Principles of Board Member Ethics

By Rita Daniels,2014-05-09 21:53
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Principles of Board Member Ethics

    Principles of Board Member Ethics

    National Association of Long Term Care Administrators

    Model Code of Conduct


    The purpose of the code is to instill and assure the public’s trust and confidence in its regulatory boards for licensed nursing home administrators and assisted living administrators.

    Trust must embrace the integrity of the people who serve on those boards, including the qualifications for public service that attracted their appointment to the state board.

    This model may be used as a set of expectations held by a state or jurisdictions, (here after referred to as states), regulatory authority for administrators that can assist individual board members and their Executives in their decision making. This tool can be further used to support recruitment and selection of members for the regulatory board by providing a mechanism to review potential board member selection. Conversely, the Code can also provide a rationale for the removal of board members whose service does not meet expectations or its otherwise

    unacceptable. The intent of this project is to provide context for state agencies to excerpt information and parts of the whole which leads to even stronger state boards and executives.

    This code does not carry the force of law, however, it may be used to provide practical detail to enhance state law, rules or regulations that address ethics and other areas pertinent to board service. NAB acknowledges the FARB Model Code of Conduct, written by Dale Atkinson, used extensively to recreate this specific NAB model code for states to edit, copy, implement all or portions of the model.

    Founding Principles

    ; The mission of a regulatory board for a licensed administrator is to ensure that the public

     will have access to competent, safe, and ethical administrators.

; Members of a regulatory board must familiarize themselves with the laws, rules,

     regulations, policies, and procedures that govern their service on the board.

    ; The work of regulatory boards for the licensed administrators is public service, not private

     interest or group advocacy.

    ; Performance of public service is a bestowed privilege, not an earned or inherited right, thus, all

     who serve do so at the pleasure of their appointing authority.

    ; Regardless of whether a member of a regulatory board for a licensed profession is a licensee

     in that or some other profession, a consumer, or any other type of member, it is essential

     for each board member to represent the public; that is, all of the people.

; Members of regulatory boards must strive beyond the norm to avoid any actual or

     perceived conflict of interest that may compromise the integrity of the board.

    ; Members of regulatory boards must strive beyond the norm to avoid any relationship, activity

     or position that may influence, directly or indirectly, the performance of his or her

     official duties as a board member.

    This Board Code of Ethics presents expectations for public service by members of the

    states long term care administrators’ board in four areas:

     1) Personal Qualities

     2) Board Decisions and Actions

     3) External Activities and Relationships

     4) Accountability

1) Personal Qualities:

    Personal qualities form the composite qualities of any group. Therefore, the recruitment and selection of group members is tantamount to the group’s fulfillment of its purpose. Members of regulatory boards must personify a set of qualities particularly and conspicuously consistent with public service.

    This section of the Code describes that set of personal qualities identified by regulators as those most likely to instill and assure the public’s trust and confidence in its regulatory boards for the licensed professions.

2) Board Decisions and Actions:

    Board decisions and actions must always be in the interest of the public; that is, for the common good, not just for the good of some. A board whose decisions and actions benefit the profession at the expense of the consumer or other groups cannot sustain public trust or confidence in its work. Eventually, the purpose of such a board will be revealed, not as protection of the public, but as protection of the profession. Actual or perceived, such a purpose is not merely inappropriate for a public regulatory body, but may be in violation of statutes governing the activity of such bodies. Also, the processes by which regulatory boards make their decisions and take their actions should be matters of public record and, in many jurisdictions, are subject to open meetings laws. This

    section sets forth expectations that may reasonably be held by the public for the activities of its regulatory boards for the licensed profession.

3) External Activities and Relationships:

    In most cases, the external activities and relationships of members of any group have the potential for enriching the contributions of the group’s members. However, governmental bodies constituted in law for the good of the general public must function in accordance with their statutory purpose. Moreover, their ability to function must be free from any influence external to the group, be it personal, financial, or otherwise that may conflict with the achievement of the statutory purpose. As governmental bodies constituted for public protection, regulatory boards for the licensed professions must exercise uncommon caution to avoid, declare and reconcile any actual or apparent conflicts of interest or affiliations of their members. In this regard, members of regulatory boards for the licensed profession are held to a higher standard of service than members of many other groups. This section outlines the areas of potential conflict of interest for board members as well as the actions the public can reasonably expect a board to take in order to avoid, declare or reconcile such conflicts.

