Future Age - July/August 2010 - (Page 32)
Top Ten Elements of a Well-Run Nursing Home
by John Capasso
ursing homes have been part of the American health care system since the early twentieth century. Many originated as congregate homes or homes for widows of deceased ministers. Today there are approximately 16,000 skilled nursing facilities providing services to seniors. Legislative, reimbursement, clinical, labor and competitive issues combine to make the job of a nursing home adminis-
trator one of the most challenging and stressful occupations imaginable. There are full-time consultants and entire books and lengthy seminars and conferences devoted to this topic. Is there a quick way to “take the temperature” of your nursing home? Based on my experience … I have identified 10 critical elements that are found in virtually all well-run nursing homes. Listed below (not in priority order) are the “top ten” most important elements.
Establish Distinct Service Lines
Skilled nursing facilities should follow the lead of acute care hospitals by establishing distinct service lines. The services most frequently provided in nursing homes are short-stay rehabilitation, memory support for seniors with Alzheimer’s disease or significant cognitive impairment, and chronic care. The geographic demarcation of these services within the facility, as well as the ability to devote specific staff to these service lines, is important to optimize quality and resident satisfaction. Staff members who are engaged with familiar residents on a daily basis are best positioned to provide ideal care. Subtle changes in resident status can be observed by staff members within this model. Promoting and advertising these services to the community is much more effective when the services in the building are geographically distinct. Hospital discharge planners, physicians and their office staff, community ministers and others who frequent the home will much more readily advocate for the services that a home can provide if they understand the distinction of services.
Optimize Resource Utilization Groups
ties of daily living and therapy services. Often, homes do not receive the reimbursement they are due because of inadequate documentation of services provided and the failure to provide the services that residents require. Staff member education is always the first step to optimize this process, followed by weekly Medicare meetings, during which everyone involved with resident care is included to discuss resident status, changes in condition and expectation for discharge. On Oct. 1, 2010, MDS 3.0 will replace MDS 2.0. This change will modify reimbursement within most resource utilization group categories. Changes in the look-back period, concurrent therapy and extensive service categories will all be impacted by MDS 3.0. All caregivers and administrative staff should be educated about the change in this process.
Hire a Strong Admissions Coordinator
Accurate resident documentation and completion of the minimum data set (MDS) is critical to correct reimbursement for residents eligible for Medicare and Medicaid reimbursement. The two key elements within this process are documentation and accurate recording of activifutureAge | July/August 2010
The admissions coordinator is the individual in your organization who has the greatest ability to impact admissions. Ideally, a successful admissions coordinator has sales experience, is personable and has the ability to cultivate strong professional relationships. Hospital discharge planners are a key group with whom the admissions coordinator should develop strong relationships. A goal of making the discharge planners’ life easy by notifying them within 30 minutes if the home will admit the resident is one important tactic. A strong relationship with key referring physicians is another important relationship which can significantly increase census.
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