

and procedures are in place to create an

environment that ensures color, accessibility,

design, temperature, and square footage are

appropriately appointed based on the residents

who reside in the care setting. Resident rooms

should allow the ability to decorate it based on

preferences and creativity as long as the room

meets federal and state safety requirements.

Other

7.50

10.00

3.75

5.00

30.00

Glossary

Term Meaning/Explanation/Denition

50 - Leadership &

Management

Abuse (1) Willful intent to cause harm. Abuse may be resident to resident or

staff to resident harm.(2) Fraud committed against a public program

such as Medicare or Medicaid

10.0 - Customer Care, Supports and Services

Access The ability of a person needing services to obtain those services. 10.0 - Customer Care, Supports and Services

Acquired Immune

Deciency Syndrome (AIDS)

A disease in which there is a severe loss of the body’s cellular immunity,

greatly lowering the resistance to infection and malignancy.

10.0 - Customer Care, Supports and Services

Activities Refer to any endeavor, other than routine activities of daily living,

in which a resident participates, that is intended to enhance his/her

sense of well-being and to promote or enhance physical, cognitive, and

emotional health. These include, but are not limited to, activities that

promote self-esteem, pleasure, comfort, education, creativity, success,

and independence.

10.0 - Customer Care, Supports and Services

Activities of Daily Living

(ADL)

Individual self-performance skills needed in everyday life such as

ambulation/locomotion, eating, toileting, grooming/personal hygiene,

and bathing.

10.0 - Customer Care, Supports and Services

Activity Therapist (AT) An allied health professional trained to develop and provide leisure time

activities for facility residents (patients).

10.0 - Customer Care, Supports and Services

Acuity The level of severity of a patient’s condition. For example, patients who

require intensive services are referred to as those having a higher level

of acuity in relation to those who require less care.

10.0 - Customer Care, Supports and Services

Acute Care Short-term, intense medical care for an episode of illness or injury often

requiring hospitalization.

10.0 - Customer Care, Supports and Services

Acute Conditions Episodic conditions that require short-term but intensive

medical interventions.

10.0 - Customer Care, Supports and Services

Administer The direct application of a vaccine or prescribed drug or device,

whether by injection, ingestion or any other means, to the body of a

resident (patient).

10.0 - Customer Care, Supports and Services

Administrator See NURSING HOME ADMINISTRATOR/NURSING FACILITY

ADMINISTRATOR

10.0 - Customer Care, Supports and Services

Admission Agreement A contract that spells out the services the nursing home will provide and

the cost of those services.

10.0 - Customer Care, Supports and Services

Adult Day Care A daytime program of nursing, rehabilitation therapies, supervision and

socialization that enables elderly people to remain in the community and

live with family. Services are generally provided on weekdays from 7

am to 6 pm to individuals who return home in the evening.

10.0 - Customer Care, Supports and Services

Advance Directive Written instructions from residents (patients) about the management

and provision of care if they become incapacitated (e.g., living wills, do

not resuscitate orders, durable power of attorney for healthcare).

10.0 - Customer Care, Supports and Services

Adverse Drug Reaction

(ADR)

Any unintended response to a drug which is injurious or harmful to

health and which occurs at normal doses.

10.0 - Customer Care, Supports and Services

Aged People who, by denition, in their culture have reached an advanced

age during which they may become less productive. In the U.S. they

are often referred to as senior citizens, especially after reaching age 65.

10.0 - Customer Care, Supports and Services

Ageism Prejudicial treatment of the elderly based on stereotypes

and misconceptions.

10.0 - Customer Care, Supports and Services

Aging-in-place Accommodating the changing needs of older adults while living in

familiar surroundings.

10.0 - Customer Care, Supports and Services

Agitation Verbal, vocal, and motor activities that are repetitive and outside of

socially acceptable norms.

10.0 - Customer Care, Supports and Services

Allopathic Medicine Medical approach--as practiced by physicians trained as doctors of

medicine (MDs)--that views medical treatment as active intervention

to produce a counteracting reaction in an attempt to neutralize the

effects of disease.

10.0 - Customer Care, Supports and Services

Alzheimer’s Disease A progressive degenerative disease of the brain, producing memory

loss, confusion, irritability, and severe functional decline. The disease

becomes progressively worse and eventually results in death.

10.0 - Customer Care, Supports and Services

Ambulation Moving about. 10.0 - Customer Care, Supports and Services

Ambulatory Able to walk with or without difculty or help. 10.0 - Customer Care, Supports and Services

Ambulatory Care

(Ambulatory Services)

Services that require the patients to come and receive needed services

at a community-based location. In a broader context, ambulatory care

can be any outpatient services such as a visit to the physician’s ofce,

clinic or outpatient surgery.

10.0 - Customer Care, Supports and Services

Annual Assessment An annual assessment of a resident’s (patient’s) physical, mental,

emotional, cognitive, and functional status.

10.0 - Customer Care, Supports and Services

Antianxiety Medication Psychoactive medications given to reduce anxiety (e.g., Ativan,

Valium, Xanax)

10.0 - Customer Care, Supports and Services

Antisepsis Removing or destroying microorganisms. 10.0 - Customer Care, Supports and Services

Aphasia Impaired ability to communicate. 10.0 - Customer Care, Supports and Services

Apraxia A speech disorder in which the tongue, lips, and vocal chords are

unable to work together. As a result, the person is unable to say what

he or she wants to say.

10.0 - Customer Care, Supports and Services

Asepsis Absence of harmful micro-organisms called pathogens. It refers to the

practice of clean procedures, such as hand-washing.

10.0 - Customer Care, Supports and Services

Aspiration The inhaling of foreign objects, such as food or beverages if swallowed

incorrectly into the lungs; results in introduction of bacteria from the

mouth and stomach into the lungs which can lead to pulmonary bacterial

infection known as aspiration pneumonia.

10.0 - Customer Care, Supports and Services

Assessment The process by which health care professionals attempt to reliably

characterize the patient’s physical health, functional abilities, cognitive

functioning, psychological state, social well-being, and past/current use

of formal services.

10.0 - Customer Care, Supports and Services

Assisted Living

Administrator

The person charged with operating an assisted living facility.

Audiologist A health care professional who is specially trained and licensed to provide

direct clinical services to individuals with hearing or balance disorders.

10.0 - Customer Care, Supports and Services

Autism A complex developmental disability that typically appears during the

rst three years of life and is the result of a brain disorder. It affects the

person’s social interaction and communication.

10.0 - Customer Care, Supports and Services

Autonomy A cluster of notions that include self-determination, freedom,

independence, and liberty of choice or actions.

10.0 - Customer Care, Supports and Services

Bed-hold When a patient is temporarily out of the facility (at a hospital or with

family), but the bed is being held and must be paid for.

10.0 - Customer Care, Supports and Services

Bedsore See PRESSURE SORE/ULCER 10.0 - Customer Care, Supports and Services

Behavioral Intervention Non-drug interventions used to change the resident’s (patient’s)

behavior or environment to lessen or accommodate the resident’s

(patient’s) behavioral symptoms.

10.0 - Customer Care, Supports and Services

Biophilia The human tendency to pay attention to, afliate with and respond

positively to nature.

10.0 - Customer Care, Supports and Services

Boarding Home A facility that offers room, and board and sometimes supervision of daily

activities. It does NOT offer health care.

10.0 - Customer Care, Supports and Services

Cardiologist A physician who specializes in the treatment of heart diseases. 10.0 - Customer Care, Supports and Services

Care Plan A plan designed to meet all of a resident’s (patient’s) identied

physical, mental, emotional, cognitive, and functional needs. The care

plan is generally the result of assessment and collaboration by an

interdisciplinary team of provider staff (also known as the Plan of Care).

10.0 - Customer Care, Supports and Services

Case Mix A system that uses resident (patient) attributes (e.g., functional

status in ADLs or cognitive abilities) to classify residents (patients)

for purposes such as reimbursement. This can also be a measure

of the intensity of care and services used by a group of residents

in a nursing facility. “Case” refers to the overall data collected and

used regarding an individual person under study. “Used” describes

the combination of variables (observations) used for classifying an

observation according to distinctive characteristics on the basis of a

dependent variable, such as time or costs.

10.0 - Customer Care, Supports and Services

Case Mix Index Each RUG (Resource Utilization Group) group is assigned a weight, or

numeric score, which reects the relative resources predicted to provide

care to a resident. The higher the case mix index (weight), the greater

the resource requirements are for the resident. Payment for each

resident is made monthly to the facility based on the case mix index for

the facility.

10.0 - Customer Care, Supports and Services

Centers for Medicare &

Medicaid Services (CMS)

Federal agency responsible for administering the Federal Medicare

and Medicaid programs. CMS headquarters is located in Baltimore,

Maryland. Formerly the Health Care Financing Administration, (HCFA).

Also administers Child Health Insurance Programs.

10.0 - Customer Care, Supports and Services

Certication The process by which federal and state governments determine if a

health care facility meets Medicare and/or Medicaid standards.

10.0 - Customer Care, Supports and Services

Certied Nursing Assistant

(CNA)

A nurse aide who has completed at least the minimum training

required by regulations.

10.0 - Customer Care, Supports and Services

Charge Nurse The nurse in charge or supervising a particular part of a facility for a

given time shift.

10.0 - Customer Care, Supports and Services

Chemical Restraint A psychoactive drug used by a facility for discipline or convenience and

not for medical treatment.

10.0 - Customer Care, Supports and Services

Chronic Continuing over a long period of time or recurring frequently. Chronic

conditions often begin inconspicuously and symptoms are less

pronounced than in acute conditions.

10.0 - Customer Care, Supports and Services

Chronic Care Care for residents (patients) who enter a nursing facility typically

because they have chronic illnesses that require more assistance than

they have available in their own home. The residents (patients) tend to

remain in the facility for several months to years.

10.0 - Customer Care, Supports and Services

Clinical Information System Information technology that is designed to be used by various clinicians

to support the delivery of patient care.

10.0 - Customer Care, Supports and Services

Clinical Pathway A care-planning tool that outlines, in a time sequence, important aspects

of care necessary for meeting specic outcomes.

10.0 - Customer Care, Supports and Services

Clinical Practice Guidelines Evidence-based standardized protocols indicated for the treatment of

specic health conditions.

10.0 - Customer Care, Supports and Services

Code of Federal Regulations

(CFR)

The codication of the general and permanent rules and regulations

(sometimes called administrative law) published in the Federal Register

by the executive departments and agencies of the federal government

of the United States. The Guidelines to Surveyors is part of these

regulations.

10.0 - Customer Care, Supports and Services

Comorbidity The simultaneous presence of two or more health problems. 10.0 - Customer Care, Supports and Services

Consultant Pharmacist Pharmacist who is contracted by the nursing home to do drug regimen

reviews and provide other services.

10.0 - Customer Care, Supports and Services

Continence The ability to self-regulate bladder and bowel elimination. 10.0 - Customer Care, Supports and Services

Continuing Care Retirement

Community (CCRC)

Also called a life-care community, it is an organization that integrates

and coordinates the independent living and other institution-based

components of the LTC continuum. Different levels of services are

generally housed in separate buildings, all located on one campus.

10.0 - Customer Care, Supports and Services

Continuum of long-term

care

The full range of long-term care services that increase in the level

of acuity and complexity from one end to the other -- from informal

and community-based services at one end of the continuum to the

institutional system at the other end.

10.0 - Customer Care, Supports and Services

Controlled Substance A drug, substance or immediate precursor included in Schedules I to

V of the Controlled Substance Act (e.g., morphine, acetaminophen

with codeine, oxycodone). Except as provided under the law, their

possession and use are illegal.

10.0 - Customer Care, Supports and Services

Cross-contamination Transfer of disease causing organisms through contact with a dirty

surface, unwashed hands, or insects.

10.0 - Customer Care, Supports and Services

Culture A society’s typical ways of behaving; its customs, morals and beliefs 10.0 - Customer Care, Supports and Services

Custodial Care Nonmedical care that includes routine assistance with the ADLs but

does not include active nursing or rehabilitative treatments. Such care

is provided to maintain function because the person’s overall condition

is not likely to improve.

10.0 - Customer Care, Supports and Services

Data Assessment and

Verication (DAVE)

A program administered by CMS designed to ensure accuracy of MDS

data accomplished through data analysis, off-site review, on-site review,

and provider education.

10.0 - Customer Care, Supports and Services

Debilitated Weak and inrm, unable to care for many personal needs 10.0 - Customer Care, Supports and Services

Dehydration A loss of the body’s normal water content which can affect both physical

and mental functions. Individuals with brain, kidney, or gastrointestinal

disease may nd it difcult to maintain a normal amount of water in the

body without the aid of medications.

10.0 - Customer Care, Supports and Services

Dementia A generic term that describes progressive and irreversible mental

dysfunction that results in complex cognitive decline. These cognitive

changes are commonly accompanied by disturbances of mood,

behavior and personality.

10.0 - Customer Care, Supports and Services

Dentition The makeup of a set of teeth including their kind, number,

arrangement and usability.

10.0 - Customer Care, Supports and Services

Depression An abnormal state of mind in which a person usually becomes inactive

and disinterested in his environment and lacks motivation.

10.0 - Customer Care, Supports and Services

Dermatologist A specialist physician who treats infections, growths, injuries, and other

disorders related to the skin.

10.0 - Customer Care, Supports and Services

Dietary history A review of a resident’s usual food intake patterns, including any food

preferences, chewing and swallowing problems, or difculties with self-

feeding that might affect overall food intake.

10.0 - Customer Care, Supports and Services

Dietitian Sometime referred to as nutritionist, a dietitian provides nutritional

information and diet-related services to residents/patients.

10.0 - Customer Care, Supports and Services

Director of Nursing (DON) A registered nurse responsible for supervising the activities, functions,

and training of nursing personnel.

10.0 - Customer Care, Supports and Services

Director of Nursing Services

(DNS)

See DIRECTOR OF NURSING (DON). 10.0 - Customer Care, Supports and Services

Discharge Planning A process that includes decisions about when a patient may need to

be discharged from the facility and what may be needed to make a

smooth transition from one level of care to another or from the facility

to living independently.

10.0 - Customer Care, Supports and Services

Dispense To deliver a prescribed drug to an ultimate user, including the compounding,

packaging, and labeling necessary to prepare the prescribed drug.

10.0 - Customer Care, Supports and Services

Do-Not-Resuscitate (DNR)

Order

An advance directive in which a person species that he or she does not

wish to have heartbeat or breathing restored in the event of a cardiac or

respiratory arrest.

10.0 - Customer Care, Supports and Services

Drug Any substance intended for use in the diagnosis, cure, mitigation,

treatment, or prevention of disease or other conditions in persons. Any

substance other than a device or food intended to affect the structure

or any function of the body of persons. In the survey guidelines, drug is

used in most cases to mean medication.

10.0 - Customer Care, Supports and Services

Drug Irregularity A drug that is given without a medical reason, in an excessive or

inadequate dose or duration of therapy, where side effects indicate that

a dose modication or drug discontinuation is indicated, or inadequate

monitoring for effect of manufacturer’s recommendations for laboratory

monitoring. This therapy results in potential negative outcomes or is

not achieving the stated objectives of the prescriber. The consulting

pharmacist should address this potential drug therapy problem at the

time of their drug regimen review.

10.0 - Customer Care, Supports and Services

Drug Regimen Review

(DRR)

The review of drugs being used by a resident (patient) to determine

effect and potential for harmful side effects.

10.0 - Customer Care, Supports and Services

Drug Utilization Review

(DUR)

The study of drug use patterns in a facility. 10.0 - Customer Care, Supports and Services

Dysarthria Slurred or unintelligible speech due to muscle weakness or other problem. 10.0 - Customer Care, Supports and Services

Dysphagia Difculty in swallowing due to a dysfunction in any phase of the

swallowing process.

10.0 - Customer Care, Supports and Services

Eden Alternative A cultural change that entails viewing the surroundings in facilities

as habitats for human beings rather than as facilities for the frail and

elderly, as well as applying the lessons of nature in creating vibrant and

vigorous settings.

10.0 - Customer Care, Supports and Services

Emphysema A chronic condition characterized by damaged air sacs in the lungs.

The resulting reduction of surface area available for gas exchange

makes breathing difcult and makes the heart work harder to circulate

blood through the lungs. All these changes make less oxygen available

to the body.

10.0 - Customer Care, Supports and Services

Energy metabolism The process in the body of breaking down calories consumed into

usable energy to allow the body to perform normal body functions.

10.0 - Customer Care, Supports and Services

Enforcement Grid A table developed by the Center for Medicare and Medicaid Services

that denes severity and scope of federal deciencies and indicates

whether plans of correction and remedies are necessary.

10.0 - Customer Care, Supports and Services

Enteral Feeding Delivery of liquid food through a tube directly into the stomach. 10.0 - Customer Care, Supports and Services

Epidemic Excessive prevalence of a negative health condition. 10.0 - Customer Care, Supports and Services

Epilepsy A brain disorder in which signals sent by nerve cells become disturbed,

causing strange sensations, emotions, convulsions, muscle spasms, or

loss of consciousness.

10.0 - Customer Care, Supports and Services

Esophagostomy Tube A small tube that enters a surgical incision on the side of the neck and is

generally removed after each feeding. The tube allows food to enter the

esophagus and then ow down into the stomach.

