Example of an extramural community based service

HS 325 Summer Session A Name: __________________

Professor Robert DeVito

Final Exam

1. The main functions of the medical director include which of the

Following: CH 9 4 Points

A. Teaching

B. Oversight

C. Advisory

D. All of the Above

2. In Part V, Case Studies, review Case Study 1 on Page 461 and 462. Respond to the assignment questions.

10 Points

1.

2.

3. Reality Orientation is a form of therapy for demented, confused, or disoriented individuals and consists of reiteration of the person’s identity, orientation to time and place, and reinforcement of consistency in daily routine. CH 10 4 Points

A. True B. False

4. Calculate the food cost per patient day given the following criteria: CH 11

8 Points

a. Cost of inventory at end of previous period = $ 125,000

b. Cost of food purchased, current month = $ 72,000

c. Cost of inventory at end of current month = $ 46,000

d. Number of meal served = 225,000

e. Number of non-patient meals served = 63,000

f. Patient Days in the month = 9,114

5. The Maintenance staff of a 450 bed facility should have how many Maintenance staff? CH 12 4 Points

A. 3

B. 5

C. 4.5

D. 5.5

6. What are the four different systems to protect a facility’s assets? CH 12

6 Points

1.

2.

3.

4.

7. What would be some of the important clauses to include in: CH 12 12 PTS

a) routine contracts –

b) open-call contracts -

c) job-unit contracts -

8. What is the main difference between an exempt employee and a nonexempt employee? CH 13 6 Points

9. Explain why the Petty Cash Fund and the Patient Trust Fund

should be reconciled each month and that the reconciliation

be done by someone other than the person responsible

for maintaining the funds. CH 13 6 Points

10. In classical management, the four basic Management functions

are: CH 14 4 points

A. Production, Skills, Command and Ability

B. Preparation, Leadership, Communication and Values

C. Planning, Organizing, Leading and Controlling

D. None of the Above

11. Long term care facilities face four main human resource challenges: employment laws and regulations, labor competition, how to

address the needs of a predominately female workforce and workforce diversity. CH 15 3 Points

A. True B. False

12. If an employee is guilty of patient abuse, they cannot be terminated unless there is progressive evidence of the offense. CH 15 3 Points

A. True B. False

13. In Part V, Case Studies, review the Case Study 4 on Page 470. Respond to the assignment questions. 6 Points

1.

2.

3.

14. What is the most critical step in fire protection? CH 12 4 Points

A. Notify the Administrator

B. Contact the Owner or the Board Chair

C. Activate the fire alarm

D. Extinguish the fire

15. Calculate the Operating Margin if Total Revenue is $ 4,556,725, total expenses are $ 3,728,600. CH 17 8 Points

16. Name the four criteria that market segments must be evaluated by.

CH 16 4 Points

17. A Variance Analysis is: CH 17 4 Points

A. A technique for managing revenues

B. The term used for the process of preparing reports

C. The difference between an actual number and a budgeted number

D. A method of a cost control

18. Which of the following characteristics is NOT related to Consistency?

CH 18 4 Points

A. Outcome

B. Continuity

C. Uniformity

D. Reliability

A Central American Immigrant Couple

Rosa and Jaime Sanchez immigrated to the United States from a Central American country 18 years ago when they were in their early 60s. A son and a daughter were already living and working in the United States when they arrived. Rosa and Jaime lived with their son, Jorge, his wife, Maria, and two small children in a two-bedroom apartment. To make ends meet, Rosa found work in the laundry of a nearby motel, and Jaime took the night janitor’s position at the local boys’ club. Rosa had hypertension, which she controlled with medications obtained at a nearby community health center. Jaime was an insulin-dependent diabetic and had to pay for most of his medical expenses.

