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Empowerment: The Paradigm for Success for the Nursing Homes of the 21st Century

Description: For a workplace to be successful, it needs to have a higher morale, thus leading to higher quality of care for residents. For a workplace to be successful in empowerment, it must have developed strong teams, and everyone must work as a team and respect one another. The research for this paper focused on many issues. The most important part of my research came from a study of the nursing assistants at Jennings Hall (JH) in Garfield, Ohio. From the data received, I concluded that the two biggest problems in many nursing homes are lack of respect and lack of team-centered attitude.
Access: This item is restricted to UNT Community Members. Login required if off-campus.
Date: December 1999
Creator: Connorton, Margaret L.
Partner: UNT Libraries

Disaster Preparedness: A Procedure Manual for a Nursing Home

Description: Disaster or emergency situations have the potential for serious impact on the safety and security of both residents and staff in a nursing home. Furthermore, federal and state laws require that all nursing facilities be prepared in case of an emergency or disaster. The first part of this document is an introduction and rationale for the development of a nursing home disaster plan. The second part is a procedure manual developed for a nursing home in Oklahoma, outlining emergency actions and recovery procedures for various types of disasters, followed by a list of emergency telephone contacts of key personnel and services both inside and outside the nursing facility.
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Date: May 2000
Creator: Reimer, Carmen Schmidt
Partner: UNT Libraries

Teamwork in the Nursing Home: The Art of Caring for Long-Term Care Residents

Description: The effects of teamwork in a long-term care setting were explored, and four key elements of teamwork in the long-term care facility were discovered. These elements--clarity of purpose, clear communication, well-defined decision-making procedures, and participative leadership--are presented in detail. The literature reviewed as well as observations from personal participation in a case study show that employing the teamwork concept in a nursing home environment significantly enhances the quality of life for the residents of such facilities.
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Date: May 2000
Creator: Saxon, Juliane M.
Partner: UNT Libraries

Tuberculosis in the Nursing Home: A Policy and Procedure Manual

Description: Tuberculosis in the nursing home is an ever-growing problem for the health care community. The incidence of tuberculosis in the United States has risen alarmingly since 1982, and high-population environments such as nursing homes are among the places where it is most prevalent. The first part of this document is an introduction to the current concerns faced by nursing home infection control personnel. It includes information about the history, symptoms, and epidemiology of the disease, as well as other topics. The second part is a policy and procedure manual that contains a basic guide to methodical testing for tuberculosis, steps for dealing with active cases of the disease, and suggestions for education of nursing home health care workers.
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Date: May 2000
Creator: Mounts, Camilla M.
Partner: UNT Libraries

Characteristics of Development Directors in Charitable Homes for the Aged

Description: This study concerns the characteristics of fund development directors employed in selected homes for the aged. The first purpose of this study is to develop a profile of job functions, through task analysis, among development directors in charitable homes for the aged. The second purpose of this study is to develop a profile of personal characteristics of development directors of charitable homes for the aged based on the following characteristics: age, sex, educational background, experience outside development, membership in community organizations and amount of specific training in fund development. One instrument was used to gather data for the study. It was distributed to a population of 29 development directors in charitable homes for the aged in Arkansas, Louisiana, Oklahoma, New Mexico, and Texas. This population was predetermined by an initial survey form sent to 193 chief executive officers in the five states mentioned above. Twenty-nine reported formalized programs employing a full-time person with at least a part-time involvement in fund development activities. Of the twenty-nine development directors surveyed, fifteen usable instruments were received (52 percent). A program was used for the survey that included crosstabulation of social characteristics, success in fund raising, length of time in position and educational preparation. Coded responses were manually typed into the computer. To accomplish the desired analysis, percentages and frequencies were used to treat the data. These non-Parametric procedures provide an understandable overview of the data obtained and are appropriate for the research questions. These procedures permit a summarization of the data in a manageable form. Following the tabulation of frequencies and percentages, Fischer's Exact Probability Test was computed to determine if significant relationships between actual preparation and needed preparation, personal characteristics, educational preparation, and success and usefulness of experience exist.
Date: May 1988
Creator: Wuenschel, Douglas F. (Douglas Ferdinand)
Partner: UNT Libraries

Nursing Homes: Sustained Efforts Are Essential to Realize Potential of the Quality Initiatives

