LTC Facility of the future design_Brittney Gajewski

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Unit 10 Assignment 1 Final

Organizational Long-Term Rehabilitation Care Future Design

By: Brittney Gajewski

HS: 5534 Leading across the Care Continuum

Professor: Dr. Washington

December 16th 2014

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I. The situation Long-Term Care facilities are facing

Currently within the state of Wisconsin, over 11,000 older adults are waiting for

long term care services and other forms of support (Wisconsin Department of Health and

Family Services). Although Wisconsin’s long-term-care initiative looks to improve the

access, quality, choice, and cost-effectiveness for long-term care, the need for long-term

care will increase by 45% by 2030. According to Blok, Luijkx, Meijboom, and Schols

(2010) diverse care for adults across different cultures is needed and in a high demand for

different types of care to be met. Additionally, Blok et al. (2010) explained with

increasing age arises the prevalence for multiple types of chronic conditions—or the

prevalence of multi-morbidity.

There is a huge gap that exists because State regulators are only looking to ensure

certain health practices, they do not look to in sure that the quality of life for the residents

of the facility are being met. State regulators are not bringing into question what

practices are inhibiting residence from achieving their daily activities of life involving

leisure activities. By providing physical an occupational therapy services on campus and

in the home, older adults can age in place and have greater access to the elements that

attribute to the quality of an individual’s life.

As a strategy to address shortcomings in the US health care system within long-

term care, the concept of Accountable Care Organizations (ACOs) sought to reform

national health legislation. Stakeholders and consumer groups use measurements that

encompass performance improvement in key national priorities. The US secretary of

health and human services launched pilot accountable care organizations that would stem

from three core principles including reliable measurement to support improved savings

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cost, and reduction of overall costs supplemented through quality based investments. The

design aspects of Accountable Care Organizations (ACOs) should involve substantial

elasticity and a strong primary care base to provide accountability for quality and total

per capita costs within long-term care. Administrators will continue to address models

specific to the long term care design with interdisciplinary relationships strategies with

potential to be put to practice on a national level.

Anheier (2005) overviews the specific fields and dimensions behind nonprofit

organizations. Further organizational structure is extensively covered and it provides a

comparative view between different intersectional relationships. Organizational theory

has centered around similar problems between management, sociology, and economic

divisions. These relationships involve governing directors or stakeholders and the

administrating staff that is held accountable for any difficulties or ethical concerns that

might be faced within long term care. The evolution, rationality of an organization, and

the relationship between the environment and the organization address three key

conceptual difficulties (Anheiner 2005). By utilizing Anheiner (2005), administrators

will have a greater perspective of the resources and types of theoretical approaches that

can be taken into account when facing special topics or issues rehabilitative long term

care. These special topics range from policy issues to global and international relations

that stem from nonprofit organizations. Administrators should utilize this tool to

continue to provide a fair perspective and a greater morale overall.

In 2009, Fry & Kriger discussed the development of a theory that aims to center

five different levels within effective leadership. This developmental theory of leadership

ventures beyond the current theory that emphasizes doing and having, and explores the

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appropriate actions of being depending on the situation an administrator faces. Leading

administrators continue to evolve with theoretical advances within rehabilitative long-

term care. Administrators provide a concise overview of effective leadership that

reviews five levels of being including: the non-dual, level of the spirit, level of the soul,

images and imagination, and the physical world. Utilizing this will advance the long-

term care facility’s epistemological models of care that is effectively carried out in an

ethical situation. Administrators will face ethical decisions on a daily basis and will

involve legal, direct, and indirect cost that are related to the facilities operations.

Leadership development from a being-centered theory supplies another view on ethical

costs and considerations in a long term care facility.

