NAB KH
straight line depreciation historical cost / useful life 100,000 / 10 = After first year, what is the book value? 100,000 - 10,000 =
$10,000 per year/$90,000
Under MCR & MCD, an individual who willfully and knowlingly certifies a material and false statement in a resident assessment is subject to a CMP of not more than ____________ for each assessment
$1000
Break even in beds = FC/{Fixed cost rate per bed - Variable Cost Rate per bed} FC is $14,000 Fixed cost rate per bed is $100 VC is $40
$14,000 per week/$100-$40 $14,000 / $60 = 233.33 per week 233.33/7 = 33 beds per day
Amount collected = (Amount of insurance carried / amount of insurance required) x loss Amount of insurance carried is $150,000 Amount of insurance required is $30,000 Loss is $ 5,000 How much will be collected from the loss?
$150,000 / $30,000 = 0.5 0.5 x $5,000= $2,500 collected from insurance company
Amount of insurance required = Value of building x coinsurance percentage Value of building is $150,000 Coinsurance is 20%
$150,000 x .20 = $30,000
Average cost per day = Average cost per resident / # of days in the month Average cost is $2,000 # of days in month is 31
$2,000/31 = $64.52
Break even in beds = FC/{Fixed cost rate per bed - Variable Cost Rate per bed} FC is $20,000 Fixed cost rate per bed is $100 VC is $40
$20,000 per week / $100 - $40 $20,000 / $60 = 333.33 per week 333.33 / 7 = 48 beds per day
Average cost per resident = monthly expense / # of residents Average cost is $200,000 # of residents is 100
$200,000 / 100 = $2,000
SSI resource limit is:
$2000
The Drug-Free Workplace Act of 1988 requires organizations having ___________ or more in federal contracts or grants to make good-faith efforts to maintain a drug-free workplace & to establish drug education & awareness programs for their employees.
$25,000
Profit margin = gross profit / sales Gross profit is $250,000 Sales is $1,000,000 What is the profit margin?
$250,000 / $1,000,000 = 0.25 0.25 is 25%
The Rehabilitation Act of 1973 required employers doing more than ___________ in business with the federal government to apply affirmative action guidelines so as to employ & promote qualified handicapped individuals
$2500
Compute Raw food PPD for the month costs in months / total paint days in month $8,500 / 77 x 31 (days in January) =
$3.56 ppd
Cost per patient day = Total annual operational costs / total patient days for the year Total annual operational costs is $4,000,000 Total patient days for the year is 30,000 days
$4,000,000 / 30,000 = $133.33 cost per patient day
(pay rate x regular hours) + (OT rate x OT hours) Net pay = Gross pay - deductions What is gross pay and what is overtime pay? (10 x 44) + 0 =
$440 (OT rate = 0)
Pay rate = $10 per hour, 44 hours worked, no sick (pay rate x regular hours) + (OT rate x OT hours) What is gross pay and what is overtime pay? OT rate is ($10 x 1.5) = $15 per hours (10 x 40) + (4 x 15) =
$460
Payback period = purchase price/how much will new purchase reduce annual operating costs per year Purchase price is $5,000 How much will new purchase reduce annual operating costs per year is $800
$5,000/$800 = 6.25 years
What are the amounts for deposits to be placed in a interest-bearing account?
$50 MCD $100 MCR skilled
The Rehabilitation Act of 1973 required employers having more than 50 employees & fulfilling a government contract worth ___________ or more were required to have written affirmative actions programs as required by the Office of Federal Contract Compliance Programs.
$50,000
Net profit margin = Net income after tax /Sales NOI after taxes is $500,000 Sales is $1,000,000 What is the net profit margin in % ?
$500,000 / $1,000,000 = 0.5 0.5 = 50%
Under MCR & MCD, an individual who willfully and knowlingly causes another individual to certify a material and false statement in a resident assessment is subject to a CMP of not more than _________ for each assessment
$5000
Break even in units= (TC-TFC)/Variable Rate TC of PT Dept is $6,500 per month TFC is $5,200 Variable cost is $8 How many patient visits are needed per month to break even?
$6,500 -$5,200 / $8 is $1,300/$8 = 162.5 visits
Break even in days = [FC/(Revenue - VC)] x # of patient days in the period FC is $600,000 Revenue is $400,000 VC is $100,000 #of patient days in the period is 9,000 How many days to break even?
$600,000 / $400,000 - $100,000 x 9,000 $600,000/$300,000 x 9,000 2 x 9,000 = 18,000 days
The turnover costs (basic salary, employment taxes and benefits) are typically in the 1.25 to 1.4 times base salary range. The cost range for a $50,000 per year employee might be __________ to _____________
$62,500 to $70,000
The FUTA tax is imposed at a single flat rate on the first ___________ of wages that you pay each employee
$7,000
The FUTA tax rate is fixed at 6%. That is the tax rate that applies to the first ______________ in wages paid to each of your employees during the year
$7,000
Acid test ratio = Quick assets/current liabilities Quick assets is $850,000 Current liabilities is $800,00
$850,000 / $800,000 = 1.06 (If more than 1 company can meet financial obligation)
Wasted cost =
(# of employees) x (days in the month) x (hours per day) x (salary per hour) x (wasted time % given)
Medication error =
(# of errors observed / # of opportunities) x 100
Accountants have determined that uncollectibles are: 5% of accounts 1-30 days overdue 10% of accounts 31-60 days overdue 25% of accounts 61-90 days overdue 50% of accounts 91-120 days overdue 1-30 days is $1,000 31-60 days is $3,000 61-90 days is $1,500 91-120 days is $2,500 What amount is estimated to be uncollectible?
($1,000 x .05) + ($3000 x .10) + ($1,500 x .25) + ($2,500 x .50) $50 + $300 + $375 + $1250 = $1,975 Will see a negative hit on P & L statement as bad debt
Wasted cost = (# of employees) x (days in the month) x (hours per day) x (salary per hour) x (wasted time % given) # of employees is 100 Days in the month is 31 Hours per day is 8 Salary per hour is $9 Wasted time percent is 2% What is the monthly employee wasted cost for January?
(100)(31)(8)($9)(.02) = $4,464 Be sure to change days and hours to 2080 in lieu of days in month and hours in day
Calculation Medication Error Rate. (medication not given + wrong medications given) / (total # of doses given + doses ordered but not given) Medication not given is 2 Wrong medication given is 2 Total # of doses given is 78 Doses ordered but not given is 2
(2 + 2) / (78 + 2) = 0.5 0.5 x 100 =5 % error rate
Amount collected =
(Amount of insurance carried / amount of insurance required) x loss
Break even in units=
(TC-TFC) divided by variable rate It is also where there is NO profit. IT is where Total Cost=Total revenue. TR can be substituted where TC is in equation
% of body weight loss =
(Usual weight-actual weight)(Usual weight) x 100
Calculation Medication Error Rate
(medication not given + wrong medications given) / (total # of doses given + doses ordered but not given)
Gross pay =
(pay rate x regular hours) + (overtime rate x overtime hours)
Compute the average daily absentee rate Lost days / {# of employees x days in the month} 100 / (200 x 31) =
0.02 ~ 2% good
Acid-test ratio=quick assets/current liabilities. Quick assets can be converted to cash quickly, such as AR. If the answer is greater than ______ the company is safe.
1
Current ratio (Current ratio or working capital ratio)=total current assets/total current liabilities; if the answer is greater than _________ the company is able to meet its current obligation or (Solvency) with a surplus of working capital
1
How many accessible routes from the handicapped parking spaces to the building is required?
1
If facility has 1-25 parking spaces, how many must be handicap accessible?
1
Resident's bedrooms must have at least _______ operable window
1
Doors must be at least ___________ fire-rated?
1 1/2 Hour
FTE (full time equivalent) 40 hours worked in 1 week =
1 FTE
Overtime rate =
1 and 1/2 times the base pay
Fire drills required:
1 fire drill per quarter per shift (minimum 12 per year, 8 hour shifts)
Gratings when located on walking surfaces, grating must have spaces no greater than how far in one direction?
1 inch
MSDS or SDS should have how many of each chemical used in the facility?
1 of each chemical
under the Age Discrimination in Employment Act, all employment related records must be retained for how long?
1 year
Short term goals are accomplished in
1-2 years
Adverse event reporting can be completed to MedWatch by fax to what number?
1-800-FDA-0178
Adverse event reporting to MedWatch can be completed by calling what number?
1-800-FDA-1088
To prove fraud, the following facts must be shown:
1. An untrue statement known to be untrue by the party making it and made with the intent to deceive 2. Justifiable reliance by the victim on the truth of the statement 3. Damages as a result of the reliance
The facility must ensure correct installation, use, and maintenance of bed rails, including but not limited to the following elements:
1. Assess the resident for risk of entrapment from bed rails prior to installation 2. Review the risk and benefits of bed rails with the resident or resident's representative and obtain informed consent prior to installation 3. Ensure the bed's dimensions are appropriate for the resident's size & weight 4. Follow the manufacturers recommendations & specifications for installing & maintaining bed rails
When implemented properly, the CAA process should help staff:
1. Consider each resident as a whole, with unique characteristics & strengths that affect his or her capacity to function 2. Identify areas of concern that nay warrant interventions 3. Develop, to the extent possible, interventions to help improve, stabilize, or prevent decline in physical, functional, & psychosocial well-being, in the contexts of the resident's condition, choices, & preferences for interventions 4. Address the need and desire for other important considerations, such as advances care planning & palliative care (ex. symptoms relief & pain management)
Care Area Assessment in the Resident Assessment Instrument, Version 3.0 (20 care areas)
1. Delirium 2. Cognitive loss/Dementia 3. Visual Function 4. Communication 5. ADL functional/ Rehabilitation potential 6. Urinary incontinence & indwelling catheter 7. Psychosocial well-being 8. Mood state 9. Behavorial symptoms 10. Activties 11. Falls 12. Nutritional status 13. Feeding tubes 14. Dehydration/Fluid maintenance 15. Dental care 16. Pressure ulcer 17. Psychotropic medication use 18. Physical restraint 19. Pain 20. Return to community referral
3 objectives of performance evaluation
1. Give employees feedback about their work performance 2. To provide a plan for directing future employee efforts toward organizational goals 3. To provide a basis on which manager will decide on promotions, compensation, & future assignments
MCR A eligibility:
1. Have had a medically necessary hospital stay of 3 days 2. Admitted to the skilled nursing facility within 30 days of hospital discharge 3. Require skilled nursing or skilled rehabilitation services that must be performed by or under supervision of skilled professionals 4. Need these services on a daily basis 5. Require these services on a inpatient basis
Each resident's drug regimen must be free of unnecessary drugs. A unnecessary drug is any drug used when:
1. In excessive dose 2. For excessive duration 3. Without adequate monitoring 4. In the presence of adverse consequences which indicate the dose should be reduced or discontinued 5. Without adequate indications for its use 6. Any combination of above reasons
Common errors made by managers using rating scales:
1. Leniency error (To avoid conflict) 2. Error of Central Tendency (Moderate scores regardless of performance) 3. Halo Effect (One particular good job behavior) 4. Horn Effect (One particular bad job behavior)
Three basic forms of negligence
1. Malfeasance 2. Misfeasance 3. Nonfeasance
Union Labor Rights for employers?
1. Management has the right to restrict union organizers to certain locations in the facility & to avoid certain time periods to avoid interference with facility operations 2. Management has the right to prohibit union activities during employee working hours 3. Management has the right to prohibit supervisors from engaging in union organizational activity
What are the four primary focuses of Fair Labor Standards Act?
1. Minimum wage 2. Overtime 3. Child Labor 4. Equal Rights
Services included in Medicare & Medicaid payment, facilities cannot charge a resident for
1. Nursing Service as required by 483.30 2. Dietary Services as required by 483.35 3. Activities program as required by 483.15 (f) 4. Routine hygiene items and services as required to meet the needs of the resident 5. Medically related Social Services as required by 483.15 (g)
Standard survey consists of 7 tasks these are:
1. Offsite preparation 2. Entrance conference 3. Initial Tour 4. Resident Sample Selection 5. Information Gathering 6. Determination of compliance 7. Exit Conference
3 stages of Alzheimer's
1. Preclinical (lasts 2 to 3 years) 2. Mild (last 1-10 years) 3. Severe (last 1 to 10 years)
Union Labor Rights for employees?
1. Right to organize & bargain collectively 2. Right to solicit & distribute union information during nonworking hours 3. Right to picket 4. Right to strike
Ethical Decision Making Model:
1. Start with a situation 2. Look at options 3. Choose the best option 4. Act upon the option chosen 5. Evaluate
The Facility Assessment includes the following:
1. The facility's resident population 2. The care required by the resident population 3. Staff competencies 4. Physical environment/equipment 5. Any ethical, cultural, or religious factors that may potentially affect the care provided by the facility
Compute acid test ratio $200,000/195,000=
1.02 (If greater than 1, company is good)
The turnover costs (basic salary, employment taxes and benefits) are typically in the _________ to __________ times base salary range
1.25 to 1.4
Backup batteries must operate entrances & exits, resident call systems, & nurses station for how long?
1.5 hours
Approximately _____________ Americans reside in about 17,000 skilled nursing facilities
1.6 million
Threshold should be how high on entrance & exit doors?
1/2 inch
Business with less than or equal to _______ employees are exempt from completing OSHA 300 log
10
Written notice must be provided by a union to the healthcare institution & the Federal Mediation & Conciliation Service ________ to engaging in any picketing, strike, or other concerted refusal to work. No such notice is required prior to similar actions in other industries.
10 Days Prior
A physician visit is considered timely if it occurs not later than ________ after the date the visit was required
10 days
New employee should be offered the Hep B series within _________ of hire according to OSHA
10 days
The Drug-Free Workplace Act of 1988 requires that the granting or contracting agency must be notified of a drug conviction within how many days?
10 days
Facilities with a DART rate of _________ are subject to OSHA inspections
10 or more
Emergency power generator must come on within how long after power failure?
10 seconds
The emergency generator must start and transfer power under load conditions within ______________ after the interruption of normal power
10 seconds
Nursing homes must report to the Food & Drug Administration or the manufacturer within how many days after the incident or incidents in which the medical devise causes or contributed to a resident's death
10 work days of becoming aware
Nursing homes with _______ employees or more must file an EEO-1 annual report, disclosing the # of employee by race, ethnicity, disability, sex, job category, & salary.
100
S corporations have less than ___________ shareholder
100
Worker Adjustment and Retraining Notification Act (WARN) of 1988 requires employers with ________ or more employees at any individual site to provide advance notice of major reductions in force
100
No room shall be more than how far from an exit in a facility?
100 feet
Compute average daily census & explain Total patient beds / # of days in the month 3100 / 31 =
100 patients
HR department in a contemporary healthcare organization has one staff for every
100 to 150 employees
Safe temp for bathing
100-110 degrees (regulated by automatic control valves)
Medicare Part A skilled services include ________ days of NF and ________ days inpatient hospital
100/150
CNAs are required to have no less than ______ of in-service education per year
12 hours
CNA training requires how many hours of in-service each year?
12 hours & must include dementia management & abuse prevention
Every ___________ dietary workers must be in-serviced on food handling
12 months
To be eligible for FMLA the employee must have worked for at least __________ prior to the leave
12 months (1250 hours) The 12 months doesn't have to be consecutive
FMLA states that covered employers (50 or more employees) must allow up to _________ per year of unpaid leave connected to pregnancy, childbirth, and recovery, or a serious health condition effecting a employee or an employees family member.
12 weeks
7.5 hour shift, Nursing CNAs = 120 hours per day. How many FTEs for the day?
120 / 7.5 = 16 FTEs
8 hour shift administration = 120 hours per day. How many FTEs for the day?
120 / 8 = 15 FTEs
Facility with more than _________ must employ a qualified social worker on a full time basis
120 beds
1200 hours total in nursing LVNs for the week. How many FTEs needed for the week?
1200 / 40 = 30 FTEs
PRN order for psychotropic drugs are limited for _________ days
14
Minors __________ & _________ years of age may be employed in Nonhazardous jobs outside of regular school hours.
14 & 15
MCD and private pay patients comprehensive assessments must be completed within ___________ after admission
14 calendar days
MCD & private pay comprehensive assessments must be completed:
14 calendar days after admission, excluding readmission with no significant change Within 14 days after the facility has determined that there has been a significant change in resident's physical or mental condition Not less than once every 12 months
Within __________ after the facility has determined that there has been a significant change in resident's physical or mental condition a comprehensive assessment must be done
14 days
Facility must electronically transmit MDS to CMS database within
14 days of completion
There must be no more than _________ between a substantial evening meal & breakfast the following day
14 hours
Hypertension blood pressure is usually greater than:
140/90
Final cooking temp for fish and other meats
145 degrees for 15 seconds
Final cooking temp for unpasteurized eggs when cooked to order in response to resident request and to eaten promptly after cooking
145 degrees for 15 seconds, until the white is completely set and the yolk is congealed
A facility must maintain all resident assessments completed within the previous _______ months of the residents' active record.
15
The Americans with Disabilities Act of 1990 applies to employers with ___________ employees working for ________ during a calendar year
15 or more 20 or more weeks
An employer has the right to file a notice of contest with OSHA are director within _________ of receipt of a notice of citation & proposed penalty
15 working days
Total hours for the year in nursing is 15,600. How many FTEs?
15,600 / 2080 = 7.5 FTEs
Minors under _____ may not be employed except under a temporary permit issued by the Department of Labor
16
Up to ________ may lapse between a substantial evening meals & breakfast the following day if a resident group agrees to this meal plan, and a nourishing snack is served
16 hours
Linen wash temp
160 degrees for 25 minutes
Final cooking temp for poultry & stuffed foods
165 degrees
Reheating foods
165 degrees for at least 15 seconds before holding for hot service
Toilet seat must be how far from the floor?
17-19 inches
With COBRA insurance coverage can continue for how long for laid-off employees?
18 months
Daily staffing sheets must be kept on file at a minimum of
18 months or whatever is required by individual state, which ever is greater
Many employment situations are prohibited for those younger than what?
18 years old
Manual washing and sanitizing temp:
180 degrees
Contained MCR & MCD reforms with very stringent requirements
1987 Omnibus Budget Reconciliation Act (OBRA)
MedWatch was founded when?
1993
Maximum slope for ramp is ________, maximum rise is ________
1:12 & 30 inches (For ever 12 in length of ramp, the ramp will rise 1 inch with a maximum rise of 30 in)
______________ are the key persons involved in employee grievances/concerns
1st line supervisor
If facility has 26-50 parking spaces, how many must be handicap accessible?
2
When hiring entry-level personnel, typically between ___ and ___ applicants are interviewed for an open position
2 & 5
Food inventory must include:
2 day supply of perishables 7 day supply of staple goods
Smoke-proof enclosures such as areas in stairwells must be at least how many hours fire rated material?
2 hour
All alleged violations involving abuse, neglect, exploitation, mistreatment, including injuries of unknown source & misappropriation of resident's property must be reported immediately, not more than
2 hours after the allegation is made if involves abuse or results in serious bodily injury. No more than 24 hours of no bodily injury
For facilities that receive approval of construction or reconstruction or newly certified after November 28, 2016 bedrooms must accommodate no more than
2 residents
Each CNA must reregister at least every
2 years
Job evaluations, merit system description & records, & payroll deduction records must be retained for how long?
2 years
Nursing homes must report to the Food & Drug Administration or the manufacturer within 10 work days after the incident or incidents in which the medical devise causes or contributed to a resident's death. How long must these records be maintained?
2 years
The first person to ask someone that is choking is
"Are you choking?"
Break even in units = (TC-TFC)/Variable Rate TC of PT Dept is $10,000 per month TFC is $8,500 Variable cost is $10 How many patient visits are needed per month to break even?
$10,000 - $8,500/10 is $1,500/$10 = 150 visits
Compute Nursing HPPD # of hours worked / # of patients 265 / 130 =
2.038 ~ 2.04 hppd (generally 2.9 and higher depending on acuity)
OWBPA (Older Workers Benefit Protection Act of 1990) covers private employers with ___________ employees, state & local government, employment agencies, & most labor unions
20 or more
Door clearing opening must be _______ & doors must be __________
20" / fire rated
__________ of employees require __________ of supervisory time
20%/80%
The comprehensive assessment must be completed within _______ after admission
21 days
Compute ADSO & explain (AR x # of days) / revenue $70000 x 31 / $100,000 =
21.7~22 days Good within 30-60 days
If, since a CNAs most recent completion of training and competency eval program, there has been a continuous period of ___________ the individual did not provide nursing or nursing related services for monetary compensation, the individual must go through new training & competency eval program or a new competency eval program
24 consecutive months (2 years)
Each facility must provide for or arrange physician services on a
24 hour a basis in case of emergency
Facility must assist residents in obtaining routine ____________ dental care
24 hour emergency
Employers must report any worker's amputation, loss of eye, or hospitalization within how long?
24 hours
Resident or his/her legal rep has the right to upon oral or written request, to access records at all times pertaining to him/herself within
24 hours (excluding weekends & holidays)
Facility must provide for or arrange physician services on a _______________ in case of emergency
24-hour a day basis
Only can garnish employee's earnings the lesser of ________ of disposable earnings or amount which disposable wages are greater than _______ times the federal minimum wage
25 % 30
Patient Protection and Affordable Care Act of 2010 states that young adults can remain on their parents plans until age what?
26
The ALOS for short term care is ________ days
27
Wall unit drinking fountain or coolers should have a clear knee space of how far from the bottom of floor & how many inches deep?
27 inches / 17-19 inches
Stairs handrails must be how high?
28"
With COBRA insurance coverage can continue for how long for disabled employees?
29 months
Each resident must receive at least _________ meals a day
3
Employee records must be kept for ____________ years
3
If facility has 51-75 parking spaces, how many must be handicap accessible?
3
Facility must promptly within ________ refer residents with lost or damaged dentures for dental services
3 days
Facility must have reports with respect to any surveys, certification, and complaint investigations made respecting the facility during the __________________
3 preceding years
Federal guidelines recommend facilities should have enough linen for at least __________
3 sets per bed
Clinical records for a minor must be retained for ___________ after the resident reaches a legal age under state law
3 years
Under the FLSA, payroll records & supporting information such as time cards & time sheets must be retained for how long?
3 years
Ramp must be?
3' deep & 5' wide
Long range goals are accomplished in
3-5 years
Minors 14 & 15 years of age may be employed in Nonhazardous jobs outside of regular school hours. They may work no more than ______ hours on a school day, _______ hours during a school week, & ________ hours on a non school day
3/18/8
Threshold should be how high on sliding doors?
3/4 inch
The Employee Retirement Income Security Act of 1975 requires certification every _____ years of the actuarial soundness of the plan & requires ________ of the employee's equity in the pension fund
3/Vesting
Records of employees exposed to toxic substances must be kept for __________ years
30
The facility must give resident ___________ written notice before resident is transferred or discharged
30 day
Conveyance upon discharge, eviction, or death of a resident with a personal fund deposited with the facility, the facility must convey within ___________ the resident's funds.
30 days
MCD will only pay for the stay if the resident stays in the facility for at least __________
30 days
The Drug-Free Workplace Act of 1988 requires that an employer must take appropriate disciplinary action against the employee, or require the employee to complete an approved drug-abuse assistance or rehabilitation program in a satisfactory manner within how many days?
30 days from receiving notice of an employees criminal drug statue conviction
Restraints must be monitored at least every ____________ removed at least every __________ for ______________ and resident exercised or repositioned at the time
30 minutes 2 hours 10 minutes
Handrails should be how far from ramp or stair tread?
30-34 inches
Average collection period (aka ADSO or Average Daily Sales Outstanding)=365 x AR/Net Operating Revenues. The answer is in days. How many days are okay?
