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4/10/2018
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Nursing Facility Administrator
Preceptor Training
2018
Self introduction and
Who was you favorite teacher (mentor) and why?
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They:
1. Hold high expectations
2. Think creatively
3. Are versatile and sensitive
4. Are curious, confident and evolving
5. Can be imperfectly human
6. Emphasize the fun in learning & life
7. Challenge you
1. Review OHLA NH Administrator, Preceptor and AIT
Program rules and Requirements
2. The leadership roles of the LTC Administrator and
application to an AIT program
3. Identify the qualities and skills necessary for an AIT
to succeed as an Administrator
4. AIT Program essentials
5. Review Contemporary LTC Issues AIT’s need to
understand
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Nursing Home Administrator Board Administrative Rules Last Updated January 2012
HL0’s primary purpose is to provide more unified and standardized regulatory oversight that results in greater regulatory accountability and efficiency.
The volunteer citizen boards and councils of OHLA provide profession-specific expertise and consultation but are not responsible for central agency operations.
Nursing Home Administrators have -Nursing Home Administrator Board
BENHA no longer exists.
OHLA Director
Holly Mercer, RN, JD
Administrative Services
Fiscal Services
Licensing Division
Citizen Boards
Regulatory Operations
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General Requirements
1) Administrator In Training Program (AIT) *
2) Dual Facility Experience – LTC + Hospital same campus
3) Advanced Education & Experience – Post Grad plus 10 years health care management
4) Reciprocity w/ equivalencies to Oregon *
OAR 853-030-0000 (3)(a) - (d) Pg. 3-4
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Bachelor's degree
Certificate of Training Completion in the Administrator in Training (AIT) program
Passing score on the National Association of Long Term Care Administrator Boards (NAB) examination within one year following the date of application, sent directly by the NAB to the Health Licensing Office (HLO)
Passing score on NHAB-approved state examination within one year preceding or one year following the date of application
No longer “limited” licensees. Mustrenew and receive regular license
Annual renewals.
Licenses not renewed become inactive
Licenses may be inactive no more than three (3) years, then expires.
OAR 853-030-0070
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Bona fide emergency
Request from facility owner/manager
Provisional licensee currently employed as either:
Assistant Administrator
Director of Nursing
Not to exceed six months
OAR 853-030-0010 Pg. 5
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20 hours each year for all licensees
CE courses must be: From accredited college/university, NAB approved
or pre-approved by OHLA Keep documentation for two years following
renewal.
Specific ethics CE no longer required
Memory Care endorsed community Administrators must obtain10 dementia care related CE’s annually
OAR 853-050-0000
OAR 411-057-0000
Approved for another 2 years (7/2017-6/2019)
www.oregoncarepartners.com
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OHLA will audit a percentage of licensees
Licensee must provide documentation of
required CE within 30 days of request
If documentation is incomplete, licensee
has 30 calendar days to provide missing info
Failure to meet CE requirements may result
in disciplinary action
OHCA CE’s online now
http://www.ohcaonline.com/Web/PT1/CEU.asp
OAR 853-050-0010
Person-centered practice
Clean and safe environment
Focus on quality of care and quality of life
Regulatory compliance
Foster communication and problem-solving
Plan, implement and evaluate integrated financial program to assure the above and accurate billing
OAR 853-060-0000
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http://www.orculturechange.org/resources/online-training-overview/
Comply with federal, state and local laws and
regulations; cooperate with investigations
Exercise appropriate supervision and responsibility
over personnel
Protect residents against abuse and neglect
Possess and maintain competencies to perform
responsibilities
OAR 853-060-0000
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Ethical and professional conduct
Leadership
Administer facility to meet mission, goals, and
generally accepted standards
Confidentiality
Stay current with standards of practice
Do not discriminate
OAR 853-060-0000
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http://www.oregon.gov/oha/PH/HLO/Pages/Board-Nursing-Home-Administrators-AIT.aspx
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Current NHAB license with no current or pending disciplinary action
NHAB-licensed administrator for 3 years
Attend NHAB-approved preceptor training
Refresher course every 3 years.
OAR 853-030-0030
Take preceptor class
Complete registration -
Pay $100 fee
Refresher class every three years – next update for you 2020.
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AIT must register with OHLA before beginning program
AIT’s complete 960 hours of training with preceptor
Preceptor may work with only one AIT at a time – no overlap
AIT has two (2) years from beginning the program, to complete training, otherwise must reapply.
Program cannot be completed in less than six (6) months.