Being-centered care involves the collaboration of mental health care and is key

when providing evidence based approaches as care options for older adults suffering from

mental health conditions (Kaskie, & Buckwalter, 2010). A comparative model that could

be integrated in collaborative models of care is the Iowa Model. Administrators could

use this model to emphasize administrative and financial procedures involved in order to

maintain effective mental health care services in the long term care setting (Kaskie, &

Buckwalter, 2010). The mental health of residents at the facility involves a collaborative

care model. Administrators can provide efficient specialty care and have management

who are responsible for financial challenges that arise with Medicare (Kaskie, &

Buckwalter, 2010).

A fall can result in restricted abilities that affect one’s quality of life and a change

in the individuals care needs. While an individual is recovering from a fall after returning

from the hospital, it is essential to provide care to one’s mental health. It has been shown

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that collaboration between ones primary care and mental health care improves one’s

quality of care (Pamerantz, et al., 2010). During this time the long term care facility

would utilize an integration program to provide a mental health specialist.

Administrators who utilize collaborative care models may be use for managing chronic

diseases and specialty care cases (Pamerantz et al., 2010).

Pressure ulcers are localized injuries that occur due to the compressed tissue

between a surface such as a chair, and a ‘bony prominence’ and often occur after hip

surgery (Baumgarten et al., 2009). Older adults over 70 years of age are more likely to

suffer a hip fracture Baumgarten et al., (2009). Surprisingly Medicare does not provide

hospitals with financial coverage for patients who suffer from pressure ulcers within

hospital settings. With financial coverage it could feasibly be possible to have more

nurses available to keep patients mobile after a surgery. It is imperative that

administrators hold a strong organizational design so that all staff members have a clear

role in their responsibilities when a resident is transferred back home after being

discharged from the hospital. Baumgarten et al., (2009) concluded that pressure ulcers

were most likely to occur within a hospital setting and although patients are encouraged

to become mobile after a hip surgery, they’re often seated and at greater risk for a

pressure ulcer. This is why part of the long term care’s organizational structure will

involve certified occupational therapist who will help with the care transitions between

the hospital, facility and home settings. Baumgarten et al.,(2009) emphasized the degree

to which a hip fracture and surgery can impact the quality of a resident’s life. This is

fundamentally relevant since the long-term rehabilitation services will determine the

severity an impact has on one’s quality of life.

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An administrator can adapt organizational health practices that are a fundamental

notion of public health practice within the long term care setting. Greater attention has

been reflected upon the key components of evidence-based public health (EBPH)

(Brownson, Fielding, and Maylahn, 2009). Administrators will make decisions based on

the current research available, take into account the values and preferences of the

residents cultural needs, include collaboration with the occupational practitioner on site

so that one’s environmental context has been personalized to fit one’s specific care needs

(Brownson, et al., 2009). This new approach to improve the population’s health has been

recommended on a national level. Administrators adapting this approach within the long

term care facility will prove to have indirect and direct benefits that reflect on the ethical

quality of a facility’s programs, policies, public or private resources and superior

workforce efficiency (Brownson et al., 2009). Decision making regarding the care of

residents will continue to be reflected within ethical and financial systems of leading

administrators in the long-term care facility.

An administrator can adapt organizational health practices that are a fundamental

notion of public health practice within the long term care setting. Greater attention has

been reflected upon the key components of evidence-based public health (EBPH)

(Brownson, Fielding, and Maylahn, 2009). Administrators will make decisions based on

the current research available, take into account the values and preferences of the

residents cultural needs, include collaboration with the occupational practitioner on site

so that one’s environmental context has been personalized to fit one’s specific care needs

(Brownson, et al., 2009). This new approach to improve the population’s health has been

recommended on a national level. Administrators adapting this approach within the long

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term care facility will prove to have indirect and direct benefits that reflect on the ethical

quality of a facility’s programs, policies, public or private resources and superior

workforce efficiency (Brownson et al., 2009). Decision making regarding the care of

residents will continue to be reflected within ethical and financial systems of leading

administrators in the long-term care facility.

