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Standards of Practice

Preamble

The profession of long-term care administration is committed to providing comprehensive health, personal, and social services for persons who require various therapeutic, protective, and supervised environments and milieus. As leaders of the profession, members of the American College of Health Care Administrators adhere to a professional Code of Ethics and are dedicated to advancing the general welfare through education, research and professional achievement. The Board of Governors of the College attests to this commitment by adopting, publishing, disseminating, and applying the following Standards of Practice. These Standards of Practice are a statement of conditions and performances which are essential for quality long-term administration and care. As an overriding principle, the long-term care administrator is expected to exercise ethical and sound judgment and decision making, assume leadership in her/his facility and community, and exemplify an administrative philosophy in congruence with the mission and goals of the organization.

I. Organizational Management and General Administration
  1. Develops long and short range objectives in order to assure that resident care is maintained and improved through facility programs, policies and procedures.
  2. Interprets the philosophy and goals of the facility in order to provide staff with adequate information to select appropriate objectives to attain the goals.
  3. Sets an example of good resident relations and care for staff by demonstrating desired supervisory techniques, communication and resident and family interaction.
  4. Delegates responsibility and authority to appropriate staff in order to carry out the work of the facility.
  5. Evaluates the quality of resident care, resident rights and the efficiency of services in order to maintain care standards by reviewing the achievement or non-achievement of the facility's goals, objectives, resident care plans, and effectiveness of management policy and procedures.
  6. Coordinates departmental activities to assure departments work together toward the achievement of goals and activities by developing an information and communication system between departments which keeps them informed and ensures the administrator will be informed of their activities.
  7. Communicates with staff to solve problems through the selection of the appropriate communication techniques: staff meetings, department head meetings, counseling, and coordination of written information.
  8. Prepares or assures the preparation of an annual budget of the facility in order to appropriately allocate resources to meet the facility's financial and program objectives and to prepare in advance potential cost control and managerial actions which may be required.
  9. Researches, analyzes and, when fiscally appropriate, installs and maintains advanced automation equipment (including computer hardware and software) that enhances facility operations, managements decisions, staff capabilities, and resident care.
  10. Ensures that the facility complies with federal, state, and local laws and regulations to meet standards of quality resident care.
  11. Maintains a safe and productive working environment for staff in order to provide quality care through the use of continuos quality improvement, allocation of resources for facility maintenance and construction, and periodic evaluations of staff morale and productivity.
  12. Improves information and personal administrative skills through professional development activities in order to direct effectively and efficiently the operations of the facility to assure clinically competent, quality care.
  13. Plans, implements, and evaluates a public relations program to enhance the positive image of long-term care services.
  14. Establishes and maintains community relationships which enhance the image and services of the facility in the community by providing outreach services and information to the community.
  15. Establishes and maintains programs which enhance relationships among residents, their families, and the facility.
  16. Plans, implements and evaluates a marketing program to advertise and provide the services of the facility.
  17. Seeks to maintain clinical preparation of the facility at an optimum level in order to assure adequate financial resources by applying marketing and outreach techniques, knowing financial requirements of the facility, and delivering quality resident care at a reasonable cost.

Requisite knowledge and skill areas include:

  • Communications
  • Goal setting and implementation
  • Health care system
  • Long-term health care directions and state of the art practice
  • Professional administrator ethics
  • Management science and practice
  • Needs assessment (facility, organizational, and personal)
  • Risk management principles
  • Public relations and marketing of long-term care services and programs.
  • Planning, implementation, evaluation strategies, and methodologies
  • Problem solving/decision making
  • Resource allocation/management
  • Community organizations (civic, religious, social, etc.) and importance of participation in community organizations
  • Effective public speaking
  • Forecasting techniques for demand for care
  • Media relations and public relations principles
  • Medical/health care providers in community
  • Information dissemination techniques for community awareness of services of the facility
  • Outreach services, their cost and impact on referrals and community opinion

With expertise in:

  • Resident care
  • Personnel management
  • Financial management
  • Environmental management
  • Regulatory management

