Long-Term Care Facilities II

Long-Term Care Facilities II

Long-term care facilities (LTC) are established and designed to provide services to people who need assistance in daily living. These facilities can provide medical and personal care services. The care services can be offered for a short or an extended period. Long-term care services have proved to be expensive in the long term. However, with the need to reduce long-term care expenditure, long-term care is fast adopting managed care plans. Reimbursement options for care services include personal funds, government programs, and private insurance financing. As the need for LTC services is fast growing, organizations are designing person- and patient-centred care programs to satisfy the LTC service consumers and achieve better health outcomes. This paper reviews two LTC facilities, one in the assisted living category and the other in the adult day care category. It will seek to establish the various departments in the facilities and their responsibilities, resources and programs for quality improvement, quality and cost control measures, the role of managed care, changes in control mechanisms about reimbursement and quality of care, and trends in managed care.

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Roles and Responsibilities of Departments in Brookdale Senior Living, Inc

Human Resource Department

The HR department is responsible for recruitment and the management of employees. The HR department selects the best-qualified staff, such as skilled nurses, physicians, Brookdale Senior Living community managers, and other support staff. It also provides training opportunities for the staff to enable Brookdale Senior Living to provide quality and competitive long-term care services continuously.

IT Department

The department offers technical support to all other departments and employees, especially the Brookdale Senior Living administration. It maintains all technologies, including the Brookdale Senior Living website, computer systems, and other communications systems.

Sales and Marketing Departments

Although two separate departments, both play a role in promoting and marinating the value of the Brookdale Senior Living brand. They are responsible for all resident and customer satisfaction.

Finance Department

The department manages Brookdale Senior Living, Inc. Cash flows, bills, wages, and salaries. It also manages facility budgets and carries out financial forecasting for the benefit of Brookdale Senior Living’s shareholders and investors.

Sources of Financing for Programs and Services offered by Brookdale Senior Living

Brookdale Senior Living Inc. charges the services and programs based on the provisions of the services and programs. The residents can finance the programs and services they are subscribed to through:

• Medicaid and Medicare financing
• Out-of-pocket financing
• Private insurance

Critical Public and Private Sources of Reimbursement for Brookdale Senior Living Services and Programs

The critical public and private sources of reimbursement for services and programs offered by Brookdale Senior Living are:

• Partial or complete Medicare/Medicaid payments
• Insurance and co-pay payments
• Resident payments for extra services that they need besides the regular service or program offers
• In some instances, balance billing

Government and Private Resources Available That Assist In Developing And Maintaining Quality Improvement Programs in Brookdale Senior Living

Brookdale Senior Living focuses on maintaining and improving the quality of the programs and services it offers in the long-term care market. The maintenance and improvement of the quality of such programs and services are assisted by government and private resources from:

• The American Healthcare Association (AHCA) and the National Center for Assisted Living (NCAL) Quality Initiatives for providing quality care,
• The Health Insurance Portability and Accountability Act of 1996 (HIPAA),
• State regulatory standards,
• Public and private review boards and websites,
• Brookdale Senior Living’s in-house quality improvement research centres.

Quality and Cost Control in Brookdale Senior Living

Brookdale Senior Living is primarily involved in research and activities that help improve the quality of the services offered across all its facilities. The organization regularly responds to criticism and reviews on various websites to understand what consumers and other stakeholders feel about their products. On cost control, Brookdale Senior Living has focused on hiring qualified and skilled staff to provide services that meet the set quality parameters and are timely and eliminate any time wastage. Also, the organization applies similar operations standards across all of its facilities to improve the efficiency of operations and reduce costs.

Ethical Aspects of Access To Care in Brookdale Senior Living

Brookdale Senior Living believes in access to quality care for all residents. However, the facility has different charges for varying services that a senior can access. The quality of care and the extent of services accessible to old residents is based on how much they can afford. The facilities also engage in strategies that aim to reduce overall operations costs to reduce the residency and care costs, which does not result in rationing of care as no residents and patients are denied any form of care that has potential benefits to their health.