4) Accountability:

    Ethical boards are accountable to those they serve. A dedicated and purposeful effort must be made to seek out the ideas and concerns of the public and the licensees. Secondarily, but also important, feedback and involvement must be solicited from the appointing or electing authority, legislature, and the regulated profession. This section outlines some areas which should be evaluated periodically by the regulatory board. It is the sincere hope of the Federation of Associations of Regulatory Boards (national collaboration of licensing boards) and NAB (National Association of LTC Administrators) that this document contributes to promoting the highest standards for selection of and service by the members of regulatory boards for the long term care administrator state boards. The vision is that this Code may play a part in enhancing the public trust in your state board, and ultimately, in ensuring that all citizens will have access to competent, safe, and ethical leadership in the long term care centers throughout the nation. NAB indirectly influences quality care by requiring highly trained and effective leadership of long term care centers and holds the administrator ultimately accountable for the operational excellence found in residentially based housing with services and skilled nursing facilities.

Personal Qualities



    A human organization cannot function with ethical integrity unless the people at its core are themselves fundamentally ethical. Core persons in an organization set the tone, create the leadership direction, and personify the organization’s messages heard by everyone, internally and

    externally. People at the core of government organizations in a democracy have an added responsibility regarding ethical integrity: they are elected or appointed to uphold public trust.

    Those persons so elected or appointed assume the lofty and highly visible responsibilities of public servants. The fiduciary relationship that characterizes public service exists between the public and all of the people and their organizations equally.

    Therefore, long term care administrator regulatory boards should be constituted to represent:

    1. The general consumer population of the regulated jurisdiction to the extent possible,

    including gender, race, ethnicity, religion, disability status, geography, socioeconomic level,

    and military service, and any other group historically under-represented in the particular

    professions to ensure that the services of the profession are accessible to all;

    2. The profession and its practices, including specialization practice areas, philosophical

    bases, practice settings, professional education programs, membership organizations, and

    research to ensure that regulatory decisions and actions take into consideration the full

    context of the profession, not just part of it; and

    3. The electing or appointing authority as a public regulatory body carrying out the

    designated mission of ensuring the public health, safety, and welfare.

    An election or appointment to a regulatory board should be based on broad and open recruitment of individuals whose conduct personifies those qualities identified as particularly suited to public service. The personal qualities of an individual that constitute appropriate attributes for public service on a regulatory board for a profession are fairly uniform across professions and jurisdictional boundaries. Identification of those qualities by electing or appointing authorities is essential to ensuring the integrity of the body whose members conduct the work of regulating the professions in the interest of public health, safety and welfare.

    To assist electing and appointing authorities in their efforts to identify qualified individuals, this section of the Code describes those personal qualities deemed most likely to instill and ensure the public trust and confidence in its boards and their members who regulate the licensed professions.

    Personal Qualities of Members of Long Term Care Administrators Regulatory Boards

I. Integrity

    A. Has no criminal professional misconduct record, nor is under current investigation of

     charges or complaints, and has an acceptable malpractice history.

     B. Possesses sound moral principles, e.g. is upright, honest, sincere.

     C. Has courage of convictions to withstand pressures to be swayed from public protection


     D. Is honest about personal agendas and leaves them outside the boardroom.

     E. Reveals any actual or perceived conflicts of interest to appropriately recuse self from

     decisions or actions in those areas of interest.

     F. Maintains confidentiality associated with examinations, disciplinary proceedings, and

     other pertinent matters.

II. Service

     A. Seeks and finds personal gratification through service to others.

     B. Is available for all regulatory activities, to be called on short notice, to travel, to be

     flexible in scheduling commitment and handling cancellations, and is not over-

     booked with other obligations.

     C. Provides accurate and timely submissions of reports, vouchers and other

     documentation associated with board service.

III. Sacrifice

     A. Tolerates inconvenience, frustration, and scheduling conflicts to be available for board


     B. