Assisted Living Administration and Management: Effective Practices and Model Programs in Elder Care

479 Pages·2010·2.67 MB·English

by  Darlene Yee-Melichar EdD

ASSISTED LIVING
ADMINISTRATION
AND MANAGEMENT
Effective Practices
and Model Programs
in Elder Care
Darlene Yee-Melichar, EdD, CHES, is Professor and Coordinator of Gerontology
at San Francisco State University (SF State). She received her BA in Biology from
Barnard College, MS in Gerontology from the College of New Rochelle, and MS and
EdD in Health Education from Columbia University. Dr. Yee-Melichar’s research
interests in healthy aging, long-term care administration, and minority women’s
health are reflected in 3 books; 90 journal articles, book chapters, book reviews, and
technical reports; and numerous community and professional presentations. She
is Vice President of the Board of Directors for the California Advocates for Nursing
Home Reform; President of SF State’s Chapter of Sigma Xi, the national research
society; and Past Chair of the DHHS-OWH Minority Women’s Health Panel of
Experts. Dr. Yee-Melichar is a Fellow of the Gerontological Society of America,
Association for Gerontology in Higher Education (AGHE), and AAHPERD’s
Research Consortium. She received the 1995 Distinguished Educator Award from
the California Chapter of the American College of Health Care Administrators; 1998
Distinguished Service Award from the American Association of Homes and Services
for the Aging; 2001 Distinguished Alumna Award from Teachers College, Columbia
University; 2007 SF State Distinguished Faculty Award for Excellence in Service; and
2007 AGHE Distinguished Teaching Award.
Andrea Renwanz Boyle, DNSc, RN, BC, is a graduate of the University of California,
San Francisco, where she received her DNSc in Nursing Science. Dr. Boyle received
her MS in Nursing from Boston University and Nurse Practitioner certification from
Peter Bent Brigham Hospital. Currently, Dr. Boyle is an Associate Professor and
Director of the Family Nurse Practitioner Program at San Francisco State University
(SF State). Dr. Boyle is the co-editor of the textbook Aging in Contemporary Society:
Translating Research into Practice, has published on health-related issues in aging, and
conducts research on evidence-based practice for nurses and problem-based learning
strategies for undergraduate and graduate students. Additionally, Dr. Boyle has been
certified as a Residential Care Facility for the Elderly (RCFE) administrator; and
currently serves as a manuscript reviewer for a gerontology nursing journal. Dr. Boyle
received the 2009 SF State Distinguished Faculty Award for Excellence in Service.
Cristina Flores, PhD, RN, is the Director of Health Services Research at the Institute
on Aging in San Francisco; an Assistant Adjunct Professor in the Department of
Social and Behavioral Sciences at the University of California, San Francisco; and a
Lecturer in the Gerontology Program at San Francisco State University (SF State).
She received her BS in Nursing from the California State University, Dominguez
Hills; MA in Gerontology with an academic emphasis in Long-Term Care
Administration from SF State, and PhD in Nursing Health Policy from University
of California, San Francisco. Dr. Flores is a registered nurse specializing in elder
care for 21 years, and an assisted living owner/operator for 14 years. She has
completed several studies relative to long-term care for the elderly. Dr. Flores’
current research projects include Developing a Consumer Information Website for
Residential Care for the Elderly (California Health Care Foundation), A Community
Approach to Improve Palliative Care Access (Sutter Health Institute for Research
and Education), and Linking Affordable Senior Housing and Services (Institute on
Aging). Her published work includes several journal articles and two book chapters
on assisted living and quality of care.
ASSISTED LIVING
ADMINISTRATION
AND MANAGEMENT
Effective Practices
and Model Programs
in Elder Care
Darlene Yee-Melichar, EdD, CHES
Andrea Renwanz Boyle, DNSc, RN, BC
Cristina Flores, PhD, RN
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Library of Congress Cataloging-in-Publication Data
Yee-Melichar, Darlene.
Assisted living administration and management : effective practices and model programs in elder care /
Darlene Yee-Melichar, Andrea Renwanz Boyle, Cristina Flores.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-0-8261-0466-3
1. Congregate housing–Management. I. Boyle, Andrea Renwanz. II. Flores, Cristina, Ph. D. III. Title.
[DNLM: 1. Assisted Living Facilities–organization & administration. 2. Aged. 3. Homes for the Aged.
4. Nursing Homes. WT 27.1]
HV1454.Y44 2010
362.61068–dc22
2010028606
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Printed in the United States of America by Hamilton Printing
In dedication to students and practitioners in health and
human services who are committed to enhancing the quality of care
and quality of life of older adults residing in assisted living facilities
and other long-term care communities.
With love and gratitude to our families and friends for their
continuing patience and moral support.
Darlene Yee-Melichar, EdD, CHES
Andrea Renwanz Boyle, DNSc, RN, BC
Cristina Flores, PhD, RN