Leader Member exchange theory (LMX theory) study’s the relationship of the

development process that occurs between employed members and administrative leaders

in long term care (Shunlong, & Weiming 2012). Shunlong & Weiming (2012) explain

objective and subjective employee performance are to outcome variables to

transformational leadership. These performances involve role perception, commitment to

facility, and team innovations. Shunlong & Weiming (2012) provided evidence that

transformational leadership instills charisma, individualized consideration, innovating

behavior, and modeled morale tied with employee’s innovating care practices.

New health care plan strategies and opportunities will continue to develop as the

older adult population’s needs continue to grow. Current aging societies reside on the

forefront of practical implementation of technological instruments used in long-term

multidisciplinary care (Lemke, & Golubnitschaja 2014). A personal approach to one’s

long term care involves research, new products, materials, and education based on one’s

care strategy. As a personalized, predictive, and preventative approach outlines the

whole spectrum it is considered to be one of the emerging practices of the future (Lemke,

& Golubnitschaja 2014). Mandated meetings with one’s multiplidiciplinary team

members allows for greater communication between the resident and care doctors

(Lemke, & Golubnitschaja 2014).

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In 2011, Kerr et al., evaluated “The Audit of Physical Activity Resources for

Seniors” (APARS), which is a new tool that can be used to assess the physical activity

environment in residence based facilities. Long-term care facilities will contain the

proper structural design required to provide a safe environment for older adults to feel as

if they’re able to engage socially and independently (Kerr et al., 2011). A person’s

environment can maintain or decrease their mobility and level of functioning. By using

this tool or a similar one that measures ones moderate to vigorous physical activity

(MVPA) the quality of the future long term care designs could provide a supplemental

environment that would help residents maintain levels of activity (Kerr et al., 2011) .

In 2012, highlights of the threats that are faced during the transition process

between care facilities such as the hospital and the long term care facility were reviewed.

It discussed key themes found in the perceptions of older adults who at times feel

‘funneled through’ the care process too quickly (Jeffs, Kitto, Merkley, Lyons, & Bell).

Administrators could use this article to help identify areas of care during this transition

period that need to be strengthened in order to truly engage the patient and their health

expected outcomes.

To further assist with the transition of care after a resident has returned after being

admitted to a hospital, designated team members at the long term care facility would

request the comprehensive geriatric assessment results from the emergency room

discharge nurse (Ellis, Whitehead, Robinson, O’Niell, & Langhorne, 2011). Ellis et al.,

(2011) concluded that there was a significant improvement in one’s chance of being alive

by receiving coordinated care amongst specialists.

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Administrators and leaders within the long term care facility will need to work

together to facilitate the knowledge and skills to produce a better-quality life outcome for

residents and their caregivers. Many residents will need end of life or hospice care

directly at the long-term care facility. To help meet patient and family needs,

interdisciplinary hospice teams contribute various professional skills (Youngwerth, &

Twaddle, 2011). An interdisciplinary-based care team is being seen more through

hospice and palliative care throughout the United States and is expected to grow over the

next few decades. By using interdisciplinary geriatric care teams, clinical outcomes have

proven decreased rates of depression, decreased chance for an adverse drug reactions, and

reduced use of home health care services (Youngwerth, & Twaddle, 2011). The future

design of long-term care being proposed involves active rehabilitative services at a

facility and within one’s home. This design of long-term care specifically aims to help

older adults recover from an injury or surgery, and utilize rehabilitative services such as

occupational and physical therapy to rebuild their strength and skilled coordination that is

needed to maintain a level of independence, autonomy, and education.

II. Description of Long-Term Care

Currently within the state of Wisconsin, over 11,000 older adults are waiting for

long term care services and other forms of support (Wisconsin Department of Health and

Family Services). Although Wisconsin’s long-term-care initiative looks to improve the

access, quality, choice, and cost-effectiveness for long-term care, the need for long-term

care will increase by 45% by 2030. According to Blok, Luijkx, Meijboom, and Schols

(2010) diverse care for adults across different cultures is needed and in a high demand for

different types of care to be met. Additionally, Blok (2010) explained with increasing

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age arises the prevalence for multiple types of chronic conditions—or the prevalence of

multi-morbidity.