OAR 853-030-0040
Packet Table of Contents Tab 2
Program Information/ Goals and Guidelines Certificate of Training Forms Certificate of Training Tracking Tool Examination Information
Available online at www.Oregon.gov/oha/ph/hlo/documents/ait-training-packet.pdf
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1) Resident Care and Quality of Life: 336 Hours
2) Human Resources: 144 Hours
3) Finance: 144 Hours
4) Physical Environment: 96 Hours
5) Leadership and Management: 240 Hours
Waiver of training hours from Resident Care and Quality of Life Domain◦ Up to 80 hours for CNA
or
◦ Up to 160 hours for LPN or RN
◦ May not combine.
◦ Waiver forms are available online
OAR 853-030-0040 (2)
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Review Tab 2 p. 1-2 Goals for AIT
Preceptor Guidelines
Four (4) hours per month in-person consultation between preceptor and AIT
The 4 consultation hours are in addition to the 960 hours ex. 6 month AIT: 960 hours + 24 hours consultation
Log for in-person consultation meetings (Tab 2 pg. 7)
OAR 853-030-0040 (3)
There are 10
Certification Training
Forms
Check off each
learning objective.
OHLA gets copy of
all ten pages at final
submission for AIT.
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Resident Care Human Resources
Recognizing whether resident needs are met.
Analyzing and interpreting customer satisfaction data.
Interpreting CMS quality measures
Analyzing and interpreting effectiveness of QA data related to resident care & service outcomes
Interpersonal communication within the IDT and relationship building.
Coaching, counseling, and teaching.
Facilitating group meetings i.e deptmeetings
Interviewing (pre-employment, investigations, exits)
Analyzing and interpreting employee performance
Team building Analyzing and
interpreting HR programs
Finance Physical Environment
Analyzing and interpreting budgets and financial statements
Interpreting financial regulations as they apply to reimbursement
Managing cash flow
Analyzing and interpreting trends in financial performance of facility
Analyzing physical plant needs
Recognizing environmental impact on residents
Analyzing and interpreting effectiveness of QA data related to environmental service and safety outcomes
Interpreting and applying safety codes
Interpreting and implementing life safety codes
Emergency/Crisis management
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Leadership & Management
Interpreting rules and regulations, and policies and procedures
Analyzing facility compliance
Using basic counseling methods
Conflict resolution, mediation, and negotiating techniques
Problem
solving/utilizing
alternative solutions
Oral and written
communication skills
Cultivating effective
relationships
Managing
organizational
behavior
Certificate of
Training
Preceptor submits
to agency at
completion of AIT’s
training
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Tracking Tool –- Optional
This form does
not need to be
submitted to
Agency
Use as back up
documentation
Keep Copies of Consultation Logs
Keep copy of Certification of Training Records
Keep copy of Training Tracking Tool
Risk Management for yourself
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The board-approved examinations for a nursing home administrator license are:
1) NAB examination with a NAB passing score; and
2) State-prepared examination administered by the agency with a board-approved passing score
OAR 853-030-0050 Pg. 8
State Federal
Can take anytime after AIT
is registered with OHLA.
Walk in basis
Can be taken 1 year prior to
application for license
being submitted or 1 year
after.
Application and all related
documents for permanent
license must submitted to
and approved by OHLA
before the AIT can take NAB
exam.
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Two forms of govt. approved ID required for examination – one must be photographic
No time limit for examination
within testing hours
Examination is closed book
OAR 853-030-0050
Schedule State Exam before the end of 960 hours
i.e. at 4 months.
Order official transcripts well in advance of
submitting application. Transcripts must be mailed
directly from institution to OHLA.
If AIT has different name from what appears on
transcript documentation of name change as filed
with the court i.e. marriage certificate or divorce
decree must be submitted to OHLA.
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150 questions
Minimum passing scale score of 113 (75%)
Three (3) hour time limit on the examination
Covers resident care and quality of life,
human resources, physical environment and
atmosphere, and leadership and
management
The NAB Study Guide can be accessed at www.nabweb.org
Register for the national examination when AIT program requirements are satisfied. Then submit application for permanent license.
NAB exams are offered at Prometric Test Centers, which are located in ◦ Eugene, Milwaukie, Portland, and Salem
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➢ 100 multiple-choice questions (double the previous # ?)
➢ Minimum passing score of 75% (was 84%)
➢ Examine given on a walk in basis at Health Licensing Office
Monday through Friday 9:00 am – 1:30 pm.
➢ Applicants can use as much time as needed within the
window. If do not arrive with enough time to take exam will
be asked to come back.
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NOTE:
HLO has moved to 1430
Tandem Ave. NE, Suite
180, Salem OR 97301.
To keep up with office
closures and other
updates, follow us on
Facebook.
Exam covers regulations for
Nursing Facilities as listed within the Oregon Department of
Human Services (DHS),Aging and People with Disabilities
Division;
Chapter 411, divisions 070, 085, 086, 087, 088 & 089.