30-60 days
Average payment period=365 x AP/Supplies expense. The answer is in days. How many days is okay?
30-60 days, too many days in AP could result in poor credit relations with vendors
Soiled linen & trash collection containers must be limited to capacity of __________ within any ____________?
32 gallons/64 sq foot area
Wheelchair passage width is _____ inches for doors and ______ inches everywhere else.
32/36
How far do grab bars for toilets have to be from the floor?
33-36 inches
Compute average collection period (365 x AR)/Net operating revenues 365 x $5000 / 52,142.86=
34.99~35 days Good you want it between 30-60 days , harder to collect as days progress
Drinking fountains & water coolers shall be no more than how many inches from floor?
36
Resident's bedroom must have at least 1 operable window and the height of the window sill (opening) must not exceed
36 inches above the floor
With COBRA insurance coverage can continue for how long for dependents following separation, divorce, or death of the previously covered employee?
36 months
Toilet must be how wide?
36"
The ALOS for long term residents is greater than __________ days
365
Average payment period=
365 x AP divided by Supplies expense
Average collection period (aka ADSO or Average Daily Sales Outstanding)=
365 x AR divided by Net Operating Revenues
Compute ALOS and explain Total patient days in the year or month / # of admissions in the year or month 70 x 31 / 55 =
39.45 ~ 39 Good The greater the ALOS the more generated revenue.
Flow of water in drinking fountain & water coolers must be at least how many inches?
4
Medication error = (# of errors observed / # of opportunities) x 100 # of errors observed is 4 (2 given & 2 crushed not suppose to be) # of opportunities is 150 What is the medication error rate? What % will cause the surveyor to write a med error deficiency?
4 / 150 = 0.026 ~ 3% 5% or greater
Nursing homes must be able to provide authorized governmental representative requested OSHA records within _____________
4 business hours
A nurse aide can work in a facility less than ________, without being certified, if the nurse aide has completed a State approved training & competency evaluation program. Registry verification is required
4 months
Resident's bedrooms must accommodate no more than
4 residents
An invoice stating 4/10 - n/30 means
4% discount if payment is made within 10 days. But if discount is not taken, payment in full is due within 30 days
Compute turnover rate in % and also list in the form of a decimal (# of employees terminated x 100) / Total FTEs (5 x 100) / 120=
4.17 % (.0417)
Overtime is paid on a weekly basis for all hours over ________ worked.
40
Mirrors should be how far from the finished floor?
40 inches
As of the summer of 2011, MedWatch has received how many adverse event reports?
40,000
Age Discrimination Employment Act of 1967 protects employees aged __________
40-70
Foods must be maintained at or below ______ and should be the same when serviced
41 degrees
_______ of NH residents suffer from fecal incontinence
46%
The American Health Care Association cites that ________ of persons residing in NH had a primary or secondary dementia diagnosis
47%
Baseline care plans must be developed within ________ hours of a resident's admission
48
Medication orders given to a nurse by physician or physician extender must be countersigned by the ordering physician or physician extender within
48 hours
Public walks (Side Walks) must be how wide?
48" (4' wide)
The facility must ensure that it is free of medication error rates of _____% or greater and residents are free of any significant medications errors
5
Fire alarm pull stations are within _________ of the exit
5 feet
When hiring entry-level personnel, a department manager should be able to select one suitable employee from among ___ or _____ candidates who all meet the published minimum requirements for the position
5 or 6
Intangible assets are amortized to expense over _________ to _________ years with the exception of goodwill
5 to 40
Allegations of abuse must be investigated and results of the investigation must be provided to officials according to State law, including the state survey and certification agencies within
5 working days of the alleged violation
The results of all investigations must be reported to the administrator or his designated rep and to other officials in accordance with state law (including to the state survey and certification agency) within
5 working days of the incident, and if the alleged violation is verified appropriate corrective action must be taken
Clinical medical records must be retained for _________ from the date of discharge when there is no requirement in state law
5 years
OSHA records must be kept how long?
5 years
OSHA requires that all records related to employee injuries & illnesses be retained for how long?
5 years
Records of serious work-related injuries & illnesses must be maintained for how long?
5 years
Accountants have determined that uncollectibles are:
5% of accounts 1-30 days overdue 10% of accounts 31-60 days overdue 25% of accounts 61-90 days overdue 50% of accounts 91-120 days overdue
What % will cause the surveyor to write a med error deficiency?
5% or greater
If toilet door opens inward, the floor space must be how big?
5' x 4 1/2 feet
Average % of Occupancy = Occupied bed days / {# of facility Beds x # of days in the month} Occupied bed days is 5,000 # of facility beds is 200 # of days in the month is 31
5,000 / 200 x 31 5,000 / 6,200 = 0.806 ~ 81%
What is a covered employer?
50 or more employees
The total # of beds in ward rooms with three or more beds must not exceed
50% of the total facility capacity
If ________ of the emplooyees who vote, vote for the union, the union will be established
50% plus 1
Dry food storage should be
50-70 degrees
Wanderers have a ___________ chance of dying if not located in the first 24 hours
54%
The FUTA tax rate is fixed at ________
6%
Administrator must submit to the State Survey Agency, the State LTC Ombudsman, residents of the facility, and legal representatives written notice of impeding closure at least ___________ prior to the date of closure
60 Days
COBRA allows a person how many days to accept the coverage or lose it permanently?
60 days
Some state regulations permit retention of a discontinued drug for _________ when the resident is still in the facility or has been transferred to a hospital
60 days
DON may service at charge nurse only when the facility has an ADC of
60 or fewer residents
Almost _______ of NH residents suffer from urinary incontinence
60%
Almost ________ of NH residents suffer from urinary incontinence
60%
An employer must provide ___________ days notice of an impending layoff of ___________ or more employees, and must notify local government & the appropriate state agency, bureau, or unit responsible for dislocated workers that provides employment & training services
60/50
Standard survey consists of __________ tasks
7
Activities should be offered on a ________ per week basis
7 day
Standard working day
7 day work week or 80 hours in a two week period
The comprehensive care plan must be developed within ________ after completion of the comprehensive assessment
7 days
Age Discrimination Employment Act of 1967. In 1968 the age ____ limitation was removed
70
For low temp washing machine the temp must be between
71-77 degrees plus a 125 part per million (ppm) of chlorine bleach rinse
Facilities initially certified after October 1, 1990 must maintain a temp range of
71-81 degrees
Employment Eligibility Verification Form I-9 must be completed within how many hours of employment?
72
Physician assessments, not performed before resident admission to the nursing home, must occur within ________
72 hours
Compute average payment period & explain (365 x AP) / supplies expense 365 x $5000 / $25,000 =
73 days, not good, should be done within 3-60 days
_________ of training and testing of paraprofessionals (CNA)
75 hours
Facility must use the services of an RN for at least ________ consecutive hours a day, 7 days a week.
8
Paid feeding assistants require ________ hours of training on federal side and ________ hours of training on state side
8 16
Corridors for new facilities must be at least
8 feet & must be equipped with firmly secured handrails on each side
Within _______ after a death of any employee from a work related incident or the inpatient hospitalization of ______ employees as a result of a work-related incident must be reported orally by telephone or in person to the Office of the OSHA, U.S. DOL
8 hours / 3 or more
Handicap parking spaces must be ______ for vehicle & _________ wide for an aisle
8' & 5'
Parking spaces for individuals with physical disabilities must be how wide?
8' wide
FTE for daily is ____________, weekly is ______________, annually is ____________
8, 40, 2080
Using the 8/80 schedule an employee must be paid overtime for any hour over ____ during a 24 hour period & for any hours over _______ in the two week pay period
8/80
Which overtime schedule gives more adequate staff scheduling?
8/80
Resident bedrooms must measure at least
80 sq feet per resident in multiple resident bedrooms 100 sq feet in a single resident room
At least ___ of the total labor workforce in the US is not unionized
80%
Adverse Impact occurs when the selection rate for any racial, ethnic, or sex group is less than ________ of the rate of the group with the highest selection rate
80% If 100 of 1000 white applicants are selected (selection rate of 10%) at least 8% of the minority applicants must be selected
Compute percent of occupancy & explain in relations to revenue Average daily census / # of beds 120 / 150 =
80% increase in percent is equivalent to increase in revenue, not necessarily increase in expense
The food service supervisor is required to have __________ of specialized training from a state approved school
90
_________ of all NF use the ACCRUAL accounting approach
99%
Frozen foods should be stored
<=0 degrees
Hot foods should be served at
>135 degrees
ABC approach
A (Ask questions) B (Behavior that resulted) C (Consequences of behavior)
Means of Egress
A continuous and unobstructed route of exit from any point in a building to a public way.
The facility must furnish a written decription of legal rights which include:
A description of the manner of protecting personal funds A description of the requirements and procedures for establishing eligibility for Medicaid, including the right to request an assessment, and spending down to Medicaid eligibility levels A posting of names, addresses, and telephone numbers of all pertinent State survey and certification agency, the state licensure office, the states ombudsman program, the protection and advocacy network, and the Medicaid fraud control unit A statement that the resident may file a complaint with the State survey and certification agency concerning resident abuse, neglect, misappropriation of resident property in the facility, and non-compliance with the advanced directives requirements
living will
A document that indicates what medical intervention an individual wants if he or she becomes incapable of expressing those wishes.
Is a form of insurance protection that covers policyholders for losses that they incur as a result of fraudulent acts by specified individuals. It usually insures business for losses caused by the dishonest acts of its employees.
A fidelity bond (surety bond)
The universal precaution for choking is
A person grabbing his/her neck & having difficulty breathing
Employers are not required under ERISA or any other law to provide
A private pension fund for their employees (ex. 401K)
BFOQ (Bona Fide Occupational Qualification)
A qualification that is absolutely necessary for the job. It is an allowed and approved reason for discrimination. Approvals are to be sought and granted on a case-by-case basis. (EX. surgeon, pilot, police, & firefighter)
When the facility puts out a notice or amendment,
A receipt of this information must be acknowledged in writing
No information should be released to an outside party without what?
A signed consent from the affected employee or a subpoena or other court order
Antipsychotic drugs should only be used when
A specific clinical condition exists
Social Security's original & sole purpose was to provide
A supplemental retirement for working people & their dependents. Offers Old Age Assistance to needy people aged 65 & older who lived in the community
A warning device that can be securely fastened indicating that the energy-isolating source is not to be used until the tag is removed
A tag
Detail of what is owed to others
A/P Report
99% of all NF use the ______________ accounting approach
ACCRUAL
ADAAG
ADA Accessibility Guidelines
Is a portable electronic device that automatically diagnosis the life threatening cardiac arrhythmias of ventricular fibrillation and pulseless ventricular tachycardia in a patient, and is able to treat them through defibrillation
AED or Automated External Defibrillator
Write offs ___________ a method of depreciation
ARE NOT
Facilities must ensure that residents without pressure sores do not develop them is ____________
AVOIDABLE
The arbitrators decision is final and both management and union must?
Abide by the arbitrator's determination
Employee Assistance Program (EAP) can help control what?
Absenteeism Tardiness Other circumstances that affect job performance
Willfil infliction of injury, unreasonable confinement, intimidation, deprivation, or punishment with resulting physical harm, pain, or mental anguish
Abuse
Before meals
Ac
Unexpected, unintentional damage to an object or injury to a resident, employee, family member, or other person.
Accident
What appears at the top of the "T" structure?
Account name & number
Examples of staff authority
Accountant in business office, RDs, paid consultants, administrative assistant, & secretary
Debit and credit in everyday speech is different from how ______________ use it
Accountants
short-term liabilities (current liabilities)
Accounts Payable (A/P)
Usually reported as net of allowance for uncollectable accounts
Accounts Receivable (A/R)
In healthcare, performance appraisal is mandated by who?
Accrediting & regulatory bodies
Records revenues and expenses when they are incurred rather than when cash is received or is paid out
Accrual Accounting
Revenues are recorded when they are earned and expenses when they are incurred, regardless of the time the cash transaction takes place
Accrual Accounting Approach
Cash budget is prepared on the _____________ of accounting
Accrual basis
______________ is shown in the face of the balance sheet or in the notes
Accumulated depreciation
Medical records belong to the facility and must be
Accurately documented Readily accessible Systematically organized
Demonstrates the facilities ability to pay its bills immediately
Acid-Test Ratio
To set someone or an entity free of accusations
Acquit
Supervisors should earn respect through _________
Actions
In performance appraisal managers compare actual observed performance versus what?
Actual performance
Treats short-stay acutely ill patients
Acute Hospital
Emergency dental services for:
Acute pain in teeth, gums, or palate broken teeth or damaged teeth requiring immediate attention
Nursing facilities must have ___________ of illumination suitable for the tasks of patients and staff
Adequate levels
Facility must ensure that the resident environment remains as free from accident hazards as is possible and each resident receives ____________ and ___________ to prevent accidents
Adequate supervision and Assistance devices
If a court orders a copy of the resident's record be given to someone else, you must
Adhere to the court order regardless of what the resident states (Not a right violation)
Unable to make decisions
Adjudicated incompetent
Decision or disposition of a case by the announcement of a judgement or a decision
Adjudication
Extensive body of public law issued by either state or federal agencies to direct the enactment of laws of the federal and state governments
Administrative Law
Patients with a diagnosis of dementia cannot sign _________
Admission paperwork (same regardless of payer source)
Program whereby a dependent elderly person is institutionalized during the work hours of his/her family
Adult Day Care
Community-based facilities for individuals who need supervised care during the daytime, but who otherwise remain in their homes.
Adult Day Services (MCR does not pay for any types of adult day services)
What does line operations do?
Advance the work of an organization
Resident has the right to refuse treatment or participate in experimental research and formulate an
Advanced Directive
Occurs when the selection rate for any racial, ethnic, or sex group is less than 80% of the rate of the group with the highest selection rate
Adverse Impact
Ways to find candidates for employment:
Advertising Networking Job Fairs Recruiting Trips Search Firms The Internet
HR _______ and ___________
Advises & makes recommendations
Written statement given under oath before an office having authority to administer oaths
Affidavit
AA
Affirmative Action
In hiring a physical exam cannot be conducted until
After a job offer has been extended
ADEA
Age Discrimination Employment Act
Protects employees from being discriminated against on the basis of age. Intended to keep employees from replacing older employees with younger employees.
Age Discrimination Employment Act of 1967
Barriers to communication
Agenda carrying Selective Hearing Difference in knowledge levels Cultural Difference Language
Both psychological and Physiological
Aging process
The aging baby boomers huge impact on society is called:
Aging tsunami
For employers using the 8/80 rule there must be a ________ or __________ in the employee handbook about 8/80
Agreement or Information
Battery power is also required to operate all what?
Alarm systems
The largest number of legal complaints centered on performance appraisal issues involves what?
Alleged violations of individual rights as specified under TITLE VII of the Civil Rights Act of 1964
The second largest number of legal complaints centered on performance appraisal issues involves what?
Alleged violations of the Age Discrimination in Employment Act
Bed hold: Charges to the beneficiary for admission or readmission are not __________
Allowable
A progressive and fatal brain disorder that destroys brain cells and cause memory loss as well as problems with thinking and behaviors that can affect an individual's work and social activities
Alzeheimer's Disease
The most common form of dementia seen in persons over 60 years old
Alzheimer's Disease
ANSI
American National Standards Institute
Prohibits facilities from discriminating against qualified individuals with disabilities in job application procedures, hiring, firing, advancement, compensation, and job training. This act prohibits potential employers from asking about a job applicant's medical condition, if any, and imposing major limitations on pre-employment physical examinations
Americans with Disabilities Act of 1990
A friend of the court. A brief written document that provide the court with information that might otherwise escape attention
Amicus Curiae
Facility must immediately inform the resident, resident's physician, legal rep, or interested family member when:
An accident involving the resident which results in injury & has the potential for requiring physician intervention A significant change in resident's physical, mental, or psychosocial status (deterioration in health, mental, or psychosocial status in either life threatening conditions or clinical complications) A need to alter treatment significantly A decision to transfer or discharge the resident from the facility Change in roommate A change in resident rights under state or federal law or regulations
Instances requiring notifications of change
An accident that results in injury that has the potential for requiring physician intervention A significant change in physical , mental, or psychosocial status such as deterioration in life threatening conditions or clinical complications A decision to alter treatment significantly such as the need to discontinue a present form of treatment due to adverse health reactions or to began a new form of treatment A decision to transfer or discharge resident
PPS (MCR Part A) includes:
An all inclusive per diem rate Routine and ancillary service Capital expenses
team appraisal
An evaluation of how well each member contributes to the team and how well the team accomplishes its goals.
Liabilities include:
An obligation of an entity due to past transactions or events Current liabilities Long-term liabilities
Reduces pain
Analgesic
Nursing homes today are involved in developing _______________ such as its own therapy and pharmacy service
Ancillary Services
Fire drills should be what?
Announced
Routine dental services include an ______________
Annual oral exam
ALL employees must be test for TB ________
Annually
The OSHA form must be submitted when?
Annually
Prohibit offering money or other valuable items in return for referrals
Anti-Kickback
Psychotropic drugs include:
Anti-depressant Anti-anxiety Anti-psychotic Hypnotic
Act on the Central Nervous System (CNS) to enable residents to deal with change in behavior
Antianxiety & Antipsychotic (Psychoactive) Medications
Destroys microorganisms
Antibiotic
What is discussed in infection control committee meeting?
Antibiotic Stewardship Program Influenza Pneumococcal Vaccinations
Tardive Dyskinesia is a neurological disorder most frequently occurs as the result of long-term or high dose of _______________
Antipsychotic Medications
Based on the comprehensive assessment of the resident, the facility must ensure that residents who have not use antipsychotic drugs are not given these drugs unless
Antipsychotic drug therapy is necessary to treat a specific condition as diagnosed & documented in the clinical record Residents who use antipsychotic drugs receive gradual dose reductions Behaviorial interventions, unless clinically contraindicated, in an effort to discontinue these drugs
The facility must not charge a resident for
Any item or service not requested by the resident
In the case of a resident who has not been adjudged as incompetent by the state court, who can exercise the resident's rights?
Any legal-surrogate designated in accordance with state law may exercise the resident's rights to the extent provided by the law
Procedures can be written at _________ of management
Any level
The resident as the right and the facility must provide IMMEDIATE ACCESS to any residents by the following:
Any rep of the secretary Any rep of the state The resident's individual physician The state long term care ombudsman The agency responsible for protection and advocacy system for developmentally disabled individuals The agency responsible for the protection and advocacy system for mentally ill individuals Subject to the resident's right to deny or withdraw consent at any time, immediate family or other relatives of the resident Subject to reasonable restrictions and the resident's right to deny or withdraw consent at any time, others who are visiting with the consent of the resident
Facility must promote the exercise of rights for each resident, including
Any who face barriers (communication, hearing, or cognitive)
Person's ability to communicate is impaired
Aphasia
Surveyors assess the focus of the dietary department based on _________ and ________
Appearance & taste of food
The formal grievance process allows employees to
Approach the next level of management without retaliation
The facility must use _____________ prior to installing a side or bed rail
Appropriate alternatives
Tongue, lips, & vocal cords are unable to work together
Apraxia
Same as mediator but the person makes the decision on the case
Arbitration
Impartial person chosen by the parties to decide the issue between the parties
Arbitrator
What is the only legal question an applicant can be asked about their age?
Are you at least 18 years old?
Pharmalogical treatment/management of cognitive symptoms of Alzheimer's Disease consists of cholinesterase inhibitors such as:
Aricept (donepexil) Exelon (rivastigmine) Razadyne (Galantamine) Cognex (Tacrine-no longer used)
Nonsteriodal Anti-Inflammatory drugs (NSAIDs) such as Ibuprofen are widely used for treating ____________ and ______________
Arthritis & Chronic Pain
It is legal to ask a applicant if they have ever been convicted of a crime and what?
Ask details associated with the conviction
Before conducting a appraisal interview, the supervisor should what?
Ask the employee to sign the appraisal form to acknowledge receipt, signing does not mean employee agrees, if refuse to sign it needs to be noted before filed
Analgesic includes:
Aspirin Acetaminophen (Tylenol) Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) (Ibuprofen)
An attempt to inflict bodily harm on another person
Assault
Intentional, unlawful, offer of corporal injury to another force, or force unlawfully directed toward another person. Intention to harm.
Assault
Regarding training, to implement competency training program, the first step is to _______ your employee needs & not to hire more staff
Assess
Facility must ensure that a resident who enters the facility with an indwelling catheter or subsequently receives one is
Assessed for removal of the catheter as soon as possible unless the resident's clinical condition demonstrates that catherization is necessary
Items owned by the facility. Economic resources that have expected future benefits to the business
Assets
Capital (Net worth) =
Assets - liabilities
Owner's capital=
Assets minus liability
Facilities that help residents with ADLs, coordinate services from outside providers, and monitor activities to help to ensure residents' health, well-being, & safety
Assisted Living Facilities
PACE (Program of All-Inclusive Care for the Elderly). Participant must be:
At least 55 years of age Live in the PACE district Qualify for nursing home services as certified by the appropriate state agency
Civil Rights Act requires all records of personnel transactions to be retained for how long?
At least 6 months unless charges are filed
The Facility Assessment must be reviewed & updated how often?
At least annually
The facility must give resident 30 day written notice before resident is transferred or discharged, unless the resident is
At risk for harming himself/herself or other residents/staff
The facility must inform each resident who is entitled to Medicaid benefits, in writing, when?
At the time of admission to the nursing facility or when the resident becomes eligible for Medicaid
The resident has a right to choose a personal ___________
Attending physician
Therapeutic diets must be prescribed by the ______________
Attending physician
The immediate supervisor should always leave his/her __________ toward an employee out of the objective evaluation
Attitude
Is a person who is authorized to perform business-related transactions on behalf of someone else such as the principal of a company.
Attorney in Fact
Disadvantages of cash accounting include expenses and revenues for a single time period are NOT
Attributed to that same period
ANSI (American National Standards Institute) requires ________ & ________ in facilities
Audible & flashing fire alarms
Concerned with hearing
Audiologist
Threatening, intimidating, decisive, & uncompromising. It motivates by fear and/or attitude. They submit or write policies & procedures & send them to owner for approval without the department heads approval or input
Autocratic leadership
Fire doors are required in corridors & must have what?
Automatic hold-open devices activated by the manual fire-alarm system so they close when the alarm goes off
ALOS
Average Length of Stay
Average cost per day =
Average cost per resident / # of days in the month
ADSO
Average daily sales outstanding
An advantage of the S corporation is that:
Avoids double taxation, it is single taxation
A qualified social worker is one with
Bachelor's degree in social work or Bachelor's degree in human Services including but limited to Sociology, gerontology, special education, rehabilitation counseling, & psychology & 1 year of supervised social work experience in a health care setting working directly with individuals
Uncollectible Accounts Receivable
Bad debt that you more likely will not be able to collect as time increases
Records the entire financial position of the nursing facility at one period in time. It summarizes assets, liabilities, and capital (owner equity) accounts
Balance Sheet (Statement of Financial Condition)
Designed to keep long-term care consumers out of costly institutions. It is aimed at removing barriers to providing long-term care in people's homes & communities
Balancing Incentive Payments Program
Regarding healthcare, caregivers demonstrate beneficence by
Balancing benefits against risks
Perpetual Inventory System is recommended to maintain and accurate count of inventory on hand (an accurate count of supplies used and those remaining in the storeroom). A ______________ is often used for this purpose.