10.0 - Customer Care, Supports and Services

Ethics Committee A multidisciplinary forum that is generally called upon to make decisions in

the patient’s best interest, particularly when legal avenues are not clear-cut.

10.0 - Customer Care, Supports and Services

Evidence-Based Care Delivery of services using best practices that have been established

through clinical research.

10.0 - Customer Care, Supports and Services

Exempt Employees Salaried workers who are exempt from overtime provisions of the Fair

Labor Standards Act.

10.0 - Customer Care, Supports and Services

Extended Survey A federal survey conducted within 14 days of a nding of substandard

care during a standard federal survey (see also STANDARD SURVEY).

10.0 - Customer Care, Supports and Services

Extrapyramidal Symptoms

(EPS)

Abnormal movements of the mouth or tongue, pill rolling, tremors, rigid

movements, mask-like face, constant movement of legs or body, tics,

blinking, pacing, eyes rolled up, drooling.

10.0 - Customer Care, Supports and Services

Gait How a person walks. 10.0 - Customer Care, Supports and Services

Gastrostomy Tube (G-tube) A mechanism for delivering nutrition through a tube that passes through

a surgical opening in the abdomen and into the stomach.

10.0 - Customer Care, Supports and Services

Geriatric Medicine Also called geriatrics. The medical knowledge of physical disability

in older persons--including diagnosis, treatment, and prevention of

disorders. Geriatric medicine recognizes aging as a normal process,

not a disease state.

10.0 - Customer Care, Supports and Services

Geriatrician A physician with special training in geriatric medicine. In earlier years,

this training was self-taught through the special attention physicians

gave their older patients. Now, one- and three-year training programs,

which follow the regular medical curriculum, are established in a number

of teaching medical centers.

10.0 - Customer Care, Supports and Services

Gerontology The study of aging from the broadest perspective. Gerontologists

examine not only the clinical and biological aspects of aging but also

psychosocial, and historical conditions.

10.0 - Customer Care, Supports and Services

Green House A small freestanding facility designed to house 7 to 10 residents who

live together in a homelike setting. Generally, a number of Green

Houses are arranged around a central skilled nursing facility that

provides support services.

10.0 - Customer Care, Supports and Services

Guardian Legal representative, appointed by a court, to make decisions for a

person not competent to make their own decisions. Generally, resident

(patient) guardians have all of the legal rights normally granted to

competent residents (patients).

10.0 - Customer Care, Supports and Services

Harm Negative effect that has occurred to a resident (patient), infringement of

a resident’s (patient’s) rights, or compromising of a resident’s (patient’s)

ability to meet their highest practicable level of physical, mental or

psychosocial well being.

10.0 - Customer Care, Supports and Services

Hierarchy A Research Utilization Group methodology of assessment classication

where an assessment is placed in the rst classication category (there

are over 40 reimbursement categories) and where a match is found by

evaluating resident conditions and services. They are normally ordered

from highest to lowest, for example extensive services, rehabilitation,

special care, clinically complex, impaired cognition, behavioral

problems, and reduced physical functions. These categories vary from

time to time.

10.0 - Customer Care, Supports and Services

Holistic Model A philosophy that emphasizes that health care delivery should focus

not merely on a person’s physical and mental needs, but should also

emphasize well-being in every aspect of what makes a person whole

and complete.

10.0 - Customer Care, Supports and Services

Home Health Care Delivery of services such as nursing care and rehabilitation therapies to

patients in their own homes because such patients do not need to be in

an institution and yet are generally unable to leave their homes safely to

get the care they need.

10.0 - Customer Care, Supports and Services

Home Telehealth Systems Use of telecommunication technology for the distance monitoring of patients

and delivery of health care with or without the use of video technology.

10.0 - Customer Care, Supports and Services

Hospice Care As dened by Medicare, supportive services provided to terminally

ill patients and their families in the nal six months of a patient’s life.

This care is managed and coordinated by a certied Medicare hospice

provider. It is a program for caring for the dying, in order to enhance

quality of life rather than battling illness or warding off death.

10.0 - Customer Care, Supports and Services

Human Immunodeciency

Virus (HIV)

A virus that attacks the immune system, the body’s natural defense

system. Without a strong immune system, the body has trouble ghting

off disease. Both the virus and the infection it causes are called HIV.

10.0 - Customer Care, Supports and Services

Hypertension High blood pressure. 10.0 - Customer Care, Supports and Services

Hypnotic Medication A psychoactive medication given to sedate or calm (e.g., Sonata,

Restoril, Ambien).

10.0 - Customer Care, Supports and Services

Iatrogenic Complications caused by the process of medical care. 10.0 - Customer Care, Supports and Services

ICF/MR A federal certification for an Intermediate Care Facility for the

Mentally Retarded.

10.0 - Customer Care, Supports and Services

Incidence A quality indicator (QI) type from the Center of Health Systems

Research & Analysis (CHSRA) that provides a description of what

has taken place with a resident (patient) over the course of the last

two MDS or OASIS assessments.

10.0 - Customer Care, Supports and Services

Incontinence Lacking voluntary control over the bladder or bowel. In most people

incontinence can be treated and controlled, if not cured. Specic

changes in body function, often resulting from disease or the use of

medications, are the cause of incontinence.

10.0 - Customer Care, Supports and Services

Individual Program Plan A written statement of the services to be provided, as developed by

an interdisciplinary team, and based on a comprehensive functional

assessment of an individual’s active treatment needs.

10.0 - Customer Care, Supports and Services

Indwelling Catheter A catheter that remains in the bladder to drain urine into a bag. 10.0 - Customer Care, Supports and Services

Infantalization Treating older adults as children. 10.0 - Customer Care, Supports and Services

Infection Control A comprehensive program to prevent the transmission of infections to

protect the residents, the staff, and visitors from contracting infections

while in the facility.

10.0 - Customer Care, Supports and Services

Infectious Waste Hazardous waste that can pose health risks from communicable

infectious agents.

10.0 - Customer Care, Supports and Services

Informed Consent The person giving consent receives information necessary to make

a health care decision, including information about the benets,

reasonable risks, alternatives, the right to refuse, and consequences of

any treatment or service.

10.0 - Customer Care, Supports and Services

Initial Survey An on-site federal survey to determine whether a provider meets

the requirements to begin participating in the Medicare and/or

Medicaid programs.

10.0 - Customer Care, Supports and Services

Injury Physical, nancial, or emotional harm. 10.0 - Customer Care, Supports and Services

Instrumental (Independent)

Activities of Daily Living

(IADLs)

Activities that include meal preparation, housework (e.g., cooking),

managing nances (e.g., keeping a checkbook) or medications,

telephone use, shopping, and transportation (e.g., how one moves up

and down stairs, how one moves in and out of cars).

10.0 - Customer Care, Supports and Services

Interdependence A state of living together (symbiosis) in a mutually benecial relationship. 10.0 - Customer Care, Supports and Services

Interdisciplinary Team A facility team which allows involvement of multiple medical disciplines

in providing patient care; can consist of all or some of the following

professionals: physician, nurse, social worker/case manager, dietitian,

therapists, pharmacists, etc.

10.0 - Customer Care, Supports and Services

Internist A physician who specializes in treating diseases related to the internal

organs of the body.

10.0 - Customer Care, Supports and Services

Interoperable Electronic medical information that is available simultaneously to various

health care providers.

10.0 - Customer Care, Supports and Services

Jejunostomy tube (J-tube) A surgically placed tube that enters the small intestine for the delivery of

specialized nutritional formulas.

10.0 - Customer Care, Supports and Services

Learned Helplessness A psychological state in which patients believe that they can no longer

do anything for themselves and must depend on others.

10.0 - Customer Care, Supports and Services

License A duly-issued certicate that permits a person to practice or a nursing

home to operate in a given state.

10.0 - Customer Care, Supports and Services

Licensed Practical Nurse

(LPN)

A person licensed as a practical nurse by state statute. An LPN

performs simple acts in the care of convalescent, sub-acute or

chronically ill patients; or provides care to acutely ill patients under the

specic direction of a registered nurse, physician, podiatrist or dentist.

Similar to an LVN (Licensed Vocational Nurse) in some states.

10.0 - Customer Care, Supports and Services

Licensure The granting of a license to a provider that has been determined to meet

a state’s requirements for operation.

10.0 - Customer Care, Supports and Services

Living Will An advance directive specifying a person’s wishes regarding medical

treatment in the event this person becomes incompetent.

10.0 - Customer Care, Supports and Services

Long Term Care (LTC) A general term used to describe care in nursing homes. This term is also

used to describe a broader continuum of care for chronic and disabled

persons that include nursing homes, assisted living facilities, board and

care facilities, and community care such as home health agencies. It is

a variety of individualized and well-coordinated total care services that

promote the maximum possible independence for people with functional

limitations and that are provided over an extended period of time, using

appropriate current technology and available evidence-based practices, in

accordance with a holistic approach while maximizing both the quality of

clinical care and the individual’s quality of life.

10.0 - Customer Care, Supports and Services

Long Term Care Facility An institution, commonly referred to as a nursing home, that is duly

licensed to provide long-term care services.

10.0 - Customer Care, Supports and Services

Maintenance Rehabilitation Rehabilitation that is aimed at preserving the present level of function

and preventing secondary complications.

10.0 - Customer Care, Supports and Services

Malpractice Negligence or carelessness in the delivery of services according to

accepted standards of care so that harm is caused to the recipient of care.

10.0 - Customer Care, Supports and Services

Managed Care An approach to delivering a comprehensive array of health care

services to a dened group of enrolled members through efcient

management of service utilization and payment to providers.

10.0 - Customer Care, Supports and Services

MDS Completion Date The date at which the RN assessment coordinator attests that all

portions of the MDS have been completed.

10.0 - Customer Care, Supports and Services

Medicaid A state program that provides medical services to clients of the state

public assistance program and, at the state’s option, other needy

individuals, as well as supplements hospital and nursing facility (NF)

services that are mandated under Medicaid. States may decide on the

amount, duration, and scope of additional services. Generally, the only

types of institutions participating solely in Medicaid are Nursing Facilities

(NFs) and Intermediate Care Facilities for the Mentally Retarded (ICF/

MR). Also called Title 19 of the Social Security Act, it is a jointly funded

federal-state health insurance program for the indigent.

10.0 - Customer Care, Supports and Services

Medical Model Delivery of health care that places its primary emphasis on the

treatment of disease, relief of symptoms, and intensive use of medical

technology, with little emphasis on the promotion of optimum health in a

holistic context.

10.0 - Customer Care, Supports and Services

Medical Nutrition Therapy A diet ordered by a physician as part of treatment for a disease or

clinical condition, or to eliminate, decrease or increase specic nutrients

in the diet. (May also be called Therapeutic Diet).

10.0 - Customer Care, Supports and Services

Medicare A federal insurance program, as referenced in Title 18 of the Social

Security Act, providing a wide range of benets for specic periods

of time through providers and suppliers participating in the program.

Providers, are patient care institutions such as hospitals, hospices,

nursing homes, and home health agencies. Benets are payable

for most people over age 65, Social Security beneciaries under 65

entitled to disability benets, and individuals needing renal dialysis

or renal transplantation. Payment for services is made by the federal

government through designated scal intermediaries (FIs) and carriers

to the providers and suppliers.

10.0 - Customer Care, Supports and Services

Medicare Data

Communication Network

(MDCN)

A secure connection that is used to transmit MDS data to each state’s

repository. A user ID and password is issued for each person who

requires access to the CMS MDS intranet.

10.0 - Customer Care, Supports and Services

Medication Error Medications not given as intended by the prescriber, as required by the

drug manufacturer, or according to acceptable professional standards.

10.0 - Customer Care, Supports and Services

Mental Retardation Below-average intellectual functioning that is long term and incurable. 10.0 - Customer Care, Supports and Services

Minimum Data Set (MDS) A federally mandated resident assessment instrument used to assess

resident physical, mental, emotional, cognitive, and functional limitations

and strengths. The MDS must be administered to all residents in

Medicare- or Medicaid-certied facilities at the time of admission,

annually, quarterly, and when a signicant change in a resident’s

condition occurs.

10.0 - Customer Care, Supports and Services

Misappropriation The deliberate misplacement, exploitation, or wrongful, temporary or

permanent use of a resident’s (patient’s) belongings or money without

their consent.

10.0 - Customer Care, Supports and Services

Multidisciplinary (or

interdisciplinary)

A team approach to problem solving or delivery of care in which all key

disciplines, such as nursing, food service, therapy, social work, and

activities, participate and make joint decisions.

10.0 - Customer Care, Supports and Services

Multisensory Stimulation

(MSS)

Also known as “multisensory behavior therapy (MSBT),” it involves

stimulation of all the primary senses through a combined effect of textured

objects, soft music, colored lighting, aromas, and favorite foods.

10.0 - Customer Care, Supports and Services

Nasoduodenal Tube A mechanism for delivering nutrition through a tube that passes through

the patient’s nose and goes down into the duodenum, the rst part of

the small intestine.

10.0 - Customer Care, Supports and Services

Nasogastric tube (NG-tube) A method of delivering nutrition through a tube that passes through the

nasal openings, down to the esophagus, and into the stomach.

10.0 - Customer Care, Supports and Services

Neglect Failure to provide goods and services to prevent resident (patient) harm,

mental anguish, or mental illness.

10.0 - Customer Care, Supports and Services

Negligence Failure to exercise the degree of care that a reasonable person would

exercise in similar circumstances.

10.0 - Customer Care, Supports and Services

Nephrologist A physician who specializes in kidney diseases, kidney

transplantation, and dialysis therapy. Nephrology is classified as an

internal medicine subspecialty.

10.0 - Customer Care, Supports and Services

Nosocomial Infection in the

LTC Facility

An infection that develops after admission to the LTCF. Infections that

are incubating at the time of admission, or develop within 48 to 72 hours

of admission, usually are community-acquired or hospital associated if

the person was transferred from the hospital.

10.0 - Customer Care, Supports and Services

Nurse Aide Competency Federal and/or state training and capability requirements needed for

employment of nurse aides in nursing homes.

10.0 - Customer Care, Supports and Services

Nurse Aide Registry A listing of nurse aides who have met Federal and/or State training and

competency requirements needed for employment in nursing homes.

10.0 - Customer Care, Supports and Services

Nurse Aide, Nursing

Assistant (NA)

An unlicensed caregiver, under professional nurse supervision, who

provides nursing and professional care.

10.0 - Customer Care, Supports and Services

Nurse Practitioner A registered nurse who meets additional state requirements to meet

this designation. In some states, nurse practitioners may act as

physician extenders to conduct certain activities such as ordering

tests and medications.

10.0 - Customer Care, Supports and Services

Nursing Facility (NF) A nursing home that meets the requirements for Medicaid certication

as dened in 1919(a) of the Federal Social Security Act.

10.0 - Customer Care, Supports and Services

Nursing Home

Administrator (NHA)

Nursing Facility

Administrator (NFA)

Long-Term Care

Administrator (LTCA)

Administrator of Records

The person charged to operate a nursing home and licensed by the

state. “As the nursing home evolved, the title of the person was

changed from operator to nursing home administrator. Since then

the term nursing home has changed to nursing facility. A few states

changed nursing home administrator to nursing facility administrator.

However, the term nursing facility has not become popular.

Predominantly they are called nursing homes, so the title nursing

homes administrator (NHA) is likely to remain in vogue.” (Townsend,

et.al., page 7).

10.0 - Customer Care, Supports and Services

Nursing Home Quality

Improvement Initiative

A program of the CMS and U.S. Department of Health and Human

Services that compiles information about nursing home residents on

eight situations/conditions called quality measures (QMs) and makes

the information available to consumers.

10.0 - Customer Care, Supports and Services

Occupational Therapist (OT) A person licensed, certied, or registered under state statutes to perform

as an occupational therapist. Generally these individuals are certied

by the American Occupational Therapy Association (AOTA).

10.0 - Customer Care, Supports and Services

Occupational Therapy Specializes in the adaptive use of the upper extremities for performing

various tasks…evaluating and treating functional impairments in the

ADLs. Occupational therapists (OTs)also play a vital role in evaluating

the independent living environment when the patient is scheduled for

discharge to home.

10.0 - Customer Care, Supports and Services

Ombudsman Paid or voluntary staff that investigate nursing home complaints from

residents and their families and act as resident advocates addressing

concerns of nursing home residents. Many Ombudsman programs are

associated with state departments or boards of aging. An ombudsman is

a trained professional who works independently with area nursing home

residents and their families to resolve concerns they may have about

their lives in a facility.

10.0 - Customer Care, Supports and Services

Omnibus Budget

Reconciliation Act of 1987

(OBRA)

Changes to the Federal Social Security Act that signicantly changed

how nursing homes and home health agencies are regulated for

Medicare and Medicaid certication. A law that enacted reforms in

nursing facility care and provided the statutory authority for the MDS.

10.0 - Customer Care, Supports and Services

Oncology A medical specialty dealing with cancers and tumors. 10.0 - Customer Care, Supports and Services

One-to-one Programming Refers to programming provided to residents who will not, or cannot,

effectively plan their own activity pursuits, or residents needing

specialized or extended programs to enhance overall daily routine and

activity pursuit needs.