Contents
Contributors xiii
Foreword by Robert Newcomer xv
Preface xix
Acknowledgments xxiii
List of Figures xxv
List of Tables xxvii
Part I: OrganIzatIOnal ManageMent
1. the assisted living Industry:
Context, History, and Overview 1
Learning Objectives 1
Introduction 1
Historical Evolution of Assisted Living 7
Defining Assisted Living 8
Resident Characteristics 14
Challenges in the Assisted Living Field 16
Conclusions 18
2. Policy, licensing, and regulations 21
Learning Objectives 21
Introduction 21
State Policy and Regulation 23
Federal Statutes That Impact Assisted Living 44
Conclusions 50
3. Organizational Overview (With Sarah Dillon, Ma) 53
Learning Objectives 53
Introduction 53
Service Models 55
Organizational Patterns by Size and Model 58
Business Models 59
Specific Affiliations 63
Future Landscape 66
Conclusions 67
vii
viii Contents
Part II: HuMan reSOurCeS ManageMent
4. recruiting and Hiring Staff 69
Learning Objectives 69
Introduction 69
Factors Influencing Workforce Recruitment 71
The Recruitment Process 72
Conclusions 90
5. t raining Staff (With Sandi Flores, rn, aDn,
and Clara allen, Ma) 93
Learning Objectives 93
Introduction 93
Orientation for Assisted Living Employees 95
Direct Care Staff 95
Facilitating Staff Training Through Learning Circles:
A Model for Training 108
Conclusions 111
6. retaining employees and empowerment 113
Learning Objectives 113
Introduction 113
Staff Turnover 114
Retention Strategies 117
Conclusions 131
7. Continuing education (With Sandi Flores, rn, aDn) 133
Learning Objectives 133
Introduction 133
Continuing Education 133
Regulatory Requirements 137
Model Continuing Education Programs 141
Conclusions 149
Part III: BuSIneSS anD FInanCIal ManageMent
8. B usiness, Management, and Marketing
(With Joseph F. Melichar, PhD) 151
Learning Objectives 151
Introduction 151
Management Theories 152
Contents ix
Management Method and Style 158
Management and Organizational Structure 161
The Business Plan 170
Operational Plan and Planning System 178
Information and Technology Support Services 182
Marketing Approaches 185
Conclusions 188
9. Financial Management in assisted living Facilities
(With raymond Yee, MBa, MPH) 193
Learning Objectives 193
Introduction 194
Accounting Systems 194
Organization 199
Department Titles and Staff 206
Use of Accounting and Financial Software 210
Financial Reporting 213
Accounting Procedures 223
Account Records 226
Budget Preparation and Execution 228
Financial Ratio Analysis 231
Risk Management 235
Most Common Accounting Terms and Definitions 240
Conclusions 241
10. legal Concepts and Issues in assisted
living Facilities (With anthony Chicotel, JD, MPP) 243
Learning Objectives 243
Introduction 243
Tort Law 244
Contracts 256
Evictions 266
Estate Planning 270
Advance Planning 273
Surrogate Decision-Making 277
Conclusions 280
Part IV: enVIrOnMental ManageMent
11. accessibility, Fire Safety, and Disaster Preparedness 283
Learning Objectives 283