CASE STUDIES The Improvement of Pharmaceutical Services in a 173-1 The Development of a Physical Therapy Service in an 182-1 Case A: The Development of a Podiatric Program for an Case B: The Development of Podiatric Programs for the Rehabilitative Services for Speech, Hearing, and Language 200-1 GUIDE FOR USE OF THE CASES DEVELOPED FOR NURSING HOME ADMINISTRATORS Introduction The major responsibility of any administrator is decision making and action taking, based on the policies of his organization, resources open to him, and the implications for the future of his courses of action and decisions. He must develop skill in analyzing a situation, defining the problems, collecting the missing information, and in considering the various alternatives open to him with their probable consequences. the most promising alternative. Then he is in a position to select and apply In attempting to provide training in administrative skills, one of the most promising techniques has been the case method. Here, people are presented with specific problems in a real-life setting, they are provided with basic information needed, they are given access to other relevant sources of information, and are asked to analyze the situation, consider alternatives, and in effect solve the problem or decide on an approach and course of action toward solving the problem. The Cases in This Collection The cases included here are specific to the nursing home administrator and his problems. They grew out of concern for the many new problems of the nursing homes in attempting to meet the conditions for participation in the health insurance program for the aged known as Medicare and the medical assistance program known as Medicaid (Public Law 89-97, Titles XVIII and XIX). Many of the cases were developed by professionals in their areas of specialization, and thus communicate to the nursing home administrator or the student of nursing home administration the professional's view of his relationship with the nursing home. It is not suggested that these cases are all-encompassing. As many cases as there are problems could be developed to meet the needs of education and training in this area. --2- Background for the Cases It will be seen that the cases in this collection with few exceptions have a common setting, the Teaching Reference Community, Dixon, Tiller County/U.S.A. This is a hypothetical community developed in 1964 by the Communicable Disease Center, Public Health Service, Atlanta, to provide realism and perspective for study of community and health problems. The demographic characteristics of the City of Dixon, Tiller County, and Fernville in adjacent Bussel County, are described in narrative and statistical form, with full attention given to the areas that are significant from a public health standpoint. The Medical Profile contains that part of the data in the Teaching Reference Community of particular interest to the nursing home administrators in consideration of the cases included here. The background information in the cases is consistent with the description given in the Medical Profile, and no assumptions can be made of resources or health agencies existing other than those included. Other background materials which should be made available to groups using the cases are: 1. 2. 3. 4. Conditions of Participation; Extended Care Facilities, HIR-11, U. S. Principles of Reimbursement for Provider Costs and for Services by Association, January 10, 1968, pp. 137-141. The Format of the Cases For the most part, the cases in this group are of the "problem-solving" (Hamilton, 1960) type, and are directed to such significant present-day concerns of nursing homes as Utilization Review, Transfer Agreements, Policy Committees and Patient Care Policies, Restorative Services, Pharmaceutical Services, Reimbursement under the Health Insurance Program, etc. These are all areas in which standards have been set by law for participation of nursing homes in the federal health insurance program. The problems in the cases are stated in relatively brief form, with only enough background information to identify the setting and the events leading up to the statement of the problem. A question or set of questions follows. A discussion of each case, incorporating alternative approaches to the problem and a likely or possible solution has been provided, but as a separately collated part of the case. Often, supporting illustrative materials are included in this part of the case and references and other sources of information are cited. Where Cases can be Used The cases can be used in many different situations for a variety of purposes: For use in applying principles previously taught to practical As a basis for general discussion of problems the group members As illustrative materials in training for nursing home administration or in studying the Medicare and Medicaid provisions. As a basis for written reports or examination problems in an educational context. To provide a cumulative and inter-related series of problems |