State regulators are not bringing into question what practices are inhibiting

residence from achieving their daily activities of life involving leisure activities. That is

why it is important for the future design of this long-term-care organization to facilitate

intergenerational relationships, and a person centered care approach. When older adults

are admitted to the facility after being discharged from the hospital after having surgery,

or after experiencing a fall—the individual will be approached in a personalized manner.

Currently, Wisconsin’s long term care expansion initiative aims to eliminate waiting lists

for long term care facilities or Community Based Residents Facilities (CBRF) by

implementing a Family Care expansion through managed care organizations and the

Wisconsin Partnership Program (Wisconsin Department of Health and Family Services).

Working along side the family care and partnership program expansion, the future

facility would be designed specifically for the functionality of older adults by having

railings in the hallways, good lighting, and accommodating seating around the facility.

Administrators would review the comprehensive geriatric assessment results from the

emergency room (Ellis et al., 2011) to help personalize a rehabilitation plan that serves

the individual and would provide the greatest functional quality outcome. Administrators

would then determine the date to which the individual will reside at the facility until

coordinating team members help one adjust to living back in one’s own home. When an

individual returns home, this organization will continue to provide rehabilitive services in

the home. While rehabilitation services at the facility would focus on rebuilding core

strengths and movements, the rehabilitation services that are continue within one’s home

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are more specific to their home environment. This allows occupational and physical

therapist to personalize the rehabilitative plan for an individual when they’re able to

assess the activities that that individual is a part of or does in their daily life.

Further, consulting services will be available to help direct older adults to the

resources they need depending on the level of care they require or medical condition that

they currently have would be available. Consulting services offered would include areas

pertaining to the improvement of quality of life, nutritional, financial, medical, and end of

life care arrangements. Aging in place would be strongly encouraged to allow for

personalized rehabilitative care.

III. Organizational policies and practices of future design.

The future design of the long-term rehabilitation a care facility will utilize a

partnership with the universities in the surrounding area in order to provide

intergenerational relationship opportunities. This facility will also use the mentoring

program for students who are going into similar careers that relate to healthcare and long-

term aging. Students would mentor with occupational and physical therapists at the

facility and within the resident’s home. These students are able to utilize this time to

obtain experience and meet their clinical hours required to finish their occupational or

physical therapy programs. Further, this would implement appropriate multicultural

relationships and a grave understanding of different ethnic values and beliefs, life styles

and activities of daily living.

While examining client’s social relationship domains and their current activity

participation, researchers were able to measure the impact of student-administered

occupational therapy on the quality of a client’s life (Moore, 2012). Utilizing the

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Activity Card Sort (ACS) and the World Health Organization Quality Of Life-BREF

(WHOQOL-BREF) as instrumental scales, Moore (2012) reported significant

improvement in those specific areas in clients lives. Further, explaining that the

occupational therapist felt they could better serve them as clients.

Clark et al., (2011) found cost-effective interventions for older adults who were at

risk for the loss of their independence and at a risk for declining health through

community based occupational therapy interventions. Significant improvements in the

quality of life of ethnically diverse older adults from various types of communities (Clark

et al., 2011) holds potential for the Wisconsin Partnership Program and the

implementation of this organization to create cost effective interventions that would

benefit Wisconsin on a community level. Activity and quality of life scales pertaining to

the lives of older adults would examine and help measure the impact students have on the

lives of older adults. The organizational design of this rehabilitative facility involves the

administrating director and administrative assistance works with the local university to

assist students meet their clinical based hours for their programs. The future facility will

have several wellness directors that help coordinate interdisciplinary care that is

cultivated to the needs of an individual. Further, the organizational staff design will

involve volunteers, administrative nurse team members, and Certified Nursing Assistants.