Description: A letter report issued by the General Accounting Office with an abstract that begins "Pursuant to a congressional request, GAO provided information on federal and state initiatives to improve the quality of nursing homes, focusing on: (1) progress in improving the detection of quality problems and changes in measured nursing home quality; (2) the status of efforts to strengthen states' complaint investigation processes and federal enforcement policies; and (3) additional steps taken at the federal level to improve oversight of states' quality assurance activities."
Date: September 28, 2000
Creator: United States. General Accounting Office.
Partner: UNT Libraries Government Documents Department

Nursing Homes: Despite Increased Oversight, Challenges Remain in Ensuring High-Quality Care and Resident Safety

Description: A letter report issued by the Government Accountability Office with an abstract that begins "Since 1998, GAO has issued numerous reports on nursing home quality and safety that identified significant weaknesses in federal and state oversight. Under contract with the Centers for Medicare & Medicaid Services (CMS), states conduct annual nursing home inspections, known as surveys, to assess compliance with federal quality and safety requirements. States also investigate complaints filed by family members or others in between annual surveys. When state surveys find serious deficiencies, CMS may impose sanctions to encourage compliance with federal requirements. GAO was asked to assess CMS's progress since 1998 in addressing oversight weaknesses. GAO (1) reviewed the trends in nursing home quality from 1999 through January 2005, (2) evaluated the extent to which CMS's initiatives have addressed survey and oversight problems identified by GAO and CMS, and (3) identified key challenges to continued progress in ensuring resident health and safety. GAO reviewed federal data on the results of state nursing home surveys and federal surveys assessing state performance; conducted additional analyses in five states with large numbers of nursing homes; reviewed the status of its prior recommendations; and identified key workforce and workload issues confronting CMS and states."
Date: December 28, 2005
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Nursing Homes: More Can Be Done to Protect Residents from Abuse

Description: A letter report issued by the General Accounting Office with an abstract that begins "Often suffering from multiple physical and mental impairments, the 1.5 million elderly and disabled Americans living in nursing homes are a highly vulnerable population. These individuals typically require extensive help with daily living, such as such as dressing, feeding, and bathing. Many require skilled nursing or rehabilitative care. In recent years, reports of inadequate care, including malnutrition, dehydration, and other forms of neglect, have led to mounting scrutiny from state and federal authorities, which share responsibility for overseeing the nation's 17,000 nursing homes. Concerns have also been growing that some residents are abused--pushed, slapped, or beaten--by the very individuals to whom their care has been entrusted. GAO found that allegations of physical and sexual abuse of nursing home residents are not reported promptly. Local law enforcement officials said that they are seldom summoned to nursing homes to immediately investigate allegations of abuse and that few allegations are ever prosecuted. Some agencies use different policies when deciding whether to refer allegations of abuse to law enforcement. As a result, law enforcement agencies were never told of some incidents or were notified only after lengthy delays. GAO found that federal and state safeguards intended to protect nursing home residents from abuse are inadequate. No federal statute requires criminal background checks for nursing home employees. Background checks are also not required by the Centers for Medicare and Medicaid Services, which sets the standards that nursing homes must meet to participate in the Medicare and Medicaid programs. State agencies rarely recommend that sanctions be imposed on nursing homes. Although state agencies compile lists of aids who have previously abused residents, which can prevent an aide from being hired at another nursing home, GAO found that delays in making these identifications ...
Date: March 1, 2002
Creator: United States. General Accounting Office.
Partner: UNT Libraries Government Documents Department

Nursing Homes: Efforts to Strengthen Federal Enforcement Have Not Deterred Some Homes from Repeatedly Harming Residents

Description: A letter report issued by the Government Accountability Office with an abstract that begins "In 1998 and 1999 reports, GAO concluded that enforcement actions, known as sanctions, were ineffective in encouraging nursing homes to maintain compliance with federal quality requirements: sanctions were often rescinded before being implemented because homes had a grace period to correct deficiencies. In response, the Centers for Medicare & Medicaid Services (CMS) began requiring immediate sanctions for homes that repeatedly harmed residents. Using CMS enforcement and deficiency data, GAO (1) analyzed federal sanctions from fiscal years 2000 through 2005 against 63 homes previously reviewed and (2) assessed CMS's overall management of enforcement. The 63 homes had a history of harming residents and were located in 4 states that account for about 22 percent of homes nationwide."
Date: March 26, 2007
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Nursing Homes: Complaint Investigation Processes in Maryland

Description: Testimony issued by the General Accounting Office with an abstract that begins "GAO discussed its recent findings on the effectiveness of federal and state nursing home complaint investigation processes, with a specific focus on its work in Maryland."
Date: June 15, 1999
Creator: United States. General Accounting Office.
Partner: UNT Libraries Government Documents Department