Bar Coding System
Unlawful touching or application of force to another human being without their consent
Battery
Facilities without an on-site generator must have what for alarms, life-safety detection, & security alarm systems
Battery Backups
A resident, even though determined to be incompetent, should
Be able to assert these rights based on his or her degree of capability
OBRA recommends staff devise alternatives to restraints such as
Bed alarms Low beds Chair alarms Use least restrictive devices
Types of transfers include:
Bed to chair Bed to Toilet
When must the facility inform residents of services available in the facility and charges for those services, including any charges for services not covered under Medicare or by the facility's per diem rate?
Before admission, at time of admission, and periodically during resident's stay
Psychological
Behavior, attitude changes, depression, & slow memory retrieval
Which of the alternative HR models is frequently used when designing performance appraisal systems, job evaluations, employee attitude surveys, etc?
Behavioral Science Model
A method of employee appraisal that uses numeric scales to measure various levels of effectiveness
Behaviorally Anchored Rating Scales
Management tool by which an organization seeks to improve its business practices by comparing them with the best practices of other organizations.
Benchmarking
Described the principle of doing good, demonstrating kindness, showing compassion, and helping others.
Beneficence
Monetary compensation such as _______ & ________, are not enough to motivate good employees
Benefits & Pay
Hypothermia is usually treated with
Blankets
Ultimate authority in private corp nursing facility is
Board of Directors
2 major categories of insurance
Bodily and property damage
BFOQ
Bona Fide Occupational Qualification
Pressure sores occur in a
Bony prominence area
Considers all income recorded in the financial records. This includes both earned and unearned revenue. When the company makes a sale to a customer, it records, or books, the earned revenue into the financial records.
Booked Revenue
Occurs when there is a violation of one or more of the terms of a contract
Breach of contract
BE
Break even
A projection of fiscal data usually 1 year
Budget
Planning & controlling device
Budget
With
C
Most nursing homes are organized as a?
C Corporation
Class B fire extinguishers are _______ based
C02 or dry chemical
Schedule I drugs __________ be administered in nursing home
CANNOT
Complete blood count
CBC
Title 42 sets minimum standards for participation in the MCR & MCD programs that must be met by all facilities regardless of location
CFR (Code of Federal Regulations)
Established quality standards for all laboratory testing to ensure the accuracy, reliability, & timeliness of patient test results regardless of where the test was performed.
CLIA (Clinical Laboratory Improvement Act)
HCFA is now
CMS
Is the governmental agency that oversees the Long-Term Care Regulatory process & LTC State agencies
CMS
Paid feeding assistant is a __________ approved position
CMS
The institution must request approval from _________ for all proposed changes in the number of bed in the approved distinct part
CMS
Who mandates that facilities maintain an effective pest control program?
CMS
Which position has the highest turnovers?
CNA
Anyone who completes a part of the MDS should be part of the IDT meeting to include:
CNA (takes care of resident) MDS Coordinator (LVN or RN) Could include (Hospice, PASARR level 2 coordinator, Rehab Director, Physician
When employee is discharged don't forget to send what for insurance?
COBRA letter
Isolation rooms should include at least a
Call light Bed Sink Restroom (Shower not required)
Employers ________ take any adverse action against an employer or applicant for refusing to take a polygraph test
Can Not
The second leading cause of death of people aged 65 and over
Cancer (Malignant)
After the owner pays all the bills, the residual money is owned by the owner, which is known as
Capital
Moved invested into the facility (investors), also known as owner's equity, shareholder's equity, fund balance, or retained earnings
Capital
Large equipment purchases or repairs to building (Generally over $500)
Capital Asset
A summarization of all anticipated capital (Items with a useful life of more than 12 months)
Capital Budget
Covers 1 year plus more futuristic views. May cover a 5 or 10 year period
Capital expenditure budget or capital spending plan
A the aging process advances, the residents need fewer ___________
Carbohydrates
Can be broken down quickly into readily available fuel for the body
Carbohydrates
Physician that specializes in diagnosis and treatment of Heart disease
Cardiologist
What type of drug is Nitroglycerin?
Cardiovascular
The resident has the right to be fully informed in advance about __________ and ___________ and of any changes that may effect the resident's well being
Care and Treatment
Paths along which employees can hope to progress, a major source of employee incentive & satisfaction
Career Ladder
Involves preparing several candidates for a single position
Career planning
________ or __________ should never be left in corridors (hallways)
Carts or equipment
Prepared based on cash basis of accounting and is based on revenue and expenses from the operating budget.
Cash Budget
Details including cash receipts, cash on hand, and cash disbursement
Cash Report
Expenses are recorded when when cash is actual disbursed and revenues are recorded when when the money is received when services are rendered.
Cash accounting
It is a common eye problem which involves clouding of the eye lens. Major symptom ia increasingly blurred vision with perception of shadows
Cataract
Laxative
Cathartic
Decision occurs at the top
Centralization
CMCN
Certified Managed Care Nurse
Line authority that runs downward from the department manager
Chain of Command
In binding arbitration, the decision of the arbitrator cannot be what?
Challenged
The purpose of progressive discipline is to
Change employee behavior from unacceptable to acceptable & to help improve work performance
CNA must report abuse to
Charge Nurse
List of every operating account in the facility
Chart of accounts
Angina or Angina Pectoris
Chest Pain
Asking applicants "are you at least 18 years old" is permissible & allowed because employment of workers under the age of 18 is governed by what?
Child Labor Laws
Foot doctor
Chiropodist same as Podiatrist
A long-lasting or recurrent illness that needs to be managed on a long-term basis
Chronic illness
The Immigration Reform & Control Act of 1986 prohibits employers from discriminating against job applicants on the basis of what?
Citizenship status or national origin
A tort is a ___________ for _____________
Civil Case/Money Damages
Conduct between private parties
Civil Law
Was the pivotal event in dramatically changing the activities of the personnel department
Civil Rights Act of 1964
A voluntary employment based public long-term care insurance program intended to provide a private financial base for disability related services & supports during working years & in old age
Class Act (Community Living Assistance Services & Support)
Which HR Model of organization process & file paper, maintain records, track statistics & key dates, & administer employee benefits plan
Clerical Model
5 Models of HR Organization
Clerical Model Counseling Model Industrial Relations Model Control Model Consulting Model
What are the alternative HR Models?
Clerical Model Legal Model Managerial Model Humanistic Model Behavioral Science Model
CLIA
Clinical Laboratory Improvement Act
CNS
Clinical Nurse Specialist
QAPI program must address all systems of care & management practices including;
Clinical care Q of Life Resident choice Utilize best available evidence to define & measure quality indicators & facility goals Reflect complexities Unique Care Services that the facility provides
The facility must allow representatives of the State Ombudsman to examine a resident's
Clinical records with the permission of the residents or the resident's legal representative, and consistent with state law
Feedback & advice given to employees by an immediate supervisor or HR professionals
Coaching
Urinary incontinence is curable to those whose __________ are adequate
Cognitive capabilities
Connective tissue that loses elasticity over time and appears to account for sagging of the skin often observed in the aging person
Collagen
What defines steps for processing grievances?
Collective bargaining agreement
There can be no _________ of resident's funds with facility funds
Comingling
Performing or doing something wrong that causes neglect
Commission of an act
Person is involuntarily admitted to a facility (psych hospital) per the judge
Committed to facility
Law passed down as a result of a court decision
Common Law
SNF or NF must be operated under _____________ and _____________ by the institution of which it is a distinct part
Common ownership and Control (Common Goverance)
Exchange of information & the transmission of meaning
Communication
Provides a 6% increase in federal MDC matching funds to states for providing community-based attendance services & support within their MCD program. It is intended to allow people to more easily receive services in the community rather than being in an hospital or nursing home
Community First Choice Options
Jury decides how much of the injury to a person should be blamed on the facility's negligence and how much the patient is to blame. Each party involved is responsible
Comparative negligence
How do you assess employee performance?
Compare actual performance with company expectations.
Nursing facilities are designed & built the walls & floors _____________ the building to prevent the spread of smoke & fire from one part of the building to another.
Compartmentalize
A facility must maintain clinical records on each resident that are
Complete Accurately documented systematically organized readily accessible
Everything is based on
Comprehensive Assessment Comprehensive Care Plan Resident Choices (person centered care)
Plan taking into consideration the total needs of the resident
Comprehensive Care Plan
Controlled drugs in participating NF are subject to this act
Comprehensive Drug Act of 1976
The facility must conduct, initially and periodically a
Comprehensive, accurate, standardized, reproduciable assessment of each resident's functional capacity
The facility must not require resident or Rep to request any item or service as a _____________ or ____________
Condition of admission or Continued stay
In termination, discharge is related to what?
Conduct & behavior
Personnel records are ______________
Confidential
Role is conflicting with the purpose and goals of the organization
Conflict of Interest
Facilities typically designed for those aged 75-82 that offer social activities & homemaker services such as meals, housekeeping services, & transportation
Congregate care facilities
The primary reason for the use of accounting procedures is to establish __________ and ___________ management control procedures
Consistent and effective
A work environment where an employee is pushed to quit a job because the employer has made working conditions intolerable
Constructive Discharge
Notification of change: Except in an emergency or when the resident is incompetent, the facility MUST within 24 hours
Consult with resident immediately Notify the resident's physician Notify the family member or legal rep
NHA must ensure that drug regimens in the facility are monitored by the
Consultant Pharmacist aka Registered Pharmacist (Rph)
Which HR Model of organization is HR expert resources?
Consulting Model
Title III of this act limits the amount of employee's earnings that may be garnished & protects employees from being discharged for any one indebtedness
Consumer Credit Protection Act of 1968
Fire safety plan must include:
Containment procedures Evacuation chart or floor plan How to use alarm devices
Residential complexes for seniors that offer comprehensive nursing care & housing options to residents as they age & their needs change. Usually has ALF, SNF, & independent living all on one campus
Continuing Care Retirement Communities
A promissory agreement between two or more persons that creates legally enforceable rights and remedies.
Contract
Area of law involved in a breach by one party relating to a purchase order
Contract law
The employee handbook is not a what?
Contract of employment
Medical Director, Dietary Consultant, PT Consultant is considered what type of services?
Contractual Services
A deformity that result when the muscle has shortened and pulls the adjacent into a flexed position
Contractures
Victim is partly responsible for their own injury. Person does not exercise reasonable care for his or her own safety
Contributory Negligence
Which HR Model of organization has substantial power & managerial decisions may be made only following clearance by HR?
Control Model
Payroll is the largest expense in nursing facility and is considered a _______________ cost
Controllable
Most important tool available to administrators in process of keeping the organization on course
Controlling
Instrumental ADLs
Cooking Cleaning Buying groceries Administering medication Handling money or finances Using the phone
Nursing facilities and skilled nursing facilities must have in operation a compliance and ethics program that is effective in preventing and detecting criminal, civil, and administrative violations
Corporate Compliance Program
Made up of shared basic assumptions & beliefs developed by an organization over time
Corporate Culture
The overall style or atmosphere of a facility. Governs how people relate to each other in the organization
Corporate Culture
With a LLP or limited liability partnership there are no ______________
Corporate taxes
A _____________ is a form of business owned by a few persons or by thousands of people
Corporation
The support cost must be spread over all revenue producing departments that support costs in a very systematic way. This is called?
Cost Finding or cost allocation
Sets up a cost unit center in each department
Cost accounting
Medicare defines a capital expenditure as an item
Cost more than $5,000 with a life expectancy of more than one year.
Which HR Model of organization is a resource to managers for people problems, resolving disputes, and disciplinary issues?
Counseling Model
What is listed on the left side of the "T" structure?
Credit Side
Using resident's funds for personal use is ____________ law
Criminal
Recklessness or carelessness resulting in injury or death punishable as a crime
Criminal Negligence
Penalties in anti-fraud and abuse measures under the PPS system can include:
Criminal/civil penalties Denial of participation in the Medicare Program Suspension of provider participation in federal care programs for 10 years
The main function of risk management is to prevent __________ before they occur, and protect ____________
Crisis/employees
CPM
Critical Path Method
Also known as person centered care or resident-directed care
Culture change
Cash and other assets that are expected to be converted to cash or sold or consumed within one year or in the operating cycle (whichever is shorter) without disturbing the normal operations of the business are called
Current Assets
Records of serious work-related injuries & illnesses, if requested, copies of the records must be provided to who?
Current employees Former employees Employee Representatives
Expected to be liquidated in a year. Included payables such as wages, accounts taxes, accounts payable, and short-term obligations such as purchase of equipment
Current liabilities
Cash, AR, and equipment (All assets that can be converted to cash in 1 year)
Current or short-term assets
Lips and nails turn blue
Cyanosis
Is a safety metric used by OSHA to show how many workplace injuries & illnesses caused the affected employees to remain away from work, restricted their work activities or resulted in a transfer to another job as they were
DART (days away, restricted, & transfers)
Types of advance directives include
DNR, living will, power of attorney
Human resource management _____________ manage employees except for those who work under them in HR dept
DO NOT
Residents have the right to manage his/her own financial affairs and _________ have to deposit their personal funds with the facility
DO NOT
OBRA ____________ require any minimum qualifications for the dietary manager
DOES NOT
Current ratio (Current ratio or working capital ratio)=total current assets/total current liabilities; if the answer is greater than 1 the company is able to meet its current obligation or (Solvency) with a surplus of working capital. It can be deceiving because it ________ reflect the _________ of the assets
DOES NOT/Liquidity
Effective November 28, 2016 QAPI committee must consist of
DON Medical Director (or designee) 3 other members (1 of the 3 must be administrator, owner, board member, or other individual in a leadership role) Infection control & prevention officer
MedWatch system included publicly available _______ & _______ for professionals
Databases & Online Analysis Tools
The effective date of approval of a distinct part is the
Date that CMS determines all requirements (including enrollment with the fiscal intermediary (FI)) are met for approval, and cannot be retroactive
DART
Days Away Restricted Transferred
OSHA reportables include what?
Deaths & accidents requiring medical treatment for employees
What is listed on the left side of the "T" structure?
Debit Side
The tendency to disperse decision making authority (delegations) in an organization structure. Delegating decision-making authority down to the lower levels in an organization
Decentralization
______________ is a more common outcome of reengineering than centralization
Decentralization
Manager makes choices among available alternatives
Decision Making
Aging population has a _______ in bowel function control
Decrease
Injurious cmcn to the reputation or good name of the victim
Defamation
The party being brought to court
Defendant
The application of electrical therapy which stops the arrhythmia, allowing the heart to reestablish and effective rhythm
Defibrillation
A retirement plan, typically funded by an employer, that pays a retiree a set amount of money on a predictable schedule
Defined benefit plan
A retirement plan to which an employer contributes money, such as 401 K while the person is employed there. When the employee leaves there the employers obligation is over
Defined contribution plan
Atrophy
Degeneration of an organ due to diuse
Can occur quickly in the elderly when a fever exists
Dehydration
Permitting decisions to be made at the lowest possible level
Delegation
Condition associated with aging that involved hallucinations and confusion
Dementia
The loss or decline in memory and other cognitive abilities. It is caused when the brain cells are damaged from various diseases or conditions
Dementia
Allows considerable employee input & is a true participative management style
Democratic leadership
Patient with loss or damaged dentures must be referred to whom?
Dentist
Amount of cost allotted to a department taking into consideration salary and other indirect costs
Department Cost Allocation
A ______________ should have no active role in administering employee benefits
Department Manager
DHS
Department of Homeland Security
DOL
Department of Labor
Promotes an efficient operation
Departments (Departmentalization)
Statement given under oath, in writing, and authenticated by a notary public
Deposition
Testimony of a witness taken upon interrogatories (questioning)
Deposition
An expense associated with an asset; also known as contra-asset?
Depreciation (Buildings depreciate, land does not)
The most common mental illness in the elderly
Depression
Historical cost of the asset is the cost of acquiring the asset
Determining Depreciation Expense
is a US law providing federal funds to Councils on Developmental Disabilities, Protection and Advocacy Systems, as well as University Centers.
Developmental Disabilities Assistance & Bill of Rights Act
Types of leadership
Dictatorial Paternal Democratic Laissez-faire
Threatening, intimidating, decisive, & uncompromising. It motivates by fear and/or attitude.
Dictatorial leadership
The usage of antimicrobial gel recommended by CDC for all other employees does not apply to what department?
Dietary employees
_____________ must approve all menus and any changes made to them
Dietitian
Residents have the right to:
Dignified existence Self-determination Communication & access to persons and services inside and outside the facility
___________ directly impacts a revenue center
Direct Costs
It is the process of communicating to employees what is to be done by each of them & helping them to accomplish it.
Directing (leading)
Who has line authority of employees in finance?
Director of finance (but does not extend beyond the boundaries of the department)
Detailed written plan that includes procedures to meet all potential emergencies & disasters, such as fire, severe weather, & missing residents
Disaster Plan
Should begin at admission and facility must assist resident with discharge
Discharge planning
A ______________ must be completed at discharge
Discharge summary
A recapitulation of the resident's stay that includes, but not limited to, diagnoses, course of illness/treatment or therapy, and pertinent lab, radiology, & consultation results
Discharge summary
The resident has the right to voice grievances without _______ or _________
Discrimination or Reprisal
Hepatitis
Disease of the liver
Destroys pathogenic Organisms
Disinfectant
What happens to the interest earned in the RTF account?
Divided among Trust Fund residents, not all residents
Minor injuries requiring first aid only ____________ need to be recorded
Do Not
Exempt employees
Do not clock in and out & are exempt from FLSA overtime
Prior to hiring it is unlawful to ask questions such as
Do you need a reasonable accommodation to perform essential functions of the job?
What is critical for any disciplinary action?
Documentation
When an employee is terminated for cause, all disciplinary actions must be what?
Documented
A resident may work in and for the facility when the desire to work is
Documented in the resident's care plan and paid at least minimum wage
Residents have the right to choose visitors and choose the time to see visitors in a manner that
Does not impose on the rights of other residents
A disadvantage of C corporations is that they are subject to ________, which means that a corporation is taxed on its net income and when the same income is distributed to shareholders in the form of dividends it is taxed again on shareholders' personal income tax returns.
Double taxation
Theorist who first discussed Theory X & Theory Y
Douglas McGregor
Position 1 (Autocratic) manager simply makes the decision & it emphasizes a scalar chain system & centralization of authority
Douglas McGregor Theory X Manager Center Leadership
Employees are involved in the decision-making process, decentralization of authority.
Douglas McGregor Theory Y
The MedWatch system collects reports of adverse reactions & quality problems, primary with __________ & ____________ and also for ______________
Drugs & Medical Devices Also FDA regulated products (dietary supplements, cosmetics, & infant formulas)
Used to coordinate care of individuals who are eligible for both MCR & MCD
Duel Eligible Initiative
A person appoints another individual to make decision on his or her behalf after the person becomes incompetent
Durable Power of Attorney (DPOA)
A legal obligation of care, performance, or observance imposed on one to safeguard the rights of others
Duty of Care
Speech is slurred or unintelligible because of muscle weakness
Dysarthria
Inability to swallow
Dysphagia
Has the authority to bring lawsuits against employers in the federal court
EEOC
Limit their beneficiaries to participating providers for any healthcare providers.
EPO (Exclusive Provider Organizations)
The facility must establish and maintain a system that assures a full, complete, and separate accounting, according to GAAP, of
Each resident's personal funds entrusted to the facility on the resident's behalf.
Assets include:
Economic Resources Represent ownership of value that can be converted into cash Tangible or Intangible
_______________ and ______________ have led many of todays retirees to return to the workforce
Economic downturns Increasing cost of healthcare
The __________ focuses on CARE instead of treatment utilizing the "homelike" atmosphere promoted by CMS
Eden Alternative
Philosophy of providing long-term care services in an environment that promotes quality of life for all involved, as opposed to the traditional institutional model
Eden alternative
Includes birds, cats, dogs, fish, rabbits, chickens, children, plants, and gardens
Edenized Home
The best way to control worker's compensation cost is to have a what?
Effective Accident Prevention program
Power or ability to bring about the desired results
Effectiveness
Ability to produce the desired effect with a minimum of effort, expense, or waste. Getting the maximum output with minimum input
Efficiency
Class C fire extinguishers are used for what?
Electrical fires
LBWA & MBWA are ___________ centered
Employee
When the employee evaluation is completed it should be signed by ______________ and ______________
Employee & Immediate supervisor
Performance evaluations should be signed by __________ and _________
Employee & immediate supervisor
Douglas McGregor's Theory Y is ______________ leadership
Employee - Centered (democratic)
EAP
Employee Assistance Program
Intended to assist employees in addressing particular personal problems that can affect their work performance. It is an employee benefit.
Employee Assistance Program
What Act prevents most private-sector employers from requiring job applicants or current employees to take polygraph tests?
Employee Polygraph Protection Act of 1988
The importance of compensation benefits in retaining employees is embodied in the need to keep them competitive so that valued employees will be encouraged to remain loyal to the organization
Employee Rentention
ERISA
Employee Retirement Income Security Act
Used to help the employee to understand his/her weaknesses & strengths as well as develop guidelines to improve his/her work.
Employee evaluation
You DO NOT withhold the FUTA tax from ____________
Employee's wages
The Immigration Reform & Control Act of 1986 applies to all employers regardless of the number of what?
Employees
Employee records are the property of the _____________
Employer
A doctrine of employment in which the employer is free to discharge individuals without cause & the employee is free to quit, strike, or cease working at any time
Employment at will
Employment in the second half of life, often in positions of greater meaning and social impact in not for profit or public interest fields
Encore career
Chronic renal failure that has progressed to the state where little or no urine is produced.
End Stage Renal Disease (ESRD)
Physician specializing in disorders affecting the endocrine system which secretes hormones into the blood stream
Endocrinologist
Grievance procedures are designed to
Ensure that employees have the opportunity for due process when they believe management ha not acted fairly
Business is recognized as a whole, and is separate from the affairs of the owners, managers, or employees
Entity Concept
Backup batteries must operate what?
Entrances & Exits Resident Call System Nurses Station
EPA
Environmental Protection Agency
EEO
Equal Employment Opportunity
Amendment to Title 7 of the Civil Rights Act of 1964 & intended to cover all employees of 15 or more persons
Equal Employment Opportunity Act 1972
EEOC
Equal Employment Opportunity Commission
Requires men & women performing equal jobs receive equal pay & is enforced by EEOC. No employer shall discriminate between employees on the basis of sex by paying wages to employees less than the rate at which he pays wages to employees of the opposite sex for equal work on jobs which require equal skill, effort, responsibility, & similar working condition
Equal Pay Act of 1963
Charleston has $805.35 in his trust fund, he expired and has no responsible party/family, what needs to happen and in what time frame?
Escheat to state within 30 days
Need to be respected, self esteem, self respect, feel of self value
Esteem Needs
Universal rules of conduct, derived from ethical theories that provide a practical basis for identifying what kinds of actions, intentions, and motives are valued
Ethical Principles
Branch of philosophy that seeks to under the nature, purpose, justification, and the founding principles of moral rules and the system they compromise
Ethics
Edema
Excessive amount of fluid between cells
Administer and enforce the law
Executive Branch of Government
The starting point in resolving turnover problems?
Exit Interview
Each departing employee should complete an ____________
Exit interview
What did the Patient Protection and Affordable Care Act do?
Expanded MCD to cover more lower-income people Subsidizing insurance premiums for persons of certain income level Providing incentives for businesses to provide healthcare benefits Prohibiting denial of claims of coverage because of preexisting conditions Other fixes aimed at expanding coverage to include greater numbers of people, controlling costs, & reducing the deficit
Costs such as salaries, supplies, repairs
Expense also known as outflow
What lists anticipated expenses of the facility for the coming year and is prepared largely by department heads
Expense budget
The COBRA premium is very ________
Expensive
Power based on skillfulness, knowledge, & training
Expert Power
Services delivered outside a patient's home. They require that the patient come & receive the services at a community based location
Extramural Services
Does not vary or change according to volume (# of patients) such as utility bill
FC (Fixed Cost)
Break even in beds=
FC/{Fixed cost rate per bed - Variable Cost Rate per bed}
Voluntary reporting by healthcare professionals, consumers, & patients id conducted on what single, one page form?