Changes Brought in Brookdale Senior Living’s Long-Term Care System to Reach Full Status as a Competition-Driven System

Brookdale Senior Living has focused much on the personalization of care and digitalization of the diagnostics process. The organization has developed specific health profiles for individual patients and residents. Brookdale Senior Living has customized care to meet the needs of each resident. Again, some versatile services and programs meet the needs of every resident. The organization has also adjusted its pricing structures to match the seniors’ specific needs.

Trinity Adult Day Care Center

Roles and Responsibilities of Departments in Trinity Adult Day Care Center

Trinity Adult Day Care is not a large long-term care facility compared to Brookdale Senior Living and other facilities that offer adult care services. However, the facility has similar departments, just like any other organization. The Trinity Adult Day Care Center’s departments and department roles and responsibilities include:

The Human Resources department

The HR department at Trinity Adult Day Care Centre has a significant role in ensuring the facility is adequately staffed. The department ensures that the staff, such as skilled nurses, meet the required technical qualifications. The HR department also prepares payrolls for all employees and ensures they are satisfied as they deliver care services.

Nursing Services Department

The department is responsible for planning, organizing, developing, and directing nursing operations in adult daycare and home care programs. The department ensures that all nursing care activities meet the highest quality of care and satisfy the needs of the program members.

Social Services Department

This department is responsible for ensuring that the services offered by Trinity Adult Day Care Center meet the members’ needs. The department also provides a good relationship between the daycare members and their families. It also manages the dietary department to ensure that the facility’s nutritional services meet the daily needs of the participants.

Accounting and Finance Department

The department manages all of the facility’s cash flows and budgets to ensure the continuity of smooth operations of Trinity Adult Day Care Center.

Housekeeping Department

The housekeeping department is responsible for maintaining the facility’s cleanliness at levels that meet the current standards and regulations. The department ensures that the facility maintains a clean, safe, and comfortable environment.

Sources of Financing and Reimbursement for Programs and Services offered by Trinity Adult Day Care Center

All participants in the Trinity Adult Day Care Center’s programs must pay a standardized enrollment with the exclusion of patients under medical assistance. Besides the enrollment fees, the participants also pay for the comprehensive care package that seeks to make the best of older people’s day. The total service fees paid are determined by the type and level of care a participant receives, among other factors. The financing for the services can be obtained from:

• Medicaid
• Long-Term Care Insurance
• Veteran’s Administration
• State and county programs and grants
• Out-of-pocket payments.

Government and Private Resources Available That Help Develop and Maintain Quality Improvement Programs in Trinity Adult Day Care Center

The Trinity Adult Day Care Center follows customer ratings and web reviews to shape its services. The facility has also partnered with Medicare star-rated facilities to improve the quality of its services further further.

Quality and Cost Control in Trinity Adult Day Care Center

Trinity Adult Day Care Center controls and manages the quality of its services and the costs of operations low by coordinating the services and programs offered. The benefits are also delivered by skilled nurses such as Registered Nurses (RNs), Licensed Vocational Nurses (LVNs), Certified Nursing Assistants (CNAs), Physical Therapists (PTs), Nursing Home Dieticians, and trained therapists. Skilled service providers can efficiently provide quality care at minimum costs.

Ethical Aspects of Access to Care in Trinity Adult Day Care Center

The Trinity Adult Day Care Center is based on the belief that individuals with cognitive, physical, psychological, or social issues need to be provided with quality care. The facility assesses each member individually to determine the type of care they require. Although all care services should be equitably accessible, Trinity Adult Day Care Center classifies health care needs and charges based on condition. This may cut out some members who need a specific type of care but cannot afford it. The facility has enough staff to provide care services as required; therefore, it does not engage in care services rationing.

Changes in the Trinity Adult Day Care Center’s Long-Term Care System to make it Reach Full Status as a Competition-Driven System

The current long-term care market is growing competitive as the number of seniors keeps growing, and the number of age-related diseases pushes a majority of the elderly under supervised care. Competition has forced organizations within the market to innovate their services, service delivery, and the programs offered. Trinity Adult Day Care Centre predominantly offers daycare services. However, with growing demand and competition, the facility now provides daycare and at-home services. The facility has improved its approach toward patient-centred care by personalizing the care services per individual participants’ needs. The Trinity Adult Day Care has a courtesy transportation van that picks up members from home to the centre and from the centre to their homes. The facility has incorporated new approaches to therapy, such as a visual arts program, music and memory therapy, and restorative nursing, giving it a competitive advantage over its competitors.