Nursing Homes: CMS Needs Milestones and Timelines to Ensure Goals for the Five-Star Quality Rating System Are Met

Description: A letter report issued by the Government Accountability Office with an abstract that begins "CMS developed and implemented the Five-Star System largely during an 8-month period in 2008 with input from long-term care stakeholders, CMS’s Five-Star System contractor, and members of a technical expert panel—a panel composed of nine individuals that CMS identified as experts in long-term care research. CMS made numerous methodological decisions during the development of the Five-Star System, including three key methodological decisions. GAO defines key methodological decisions as those that at least six technical expert panel members—of the nine that GAO contacted—recalled as eliciting the most intense review and discussion during the development of the Five-Star System. One key methodological decision was how to combine the component ratings to create an overall rating. The other two key methodological decisions pertained to how to create ratings that account for variation in the type of care provided across nursing homes."
Date: March 23, 2012
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Nursing Homes: Additional Steps Needed to Strengthen Enforcement of Federal Quality Standards

Description: A letter report issued by the General Accounting Office with an abstract that begins "Pursuant to a congressional request, GAO provided information on the enforcement of federal nursing home standards, focusing on: (1) national data on the existence of serious deficiencies in nursing home compliance with Medicare and Medicaid standards; and (2) the use of sanction authority for homes that failed to maintain compliance with the standards."
Date: March 18, 1999
Creator: United States. General Accounting Office.
Partner: UNT Libraries Government Documents Department

Nursing Homes: Proposal To Enhance Oversight of Poorly Performing Homes Has Merit

Description: A letter report issued by the General Accounting Office with an abstract that begins "Pursuant to a congressional request, GAO reviewed the Health Care Financing Administration's (HCFA) proposal to expand the definition of "poor performing" nursing homes to include homes with repeated actual harm violations (G-level deficiencies)."
Date: June 30, 1999
Creator: United States. General Accounting Office.
Partner: UNT Libraries Government Documents Department

Nursing Homes: Complaint Investigation Processes Often Inadequate to Protect Residents

Description: A letter report issued by the General Accounting Office with an abstract that begins "Pursuant to a congressional request, GAO provided information on how states implement the federal requirement that establishes a process for nursing home complaint investigations, focusing on the: (1) effectiveness of state complaint investigation practices as a component of the system to ensure sustained compliance with federal nursing home quality-of-care standards; and (2) Health Care Financing Administration's (HCFA) role in establishing standards and conducting oversight of states' complaint investigation practices and in using information about the results of complaint investigations to ensure compliance with nursing home standards."
Date: March 22, 1999
Creator: United States. General Accounting Office.
Partner: UNT Libraries Government Documents Department

Nursing Homes: Public Reporting of Quality Indicators Has Merit, but National Implementation Is Premature

Description: A letter report issued by the General Accounting Office with an abstract that begins "GAO was asked to review the Centers for Medicare & Medicaid Services (CMS) initiative to publicly report additional information on its "Nursing Home Compare" Web site intended to help consumers choose a nursing home. GAO examined CMS's development of the new nursing home quality indicators and efforts to verify the underlying data used to calculate them. GAO also reviewed the assistance CMS offered the public in interpreting and comparing indicators available in its six-state pilot program, launched in April 2002, and its own evaluation of the pilot. The new indicators are scheduled to be used nationally beginning in November 2002."
Date: October 31, 2002
Creator: United States. General Accounting Office.
Partner: UNT Libraries Government Documents Department

Nursing Homes: Federal Monitoring Surveys Demonstrate Continued Understatement of Serious Care Problems and CMS Oversight Weaknesses

Description: A letter report issued by the Government Accountability Office with an abstract that begins "GAO reports since 1998 have demonstrated that state surveyors, who evaluate the quality of nursing home care on behalf of CMS, sometimes understate the extent of serious care problems in homes because they miss deficiencies. CMS oversees the effectiveness of state surveys through the federal monitoring survey program. In this program, federal surveyors in CMS's regional offices either independently evaluate state surveys by resurveying a home (comparative surveys) or directly observe state surveyors during a routine nursing home survey (observational surveys). GAO was asked to evaluate the information federal monitoring surveys provide on understatement and the effectiveness of CMS management and oversight of the survey program. To do this, GAO analyzed the results of federal monitoring surveys for fiscal years 2002 through 2007, reviewed CMS guidance for the survey program, and interviewed headquarters and regional office officials."
Date: May 9, 2008
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Nursing Homes: Federal Efforts to Monitor Resident Assessment Data Should Complement State Activities