Other administrating staff members include administrating transfer coordinators

who help one move individuals from the hospital to the facility, and finally back into

one’s own home. These administrators would work collaboratively as a team with

administrating consultation services at the facility in order to provide overall supportive

and feasible transitions for every person. In 2012, Jeffs et al., revealed three key themes

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found in the perceptions of residents and their families going through interfacility care

transitions including: the feeling of being channeled through at a quick pace, the lack of

education and recognition in the difficulty faced when adjusting from total care to self-

care practices. Together at the future facility, administrators and their staff will work

with residents and their families to ensure families are provided with accurate

information that they can understand and educational resources for individuals and their

families to remain in control when adjusting to different levels of care at all times during

the rehabilitation process. Jeffs et al., (2012) concluded patients need to play a more

effective role in their recovery transitions and that family members play a valuable role in

the development of the patients’ personal care rehabilitation plan.

IV Long-Term Care management strategies and methods

In the future cultural or ethical concerns may arise if there is conflict between

staff and or the residents. Future administrators would discuss with both parties and

depict what occurred, is misunderstood, or disrespected between the resident and their

caregiver if they’re ever to resolve the situation on hand. According to Hoban, (2005)

many complaints arise from situations with miscommunication resulting in cultural

misunderstandings. Administrators would urge the resident and the caregiver to devote

time to mediate their relationship and overcome any cultural barriers that are affecting the

quality of care and facilitation of care. This resolution should also be applied to conflict

experienced between caregivers and other partnership staff members working at the

facility.

Problems of culture clash that can emerge in the Long-term care environment can

involve ethnicity, culture, and personal “diversity” and are not limited to personal

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habits. Hoban (2005) explains many service caregivers are interacting with one another

and facilitating activities that encompass the elders’ daily life. By holding educational

diversity workshops with the direct caregivers, a better relationship can be

fostered. Annual picnics with families of residents and the associates have shown to

create better functioning amongst residents, and respect for other workers and situations

like the one scene in this weeks media piece (Hoban, 2005).

Hoban (2005) expanded on how breakout discussions amongst associates’

interpretations and senses about diverse topics strive for the understanding that

everybody faces aging and everybody deserves to age with dignity. Through this the

facilities administrator would advocate for both parties to resolve any culture clashes or

perceived tensions. Depending on the type of facility, public and private organizations

and individuals within Wisconsin have the option of joining Wisconsin Long-term care

workforce alliance. According towww.wiworkforcealliance.com, their purpose is aimed

at the long-term care workforce and strategies to improve the status of being a caregiver.

Advocating for both parties displays a balance amongst the caregivers and the

residents and is often encouraged to create a harmony within long term care (Hoban,

2005). It is important that residents feel safe and that they are given equal dignity if

concerns are raised. The administrator manages all grievances in an ethical, and

justifiable manor in order to bridge tensions between different ethnicities.

Youngwerth & Twaddle, (2011) explained that interdisciplinary team care models

have a greater chance of producing a superior outcome because patient care utilizes

combined knowledge and skills. While multidisciplinary team members can each be

identified as “wedges of a pie” (Youngwerth &Twaddle 2011), their contributions remain

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separate from the rest of the pie. Transdiciplinary model allows for more communication

and collaboration between team members but the definition of each team member’s role

remains disorganized. By using synergistic interactions with team members who are

experts within their own specialty—team members will bring their skills together to

provide collaborative rehabilitee care plans for older adults. Teams that taken

interdisciplinary care approach are more likely to show care with the patient and their

family, consideration with their values and culture, and heighten the commitment and

productivity from older adults themselves (Youngwerth &Twaddle 2011). For

interdisciplinary care to be applied in the future it will need to be a part of the education

in the healthcare field, this way there is a standardization in the delivery of quality health

care. Team members practicing this approach within the geriatric field have seen clinical

outcomes related to: a decrease in the admission to nursing homes, a decrease in drug

reactions, and lower rates of depression and symptoms of delirium. Finally, clinical

outcomes with interdisciplinary care models have shown that older adults are able to

maintain their functional health status, and decrease the loss in activities with their daily

life (Youngwerth &Twaddle 2011).

