The senior healthcare industry can be quite hectic to run due to the many departments and variables that must be managed. There can be a number of different physicians, ARNP's, home health, and private third party providers in this type of industry. The residents in a private pay facility present with a vast variety of needs, colors, cultures, personalities and beliefs. Not only does this industry assume responsibility for the residents, but it also assumes the role as a liaison between the families, educator of the aging process, support group facilitator, and active provider of all needs of all involved. There are a number of laws, regulations, internal policies and procedures, and internal working components that create a world of its own within the walls of the community. All of these components contribute to the needs to approaching everything as a team, keeping communication open, and providing consistent positive reinforcement to keep things running smoothly.

Many of the senior industries are comprised of stakeholder groups that tend to have significantly different interpretations of the business's mission statements. Stakeholders can complicate the distinctions between ethics, laws, beliefs, oaths, etc. Ethics is defined as being the study of morals and specific moral choices. Laws are the rules defining conduct established by custom, agreement, and/or authority. Beliefs are known as convictions or opinions, and oaths are the formal promises to fulfill a pledge. Chief executive officers are in a position to meet with stakeholders to discuss mission statements and to distinguish the differences of the policies within every scope of the industry versus leaving the interpretation to the stakeholders individually. In addition, taking the time to educate the stakeholders and additional supporting factors can allow everyone to work together respectfully while supporting the CEO's.

In the senior industry, residents often refuse some medical services and staff members can refuse to provide specific services. Both situations often express a conflict with the interventions in place and a violation of personal moral or religious beliefs. Understanding this industry respects the rights of our residents to refuse treatment, it also reserves the right to enforce employees to follow said directives. Residents and their families will be advised to accept the recommended services however they can refuse at any time, as it is their right to refuse and have a choice. Employees should not be allowed to act on their own beliefs as everyone's beliefs can vary significantly; up to an including placing a resident at risk. Therefore introductory and regular staff meetings should be maintained to establish and reinforce the companies policies and procedures while defining the specific beliefs that work within a common rule that can be followed allowing a gray area as needed.

With all of that in place, the jobs within the senior healthcare industry are to be followed in accordance with the companies rules and regulations as defined by the state laws and corporate policies and procedures. Providing distinct chain of commands allows employees to have an outline of who can assist when and if individual perspectives are in or not in agreement with that of the organization. Employees that refuse to perform their duties as defined are subject to termination. This outline allows staff to continuously evaluate their position and aid in the elevation of confusion.

Adult Protective Services (APS) is charged with the responsibility of protecting vulnerable adults from being harmed. Components that constitute harm include abuse, neglect, or exploitation by individuals or an adult's inability to care for themselves adequately. The state of Florida requires individuals to report any reasonable cause or suspect of abuse to vulnerable adults. This is happening despite the organization being in agreement with the states wishes. To elaborate, the senior healthcare industry is comprised of many different levels of employees. Because this industry is comprised of employees from significant backgrounds, beliefs, and morals, there can often be claims of abuse with unfounded evidence. Employees are subject to make false claims to retaliate at the employers or gain financially from the families involved.

Florida is one of the top states in America that allows individuals to be protected from retaliation in these events but also paves the way for significant lawsuits; regardless of circumstance. Attorneys are often referred to as "ambulance chasers" in this industry. The ideal situation the executive directors can create is one in which they educate the department heads to ensure all paperwork is complete and in accordance to the companies policies and procedures but also in compliance with state laws and regulations. The senior industry is bound by a plethora of laws and regulations, so it is imperative to ensure compliance in all paperwork practices and to require compliance from everyone involved, i.e., physicians, nurse practitioners, private third party vendors, etc. With the appropriate systems in place, there can be a significant decrease in the number of potential lawsuits and false claims.

Staff members in the entire community are required to obtain Do Not Resuscitate (DNR) directives in the initial move-in process or during the residing time of the residents stay. Regardless of directive, staff is to provide CPR regardless of directive for any and all residents if Hospice is not a current service provided for the individual. The employees are required to honor the company policy until relief is provided by paramedics or EMS regardless of the directives on file. This industry's policies vary by company, but the outcomes are often very similar. Life saving measures on a senior with significant decline is detrimental to their ability to actually live and often creates far worse outcomes than what was originally present. Company directors are in place to uphold the company policy while supporting the company standards to do all that they can. These policies are signed by every associate that is employed by the company and requires compliance or can subject an associate to termination. Most of the senior industries are very specific in what they require in an emergency situation because of the current outlines of the state's laws and regulations. Failure to adhere to all of the above can provide fuel for lawsuits, closure of the company, and ultimately unwarranted deaths.

Communication is necessary to ensure the reduction in chaos that can easily occur in the senior healthcare industry. With the significant increase in senior housing options, there has to be an emphasis on communication between families, residents, doctors, nurses, and extending staff to avoid internal breakdowns. Many of the organizations are implementing internal forms of problem solving methods to identify where the communication is breaking down in order to create new systems to avoid similar breakdowns in the future. From this point, problem solving methods are created, alternatives to avoiding problems are put into practice, and the organizations are capable of saving time and money.

