Course: HCA-621-Nursing Home Administration Case Study

*Make an argument for expectation setting when working with outside consultants.

As a nursing facility administrator, you will be expected to make decisions about how your facility is operated. Since nursing facilities are one of the most regulated industries in the world you are making these decisions within the context of official codes, rules, and regulations issued by the federal and state governments. With the COVD pandemic administrators were dealing with 3 levels of government ,changing the rules on a daily/weekly/monthly basis, sometimes in conflict, making it almost impossible for administrators. To be an effective administrator, you must be able to differentiate between those decisions that can wait, how long they can wait and those that need to be made immediately. You generally want to make as many decisions as possible, as quickly as you feel comfortable making them, if you have the information you need. You will find that the ineffective administrator is the one who is afraid of mistakes or making" enemies" and their decision-making process takes too long and frustrates employees.

Since an administrator cannot personally perform all the management tasks in the nursing facility these tasks are assigned to upper, middle, and lower level managers throughout the organization. The administrator, as the upper level manager, delegates the appropriate decision making authority to middle and lower level managers in the facility. Written policies give the framework for the managers to make these decisions in the absence of the administrator. This assures that the nursing facility, which is a 24-hr. hour a day 365 days a week business, has the proper administrative structure and coverage.

The difference between line-staff relationships is a concept that needs to be understood within the realm of management functions. If the administrator empowers you to make decisions for the facility you have line authority, if you can only make recommendations and advise you are said to have staff authority.

Typical line managers include your departmental managers while your paid consultants perform a traditional staff role. Successful administrators not only understand the difference but utilizes the staff and line functions to bring the best possible care to the residents.

Thinking about all these management functions a nursing home administrator must oversee, use Case Study 1 - Reimbursement Consultant Contracted to Assist Nursing Facility below and answer the questions at the end in a 1 - 2 page paper.

Case Study 1 - Reimbursement Consultant Contracted to Assist Nursing Facility

The adminstrator at Field Nursing Facility has thought for some time of his clinical staff was not capturing the information required to maximize reimbursement for the facility. he decided to contract with a reimbursement consultant to increase the staff's knowledge of how to set up system to assure the facility was properly documenting the care it was providing. In this way the facility would be able to meet the medicare and medicaid regulatory requirements that would increase their revenue.

Ms. Flansburg, the reimbursement consultant, met with the administrator along with the Director of Nursing (DON), MDS coordinators, who reports to the DON, director of Finance and Director of Therapies. They met for a half hour and Ms. Flansburg was introduced to the staff. She was given direction to interview the administrative and supportive staff in order to find out how process of gathering reimbursement informations was currently being performed.She would then report her findings and recommendations to the administrator at the end of the day and the team at 9:00 am the next morning.

Ms. Flansburg met with the administrator at the end of the day and stated she had discovered many flaws in the information gathering and documentation. she reported to the administrator that she directed staff to change what they were doing in some instances, directing staff to perform their function outside the facilities existing policies. She stated she this to immediately increase the reimbursement to the facility and ratify any medicare or medicaid auditor that may review the records in the future. The administrator thanked her intervening and said he looked forward to the 9:00am meeting the following day with the administrative staff.

The next day at 8:00am the administrator's phone rings and he is being asked by his administrative staff to meet with them immediately. The administrative staff is angry and holding him responsible for what Ms. Flansburg was allowed to do the previous day.

1. Does the administrative staff have a right to be angry?

2. What did the administrative do wrong?