II. Resident Care

  1. Ensures quality resident care through planning, implementation, and evaluation of nursing services to maintain maximum health potential: social services to meet psychological and social needs and rights; dietary services to meet nutritional requirements and needs; medical services to ensure appropriate medical care; activities to meet the social recreational and therapeutic recreational needs; clinical records program to ensure continuity of care, pharmaceutical program to support appropriate medical care; and rehabilitation services that will maintain and/or maximize potential of residents; auxiliary services to enhance quality of life for residents; environmental services to provide a pleasing environment; and satisfaction index surveys to evaluate quality of care and quality of life.
  2. Recruits, hires, and provides ongoing education for a health care team in order to assure quality care of the long-term care resident.
  3. Obtains and coordinates consultant services as needed for total care (dental, speech and hearing, pharmacist, OT, PT, mental health, etc.) by assessing the needs of residents and arranging services of consultants.
  4. Coordinates the development and evaluation, with the health care team, of resident care goals and policies in order to assure that adequate resources, environments, and services are provided to the residents.
  5. Meets regularly with the health care team to assure highest practicable care is being delivered.
  6. Recruits a qualified medical director and develops a professional relationship with the medical director that ensures a well planned and implemented medical care program.
  7. Ensures that staff make appropriate discharge decisions, that services are in place to assure the discharged resident's success at home and that the facility does not incur liability in the discharge or transfer to another level of care.
  8. In cooperation with the medical director, maintains strong relationships with community medical practitioners including attending physicians and physician extenders.
  9. Promotes communication between facility staff and the residents in order to assure a caring environment with appropriate nursing and psychosocial services.
  10. Develops facility standards for resident care by identifying those factors which affect care, as well as variables within each factor which can be adjusted and evaluated.
  11. Develops program to assure staff adherence to Residents' Bill of Rights.

Requisite knowledge and skill areas include:

  • Communication methods for dissemination and implementation of resident care policies
  • Other services within the continuum of care available to residents/patients
  • Discharge planning, discharge resources and associated liability issues
  • Current literature, research and regulations on the establishment of care standards and relevant factors (i.e. nursing, medical care, etc.)
  • Family counseling/consultation
  • Interpersonal relations
  • Legal rights of residents including privacy, right to information, informed consent, self determination and Advance Directives
  • Medical and psychosocial needs of the elderly and chronically ill
  • Medical care, social services, activities, food services, clinical records, pharmacology, and rehabilitation
  • Resident care plans and goals
  • Computer management information systems for resident records and care
  • Psychology and physiology of aging
  • Quality improvement
  • Responsibility of health care team in developing resident care plans, goals and policies
  • Roles and standards of clinicians
  • Social, emotional, physical, and financial needs of residents and their families
  • Staffing patterns necessary for quality care

III. Personnel Management

  1. Coordinates the development of and disseminates written personnel policies and procedures including job descriptions, employee expectations, employer benefits, and performance appraisal processes.
  2. Establishes safety rules and procedures that incorporate federal regulations and OSHA requirements to ensure employee health and safety.
  3. Assures adherence to established personnel policies and procedures.
  4. Promotes productivity and good morale among personnel to assure quality life and care for residents by providing motivation, a good working environment, and recognition for quality work.
  5. Creates a positive atmosphere for communication between management and employees through receptive management and the use of various media.
  6. Establishes clear lines of authority and responsibility within the staff in order to assure understanding and production of quality work and the methods for its accomplishment.
  7. Recruits and hires qualified supervisors to meet the requirements of their position by identifying a number of qualified individuals, screening applicants, interviewing and hiring the person who most closely meets the requirements.
  8. Coordinates the development and implementation of personnel policies and procedures based on the goals of the organization in order to assure fair and efficient procedures are followed in recruitment, hiring, employment, and termination of staff.
  9. Establishes wage and salary scales which attract competent staff while controlling costs within budget.
  10. Plans, implements and evaluates an orientation program to facilitate adjustment of employees to the organization and the job through appropriate educational methodology.
  11. Plans, implements, and evaluates a program which will provide an opportunity for the personal growth and development of employees through a performance evaluation process.

Requisite knowledge and skill areas include:

  • Development of personnel policies, regulations, and laws including grievance procedures: job descriptions; labor, tax, minimum wage, EEOC, NLRB, and ADA rules and regulations, workmen's compensation and other fringe benefit requirements and wage and benefit scales for staff and the current market value of labor in various job description categories
  • Employee recruitment, assessment, motivations, and recognition methodologies
  • Information, communication and counseling channels within the facility
  • In-service/training needs assessment, program planning, costs, implementation, and evaluation
  • Analysis of absenteeism and turnover rate
  • Union organizing, negotiations, and contracts
  • Organizational theory, lines of authority and responsibility; job description development and maintenance
  • Recruitment and interview techniques, job description development, hiring practices, and wage scales for different supervisory positions.
  • Staffing methodologies and patterns including job analysis techniques.
  • Written and oral communication skills for effective employee relationships