The executive directors of these organizations do not always know how the physicians are responding to all of the problems they face due to the various interpretations they may have of their Hippocratic oaths regarding the resident's rights to age in place or die in place. This type of managed care has the ability to limit the power of the physicians; creating uncertain outcomes for many of the residents. Not only is power limited, but the amount of patients a physician has to "see" and/or "treat" is continuing to exceed practical numbers due to the confines of their corporate or insurance requirements. Physicians are now being paid to serve as a "house physician" allowing industries to minimize areas of miscommunication by monopolizing the organization with minimal choices for treatment. Contracts allow residents to continue treatment with their preferred providers, however there is typically a significant cost for doing so. With the practice of contracting "house physicians", executive directors are limited the amount of dysfunction within the community and able to establish and reinforce company policies and procedures with the few serving the organization. In addition, the physicians can be witnessed responding to situations, providing care, and building professional relationships. This allows the executive director to select physicians that are in alignment with the companies policies and procedures.

With the senior healthcare industry on the rise, it is imperative to continue to place emphasis on the methods of payment for services provided. It isn't common for business directors to alter payments out of compassion, but the corporate officials are consistently auditing this system to ensure all financials to be accurate. Ensuring that all business directors are acting in support of company policies allows the company to track resident's rental fees, level of care fees, community fees, etc. Staying consistent with the business practices allows for consistency in every area of the organization. In doing so, the image of the organizations is often positive allowing for continued financial gain.

A common practice when approached with an individual or family in need of financial assistance is to provide referrals to other communities that can meet their needs personally, medically, and financially. This creates a positive referral network where everyone works together versus against each other. By working towards financial solutions for the individuals and families, future residents are able to move into the community in good faith while receiving continued support to explore all options prior to making such commitment. This practice also reduces staff from going against the company's policies.

With the rise in the senior healthcare industry, insurance laws and regulations continue to create discord due to the constant changes. Because of this, many of the companies are moving toward private pay to avoid having to deal with the ever changing laws encompassing insurances. For the organizations that opt to utilize insurance for payment, they have to continue to learn and navigate the ways of the insurance world with a driving force of gating paid for services provided. Insurance determines who gets covered and how much the company is provided as reimbursement for payments incurred. Of those, Medicare and Medicaid assist with the costs of specific senior healthcare facilities. The premium costs have continued to rise with the growing need of services.

With the uncontrollable rises in insurance, healthcare companies are required to cut costs. Many of the senior industries are cutting expenses by placing the responsibility of necessary supplies on the families to avoid absorbing the costs. Another trend in Florida is to utilize certified medication technicians to dispense and distribute scheduled medications versus licensed nurses. In doing so, the average savings annually can be significant. Companies are continuing to review the areas within the organization that are flexible and cost effective. Examples that reflect this movement is reduction of management, ratio staffing versus staffing based on actual acuity, and costs incurred for repackaging of medications. Lastly, there is an overall emphasis to reduce the amount of disposable products with reusable products to save hundreds of thousands of dollars each year.

Census is the driving factor in the decision making process. Understanding that communities can implement renovations and improvements to drive the increase in census, many communities are seeking to provide state-of-the-art facilities with optimal provisions for specific demographics or diagnosis's. For example, there has been a significant increase in the diagnosis's of dementia. Because of this, companies are consistently researching how to create the best environment for such a patient and adding everything possible to set them apart from their competitors. Many of the assisted living facilities in Florida are adding dementia or memory care neighborhoods that specialize in meeting the needs of individuals with dementia at a higher level of care cost while also offering an assisted living environment for individuals that require much less care. By creating more specialized care, census counts tend to increase. These improved offerings allows the community will see firsthand how the senior living facility has improved and cares about its patients and that will result in an increase of faith in the community. With the increased faith, the communities then contribute to a large marketing group and/or firm for increased visibility and advertising. In doing so, individuals are reached that may not reside in or near the actual community.

There will always be problems with running senior healthcare facilities, however the solutions mentioned herein can minimize unexpected and expected outcome by administering detailed procedures to help. Additionally, it is the responsibility of everyone involved to assist the facilities in staying open, remaining compliant, and maintaining a stable health environment that can be marketed as such. The foundations leaders are responsible for having a solid understanding of the state laws and regulations, as well as a working understanding of the companies policies and procedures. Most importantly, the companies' stakeholders, employees, and community have to coordinate a combined understanding of the facility's mission to ensure its survival. The solutions are not impossible, but require creativity and a commitment to critical thinking on all parts to ensure it can be done effectively.