➢ Oregon Nursing Home Administrator’s Board Administrative
Rules.
Chapter 853, divisions 050 and 060.
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Questions?
“Tell me and I forget. Teach me and I remember. Involve me and I learn.”
Benjamin Franklin
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➢ Why did you become a Nursing Home
Administrator?
➢ Why do you want to be a preceptor?
Group discussion
What does the owner, company expect?
What do residents expect?
What do families expect?
What do staff expect?
What do regulators expect?
What do Ombudsman expect?
What do managed care groups expect?
Other stakeholders?
Your AIT?
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1
2
2
2
2
2
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Quality LTC
Organizations
Resident Centered
Services
Culture Change
• Informed Choice
• Independence/Autonomy
• Person Centered Care
• Informed Risk
• Dignity/Privacy/Respect
Quality
Improvement
• Quality Metrics
• Proactive Audits
• Action Plans
• Team Oriented
• Best Practice
• QI Models (i.e.,
Baldrige Awards)
Leadership
& Workforce
• Mission and Vision
• Ethical Practices
• Fiscal & Budget
Responsibility
• Appreciation
• Retention
• Training & Growth
Opportunities
Compliance
• Rules and Regulations
• Balanced Public Policy and
Regulation
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Defines LTC excellence as a leader and provides a process by which individuals (you, AIT’s) can assess their level of performance and plan for improvement.
Provide clear leadership competencies and
proficiencies for long term care leaders
Provide leaders and opportunity to assess their
proficiency level in 14 leadership assessment scales
Provide leaders an opportunity to develop and
document a self-improvement plan- choosing one
or two of the 14 assessment scales
Tangible Tools - Provide resources –
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Areas of Competence1. Leader2. Performance Improvement Catalyst3. Inerpersonal Relations Facilitator4. Human Resources Developer5. Resource and Finance Manager6. Standards and Compliance Expert/Resource7. Customer Service Advocate
Let’s take a look…..Tab 6, pg 5-13
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Develop and communicate the vision.
Hold people accountable.
Create a culture of continuous improvement.
Foster learning and mentoring across the organization, starting with themselves.
Not realistic to expect a leader to be equally competent in all areas
Not considered fixed or unchangeable
Do not favor a single style of leadership
Not totally discrete – cross referencing
Not limited to a single environment or department
Clearly define the expectations for excellence
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Source: Emotional Intelligence Daniel J Goleman, Author
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I. Self-Assessment◦ Review the Seven Roles -◦ Read the Scales –◦ Objectively Record Data on the Scales –◦ Score yourself◦ Compile a Self-Profile
II. Professional Improvement plan◦ Select one or two scale topics which you wish to
improve◦ Write a self improvement plan using:
Self Improvement Plan Consider using the SMARTS action plan format to set goals:
Specific, Measurable, Achievable, Realistic, Timely, Supported
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1. Living Mission and Values
2. Modeling Effective Leadership
3. Modeling Supervisory Skills
4. Ensuring Optimum Care Standards
5. Attracting and Retaining Staff
6. Developing Staff
7. Championing Quality Improvement
8. Integrating Risk Management
9. Exhibiting Regulatory Expertise
10. Managing Resources
11. Communicating Effectively
12. Facilitating Change
13. Managing Conflict
14. Advocating Customer Satisfaction
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How do you establish optimum care standards?
In what specific ways do you establish systems & protocols that meet or exceed these standards?
How do you ensure maintenance of these standards?
What are the various methods and strategies you use to attract and retain staff?
How do you guarantee job descriptions adequately reflect their roles?
How do you foster high levels of job satisfaction?
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SMARTS Goals - Creating a Plan for Improvement
Specific – What are you going to do?
Measurable - Criteria for measuring progress.
i.e. long term goal - ↓CNA Turnover
short term goal – take BOLI class on hiring
Attainable – How will you accomplish goal? Stretch goal.
Realistic – Is it do-able? First organization mission, goals.
Set bar high but not crazy. 20% ↓ vs. 100%
Timely - Set target dates, deadlines. 1 year by Dec 31.
Supported – ID necessary resources, your commitment.
Strategic
Objective,
Goals, Action
Plan
Who is
Responsibl
e?
Resources
(people, budget, equipment,
other)
Target
Finish Date
Comment
s
S,M S A,R,S T
70
IMPLEMENTATION EVALUATION
What needs
to done?
By whom
and when?
What
resources?
What evidence
indicates
progress?
How and when will
evidence be
gathered?
S S,T A,R,S M M,T
Statement of Objective/Goal:
___________________________________________
1.
2.
