dementia.

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You did such a great job of turning around the last facility you managed!Now you have been recruited to take the position as administrator of a retirement community called Midview, which is located in the mountains near Los Angeles.Midview has independent living, assisted living, and skilled nursing facilities.There is no designated separate area for people with dementia. Like your last facility, there are many issues to address, and you will have to rely on all of your knowledge about legal and regulatory issues in long-term care to solve them.

The independent living has 200 apartments and is 90% occupied.Your director of marketing tells you that occupation rates could be even higher, but you have had complaints from potential residents about all of the people in wheelchairs.She wants to start marketing the housing as “active seniors only” and use only pictures of healthy people playing tennis and golf in your ads.She would also like to have separate floors in the building for people of different ethnicities and nationalities, since she believes that residents will be more comfortable if they can be around those with similar backgrounds.Finally, she wants to have a firm “no pets” rule in order to keep the building quiet and clean.When you tour the building and review the files, you notice that there many requests from tenants for modifications to the apartments for things like installing grab bars or widening the doors to allow walkers or wheelchairs, but the facility has not responded.Your facilities director tells you that it is better not to respond, because maybe then those tenants will get frustrated and move out, so you won’t have to deal with their problems.

The assisted living (also called residential care facility) has 55 apartments and has a good occupancy level of 92%.There has been a recent elopement where the resident went outside, slipped and fell on the ice, and broke his leg.He was not discovered for some time, and also had frostbite from lying in the snow.He is currently in the skilled nursing facility undergoing rehabilitation.The family is very upset and complained to the state.The facility was issued a citation for lack of supervision as it was documented that this resident was confused and deemed a wander risk.The staff at this facility tells you that the best thing to do is refuse to take this resident back when he is discharged from the nursing home, since he is too difficult to care for.They also say that the family wants to meet with someone from the facility to talk about what happened, but the last manager recommended that you stonewall and say the facility did nothing wrong.Staff wants you to refuse to meet with the family, and to start eviction proceedings while the resident is in the nursing home.You decide to review his file, but cannot find a copy of an admission agreement signed by the resident.Staff tells you that they don’t bother with admission agreements since people in the mountains are so friendly and easy to get along with.They say that everything is done on a handshake.You also notice that there are many residents at the assisted living facility who have dementia.You are a little bit concerned because there are no door locks or monitors or systems of any kind to track where residents are in the facility.The facility has also been written up because of substandard fire and smoke alarms. Overall, this facility seems really low-technology!

The skilled nursing facility has sixty beds and has averaged 82% occupancy levels for the last year.The facility takes a mix of private pay, Medicaid, and Medicare patients.They received a poor survey where they had twenty four deficiencies.There are two pending lawsuits.One was based around a fall and the other was due to a death caused by aspiration.The Director of Nursing is new to the position as she worked in assisted living previously.She says they would like to start a quality assurance program, but have not gotten around to it yet.You ask to see the most recent inspections/state surveys, and they do not have any copies.Staff tells you that the last manager had them shred a bunch of files when the lawsuits were filed, and they think that the surveys were included by accident in the records that were destroyed.They tell you that they are also going to delete all of the e-mails relating to the lawsuits, but have not gotten around to it yet. You review the files that are available, and you notice that there are a number of complaints from residents and their families because they are not allowed to meet in groups at the facility.There are also a lot of complaints from families that residents with dementia are being restrained or drugged most of the time.When you check the files for these patients, you do not find any doctor orders for physical or chemical restraints.When you ask the Director of Nursing about this, she tells you not to worry about it, because you can just transfer or discharge the patients who complained to get rid of them.She offers to get them all out by the weekend, if that would help.She says that Wild Bill, one of the new aides, just got out of prison for dealing drugs and elder abuse, and he would be a great person to help get those patients out of the building.You notice that Wild Bill has a bag full of watches, rings and hearing aids and was seen earlier carting boxes of medication out to his car.

Your head is spinning from everything you have seen so far at Midview.But you need to come up with a plan to address all of the problems, and you need to start working on it right away.What steps will you take at each facility?What problems do you see, and what additional steps would you take to uncover problems that you don’t know about yet?What laws do you think the facilities may be breaking?How will you get the facilities into compliance?Are there areas where you can improve, even if the facility is technically in compliance with laws?How would you manage and mitigate the risk of current and future claims against the facilities?

You must citewhich laws and regulations apply, and what state and federal agencies would oversee your facilities or might become involved in complaints against your facilities. You must also include a list of references/works cited at the end of your paper, which can be listed inMLA or APA format at the end of your paper. YOU WILL EARN POINTS BASED ON SUCCESSFULLY IDENTIFYING ISSUES IN THE HYPOTHETICAL, SO BE SURE TO ADDRESS THE FACTS PRESENTED THOROUGHLY.

The paper should be 10 pages double-spaced or longer. The paper should be submitted through Blackboard no later than 10:00 a.m. PST on 12/01.Save your paper in the Microsoft Word format (.doc or .docx) with a title of the file set as your last name & “final” (e.g. smith_final.docx). Required format is 12 point font with one-inch margins.

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