10.0 - Customer Care, Supports and Services

Online Survey/ Certication

and Reporting (OSCAR)

CMS database that includes Medicare and Medicaid certied facility

demographic information, results of on-site surveys, and aggregate

nursing home resident characteristics for comparison with state and

national peer information.

10.0 - Customer Care, Supports and Services

Ophthalmologist A physician who specializes in the treatment of diseases and injuries

of the eye.

10.0 - Customer Care, Supports and Services

Optician An optical technician who generally hold an associate’s degree in

optometry. An optician dispenses and ts eyeglasses.

10.0 - Customer Care, Supports and Services

Optometrist A licensed professional who holds a doctor of optometry (OD) degree and

is trained to diagnose and treat vision problems and other eye disorders.

They most commonly prescribe eyeglasses and contact lenses.

10.0 - Customer Care, Supports and Services

Orthopedist A physician who specializes in correcting deformities of the skeletal

system and may surgically repair bones and joints.

10.0 - Customer Care, Supports and Services

Osteopathic Medicine Medical approach -- practiced by doctors of osteopathic medicine (DOs)

-- that emphasizes the musculoskeletal system of the body such as

correction of joints and tissues.

10.0 - Customer Care, Supports and Services

Outcome The status of care provided to a resident (patient). 10.0 - Customer Care, Supports and Services

Palliation Medical care that is focused on relieving unpleasant symptoms such as

pain, discomfort, and nausea.

10.0 - Customer Care, Supports and Services

Palliative Care Management and support provided for the reduction or abatement of

pain, for other physical symptoms and psychosocial and spiritual needs

of individuals with terminal illness and includes physician services,

skilled nursing care, medical services, social services, services of

volunteers and bereavement services, but does not mean treatment

provided to cure a medical condition or disease to articially prolong life.

It is the alleviating of suffering where “cure” of underlying disease is no

longer possible.

10.0 - Customer Care, Supports and Services

Parenteral Nutrition (PN) Delivering a special liquid nutritional formulation directly into the blood

stream, when the gastrointestinal tract is not functioning properly.

10.0 - Customer Care, Supports and Services

Parkinson’s Disease A progressive disorder of the central nervous system. Clinically, the

disease is characterized by a decrease in spontaneous movements, gait

difculty, postural instability, rigidity and tremor. Parkinson’s disease is

caused by the degeneration of certain neurons in the brain.

10.0 - Customer Care, Supports and Services

Passivity A decline in human emotions, withdrawal from interactions with others

and surroundings, and a decrease in motor activity.

10.0 - Customer Care, Supports and Services

Pathogen Disease-causing organism. 10.0 - Customer Care, Supports and Services

Pathological Waste Waste that may contain human tissue, blood, or body uids. 10.0 - Customer Care, Supports and Services

Percentile Rank For the CHSRA QIs,a means of ranking providers based on how they

compare with each other on each separate QI. The higher a provider’s

percentile ranking, the more apt the provider is to have a care concern.

10.0 - Customer Care, Supports and Services

Person Appropriate

Activities

Refers to the idea that each resident has a personal identity and history that

involves more than just his/her medical illnesses or functional impairments.

(Miller, cited in The Long Term Care Survey, 2008, page 86).

10.0 - Customer Care, Supports and Services

Physiatrist A medical doctor who has specialized in physical medicine,

rehabilitation, and pain medicine.

10.0 - Customer Care, Supports and Services

Physical Restraint Devices that prevent or restrict resident (patient) movement. A device or

manual method that works to treat a medical symptom(s) but is attached

to or adjacent to the individual’s body so that freedom of movement or

normal access to one’s body is restricted.

10.0 - Customer Care, Supports and Services

Physical Therapist (PT) A person licensed, certied, or registered by state statute to perform as

a physical therapist. Generally, these individuals are certied by the

American Physical Therapy Association (APTA).

10.0 - Customer Care, Supports and Services

Physical Therapy Physical therapy or physiotherapy (often abbreviated to PT) is

a physical medicine and rehabilitation specialty that remediates

impairments and promotes mobility, function, and quality of life through

examination, diagnosis, prognosis, and physical intervention (therapy

using mechanical force and movements). Some examples of physical

therapy are strength training, tting and using articial limbs, training to

use canes and walkers.

10.0 - Customer Care, Supports and Services

Physician Assistant (PA) A person licensed or certied by state statute to perform as a physician

assistant. It is a trained professional who can perform physical

examinations, diagnose and treat illnesses, order and interpret laboratory

tests, and make rounds at LTC facilities under the direction of a physician.

10.0 - Customer Care, Supports and Services

Pioneer Network A national organization that began as a grassroots movement of

caregivers, consumer advocates, and others who were concerned about

the quality of life in nursing homes. The organization advocates cultural

change in nursing facilities through educating, sharing of ideas, and

forming coalitions with stakeholders such as regulators, ombudsmen,

consumers, and care professionals.

10.0 - Customer Care, Supports and Services

Plan of Correction (POC) A provider’s plan for how and when it will correct federal deciencies

and/or state violations.

10.0 - Customer Care, Supports and Services

Podiatrist A physician who treats patients with diseases or deformities of the feet. 10.0 - Customer Care, Supports and Services

Post-Acute Care Care for residents (patients) who are admitted to a facility following an

acute care hospitalization. Care may involve high-intensity rehabilitation or

clinically complex care. Most post-acute stays are for less than 30 days.

Some post-acute stays lead to long term admissions for chronic care.

10.0 - Customer Care, Supports and Services

Post-Survey Revisit An on-site provider visit intended to verify correction of deciencies and/

or violations cited during a survey.

10.0 - Customer Care, Supports and Services

Preadmission Screening/

Annual Resident Review

(PASARR)

Federally required screening of all nursing home residents, prior to

admission, to determine if the individual residents are mentally ill or

mentally retarded.

10.0 - Customer Care, Supports and Services

Pressure Sore/Ulcer An inamed lesion of the skin or internal mucous tissue caused by

pressure or friction. Pressure sores are classied (Stages 1 - 4) for

increasing severity.

10.0 - Customer Care, Supports and Services

Prevalence A type of QI or QM that provides a description of a resident or patient

at a point.

10.0 - Customer Care, Supports and Services

Primary Care Basic, routine, continuous, and coordinated medical care rendered by

a primary care physician or a mid-level provider such as a physician’s

assistant or nurse practitioner.

10.0 - Customer Care, Supports and Services

Prior Assessment The assessment that occurs in the most recent four months (46-165

days) preceding the target assessment (See Assessment and

Target Assessment).

10.0 - Customer Care, Supports and Services

Program of Activities Includes a combination of large and small group, one-to-one, and

self-directed activities; and a system that supports the development,

implementation, and evaluation of the activities provided to the residents

in the facilities.

10.0 - Customer Care, Supports and Services

Provider Initiative Project

(PIP)

A quality indicator information system for long term care developed by

the Center for Health Systems Research and Analysis (CHSRA) at the

University of Wisconsin-Madison that utilizes MDS assessment data.

10.0 - Customer Care, Supports and Services

Psychoactive Medication Medications used to change, modify, or alter an individual’s behavior

or mood. This general term includes antianxiety, antidepressant,

antipsychotic, and hypnotic medications.

10.0 - Customer Care, Supports and Services

Psychotropic Medications Psychoactive medications used to change, modify, or alter an

individual’s behavior or mood. This general term includes antianxiety,

antidepressant, antipsychotic, and hypnotic medications.

10.0 - Customer Care, Supports and Services

Personal User Identication

(PUID)

An individual logon that is unique to each staff member who uses the

ePIP system. New IDs can be requested at any time by contacting the

ePIP help desk.

10.0 - Customer Care, Supports and Services

QI Domain For the CHSRA QIs, the broad areas of care that represent the common

conditions and important aspects of care and life to nursing home

residents. Each domain is represented by one or more QIs.

10.0 - Customer Care, Supports and Services

Quality Assurance A provider program to monitor and study the quality of the services it

delivers, and to make recommendations for improvement. A designated

quality assurance committee usually coordinates this activity.

10.0 - Customer Care, Supports and Services

Quality Indicators (QIs) CHSRA’s indicators of provider level and resident (patient) level status

derived from MDS (OASIS) information. The QIs are pointers or

signposts of resident (patient) and/or provider care problems. QIs are

used by surveyors to help structure the survey process and can be used

by the provider to help monitor and improve their own performance.

10.0 - Customer Care, Supports and Services

Quality Initiative Survey

(QIS)

An initiative by CMS to move the facility survey process to completing

surveys on laptops using wireless technology. This will enable the

surveyors to communicate with each other via laptop throughout the

survey process itself.

10.0 - Customer Care, Supports and Services

Quality Measures (QMs) Publicly reported information made available by CMS to help consumers

assess the quality of nursing home care. There are two categories

of quality measures: (1) conditions relevant primarily to long-term

residents (patients) (chronic care), including decline in late loss ADLs,

pressure sores, residents with pain, physical restraints, and prevalence

of infections; and (2) short-stay (temporary) residents (patients) (post-

acute care), specically prevalence of delirium, residents with pain, and

improvements in walking. Many of the QMs are based on, and virtually

identical to, QIs.

10.0 - Customer Care, Supports and Services

Quality of Care General area of the federal nursing home requirements that addresses

specic issues.

10.0 - Customer Care, Supports and Services

Quality of Life General area of the federal nursing home regulations that addresses

resident (patient) life issues such as dignity, participation in activities,

social services, accommodation of needs, and the facility’s environment

such as lighting, sound, temperature and homelike environment.

10.0 - Customer Care, Supports and Services

Quarterly Assessments MDS assessments required each quarter for all residents (patients) in

Medicare and/or Medicaid facilities.

10.0 - Customer Care, Supports and Services

Range of Motion (ROM) The extent or magnitude of a resident’s (patient’s) joint movement. 10.0 - Customer Care, Supports and Services

Reality Orientation A form of therapy for confused or disoriented individuals that consists

of reiteration of the person’s identity, orientation to time and place, and

reinforcement of consistency in daily routine. Repeated attempts are

made to draw the person into conversation, using simple questions,

pictures, or whatever may spark their interest.

10.0 - Customer Care, Supports and Services

Recreational Therapist (RT) A person certied, by a recognized certifying organization, to perform as

a recreational therapist.

10.0 - Customer Care, Supports and Services

Registered Dietitian The health professional designated to oversee food and nutrition

services in acute and long-term care settings by both the Centers

for Medicare and Medicaid Services and the Joint Commission on

Accreditation of Healthcare Organizations; this professional has

received a degree in nutrition science, completed a 1,000-hour

dietetic internship, and passed a comprehensive national registration

examination - a minimum of 15 continuing education hours must be

obtained and approved by the Commission on Dietetic Registration for

the registered dietitian credentials to be maintained.

10.0 - Customer Care, Supports and Services

Registered Dietitian (RD) A person registered as a dietitian by state statute or the American

Dietetics Association.

10.0 - Customer Care, Supports and Services

Registered Nurse (RN) A person registered as a nurse by state statute. 10.0 - Customer Care, Supports and Services

Registered Pharmacist

(RPh)

A person registered as a pharmacist by state statute. 10.0 - Customer Care, Supports and Services

Regulations Federal requirements promulgated to “esh out” the statutory requirements

in the Social Security Act (see also Rules and Statutory Requirement).

10.0 - Customer Care, Supports and Services

Resident Assessment

Instrument (RAI)

A tool to help facilities identify residents’ needs and strengths and

develop an appropriate care plan. The federal RAI system includes:

the MDS, RAPS, and utilization guidelines. It is the designation for the

complete resident assessment process mandated by CMS, including the

comprehensive MDS, RAPS, and care planning decisions.

10.0 - Customer Care, Supports and Services

Resident Assessment

Protocols (RAPs)

Eighteen problem-oriented guides for care planning with “trigger”

conditions to signal the need for additional assessment and review (e.g.,

activities RAP, mood state RAP, pressure ulcer RAP, etc.). Checking

certain boxes or combination of boxes upon lling out the MDS

form trigger the requirement for that resident’s care plan to address

condition(s) identied as in need of special attention.

10.0 - Customer Care, Supports and Services

Resident Centered Care Practices that encourage residents to be involved in making decisions

about their care and daily activities; examples of resident-centered

dietary functions include cook-to-order eating schedules, resident-

involved menu planning, and buffet style or family dining meal service.

10.0 - Customer Care, Supports and Services

Resource Utilization Groups

(RUGS)

A collection of nursing facility resident classication systems used in a

variety of case mix indexed reimbursement systems. Using assessment

tools like the MDS 3.0, these systems group residents by expected level

of resource utilization, usually based upon staff time measurements per

resident per day. Relative resource utilization is reected in a case mix

index (CMI) value assigned to each RUG cell.

10.0 - Customer Care, Supports and Services

Respite Care Any temporary long-term care service (adult day care, home health, or

temporary institutionalization) that focuses on giving family caregivers time

off while the patient’s care is taken over by the respite care provider.

10.0 - Customer Care, Supports and Services

Scope The extent or magnitude of decient facility practice on resident (patient)

outcome. There are three levels of scope as described in the Federal

Enforcement Grid (see also ENFORCEMENT GRID)

10.0 - Customer Care, Supports and Services

Sentinel Health Events Signicant conditions or events that exist for only a single case or a few

cases. For the CHSRA QI, they may represent a signicant problem

that needs to be investigated (e.g., fecal impaction, dehydration,

pressure ulcers--low risk).

10.0 - Customer Care, Supports and Services

Septicemia Also called “blood poisoning,” it is a rapidly progressing and life

threatening infection due to the presence of bacteria in the blood.

10.0 - Customer Care, Supports and Services

Severity The effect of seriousness of decient facility practice on resident

(patient) outcome. There are four levels of severity as described in the

Federal Enforcement Grid (see also ENFORCEMENT GRID).

10.0 - Customer Care, Supports and Services

Shelf-Stable Food Preserved (often canned or boxed) food which is able to be stored at

room temperature for long periods and made ready for service in an

emergency situation without the use of electricity.

10.0 - Customer Care, Supports and Services

Short-Term Stay Admission and discharge of a nursing home resident (patient) that

occurs in less than 14 days.

10.0 - Customer Care, Supports and Services

Side Effect Undesirable effect of a medication that causes minimal discomfort

in some people.

10.0 - Customer Care, Supports and Services

Signicant Change A major decline or improvement in a resident’s status that will not

normally resolve itself without further intervention by staff or by

implementing standard disease-related clinical interventions, that has an

impact on more than one area of a resident’s health status and requires

interdisciplinary review or revision of the care plan, or both.

10.0 - Customer Care, Supports and Services

Signicant Change in

Condition

A substantial modication in a resident’s (patient’s) physical, mental,

emotional, cognitive, or functional status that requires a new assessment

using the MDS instrument, and also generally requires notication of the

resident’s (patient’s) attending physician, family, or guardian.

10.0 - Customer Care, Supports and Services

Signicant Medication Error Medication error that cause a resident (patient) discomfort and/or

jeopardizes his/her health and safety.

10.0 - Customer Care, Supports and Services

Signicant Weight Loss The threshold used to determine when intervention and documentation

is required to prevent under-nutrition from excessive weight loss; in the

long term care setting, signicant weight loss is 5% in 30 days, 7.5% in

90 days and 10% in 180 days.

10.0 - Customer Care, Supports and Services

Skilled Nursing Facility (SNF)

Skilled Nursing Facility

(SNF)

A nursing home that meets the requirements for Medicaid certication

as dened in 1819(a) of the Federal Social Security Act. Also the term

used by most states to dene the type of nursing home that is licensed

to provide the highest level of care.

10.0 - Customer Care, Supports and Services

Social Security Act Federal statutory law that includes the requirements for participation in

the Medicare and Medicaid programs.

10.0 - Customer Care, Supports and Services

Speech Language

Pathology

Encompasses evaluation and treatment of speech, language, and

cognitive disorders; treats several kinds of disorders such as aphasia,

dysarthria, and dysphagia.

10.0 - Customer Care, Supports and Services

Speech Pathologist (SP) A person licensed, certied, or registered by state statute to perform as

a speech pathologist.

10.0 - Customer Care, Supports and Services

Speech Therapist (ST) A person licensed, certied, or registered by state statute to perform as

a speech therapist.

10.0 - Customer Care, Supports and Services

Standard of Care The duty to have and to use the degree of knowledge and skill that is

usually possessed and used by competent, health care providers in

similar circumstances.

10.0 - Customer Care, Supports and Services

Standard Precautions (SP) General infection control precautions to be used when delivering hands-

on care to any patient, or when handling soiled articles of linen and

clothing. It requires the use of gloves, gowns, and masks as necessary

to avoid contact with body uids.

10.0 - Customer Care, Supports and Services

Standard Survey An on-site federal survey of nursing homes conducted every 9-15

months to determine compliance with federal regulations for Medicare

and/or Medicaid.

10.0 - Customer Care, Supports and Services

State Operations Manual

(SOM)

The title given to the current set of requirements and guidelines to

surveyors. Current edition with changes in red can be downloaded from

the CMS web site, www.cms.gov

10.0 - Customer Care, Supports and Services

Statement of Deciency

(SOD)

A written summary of noncompliance with regulations found during a

federal provider survey or complaint investigation (see also VIOLATION).