V. Long-Term Care financial and budgetary principles

Residents will be admitted to the facility after having been admitted to the

hospital. These individuals will be referred to the rehabilitation facility through the

university hospital. During this time, administrators will work with stakeholders and

other administrating coordinators to further align care-funding resources. This future

rehabilitation facility will apply a person-centered Green House conceptual approach to

care.

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By utilizing a more client centered care approach, administrators and staff

members will be able to design a more personal rehabilitation plan according to one’s

lifestyle and activities of daily living. This will be especially important during one’s

transition back into their home where their occupational therapy services will be

personalized to their home environment. According to Bilsky, & Aber (2007)

administrators approaching care services from a business perspective are able to place a

cost on quality measures; this approach will be reviewed by administrating staff members

and applied at the rehab facility and then within a resident’s home. Financial

administrators and stakeholders will work together with the state’s health department

resources to improve quality system surveys. In the future, the state’s health department

will be more involved and recognize other cultural barriers and techniques.

For successful implementation, policy makers and labor departments will need to

work together with the state governing board to help redesign job roles, responsibilities,

and more extensive entry-level training to gain the proper administrating care credentials.

Utilizing data sets gathered from the results of future research, future policies can be

devised to promote a greater sense of well being in person centered care (Koren, 2010).

The redesigned role of the caregiver, referred to as Shahbazim, within Green

Houses allow for greater self-managed interdisciplinary team approaches to rehabilitative

care. It was found that Shahbaz were able to take on more defined responsibilities

without affecting the amount of time spent with each resident (Sharkey, et al., 2010).

By taking on roles including cleaning, laundry, and cooking, other hiring staff expenses

for these areas can be virtually eliminated. Shahbazim is quickly taking upon the role as

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the “midwife of elderhood”, rising in elevated job characteristics and an elevated

important job status (Loe and Moore, 2011).

The Green House model allows greater reciprocal relationships to emerge from its

unique perspective of care. Further these Green House “culture change” principles will

guide the promotion of maximum functionality, offer greater areas for meaningful

activities, for residents and result in positively fostered spiritual and emotional well-being

(Loe and Moore, 2011). The structurual and cultural aspects of Green Houses empowers

caregivers and their residents. Reports support that Shahbasim feel greater sense of

personal fulfillment and professional fulfillment, greater sense of accomplishment, and

higher job satisfaction rates (Loe and Moore, 2011).

Empowerment of Shahbasim is the core aspect of culture change initiatives that

stem from the development of the Green House model. In 2011, Bowers detailed upon

the quality of the resident’s life is dependent upon the contingency of the caregivers

assignments and their relationship with the staff. For enhanced efficiency and

effectiveness, staff will be encouraged to make collaborative decisions to manage

resident’s care plans and work to provide a homelike atmosphere (Koren, 2011). This

established systematic care process is measurable to continued quality improvements, and

has shown to surpass other resident clinical outcomes. Organized cultural care

management has shown to have positive effects on staff’s performance and on staff turn

over (Koren, 2011).

The state of Wisconsin can use Medicaid dollars, grants, Civil Monetary Penalty

funds, legislative funds, or a permutation to help forefront cultural change activities. To

manage capital costs, policy makers will reconstruct codes for person-centered care

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design innovations, creating interests, targeting grants and other tax credible barriers to

replace what is typically thought of as a ‘nursing home or rehabilitation facility’. The

future rehabilitation facility can also use the states’ payment incentives to adopt person

centered care (Koren, 2011). In 2013, Miller et al. studied the prevalence of culture

change practices within nursing homes and how its prevalence is associated with state

Medicaid reimbursement policies. As culture change practices are implemented through

policy changes, it can be used as a promising strategy for enlarged Medicaid

reimbursement funds (Miller et al., 2013). With the states pay-for-performance Medicaid

reimbursement rate, the inclusion of culture change will increase performance measures

on the future rehabilitation environment.