FDA 3500
Administrators should secure a copy of what for reporting problems with drugs?
FDA's Medwatch Packet
A method that assumes older supplies in stock are used first. If inflation occurs, the value of the remaining goods in stock is higher than goods already used. It is a method often used in operations as a means of using up certain inventories to prevent spoilage. It is often used in kitchen as well as pharmacy where a item may have a short shelf life.
FIFO (First in first out)
federal regulations mandate certain benefits be available to employees such as :
FML Worker's Comp Social Security Medicare Unemployment tax
An example of a required employee benefit is _______ & _____
FML & Overtime pay
What do staff departments
Facilitate the work, striving to enable overall efficiency & effectiveness
OSHA targets who?
Facilities with high incident rate (Work-related illness or injury)
If Basel has -2.50 in his trust fund, what is the problem?
Facility gave him money that he doesn't have
Daily staffing at the beginning of the shift must be posted in a prominent place that is accessible to visitors and well as residents. It must include:
Facility name Current date Total hours and actual hours worked # of RNs # of LVNs # of CNAs Census
What act governs payment of wages?
Fair Labor Standards Act (FSLA)
This act states that employer must advise applicants if credit reports will be requested
Fair credit reporting act
Supervisors should be _________, _________, & ______________
Fair, firm, & consistent
A MAJOR cause of disability and death in the elderly
Falls
Confining another person within fixed boundaries against their will
False Imprisonment
Who authorized the imposition of damages up to three times the amount of the fraud and civil monetary penalties per false claim? Intentionally submitting false claims for reimbursement
False claims act
FMLA
Family & Medical Leave Act of 1993
NSAIDs provide ______ and _______ pain relief
Fast & effective
The body's source of energy reserve
Fats
Each __________ through ____________, employers must post a summary of the injuries & illnesses recorded the previous year
February through April
OSHA 300A must be displayed in the facility each __________ through __________
February through April
QAPI plan must be submitted to ___________ upon request as well as CMS
Federal & state surveyors
Act which may require compulsory arbitration
Federal Mediation & Conciliation Act
FUTA
Federal Unemployment Tax Act
Employers must pay _______________________ in order to fund the unemployment tax system
Federal and state unemployment taxes
The benefits paid to jobless workers are financed through
Federal and state unemployment taxes paid by employers
OSHA requirements do not have to followed if?
Federal standards are exceeded (more stringent)
A crime of a graver or more atrocious nature than those designated as misdemeanors
Felony
A crime that is punishable by a term of imprisonment of more than 1 year
Felony
Hemodialysis
Filtering of the blood
What can be imposed for missing or incomplete I-9 forms?
Financial Penalties
Financial Accounting vs. Managerial Accounting
Financial accounting is usually for outside or third party use Managerial accounting is usually for inside or internal use
Administrator compares ultimate financial results with the ex[ected
Financial results
Building materials must all be what dependent on the number of stories in the building?
Fire-rated
Washer & dryer filters must be cleaned. Dry traps must be cleaned to prevent what?
Fires
Attending physician must be notified ___________ immediately in the event of a medication error
First
Accidents & Incidents that do not have to be reported are those that require only __________ & do not result in _____________
First aid/Time lost
Refers to an entity or private company that has a contract with the center for Medicare & Medicaid services to determine and to pay part A and some part B bills such as bills from hospitals, on a cost basis and to perform other related functions
Fiscal Intermediary
FC
Fixed Cost
Capital assets is also
Fixed assets
Capital Budget is prepared for ___________ such as real estate, buildings, and equipment
Fixed assets (AKA long-term assets)
Decorations & curtains must be what?
Flame retardant & record of fire-rating kept by facility
Middle managers are often eliminated & responsibilities of remaining managers, usually first line supervisors, are increased
Flattened Organization
Policies allow considerable _______________ in decision making
Flexibility
Provides recommendations for nutritional menu planning
Food & Nutrition Board of the National Research Council
FANS
Food & Nutrition Service Staff
FSS
Food Services Supervisor
A mediator advises or counsels and does not what?
Force a settlement
What form do user facilities report device-related death or device-related serious injury?
Form FDA 3500A
Memos
Formal communication
Regarding public relations (marketing), the primary focus is to
Foster community relations & not to attract new patients
The menus for nursing faiclities are based upon the ________ and __________
Four food groups Recommended Dietary allowance
Idea that post retirement employment provides additional income when the traditional three sources are insufficient
Four pillars of retirement income
The father of scientific management
Frederick W. Taylor
Employee benefit that is not required by law such as sick time, leave/vacation time, or worker's compensation
Fringe benefit
upward communication
From subordinates to upper mgmt
downward communication
From upper mgmt to lower level
OBRA mandates that a facility employ a qualified dietitian either _________, __________, or __________
Full-time Part-time Consultant
Working capitals is
Funds available to facility
A series of accounting rules which books and financial statements are prepared. Standardized for all businesses.
GAAP (Generally Accepted Accounting Principles)
Physician who treats and diagnosis diseases of the digestive tract
Gastroenterologist
EPO (Exclusive Provider Organizations) it uses a __________________ to authorize non-primary care services
Gatekeeper approach
Records of transactions that do not properly fit into any other journal such as A/P journal, cash disbursement journal, and sales journal
General Journal
Summary of all debits and credits contained in the journal for a period of a time.
General Ledger
Addresses the organization's structure leadership, employee parking, facility security, infection control, universal precautions, EAP, work rules, & health benefits
General Orientation
____________ are not useful and should be avoided in any element of an performance appraisal
Generalizations
GAAP
Generally Accepted Accounting Principles
One of the first management theorists that emphasized the importance of human & social behavior in management
George Mayo
Physician who specializes in treatment of diseases of the elderly
Geriatrician
Professionals who study the problems of the aging population in society and they are NOT physicians
Gerontologist
Symptoms usually do not appear until irreversible damage is done. Fluid pressure builds up in the eye causing loss of sight. Untreated, it can cause total blindness.
Glaucoma
Example of medical devices include:
Glucometer Pace makers Infusion Pump Restraints Scales Thermometers
Examples of devises that indirect transmission can happen
Glucose monitoring devises Scrubs Lab coats Electronic thermometers
Every dept in the nursing facility should have _____________ and _______________
Goals & objectives
To participate in Medicare facility must have a ____________________.
Governing Board
Affirmative Action & Equal Employment Opportunity are no longer mandated for organizations which they formerly applied. AA required organizations holding ____________ to demonstrate that positive efforts were being made to align the composition of organization's workforce
Government Contracts
Pension Guarantee Corporation is?
Government agency established to guarantee benefit payments to participants of legally qualified defined-benefit pension plans. It also reduces or eliminates the deduction of contributions by employers for better funded plans
An example of informal organization
Grapevine
Example of informal organizations. Employees act as "center of information"
Grapevine
Class B fire extinguishers are used for what type of material?
Grease & flammable liquid
A deinstitutionalization movement for long term care in which individuals who require care live in small homes and have access to clinical & personal care services on the level of those provided in high-quality nursing homes
Green houses
Examples of involuntary movements include:
Grimacing Tongue Movements Excessive eye blinking
Gross profit aka
Gross Income
Profit margin =
Gross profit / sales
Profit Margin (Contribution Margin)=
Gross profit divided by sales
Appointment by a probate court of a substitute decision maker for a person a judge declares incompetent
Guardianship/conservatorship
Never make decisions based on ________ feeling
Gut
Agency within the US Dept of Health & Human Services that states deal with regarding MCR & MCD.
HCFA or CMS
5 ADLS
HMEDC Hygiene Mobility Elimination Dining Communication
Organized healthcare systems that are responsible for both the financing and delivery of a broad range of comprehensive health services to an enrolled population
HMO (Health Maintenance Organizations)
All offers of employment are ordinary processed through what department?
HR
_________ staff are not affected by reengineering
HR
What are staff areas in healthcare?
HR Finance Housekeeping (ESS) Maintenance (Engineering)
_________ and _________ can be outsourced
HR & payroll
Staff Function & no line authority
HR Management
Who should check references of applicants?
HR or Central Office
Where recruitment occurs
HR/Personnel Management
An antipsychotic drug
Haldol
Is the primary means of preventing the spread of infections
Hand Hygiene
A lack of ________ remains a MAJOR source of the spread of infections in the healthcare setting
Handwashing
What is a key procedure in standard precautions (universal precautions)
Handwashing
Battery operated smoke detectors must be installed in resident's sleeping rooms and public areas by May 24, 2006, exceptions include
Hard wired AC smoke detection system in patient rooms and public areas that is installed, tested, and maintained in accordance with NFPA 72 Sprinkler system maintained in accordance with NFPA 13
The facility must provide reasonable access to any resident by an entity or individual that provides
Health Social Legal Other services to the resident, subject to the resident's rights to deny or withdraw consent at any time
HCFA
Health Care Finance Administration
Privacy standards that facilities must ensure their residents in order to continue to be eligible for Medicare funds. Privacy of resident information. The intent was to enable workers to change jobs without losing coverage.
Health Insurance Portability & Accountability Act of 1996 (HIPAA)
Intended to reduce costs by eliminating regulatory barriers to HMO development & encouraging the proliferation of what was seen as a more cost-effective healthcare delivery system
Health Maintenance Organization Act of 1973
A legal document that allows a person to appoint a healthcare agent to make treatment decisions in the event he or she becomes incapacitated and is unable to make decisions for him or herself
Healthcare Proxy
While on FMLA employees must continue to receive
Healthcare benefits but are not entitles to accrue vacation, sick time, or seniority
involves an unlawful act, generally deception for personal gain
Healthcare fraud
A majority of labor relations activities consist of ______ and ______ complaints
Hearing & Resolving
Acute Myocardial Infarction (AMI)
Heart attack
The _______________ is used for first aide in choking
Heimlich Maneuver
Kidney dialysis is also called
Hemodialysis
Heat sanitization comes from
High temp dishwasher
Motivation factors for Douglas McGregor Theory Y are the ___________ of Maslow Hierarchy of Needs
Higher order
The most common serious injury in the elderly is ?
Hip fracture
The resident has the right to be fully informed in language that he or she can understand of his or her total health status, including but not limited to,
His or her medical condition
After the first year, the book value of the asset =
Historical cost - annual depreciation expense
Annual depreciation expense =
Historical cost divided by useful life
The overall resident-care management system should use a _____________ approach, since it must address the total needs of an indiviual
Holistic
Provides part time skilled services
Home Health
Active euthanasia is
Homicide
Treatment that provides support and comprehensive care for the dying and focuses on maintaining quality of life by relieving the patient's physical, emotional, or spiritual suffering
Hospice
After washing and rinsing, dishes & utensils are sanitized by immersion in either:
Hot water sanitizing at least 171 degrees for 30 seconds (wash cycle must be 140 degrees & rinse cycle 180 degrees) Chemical sanitizing solution
Indirect nursing costs include
Housekeeping Maintenance Interest expense Administration Payroll Utility Depreciation Taxes
The facility must inform the resident or rep requesting a item or service for which a charge will be made that there will be a charge and ___________
How much it will be
The most valuable asset in any organization
Human Capital (people)
Recordkeeping, employee recruitment & selection, training & development, compensation management, performance evaluations, & labor relations
Human Resource Functions
Personnel is now called what?
Human Resources
Which of the alternative HR models foster human values & potential within an organization?
Humanistic Model
Used to higher blood pressure
Hypertensive
Employers must verify the employment eligibility status of newly hired employees as part of the hiring process, who might audit this?
ICE DOL DHS
Are to participate in the care plan meeting and other appropriate staff or professionals in disciplines as determined by resident's needs or as requested by the resident
IDT
The ________ should be involved in discharge planning
IDT
The CAA is part of the care plan and should be brought to the
IDT/Care Plan Meeting
The resident has the right to self administer medications if first the ________ has determined that the practice is safe and a _______________ is obtained.
IDT/Physician's order
It is __________ for anyone other than the pharmacy to re-label medication
ILLEGAL
Model HMO that provides medical care to its subscribers through contracts it establishes with independent physicians
IPA (Independent Practice Association)
The goal of the ABC approach is to
Identify the activator that caused the bahavior
The QAPI committee is responsible for
Identifying issues that necessitate action by the committee
Difference in line operations and staff operations?
If a line operation is ignored or omitted, the physical product or services remains incomplete. Staff operations do not advance the work of the organization or hasten its completion. Staff positions may be removed and the productive work of the organization will usually continue.
Loss of weight is generally caused by __________ and ___________ in the elderly
Ill fitting dentures and Decreased sense of small
Exchanging pay scale information with professional colleagues in different organizations is essentially ____________
Illegal (organizations should use healthcare association, hospital association, or neutral third party)
Only the ______ should complete an evaluation form on an employee
Immediate Supervisor
The employee evaluation should be completed by the ______________.
Immediate supervisor
What Act requires employers to review, and, as necessary, modify their hiring practices?
Immigration Reform & Control Act of 1986
ICE
Immigration and Customs Enforcement
Residents that are high risk of infection include:
Immobilized Residents Residents with pressure sores Altered Immune System Recently discharged from hospital
Housekeeping materials and all chemicals should be stored where?
In locked room away from residents
Many people fail at assessing employee performance because they are what?
Inappropriately trained Insufficiently oriented Inadequately supported
____________ are necessary if resident, employee or visitor is injured
Incident report
Performance Evaluation
Includes establishing goals for the employee to achieve until next scheduled performance evaluation. The main purpose is to focus the energies of the employee on the performance level expected of them
SNF or NF is financially integrated with the institution of which it is a distinct part, as evidence by the sharing of
Income & expenses with that institution, and the reporting of the costs on that institution's cost report
Projected revenues are based on the _____________, not on the amount of cash received for services during the month. It is an estimate of cash coming in and going out for the next 12 months
Income earned in the time period
Inability to control or restrain natural discharges
Incontinence
The ability to control the timing of elimination and it is involuntary
Incontinence
Category of housing options for individuals who are able to live without assistance
Independent Living
The QAPI committee focuses on
Indicators of the outcomes of care & quality of life
Transfer of an infectious agent through a contaminated intermediate object such as resident care devise shared without disinfecting & cleaning between each resident
Indirect Transmission
Costs that can't be directly associated with a revenue center.
Indirect costs
A ledger consists of
Individual accounts (Payable & Receivable)
Conveyance upon discharge, eviction, or death of a resident with a personal fund deposited with the facility, the facility must convey within 30 days the resident's funds and a final accounting of those funds, to the
Individual or probate jurisdiction administering the resident's estate
Worker's Compensation standards _______ by the state, some states have a self-insured program, this program is not worker's compensation but a _________ benefit
Individualized/Fringe
Which HR Model of organization workforce is unionized & there are periodic contract negotiations; grievances; arbitrations; confrontations?
Industrial Relations Model
Improper handling of soiled linens is the major cause of exposure to what by residents & staff?
Infection
IC Committee
Infection Control Committee
TITLE VII of Civil Rights Act
Influenced affirmative Action & Americans with Disabilities Act. Prohibits discrimination in employment practices on the basis of age, sex, race, martial status, religion, national origin, or handicap. 1964 Uses the Equal Employment Opportunity Commission to implement the provisions of the civil rights act Prohibits discrimination with regard to any employment condition including hiring, firing, promotion, transfer, & admission to training programs.
Long term care continuum has 3 major subsystems The informal system The community based system The Institutional System Which is the largest?
Informal Care
As a rule of thumb, an ___________________ is acceptable only of the manager can stay in close contact with all aspects of the operation
Informal Management Control System
Chatting in lounge, casual conversation
Informal communication
LTC facilities must electronically submit to CMS complete & accurate direct care staffing information including
Information for agency & contract staff, based on payroll & other verifiable & auditable data
horizontal communication
Information that flows between peers or persons of equal rank or status
Social Services Role
Informational Case Manager Coordination Enabler/Facilitator Intervention Advocacy
Individual receiving treatment is informed about the nature & consequences of a procedure
Informed Consent
The relationship between the patient and physician is considered an ____________
Informed consent (patient agrees)
Injury not observed by anyone and can not be explained by the resident and the injury is suspicious because of the extent of the injury or the location of the injury
Injury of unknown origin
Process of bringing new ideas into the way an organization accomplishes its purposes
Innovation
Capital (net worth) is less than
Insider claims
Sleep disorder which is common among the elderly
Insomnia
A facility may install alcohol-based hand rub dispenser in its facility if the dispensers are what?
Installed in a manner that adequately protects against inappropriate access
A common example of prepaid expense is
Insurance
Nonphysical resources and rights that have a value to the firm because they give the firm some kind of advantage in the marketplace.
Intangible Assets
_________________ lack of physical substance and usually are very hard to elevate.
Intangible assets
If it is _____________, it is not an accident
Intentional
Comprehensive care plan is a ____________ communication tool
Interdisciplinary
Residents whose care is funded by Medicaid the facility must deposit resident's personal funds in excess of $50 in an
Interest bearing account
In a MCR facility funds in excess to $100 must be deposited into an:
Interest bearing account separate from the facility's operating account
The resident have the right to be free of
Interference Coercion Discrimination Reprisal from the facility in exercising his or her right
Physician who specializes in diagnostic procedures and treatment of nonsurgical cases
Internist
Person who dies without a will
Intestate
Community based systems include
Intramural & Extramural Services
Taken to patients who live in their own home
Intramural system (ex. Meals on Wheels)
Current assets include:
Inventory
Trading these assets is a normal business of a company.
Inventory
The ____________ reported on the balance sheet is usually the historical cost or fair market value, whichever is lower. This is known as the "lower of cost or market" rule
Inventory Value
Locked central storeroom
Inventory control (supplies & equipment)
All grievances/complaints must be
Investigated & educate staff on grievance process
Each facility should have a infection control committee. The infection control committee is responsible for
Investigation Control Prevention of infections in facility
Result of a negligent act (reckless driving)
Involuntary manslaughter
Separation of a resident from other residents or from his or her room against the resident's will or will of the legal rep
Involuntary seclusion
Toilet doors may open ______ or ___________
Inward or Outward
Short term disability _________ a universal legal requirement
Is Not
Goal of TQM (Total Quality Management)
Is that HR in every unit arrive at a level of daily performance reflecting a passion for quality
A Resident can be moved to another room without consent if
It is due to the protection of other residents
If the patient can release the restraint
It is not a restraint
Fixed asset include:
Items such as building and equipment
Decertification of a union: Employees can remove a union when?
Its leaders fail to meet members expectations
The OSHA form must be posted where employees can see it during ____ & ______ of every year
January & February
Group of positions that are similar in their duties?
Job
One way to defend job against unemployment charges of unfair employment practices is to conduct ______________ and prepare _______________
Job Analysis / Job Description
Includes job identification information Job summary Principle duties performed Job specifications
Job Description
Should be flexible & should allow room for innovations & employee participation & input. These are the most obvious & visible output of a job analysis
Job Description
Information at a job that results in a statement of the job to be done, usually a list of duties?
Job Description (Position Description)
The most obvious & visible output of a job analysis
Job Description (Position Description)
Position description elements:
Job ID information Job Summary Principal duties performed Job specification
Provides purpose, nature, & extent of the tasks performed by the person in the position.
Job Summary
Position Description Components:
Job Title Status: Exempt vs. Non-exempt Summary of duties Salary Range Knowledge required Skills required Effort required: Mental or Physical Responsibility: consequences of error Working conditions General Statement: Other duties as assigned
Distinguishes one job from another
Job Titles (Job Classifications)
Process of defining a job in terms of tasks or behaviors Process of grouping a series of related tasks into a position
Job analysis
What precedes the preparation of a position description?
Job analysis
The purpose of conducting a job analysis is to prepare a?
Job description
A statement of skills, education and experience required to do a job is called a __________.
Job specification
Outlines the minimum specific skills, efforts, & responsibilities required of an incumbent in the job
Job specification
The FIRST step in the accounting cycle which consists of recording transactions on a daily or chronological basis
Journalizing
Treatments for End State Renal Disease includes:
Kidney Transplant and dialysis
Class K fires are ___________ fires
Kitchen
The Immigration Reform & Control Act of 1986 established civil & criminal penalties for what?
Knowlingly hiring, recruiting, referring, or retaining in employment persons designated as unauthorized aliens.
_______________ or ________________ allows administrator to assure him/herself that facility resources & finances are successfully being used to best meet the needs of the residents
LBWA & MBWA
What is used to handle resident & family concerns?
LIFE Listen Investigate Feedback Evaluate
Two methods of inventory costing used to account for effects of inflation or deflation on the price of inventory
LIFO & FIFO
A method that assumes that "newer" inventory will be used 1st. The goods remaining in inventory is lower than the the value of the goods already used to provide services
LIFO (Last in first out)
Items owed by the facility. Outsider claims such as bills
LIabilities
Taxed as a partnership. A form of business owned by a few persons or by thousands of people
LLC (Limited liability Company or corporation)
Limits a partner's liability; no individual liability (unless fraud occurs) for malpractice of other partners. A business owned by two or more persons.
LLP (Limited liability Partnership)
Under no circumstance can the _______ or ________ service in the capacity of the DON
LPN or LVN
Every container in a facility must be ___________ according to the Hazard Communication Program
Labeled
Landrum-Griffin Act of 1959 is also known as
Labor Management Reporting & Disclosure Act
The most common associated causes of UTI include:
Lack of hand washing between patient contacts Close proximity of residents with catheters Prevalence of residents who have indwelling catheters
Easy going, supportive style which the leader tells his staff what he wants accomplished & leaves them alone
Laissez-faire leadership
Seeks to protect the interests of the individual union member against possible union abuses
Landrum-Griffin Act of 1959
Dementia is an acquired persistent impairment of intellectual function that compromises at least 3 of the following spheres of mental activity:
Language Memory Visual/spatial skills Emotion or personality Cognition
A distinct part SNF or NF is physically distinguishable from _______________ or ____________ that houses it
Large institution / Institutional Complex
Each facility toilet must have a
Lavatory with mirror and a toilet
Process of influencing employees to work willingly & enthusiastically toward common goals whether managers are present or not
Leadership
LBWA
Leading by walking around
Which of the alternative HR models is part of workforce is unionized?
Legal Model
HR provides services that are essential to the __________________ of an organization
Legal Survival
If the past employer had relevant & documented knowledge of a serious problem & did not reveal that info upon request, the former employer could be at rick for what?
Legal action brought on by the new employer
A patient with dementia will need either a ______ or ________ to make decisions for him or her
Legal guardian or responsible party
Employers must verify if applicants are __________ to work in the USA
Legally Eligible
This landmark federal legislation comes by its common name "OBRA" through the
Legislative process
Power according to position
Legitimate Power
Assets =
Liabilities + Capital
Assets=
Liabilities + Owner's Equity
Written defamation is ______________
Libel
Nursing facility administrators must be ______________ in every state that they work
Licensed
Depending on the state law, the physician can delegate the prescribing of diet/therapeutic diets to the ____________
Licensed dietitian Other than that dietitian can make only recommendations
Dumpster requirements include:
Lid closed due to pests Located far from dietary service as possible
A claim or charge on a particular property for payment of a debt or obligation
Lien
LSC
Life Safety Code
NFPA (National Fire Protection Association), 2000 edition is used regarding what?
Life Safety Code inspections/regulations
NFPA requires generator supply power to at least:
Life Support System Nurses Station Medication Prep area Alarm system Boiler room (power room) Communication System
Allows payment to relatives to give care to family members regardless of the age pf the one being care for
Lifespan Respite Care Act of 2006
An emergency electrical power system must supply power adequate at least for
Lighting all entrances & exits Equipment to maintain the fire detection alarm extinguishing systems Life support systems in the event the normal electrical supply is interrupted
Emergency power must supply power adequate for at least to run what?