Statements of deciency are written on a CMS 2567 form.

10.0 - Customer Care, Supports and Services

Stoma An articially created opening in the body. 10.0 - Customer Care, Supports and Services

Stroke A sudden interruption in the blood supply of the brain. Most strokes are

caused by an abrupt blockage of arteries leading to the brain (ischemic

stroke). Other strokes are caused by bleeding into brain tissue when a

blood vessel bursts (hemorrhagic stroke).

10.0 - Customer Care, Supports and Services

Subacute Type of nursing home care that is generally considered above skilled

nursing but below acute hospital care.

10.0 - Customer Care, Supports and Services

Substandard Care Substandard quality of care is any deciency in 42 CFR 483.13 --

Resident Behavior and Facility Practice, 42 CFR 483.15 -- Quality of

Life or 42 CFR 483.25 -- Quality of Care that constitutes immediate

jeopardy to resident (patient) health or safety; or a pattern of or

widespread actual harm that is not immediate jeopardy; or a widespread

potential for more than minimal harm that is not immediate jeopardy,

with no actual harm. On the Federal Enforcement Grid, substandard

care equates to boxes F, H, I, J, K and L, and also results in imposition

of penalties (see also ENFORCEMENT GRID). Four elements are

required for a civil lawsuit: (1) duty owed, (2) breach or violation of that

duty, (3) damage or injury, and (4) causation. (see the Enforcement

Grid)” to the end of denition.

10.0 - Customer Care, Supports and Services

Substantial Compliance Minor deciencies or violations, but a facility generally meets the

intent of federal or state regulations. On the Federal Enforcement

Grid, Substantial Compliance is equated to boxes A-C (see also

ENFORCEMENT GRID).

10.0 - Customer Care, Supports and Services

Target Assessment The most recent full or quarterly assessment that is available for the

time in which the QM score is calculated (see ASSESSMENT and

PRIOR ASSESSMENT).

10.0 - Customer Care, Supports and Services

Temperature Danger Zone The temperature range of 40F (5C) and 140F (60C) in which food

bacteria thrive and multiply rapidly.

10.0 - Customer Care, Supports and Services

Terminal Care Care provided to a dying resident (patient) that may or may not include

hospice care (see also HOSPICE CARE).

10.0 - Customer Care, Supports and Services

Texture Modication Changing the consistency of food offered to a resident to help

accommodate difculties in chewing or swallowing; textures can include

chopped food (the size of green peas), ground food (the size of apple

seeds), and pureed food (the consistency of smooth mashed potatoes).

10.0 - Customer Care, Supports and Services

Therapeutic Diet A diet ordered by a physician as part of treatment for a disease or

clinical condition, or to eliminate, decrease or increase specic nutrients

in the diet. (May also be called Medical Nutrition Diet).

10.0 - Customer Care, Supports and Services

Threshold A set point for each CHSRA QI at which the likelihood of a problem is

sufcient to warrant further investigation. There may also be a concern

below the threshold especially if the percentile rank is close to the

threshold. Generally, the threshold point is set at the 90th percentile

(see also PERCENTILE RANK).

10.0 - Customer Care, Supports and Services

Transfer (1) Movement of a patient from one surface to another, such as from a

bed to a chair, or from a wheelchair to a car seat. (2) Movement of a

patient from one facility to another.

10.0 - Customer Care, Supports and Services

Transitional Care Unit (TCU) A skilled nursing unit located within a hospital. 10.0 - Customer Care, Supports and Services

Transmission-based

Precautions

Infection control precautions to follow when caring for patients who

have communicable disease. These precautions are used in addition to

standard precautions.

10.0 - Customer Care, Supports and Services

Universal Precautions Measures taken to prevent transmission of infection from contact with

blood or other body uids or materials having blood or other body uids

on them, as recommended by the U.S. Public Health Services Centers

for Disease Control and adopted by the US Occupational Safety and

Health Administration (OSHA) as 29 CFR 1910.1030.

10.0 - Customer Care, Supports and Services

Unnecessary Drug Any of the following: drug that is given without a medical reason; drug

given in excessive dose; drug given for an excessive amount of time; drug

without adequate monitoring; drug given with side effects and/or adverse

reactions that indicate the drug should be reduced or discontinued.

10.0 - Customer Care, Supports and Services

Validation Therapy A type of therapy in which a person’s belief that he or she is actually

living in the past is accepted and validated by staff members working

with the patient.

10.0 - Customer Care, Supports and Services

Variance The granting of an alternate requirement in place of a federal or

state regulation.

10.0 - Customer Care, Supports and Services

Ventilator A small machine that takes over the breathing function by automatically

moving air into and out of the patient’s lungs.

10.0 - Customer Care, Supports and Services

Violation A written summary of noncompliance with regulations found

during a state provider survey or complaint investigation (see also

STATEMENT OF DEFICIENCY). The written document is generally

called a Notice of Violation.

10.0 - Customer Care, Supports and Services

Vital Signs Generally, body temperature, pulse rate, blood pressure, and respiratory

rate are referred to as vital signs. Any abnormalities in these measures

should trigger further clinical evaluation.

10.0 - Customer Care, Supports and Services

Waiver The granting of an exemption from a federal or state regulation (see

also VARIANCE).

10.0 - Customer Care, Supports and Services

Immediate Jeopardy (IJ) A situation in which a provider’s noncompliance with one or more

regulations has caused, or is likely to cause, serious injury, harm,

impairment, or death to a resident (patient). (42 CFR Part 489.3.)

10.0 - Customer Care, Supports and Services

& 50.0 - Leadership & Management

Adverse Impact Under the Civil Rights Act of 1964 and its amendments, adverse impact

occurs whenever the selection rate for any protected group is less

than 80% of the rate for the group with the highest rate. The focus is

on the hiring standard used by the employer as a method of screening

applicants. “The burden of proof is on the employer to show that a

hiring standard is job related.”

20.0 - Human Resources

Afrmative Action Review of a facility’s hiring practices (recruiting, advertising, and data

on the applicants) by the federal government to ensure conformity to

the 1964 Civil Rights Act and its amendments. Legal violations can be

processed if it is determined that the facility has discriminated based on

age, sex, marital status, race, religion, handicap or national origin.

20.0 - Human Resources

Arbitration Utilization of a third party to resolve disputes. As used here, this

concept is related to facilities that have unions. The third party hears

the arguments on both sides and then makes a decision which is

binding on both the union and the facility.

20.0 - Human Resources

Bargaining Unit Determination by the National Labor Relations Board of which workers

will be grouped together for the purposes of forming or taking steps

towards forming a union.

20.0 - Human Resources

Benets (Fringe Benets) Compensation other than wages paid to workers, such as paid vacation/

leave, paid health insurance, and retirement plans.

20.0 - Human Resources

Career Ladder Paths or promotion routes established by the organization along which

employees can seek to progress, such as nancial assistance and

release time to CNAs who seek to become a licensed nurse, or a

licensed practical nurse who seeks to become a registered nurse.

20.0 - Human Resources

Career Paths Dened avenues for upward mobility available to employees within an

organization (similar to career ladder.)

20.0 - Human Resources

Clinical Approach to Hiring

Decision

A hiring technique in which the employer makes the decision after

reviewing all the information in hand about the match of the applicant

and the job (see also STATISTICAL APPROACH.)

20.0 - Human Resources

Coaching Either help given by a superior to a subordinate, or personal assistance

from a person who is not the employee’s supervisor, but may be a

manager of another division or from outside the company.

20.0 - Human Resources

Collective Bargaining Bargaining by groups of workers recognized and constituted through

supervised election procedures under the National Labor Relations Board.

20.0 - Human Resources

Compensation Management Determining and administering wage, incentive, and benet programs

for a facility.

20.0 - Human Resources

Compensation Theory Ideas or approaches to the functions of wages and benets in

motivating employees to meet the requirements of the employer (see

e.g., EQUITY THEORY).

20.0 - Human Resources

Controlling (as a managerial behavior) Determination by administration of how well

jobs have been done and what progress is being made to achieve the

organization goals, then taking necessary corrective actions to achieve

these goals. It is the process of monitoring, evaluating and correcting.

20.0 - Human Resources

Cost of Living Allowance

(COLA)

Upward adjustments in wages during times of ination to assist workers

to maintain their purchasing power.

20.0 - Human Resources

Cultural Competency The ability of service agencies to understand the world view of clients of

different cultures, and adapt practices to ensure their effectiveness.

20.0 - Human Resources

Cultural Diversity The mosaic of individuals and groups with varying backgrounds,

experiences, styles, perceptions, values and beliefs.

20.0 - Human Resources

Discrimination The use of any selection procedure which has an adverse impact on the

hiring, promotion or other employment or membership opportunities of

members of any race, age, religion, marital status, sex, or national origin.

20.0 - Human Resources

Employee Assistance

Program (EAP)

24-hour, 7-day-a-week condential telephone service providing

assistance to employees on matters such as child and elder care,

substance abuse, nancial counseling, etc.

20.0 - Human Resources

Employee Handbook A compilation of the facility policies that directly relate to work

conditions. It is often treated as a binding contract by the courts.

20.0 - Human Resources

Empowerment The concept of encouraging and authorizing workers to take the initiative

to improve operations, reduce costs, and improve quality of services.

20.0 - Human Resources

Equal Employment

Opportunities Commission

(EEOC)

The organization created by the Civil Rights Act of 1964 to carry out

the provisions of that act. The EEOC also administers the Americans

with Disabilities Act of 1990 (ADA), the Age Discrimination in

Employment Act of 1967 (ADEA), Equal Pay Act of 1963 (EPA), The

Pregnancy Discrimination Act of 1978, and the Genetic Information

Nondiscrimination Act (GINA).

20.0 - Human Resources

Equity Theory Concept that employees seek an exchange in which their wages and

benets are equal to their work effort, especially when compared to

wages and benets being paid to similarly situated co-workers.

20.0 - Human Resources

Error of Central Tendency Error by supervisors using rating scales in employee evaluations when

consistently giving only moderate scores to employees on performance

appraisals, regardless of whether the employee is a poor or an

outstanding performer.

20.0 - Human Resources

Expectancy Theory Belief that the level of motivation to perform (make an effort at work) is a

mathematical function of the expectations individuals have about future

outcomes multiplied by the value the employee places on these outcomes.

20.0 - Human Resources

Federal Mediation and

Conciliation Service (FMCS)

A federal agency making government facilities available for conciliation,

mediation and voluntary arbitration of labor disputes.

20.0 - Human Resources

Flex Time A program allowing employees to choose the hours they work, so long

as they put in the expected number of hours per time period.

20.0 - Human Resources

Flexible Spending Account An optional benet in which employees can set aside a designated

amount of funds for future medical services. As medical services

are incurred, the charge is made against the account. The funds are

usually a pre-tax withdrawal from the employees check. This optional

benet must be a careful calculation and is usually for persons that

have consistent or relatively high medical expenses. There is an

administrative fee from the processing agent and funds not used can’t

be carried over to the next year.

20.0 - Human Resources

Global Rating A summary score based on the components of a performance appraisal. 20.0 - Human Resources

Goal Setting Setting of objectives to be achieved by an employee before the next

performance appraisal.

20.0 - Human Resources

Grievance Procedure The established method, and outlined in the employee handbook, by

which an employee can have any decision of a supervisor reviewed by

higher level management with the organization.

20.0 - Human Resources

Halo Effect Error made by supervisors using rating scales in an employee

evaluation where they value one particular type of job behavior and

permit the presence or absence of that one trait to color several or most

other trait ratings.

20.0 - Human Resources

Health Insurance A fringe benet available to many nursing facility employees. Typically

the employee is covered free or shares in the cost, and can obtain

family coverage for an additional periodic payment.

20.0 - Human Resources

Health Insurance Portability

and Accountability Act

(HIPAA)

Established principles of patient privacy and condentiality regarding use

and misuse of their personal medical information and records, as well as

standards for communication, storage and transmission of information.

20.0 - Human Resources

Human Resource

Management

The organizational function of planning for human resource needs,

recruitment, selection, compensation, development, evaluation, and

handling of grievances and labor relations.

20.0 - Human Resources

In Migration--Out Migration Movement of laborers into or out of the geographic area within which a

facility is recruiting for specic positions.

20.0 - Human Resources

Individual Bargaining Individuals with skills especially needed by a facility may be able to

negotiate a higher wage than other employees in similar positions.

20.0 - Human Resources

In-Service Training Seminars, online programs, DVDs, workshops, etc., offered during the

work career of the employee. An “in-service” is an educational session.

20.0 - Human Resources

Job A collection of tasks assigned to an employee. 20.0 - Human Resources

Job Analysis The process of dening a position in terms of tasks or behaviors required,

specifying the qualication of the employee to be assigned those duties.

20.0 - Human Resources

Job Bidding The practice of posting available jobs on bulletin boards and

encouraging employees to apply or bid for openings.

20.0 - Human Resources

Job Description A statement of the tasks to be done based on the job analysis,

usually including a list of duties and responsibilities of the position in

order of importance.

20.0 - Human Resources

Job Evaluation The process of assessing and rating all jobs in an organization as a

basis for the wage and salary system.

20.0 - Human Resources

Job Family A group of two or more jobs that have similar duties, for example, the

duties of the registered nurse and licensed nurse practitioners.

20.0 - Human Resources

Job Posting Same as job bidding; a form of internal recruitment in which job openings

are posted on the bulletin boards, inviting employees to bid.

20.0 - Human Resources

Job Specication A statement of the skills, education, and experience required to perform

the work. This is derived from the job description.

20.0 - Human Resources

Job Title Naming of the job to distinguish from all other jobs, often indicating

level, e.g., Supervisor II.

20.0 - Human Resources

Job Worth Establishing the value of a job by comparing it to all other jobs

accomplished by an organization.

20.0 - Human Resources

Key Job Comparison A method of establishing wage rates for jobs, based on comparing all jobs

in the organization to a touchstone job in the facility, such as nursing.

20.0 - Human Resources

Labor Market The geographic area from which applicants for positions are to be recruited. 20.0 - Human Resources

Layoff Temporary dismissal of workers from their jobs due to lack of work,

not “for cause.”

20.0 - Human Resources

Leniency Error Consistently giving high ratings to all employees when evaluating in an

attempt to avoid conict.

20.0 - Human Resources

Life Insurance Some facilities offer free or shared fees for life insurance (a specic

payment amount upon the death of the insured), usually term type life

insurance, as a benet. Term insurance features low premiums or high-

dollar coverage, but has no cash, loan or other value.

20.0 - Human Resources

Line Manager Person responsible for performing most of the personnel functions, who

is delegated authority by the administrator to make decisions on his/her

behalf and authority to commit facility resources.

20.0 - Human Resources

Manpower Inventory A projection of the present and future availability of qualied personnel

in a number sufcient to meet facility needs.

20.0 - Human Resources

Mediation Another concept that is related to facilities that are unionized. In this

case, the third party seeks to reach a settlement between the union and

the facility on an issue.

20.0 - Human Resources

Mentor An individual who agrees to advise a person over a set period of time. 20.0 - Human Resources

National Labor Relations

Board

An organized panel set up to administer the process under the National

Labor Relations Act, under which unions become certied as the

bargaining agents for groups of workers.

20.0 - Human Resources

Nepotism Favoring one’s family members in hiring practices. 20.0 - Human Resources

On-The-Job-Training Assignment of employee to one staff member who assists the employee

to acquire the capabilities required to perform job duties within the facility.

20.0 - Human Resources

Organizing The grouping of activities and people who will carry them out, assigning

roles and delegating authority.

20.0 - Human Resources

Ownership Term coined to suggest giving employees a proprietary sense of

participation in the facility and its goals through treating employees as

members of a team.

20.0 - Human Resources

Performance Evaluation Usually an annual evaluation of employees in which the performance of

the employee is formalized into written appraisals or rating scales by the

administrator and given to the employee prior to a face-to-face meeting

to review the evaluation and allow the employee to respond to the

comments or rating. This evaluation is based on clear measures and

goals set the previous year. Setting work goals for the next evaluation

period is also part of this process.

20.0 - Human Resources

Performance Feedback Same as performance evaluation; comments by the employee on the

employee on the evaluation by the administrator.

20.0 - Human Resources

Performance-Centered

Objectives

Stating training goals in terms of behaviors that can be learned and

observed by supervisors or others, e.g., ability to demonstrate proper

procedures for turning a resident suffering from pressure ulcers.

20.0 - Human Resources

Personnel Manager An individual that assists line managers in record keeping, recruitment,

selection, training and retaining employees as well as compensation

management and performance evaluation. This person is most

responsible for the human resources function.

20.0 - Human Resources

Planning Deciding what is to be done, setting short- and long-term objectives,

then identifying the means for achieving them. Requires forecasting the

economic, social, and political environment anticipated for the organization

and the resources that will be available to it.

20.0 - Human Resources

Position The responsibilities and duties performed by one individual. There are

as many positions as there are employees.

20.0 - Human Resources

Preliminary Interview A short questionnaire and interview used by some facilities to help

screen out unsuitable applicants for a position.

20.0 - Human Resources

Prevailing Wage Rate The wages paid by the predominant number of facilities in a community.