Two years after the arrival of her in-laws, Maria gave birth to another child. During the next 6 years or so, Rosa and Jaime learned barely enough English to become U.S. citizens. During this time, Jorge and Maria purchased a modest three-bedroom home, and the parents occupied one of the bedrooms. Rosa and Jaime had to stop working because of old age and declining health. Without a source of income, they qualified for Supplemental Security Income (SSI) and Medicaid. Most of the SSI income was handed over to the son for their room-and-board expenses. Medicaid covered their medical expenses.

Starting at age 71, Jaime suffered several ministrokes. His blood sugar had not been well controlled. He also developed glaucoma in one eye and was barely able to see with that eye. The son and his wife both had full-time jobs. Before, Rosa was able to spend a lot of time taking care of her grandchildren, but now her husband required more attention. He needed assistance with bathing. He also needed insulin injections and blood sugar monitoring three times a day. Their daughter, who lived with her family about 15 miles away, came over and provided help periodically.

Jaime is now 77 years old. Two years ago, he fell and injured one of his ears. He has lost 75% of his hearing in that ear. Fortunately, he did not sustain any fractures. He wears a hearing aid in the other ear. Recently, he complained of declining eyesight in the good eye. An eye exam showed signs of macular degeneration. Rosa does not have the level of strength she once had to take care of Jaime. Both Jaime and Rosa use canes for walking because of some limitations in mobility.

Jaime and Rosa’s grandchildren are growing. They need more space in their home and time to devote to their school work. Jorge and Maria show some level of frustration because they are unable to devote the necessary time to take care of Jorge’s elderly parents. The parents don’t have the money to go to an assisted living facility, but perhaps they can qualify for care in a nursing home. Jorge, Maria, and Jorge’s sister have come to realize that the parents need to move out, but they don’t know where to turn.

Jorge calls a nursing home located 6 miles from his home and makes an appointment to see the administrator.

Assignment

1. On the basis of the information given in the case, assess Jaime and Rosa’s current long-term care needs.

2. What type of living and care arrangement would you recommend?

Advance Directives

The assistance of Patrick Claudius, MD, in developing this case is gratefully acknowledged.

An 18-year-old male patient was admitted to Greenfields Nursing Home, South Carolina, from another skilled nursing facility located in North Carolina. The patient was moved to South Carolina because he qualified for Medicaid in that state. The patient stayed at Greenfields for 12 years until his death at the age of 30.

The patient had sustained a serious head injury in an auto accident at the age of 15. As a result of this injury, the patient became comatose. He remained in a persistent vegetative state and had a G-tube for enteral feeding. However, the patient’s overall condition was stable. He received maintenance rehabilitation for severe contractures in hands, arms, and feet. The patient also received regular sensory stimulation.

The patient had fevers off and on in the range of 100° F (37.8° C) to 102° F (38.9° C). His fevers were most likely to be secondary in nature because most other causes, such as infections, were ruled out. The nursing staff was able to control the fevers using ice packs and alternate administration of Tylenol and Motrin. At times, however, the patient would have episodes of urinary tract infection. He was also hospitalized with recurrent aspiration pneumonia. He began running fevers as high as 106° F (41° C). Sputum and urine cultures showed the presence of methicillin-resistant Staphylococcus aureus (MRSA) infection. At times, severe infection required hospitalization in the intensive care unit. Intermittently, the patient had to be placed on a ventilator.

Shortly after the auto accident, the patient’s mother had abandoned him. The mother is the one who caused the accident that resulted in this patient’s severe head trauma; she was driving the vehicle in a state of intoxication. The patient had no family contact whatsoever. The court appointed the Department of Social Services as the patient’s legal guardian. The Department of Social Services, however, was uninvolved in his care and did not give any directives regarding continuity of treatment. The patient eventually died of natural causes.

Assignment

1. Should the patient have been referred to hospice care?

2. The patient went into coma at the age of 15 and had no advance directives. What role would advance directives have played in this case?

3. How might Greenfields Nursing Home be able to obtain advance directives in a similar situation?