VI. Conclusion

Perhaps one of the most important steps coming to long-term care over the next

two decades involves advances in medical and behavioral health for elder adults. Long-

term rehabilitation care organizations are at the forefront to encourage older adults to

learn how to remain active and age healthily. As long-term rehabilitation, care devolves

over the next few decades’ doctors and other team members would be able to further

track the progress and status of baby boomer generation after experiencing a fall. It is

imperative that baby boomer generation be trained on any technology that they may need

to use in order to manage their chronic condition.

The care for future generations of elders shows a pressing need for a better

education on the technology that is being used today to track medical progress. The

future rehabilitation center will host educational classes for elders we need to use any

technical devices to communicate with any occupational therapist, physical therapist,

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doctors, pharmacists, or other team members who are involved in ones interdisciplinary

care plan. In the future, older adults can communicate with team members about any

questions they have regarding their rehabilitation plans and further allow for a smoother

transition between the greenhouse environment and one’s own home. For instance if one

has a question on how to perform a specific exercise, their physical therapist would be

able to response by sending a video that shows how to perform exercises and further

discuss which muscles the elder should be concentrating on all doing there rehabilitation

exercises. Leading administrators within the system would respond by implementing

changes in legislation to provide sufficient funding for older adults to gain greater access

to technology within long-term rehabilitative care. Further leaders would ensure older

adults utilizing these technological resources are educated on their function and purpose.

In conclusion, it is recommended legislation preserve funding to develop Green

House rehabilitation homes within Madison and surrounding area. The funding to

develop these Green House rehabilitation homes serves to improve the quality of life of

caregivers and residence themselves. The implementation of this long-term rehabilitation

care organization will allow Madison’s older adults to recover from injuries or surgeries

in a homelike atmosphere that provides occupational and physical therapy and overall

support for the individual’s personalized care needs. Utilizing interdisciplinary care

teams will foster effective communication amongst care team members and the resident

and lead to a positive collaborative outcome towards a successful recovery.

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Reference:

Anheiner (2005). Nonprofit organizations; theory, management, policy. New York NY,

Routlege, Talor & Frances Group.

Blok, C., Luijx, K., Meijboom, B., & Schols, J. (2010). Improving long-

term care provision: towards demand-based care by means of modularity. BMC Health Services Research, 10.

Brownson, R. C., Fielding, J. E., & Maylahn (2009). Evidence-based public health: a

fundamental concept for public health practice. Annual Review Public Health, 30,

175-201.

Bowers, B. (2011). Empowering direct care workers: lessons learned from the green

house model. Seniors Housing & Care Journal, 19(1), 110-120.

Buamgarten, M., Margolis, D. J., Orwig, D. L., Shardell, M. D., Hawkes, W. G.,

Langenberg, P., Palmer, M. H., Jones, P. S., McArdie, P. F., Sterling, R.,

Kinosian, B. P., Rich, S. E., Sowinski, J., & Magaziner, J. (2009). Pressure

ulcers in elderly hip fracture patients across the continuum of care. Journal of

American Geriatric Society, 57(5), 863-870.

Clark, F., Jackson, J., Carlson, M., Chou, C-P, Cherry, B. J., Jordan-Marsh, M...Azen, S.

P. (2011). Effectiveness of a lifestyle intervention in promoting the well-being of independently living older people: Results of the Well Elderly 2 Randomized Controlled Trial. Journal of Epidemiology & Community Health. Retrieved from: http://jech.bmj.com/content/early/2011/06/01/jech.2009.099754.full

21 Gajewski

Chalkidou, K., Tunis, S., Lopert, R., Rochiax, L., Sawicki, P. T., Nasser, M., & Xerri, B.