Most businesses indicate they pay the prevailing wage rate or a

competitive rate.

20.0 - Human Resources

Preventive Labor Relations Maximizing the communication and facility acceptance by non-unionized

employees in hopes that they will not feel the need to form a union to

achieve their work goals.

20.0 - Human Resources

Progressive Discipline Use of a specied number of verbal, then written warnings for each

offense of the same rule before suspending or ring an employee.

20.0 - Human Resources

Rate Range The pay variation permitted within a class or grade of jobs. 20.0 - Human Resources

Rating Scale Listing a number of characteristics, traits and/or requirements of an

employee’s position on a line or scale which is checked off by the rater

as the degree to which the employee does or does not possess a

specied characteristic, trait, or ability to ll a slated requirement.

20.0 - Human Resources

Ratio Hiring Requirement by a government agency that an employer increase the

proportion of women or minority persons in the employer’s workforce.

20.0 - Human Resources

Reasonable

Accommodation

Actions such as alteration of facilities and the work environment as well

as job restructuring to focus on the essential functions, and altering or

eliminating nonessential aspects of a job in order to accommodate a

disabled employee.

20.0 - Human Resources

Referrals Recommendations by others of a person for a position at a facility. 20.0 - Human Resources

Search Firm Employment agency which usually focuses its efforts on middle and

upper level positions, often conducting national searches, charging the

employer for the services.

20.0 - Human Resources

Stafng Involves such activities as recruiting, orienting, training, rating,

disciplining and terminating employees.

20.0 - Human Resources

Statistical Approach to

Hiring

Identifying the most valid predictors of job success, then using weights

in a formula to choose among applicants for a position (see also

CLINICAL APPROACH).

20.0 - Human Resources

Task A coordinated and aggregated series of work elements used to produce

an output (e.g., making beds).

20.0 - Human Resources

Task Analysis Review of job descriptions and activities essential for performing each

job (step two of establishing training needs).

20.0 - Human Resources

Uniform Guidelines on

Employee Selection

Procedures

A publication of four federal agencies in 1987 setting standards by which

federal agencies determine the acceptability of validation procedures

used for written tests and other selection devices.

20.0 - Human Resources

Wage Class Establishment of pay grades and rates by employers to both achieve equity

and offer some exibility to supervisors in setting an employee’s wage.

20.0 - Human Resources

Wage Mix Determination of wage rates by considering the labor market,

prevailing wage rates, cost of living, ability to pay, collective bargaining

agreements, individual bargaining agreements, and value of the job.

20.0 - Human Resources

Wage Policy Decisions by management on the rate of pay for the facility staff, the

amount of discretion supervisors may use in setting individual salaries,

the spread between pay rates for long-time and new employees, and

the periods between pay raises together.

20.0 - Human Resources

Accelerated Method of

Depreciation

A depreciation method that allows for larger amounts of depreciation in early

years and smaller amounts in later years. The double declining-balance

method is an example. This enables the owner to receive tax and/or

reimbursement benets more quickly than using the straight line method.

30.0 - Finance

Accounting The process of identifying, recording, and communicating information

about the nancial position and results of operations of a business

entity, using principles designed to facilitate informed decision-making

by the entity’s managers as well as by external groups.

30.0 - Finance

Accounting Equation Assets = Liabilities + Owners’ Equity (capital). This equation states that

the assets of a rm are equal to the claims of the creditors plus the claims

of the owners. The balance sheet is a detailed statement of this equation.

30.0 - Finance

Accounts Payable Amounts owed to suppliers for goods and services. 30.0 - Finance

Accounts Receivable Amounts owed to the facility for services or for the sale of goods. 30.0 - Finance

Accrual Basis of Accounting A system of accounting in which revenues are recorded in the period

earned, and expenses are recorded in the period incurred even if cash

is received or paid in a later or earlier time period. (Contrast with cash

basis of accounting)

30.0 - Finance

Accumulated Depreciation The total depreciation from the start of the life of a plant asset

to any point in time. On the balance sheet, there is a deduction

for accumulated depreciation taken from the gross evaluation of

depreciable plant and equipment to yield a net evaluation.

30.0 - Finance

Acid-Test Ratio (or Quick

Ratio)

Cash and other current assets that can be converted to cash right

away (such as marketable securities and current receivables) divided

by current liabilities. A measure of the ability of a rm to pay its current

liabilities in the very short term (see also CURRENT RATIO).

30.0 - Finance

Adjusting Entries Entries made at the end of an accounting period to record certain

transactions or other accounting events that have not been recorded

or have been improperly recorded during the accounting period.

Examples include entries for depreciation expense and unused

portions of prepaid expenses.

30.0 - Finance

Administrative Information

System

Information technology that is designed to assist in carrying out nancial

and administrative support activities such as payroll, patient accounting,

billing, accounts receivable, materials management, budgeting, cost

control and ofce automation.

30.0 - Finance

Aging of Accounts

Receivable

Summarizing unpaid balances in terms of age groups, such as:

currently due, 1-30 days past due, 31-60 days past due each of the

remaining 30-day periods through 151-180 days past due, and nally

past due more than 180 days. This classication may be broken down

by type of debtor. Aging receivables is a step in the collections effort, in

reporting on the balance sheet a deduction from accounts receivable for

estimated bad debt, and in making write-off decisions.

30.0 - Finance

Aging Schedule Also called an “aging report,” it shows the length of time that various

amounts within each patient’s account have been outstanding (not paid).

30.0 - Finance

Allowable Charge The maximum fee that a third party will use in reimbursing or paying a

provider for a service rendered.

30.0 - Finance

Allowable Costs Costs that are reimbursable under a third-party payment formula. 30.0 - Finance

Amortization of Debt The periodic reduction of a debt by regular payments applied to both

principal and interest over a scheduled period.

30.0 - Finance

Ancillary Charges Extra charges for supplies and services, e.g., drugs and lab tests, that

are not included in the per diem rate.

30.0 - Finance

Anti-Kickback Law The Medicare and Medicaid Anti-Kickback Law penalizes anyone who

knowingly and willfully solicits, receives, offers, or pays a remuneration

in cash or in kind to induce, or in return for:

A. Referring and individual to a person for the furnishing, or arranging

of the furnishing, of an item or service to be paid for by the Medicare or

Medicaid program; or

B. Arranging or recommending the purchase, lease, or order

of goods or services to be paid for under Medicare or Medicaid.

Violators are subject to criminal penalties or exclusion from participation

in the Medicare and Medicaid programs, or both (see also SAFE

HARBORS).

30.0 - Finance

Assets Resources owned by a business that are measured in monetary

terms. On a balance sheet, assets are generally classied into

current and noncurrent portions. Current Assets are cash, accounts

receivable, supply inventories, and prepaid expenses. Noncurrent

assets include Property, Plant & Equipment (PP&E)(also referred

to as xed assets, capital assets, or plant assets) which are assets

having an estimated life in excess of one year and not intended for

sale in the ordinary course of operations.

30.0 - Finance

Assisted Living Facility

(ALF)

Term applied to broad array of residential options for frail seniors who

need assistance with one or more activities of daily living, such as

dressing or bathing, but do not require continuous skilled nursing care.

ALF’s generally emphasize a homelike environment offering a maximum

amount of independence, privacy, and choice.

30.0 - Finance

Audit Examination of accounting systems, controls, and records to ascertain

their conformity to legal and professional standards and their adequacy

in protecting against loss of assets by fraud and waste.

30.0 - Finance

Average Daily Census The average number of patients per day over a specied period of time

such as a week, a month, or a year.

30.0 - Finance

Baby Boomers People born between 1946 and 1964. This age group constitutes

approximately 70 million Americans who will start retiring around 2010.

By 2030, when all the Baby Boomers will have retired, experts predict

that they will severely strain the nation’s health care system.

30.0 - Finance

Bad Debt An account receivable determined to be uncollectible. 30.0 - Finance

Balance Sheet (or Statement

of Financial Position)

A report summarizing a rm’s assets, liabilities, and owners’ equity at a

specic date.

30.0 - Finance

Bank Statement Statement sent by a bank to a bank account holder showing beginning

and ending balances, and all transactions in the account for a month.

30.0 - Finance

Bank Statement

Reconciliation

Process of explaining and correcting any discrepancies between a bank

statement balance and the depositor’s record of the cash balance.

30.0 - Finance

Benet Period Period of consecutive days during which covered services furnished to

a patient, up to certain specied maximum amounts, may be paid for

by an insurance plan. Each insurance carrier has its own denition of

benet period.

30.0 - Finance

Bidding The process of requesting from vendors a response (bid or offer) to

provide goods or services according to written specications. The

bidding may be closed (directed to select bidders) or open (to all

bidders). The bids may be negotiated (as to price, payment terms, etc.)

before a contract is nalized.

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Bonds Interest-bearing notes, usually in $1,000 or $5,000 amounts, in which

the issuer (borrower) promises to repay the bondholder (lender) the

principal and interest of a loan according to a schedule.

30.0 - Finance

Bookkeeping The clerical process of recording the financial transactions

of an organization.

30.0 - Finance

Break-Even Point The point at which total revenues for a rm or a program are equal to

the total expenses incurred. This may be illustrated on a graph where

revenues (and expenses) are plotted on the vertical axis while resident-

days are plotted on the horizontal axis. Look for the point where the

line representing total cost (xed plus variable) intersects with the line

representing total revenue. The number of resident-days indicated by

the point on the horizontal axis directly below this intersection is the

number of resident days needed for the rm or program to break even,

i.e., neither incur any loss nor make any prot.

30.0 - Finance

Budget A tool for exercising nancial control. It sets expectations that become

nancial objectives that the administrator is responsible for achieving.

“Budgeting” is the process of nancial planning.

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Case-Mix-Based Payment

Systems

Payment systems used by Medicare and many state Medicaid programs

under which the per diem rates for each nursing facility are determined

in part by some measure of the acuity, and thus the likely resource

consumption, of each covered resident in the facility. Assessments

are conducted to classify covered residents into dened groups based

primarily on functional disability scores, but certain diagnoses, service

needs and behavioral problems may also be considered. The per diem

rate is different for each group, with higher rates paid for residents

needing and receiving more services.

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Cash Basis of Accounting A system of accounting in which revenues are recorded when cash is

received, and expenses are recorded when cash is paid (contrast with

accrual basis of accounting).

30.0 - Finance

Cash Flow Cash inows from collections of revenues and other sources minus cash

outows for payments of expenses and liabilities. A cash budget of

cash-ow forecast projects these amounts, whereas a cash ow report

shows actual experience.

30.0 - Finance

Census Number of patients in a facility on a given day. 30.0 - Finance

Charity Care Care provided to a patient who does not have the capacity to pay. 30.0 - Finance

Chart of Accounts A list of names and numbers of all the accounts used in a business.

There typically are accounts for various subcategories of each of the

following: assets, liabilities, owner’s equity, revenues, and expenses.

30.0 - Finance

Civil Law Body of laws governing private legal affairs, such as private rights and

duties, contracts, and commercial relations.

30.0 - Finance

Civil Liability The three primary sources in health care malpractice lawsuits are: (1)

failure to obtain consent before intervening in the life of the resident;

(2) breach or violation of a contract or promise; and (3) the rendering of

substandard, poor-quality care.

30.0 - Finance

Claim A bill submitted to the scal intermediary claiming payment for

services provided.

30.0 - Finance

Collection period Number of days’ worth of revenue that is accounts receivable. 30.0 - Finance

Contractual Discount The difference between the rate the facility normally charges for

services to its self-pay residents, and the lower rate that the facility

has agreed to receive as reimbursement from Medicare, Medicaid, or

other third-party payers. For external reporting purposes, revenues

are recorded as the amount to be actually collected. However, for

internal reporting purposes, management may record such contractual

discounts as deductions from operating revenues on the income

statement and accounts receivable on the balance sheet so that the

amount of discounts given to each payer class is known.

30.0 - Finance

Controller (or Comptroller) The chief accountant of a rm. 30.0 - Finance

Cost Center An organizational unit charged with responsibility for controlling its

own costs, and so its costs (for salaries, supplies, etc.) are separately

accumulated in the accounts. A cost center may or may not be a

revenue center, i.e., a unit providing direct services to patients for which

they are charged.

30.0 - Finance

Cost Shifting Practice by health care providers of charging private-pay patients more

than the actual costs of their care, in order to compensate for shortfalls

in payments for patients covered by Medicaid and other government

programs which may pay less than actual costs.

30.0 - Finance

Current Ratio Current assets divided by current liabilities. A measure of a rm’s ability

to pay current debts. A current ratio much below 1.00 (or 1:1) may

indicate problems in meeting current liabilities as they become due.

(see also ACID-TEST RATIO).

30.0 - Finance

Days in Resident Accounts

Receivable

The number of days during which expenses could be paid using the

cash on hand. It is:

Cash + Marketable Securities

(Total operating expenses minus depreciation)/365

30.0 - Finance

Days of Care Also called “Patient Days.” Cumulative census over a specified

period of time.

30.0 - Finance

Debt Service Coverage

Ratio

Projected annual cash ow (i.e., excess of cash receipts over cash

expenses), divided by required annual debt payments. Measure used

by potential lenders of the credit-worthiness of an entity.

30.0 - Finance

Debt-to-Assets Ratio A measure of the relative obligations of a facility. Generally, the lower

the debt ratio, the more nancially sound the facility is believed to be.

The ratio is calculated by:

(Current Liabilities + Noncurrent Liabilities) / Total Assets

30.0 - Finance

Deemed Status Medicare rule that a hospital accredited by the Joint Commission on

Accreditation of Healthcare Organizations is deemed to have met the

Medicare certication criteria.

30.0 - Finance

Depreciation The systematic allocation of the cost of a xed asset to expense over

its useful life.

30.0 - Finance

Differentiation A competitive strategy in which a facility creates distinctive features that

allow customers to distinguish the facility’s offer from that of its competitors.

30.0 - Finance

Dividend A distribution of earnings to shareholders of a corporation. 30.0 - Finance

Double-entry Accounting The system of recording transactions that requires each transaction

to be recorded at least twice: as an addition or subtraction to one

account (a debit), and as an addition or subtraction to at least one other

account (a credit). This system provides a logical way to record much

information. At the end of a period, after all adjusting entries are made,

the sum of the debits should equal the sum of the credits. When a trial

balance indicates that these two totals are equal, the “books balance”

and nancial statements can be prepared. Failure to nd this equality is

an indicator that one or more recording errors were made.

30.0 - Finance

Double-entry Rules Increases in asset accounts and expense accounts are recorded as

debits; decreases are credits. Increases in liability, revenue, and

owners’ equity accounts are credits, decreases are debits.

30.0 - Finance

Durable Power of Attorney Appointment of an agent who is empowered to act on behalf of the person

creating the power in the case of future incompetence. (Ordinary POA

ends when the person creating the power becomes incompetent).

30.0 - Finance

Earnings Before Interest,

Taxes, Depreciation,

Amortization, and Rent

(EBITDAR)

This shows cash ow available to pay interest, rent and taxes after

paying operational costs. It is a measure used by potential lenders to

determine the credit-worthiness of an entity.

30.0 - Finance

Elimination Period In a long-term care insurance plan, the initial waiting period during which

LTC services are used but not covered by insurance.

30.0 - Finance

Equity The excess of a rm’s assets over its liabilities equals the owner’s equity

(in a for-prot corporation).

30.0 - Finance

False Claims Act Federal law that provides for civil or criminal penalties for individuals

and entities for submitting a false claim, or causing a false claim to be

submitted, to a federal health care program. False or fraudulent claims

include claims for items not provided or not provided as claimed, claims

for services that are not medically necessary, and claims when there

has been a failure of care. Many states have a parallel law that applies

to the state Medicaid and other state health care programs.

30.0 - Finance

First In, First Out (FIFO) 1. Inventory usage ideal of using the oldest supplies rst (as long as the

use-by or expiration date has not been reached). To facilitate this, new

supplies are shelved based on the use-by or expiration date, so that the

oldest products are stored in front of, or otherwise made more accessible

than, more recently acquired products.

2. Inventory costing method for balance sheet purposes that assumes

that the rst goods purchased (rst-in) are the rst goods used (rst-out),

so the ending inventory should be valued at the cost of the most recent

goods purchased. The Last In, Last Out method assumes the opposite ,

and values ending inventory at the cost of the earliest goods purchased.

30.0 - Finance

Fixed Costs Costs that do not vary with the number of patients. These costs are

not controllable.

30.0 - Finance

Flexible Budget An adjusted budget in which the costs are raised or lowered to reect

the actual census.

30.0 - Finance

Fraud Deliberate deceit by providers or consumers in obtaining payment for

services that were not actually delivered or received, or in claiming program

eligibility. To be distinguished from abuse, which refers to improper or

excessive use of program benets, resources, or services by either

providers or consumers. Abuse is not necessarily intentional or illegal.

30.0 - Finance

Funded Depreciation The setting aside of a portion of retained earnings (equal to a

depreciation expense) in a separate account designated to be used only

for the purchase of replacement capital assets.

30.0 - Finance

General Ledger Financial record, consisting of a collection of accounts, that summarizes

all the entries in each of the journals for an accounting period, for

the purpose of keeping a continuous record of account balances and

arriving at a trial balance.

