Licensing Requirements and Accreditation Affecting Long-Term Care

Licensing Requirements and Accreditation Affecting Long-Term Care

Michael E. Puckett

University of Phoenix

HCS/443

August 5, 2006

Licensing Requirements and Accreditation Affecting Long-Term Care

The world of health care is changing from the needs of individuals due to changes in expectations of the health care organizations. One steady component of long-term care is the need for regulation in the industry that serves the public. Regulation is provided in several ways that includes licensing bodies, accreditation-granting entities, and state monitoring systems. The education and licensing of facilities, and those who work in long-term care have governance needs in order to protect the public served. In order to protect and serve the public, licensing, credentialing, monitoring, and receiving accreditation is not only desirable, but also needed for facilities, employees, and organizations.

Education and Licensure

Nursing Home Administrator

Education and subsequent licensure of a Nursing Home Administrator (NHA) begins with a Bachelor's Degree in Nursing Home Administration or Health Care Administration. After graduation the he or she must complete 1000 hours of apprenticeship as an Administrator-in-training under the guidance of a currently licensed NHA (Florida Department of Health, n.d.). The next step is actual licensure after testing is completed and passed.

In the state of Florida, testing for licensure is completed on a monthly basis after the required fees are paid (Agency for Health Care Administration, 2004a). The new administrator now has the responsibility upon employment to continue to work with ethical, and sound judgment to ensure the safety of individuals under his or her care. When a governing body, such as the Agency for Health Care Administration (AHCA), questions safety or sanitation of a facility potential loss of license of the facility or the NHA could result (Agency for Health Care Administration, 2004b).

The NHA could lose his or her license for being found to have unprofessional conduct while inside or outside of the facility. Unprofessional conduct involves behavior that fails to meet the ethical standards of the profession. Examples that could affect the license of the individual include inappropriate use of drugs or alcohol or crimes that may include Medicare/Medicaid fraud, rape, murder, or larceny.

Skilled Facility

Licensure for a facility is regulated by the same agency that monitors the care in such facilities. Yearly inspections take place at facilities in a quality improvement for the citizenry who are provided services directly or indirectly by the facility. In addition to surveys conducted by individual state regulatory agencies, additional accreditation can be requested and given by the Joint Commission of Health Care Organizations.

Regulatory Agencies that Affect Long-Term Care

The regulatory body that can affect a NHA and a skilled nursing facility is AHCA as previously mentioned. Formal and unannounced visits are completed on an annual basis (or as needed) to establish the safety of the individuals in the care of the facility and its licensed employees (Patricia Duckham, personal communication Aug 3, 2006). AHCA maintains a website that has several categories of the scope of the range of health care issues and departments that the agency monitors (Agency for Health Care Administration, 2004c). In the case of a NHA, the department of Medical Quality Assurance under the supervision of AHCA monitors licensees (Agency for Health Care Administration, 2004d). In the process of any investigation, an ombudsman interview is the first process when complaints are filed. If the ombudsman finds that the complaint is valid, a staff of investigators could issue a formal review of a three-day inspection of the facility. The inspection looks at the maintenance of the facility, safety of the individuals receiving care, proper charting by the licensed individuals, hiring practices, and financial paperwork.

Accreditation

Skilled nursing facilities have the ability to receive accreditation through the Joint Commission of Health Care Organizations (JCHCO).

JCAHO accreditation helps manage risk exposure and helps stimulate improvement of care, enhancing community confidence. Accreditation also facilitates internal performance efforts and helps providers measure themselves against objective national standards (Accreditation Information, 2001).

During a survey, a review of the mission and values will be compared to the actual records of the facility. As the mission and values are the standard that sets the facility apart from other comparable facilities the compliance of reflecting them is important. Policies and procedures exist due to knowledge already known or in response to activities that rendered them necessary. The surveyors inspecting a facility know this and watch for adherence to the policies whether the policy is about admission paperwork or education of a patient. According to the website by Hospital Policy Net, Inc., "The Federal government, JCAHO, insurance company payers, and patient advocacy groups are all watching patient error rates and the hospitals where they occur" (2006 Patient safety improvement programs, 2006). Part of a hospital's Risk Management or Utilization Review department