Description: A letter report issued by the General Accounting Office with an abstract that begins "Nursing homes that participate in Medicare and Medicaid must periodically assess the needs of residents in order to develop an appropriate plan of care. Such resident assessments are known as the minimum data set (MDS). According to officials in the 10 states with MDS accuracy review programs in operation as of January 2001, these programs were established to set Medicaid payments and identify quality of care problems. Nine of the 10 states conduct periodic on-site reviews in all or a significant portion of their nursing homes to assess the accuracy of the MDS data. These reviews sample a home's MDS assessments to determine whether the basis for the assessments is adequately documented in residents' medical records. These reviews often include interviews of nursing home personnel familiar with residents and observations of the residents themselves. States with separate MDS review programs identified various approaches to improve MDS accuracy. State officials highlighted the on-site review process itself and provider education activities as their primary approaches. State officials also reported such remedies as requiring nursing homes to prepare a corrective action plan or imposing financial penalties on nursing homes when serious or extensive errors in MDS data are found. Following the 1998 implementation of Medicare's MDS-based payment system, the Health Care Financing Administration began its own review program to ensure the accuracy of MDS data."
Date: February 15, 2002
Creator: United States. General Accounting Office.
Partner: UNT Libraries Government Documents Department

Nursing Homes: CMS's Special Focus Facility Methodology Should Better Target the Most Poorly Performing Homes, Which Tended to Be Chain Affiliated and For-Profit

Description: A letter report issued by the Government Accountability Office with an abstract that begins "In 1998, CMS established the Special Focus Facility (SFF) Program as one way to address poor performance by nursing homes. The SFF methodology assigns points to deficiencies cited on standard surveys and complaint investigations, and to revisits conducted to ensure that deficiencies have been corrected. CMS uses its methodology periodically to identify candidates for the program--nursing homes with the 15 worst scores in each state--but the program is limited to 136 homes at any point in time because of resource constraints. In 2008, CMS introduced a Five-Star Quality Rating System that draws on the SFF methodology to rank homes from one to five stars. GAO assessed CMS's SFF methodology, applied it on a nationwide basis using statistical scoring thresholds, and adopted several refinements to the methodology. Using this approach, GAO determined (1) the number of most poorly performing homes nationwide, (2) how their performance compared to that of homes identified using the SFF methodology, and (3) the characteristics of such homes."
Date: August 28, 2009
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

The Role of Social Capital in Organizations: The Precursors and Effects of Social Capital among Certified Nurse Aides in Nursing Homes

Description: The role of social capital in forming organizational commitment is the focus of this research. Organizational social capital is the idea that social relationships have value in the organization. The theoretical framework is based on Kanter's (1993) structure of organizational commitment. This research views the structure within organizations based on global empowerment, job satisfaction, organizational commitment, and social capital. In addition, the role that race, income, and education affect the organizational structure is also taken into account. The organizational configuration was assembled using a structural equation model with latent variables employing a sample of 235 certified nurse aides. The sample was collected from 10 nursing homes in the Dallas-Ft.Worth metropolitan area. It was expected that Kanter's general format is reestablished within the sample. In fact, the study found that empowerment significantly influences job satisfaction. In turn, job satisfaction does foster organizational commitment. Although Kanter's original thesis was supported in this analysis, it was also determined that social capital plays a significant mediating role in creating organizational commitment. Furthermore, this research indicates that social capital alone can create organizational commitment. Thus, in conclusion, this research builds on Kanter's original idea and argues that organizational commitment is based on job satisfaction, global empowerment, and social capital.
Date: May 2007
Creator: Potts, Helen
Partner: UNT Libraries

Nursing Homes: Success of Quality Initiatives Requires Sustained Federal and State Commitment

Description: Testimony issued by the General Accounting Office with an abstract that begins "Pursuant to a congressional request, GAO discussed the quality of care in nursing homes, focusing on: (1) progress in improving the detection of quality problems during annual surveys; (2) how the prevalence of identified problems has changed; (3) the status of efforts to strengthen states' complaint investigation processes and federal enforcement policies; and (4) additional activities occurring at the federal level to improve oversight of states' quality assurance activities."
Date: September 28, 2000
Creator: United States. General Accounting Office.
Partner: UNT Libraries Government Documents Department