30.0 - Finance

Generally Accepted

Accounting Principles

(GAAP)

The policies, standards, and rules followed by accountants in

the preparation of financial statements and in recording and

summarizing transactions.

30.0 - Finance

Health Maintenance

Organization (HMO)

An organization that has management responsibility for providing

comprehensive health care services on a prepayment basis to

voluntarily enrolled persons within a designated population.

30.0 - Finance

Historical Cost (or

Acquisition Cost)

Cost of acquiring a depreciable asset, which includes not only the purchase

price but also the cost of taxes, shipping, assembly and installation.

30.0 - Finance

Home- and Community-

Based Services (HCBS)

Waiver

Enacted under Section 1915(c) of the Social Security Act, the program

allows states to offer LTC services that are not otherwise available

through the Medicaid program. The latter had authorized payments for

institutional care only.

30.0 - Finance

Income An increase in owner’s equity resulting from services rendered or

goods provided.

30.0 - Finance

Income Statement (or

Statement of Revenue and

Expenses)

A report which lists, in summary form, revenues and expenses for a certain

time period, such as a month or a year. A prot results from an excess of

revenues over expenses for the period, and a loss occurs when expenses

exceed revenues. So the income statement also shows prot or loss, and is

therefore also called the prot-and-loss (or P-and-L) statement.

30.0 - Finance

Independent Contractors Category of persons providing services who are not considered by the

IRS as employees. Therefore, employers generally do not have to

withhold federal income tax or FICA taxes on payments to independent

contractors. The IRS offers 20 guidelines for determining whether an

individual falls into this category. The general rule is that independent

contractors “follow independent trade, business or profession in which

they offer their services to the general public,” and those who pay for

their services “have the right to control or direct only the result of the

work and not the means and methods of accomplishing the result.”

However, employers who pay an independent contractor $600 or more

during a year must issue and le a Form 1099-MISC.

30.0 - Finance

Intangible Asset An item or right that has no physical substance and provides an

economic benet. The reputation of a nursing facility as the best

caregiver in the community is a valuable intangible asset, for example.

30.0 - Finance

Inventory The goods and materials on hand which are to be used in producing

services or held for resale.

30.0 - Finance

Invoice Document prepared by a seller for a buyer that describes goods sold or

services rendered and the terms for payment.

30.0 - Finance

Journal Book of original entry, the rst place in which transactions are formally

recorded. Entries are in chronological order. A separate journal is

generally maintained for the following categories of transactions: cash

receipts, cash payments, billings, accounts payable, and payroll. A

General Journal is used for entries that do not properly belong in any of

the other journals, and for adjusting entries. Adjusting entries include

entries for depreciation, prepaid expenses, and inventory usage.

30.0 - Finance

Kerr-Mills Act Congressional legislation that made federal funds available to states for

health care for the needy.

30.0 - Finance

Kickback A portion of a fee, salary, or other payment that is given to a third party

for having assisted--or refrained from preventing--the payment in the

rst place. Most types of kickbacks are unethical or illegal.

30.0 - Finance

Lease A contract requiring the lessee (user) to make periodic payments

(rentals) for a specied period of time to the lessor (owner) for the use

of an asset. Operating leases are generally for a short term or limited

number of years. A capital lease is a long-term lease agreement

extending generally for the entire life of equipment or property leased.

Operating lease expenses are listed on the income statement. Capital

leases should be reported as assets and as long-term liabilities on the

balance sheet. The asset (capital lease) is amortized for depreciated

based on its useful life.

30.0 - Finance

Liabilities Debts owed by a rm to a persons or rms other than its owners. On a

balance sheet, liabilities are classied as current if they are due within

one year from the balance sheet date, and long-term (or non-current) if

they are due more than one year from the balance sheet date.

30.0 - Finance

Line of Credit Form of nancing in which a nancial institution commits itself to make

a loan to a company up to a specied maximum amount. The company

may choose to use its line of credit, subject to the terms of credit, when

and if the need arises.

30.0 - Finance

List of Excluded Individuals/

Entities

Online database maintained by the OIG (www.hhs.gov/oig) providing

information regarding over 15,000 individuals and entities that are

excluded from participation in Medicare, Medicaid and other federal

health care programs. Certied facilities should check (and periodically

recheck) this list and must refrain from contracting with or otherwise

doing business with anyone on it in the course of providing items or

services for which payment may be made under a federal health care

program. Providers are advised to also check the General Services

Administration (GSA) monthly “List of Parties Excluded From Federal

Procurement and Non-procurement Programs” at http://epls.arnet.gov.

30.0 - Finance

Loan-to-Value Percentage The maximum loan amount based on a percentage of the borrowing

facility’s appraised value.

30.0 - Finance

Long-Term Asset An asset with future economic benets that are expected for a number

of years. Long-term assets are reported on the balance sheet as

noncurrent assets and include buildings and equipment. A new central

building for a life care community may have a long-term expected asset

value for perhaps 40 or more years to come.

30.0 - Finance

Managed Care Organization

(MCO)

Entity that integrates the nancing and delivery of health care to covered

individuals by means of arrangements with a limited number of selected

providers. It provides nancial incentives for membership, quality

assurance programs, and formal utilization management programs (i.e.,

processes to evaluate the necessity, appropriateness, and efcacy of

health care services). (see also Medicaid MCO).

30.0 - Finance

Medicaid Managed Care

Organization (MCO)

Entity that has entered into a risk contract with a state Medicaid agency

to provide a specied package of benets to Medicaid enrollees in

exchange for a monthly capitation payment on behalf of each enrollee.

These plans may include or carve out acute care services. Some

MCOs coordinate Medicare and Medicaid services for dually eligible

beneciaries. Such arrangements may include a capitated amount

for both Medicare and Medicaid services or only Medicaid with an

additional fee paid to the MCO to coordinate Medicare services that are

not part of the plan.

30.0 - Finance

Mortgage A written promise giving a creditor an interest in the debtor's property as

security (collateral) for a debt.

30.0 - Finance

Net present value In corporate nance, the present value (i.e., the value of cash to be

received in the future expressed in current dollars) of an investment

in excess of the initial amount invested. When a proposed project,

such as building a new wing has a positive net present value, it should

perhaps proceed; when a proposed wing shows a negative net present

value, it should perhaps be delayed or abandoned.

30.0 - Finance

Note A written promise to pay a specic sum with or without interest at a

xed future date.

30.0 - Finance

Occupancy Rate The ratio of actual number of resident days to the total possible resident

days, usually expressed as a percentage. Alternatively, the ratio of

occupied beds to available licensed beds. For example, if a facility has

100 beds and 80 are occupied for a day, the occupancy rate is 80/100

or 80%. This may be reported as the average of the daily occupancy

rates for a period , such as 30 days or a year. A particular resident’s

bed may be considered an occupied bed in calculating this rate even

though that resident is in the hospital or temporarily discharged for some

other reason, if the facility is receiving a “bed-hold” or “bed-reserve” rate

and/or is reserving the bed for that resident.

30.0 - Finance

Ofce of Inspector General

(OIG)

Ofce in the US Department of Health and Human Services charged

with identifying and eliminating fraud, abuse and waste in the Medicare,

Medicaid, and other DHHS programs. The OIG carries out this mission

through a nationwide program of audits, inspections, and investigations,

and through issuance of Special Fraud Alerts.

30.0 - Finance

Operating Margin Total prot (or loss) as a percent of total revenue. 30.0 - Finance

Opportunity Cost The value of the benets sacriced when money or other asset is used

one way rather than in an alternative way. It is the net benets that

might have been obtained had the money been spent on the next best

use. For example, if $1,000 is spent for activity program supplies, the

opportunity cost of NOT having the benets of $1,000 worth of food

or landscaping services, or of not earning the interest had the money

simply been left in the bank.

30.0 - Finance

Payback Period

A simple device for comparing investment proposals. It is the time in

years for the net cash inow from a capital investment to be equal to

its cost, that is for the item to “pay for itself.” It is criticized for failure

to consider the time value of money, expected net cash ows after

the payback period, and some key benets from use of an item. If

the estimated net cash receipts are the same amount each year, the

payback period is calculated by dividing the total investment by the

expected annual savings or increase in net cash inow. Depreciation

does not affect cash ow, so it is ignored.

EXAMPLE: A machine is purchased for $30,000 to replace a worker

earning $20,000 per year.

Payback period = Total Investment

Annual savings or increased net cash ow = $30,000

$20,000 = 1.5 years

30.0 - Finance

Pledging of Accounts

Receivable

Use of receivables as security or collateral for a loan. When this is done

“with recourse,” the borrower remains responsible for collecting the

receivables but promises to use the proceeds for repaying the debt. In

contrast, factoring of receivables is the sale of receivables as a means

of short-term nancing. When this is done “without recourse,” the seller

transfers not only the receivables but also the risk of default.

30.0 - Finance

Posting A step the accounting process when journal entries are transferred

(posted) to accounts in the general ledger in order to summarize

information such as cash on hand.

30.0 - Finance

Prepaid Expense Expenses paid in advance for several months, e.g., building rental

payments, journal subscriptions, insurance premiums. These expenses

are allocated to the months by adjusting entries.

30.0 - Finance

Prospective Payment

System (PPS)

A payment system developed for Medicare for skilled nursing

facilities that pays facilities an all-inclusive rate for all Medicare

Part A beneciary services. Payment is determined by a case mix

classication system (RUGs).

30.0 - Finance

Prospective Rate-Setting Practice by Medicare and most state Medicaid programs of using

predetermined rates to reimburse nursing facilities without adjusting

payment to cover actual costs. The states use a wide variety of

methodologies to develop these rates. If the provider can keep

costs below the formula determined rate, a prot can be made. If the

provider’s costs exceed the rate, a loss is incurred.

30.0 - Finance

Purchase Order Document from a prospective purchaser requesting a seller to provide

certain quantities of described goods or services at a given price, with

payment to be made later.

30.0 - Finance

Reserve Funds set aside to meet some future obligation. 30.0 - Finance

Restricted Funds Funds established to account for assets with uses limited by the

requirements of donors or grantees. For example, a fund may be restricted

to plant replacement. If the donor has specied that the principal must be

maintained perpetually, and only the investment income it generates may be

expended, the principal is accounted for as an endowment fund.

30.0 - Finance

Retained Earnings

(or earned surplus,

undistributed prots)

The income left to a company after taxes and dividends have been paid

and are a major source of funds for the company’s expansion.

30.0 - Finance

Return on Equity (ROE) A means of assessing a company’s protability. It is calculated by

dividing the rm’s annual net income by total shareholder’s equity.

30.0 - Finance

Revenues Income earned from carrying out the activities of a rm. Revenues of health

care institutions are typically reported in terms of these three components:

a. Patient service revenues may be divided into the “room, board,

and general nursing services” covered by rates billed to all patients;

and ancillary services, such as physical therapy or pharmacy, which are

billed to only some patients. Patient service revenues accounts may

also be segregated by level of care (skilled, intermediate) or by payer

status (self-pay, Medicare, Medicaid, commercial insurance).

b. Other operating revenues are revenues earned incidental to the

main purpose of rendering patient care, such as revenues from the

employee cafeteria, beauty shop, and other concessions.

c. Non-operating revenues may include separate line items for

interest and other investment income, unrestricted gift income or gains

(or losses) on sales of property.

30.0 - Finance

RUG Creep A form of upcoding under the Medicare Prospective Payment System

for SNFs which occurs when the SNF falsely or fraudulently completes

the MDS, and this results in incorrect assignment of a resident to a

higher-paying RUG category.

30.0 - Finance

Safe Harbors Federal regulations that dene practices that, if fully followed, will

not be considered violations of the federal anti-kickback. There

are regulations, for example, that describe conditions under which

discounts may be received from equipment suppliers, and conditions

under which payments may be made to operators of referral services.

30.0 - Finance

Self-Insurance An alternative to purchased insurance. An entity assumes its own

expenses relative to a specic risk of loss by periodically setting aside an

actuarially determined amount of money, which may be held by a trustee.

30.0 - Finance

Special Fraud Alerts Statements issued by the Ofce of Inspector General (OIG) to the

general health care community addressing national trends of health care

fraud and providing guidance relative to violations of the anti-kickback

statute and other federal laws.

30.0 - Finance

Stark Act Common name for a set of laws, including the Ethics in Patient

Referrals Act of 1989, that prohibits the practice of “self-referral” by

physicians, that is, referrals of Medicare and Medicaid patients to

a provider of services paid for by government programs, when the

physician has a direct or indirect ownership or investment interest in

that provider. “Safe harbors” is the name given to permissible referral

practices, as outlined in laws. Some states have a law limiting “self-

referral” regardless of payer source.

30.0 - Finance

Statement of Cash Flows Financial statement that displays how the cash balance has changed

during a scal period. Cash increases and decreases are reported in three

categories of activities: operating, investing, and nancing. This information

can be useful in assessing the entity’s ability to generate positive future net

cash ows, meet its nancial obligations, and pay dividends.

30.0 - Finance

Statement of Changes in

Owners’ Equity (or Fund

Balance)

A financial statement that reflects the beginning owner’s equity, the

profit or loss of the current period, and the ending owner’s equity as

of the balance sheet date. Not-for-profits use “fund balance” instead

of “owner’s equity.”

30.0 - Finance

Straight-line Method of

Depreciation

A depreciation method that allocates equal amounts of depreciation

expense to each full period of the asset’s life:

Annual Depreciation Expense = (Historical cost) / (Years of

estimated useful life)

30.0 - Finance

Subacute Care As dened by the American Health Care Association, this is: “a

comprehensive inpatient program designed for an individual who: (1)

has had an acute event as a result of an illness, injury or exacerbation

of a disease process, (2) has a determined course of treatment; and

(3) does not require intensive diagnostic and/or invasive procedures.”

Sub-acute medical and rehabilitative care programs in nursing facilities

may include specialty programs for : Post-operative recovery, extensive

wound care, ventilator support, brain injury care, hospice care, and

respiratory or pulmonary management.

30.0 - Finance

Supplies Items consumed in the normal course of business operations, e.g.,

bandages and soap. Projected supply expenses are included in the

operating budget, not the capital budget.

30.0 - Finance

Swapping Practice of a supplier giving a nursing facility excessive discounts on

Medicare Part A items and services in return for the ability to service

and bill nursing facility residents with part B coverage. This may be

considered an illegal inducement.

30.0 - Finance

Third Party Payer Commercial insurer or other private or public entity (such as Medicare

and Medicaid) which pays for all or part of the charges for a resident.

30.0 - Finance

Upcoding The selection, when a claim is submitted to a third-party payer, of a

billing code that is not the most appropriate descriptor of a service or

condition and that may result in an overpayment to the provider. One

type of upcoding is RUG creep.

30.0 - Finance

Useful Life (or Service Life) The period of time a xed asset (such as a building, piece of equipment,

or vehicle) can be used by its owner in the production or sale of other

assets or services. In order to allocate depreciation over time, total

service life must be estimated when a xed asset is purchased.

30.0 - Finance

Variable Cost A cost that varies with the change in the number of patients. 30.0 - Finance

Variance Analysis A control technique that evaluates signicant differences between

budgeted and actual revenues and expenses.

30.0 - Finance

W-2 Form that the IRS requires an employer to give each employee by

January 31 that shows the employee’s earnings and income tax and

FICA tax deductions for the past year.

30.0 - Finance

W-4 Form that the IRS requires an employer to allow each employee to

submit on which the employee indicates marital status and number of

withholding allowances claimed. This information must be used by the

employer in determining amount of income tax to withhold.

30.0 - Finance

Working Capital The excess of current assets over current liabilities. Working capital

management is the effort to increase this desirable excess by increasing

current assets and decreasing current liabilities in various ways.

30.0 - Finance

Write-off Removing an uncollectible account from the accounts receivable.

Bad debts expense is increased and the asset, account receivable, is

decreased when the account receivable is written off.

30.0 - Finance

Accident Any unexpected or unintentional incident, which may result in injury

or illness to a resident. This does not include adverse outcomes from

treatment or care.

40.0 - Environment

Area of refuge A zone of safety within a building that is protected from the effects of re

and smoke that provides direct access to an exit.

40.0 - Environment

As-built plans The blueprints or plans depicting the way the building was actually

completed and approved.

40.0 - Environment

Avoidable Accident An accident that occurred because the facility failed to identify and evaluate

a hazard, implement interventions, and monitor the effectiveness.

40.0 - Environment

Bloodborne Pathogens Pathogenic micro-organisms that are present in human blood and can

cause disease in humans. These pathogens include, but are not limited

to, hepatitis B virus (HBV) and human immunodeciency virus (HIV).

40.0 - Environment

Effective Pest Control

Program

Measures used to contain and eradicate common household pests (e.g.,

roaches, ants, mosquitoes, ies, mice and rats).

40.0 - Environment

Environment Refers to any area outside or inside the facility that is frequented by

residents, staff, and guests and areas within the facility including the

residents’ rooms, bathrooms, hallways, dining and activity areas and

therapy areas.

40.0 - Environment

Health Hazard Chemical One for which there is signicant evidence, based on at least one study

conducted in accordance with established scientic principles, that an

acute or chronic health effect may occur in exposed employees.