Role of Managed Care and Its Impact on Long-Term Care Reimbursement

Managed care aims to provide health insurance to populations to enable them to access quality health services at reduced costs (Perez, 2018). Managed care plans allow insurance companies to select providers for patients that can provide care services based on need. Participants in managed care have the necessary medical care access. Managed care improves health quality by emphasising disease prevention rather than the treatment of disease (Heaton & Tadi, 2020). As managed care enables the provision of services at a reduced cost, it has made it possible for long-term care patients to reimburse providers upon the reception of services, even in emergencies. Managed care also allows patients in long-term care to have options in making payments for health products and services.

Changes Made in the External and Internal Control Mechanisms to Control the Management, Financing, and Quality in the Long-Term Care Systems

The long-term care systems have rapidly moved from a fee-for-service environment to managed care. This has pushed changes in the external and internal mechanisms of control that define the nature of management and quality of long-term care systems. The most notable disruptive change in long-term care systems, mainly as observed in Brookdale Senior Living, is the movement of nurses from service to leadership positions. In the era of managed care, nurses are joining leadership ranks to present patients’ needs to health managers and policymakers to improve the financing and quality of care provided. Nurses in clinical leadership positions have been linked to changes in healthcare management and improved quality of care (Boamah, 2018).

Trends in Long-Term Care Reimbursement System in Order to Provide Better Reimbursement Options for Consumers and Providers

The US population is predominantly aging, and the demand for long-term care services is increasing (Lupu et al., 2019). This has an impact on the economy and medical expenditure. However, it comes in when healthcare financing is pushed towards reducing health expenditures. Various reimbursement trends are emerging in long-term care systems to accommodate the growing demand for long-term care needs and help reduce care costs. Some of the notable trends include:

• The Emergency of Accountable Care Organizations (ACOs),
• Prospective payments for future care,
• Medicare Advantage plans
• Adoption of new technologies and web-based tools to promote long-term health

References

Boamah, S. (2018). Linking nurses’ clinical leadership to patient care quality: The role of transformational leadership and workplace empowerment. Canadian journal of nursing research, 50(1), 9-19.

Heaton, J., & Tadi, P. (2020). Managed care organization.

Lupu, D., Quigley, L., Mehfoud, N., & Salsberg, E. S. (2018). Will the supply keep up with the growing demand for hospice and palliative medicine physicians? Journal of Pain and Symptom Management, 55(4), 1216-1223.

Perez, V. (2018). Effect of privatized managed care on public insurance spending and generosity: Evidence from Medicaid. Health Economics, 27(3), 557-575.

 

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Working on the same two facilities that you identified in W3 Assignment 2, prepare a Microsoft Word document including the following:

Describe the roles and responsibilities of the administration in each department of your chosen facility.
Identify and list the sources of financing available to consumers for the various programs provided by your chosen facilities. Identify the critical public and private sources of reimbursement available. Also, discuss the role played by managed care and its impact on long-term care reimbursement.
Describe the various government and private resources that assist in developing and maintaining quality improvement programs in your chosen facilities. Describe how quality and cost are controlled in your preferred facilities. Also, discuss the ethical aspect of access to care in the facilities, including rationing.
Based on your observations and learning from the two facilities, discuss the changes in the long-term care system to make it reach full status as a competition-driven system. You may include the following points in your discussion:
Discuss the changes made in the control mechanisms (external and internal) to control the management, financing, and quality of the long-term care systems.
Discuss the changes in the long-term care reimbursement system to provide better reimbursement options to consumers and providers.
Discuss the changes made in providers’ efforts to accommodate the changing magnitude of the day-to-day needs of long-term care consumers.
Use your course and textbook readings and the South University Online Library to support your work. As in all assignments, cite your sources in your career and provide references for the citations in APA format.