Lighting all entrances / exits Equipment to maintain the fire detection, alarm, & extinguishing systems Life support system in the event the normal electrical supply is interrupted
Closing the doors during a fire will what?
Limit the spread of fire & smoke & limiting & eliminating any loss of life
Assistant Administrator has ___________ authority
Line
Dietary service have __________ activities & ___________ activities
Line & staff (Line=feed residents & staff=prepare the cafeteria)
Person who is empowered by the administrator to make decisions for the organization. Decision-making vested in the supervisor
Line authority
solid line in organizational chart
Line authority
Manager of staff activity. They supervise & coordinate people
Line manager
If an activity or position is abandoned & the workflow is immediately disrupted, then it is what?
Line operation
When an error is made in medical record;
Line should be drawn through error Correct info is written Person must initial & date
Assets that can be converted to cash quickly without appreciable loss (limit impact on its value for ex. cash, stocks, bonds)
Liquid Assets
Arbitration is an alternative to what?
Litigation
Advance directive which resident gives instructions on if he/she wants life-sustaining equipment to be used
Living Will
Upon admission, it is strongly recommended that the residents have a ________________ and ________________
Living will / advance directive POA
Work orders to repair equipment should include at a minimum what?
Location Date Problem
Some type of lock, either key or combination, that will hold an energy isolated device in a safe position that prevents energizing the machine or equipment
Lockout Device
A type of lock, either key or combination type, that will hold an emergency isolating device in a safe position that prevents energizing the machine or equipment.
Logout Device
Assets that can not be converted to cash within 12 months
Long-term asset
Expected not to be liquidated within 1 year. Includes issued long-term bonds, notes payables, long-term leases, pension obligations, and long-term product warranties
Long-term liabilities
OSHA mandates what?
Loss prevention
Chemical sanitization comes from
Low temp dishwasher
Physical therapy is done on what part of the body?
Lower
Nurse supervisor, charge nurse, ADON, are considered ______________ management
Lower level
Guide employees according to established policies of the facility
Lower level management
Motivation factors for Douglas McGregor Theory X are the ___________ of Maslow Hierarchy of Needs
Lower needs
When reengineering, decisions must be made closer to an organization's what?
Lowest level
Unlike the heart, the _________ has the ability to repair itself after infection or damage
Lung
Medication with a ________________ must be returned to the pharmacy and you should receive a credit
MARRED LABEL
Emphasizes setting specific, jointly developed common goals (by management & employees with a time period for goal achievement & performance feedback. It means to identify goals, determine procedures, set time limits & continuously measure progress. Everyone knows what is expected & how long it should take.
MBO (Mgmt by objectives)
Cornerstone of building any team, and it helps reduce turnover & absenteeism
MBWA (Manage by walking around)
Medicare paid for 25%, MCD & other public funds paid 42%. The largest payer for long-term care services is?
MCD
Hospice providers will bill ________ for services provided
MCR A
SS Amendments of 1994 amended to raise the limit from $50 to $100 for the minimum about of resident's funds that facilities must entrust to an interest bearing account. This increase only applies to :
MCR SNF residents
Sources of healthcare revenue:
MCR, MCD, PVT pay, Insurance, & managed care
Is a standardized instrument process used to assess nursing home residents
MDS (Minimum Data Set ) or RAI (Resident Assessment Instrument)
uniform data set used to complete comprehensive exam
MDS (Minimum Data Set)
Examples of direct transmission illness include:
MRSA, VRE, FLU
Employees must be aware of hazardous chemicals in the workplace by using the?
MSDS (Material Safety Data Sheet) now called SDS (Safety Data Sheet)
Facility can not impose a charge against the personal funds of a resident for any item or service for which payment is
Made under Medicare or Medicaid
The secondary reason for performance appraisal is what?
Maintain performance at a acceptable level
In maintenance, work orders do not include how to fix the problem because?
Maintenance should already know how to fix the problem or know a vendor that can fix the problem
With the LBWA & MBWA methods the administrator is able to uncover problems before they become
Major problems
Performance of an unlawful or improper act
Malfeasance
What is an example of a lockout device need?
Malfunctioning electrical outlet
Pertaining to governing body ____________ employees must be disclosed
Management
With a organizational chart in a large organization, management must use the ______________ to understand what is going on
Management Control System
The governing body establishes and implements policies regarding
Management and operation of the facility
MBWA
Management by walking around
Douglas McGregor Theory X is ________________ leadership
Manager-Center
Th power to command, issue orders, or direct action by subordinate
Managerial Authority
Which of the alternative HR models decentralization occurs; so many people interpret organizational guidelines?
Managerial Model
commission of an unintentional act that results in the death of another person
Manslaughter
During the economic boom following WWII, health insurance programs became part of what?
Many organizations benefit packages
Schedule I drugs include:
Marijuana Heroin LSD
Choosing a market segmentation that provides the organization with the maximal opportunity to achieve a leadership position in the marketplace
Market positioning
Dividing a market into subsets in which each subset has characteristics in common.
Market segmentation
The process of planning & executing the conception, pricing, promotion, & distribution of goods, ideas, & services to create exchanges that satisfy both individual & organizational objectives
Marketing
Bridges the gap between the community and nursing facility residents
Marketing (Open House)
The product or service, price, promotion, & place of channels of distribution
Marketing mix
Needs become salient (powerfully motivating) at each successively higher level mainly after the needs at each lower level are satisfactorily met. Until the individual has met the needs for survival and basic security (lower level) these will dominate until met. Lower needs must be satisfied before higher needs can be used to motivate desired behavior.
Maslow's Hierarchy of Need
MSDS
Material Safety Data Sheet
The care plan must include _________ and __________ to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment. it it person-centered
Measureable Objectives Timetables
Four foods required in a balanced diet
Meats Vegetables Milk Fruit
Adverse event reporting can be completed to MedWatch by mailing in?
MedWatch 3500
MedWatch disseminates important safety information to the medical community & general public via what?
MedWatch website & MedWatch E-List
Utilized to resolve disputes by using a third party
Mediation
Distinct part =
Medicaid portion of the facility Title 19
Drugs are not what?
Medical Devices
Provides medical supervision & is paid a contractual monthly fee. He/she responsible for the implementation of resident-care policies & the coordination of medical care in the facility
Medical Director
Responsible for implementation of resident care policies & the coordination of medical care in the facility
Medical Director
SNF or NF must have a designated __________ who is responsible for implementing care policies and coordinating medical care, and who is directly accountable to the management of the institution of which it is a distinct part
Medical Director
The MedWatch system is intended to detect safety hazard signals for medical products, if a signal is detected, the FDA can issue what?
Medical Product Safety Alerts Order product recalls, withdrawals, or labeling changes to protect public health
MedWatch system of voluntary reporting allows such information to be shared with who?
Medical community or general public
Pregnancy is considered a
Medical disability
Can order an autopsy without the consent of the next of kin
Medical examiner
Need higher ALOS for ________ patients
Medicare
Violation of law concerning _____________ would be brought in the U.S. District Court
Medicare
__________ guidelines stay the same under PPS
Medicare
Annual Uniform Cost Statement is required of __________ & __________ facilities by each state and _________ requires the financial statement to be filed at the end of the year.
Medicare & Medicaid Medicare
MAC
Medicare Administrative Contractor
It is considered a medical insurance plan?
Medicare B
Now separate from Social Security and the employee & employer each pays 50% of the tax
Medicare Tax
Is used for reporting an adverse event or sentinel event.
Medwatch
The Food & Drug Administration's Safety Information & Adverse Event Reporting Program. Is called what?
Medwatch
Working capital is used to
Meet short-term financial commitments/obligations
Periodic pay increase plans based on performance
Merit Pay
In smoking area _________ with self-closing covers are required
Metal containers
The use of mobile technologies for healthcare purposes
Mhealth
___________ managers & ___________ managers do not view themselves as change agents
Middle & Department
Is responsible for implementing policies
Middle level management
Authority invested in a supervisory nurse is
Middle management authority
The ___________ is prepared by the night nurse and forwarded to the facility's business office, where the report is used for calculating daily revenues for all patients
Midnight Census Report
In hiring the government may require a facility to increase the proportion of
Minority persons (ration hiring)
Deliberate misplacement, exploitation, or wrongful, temporary or permanent use of a resident's belongings or money without the resident's consent.
Misappropriation
OBRA uses to mean theft of resident's property
Misappropriation
One of the primary reasons for employee dismissal is ________________
Misconduct
A crime that is punishable by a term of imprisonment of no more than 1 year
Misdemenanor
Improper performance of an act
Misfeasance
Explains goals & objectives of the facility
Mission Statement
Job summary should be related to the _____________ of the department and ______________ of the organizations
Mission Statement / Global Mission
The facility must develop and implement written policies and procedures that prohibit
Mistreatment Neglect Abuse Misappropriation of resident property
Each resident has the right to be free from
Mistreatment Neglect Misappropriation of Property
Type B
Moderate Achievers
A grant program that encourages a beneficiary discharged from an institutional care facility to remain in the community & receive services at home
Money follows the Person Program
Average cost per resident =
Monthly expense / # of residents
Generators must be tested _____________ with a full load for ___________ at __________ capacity
Monthly/30 min/30%
When mopping a hall you should?
Mop one side at a time and place wet floor sign
The facility may charge the resident for requested services that are
More expensive than or in excess of covered services
Many employers with how many employees are required to keep a record of serious work-related injuries & illnesses?
More than 10 employees
Schedule II drugs include:
Morphine Codeine Cocaine Opium
Job Identification
Must include, at a minimum, the position, title, the department location, & the last date which the content of the position description was verified
Are often used for residents with glaucoma problems, dilates the pupils of the eyes to relieve eye pressure
Mydriatics (Optical Medication)
___________ is considered upper level management
NHA
The focus on ADLS is to
NOT let them decline
Nonsteroidal Anti-Inflammatory Drugs
NSAIDs
The facility must inform each resident of the ___________, ___________, and ______________ the physician responsible for his or her care
Name Specialty Way of contacting
Non-cholinesterase inhibitor includes:
Namenda (Menmantine)
NFPA
National Fire Protection Association
Provided legal protection to labor unions & made the task of organizing workers considerably easier for unions than it has been.
National Labor Relations Act of 1935 (Wagner Act)
The first nationwide American legislation to favor the growth of trade unions, define the rights of workers, unionization, collective bargaining (unions). This act made it illegal for an employer to refuse to negotiate with a union. Governed relationships between work organizations & labor unions. Defines certain conduct of employees & employers as unfair labor practices & provides for hearings on complaints that such practices have occurred.
National Labor Relations Act of 1935 (Wagner Act)
It is an independent agency of the US government charged with conducting elections for labor union representation & investigating/remedying unfair labor practices
National Labor Relations Board
NLRB
National Labor Relations Board
Communities with a large proportion of older persons residing within a specific geographical area
Naturally Occurring Retirement Communities
For adequate workplace motivation, it is important that leadership understands which _______ are active for individual employee motivation
Needs
The comprehensive assessment must assess the resident's
Needs Strengths Goals Life history Preference
Failure to provide goods and services necessary to avoid physical harm, mental anguish, pain, emotional distress, or mental illness
Neglect
Failure to exercise the degree of care a reasonable person would exercise under the same circumstances, which results in injury to another.
Negligence
Negligence without proof. Occurs when the act complained of is in violation of a safety statute. Include acts that are so clearly harmful to others that it is plain to any reasonable person that negligence must have occurred.
Negligence per se
If an employee causes harm while working for the organization that failed to check references, the organization is at risk for being charged with what?
Negligent hiring
During a mediation, the mediator will attempt to get the union & facility to:
Negotiate a settlement
NW
Net Worth
Working capital is also called
Net current assets
Net Profit Margin
Net income after tax / Sales
Net Profit margin=
Net income after tax divided by sales
Physician who diagnosis and treats disease of the brain nervous system, and spinal cord
Neurologist
When should the RTF account be deposited into the facility operating account?
Never
Automatic sprinkler protection is required of all ?
New Health Care Facilities
Examples of training:
New employee orientation On-The-Job Off-Site Training
Most common medication prescribed for persons with angina
Nitroglycerin
Is there a cure for Parkinson's?
No
The purpose of COBRA is to ensure that?
No one is suddenly without coverage
C Corporations have ___________ on ownership
No restrictions
Prohibited smoking areas must have what?
No smoking signs
Makes profit, but invests profit into business operations
Non-profit corporation
Smoking area clearly marked & contain only ______________ ashtrays
Noncombustible
Employer pays for all cost of the insurance
Noncontributory insurance policies
Failure to act when there is a duty to act as reasonably prudent person
Nonfeasance
Ethical principle that requires caregivers to avoid causing patient harm
Nonmaleficence
The attempt to determine what moral standards should be followed so that human behavior and conduct may be morally right
Normative Ethics
Values of an organization are general expectations of all employees
Norms
Legalized union organizing activities & affirmed workers' rights to organize for collective bargaining purposes. It limits the power of the federal courts to issue injunction in cases involving or growing out of labor disputes.
Norris-LaGuardia Act 1932
Infections that are associated with institutionalization or acquired while in a health care facility
Nosocomial Infections
Residents that are deemed _________ may smoke only when supervised by staff, family, or volunteer
Not Responsible
The facility must also provide the resident with __________ prior to admission, upon admission, and during the resident's stay
Notice
Food must be:
Nourishing Palatable Attractive Well-balanced Served at proper temp Prepared to meet individual needs
Trailblazer Health Enterprises LLC was both the fiscal intermediary (Part A) and carrier (Part B) for providers in Texas. it is now called?
Novitas Solutions (Highmark Medicare Services before that)
An RN meeting state requirements governing qualifications of a nurse practitioner
Nurse Practitioner
There should be a non-discriminating policy also regarding admitting patients to _______ and _________
Nursing Facility & Room assignments
_________ requires that a licensed nurse must serve as the charge nurse on each work shift
OBRA
CAA (Care Area Assessment) are not required for Medicare PPS assessment. They are required for
OBRA comprehensive assessment (admission, annual, significant change in status, or significant correction of a prior full) However, when a Medicare PPS assessment is combined with a OBRA comprehensive assessment, the CAA must be completed in order to meet the requirements of the OBRA comprehensive assessment
___________ of the US DHHS enforces corporate compliance
OIG
A single institution can have a maximum of __________ distinct part SNF and _________ distinct part NF
ONLY ONE / ONE
Imposes on employers a general duty to provide each employee a safe work place, free from recognized hazards causing or likely to cause death or serious physical harm.
OSHA
A log & summary of occupational injuries & illnesses that occur within the nursing home each calendar year
OSHA 300
A summary of OSHA 300, but does not contain the names of the employees who were involved in accidents or injuries
OSHA 300A
Standardized records of illness & injuries must be recorded on the what?
OSHA form (Log & summary of Ocuupational Injuries & Illnesses)
An ____________ must be displayed to inform employees of their rights & responsibilities, & compiling annual figures on work-related illnesses & accidents
OSHA poster (OSHA 300 log)
Prohibits age-based employment discrimination against persons 40 years of age or older
OWBPA (Older Workers Benefit Protection Act of 1990)
The ADEA (Age Discrimination Employment Act) allowed reductions in benefits for older workers in situations where added costs were incurred to provide the benefits. Who removed employers' option to just lower benefits for older workers?
OWBPA (Older Workers Benefit Protection Act of 1990)
OSHA
Occupational Safety and Health Administration
Upper limbs focus
Occupational Therapy
Average % of Occupancy =
Occupied bed days / {# of facility Beds x # of days in the month}
Cash accounting records expenditures and receipts as they _________
Occur
Each resident must be offered an influenza immunization ___________________
October 1 - March 31 Annually
OIG
Office of Inspector General
OAA
Old Age Assistance
Immediate access to the residents must be granted to the ____________, _______________, and ________________
Ombudsman Rep of the State Resident's physician
Failure to do something that causes neglect
Omission of an act
The drug regimen review is completed by the licensed pharmacist and must be reviewed at least
Once a month
Residents must be seen by a physician at least
Once every 30 days for the first 90 days of admission Once every 60 days thereafter
Consistency; accounting reports are prepared the same year after year
Ongoing concern concept
A planning and controlling device. Generally deals with actual short-term revenues and expenses necessary to operate the facility
Operating Budget
What contains the expense budget & revenue budget?
Operating budget
Types of budgets include:
Operating budget Cash Budget Capital Budget
Non-cash employee retention incentives include:
Opportunities for training & development Tuition Assistance Programs Career development Succession Planning Programs
The facility must inform the resident both _________ and ____________in a language that the resident understands of his or her rights and all rules and regulations governing resident conduct and responsibilties during the stay in the facility
Orally and written
HR generally make recommendations for changes in compensation, which are usually reviewed by who before implemented?
Organization's Board of Directors
Shows the organizational structure
Organizational Chart
A set of shared values, norms, or rituals that organization members have regarding the functioning and character of their organization
Organizational Culture
Cross-training employees with similar types of jobs provides what?
Organizational Flexibility
It is the method of ensuring the work necessary to achieve a goal is broken down into segments, each of which can be handled by one person. First step in implementing a plan & where departmentalization occurs. Takes place at all levels of the organization
Organizing
Foundation for employment & a use of a checklist is valuable.
Orientation
________ & _________ of employees is an important factor affecting employee retention
Orientation & Supervision
The cartilage and other components of the joint begin to wear way or degenerate as the disease progresses
Osteoarthritis
Softening of the bones and it is common among many elderly people. Caused by a lack of calcium.
Osteoporosis
Many older persons are at risk for breaking bones. Diagnosis:
Osteoporosis & Osteopenia
Involves assisting displaced employees in finding new employment
Outplacement
When employees are discharged _________ could be offered?
Outplacement
Personalities. Type A
Overachievers-more stressed-perfectionist
Damp linens are not to be left in the machine
Overnight
Who has ultimate responsibility for the facility?
Owner
Money that a company owner has taken from the business for personal use, similar to a company that pays dividends
Owner's Drawings
Sum of business resources owned by the owner
Owner's capital
At the option of the physician, required visits in SNF after the initial visit may alternate between personal visits by the physician & visits by a
PA NP Clinical Nurse Specialist (CNS)
A unique capitated managed care benefit for the frail and elderly
PACE (Program of All-Inclusive Care for the Elderly
The changes OBRA brought to nursing home care are enormous. Some of the most important resident provisions include: PASARR
PASARR Level I-Indentification Function PASARR Level II-Evaluation function to determine whether NF services and specialized services are needed
A textual resource for the use of drugs and side effects
PDR or Physician Desk Reference
Example of a outsourcing organization is?
PEO (Professional Employer Organizations)
Control tools showing the relationship among the activities that makeup a project (completion times/dates for each step/task in the project). It involves development of a flowchart which shows an event, and a plan with a completion that can be measured at a given time. It is a tool that facilities decision-making.
PERT/CPM
Plans that use primary care physicians as gatekeepers to coordinate and control medical care
POS (Point-of-Service Plans)
5 functions of managers
POSDC Planning Organizing Staffing Directing (Decision making) Controlling
Purchased for continued and long care use in earning profit in a business
PPE (Property, plant, & equipment)
Entities through in which employer health benefit plans and health insurance carriers contract to purchase healthcare services for covered beneficiaries from a selected group of participating providers
PPO (Preferred Providers Organizations)
Budget Reform Act of 1997 established a:
PPS (Prospective Payment System)
New payment method for skilled nursing facilities. It establishes new rules for assessment of Medicare A skilled residents, and for determining the amount to be paid to skilled nursing facility. It sets per diem rates for resident care
PPS (Prospective Payment System)
A growing area of responsibility for nursing because it often involves nursing judgements about when to give pain medication if the medication is not prescribed on a fixed dosage
Pain management
Alleviating suffering
Palliative Care
The comprehensive, multidisciplinary care of patients with life limiting illnesses
Palliative Medicine
Class A fire extinguishers are used for what type of material?
Paper, wood, rubber, plastic, linen, wool, etc)
Degenerative disorder of the central nervous system affecting the motor system
Parkinson's Disease
Requires input from staff member on several levels of the organization
Participatory approach
Sympathetic, fathering/mothering style that provides many rewards
Paternal Leadership
Also known as Healthcare Reform
Patient Protection & Affordable Care Act of 2010
Which act concerns advanced directives and advanced directives should be discussed in writing and provided to the resident upon admission?
Patient Self-Determination Act (PSDA) of 1990
Employees want to know first about _________ and then _____________
Pay / Benefit
Mandatory submission of staffing information based on _______ in a uniform format
Payroll data
Direct costs for nursing department would include
Payroll taxes Salaries Benefits Medical supplies Capital equipment involved with a particular department Any other costs that impact the respective department
Variable expense:
Payroll taxes, raw food cost, salary expense, repairs, and supplies
Staff should check for smoke barrier ___________
Penetration
An example of antibiotic includes:
Penicillin
PBGC
Pension Benefit Guarantee Corporation
PBGC
Pension Benefit Guaranty Corporation
Requires organizations with underfunded pension plans to make additional payments to the Pension Benefit Guarantee Corporation (PBGC)
Pension Protection Act of 1987
One who may be responsible for financial matters of a Medicaid resident
Pension Trustee
Buildings don't take care of people, ___________ take care of people
People
Primary focus is on people (producers) instead of machines
People-centered managers
With Worker's Compensation employees receive a ________ of lost wages due to work-related accident or illness
Percentage
What do line departments do?
Perform an organization's work & advances the work of the organization
In termination, dismissal is related to what?
Performance
It is used to facilitate improvement in employee performance, provide formal or official feedback to employees concerning their job performance, & collect information for decisions concerning compensation & other personnel transactions such as promotions & transfers.
Performance Appraisal
A systematic employee review that occurs on a regular basis in which the employee receives feedback about his/her job performance
Performance appraisal
Each facility must have a written disaster plan and it should be reviewed __________
Periodically
May be performed for bedridden patient. It involves filtering out the excess fluids from the peritoneum, which lines the abdominal organs
Peritoneal Dialysis
Recommended to maintain and accurate count of inventory on hand (an accurate count of supplies used and those remaining in the storeroom)
Perpetual Inventory System
Direct transmission
Person to person
Focus on the resident as the locus of control & support the resident in making their own choices & having control over their daily lives
Person-centered
The resident has the right to ___________ and __________ of his or her personal & clinical record
Personal privacy & confidentiality
What is the most effective marketing tool?
Personal tour through the building that includes meeting staff & patients
Fringe benefits are found in ________ not job descriptions or job analysis
Personnel policies
Process of deciding which of the applicants best fits the requirements of the job
Personnel selection
Destruction of discontinued drugs should be under supervision of the
Pharmacist
Only a ______________ or ________________ may fill prescriptions, and thus dispense drugs
Pharmacist or physician
Only the ______ can re-label medication
Pharmacy
It is illegal to ask an applicant to provide what with application?
Photograph
Physician who specializes in physical medicine, body movements, and conditioning
Physiatrist
Each resident must received and the facility must provide the necessary care and services to attain or maintain the highest practicable ________, _________, and _______ well-being, in accordance with the Comprehensive Assessment and Plan of Care
Physical Mental Psychosocial
Two types of restraints?