40.0 - Environment

Integrated Pest

Management (IPM)

A program of Serve Safe that outlines procedures for controlling access

of pests to the building.

40.0 - Environment

Life Safety Code Rules and standards developed by the National Fire Protection Association

to address construction, protection, and occupancy features necessary to

minimize danger to life from the effects of re, including smoke, heat, and

toxic gases created during a re in which nursing facilities must comply.

40.0 - Environment

Nosocomial Infection An infection that is acquired by a person within the facility. 40.0 - Environment

Physical Hazard Chemical A chemical for which there is scientically valid evidence that it is a

combustible liquid, a compressed gas, explosive, ammable, or organic

peroxide, an oxidizer, pyrophoric, unstable (reactive) or water-reactive.

40.0 - Environment

Preventive Maintenance A program to assure that equipment and components operate in

optimal conditions. This includes inspections of all systems and

equipment on a scheduled basis and planned performance of certain

tasks aimed at preventing unexpected equipment failures.

40.0 - Environment

Unavoidable Accident An accident occurring despite the facility’s efforts to identify and evaluate a

hazard, implement interventions, and monitor the effectiveness.

40.0 - Environment

Accreditation Accreditation of a nursing facility by the Joint Commission on

Accreditation of Healthcare Organizations (JCAHO)

50.0 - Leadership & Management

Administrative Law Rules and regulations formulated by departments or agencies of the

executive branch of government to carry out the intent of statutory law.

50.0 - Leadership & Management

Agent Someone authorized to act on behalf of another (a principal); for

example, a corporation generally authorizes the administrator to

represent it or act on its behalf.

50.0 - Leadership & Management

Best practices Evidence-based practices 50.0 - Leadership & Management

Board of Directors Also “board of trustees” or “governing body.” It has the ultimate legal

responsibility for a facility’s operations.

50.0 - Leadership & Management

Civil Money Penalties A per day or per instance ne resulting from deciencies in quality of

care or resident safety following a CMS Survey.

50.0 - Leadership & Management

Community Advisory Board Composed of key community leaders, the community advisory

board functions as the “eyes and ears” for the facility. Through

their inuences, the advisory board members can also assist the

administrator to form meaningful partnerships with community agencies.

50.0 - Leadership & Management

Culture Change (Cultural

Change)

A course of action to move from one way of doing things to another.

In long-term care, culture change is widely referred to as a process

of transforming from an institutional to a homelike model. It is the

integration of the three elements of person-centered care -- clinical

care, socio-residential elements and human factors -- along with

the enrichment of the environments in which people live and the

empowerment of both clients and associates.

50.0 - Leadership & Management

Deciency A nursing facility’s failure to meet any of the standards as determined

by a survey.

50.0 - Leadership & Management

Dual Certication A facility that is dually certied as both a skilled nursing facility and

a nursing facility. Such facilities can admit Medicare and Medicaid

residents in any part of the facility.

50.0 - Leadership & Management

Good Faith A legal term that refers to actions that are generally consistent with how

a reasonable person would act under similar circumstances.

50.0 - Leadership & Management

Governance The act of governing. It refers to trusteeship and stewardship of an

organization’s resources and capabilities to benet is stakeholders.

50.0 - Leadership & Management

Incident Any unexpected negative occurrence involving a patient, family, or

employee, or visitor.

50.0 - Leadership & Management

Leadership The art of collaboratively engaging colleagues toward a shared vision.

As dened by Yukl, leadership is “the process of inuencing others to

understand and agree about what needs to be done and how to do it, and

the process of facilitating individuals and collective efforts to accomplish

shared objectives.”

50.0 - Leadership & Management

Management Organization and coordination of the activities assigned to a department

or group of people in accordance with objectives, policies and

procedures. It is what managers do to maintain an organization and

move it forward. Management is about getting tasks accomplished

on a daily basis, as opposed to leadership, where the individual’s

main objective is to inspire and motivate people. You lead people and

manage things.

50.0 - Leadership & Management

Management By Objectives

(MBO)

A system of management that is based on a joint agreement between

supervisors and associates on what specic measurable objectives

would be accomplished over a given period of time, at the end of which

the supervisors evaluate individual associates on the basis of the

accomplishment of these objectives.

50.0 - Leadership & Management

Management Information

System (MIS)

A system for managing information to assist the organization in

evaluating, planning, and implementation of daily work to improve

processes and resident care.

50.0 - Leadership & Management

Minimum Data Set (MDS) The MDS is a resident assessment tool, utilizing computerized

resident information to assess and monitor resident care. Reports are

electronically transmitted to CMS, as well, to classify a resident into a

resource utilization group (RUG) which sets the reimbursement level for

the patient’s care. It is a core set of screening, clinical, and functional

status elements, including common denitions and coding categories

that form the foundation for the comprehensive assessment for all

residents of long-term care facilities certied to participate in Medicare

and/or Medicaid.

50.0 - Leadership & Management

National Institute of

Occupational Safety and

Health (NIOSH)

Federal agency formed under the Occupational Safety and Health Act

(OSHA) to establish and monitor workplace safety standards.

50.0 - Leadership & Management

Nursing Facility (NF) A facility licensed to provide assistance with activities of daily living

such as bathing, dressing, eating (often referred to as custodial care) in

addition to providing general nursing and medical care. A nursing facility

must be certied to receive Medicaid reimbursement.

50.0 - Leadership & Management

Nursing Home Compare

A public website, www.medicare.gov, which includes facility information

and previous survey results from the Online Survey Certication and

Reporting data (OSCAR)and other facility performance measures from

the Minimum Data Set (MDS) for consumer review.

50.0 - Leadership & Management

Online Survey Certication

and Reporting Data

(OSCAR)

A database of facility characteristics and previous inspection results

related to nursing facility performance. The OSCAR 3 report

summarizes a facility's regulatory compliance history . The OSCAR 4

reports the facility's recent survey results and provides an opportunity

for benchmarking by comparing those results to other facilities,

statewide and nationwide.

50.0 - Leadership & Management

Person-Centered / Person-

Directed Care

A philosophy of care in which the focus of the community is on meeting

the expressed desires of the residents.

50.0 - Leadership & Management

Plan of Correction (POC) A written plan developed by the facility, outlining steps the facility has taken

or will take to correct deciencies found during licensure or other surveys.

50.0 - Leadership & Management

Resource Utilization Group

(RUG)

Group based on MDS information; utilized to determine

reimbursement rates.

50.0 - Leadership & Management

Servant Leadership Leadership in which the focus is on serving others. 50.0 - Leadership & Management

Sharps A term used to describe medical devices such as needles, lancets

and syringes, which put individuals at risk for “needle sticks,” or the

transmission of blood and bodily uids from the device to an individual.

50.0 - Leadership & Management

Skilled Nursing Facility

(SNF)

A facility licensed to provide nursing and medical care requiring a certain

level of training and expertise. To qualify as a Medicare provider and

receive Medicare reimbursement, a facility must be certied as a SNF.

50.0 - Leadership & Management

Substandard Quality of Care One or more requirements were not met, resulting in immediate jeopardy

to resident health or safety, and a scope or pattern of widespread actual

harm, or a widespread potential for more than minimal harm.

50.0 - Leadership & Management

Survey An inspection to verify compliance with state and federal standards. 50.0 - Leadership & Management

Transformation The act or process of major or complete change. 50.0 - Leadership & Management

Transformational

Leadership

A participatory, holistic, organizationally driven leadership model where

the focus is on educating, supporting and caring for one another.

50.0 - Leadership & Management

Vision A mental image or dream of what an organization is trying to create

and become.

50.0 - Leadership & Management

Administrator In Training

(AIT)

An internship with an approved certied preceptor where on-the job

training occurs in preparation for licensing as a NHA.

Americans with Disabilities

Act (ADA)

A US labor law, established in 1990, which prohibits discrimination

based on a disability. This law mandated that businesses and

organizations make signicant changes in physical accessibility to their

buildings as well as their employment and customer service policies.

Certicate of Need (CON) Aimed at restraining health care facility costs and allowing coordinated

planning of new services and construction. Laws authorizing such programs

are one mechanism by which state governments seek to reduce overall

health and medical costs. Certain health care providers are required to

obtain state approval before offering new or expanded services.

Community-Based Care See Adult Day Care

Corporate Integrity

Agreement

Agreement negotiated by the Ofce of the Inspector General (OIG) with

a health care provider as part of the settlement of a federal health care

program investigation arising under the False Claims Act. To avoid

severer penalties, a company may agree to such compliance activities

as: hire a compliance ofcer or appoint a compliance committee,

develop written standards and policies, implement an employee training

program, and/or retain an independent review organization to evaluate

claims submitted to federal health care programs.

Functional Disabilities Limitations on one’s ability to function independently.

National licensing exam The examination handled by NAB (National Association of Long-Term-

Care Administrator Boards) that an applicant must take to be a licensed

NHA or ALA (two different exams).

Preceptor A LTC administrator who meets prescribed qualications and has been

certied to mentor interns in an AIT program.

Utilization Review Intended to ensure that the Medicare system did not pay for care

beyond that which was determined to be necessary. Recent years have

seen increased involvement of other payers and the compressing of

allowable lengths of stay.

Related to all domains of practice.

Prefixes

Prexes Meaning Example

a-, an- without anorexia

ab- from, off, away abnormal

ad- toward, to, at advertise

an- without anoxia - absence of oxygen supply

adeno- gland adenoma - a benign epithelial tumor in which

the cells form recognizable glandular structures

ambi- both ambilateral (both sides)

ana- up, toward anabolism (building up metabolism)

angio- relating to a vessel angiobrosis (hardening of a vessel wall)

ante- in front of, before ante cibum (before a meal)

anti- against as antidote or antiseptic

arthro- pertaining to the joints arthropathy (any disease affecting the joints)

auto- self, same autoanalysis (analysis by a person of their own

disorder)

bact relating to bacteria bacteuria (presence of bacteria in the urine)

bi- two bilateral (relating to both sides)

bio- relation to life biopsy (the process of removing tissue from

living residents for a diagnostic examination)

brady- slow bradycardia (slow heart)

broncho- relating to the trachea or windpipe bronchoedema (swelling of the mucosa of the

bronchial tube)

carcino- pertaining to cancer carcinogen (any cancer producing substance)

cardi or

cardio-

pertaining to the heart cardioplegia (paralysis of the heart)

cata- downward, against catabolism (the breaking down in the body of

complex chemical compounds into simpler

ones, often accompanied by the liberation of

energy)

celio- pertaining to the abdomen celiectomy (excision of the stomach)

cephalo- head cephalogram (x-ray image of the structure of the

head)

cervic-, cer-

vici-, cervi-,

cervico-

neck OR cervix cervicovesical (pertaining to the urinary bladder

and the cervix)

chiro- pertaining to the hand chiroplasty (plastic surgery on the hand)

chole- pertaining to bile cholecystotomy (incision into the gall bladder)

circum- around circumcorneal (around or about the cornea of

the eye)

com-, con- with, together complication (a disease or adverse condition

associated with another disease or adverse

condition)

contra- against, opposite contraindicated (not recommended, advised

against)

counter- against, opposite counteraction (action of a drug or agent op-

posed to that of some other drug or agent)

cranio- pertaining to the head cranioplasty (any plastic operation on the skull)

cyst-, cysti-,

cystido-,

cysto-

pertaining to the bladder cystitis (inammation of the urinary bladder)

cyto- relation to a cell cytolysis (the dissolution of a cell)

de- down, away from debrillation (the arrest of brillation, that is

irregular or rapid randomized contractions of the

cardiac muscle restored to normal rhythm)

dent- or

denti-

teeth dentures

derm-,

derma- or

dermi-

pertaining to the skin dermatitis (inammation of the skin)

dextro- toward or on the right side dextrocardiogram (the part of the ECG that is

derived from the right ventricle of the heart)

di- double, twice diarthric (relating to two joints)

dia- through, apart diagastric (through the stomach)

dys- painful, difcult dysphasia (difculty in talking)

ecto- out, away from ectoderm (the outermost layer of the skin)

em-, en- in front of, before embolic (pushing or growing in)

encephalo- condition of the brain or head encephalomyolitis (an acute inammation of the

brain and spinal cord)

endo- within, inner endocarditis (inammation of the endocardium

or lining membrane of the heart) or endoscopy

(an examination of lower intestinal tract)

entero- relating to the intestines enterocolitis (inammation of the mucous mem-

brane of both small and large intestines)

epi- above, upon, over epidermititis (inammation of the epidermis or

the supercial layer of the skin)

eu- good euphoria (a feeling of well-being, commonly

exaggerated and not necessarily well founded)

bro- pertaining to ber bromyalgia (a condition characterized by fa-

tigue, stiffness, and chronic pain of the muscles,

tendons and ligaments)

gastro- stomach gastrostomy (the establishment of an articial

opening into the stomach, usually for feeding

purposes)

gero- old age as in gerontology

glyco- relationship to sweetness (sugar) glycogen (the chief carbohydrate storage ma-

terial in animals formed by and largely stored in

the liver and, to a lesser extent, in the muscles)

gyneco-,

gyno-

pertaining to a female gynecology (the science of diseases of women,

especially those of the genital tract)

hemato-,

hema- or

hemo-

pertaining to the blood hemorrhage (bleeding, a ow of blood); hematu-

ria (blood in the urine)

hemi- half hemialgia (pain affecting one entire half of the

body)

hepat-,

hepatic-,

hepato-

liver hepatitis (inammation of the liver)

histo- relationship to tissue histolysis (disintegration of the tissue)

hydro- pertaining to water hydrocyst (a cyst or sore with clear, watery

contents)

hyper- excessive hyperesthesia (abnormal acuteness of sensitivi-

ty to touch, pain or other stimuli)

hypno(a)- relating to sleep hypnotherapy (the treatment of a disease by

inducing prolonged sleep)

hypo- deciency, lack of hypochondria (a false belief that one is suffering

from a disease)

hystero- relating to the uterus hysterogram (an x-ray of the uterus)

ileo- relating to the ileum (remote end

of the small intestine)

ileocolitis (inammation of the mucous mem-

brane of both ileum and colon)

infra- below, beneath infracardiac (beneath the heart, below the level

of the heart)

inter- between intercostal (between the ribs)

intro- in, into introgastric (leading or passed into the stomach,

such as a nasogastric tube for feeding)

kerato- relating to the cornea, or horny

tissue

keratoconjunctivitis (inammation of the con-

junctiva at the border of the cornea of the eye)

labio- relating to the lip labiocervical (pertaining to the lip and to the

neck)

macro- large, long macrocyte (a giant red cell)

mast- relating to the breast mastectomy (amputation of the breast)

mega- large, oversize megacardia (enlargement of the heart)

meta- after, beyond, transformation metastasis (the shifting of a disease)

micro- small microinfarct (a very small infarct, ie, death

of tissue due to lack of blood supply, due to

obstruction of circulation in capillaries or small

arteries)

mono- one or single monocular (refers to one eye)

multi- many multicellular (composed of many cells)

myel- pertaining to the spinal cord myeloplegia (spinal paralysis)

myo- relating to muscle myotrophy (muscular atrophy)

naso- pertaining to the nose and nasal

passages

nasogastric

necro- relating to death necrocytosis (death of cells)

neuro- relating to the nerves a neurogenic bladder is one that is controlled

by the nervous system rather than by voluntary

control by the person

nephr(o)- pertaining to the kidney nephritis (inammation of the kidney)

odont- relating to the teeth odontalgia (a toothache)

omo- pertaining to the shoulder omodynia (pain in the shoulder joint)

opthalmo- relating to the eye opthalmoplegia (paralysis of the motor nerves

of the eye)

opto- relating to vision optometer (an instrument for determining the

refraction of the eye)

ortho- straight orthostatic (standing upright from a sitting or

reclining position)

osteo- pertaining to the bones osteoporosis (reduction in the quantity of bone

or atrophy of skeletal tissue)

oto- pertaining to the ear otology

oxy- sharp, acute oxyesthesia (a condition of increased acuity of

sensation)

pachy- thick pachylosis (a condition of roughness, dryness,

and thickening of the skin)

pan- all pancarditis (diffuse inammation of the heart)

para- two like parts paraplegia (both legs paralyzed)

patho- disease pathogenesis (the origin or development of a

disease)

per- through perfusion (the act of pouring over or through,

especially the passage of a uid through the

vessels of a specic organ)

peri- around peribronchitis (inammation of the tissues

surrounding the bronchial tubes)

phleb(o)- relating to a vein phlebitis (inammation of a vein)

pneumo- lung pneumonia (inammation of the lung)

poly- many, much polyarthritis (inammation of several joints)

procto- relating to the anus proctoscope (a short tubular instrument with

illumination for inspecting the rectum)

pseudo- false pseudo dementia (a condition of indifference

to one’s surroundings without actual mental

impairment)

psycho- pertaining to the mind psychotherapy (counseling help)

pulmo- lung pulmonologist (a specialist in the anatomy,

physiology, and pathology of the lungs)

pyo- signifying pus pyoderma (any infection of or on the skin that

contains pus, that is, a collection of white blood

cells and other materials generated by the

immune response)

quadra- involving four as quadraplegia (all 4 limbs paralyzed)

rachi- spine rachiocampsis (curvature of the spine)

rhino- nose rhinoplasty (a repair of the nose)

semi- partial, not full semiconscious (only somewhat awake and able

to understand what is happening around you)

sub- under subcutaneous (under the skin)

syn- loss syncope (to faint, a temporary loss of con-

sciousness due to generalized cerebral isch-

emia, that is, too little blood getting to the brain.