References

Adult Protective Services. (2014, October 17). Retrieved March 14, 2015, from http://www.myflfamilies.com/service-programs/adult-protective-services

Augustsson, H., Törnquist, A., & Hasson, H. (2013). Challenges in transferring individual learning to organizational learning in the residential care of older people. Journal of Health Organization and Management, 27(3), 390-408. doi:http://dx.doi.org/10.1108/JHOM-Sep-2012-0163

Hellriegel, D., & Slocum, J.W. (2011). Organizational behavior (13th ed.). Mason, OH: Cengage Learning

Nystrom, P. C. (1993). Organizational cultures, strategies, and commitments in health care organizations. Health Care Management Review, 18(1), 43. Retrieved from http://search.proquest.com/docview/194729263?accountid=158297

Vandenberghe, C. (1999). Organizational culture, person-culture fit, and turnover: A replication in the health care industry. Journal of Organizational Behavior, 20(2), 175-184. Retrieved from http://search.proquest.com/docview/224881038?accountid=158297

Ziegenfuss, J. T., J., & Bentley, J. M. (2000). Implementing cost control in health care: Strategies driven by an organizational systems approach. Systemic Practice and Action Research, 13(4), 453-474. Retrieved from http://search.proquest.com/docview/211465367?accountid=158297

Zinn, J. S., Mor, V., Castle, N., Intrator, O., & Brannon, D. (1999). Organizational and environmental factors associated with nursing home participation in managed care. Health Services Research, 33(6), 1753-1767. Retrieved from http://search.proquest.com/docview/211737853?accountid=158297
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Operating cash flows (net income plus amortization and depreciation) minus capital expenditures and dividends. Free cash flow is the amount of cash that a company has left over after it has paid all of its expenses, including investments. Negative free cash flow is not necessarily an indication of a bad company, however, since many young companies put a lot of their cash into investments, which diminishes their free cash flow. But if a company is spending so much cash, it should have a good reason for doing so and it should be earning a sufficiently high rate of return on its investments. While free cash flow doesn't receive as much media coverage as earnings do, it is considered by some experts to be a better indicator of a company's financial health.

Read more: http://www.investorwords.com/2084/free_cash_flow.html#ixzz2baZ3iDHE

Operating cash flows (net income plus amortization and depreciation) minus capital expenditures and dividends. Free cash flow is the amount of cash that a company has left over after it has paid all of its expenses, including investments. Negative free cash flow is not necessarily an indication of a bad company, however, since many young companies put a lot of their cash into investments, which diminishes their free cash flow. But if a company is spending so much cash, it should have a good reason for doing so and it should be earning a sufficiently high rate of return on its investments. While free cash flow doesn't receive as much media coverage as earnings do, it is considered by some experts to be a better indicator of a company's financial health.

Read more: http://www.investorwords.com/2084/free_cash_flow.html#ixzz2baZ3iDHE

If a company increases its sales, and no other factors change, the company will earn more profit. However, the company can decide to sell more products by making certain trade-offs, which will reduce the amount it earns on each product. The company's market share and total sales revenue might increase, but the company could still be worth less money.

Read more: http://www.ehow.com/info_7756766_possible-decrease-value-profitable-company.html#ixzz2banhbXNG

If a company increases its sales, and no other factors change, the company will earn more profit. However, the company can decide to sell more products by making certain trade-offs, which will reduce the amount it earns on each product. The company's market share and total sales revenue might increase, but the company could still be worth less money.

Read more: http://www.ehow.com/info_7756766_possible-decrease-value-profitable-company.html#ixzz2banhbXNG

1 Quality

• One method of increasing sales growth is to increase the quality of the product. For example, a restaurant can purchase higher-quality beef and bread to make sandwiches. If the restaurant doesn't raise its menu prices, it can attract more customers because it is offering a better deal. The restaurant may still earn less money because it is now paying more money to purchase food, compared to the amount it receives from each customer.

2 Large Clients

• A company can make more sales by selling[pic] products to large clients. Large clients have a strong bargaining position because of their volume purchases and may extract concessions from a manufacturer. The large client may agree to purchase a million units of a product, but only if the manufacturer lowers its prices by 10 percent.

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3 Supplier Limits

• Sales growth may require a manufacturer to use more resources than its current suppliers offer. According to the University of Vermont, this is a major issue for organic food companies. For example, if a company has a deal to purchase wood from a timber company so it can make chairs, and it starts selling more chairs, the timber company may not be able to provide additional wood. The company may have to purchase wood from another supplier that charges higher prices for the wood it sells.

4 Risky Clients

• A company can increase its sales by selling products to less reliable buyers. If a company only allows a buyer with a credit score of 700 to purchase goods on credit, it can increase its sales by allowing credit purchases for buyers with a score of 600. The company's sales will increase, but the company's earnings are less reliable because it may have more accounts receivable that it can't collect.

5 Loans

• A company often has to borrow money to finance an expansion. If the company needs to make a major investment such as a new office building or a new factory, it may need to issue millions of dollars of debt to make the purchase. Any ratio that relates to the company's debt changes, such as its debt to income or debt to equity[pic], can reduce the company's attractiveness to investors, decreasing its value.

Read more: http://www.ehow.com/info_7756766_possible-decrease-value-profitable-company.html#ixzz2baq3JnZ6