Physical & Chemical
Lower limbs focus
Physical Therapy
PT
Physical Therapy
All residents exercises such as therapy must be ordered by a _______ and included in the patient plan of care
Physician
During drug regimen pharmacist must report irregularities to
Physician
Each resident must be under the care of a
Physician
At the time each resident is admitted, the facility must have
Physician orders for the resident's immediate care
PDR
Physician's Desk Reference
Lab & X-ray or other diagnostic services must be provided and a __________ must be written and the nurse must notify the _______________ of lab results that fall outside the clinical reference range
Physician's order Physician, PA, NP, or certified nurse specialist
Per the teachings of Abraham Maslow there are general needs which have to be fulfilled before a person is able to act unselfishly
Physiological Safety Love Esteem
Requirements for human survival (water, food, clothes)
Physiological Needs
List Maslow's Hierarchy of Needs from bottom to top
Physiological Needs Safety Needs Social Needs Esteem Needs
Deming's Process Improvement Cycle
Plan Do Study/Check Act
The first step, where we set the objectives of the organizations. Long-range goals are identified, established, & accomplished during strategic planning. It helps facility to re-evaluate its mission & identify its long-term goals
Planning
Unless adjudged incompetent or incapacitated under the laws of the state, the resident has the right to participate in __________ and ____________
Planning care & Treatment
Moving party in filing of a negligent action. The party bringing the lawsuit to court.
Plantiff
Two common nosocomial infections are:
Pneumonia & UTIs
What is the most common reason for transferring NH residents tot he hospital?
Pneumonia (especially aspiration pneumonia)
A trained professional, who is not a medical director, concerned with care of feet
Podiatrist
Broad statements of goals & procedures; can be verbal, written, or implied overall guide that sets up boundaries supplying the general limits & direction in which mangerial action will take place; generalized statements of intention
Policies
Alzheimer's disease could lead to ________ and ___________
Poor appetite and weight loss
What is a MAJOTR cause of malnutrition among the elderly?
Poor dentition
Anorexia (loss of appetite) among some elderly leads to skipping meals, bu the primary cause of malnutrition in a nursing facility is
Poor dentition (teeth)
Responsibilities & duties performed by one individual?
Position
______________ are integral to an organization's efforts to be fair an equitable to all employees
Position Description
Job description is now known as
Position description
Supervisors who take time for one-on-one relationships are usually rewarded with ___________ and ___________ that far exceed the time invested in employee interactions
Positive employee attitudes Increased Productivity
PAC
Post acute care
Help the transition of individuals needing additional support after a discharge from hospital-based, acute care setting
Post-Acute Care Units or Transitional Care Units
To make a entry in a ledger
Posting
Balancing mechanisms appear to function less well, resulting in some persons aged 65 and over being progressively at risk of tripping
Postural Imbalances
The ability to influence/control the behaviors of others
Power
An agreement in which a person (principle) gives another person the authority to make decisions on behalf of the principal (Attorney in fact)
Power of attorney (POA)
POA
Power of attorney (POA)
Under the common law, a POA becomes ineffective if its granter dies or becomes incapaciatted meaning unable to grant such power, because of physical injury or mental illness. Unless the granter has specified that the POA will continue to be active is the granter becomes incapacitated.
Power of attorney with durable provisions in US Enduring Power of attorney elsewhere
OBRA requires ___________ of any new resident who might have some for of mental illness or mental disability that prohibits admission
Preadmission Screening
PASARR
Preadmission Screening and Annual Resident Review
Defined that discrimination on the basis of pregnancy, childbirth, or related medical conditions as unlawful sex discrimination under Title VII of the Civil Rights Act of 1964
Pregnancy Discrimination Act of 1978
Cash accounting does NOT recognize expenses that are _________ such as insurance paid up to several months to years ahead
Prepaid
These are expenses paid in cash and recorded as assets before they are used or consumed
Prepaid expense
The gradual loss of acute hearing in which the resident may hear what is said but has poor word acuity. It is characterized by inability to hear certain tones
Presbycusis
Area where the skin and underlying tissues are eroded as a result of a lack of blood flow
Pressure sore
Residents that are bedfast or chairbound for long periods of time are at high risk for developing ____________
Pressure ulcers
The purpose of the EEOC is to
Prevent any person from engaging in any unlawful employment practice
The primary reason for employee incident reports is to
Prevent future accidents
An internal control for risk management would be to improve the ______________, which is to ensure safe operation of equipment
Preventative Maintenance Program
Used to ensure all equipment is monitored & operating effectively
Preventive Maintenance
Since the early 1990s the free exchange of wage information has been legally regarded as what?
Price fixing under antitrust regulations, however the Justice Department eventually decided that not-for-profit healthcare organizations should be held to the same standards as other industries.
PPS is a __________
Priced based system
Duties are broken down by tasks, & the task that are most critical are listed first
Principal duties performed
Notice of Rights and services must be provided when?
Prior to or upon admission
Resident rights must be provided to resident when?
Prior to or upon admission
Gave federal staff the right to examine their HR records, including letters of reference, unless they waived the right when they requested the letter
Privacy Act of 1974
Davidson has $3,000 in trust fund in May, what will happen to Davidson for the month of May?
Private Pay
Step by step guide by which a task is to be performed in order to attain a goal.
Procedures
Reengineering focuses on ________ and not people
Process
Routine use of polygraph tests are only permitted in organizations that?
Produce & distribute controlled substances Nuclear Power Transportation Currency Commodities Proprietary Information
Example of Norms
Professional standards for nurse & nurse aides
Shows whether revenues were sufficient to cover expenses during a certain time period. Shows if you made or lost money. It is the statement of current income and expenses.
Profit & Loss (P&L) aka Income Statement
With S Corporations ________ and ________ are divided and passed on to shareholders
Profits and losses
Outlook for a resident's future condition
Prognosis
PERT
Program Evaluation and Review Technique
Battery operated smoke detectors must be installed in resident's sleeping rooms and public areas by May 24, 2006, the facility must have
Program for testing Maintenance Battery replacement to ensure the reliability of the smoke detectors
Portable space heaters are what?
Prohibited except in non-sleeping staff & employee areas where the heating element do not exceed 212 degree F
Taft-Hartley Act of 1947
Prohibited unions & managers from doing certain actions Prohibited unfair labor practices It is a US Federal Law that monitors activities & power of labor unions Favors labor unions
TITLE VI of the Civil Rights Act
Prohibits people from discrimination based on race, color, or national origin in programs or activities that receive Federal Financial Assistance
A key element in reducing costs of work related illnesses & injuries is what?
Proper training of all employees upon hire & annually thereafter
Fixed expenses include:
Property tax, liability insurance, and property insurance
to give federally-funded protection and advocacy systems (P&As) authority to investigate possible abuse or neglect occurring in the community, including in facilities, like schools, that provide services to people with mental illness.
Protection and Advocacy for Mentally ill Individuals Act
Necessary for growth, repair of damaged tissue, transporting nutrients and chemicals throughout the body, & producing various hormones and enzymes. The building block of all cells
Protein
Primary purpose of HR management is to
Provide quality resident care with efficiency & economy
Before a nursing facility transfers a resident tot he hospital or allows a resident to go on therapeutic leave, the nursing facility must
Provide written information to the resident and resident's family member or Legal Rep that specifies the facility's bed hold policy
NEVER discipline staff in
Public
Involves a party & governmental subdivision
Public Law
Exists when employees believe managers has ability to punish unacceptable behavior & it is usually the last resort
Punishment power aka Coercive power
The resident or his legal rep has the right after receipt of his or her records for inspection, to
Purchase at a cost not to exceed the community standard photocopies of the records or any portions of them
Physician may delegate the task of writing dietary orders to a _____________ and delegate the task of writing therapy orders to a ____________
Qualified dietitian Qualified therapist
Employee Assistance Program (EAP) Addressing personal problems contributes to improvements in ________ & ___________
Quality & Productivity
QAPI
Quality Assessment & Performance Improvement
The focus of the NF should be ____________ regardless of it is profit or not for profit
Quality Care
A private, not for profit organization staffed by trained professionals who review medical care & help beneficiaries with complaints about the quality of care & implement improvements in the quality of care available throughout the spectrum of care
Quality Improvement Organization
QIO
Quality Improvement Organization
A fundamental principle that applies all treatment and care provided to the facility residents
Quality of Care
Resident care practices utilized by staff must reflect _____________ which promtes the highest practicable physical, mental, & psychological well-being
Quality of Care
QAPI meets at least
Quarterly
Residents with trust fund accounts must receive from the facility a ______________ statement and on request to the resident or his or her legal rep
Quarterly
The infection control committee should meet at least _____________
Quarterly
Fire drills must be conducted how often?
Quarterly on each shift
Acid test ratio =
Quick assets/current liabilities
Nosocomial infections should be identified _______________, paying special attention to residents at high risk of infection
Quickly
Fire Drill Steps:
R-Rescue A-Alarm C-Calm E-Extinguish
Fire drill steps:
RACE
___________ must coordinate or conduct each comprehensive assessment with appropriate health professionals, and cetify that the assessment is complete
RN
Is the best way to avoid stiffening (contractures) of hand and leg joints
ROM or Range of Motion
The best treatment for contractures is
ROM or Range of motion because the resident is unable to do exercises for themselves
Payment level for reimbursement?
RUG (Resource Utilization Group)
Once the MDS is completed it will generate a
RUG (Resource Utilization Group) with is used to bill MCD, MCR, or Hospice entities
__________, __________, and __________ impact the financial stability of nursing home
RUGs, PPS, Managed Care
What can you not ask a applicant about?
Race Color Religion Creed National Origin Sex Marital Status Birth Control Practices Previous worker's comp
First Federal legislation sanctioning union organization & the right to bargain collectively with management
Railway Labor Act of 1926
A distinct part must include all of the beds within the designated area, and cannot consist of a
Random collection of individual rooms or beds that are scattered throughout the physical plant
The facility must make the most recent survey results available for examination in a place
Readily accessible to residents and must post a notice of their availability and receive information from agencies acting as client advocates and be afforded the opportunity to contact these agencies
A form of therapy for demented, confused, or disoriented individuals & consists of reiteration of the person's identity, orientation to time & place, & reinforcement of consistency in daily routine
Reality orientation
MedWatch also disseminates medical product safety alert such as what?
Recalls & other clinical safety communications-via its website, email list, Twitter, & RSS feed
Individuals with disabilities can not be excluded from participation in an activity that what?
Receives Federal Financial Assistance
OSHA 300 log only records injuries & illnesses that OSHA classifies as _______ & _________
Recordable & Work Related
Process of locating prospective staff
Recruitment
Addressing something that is currently being done & redesigning a process & the same result is achieved.
Reengineering
Power to influence based on liking or identifying with another person & employees are more apt to do what the administrator asks
Referent Power
Employee Assistance Program (EAP) is primarily a __________ program that helps individuals to identify & focus on their own needs & problems
Referral
Oursourcing
Refers to the practice of contracting with third-party companies or vendors outside the organization (usually in another country) to deliver products and services to customers or produce products.
If an employee refuses to sign performance evaluation
Refusal is noted on evaluation & signed by the employee's supervisor
Relaxing the restrictions in some modified diets, called liberalized diet, may help prevent malnutrition
Regarding Dietary Services
Activity Director must be:
Registered or licensed therapeutic specialist eligible for certification a qualified OT or COTA Completed a training course approved by the state or has 2 years of experience in a social or recreational program within the last 5 years, 1 of which was full-time in a patient activity program in a health care setting.
Usually a consultant. Responsible for drug regimen review, med pass observations, and recording/reporting drug error rates.
Registered pharmacist
Applied only to employees of the federal government & to employees doing specified amount of business with the government. Prohibits discrimination in hiring, promotion, & other employment of the handicapped, paralleling Title VII of the Civil Rights Act of 1964
Rehabilitation Act of 1973
What Act is the precursor of the American with Disabilities Act (1990)?
Rehabilitation Act of 1973
Should focus on restoring the resident to his/her maximum functional level
Rehabilitation Services
employer must guarantee that, upon returning from leave, an employee will be
Reinstated to the previous position held or placed in a fully equivalent position with no loss of benefits or senority
TITLE VI Civil Rights Act in 1964 does not apply to a
Religious Corporation
_____________ and _____________ of conduct sometimes conflict with the ethical duty of caregivers to save lives
Religious beliefs and codes
Remembering & in some ways reliving past experiences
Reminiscence
RACE
Remove (residents from danger) Alarm (pull the alarm) Control (fire if possible, but use correct extinguisher Evacuate (adjacent areas)
States that most organizations are rated on a 4 point scale ranging from exploitive authoritative to participate authoritative
Rensis Likert
Reengineering includes:
Reorganizing Downsizing Rightsizing Repositioning Revitalizing Modernizing
If the facility has reason to believe that a resident's representative is making decisions or taking actions that are not in the best interest of the resident, the facility shall
Report such concerns in the manner required under state law
MedWatch form 3500B was introduced to facilitate what?
Reporting by healthcare consumers
Administrator of the SNF or NF __________ and ________ to the management of the institution of which the SNF or NF is a distinct parts
Reports to and is directly accountable
When transferring or discharging a resident other than notice to the resident in writing the facility must send a copy of the notice to
Representative of the Office of the State Long-Term Care Ombudsman
Statutory benefits are what?
Required by law
Requirements which nursing homes must meet to provide services to MCR and MCD patients?
Requirements of participation
"A thing decided" once the court makes a decision, that decision continues to bind those parties in any future litigation on the same issue
Res judicata
Every effort should be made to include the input of the ___________, _____________, or ___________ in creating the individualized care plan
Resident Family Resident's Rep
IDT includes;
Resident Resident's Family Legal Representative Physician RN responsible for resident Nurse Aide responsible for resident Member of FANS
Revenue Centers generate revenue, usually through __________________
Resident Care
QAPI is ___________ regardless of facility department
Resident Centered
RTF
Resident Trust Fund
Direct costs directly impacts a revenue center and are often called _______________
Resident care costs
The resident has the right to exercise his or her rights as a ___________ and as a ___________
Resident of the facility and as a citizen or resident of the US
Only the ___________ and the ____________ are authorized to review/receive medical records
Resident/Documented legal rep
Owner's equity (also known as stakeholder's equity & capital) included:
Residual claim or interest, after all liabilities are paid. If liability exceeds assets, negative equity exists Remaining interest in assets of a company, spread among individual shareholders of common or preferred stock Last or residual claim against assets, paid only after all other creditors are paid. In such cases where even creditors could not get enough money to pay their bills, nothing is leftover to reimburse owners' equity. Those owners' equity is reduced to zero.
Assets are
Resources
The facility must conduct & document a facility-wide assessment to determine what?
Resources necessary to care for its residents competently during both day to day operations & emergencies
When family needs a break from caring for relatives in which they are paid _________ is used?
Respite Care
Let the master speak, according to the law, the employer is responsible for the actions of its employees while they are on duty
Respondeat Superior
Malpractice is a must because of ______________
Respondent Superior
Restoring to normal function from an impaired physical or disease disability
Restorative Nursing
Used for sleep induction
Restoril
Cannot be removed easily which restrict freedom of movement or normal access to one's body
Restraint
RE
Retained Earnings
Used when an employee terminates an employee generally for reasons other that work-performance related causes, such as reporting an employer for illegal conduct, filing a discrimination charge, or opposing unlawful activity
Retaliatory Discharge
If age is a bona fide occupational qualification (BFOQ) the person is forced to ________
Retire
Withdrawing from ones occupation, business, or office and pursuing new activties
Retirement
Strengthens & accelerates funding of underfunded pensions & increases Pension Benefit Guarantee Corporation (PBGC) premiums for plans that pose the greatest risks
Retirement Protection Act of 1994
Projects monthly income for the next fiscal year
Revenue Budget
____________ is not prepared on a department basis. It is usually prepared at a corporate level
Revenue Budget
Departments that generate revenue such as therapy, nursing, pharmacy, lab, dietary, barber shop, beauty shop, & vending machines
Revenue Centers
Earnings from operations
Revenue also known as Inflow
Nursing, physical therapy, occupational therapy, speech therapy, pharmacy, cafeteria (guest meals), adult day care program, and lab are ___________________
Revenue centers
The indirect cost has to be allocated to _________________ that are also cost centers
Revenue producing Departments
Administrators are given reward power to induce/persuade employees or residents to do what the administrator asks, this is called
Reward Power
5 rights of medication administration
Right Medication Right dose Right time for administration Right Route Right Patient (ID band, facesheet, or photo)
Any event or process that can lead to actions which result directly or indirectly in economic losses or damage to the facility is defined as:
Risk
A program to reduce occurrences (incidents) that may lead to action that result in damage to the facility and its reputation or in an economic loss
Risk Management
Who studies loss trends such as costs associated with workers' compensation?
Risk Manager
Schedule V drugs include:
Robitussin
Chronological review of an event to identify what, how, why, when, and where an unwanted event occurred in order to prevent reoccurrence of the event
Root Cause Analysis (RCA)
RCA
Root cause analysis
Specify certain actions to be taken or not taken
Rules
Pays no corporate taxes with some exceptions regarding long-term capital gains.
S Corporation
MSDS (Material Safety Data Sheet) is now called?
SDS
When leaving an SNF, a resident can choose to make bed hold payments to the ________
SNF
What amended to raise the limit from $50 to $100 for the minimum about of resident's funds that facilities must entrust to an interest bearing account?
SS Amendments of 1994
The facility must provide a ________, _________, ___________, and _________, allowing the resident to use his or her personal belongings to the extent possible
Safe Clean Comfortable Homelike Environment
OBRA requires that the facility provides a
Safe Clean Comfortable Homelike environment
Managers should ensure that employees are thoroughly educated in what?
Safe work practices Safe handling of needles & sharp objects Safe lifting
Homelike is okay, but please be concerned about __________ 1st over the residents rights
Safety
SDS
Safety Data Sheet
Personal security, financial security, health & well-being, overall safety
Safety Needs
The MedWatch system is intended to detect what?
Safety hazard signals for medical products
Valid reasons for immediate transfer
Safety of the individuals in the facility would be endangered Health of the individuals in the facility would be endangered Health of the resident improved sufficiently to allow more immediate transfer or discharge Immediate transfer is required by the resident's urgent medical needs The resident has not resided in the facility for 30 days
Begins when a group of employees at one organization applies pressure for more money, this is called what?
Salary Bumping
Requires publicly held companies to implement internal controls over their financial reporting, operations, and assets to evaluate the strengths and weaknesses of these internal controls (segregation of duty-check and balances, IT security, cameras) in official documents filed with the SEC and to make regular disclosures concerning the viability of these controls and potential fraud or losses that may affect the company's financial position
Sarbanes-Oxley (SOX) Act of 2002
Outsourcing can what?
Save money
Is the chain of command ranging from the highest authority to the lowest rank
Scalar Chain
Most frequently used. It demonstrates a line organization in which the structure is characterized by a vertical flow of authority
Scalar Chain
These are high abuse potential and no accepted medical use in the US
Schedule I Drugs
Accepted medical use in the US, has high abuse & dependency potential.
Schedule II drugs
A separate key must be used to gain access to the ________ and another key is used to gain access to __________________
Schedule II drugs / Non-Schedule II drugs
Less abuse potential that schedule II
Schedule III drugs
Less abuse potential than schedule III drugs
Schedule IV drugs
Less abuse potential than schedule IV
Schedule V drugs
The facility must develop and implement written policies and procedures that prohibit Mistreatment, Neglect, Abuse, and Misappropriation of resident property. These policies and procedures must include 7 components outlined by OBRA
Screen potential employees Training Prevention Identification Investigation Protection Reporting/Response
Pre-employment procedures to ensure that workers are qualified to work; includes conducting extensive criminal background checks, viewing registration boards for clinical personnel in every state where the person is licensed or certified, and drug testing
Screening
A specialized housing subsidy program under the US dept of Housing & Urban Development that provided financing for construction of housing for low-income senior citizens & those with disabilities.
Section 202
What section on the Rehab Act of 1973 covers the rights of all individuals with disabilities?
Section 504
An affordable housing assistance program under the US dept of Housing & Urban Development that provides funds to landlords who designate a portion of their property for section 8 tenants & rental vouchers to individuals who then select their own housing
Section 8
SEC
Securities and Exchange Commission
The job description (position description) can be used to ?
Select Train Evaluate Compensate Employees
Can be a productive component of a performance appraisal system. It is not for everyone. Some employees may be intimidated by it
Self Appraisal
The desire to become more & more of what we are & to become everything that you are capable of becoming
Self-Actualization
The # after the title may indicate the level of the position in the organization. Higher numbers usually mean what?
Senior Level Positions
Incorporates therapies that stimulate the senses in patients with dementia or in those in comatose or vegetative states
Sensory stimulation
Drugs used for external purposes must be stored ______ from drugs used for internal purposes
Separately
Schedule II drugs must be ____________ locked.
Separately
Facility must provide ______________ and ______________ for storage of controlled drugs listed in Schedule II of the Comprehensive Drug Abuse Prevention & Control Act of 1976 & other drugs subject to abuse
Separately locked Permanently affixed compartments
The changes OBRA brought to nursing home care are enormous. Some of the most important resident provisions include: New opportunities for potential & current residents with mental retardation and mental illnesses for
Services inside and outside of a nursing home (PASARR)
What does the attitude of the organizations' CEO do?
Sets the tone for the rest of the employees
Employers must not ask questions that might be construed as violating the Civil Rights Act, Title, & or the Americans with Disabilities Act. DO not ask questions related to
Sex Age Race National Origin Education Religion Arrest & Conviction Records Marital Status Credit Rating Disabilities
It is unwelcome sexual advances, demands, or requests for sexual favors, or other conduct of a sexual nature
Sexual Harrassment
Under the Civil Rights Act of 1964, ______________ is a form of sex discrimination
Sexual Harrassment
Obvious symptoms of Parkinson's Disease include:
Shaking Rigidity Slowness of movement Difficulty walking unstead gait
Setup to ensure businesses do not monopolize
Sherman anti-trust act
Can be sold, liquidated, or converted to cash to pay liabilities within 1 year
Short-term asset
Include securities bought and held for sale in the near future to generate income on short-term price differences (trading securities)
Short-term investments
One that causes a resident discomfort, or jeopardizes his health & safety or a medication error rate >5%
Significant Medication Error
Suggested parameters for evaluating significance of unplanned and undesired weight loss. 6 month
Significant loss 10% Severe loss >10%
Suggested parameters for evaluating significance of unplanned and undesired weight loss. 1 month
Significant loss 5% Severe loss > 5%
Suggested parameters for evaluating significance of unplanned and undesired weight loss. 3 month
Significant loss 7.5% Severe loss >7.5%
What makes a isolation room?
Single occupancy Ventilated to the outside Negative air flow pressure Private toilet Hand washing facilities Identified by signs when in use
Concerned with the outcome or consequences of an action in which the ends can justify the means.
Situational Ethics
Facilities that provide medical, nursing, or rehabilitative services on an inpatient basis
Skilled Nursing Facilities
Capable of organizing resources & finances available to best meet the needs of the resident
Skilled administrator
Documentation must be done daily for residents on ____________
Skilled services
Physiological
Skin loses elasticity, bruises & tears easily, wrinkles, decline sense of taste & smell, problems with balance, depressed immune system, some loss of hearing, Parkinson's disease, dementia, strokes, & incontinence
Oral/verbal defamation is __________
Slander
Increased pension protection & makes it easier for workers to roll over (change to another fund or plan) their retirement savings upon changing employment
Small Business Job Protection Act of 1996
The fire alarms must automatically be activated by __________ and ____________
Smoke & fire
Battery operated __________________ must be installed in resident's sleeping rooms and public areas by May 24, 2006`
Smoke detectors
The facility must offer _________ at bedtime daily
Snacks
Caring for residents with C-Diff, employees must use what to clean hands?
Soap and Water
Need for love & belonging (friendship, intimacy, & family)
Social Needs
A federal government program that pays benefits to senior citizens & certain other individuals.