tachy- rapid tachycardia (rapid beating of the heart)

thermo- heat thermophobia (morbid fear of heat)

thorac(i)-,

thorac(o)-,

thoracico-

pertaings to the chest or thorax thoracostomy (a small incision of the chest wall,

with maintenance of the opening for drainage

through a chest tube)

tri- three triceps (muscle with three heads)

uni- one unicellular (composed of one cell)

uro- relating to the urine urosepsis (septic poisoning from retained and

absorbed urinary substances)

vaso- vessel vasoconstriction (narrowing of the blood

vessels)

Suffixes

Sufxes Meaning Example

-ac pertaining to cardiac (pertaining to the heart)

-algia pain neuralgia (nerve pain)

-cele hernia, pouching hydrocele (a pathological accumulation of

serous uid in a body cavity)

-centesis surgical puncture paracentesis (puncture of the body cavity for

removing uid)

-clasis breaking thromboclasis (breaking up of a blood clot)

-clysis washing, irrigation enteroclysis (enema of the intestines)

-cyte cell hematocyte (any blood cell)

-ectasia dilation, stretching gastrectasia (dilation of the stomach)

-emesis, -emis vomiting hyperemesis (excessive vomiting)

-ectomy excision (cutting out) tonsillectomy (cutting out of the tonsils)

-emia denoting a condition of the blood glycemia (sugar in the blood)

-emis vomiting

-genesis condition of producing carcinogenesis (the origin or production of

cancer)

-ism abnormal condition from excess of something alcoholism, botulism

-itis inammation dermatitis (inammation of the skin)

-lith stone nephrolith (kidney stone)

-lysis breakdown hemolysis (the destruction of red blood cells)

-malasia softening osteomalasia (a disease characterized by

gradual softening and bending of the bones)

-mania madness or passion for as kleptomania (compulsive stealing)

-megaly enlargement cardiomegaly (enlargement of the heart)

-odynia painful condition cardiodynia (pain in the heart)

-ology study of as neurology (study of nervous system)

-oma tumor carcinoma (a malignant tumor)

-opsy examination or inspection biopsy (excision of a small piece of living tissue

from a patient for microscopic examination)

-orexia appetite, desire anorexia (loss of appetite)

-orrhaphy suture gastrorrhaphy (the suture of a perforation of

the stomach)

-orrhea, -rrhea ow, discharge gastrorrhea (excessive secretion of gastric

juice or mucus by the stomach)

-osis abnormal or diseased condition as in osteoporosis (bone disease)

-ostomy to make a new opening colostomy (the establishment of an articial

anus by an opening into the colon)

-otomy incision, to cut into nephrotomy (an incision into the kidney)

-paresis partial or incomplete paralysis hemiparesis (weakness of the entire left or

right side of the body)

-path morbid or diseased sociopath (a person who feels no remorse or

guilt about behaving in socially unaccepted

ways)

-pathy disease neuropathy (any nerve disease)

-penia deciency leukopenia (any situation in which the total

number of leukocytes (white blood cells) in the

circulating blood is less than normal)

-pepsia digestion dyspepsia (indigestion or upset stomach)

-pexy xation, to put into place nephropexy (surgical attachment of a oating

kidney)

-philia a liking or afnity for as hemophilia (a bleeder)

-phobia fear claustrophobia (fear of being closed in a small

space)

-plasty surgical repair thoracoplasty (reparative or plastic surgery to

the chest)

-plegia paralysis as hemiplegia (a paralysis of one side of the

body)

-pnea breath polypnea (very rapid breathing)

-rhythmia rhythmical arrhythmia (any variation from the normal

rhythm of the heart)

-rrhage abnormal or excessive discharge or ow hemorrhage (bleeding)

-sclerosis hardening arteriosclerosis (hardening of the arteries)

-spasm sudden violent contraction of muscles myospasm (spasm of a muscle)

-stasis arrest, control cholestasia (an arrest in the ow of bile from

the liver)

-taxis order, arrangement thermotaxis (regulation of the temperature of

the body)

-tripsy crushing lithotripsy (the crushing of a stone in the kidney

by a machine called a lithotripter, that uses

sound waves to break stones into minute parti-

cles, which can then be passed in the urine)

-trophy development, nourishment hypertrophy (an overgrowth or increase in the

bulk of a body part or organ)

-uria urine albuminuria (the presence of protein in urine,

chiey albumin; albumin is any protein that is

soluble in water)

Abbreviations

aa of each

Abd abdomen

ac before meals

AD advance directive

ADL activities of daily living

Ad lib as much as desired, at pleasure

A/G albumin/globulin ratio

AIDS acquired immunity deciency syndrome

A.M.A. against medical advice

AMD age-related macular degeneration

amp ampule

amt amount

aq water

aq dist distilled water

ASH.D. arteriosclerotic heart disease

BE barium enema

bId twice a day

BMR basal metabolic rate

BP or B/P blood pressure

BRP bathroom privileges

c with

Ca carcinoma

CAD coronary artery disease

caps capsules

cath catheter

CBC complete blood count

c c cubic centimeter

cf compare

CHF congestive heart failure

CMP comprehensive metabolic panel

CNS central nervous system

COLD chronic obstructive lung disease, same as COPD

comp compound

COPD chronic obstructive pulmonary disease

CVA cerebral vascular accident

d/c discontinued

decub lying down

Diab diabetic

Diag or Dx diagnosis

Diff differential blood count

Dil dilute

Disc discontinue

Disch or D/C discharge

DM diabetes mellitus

DNR do not resuscitate

dx diagnosis

EEG electroencephalogram

EKG or ECG electrocardiogram

EMS emergency medical service

ESRD end stage renal disease

exam examination

 or d uid

FUO fever of unknown origin

Fx fracture

GII gastrointestinal

gm gram

gr grain

gtt or gtts drop(s)

H or hr hour

HBP high blood pressure

HBV Hepatitis B virus that infects the liver; highly

contagious

HIV human immunodeciency virus

hs at bedtime

hypo hypodermically

IDDM insulin dependent diabetes mellitus

IM intramuscular

inf infusion

I & O intake and output

IV intravenous

KUB kidney-ureter-bladder

l liter

lab laboratory

Lat lateral

lb pound

liq liquid

mg milligram

min minute

ml milliliter

mm millimeter

MN midnight

MRSA methicillin-resistant Staphylococcus aureus

N noon

NIDDM noninsulin dependent diabets mellitus

no number

noct. at night

NPO nothing by mouth

NV nausea and vomiting

od right eye

OOB out of bed

os left eye

OT occupational therapy

ou both eyes

oz ounce

p pulse

pc after meal

PEARL pupils equal and reactive to light

PEG percutaneous endoscopic gastrostomy

po by mouth

prn as needed

prog prognosis

PROM passive range of motion

pt pint

PT physical therapy

PX physical exam

qd every day

qh every hour

qhs each bedtime

qid four times a day

qn every night

qod every other day

qs sufcient quantity

ROM range of motion

Rx prescription

s without

SOB shortness of breath

sol solution

sos one dos, if necessary

spec specimen

SS soap solution

ss half

stat immediately

surg surgery

T temperature

tab tablet

TB tuberculosis

tId three times a day

tinct or tr tincture

TO telephone order

TPR temperature, pulse and respiration

u unit

ung ointment

URI upper respiratory infection

UTI urinary tract infection

VO verbal order

vol volume

vs vital signs

WBC white blood cells

W/C wheel chair

wt weight

Therapeutic Actions

Drugs Therapeutic Actions Example (if applicable)

Analgesic reduces pain (does not cure illness). Two types are (a)

opiates as codeine, morphine, and Davon and (b) nonopi-

ates as aspirin, Tylenol and Advil

See denition given for two types and examples

Antacid neutralizes the acid in the stomach Maalox®

Antianemic used in treatment of anemia liver extract

Antibiotic destroys microorganisms in the body penicillin, doxycycline, Keex

Anticoagulant depresses (slows) the clotting of blood Coumadin (given orally) or heparin (injected)

Anticonvulsant used to prevent or control convulsions Dilantin, phenobarbital, and intravenous Valium

Antidepressant given to relieve depression Prozac, Zoloft, Paxil

Antidote used to counteract poisons

Antihistamine used in certain allergy cases and to dry out nasal tissues

to reduce postnasal drip

Benadryl, Chlortrimeton

Antiseptic slows down growth of bacteria, but does not kill all of the

bacteria

hydrogen peroxide

Antispasmodic relieves smooth muscle spasm Valium ® (diazepam)

Antipsychotic drug given for mental disorders Thorazine, loxitane, Mellaril

Antitoxin neutralizes bacterial toxins in infections tetanus antitoxin

Antitussive given to control coughing Robitussin ® and Phenergen expectorant

Astringent used to constrict skin and mucous membranes by with-

drawing water

alum

Carminative an agent that reduces atulence (gas) in the stomach or

intestinal tract

Simethicone tabs

Cathartic laxative, purgative, inducing bowel movements cascara sagrada

Caustic destroys tissue by local application silver nitrate

Chemotherapeutics chemicals used to treat illness sulfanilamide for streptococcal infection

Coagulant stimulates clotting of the blood

Decongestant constricts blood vessels in the nose and relieves nasal

congestion

Sudafed, Afrinol

Diaphoretic used to induce perspiration Solution of acetate to ammonium (2 oz)

Disinfectant destroys pathogenic organisms Zephiran ® chloride

Diuretic stimulates elimination of urine, often used with medica-

tions prescribed to reduce hypertension

diazide, Lasix, Diuril

Emetic induces vomiting warm salt water

Emollient used to soften and soothe tissue cold cream, petroleum jelly

Expectorant used to induce coughing, an agent that increases bron-

chial secretion and facilitates its expulsion (coughing)

Robitussin ®

Generic Substitution a different brand or an unbranded drug product substi-

tuted by the pharmacist for a trade-name drug product

prescribed. The drugs are exactly the same chemically

and in the same dosage form, but distributed by different

drug companies.

Hypertensive helps raise blood pressure

Hypnotic assists patients/residents to fall asleep Nembutal

Laxative used to relive constipation Dulcolax, Doxidan, Metamucil

Miotic constricts the pupil of the eye

Mydriatic dilates the pupil of the eye

Palliative relieves pain without curing aspirin, Tylenol

Parenteral drug or solution given by subcutaneous or intravenous

injection

Placebo inactive medication having no physical healing effect.

Usually given to satisfy the resident. Also used in drug

studies to determine the effectiveness of another drug.

May be given orally, by injection, as a suppository, or

topically

Sedative relieves anxiety and emotional tensions Seconal ®

Suppository semisolid substance for introduction into the rectum,

vagina or urethra where it is dissolved and absorbed.

Suspension medication served in a liquid form

Tonic, or stimulant used to stimulate body activity Eldertonic ® or Ritalin ®

Topical medication medication applied to an area of the skin, as ointments

and lotions

Vasoconstrictor causes blood vessels to narrow or constrict Pseudoephedrine

Vasodilator expands or dilates blood vessels

Vitamins used in replacement therapy vitamin C

Common Diagnoses

Acquired Immune

Deciency Syndrome

(AIDS)

A syndrome that results in a person having little or no immunity to disease.

Alcoholism A chronic, progressive, potentially fatal disease characterized by physical dependency and/or pathological

organ changes due to ingestion of alcohol.

Alzheimer’s disease A chronic, progressive, degenerative cognitive disorder. It accounts for over 60% of all dementias, commonly

occurring in people over 65. The disease is staged according to the behaviors exhibited by the victim. There

are three stages, with Stage I considered the early stage and Stage III the late stage.

Age-related Macular

Degeneration (AMD)

A disorder of the eye characterized by the inability to see anything that requires straight ahead vision, often

resulting in blindness.

Angina pectoris Severe pain about the heart, usually radiating to the left shoulder and down the arm.

Anorexia Loss of appetite - serious psychological disorder.

Aphasia Absence or impairment of the ability to communicate through oral and/or written language; it often occurs

after brain damage in accidents and from strokes.

Apnea Temporary cessation of breathing, a serious symptom sometimes occurring in the aged during profound

sleep.

Arteriosclerosis Thickening, hardening and loss of elasticity of the walls of the arteries; it is the most frequent metabolic

disorder of the aged.

Arthritis Inammation of a joint, usually accompanied by pain, and frequently by changes in bone and joint structure.

Atrophy A decrease in size of an organ or tissue that can result from a number of factors including malnutrition and

inactivity.

Benign Disequilibrium of

Aging (BDA)

A very common disorder in which the balance centers of the inner ear fail to function properly causing imbal-

ance while walking.

Botulism Food poisoning caused by toxin of bacillus that may infect preserved foods, sausage and canned meats.

Carcinoma A new growth or malignant tumor that tends to give rise to metastasis; it is synonymous with the term cancer.

Cataract The darkening of the lens of the eye or its capsule or both; very common in the aged; the most common

cause of blindness of adults. The only effective treatment is surgery.

Cerebrovascular accident

(CVA)

A cerebrovascular condition resulting from a hemorrhage, a stroke - may result in paralysis.

Congestive heart failure

(CHF)

A condition characterized by weakness, breathlessness, abdominal discomfort, and edema in the lower

portions of the body due to reduced outow of blood from the heart.

Coronary heart disease Myocardial damage due to insufcient blood supply, caused by pathological changes in the coronary arteries.

Cystitis Inammation of the bladder; also called a urinary tract infection (UTI).

Dementia Impairment of mental powers due to organic causes.

Depression An affective disorder characterized by feelings of hopelessness, sadness, and inadequacy. It is the most

frequent mental problem in nursing facilities. Residents may withdraw, isolate themselves, lack motivation,

and/or show agitation.

Diabetes A general term for disease characterized by many symptoms, one of which is excessive urination. There are

many types but usually refers to diabetes mellitus (sugar diabetes) in which there is a deciency of insulin.

End-stage renal disease A permanent failure of the kidneys to perform essential functions that results in a need for dialysis.

Epilepsy A recurring paroxysmal disorder of the brain characterized by sudden, brief convulsive seizures, altered

consciousness, motor activity, or sensory phenomena.

Fecal Impaction Constipation caused by a rm mass of feces in the colon or rectum. The size or rmness prevents its pas-

sage. Common in nursing home residents.

Glaucoma Disease of the eye characterized by increase in pressure within the eye; may result in blindness. It can be

controlled but generally has no cure.

Heart attack Descriptive term for a clinical condition caused by occlusion of a coronary artery(s), characterized by heavy

pressure or squeezing pain in the chest that may spread to the shoulder and arm. There may also be sweat-

ing, nausea, vomiting, and shortness of breath.

Hemiparesis Partial or incomplete paralysis of one side of the body.

Hemiplegia Paralysis of one side of the body.

Hypertension A condition in which a person has higher blood pressure than normal.

Hemophilia Hereditary blood disease in which there is greatly prolonged coagulation time for blood; abnormal bleeding

occurs.

Herpes A general term used for a variety of infections of nerve endings caused by a number of different herpes

viruses.

Methicillin-resistant

Staphylococcus Aureus

(MRSA)

Infection that is resistant to anti-infective agents. Patients with MRSA should be isolated in a manner consis-

tent with the state of infection.

Multiple sclerosis A chronic, slowly progressive disease of the nervous system, with many symptoms, that is degenerative.

Nephritis Inammation of the kidney.

Obesity Abnormal amount of fat on the body, usually 20 to 30 percent over the average weight for a person’s age,

sex, and height.

Osteoporosis Disease of the bone characterized by a reduction in bone density associated with loss of calcium.

Paraplegia Paralysis of lower portion of the body and of both legs.

Parkinson’s Disease A chronic nervous system disease characterized by a ne slowly-spreading tremor, muscular weakness and

rigidity, and peculiar gait; common in the aged.

Pulmonary conditions Disorders of the lungs and bronchial tubes, as pneumonia, lung cancer and bronchitis.

Quadriplegia Paralysis of all four limbs and usually the trunk of the body.

Senile dementia Deteriorative mental state due to organic brain damage occurring in the aged, characterized by loss of

memory.

Shingles Acute inammation of peripheral nerves in the trunk of the body, and sometimes elsewhere, by a herpes

virus.

Standing Orders Physician orders that nurses can activate in specic situations without rst having to notify the physician.

These orders are specic to the individual attending physician, and the scope of the orders may vary greatly

from one doctor to the next.

Stroke Sudden loss of consciousness followed by paralysis caused by hemorrhage into the brain, formation of a

blood clot, or rupture of an artery in the brain; a cerebrovascular accident (CVA).

Syndrome A group of signs and symptoms that collectively characterize or indicate a particular disease or abnormal

condition, such as Down’s Syndrome.

Forms and Flashcards

Proposed Curriculum and Checklist

AIT/Preceptor Agreement/Training Permit

Forms

Proposed AIT Program

AIT Monthly Report

AIT Program Hours Completed

AIT Documentation of Completion Form

Flashcards

Already used by many states, you can also get an app for your Smart Phone to

study these anywhere.

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Therapeutic Actions

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