(2009). Compariative Effectiveness research and evidence-based health policy:

experience from four other countries.

Ellis, G., Whitehead, M. A., Robinson, D., O’Neill, D., & Langhorne, P. (2011).

Comprehensive geriatric assessment for older adults admitted to hospital: meta-

analysis of randomized controlled trials. BMJ, doi:10.1136/bmj.d6553.

Fry, L., & Kriger, M. (2009). Towards a theory of being-centered leadership: multiple

Levels of being as context for effective leadership. Human Relations, 62(11),

1667-1696

Hoban (2005). Making way for staff diversity; all members’ can be

accommodated and empowered—if you work at it. Nursing Homes/ Long-

term care management, 18-22.

Jeffs, L., Kitto, S., Merkley, J., Lyons, R. F., & Bell, C. M. (2012). Saftey threats and

opportunities to improve interfacility care transitions: insights from patients

and family members. Patient Preference and Adherence 6, 711-718.

Koren, M.J. (2010). Person-centered care for nursing home residents: the culture-change

movement. Health Affairs, 29(2), 312-317.

Kaskie, B.P., & Buckwalter, K. C. (2010). The collaborative model of mental health

care for older Iowans. Research in Gerontological Nursing, 3(3), 200-207.

Kerr, J., Carlson, J. A., Sallis, J. F., Rosenberg, D., Leak, C. R., Saelens, B. E., Chapman,

J. E., Frank, L. D., Cain, K. I., Conway, T. I., & King, A. C. (2011). Assessing

health- related resources in senior living residences. Journal of Aging Studies,

25, 206-214.

22 Gajewski

Lemke, H. U. & Golubintschaja (2014). Towards personal health care with model-

guided medicine: long-term PPM-related strategies and realization opportunities

within ‘Horizon 2020.’ The EPMA Journal, 5(8), 1-9.

Loe, M. & Moore, C. D. (2012). From nursing home to green house: changing contexts

of elder care in the United States. Journal of Applied Gerontology, 31(6), 755-

763.

Miller, S.C., Looze, J., Shield, R., Clark, M.A., Leopore, M., Tyler, D. Sterns, S., & Mor,

V. (2014). Culture change practice in U.S. nursing homes: prevalence and

variation by state Medicaid reimbursement policies. The Gerontologist, 54(3),

434-445.

McClellan, M., McKethan, A. N., Lewis, J. L., Roski, J., & Fisher, E. S. (2010). A

national strategy to put accountable care into practice. Health Affairs 29, 5, 982-

990.

Moore, S. (2012). On-campus student occupational therapy clinic’s participation and

quality of life.

Pomerantz, A.S., Shiner, B., Watts, B. V., Detzer, M. J., Kutter, C., Street, B., & Scott, D. (2010). The white river model of collocated collaborative care: a platform for mental and behavioral health care in the medical home. Family Systems & Health, 28(2), 114-129. Sharkey, S. S., Hudak, S., Horn, S. D., MStat, B. J., & Howes, J. (2010). Frontline

caregiving daily practices: a comparison study of traditional nursing homes and the green house project sites. Journal American Geriatric Society,

23 Gajewski

DOI:10.111/j.1532-54152010.03209.x. Shunlong, X., & Weiming, Z. (2012). The relationship between transformational

leadership, LMX and employee innovative behavior. Journal of Applied Business

and Economics, 13(5), 87-95.

Wisconsin Department of Health and Family Services, Division of Disability and Elder Services. What is the managed long-term care expansion initiative? Retrieved from http://www.dhs.wisconsin.gov/managedltc/generalinfo/index.htm Youngwerth, J., & Twaddle, M. (2011). Cultures of interdisciplinary teams: how to foster

good dynamics. Journal of Palliative Medicine, 14(5), 650-653.