Social Security
It often serves as the primary source of retirement income for low income elderly persons
Social Security
Is a program that provides block grants for social services. These grants are fixed amounts of funding given to states for various purposes, including community based care for the elderly & disabled
Social Security Act created by Title XX
Old age insurance policy
Social Security Act of 1935
Indirectly responsible for the NH industry as it exists today
Social Security Act of 1935 aka Old Age Insurance
3 most common sources of retirement income
Social Security Benefits Employee pensions Personal savings
The employer is required/mandated also to pay a certain share of what?
Social Security taxes (per the Social Security Act of 1935) 50%
____________ is the oldest form of ownership
Sole Proprietorship
Unincorporated business ownership by one person
Sole proprietorship
A balance sheet or statement of financial condition reflects the firm's
Solvency (Ability to Pay)
Palliative care extends the principles of hospice but begins at an earlier point in the disease process, and accepts that
Some curative therapies may be appropriate even though the patient has been diagnosed with a fatal disease
Residents have the right to retain and use personal possessions including:
Some furnishings, appropriate clothing, as space permits, unless to do so would infringe upon the rights or safety of other residents
The number of employees a manager is required to direct & control
Span of management or span of control
A managers should use ___________ when conducting appraisal interviews
Specifics
Focuses on Aphasia, Dysarthria, Apraxia, & Dysphagia
Speech Therapy
If Anthony has $1800.50 in his trust fund, what needs to happen to this balance and what purchases should be suggested to the family/responsible party/cognitive patients?
Spend down/purchase items
Protection to spouses of people receiving home & community based services
Spousal Impoverishment Protections
Pest control the facility can not use
Spray pesticides and must not use non-aerosol pesticides
Administrative assistant has ____________ authority
Staff (can not make decisions on behalf of the Administrator is only ADVISORY)
Dotted lines on org charts
Staff authority
Person with advisory role to the manager with no authority to make decisions for the organizations
Staff authority
If there is no apparent short-term effect on workflow, it is what?
Staff operation
______________ cannot attend the resident or family council meeting unless invited
Staff or administrator
Ensuring that the facility is staffed appropriately & staff have been trained on the care needed by the residents
Staffing
Outstanding check for over 60 days
Stale Check
Two common sources of carbohydrates includes:
Starches & Sugars
Who regulations water temperatures?
State
Nursing hours per resident day are established by
State & Federal approval
Dietary manager requirements are per ____________
State requirement
Residents have the right to send and promptly receive mail that is unopened and have access to ____________, ___________, and ________ at the resident's own expense.
Stationary Postage Writing implements
Law enacted by legislation
Statutory Law
Employer is required by law to provide what?
Statutory benefits
__________, __________, __________, and ___________ food in accordance with professional standards for food service safety
Store Prepare Distribute Serve
Acceptable Accounting Methods of depreciation:
Straight Line Sum of the digits Declining Balance
Depreciation method which historical cost of an asset is spread evenly over its useful life
Straight line depreciation
The long-term planning process by key stakeholders in which the organization's goals, measurable objectives, & direction for the immediate future are determined
Strategic planning
Violence in the workplace is often a result of what?
Stress
An organized work stoppage orchestrated by a union
Strike
Department managers who want to personally become involved in checking applicant references should be what?
Strongly discouraged or forbidden to do so
Performance appraisal is a ____________ event
Structured
An institution cannot designate a distinct part SNF or NF, but instead must
Submit a written request with documentation that demonstrates it meets the criteria set forth to CMS to determine if it may be considered a distinct part
Involves preparing a single, designated successor
Succession planning
What type of planning is critical to success of any organization?
Succession planning
A symptom exhibited by some people with Alzheimer's or other dementias characterized by confusion, anxiety, and agitation in the early evening or into the night
Sundowning
What does decision making authority do?
Supervisor hires Fires Makes judgmental evaluations
What does staff operations do?
Support & enhance the work of an organization by making it possible to continue producing products or delivering services as intended.
Indirect costs are also known as:
Support Service Costs
Facility must purchase a _____________ to assure the security of personal funds deposited i the resident's trust fund
Surety Bond
An agent who acts on behalf of a patient who lacks the capacity to participate in a particular decision
Surrogate Decision Maker
Examples of speech therapy include:
Swallowing Chewing Communicating
HR should be available to minimize undesirable occurrences to an organization through the what?
Systematic Identification of Potential problems
The simplest account structure is shaped like the letter
T
Each general account has _______________
T-account (debit & credit side)
TC (Total Cost)=
TFC (total fixed cost) + (VC per unit x volume units)
TC (Total cost)=
TFC + (VC per unit x volume units)B
Continously improving the quality of products & processes
TQM (Total Quality Measurement)
A philosophy of total organizational involvement in improving all aspects of quality of service
TQM/CQI
Break even is where
TR (Total Revenue=Total Cost)
What changes with volume?
TVC (Total variable costs)
Used when a energy source is not capable of being locked out
Tagout Device
Used when an energy source is not capable of being locked out. A prominent warning device such as a tag that can be easily fastened is attached.
Tagout Device
Contain various subclasses, including current assets & fixed assets.
Tangible
________________ are those that have a physical substance and can be touched. Such as currency, buildings, real estate, vehicles, inventories, equipment, and precious metals
Tangible Asset
Most common employee problem is?
Tardiness to work
A difficult to treat and often incurable disorder resulting in involuntary, repetitive body movements,
Tardive Dyskinesia
A coordinated and aggregated series of work elements used to produce an output?
Task
A weakness is the inevitable difference that exits among individuals
Team appraisal
The delivery of health related services & information via telecommunication technology
Telehealth
The practice of using technology, such as computer or telephone, to monitor the medical condition of a patient from a long distance or consult with colleagues in different locations
Telemedicine
Items and services that may be charged to the resident's fund IF they are requested by resident, the facility informs the resident of a charge, or payment is not made by MCR and MCD
Telephone Radio Smoking items Novelties Cosmetics Flowers Plants Personal clothing Private room
TTY
Telephone Text
Residents have the right to privacy while making a
Telephone call
T
Temperature
A person who dies with a will
Testate
Facilities should ensure residents do not receive psychotropic drugs pursuant to a PRN order unless
That medication is necessary to treat a diagnosed specific condition that is documented in the clinical record
________________ mandates nursing homes implement corporate compliance and ethics programs
The Affordable Care Act of 2010
Calls for denial of payment under MCR and MCD to facilities charged with abuse and mistreatment of patients. It also directed the states to establish nurse aide registries
The Balanced Budget Act of 1997
Who administers & enforces Title III of the Consumer Credit Protection Act?
The Department of Labor Wage Hour Division
Sets minimum funding levels for pension funds (also called vesting)
The Employee Retirement Income Security Act of 1975
Responsible for establishing & implementing policies in the nursing facility
The Governing Body
Taft-Hartley Act of 1947 is also known as
The Labor Management Relations Act
The separate Federal Nursing Home Reform Act along with many other separate bills was rolled into one bill to insure final passage of all the elements is?
The Omnibus Budget Reconciliation Act of 1987 or OBRA '87
Who ensures that the automatic control valve on the water heaters are checked regularly?
The administrator
Blue prints on the building & any renovations must be kept for inspection by who?
The agency that monitors LSC (Life Safety Code) compliance
Every state's unemployment system bases the employer's tax rate on?
The amount of benefits paid to former workers
The SNF must inform residents in advance of their option to make bed-hold payments, as well as
The amount the facility charges
The IDT (Interdisciplinary Team) includes but not limited to:
The attending physician A RN with responsibility of the resident CNA with responisibility for the resident A member of Food & Nutrition Service Staff Representative of the resident
Objective evaluations of employees should not include
The attitude of the supervisor toward the employee
Administrators has the power from ____________ or ____________ to tell employees what to do & to expect them to do it
The board or owner
Hospice provider also bill Medicare Part A for services rendered, hence the reason that you can NOT skill someone that is on Hospice UNLESS
The diagnosis is different or NOT related to the Hospice diagnosis
What should the facility do with information on how to apply for Medicaid & Medicare benefits?
The facility must prominently display the written information Provide to the residents and applicants for admission either orally or written Include information on receiving refunds for previous payments covered by these benefits
If an employee accepts COBRA after they leave they are required to pay?
The full insurance premium
Is the policy making arm of the organization & has legal & fiduciary responsibility for how the organization functions. Responsible & accountable for ensuring that an ongoing QAPI program is defined, implemented, & maintained & addresses identified priorities.
The governing body
Long term care continuum has 3 major subsystems
The informal system The community based system The Institutional System
The facility must inform each resident who is entitled to Medicaid benefits, in writing, at the time of admission to the nursing facility or when the resident becomes eligible for Medicaid of
The items and services under the State plan and for which the resident many not be charged Those other items and services that the facility offers and for which the resident may be charged, and the charges for those services Inform each resident when changes are made to the items and services listed above
Cost of expenses account purchased one month is expensed over
The next several months
Medication error:
The observed medication administration of drugs does not comply with physician orders The administrator's primary focus is on the effect on the resident Report to physician IMMEDIATELY Accidentally giving a dehydrated patient a diuretic is a significant medication error
In the case of an a resident adjudged incompetent under the laws of a state by a court of competent jurisdiction, the rights of the residents are exercised by
The person appointed under state law to act on the resident's behalf
Job ID must include:
The position title The department location Last date on which the content of the position description was verified It could include title of the supervisor to help show how the position fits within the organizational structure
A resident has the right to refuse transfer to another room within the institution if
The purpose of the transfer is to relocate a resident of a SNF from the distinct part of the institution that is a SNF to a part of the institution that is not a SNF A resident of the NF from the distinct part of the institution that is a NF to a distinct part of the institution that is a SNF
Records of serious work-related injuries & illnesses help employers, workers, & OSHA evaluate what?
The safety of a workplace Understand industry hazards Implement worker protection to reduce & eliminate hazards Prevent future workplace injuries & illness
ANSI (American National Standards Institute) and ADAAG (ADA Accessibility Guidelines) are both what?
The same
Skilled nursing facilities participating in MCR must meet certain specified requirements and the __________ may impose additional requirements if necessary for the health and safety of individuals to whom services are furnished in the facilities
The secretary
If the automatic control valve of the water heater malfunctions, what could happen?
The water temperature could rise sufficiently and burn resident
Most business managers believe that employees naturally dislike work, prefers to receive extensive direction from superiors, wishes to avoid taking responsibilities in the organization, has little ambition, & is motivated more by a need for security than any other factor. REQUIRES MANAGERS TO USE FEAR OR PUNISHMENT TO MOTIVATE EMPLOYEES
Theory X
Opposite of Theory X & more positive
Theory Y
Tends to promote stable employment, high productivity, high employee morale & satisfaction. It applies to motivating employees, 7 situational leadership theories align easily
Theory Z by William Reddin
A person requires the Heimlich Maneuver if:
They cannot breathe, cough, or speak They make high pitch sounds when they breath Lips and nails turn blue
An intermediary pays for the legal obligations incurred by residents?
Third party Payer
Concept used by financial planner to describe the 3 most common sources of retirement income Social Security Benefits Employee pensions Personal savings
Three-legged stool of economic security
The 3 most important factors in fire prevention & control planning are:
Time Smoke Closed Door
Overtime is paid at ______ and ______
Time & a half
The interval covered by the financial reports, usually 1 year
Time period concept (Accounting Period)
______________ sets minimum standards for participation in the MCR & MCD programs that must be met by all facilities regardless of location
Title 42
Primary purpose of Life Safety Code is to what?
To ensure there is a reasonable degree of safety to protect people from fire & related hazards in public facilities.
The primary purpose of a performance appraisal is what?
To improve employee performance in the present job
Unemployment insurance system was designed with two major goals in mind
To provide workers that lose their job through no fault of their own with weekly checks To promote economic stability by rewarding those employers who minimize their workforce turnover, and by maintaining the flow of dollars through the economy even when there is widespread unemployment
With a organizational chart in a small organization, top management will be able
To see what is happening
Administrator (or corporate) alone prepares the annual budget with little or no guidance from department heads
Top down approach
Two method of budget preparation:
Top down approach & Participatory approach
A wrong or literally means "twisted". Exists when plantiff is harmed as a direct result of breach of duty. Facility fails to provide care to residents causing harm to the residents.
Tort
TC
Total Cost
Cost per patient day =
Total annual operational costs / total patient days for the year
Working capital (Net current Assets)=
Total current assets minus total current liabilities
ALOS (Average length of stay)=
Total patient days in the year divided by number of admissions in the year (or month)
An approach that leaders use to ensure the organization will have the best possible chance to survive & grow in the future
Training
Facilities must have a __________ with a hospital
Transfer Agreement
Facilities must have a written transfer agreement with one or more hospitals approved for participation under the Medicaid & Medicare programs
Transfer agreement
Symptoms of Parkinson's disease include
Tremor or trembling, of any of the limbs while at rest, rigidity or muscle stiffness, and bradykinesia
TF
Trust fund
The termination of employment, which can be voluntary or involuntary
Turnover
Employees that are often ignored or taken for granted contribute to what?
Turnovers
Schedule II drugs include:
Tylenol Codeine
A therapeutic diet must also state ________ and _________ of the diet
Type & consistency
It is the most common form of catheter-related infections
UTI or Urinary Tract Infection
What accounts for 30% of all nosocomial infections?
UTI or Urinary Tract Infection
Satisfied employees leaves most often due to feeling _____________ and _______________
Underused Under appreciated
Adverse Event
Undesireable experience associated with the use of a medical product
Employees that are laid off must be reported to the state so they can receive what?
Unemployment Compensation
Concerned with donation of one's body or body parts at time of death
Uniform Anatomical Act
Established the standards by which federal agencies determine acceptability of validation procedures used for written tests & other selections, has become the handbook for decision making in HR
Uniform Guidelines on Employees Selection procedures
running anti-organizing campaigns, conducting negotiations, and administering contracts...what are these?
Union related activities
The most cost and time efficient method of passing medications is to use the __________. This will decrease medications errors.
Unit dose method (pill punch packet)
Emphasizes the importance of each person being accountable to only 1 supervisor
Unity of command
An approach to infection control that assumes that all human blood and certain bodily fluids are to be treated as if they are infectious for HIV, HBV, and other bloodborne pathogens
Universal Precautions
Means of egress must be ___________ at all times & resident's doors must lead to a corridor with a exit
Unobstructed
The basis of Maslow's theory of motivation is that human beings are motivated by
Unsatisfied needs, and that certain lower needs need to be satisfied before higher needs can be addressed.
Employees are unlikely to remain loyal or maintain their employment if they feel what?
Unwelcome Excluded Or think they have few opportunities to excel
Section 703 of TITLE VII & the EEOC defines sexual harassment in employment as unwelcome sexual advances, requests for sexual favors, & or other verbal or physical conduct of a sexual nature when this conduct explicitly or implicitly affects an individual's work performance; or creates an intimidating, hostile, or offensive work environment. Sexual conduct is only illegal when?
Unwelcomed by the victim
Pain assessments must be completed upon __________, ___________, and ___________
Upon admission Quarterly As needed
The resident or his legal rep has the right after receipt of his or her records for inspection, to purchase at a cost not to exceed the community standard photocopies of the records or any portions of them when?
Upon request and 2 working days advance notice to the facility
Resident or legal rep can request copies of medical record when?
Upon request and two working days advanced notice to facility (which would be by day 3)
A written fire safety plan provides the following:
Use of alarms Transmitting of alarm to fire dept Response to alarms Isolation of fire Evacuation of immediate area
W-9
Used to setup new vendors for tax purposes (A/P)
The number of years the item can be expected to be used
Useful life of an asset
TVC (Total variable costs)=
VC (Variable Cost) per unit x volume units
What does not change with volume?
VC (Variable cost)
TVC (total variable cost) is
VC (variable cost) per unit x volume units
A person's belief that he or she is actually living in the past is accepted & validated by the staff members working with the patient
Validation therapy
Schedule IV drugs include:
Valium Diazepam
Amount of insurance required =
Value of building x coinsurance percentage
The _____________ that is lost while a position remains vacant can cost a lot
Value of output
VC
Variable Costs
Varies according to to volume such as dietary food, supplies, etc
Variable Costs (VC)
A written contract is required for all _______________ such as lab, x-ray, dental, audiology
Vendor Services
Types of abuse:
Verbal Sexual Physical Involuntary seclusion Mental
Pertaining to abuse residents have the right to be free from
Verbal Sexual Physical Mental Abuse Corporal punishment Involuntary seclusion
Progressive Discipline is
Verbal-written-final-termination
One disadvantage of ERISA rules are
Very demanding & many employers choose not to offer pension plans
Redundant cueing of residents combines _________ with music
Visual
The purpose of the ANSI (American National Standards Institute) regulations was to make building accessible to and useable by the ___________ and _____________ handicapped
Visually & Physically
Act to control certain body functions and regulate the body's utilization of other foods
Vitamins
Used in replacement therapy
Vitamins
__________ and ___________ are the most common classes of medication Rx to the elderly nursing home residents
Vitamins & Minerals
Any waivers or release of age discrimination must be _________ & part of an understandable, written agreement between employer & employee.
Voluntary
Medicare Part B is ______________
Voluntary
Intentional killing of another person
Voluntary Manslaughter
Managers can not be involved in decertifictaion of a union, and they can not what?
Volunteer info to employees about decertification
Could be held personally liable if he/she works outside his/her assignment/scope
Volunteer worker
It is okay for ___________ in the activity department to handout mail and it also shows active community involvement
Volunteers
Fair Labor Standards Act (FSLA) also known as?
Wage & Hour Act
Should be based on merit increase, depending upon the quality of work the employee performs
Wage Evaluation Program
The EEOC (Equal Employment Opportunity Commission) was created by?
Wagner Act in 1935
The act by a person with dementia of walking, riding, or driving off supervised, leading to a potentially dangerous situation
Wandering
Walking around aimlessly, in and out of rooms and outside of the building, with little or no awareness of potential dangers
Wandering
Example of emetic includes:
Warm salt water
Dish washing 3 step process
Wash Rinse Sanitize
Low temp dishwasher temps:
Wash 120 degrees Final rinse 50 pp, hypochlorite on dish surface in final rinse
High temp dishwasher temps:
Wash 150-165 Degrees Final rinse 180 degrees
Class A fire extinguishers are _______ based
Water
Class C (Electrical) & __________ can never be used together because it conducts electricity & may injure the person using this
Water
The best form of protection against bloodborne pathogens is
Wearing latex gloves and use proper handling techniques
Generators must be started at least how often?
Weekly
It is legal to ask an applicant is they are a citizen of the United States, however it is illegal to ask what?
What country they are a citizen.
Performance appraisal reminds employees
What employers expect of them
You cannot ask a applicant their native language, but you can ask what?
What languages they speak & write fluently
What information does MDSD or SDS give?
What to do if there is a spill Contact with eyes, skin, etc. What to wear proper PPE Compounds in chemical Where to store the chemical Emergency telephone number
Reasonable accommodations must be made by an employer for an applicant with a disability, except
When the accommodations would impose undue hardship or unreasonable expense on the operation of the business
Facility must notify each resident that receives MCD benefits:
When the amount in the resident's account reaches $200 or less than the SSI resource limit ($2000) for one person If the amount in the account, in addition to the value of the resident's other nonexempt resources, reaches the SSI resource limit ($2000) for one person, the resident may lose eligibility for MCD or SSI
A resident may approve or refuse the release of personal & clinical records to any individual outside the facility except
When the resident is transferred to another health care institution or record release is required by law.
The fire safety code specifies what?
Which materials must be 2 hour & 1 hour fire-resistant or less
A person who reports corruption & criminal & unethical business practices in the workplace to appropriate government authorities
WhistleBlower
Bequest of real/personal property effective at the death of the testor
Will
Nursing homes must report to the manufacturer (FDA if manufacturer is unknown) within how many days after the incident or incidents in which the medical devise causes serious injury?
Within 10 work days of becoming aware
Employers must report any worker fatality within how long?
Within 8 hours
Employees should not have to pay for injuries that occurred at work, this is called
Worker's Compensation
What has the government mandated as a statutory benefit?
Workmen's Comp
Firing or laying off an employee for illegal reasons in violation of existing civil law
Wrongful termination
The FUTA tax is imposed at a single flat rate on the first $7,000 of wages that you pay each employee. Once an employee's wages for the calendar year exceed $7,000
You have no further FUTA liability for that employee for the year
______________ affect your tax rate in unemployment insurance. This is one of the few times in life when you can influence your tax rate by ______________
Your actions
Break even in days =
[FC/(Revenue - VC)] x # of patient days in the period
Break even in days=
[FC/(Revenue-variable cost)] x number of days in the period
Perpetual Inventory System is recommended to maintain and accurate count of inventory on hand (an accurate count of supplies used and those remaining in the storeroom). A Bar Coding System is often used for this purpose. It involves keeping
a daily record of supplies received, issued, and left in inventory
There must be no more than 14 hours between a substantial evening meal & breakfast the following day, except when
a nourishing snack is provided at bedtime
Threshold
a strip of wood, metal, or stone forming the bottom of a doorway and crossed in entering a house or room.
cerebrovascular accident (CVA)
a.k.a. "Stroke". Lack of blood supply to the brain causing brain damage
Food danger zone temp range
above 41 degrees and below 135 degrees that allow the rapid growth of pathogenic microorganisms that can cause foodborne illness
AROM
active range of motion
Facility must record and periodically update the __________ and ___________ of the resident's legal rep or interested family memeber
address/phone number
The success of the NH depends directly on
adequate staffing
The facility must ensure that all alleged violations involving mistreatment, neglect, or abuse, including injuries of unknown source, and misappropriation of resident property are reported immediately to the
administrator of the facility Other officials in accordance with state law through established procedures (including to the state survey & certification agency)
pc
after meals
palatable
agreeable to the taste
The resident has the right to ________ any discharge
appeal
AHD
arteriosclerotic heart disease
The facility must ensure that the resident environment remains
as free of accident hazards as is possible and each resident receives adequate supervision & assistance devices to prevent accidents
PRN
as needed
prn
as needed
Administrator is to ensure all employees make the right decisions for the organization as often
as possible
A resident who enters the facility with an indwelling catheter or subsequently receives one is
assessed for removal of the catheter as soon as possible unless the resident's clinical condition demonstrates that the catherization is necessary
The most important reason for depreciation is for
asset replacement
In "T" structure accountants record increase in __________, ___________, and _____________ on the debit side
asset, expense, and owner drawing accounts
ALF
assisted living facility
hs
at bedtime
Final cooking temp for grounds meat, ground fish, and eggs held for service
at least 155 degrees
ADC
average daily census
Percent of occupancy or occupancy rate=
average daily census divided by number of beds (Occupied beds divided by total beds)
In some cases, a resident may decline particular services or treatments that the IDT believes may assist him or her to attain the highest practicable level of well-being. In such cases, the resident's wishes should
be honored and documented in the clinical record and alternatives should be offered before the care plan is finalized
Daily staffing at the beginning of the shift must
be posted in a prominent place that is accessible to visitors and well as residents.