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Finding the Right AIT
Qualities & Skills
•Fits organizational culture
•Fit for community/type of facility
•Behavior based interviewing
•AIT Interview & Training Process
Tabs 4-5
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Qualities & Skills
Where do I find applicants?
• Organizational recruitment practices policies
• Schools
• Internal Leadership Programs
• Internships
• Employment Fairs
• Department Heads
• Web
• The Unusual Suspects
• Networking
Qualities & Skills
Behavioral or Situational-Based Interviewing -
Resume & Application only gives you so much
• An application gives you reasons for leaving, criminal
history, hidden references, salary
• Length of service issues
• Management or leadership skills that translate
• Management experience, multiple aspects of any job
• Utilizes past behaviors as a more reliable indicator of future
job performance.
• Open-ended questions asking for specific examples of past
job behavior.
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Content – Program Essentials
What topics do you train on?
Use the Training Packet
Review & Compare the topics contained in the OHLA
training packet with topics with leadership qualities &
domains, your organizational standards plus what you
know are hot issues.
What don’t you see on the lists?
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1.
2.
3.
4.
5.
Method
How we train –
Brainstorm a list of possible ways to train
Adult Learning Styles• Auditory: Hearing the material
• Visual: Seeing the material
• Kinesthetic: Learn by Doing
Tab 5 Page 1
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The Training Plan
Write down everything you think an AIT should know
about EHR, Transitions of Care, Rules of Participation?
Identify the most essential information an Administrator
should know about these topics?
How will you organize those learning opportunities?
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The Training Plan
Measurable Objectives
• Use Action Verbs
Compare Complete Construct
Select Describe Draw
Explain Identify List
Operate Recite Arrange
Demonstrate Teach
The Training Plan
Write objectives that state how the AIT will learn about
each topic regarding EHR:
• Understand the applications and goals of EHR System
• Understand state and federal regulations
• Understand policies and procedures/confidentiality
• Understand staff training and inservice needs
• Understand fiscal issues related to EHR
• Understand maintenance, security, emergency back up
• Understand the inter and intra organizational dynamics of EHR
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Ongoing Communication
The Essentials of Teaching Adults
• Participatory atmosphere
• Must relate to own experience
• Shown respect and allowed to voice their own opinion
• Needs time to debrief and review
Ongoing Communication
Compatibility
• Personality
• Learning Style
• Communication style
Evaluation and Feedback
• Type
• Frequency – Required to do 4 hours per week.
• Staff as an indicator
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Ongoing Communication
Not Everyone will make it! Strategies ?
Derailers:
• Approval dependent
• Argumentative or defensive
• Arrogant
• Self-promoting or Attention Seeker
• Volatile
• Quick to blame others
• Victim mentality
• Not competent
• Lacks self confidence
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Where to Start?
Related Experience in other areas
• Departmental or leadership skills
• Does it translate
• Example: Worked in hospital maintenance; responsible for
hiring/firing or teacher; planning, organizing, counseling
Most developed areas?
Least developed areas?
Using the Leadership Excellence Evaluation Tool can
help the AIT and you zero in on key training areas.
Learning Journal
Learned:
• The most significant concepts, principles or ideas learned or
realized from the meeting today
Application or Action
• How learning can be applied or implemented
• Things to start doing or stop doing at the facility
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Use all learning styles
Consider scheduling some learning objectives in a processes fashion versus scheduling big blocks in one department.
i.e. following a resident from hospital to admission observe each discipline complete the resident assessment(s).
Case Studies
Have the AIT Teach Staff a concept or prepare a presentation for the community
Research
Hitting the Hot Topics
Meeting the Leadership Challenge in Long Term Care: What You Do Matters by David Farrell, Cathie Bradie, & Barbara Frank
Dementia Beyond Drugs: Changing the Culture of Care by Dr. Alan Power, MD
The Tipping Point: How Little Things Can Make a Big Difference by Malcolm Gladwell
The World Is Flat: A Brief History of the Twenty-First Century by Thomas L. Friedman is A Whole New Mind: Why Right-brainers Will Rule the Future by Daniel H. Pink,
If Disney Ran Your Hospital: 9 1/2 Things You Would Do Differently by Fred Lee
From Good to Great by Jim Collins
Being Mortal and the Checklist Manifesto by Atul Gawande
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The average # of citations between 2015 and 2016 for nursing facilities rose 17%
The trend line for average number of survey citations for both nursing facilities jumped 30%from Q4 2016 to Q1 2017.
Nursing facilities have four Ftags related to assessment and care planning in the top 10 citations. F309, provide necessary care for the highest practicable well-being, continues as the number one citation.
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You will be Famous!
Double check to see you get posted.
Questions?
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