IV. Financial Management

  1. Plans, implements, and evaluates an integrated financial program to meet the facility's goals.
  2. Coordinates the development of a budget which assures allocation of fiscal resources to meet regulatory requirements and provides quality services at a reasonable cost.
  3. Evaluates the implication of budget on the quality of care.
  4. Uses generally accepted accounting practices in accordance with sound financial management.
  5. Establishes financial controls, checks and balances to operate within budget.
  6. Projects and monitors cash flow, investments, and capital expenditures to ensure financial stability.
  7. Projects income and identifies revenue sources in order to meet the financial goals of the facility.
  8. Implements the financial goals of the governing body into management plans and budgets to achieve these goals by selecting appropriate objectives such as facility size, growth, structure, care and service, staffing, etc., to meet these goals.
  9. Plans future programs and estimates costs to reach decisions on growth, expansion, building, staffing, and investment by identifying objectives and costs of future programs.
  10. Projects insurance needs of facility and secures appropriate coverage.
  11. Coordinates financial reporting and audit systems.
  12. Analyzes current financial performance to ensure conformance with long term goals and standards of quality.

Requisite knowledge and skill areas include:

  • Ancillary and other revenue producing sources
  • Capital budgeting
  • Computer management information systems for financial management
  • Cost components for service programs, renovation/expansion of facility, and new construction
  • Financial analysis (i.e. resources, revenues, financial ratios)
  • Generally accepted accounting practices (i.e. budgeting, cash flow, inventory, banking, auditing procedures, fixed costs, variable costs, investments, collection, billing, purchasing, etc.)
  • Industry standards and trends
  • Interpreting financial results for Board and/or appropriate staff
  • Insurance needs of facility
  • Loan acquisition
  • Materials management, including inventory and purchasing
  • Resident financial evaluation, banking procedures, and account management
  • Payroll procedures
  • Regulatory requirements for budgeting
  • Reimbursement regulations
  • Tax laws and reporting
  • Techniques for determining reasonable costs/pricing
  • CPA audit reports

V. Environmental Management

  1. Plans, implements, and evaluates maintenance of building grounds and equipment.
  2. Plans, implements, and evaluates a program of environmental services which provides a clean and attractive home for residents, staff and visitors.
  3. Plans, implements and evaluates a safety plan which ensures the health, welfare, and safety of residents, staff and visitors.
  4. Plans, implements, and evaluates employee health, safety, and educational programs which minimize the facility's exposure to liability.
  5. Develops, implements, and evaluates fire, emergency and disaster plans to protect the safety and welfare of residents, staff and property.

Requisite knowledge and skill areas include:

  • Architectural and environmental design to accommodate the elderly and the handicapped
  • Building code rules and regulations
  • Community emergency resources
  • Effective training for emergencies
  • Evaluation procedures for housekeeping and physical plant
  • Sanitation and infection control
  • Materials management
  • Preventive maintenance
  • Procedures for designating responsibility in emergency planning
  • Pest control
  • Safety, fire and disaster guidelines of the National Fire Protection Association and in Life Safety Codes as well as local ordinances
  • Security measures

VI. Regulatory Management/Governance

  1. Interprets federal and state regulations to assure compliance and efficient integration with established policies and procedures of the facility.
  2. Directs compliance of the facility with government regulations.
  3. Monitors medical reporting, staffing and procedures in order to assure compliance with regulations and quality care.
  4. Evaluates staff work procedures and policies to assure compliance with federal and state regulations.
  5. Provides management reports to facilitate decision making by the governing body.
  6. Interprets the governing body's philosophy and goals to the staff to assure that the board's intent is followed and established policies and procedures reflect the governing boards' philosophy.
  7. Acts as liaison between the governing body, regulatory agencies and the public.
  8. Develops, implements and monitors legal liability risk management for the facility, the administration and the governing body.

Requisite knowledge and skill areas include:

  • Governing body's mission, philosophy, goals, and ethics
  • Equal Employment Opportunity Commission, Americans with Disabilities Act and Immigration laws and regulations
  • Area agencies on aging and ombudsman programs
  • Decision making process of the governing body
  • Government regulations and guidelines (facility, life and safety, resident care, OSHA, FDA, CDC, etc.)
  • Information needs of the governing body
  • Labor laws
  • Legislative process
  • Licensure and certification
  • Long-term care certification survey process and procedures
  • Medicare and Medicaid; HMO's and health alliances
  • Methods for complying with government regulations and guidelines
  • Preparation and format for management reports
  • Continuous quality improvement programs to monitor facility status of required reporting, charting, review, and staffing requirements
  • Professional licensing boards
  • Quality improvement
  • Family, resident and staff satisfaction procedures to monitor and improve quality
  • Regulations affecting reimbursement, capital expenditure, ownership, disclosure and reports.
  • Regulatory agency practices
  • Residents' Bill of Rights
  • Responsibility of administrator and governing body for compliance with regulations
  • Tax laws (proprietary and nonprofit)