Decubitis Ulcer
bedsore
ac
before meals
BARS
behaviorally anchored rating scale
Risk Management is identifying and solving problems before they get out of hand, preventing _____________________
being sued
non-cancerous
benign
Twice per day
bid
Hematuria
blood in the urine
BP
blood pressure
Cyanosis
bluish discoloration of the skin
Patients with osteoporosis are at risk for
bone breaking in falls
Unlike some other payroll taxes, the ___________ must pay the FUTA tax
business
po
by mouth
Pay back period
calculated by dividing purchase price by how much will new purchase reduce annual operating costs per year
It is the most liquid asset, which includes currency, deposit accounts, and negotiable instruments (money orders, checks, bank drafts)
cash and cash equivalents
Types of current assets:
cash and cash equivalents, short-term investments, receivables, inventories, prepaid expenses
CNS
central nervous system
CVA
cerebrovascular accident (stroke)
COTA
certified occupational therapy assistant
Checking performance & taking corrective action, with planning you constantly ____________, ___________, & ____________ the plan as necessary
check recheck modify
COLD
chronic obstructive lung disease aka COPD
COPD
chronic obstructive pulmonary disease
Liabilities + Capital is
claims on resources
Social worker should assist resident & family to use
community resources
Paid feeding assistants cannot feed anyone with
complicated eating disorders such as swallowing difficulties & aspiration problems
Records are
confidential
If you allow consultants to discipline your staff, it is
confusing & a big concern & it leads to role ambiguity
CCRC
continuing care retirement community
CQI
continuous quality improvement
The resident's bedrooms must have direct access to a
corridor
If a business owner losses $5000 of the company's cash while gambling, the cash account, which is an asset, must be ___________ for $5000
credited
Working capital=
current assets - current liabilities
current ratio=
current assets/current liabilities
Resident's bedroom must be cleaned
daily
Each general account has a T-account _________ is left side and ________ is right side
debit/credit
Per the teachings of Abraham Maslow there are general needs which have to be fulfilled before a person is able to act unselfishly. These needs are dubbed?
deficiency needs
Neuritis
degeneration lesion and inflammation of nerves
Osteoarthritis
degenerative joint disease
Osteoarthritis is also called
degenerative joint disease
Ultimate responsibility can not be
delegated
5 stages of grief
denial, anger, bargaining, depression, acceptance
If the dietitian is not employed on a full time basis, the facility must
designate and employee to manage the food service department
In the case of an a resident adjudged incompetent under the laws of a state by a court of competent jurisdiction, the adjudged resident has the right to
designate the representative
advanced directive (living will)
details the conditions under which life support measures should be used
Each resident has a right to self-administer drugs, provided that the IDT has
determined for each resident that this practice is safe & per physician order
The facility must provide equal access to care regardless of
diagnosis severity of condition payment source
Under a durable power of attorney, the authority of the attorney in fact and/or makes decision on behalf of the grantor continues until the grantor __________
dies
Under the common law, a POA becomes ineffective if its granter __________ or _____________ meaning unable to grant such power, because of physical injury or mental illness. Unless the granter has specified that the POA will continue to be active is the granter becomes incapacitated.
dies or becomes incapacitated
Aphasic
difficulty communicating
Dysphagia
difficulty swallowing
Dysphagia
difficulty swallowing (ST involved)
OBRA specifies the facility must ensure the resident's ADLs do not
diminish unless the resident's condition demonstrates that diminution is unavoidable
Cost associated with turnover could be _________ or _________
direct or indirect
Too many fringe benefits can be a _________
disadvantage
Facility must promptly within 3 days refer residents with lost or damaged dentures for dental services. If a referral does not occur within 3 days facility must
document what they did to ensure resident could still eat & drink adequately while awaiting dental services & the extenuating circumstances that led to the delay
gtt, gtts
drops
DPOA
durable power of attorney
Resident's bedroom must have privacy curtain for
each bed in a multiple-bedded room
ou
each eye
EKG
electrocardiogram
E.D.P
electronic data processing
All employees must be trained in
emergency procedures
Induces vomiting
emetic
Non-exempt employees
employees covered by the FLSA requirements for overtime pay & clock in
If the employee refuses the Hep B series upon hire, but wants it later, who pays for it?
employer as long as the employee is still occupationally exposed
When all debits and credits are totaled each month they should ___________
equal
The facility must have a Governing body (board of directors) or designated persons functioning as a governing body that is legally responsible for
establishing & implementing policies regarding the management & operations of the facility Appoints a licensed administrator who is licensed by the state where licensing is required & responsible for the management of the facility
Facility must complete a performance review of every nurse aide at least once
every 12 months
QH
every hour
____________ communication is the best method of communicating with employees
face to face
First step in developing a marketing program is to define the ______________ and ________________
facilities goals and objectives
S Corporations pay no ____________
federal income taxes
Once the receiver decodes the message, the receiver will send ____________
feedback (verbal or non-verbal)
FUO
fever of unknown origin
FIFO
first in first out (In case of deflation)
FI
fiscal intermediary
Fx
fracture
Facilities must ensure that the environment is _________ of accident hazards
free
FTE
full time equivalent
GDR
gradual dose reduction
Resident's bedroom must have a floor at or above
ground level
ss
half
Residents, family, or resident rep should be invited to participate in team discussions in an ongoing manner, and be encouraged to share their perspectives on the delivery of care. This can be accomplished by
having individual team members discuss preliminary care plan ideas with the resident, family, or resident rep in order to get suggestions, confirm agreement, or clarify reasons for developing specific goals and approaches
Arteriosclerotic Heart Disease
heart disease caused by hardening of the arteries
Hypertension
high blood pressure
If fire occurs, _________ on duty is in charge until firemen arrive
highest ranking person
HPPD
hours per patient day
Low body Temperature
hypothermia
SOS
if necessary
Face to face communication allows the administrator or supervisor to confirm
if the employee understands
While a person is motivated to fulfill basic needs and desires, they continue to move towards growth, and eventually self-actualization. The satisfaction of these needs is quite healthy while preventing gratification makes us
ill or act evilly
Discrimination on the basis of race or national origin is what?
illegal
stat
immediately
An effective supervisor is one that who establishes a reputation of ___________
impartiality
Dysarthria
imperfect articulation of speech (Involve ST)
Cholinesterase Inhibitors are beneficial if used
in early stages of Alzheimers
Residents have the right to share a room with his or her spouse when marries residents live
in the same facility and both spouses consent to the arrangement
Aphasia
inability to speak or form language (ST involved)
Drying food preparation equipment & utensils with a towel or cloth may
increase risks for cross contamination
Change is _________
inevitable
ICP
infection control practitioner.
Arthritis
inflammation of a joint
Myocarditis
inflammation of the heart muscle
Nephritis
inflammation of the kidney
gatritis
inflammation of the stomach
Phlebitis
inflammation of the walls of a vein
IDDM
insulin dependent diabetes mellitus
Fraud is ______________ deception that results in injury to another
intentional
The facility must have evidence that all alleged violations are thoroughly
investigated, and must prevent further potential abuse while the investigation is in progress
Staff or visitors may attend resident groups if
invited by group
KUB
kidneys, ureters, bladder
Anemia
lack of a normal number of red blood cells
LIFO
last in first out (In case of inflation)
os
left eye
With sole proprietorship there is no ____________ between the business and the owner as entities.
legal distinction
In "T" structure accountants record increase in __________, ___________, and _____________ on the credit side
liability, revenue, and owner's capital account
With a LLP or limited liability partnership the partners are not ___________ for partnership debts beyond the amount of funds contributed.
liable
Administrator has _____________ from governing board
line authority
Acid-test ratio=quick assets/current liabilities. Quick assets can be converted to cash quickly, such as AR. If the answer is greater than 1 the company is safe. Reflects the ____________ of the assets
liquidity
Anorexia
loss of appetite
A patient with dementia cannot
make informed decisions
cancerous
malignant
MBO
management by objectives
Administrator must be licensed by the State & responsible for
management of the facility
Peritoneum
membrane that lines the abdominal cavity
A common misconception about the aging process is
memory loss to the brain decreasing in size
There must be a ___________ for communication to occur
message
MRSA
methicillin-resistant staphylococcus aureus
DON & Dept heads are considered _______ management
middle level
Daily staffing sheets have to be kept for
minimum of 18 months
Drug regimen review must be done on each resident at least ______________
monthly
The higher the contribution margin the
more profitable the company is
As depicted in the Maslow's Needs Pyramid when a need is satisfied it no longer
motivates & the next higher need takes its place
NORC
naturally occurring retirement community
Residents whose care is funded by Medicaid the facility must deposit resident's personal funds in less than $50 in an
non interest bearing account, interest bearing account, or petty cash fund
NIDDM
non-insulin dependent diabetes mellitus
In a MCR facility Funds less than $100 must be maintained in an:
non-interest bearing account, interest bearing account, or petty cash fund
Pressure ulcers are sometimes ___________ in certain disease states
non-preventable
Chopping boards must be
nonporous
A resident that enters the facility without an indwelling catheter is
not catharized unless the resident's condition demonstrates that catherization is necessary
Replacement therapy is used when
not getting enough from food source
Quarterly assessment must be completed
not less frequently than once every 3 months
NPO
nothing by mouth
Turnover rate in percent =
number of employees terminated x 100 divided by total FTE (full time equivalent) or number of positions the facility has divided by the # of employees who leave in a given period.
HPPD (hours per patient day)=
number of hours worked divided by number of patients
OT
occupational therapy
ung
ointment
MCD & private pay patients comprehensive assessment must be completed not less than
once every 12 months
For every debit entered, there is _____________ credit entries that equal the debit
one or more
A distinct part SNF or NF may be comprised of
one or more buildings or designated parts of the building
People centered environments focus on ___________ and not __________
output / pace
Productivity =
output/input
OTC
over the counter
OTC
over the counter drugs (Non-Rx drugs)
quadriplegia
paralysis of all four limbs
Hemiplegia
paralysis on one side
ppm
part per million
PROM
passive range of motion
Intangible assets include:
patents, trademarks, copyrights, franchises, goodwill, computer programs, and financial assets including accounts receivable, stocks, and bonds
The Federal Unemployment Tax Act or FUTA imposes a _____________ on employers, based on the wages they pay their employees
payroll tax
With sole proprietorship the owner is responsible for both ________ and ________ debts
personal and business
With sole proprietorship the financial activities of the business are kept separately from the proprietor's _______________ activities
personal financial
PPE
personal protective equipment
PTA
physical therapist assistant
Treat all substances containing blood as
potentially infectious
A resident can receive a second pneumococcal immunization, upon a
practitioners recommendation, five years after the first immunization and as long as that vaccine was administered before the age of 65
Rx
prescription
Inflation or deflation only means
price changing
Title 7
prohibits employment discrimination based on race, color, religion, sex, or national origin
A facility must __________ and ___________ the rights of each resident
protect and promote
Drug regimen review must include review of residents on
psychotropic drugs
P
pulse
PEARL
pupils equal and reactive to light
payback period =
purchase price/how much will new purchase reduce annual operating costs per year
Acid-test ratio=
quick assets divided by current liabilities
ROM
range of motion
MCD and private pay patients comprehensive assessments must be completed within 14 calendar days after admission, excluding
readmission in which there is NO significant change in resident's physical or mental condition
A signed employee handbook __________ should be retained as evidence that an employee has received & reviewed the handbook
receipt
RD
registered dietician (Dietary Consultant)
COBRA
regulations that give employees who lose their health benefits because of unemployment, the right to choose to continue group health benefits provided by their group health plan.
Under PPS, the facility should manage costs with the ______________ price
reimbursement
Emergency Dental Services. Facility must assist residents who are eligible & wish to participate to apply for
reimbursement of dental services as an incurred medical expense under the state plan
Injury of unknown origin is
reportable
the thing speaks for itself
res ipsa loquitur
RAI
resident assessment instrument (aka MDS)
A resident has the right to organize and participate in
resident groups in facility
If the generator goes out, the main focus is
residents on life support equipment
Nurses' station must be equipped to receive residents calls through a communication system from the
residents rooms, toilet, & bathing faiclities
R
respiration
Facility must use the services of an RN for at least 8 consecutive hours a day, 7 days a week. Unless, there is a waiver. If there is a waiver, it is subject to
review annually by the Secretary of the Department of Health & Humans services (DHHS)
od
right eye
Ownership equity is also known as
risk capital or liable capital
Facility must assist residents in obtaining __________ and ________ dental care
routine and 24-hour emergency
As long as a job meets the FLSA test professional, administrative, or executive it is a __________ exempt from overtime requirements of FLSA
salaried position
A physician may give a resident ____________ drugs
sample
The __________ send the message, which is decoded by the ____________
sender/receiver
Isolation rooms should not be
shared (not even with spouse)
During interviews, avoid what?
short-answer & open-ended questions Leading questions Writing during interview
SOB
shortness of breath
Each person who completes a portion of the assignment must
sign & certify the accuracy of that portion of the assessment
RN must ________ and ________ that the assessment is completed
sign and certify
For facilities constructed or reconstructed after November 28, 2016, each resident room must have a
sink & commode
Bradykinesia
slowness of movement
ST
speech therapy
Managers should always either _______________ or _____________ to ensure tasks have been completed effectively & efficiently
spot check or randomly audit
If a facility policy or procedure sets higher standard than the state or federal requirements, the facility will be held to that higher standard both at the
state & federal surveys & in courts of law
Comatose
state of unconsciousness
Nursing hours per resident day are determined by
state with federal approval
Paid feeding assistant must complete a ___________ and they must work under the supervision of a _____ or _________
state-approved training course RN or LVN
SWOT
strengths (Internal), weaknesses (Internal), opportunities (external), threats (external)
Nitroglycerin is administered
sublingually
Written order issued by the court to require the appearance of a person in the court
subpeona
OBRA requires facilities have ______________ nursing staff to provide nursing and related services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, as determined by resident assessment and individual plans of care
sufficient
tab
tablet
TO
telephone order
Residents are more likely to participate in activities if
the activities are personally satisfying
PRN order for psychotropic drugs are limited for 14 days and can not be renewed unless
the attending physician or prescribing practitioner evaluates the resident for the appropriateness of that medication
Resident's room must have a call light that must reach
the bed (the best system is one that has to be turned off by the resident's bed)
A resident has the right to perform services for the facility when
the facility has documented the need or desire for work in the plan of care, the plan must specify the nature of the services performed and whether services are voluntary or paid, Compensation for paid services is at or above the prevailing rates Resident agrees to the work arrangement described in the plan of care
Each resident must be offered an influenza immunization October 1 - March 31 Annually, unless
the immunization is medically contraindicated or the resident has already been immunized during the time period
Each resident must be offered a pneumococcal immunization, unless
the immunization is medically contraindicated or the resident has already been immunized.
A resident has a right to examine the results of
the most recent survey of the facility conducted by federal and state surveyors and any POC in effect with respect to the facility
Substitutions for the four foods required are allowed as long as
the substitutions are comparable nutrients
Supervisors will direct employees to complete certain tasks, however it is the delegator's responsibility to ensure
the task is completed
Facility must use the services of an RN for at least 8 consecutive hours a day, 7 days a week. Unless,
there is a waiver.
An organization uses financial resources to acquire both
things (material resources) & people (human resources)
A resident has the right to voice grievances without discrimination or reprisal. Such grievances include
those with respect to treatment which has been furnished as well as that which has not been furnished & prompt efforts by the facility to resolve grievances the resident may have, including those with respect tot he behavior of other residents
tid
three times a day
Effective managers can devote _________ and ___________ to all subordinates
time & attention
New remedies that need to be applied to certified nursing homes that fail
to meet minimum federal standards
Negligence is a __________ and is intentional
tort (a civil wrong)
PPD (Cost per patient day)=
total costs in month divided total patient days in month
Current ratio (Current ratio or working capital ratio)=
total current assets divided by total current liabilities
TFC
total fixed cost
FTE (full time equivalent)=
total number of hours worked or budgeted divided by 40 (40 hour work week for full time employee)
Average Daily Census (ADC) =
total patient days divided by days in the month
TQM
total quality management
TR
total revenue
TVC
total variable cost
Assault DOES NOT require ____________
touch
Direct costs are ____________ to the cost object and indirect costs are _____________ to the cost object
traced/allocated
TCU
transitional care unit
Administrators when confront with external changes that might affect the organization, will
try to ignore them
TB
tuberculosis
Sublingually
under the tongue
The facility should report any knowledge it has of actions by a court of law against an employee, which would indicate
unfitness for service as a nurse aide or other facility staff to the State nurse aide registry or licensing authority
Residents have the right to send and promptly receive mail that is
unopened
Facility must have reports with respect to any surveys, certification, and complaint investigations made respecting the facility during the 3 preceding years, and any POC in effect with respect to the facility, available for any individual to review
upon request
URI
upper respiratory infection
Levels of management
upper, middle, lower and line staff
UTI
urinary tract infection
VO
verbal order
vs
vital signs
qui tam relator
whistle-blower
WBC
white blood cell
s
without
Afebrile
without fever
Worker's compensation insurance only covers
work related injuries
A state program that provides healthcare to the medically indigent?
Title 19
Meals on wheels _____________ pays for home delivered meals
Title 3c of the older American Acts
Resident have the right to return to the ____________ after a hospital stay or an overnight visit with family and friends
Nursing home
As minimum standard, Long-Term Care Ombudsmen should view ________ as a baseline that should be built upon to reach not only resident "well-being" but also happiness and fulfillment.
OBRA
In its 1986 report the Quality of Care in Nursing homes, the expert panel recommended:
1. Stronger federal role in improving quality 2. Revisions in performance standards, the inspection process, and the remedies to improve nursing home services 3. Better training of nursing home staff 4. Improved assessment of resident's needs 5. A dynamic and evolutionary regulatory process
What set in motion forces that changed the way state inspectors approached all their visits to nursing homes?
OBRA
How many weeks of work are required for an employee to be eligible for unemployment benefits?
26 weeks
Because of OBRA antipsychotic drug use declined by __________ and physical restraint use was reduced by approximately ______________
28-36% 40%
With Medicare Part A skilled services, therapy must provide __________ days per week, g-tube, pressure ulcer treatment multiple stages 2, 3, or 4.
5
In Medicare Part B physicians are paid __________ of the approved charge
80%
Medicare limits inpatient respite care to stays to
<=5 consecutive days
The changes OBRA brought to nursing home care are enormous. Some of the most important resident provisions include: NF must notify the state mental health authority or state intellectual disability authority, as applicable, promptly after
A significant change in mental physical condition of a resident who has a mental disorder or intellectual disability for resident review
The Medicare & Medicaid legislation included those distinct advocacy roles and subsequent regulations and other guidance has given LTCOPs __________.
Additional tools to serve residents interests
The ___________ is the ONLY person held accountable for the entire financial operation of the facility or institution
Administrator
PACE (Program of All-Inclusive Care for the Elderly) is targeted at elders who are eligible for MCD and MCR funding to stay in nursing homes but prefer to
Age in the community. They can live in the community safely without 24 hour supervision
Telephones accessible to ______________ and privacy while using the phone, including TTY and TDD services
Bed-ridden patients
Continuity of care according to the need and cost of service rendered?
Case Mix Management
Uniform ________________ for Medicare & Medicaid homes
Certification Standards
CNAs must be __________ and ____________ in every state that they work
Certified & Registered
OBRA has changed the care of lives of nursing home residents across America. There have been significant improvements in the
Comprehensiveness of Care Planning
Amount of money Medicare recipients must pay for hospital service?
Deductible
The changes OBRA brought to nursing home care are enormous. Some of the most important resident provisions include: A resident assessment process leading to
Development of an individualized care plan
Observing _________ and ___________ administration are a focal point of every annual inspection
Dining & Medications
DME
Durable Medical Equipment
Prohibitions on turning to ______________ to pay for Medicare & Medicaid services
Family Members
Under OBRA, Long Term Care Ombudsmen Programs have defined roles to
Fulfill and tools to use in the annual inspection process to nurture the conversations between residents/families and inspectors and life in the nursing home
Given to persons believed to be at the end of their lives, with about 6 months or less to live.
Hospice Care
___________ from all disciplines assess residents needs.
IDT (Interdisciplinary Team)
IoM
Institute of Medicine
OBRA also recognized the unique and important role performed by the ___________ for nursing home residents
LTCOP (Long-Term Care Ombudsmen Program)
LTCOP
Long-Term Care Ombudsmen Program
The changes OBRA brought to nursing home care are enormous. Some of the most important resident provisions include: New expectations that each resident's ability to walk, bathe, and perform other activities of daily living will be
Maintained or improved absent medical reasons
Requires facility to provide an adequate dining area, large enough to accommodate comfortably the
Maximum # of people who usually occupy the space
___________ is the predominant payer source in NH
Medicaid (MCD)
A federal insurance program for the elderly (<=65 years of age) and some disabled (ESRD)
Medicare (MCR) Title 18
Hospice provider also bill __________ for services rendered
Medicare Part A
Which Medicare service plan is skilled services?
Medicare Part A
Pays for healthcare provided in home as well as Medicaid patients that have Medicare B
Medicare Part B
HMO/Managed Care
Medicare Part C
MDC medications for drugs (medication)
Medicare Part D
The Federal Nursing Home Reform or OBRA '87 creates a set of ________________ of care and rights for people living in certified nursing facilities
National Minimum Standards
Residents have the right to remain in the nursing home absent
Nonpayment Dangerous behaviors Significant change in resident's medical condition
A form of public assistance to the needy who were age 65 or older and lived in the community
Old Age Assistance (OAA)
Social Security Act of 1935. The purpose of this act was to provide a supplemental retirement income for working people and their dependents. It also provided
Old Age Assistance (OAA)
Administrator should get the ___________ involved when there is an involuntary discharged of residents
Ombudsman
Employers are taxed according to their:
Past records
The residents have the right to be free of unnecessary and inappropriate _____________ and ____________
Physical & Chemical Restraints
Residents have the right to choose a personal ___________ and to access medical records
Physician
Medicare part B pays for:
Physician Services Home Health Therapy Lab Enteral Feeding DME (Durable Medical Equipment) X-Ray
PACE
Program of All-Inclusive Care for the Elderly
MCD facilities are certified by the state and assigned a ____________ by the state
Provider Number
MCR facilities are certified by CMS and CMS assigns the ___________
Provider Number
A fundamental principle that applies to all treatment & care provided to facility residents
Quality of Care
According to OBRA '87 resident-care practices utilized by staff must reflect ____________ which promotes the highest practicable physical, mental, and psychosocial well-being of each resident utilizing sufficient to provide nursing & related services
Quality of Care
A fundamental principle that applies to all care and services provided to facility residents
Quality of Life
The changes OBRA brought to nursing home care are enormous. Some of the most important resident provisions include: Emphasis on a resident's
Quality of Life & Quality of Care
Congress asked the institute of medicine (IoM) to study how to better
Regulate the quality of care in the nation's Medicaid and Medicare certified nursing homes.
Provides relief to primary caregiver.
Respite Care
Residents have the right to choose their own ______________
Roommate
The purpose of this act was to provide a supplemental retirement income for working people and their dependents.
Social Security Act of 1935
Who gives finance assistance for disabled or elderly?
Social Security Administration
26 weeks of work are required for an employee to be eligible for unemployment benefits. ___________ employees should be terminated during the probationary period.
Substandard
What became a law with growing public concern with poor quality of care in too many nursing homes and the concerted advocacy of advocates, consumers, provider associations, and health professionals?
The Federal Nursing Home Reform Act
Congress, then and now, usually completes a huge measure of its budgetary and substantive work in one large bill. The bill accomplishing that function in 1987 was entitled
The Omnibus Budget Reconciliation Act of 1987 or OBRA '87
Employers that decrease its unemployment claims by employees will decrease its:
Unemployment tax cost
Minimum federal health and care requirements for nursing homes are to be delivered through
Variety of established protocols within nursing homes and regulatory agencies
Best practice is to have a case mix meeting _________ to review MCD RUGS or case mix index
Weekly
The first step in determining a resident's potential is
assessing the resident's needs
Inspectors no longer spend their time with staff and facility records, but with
conversations with residents and their families
IDT
interdisciplinary team
CNAs are not
licensed personnel
Residents have the right to organize and participate in a __________ or __________ council
resident or family
RUG
resource utilization group
Residents have the right to __________ or ____________ funds with the nursing home
safely maintain or bank personal
TDD
telecommunication device for the deaf
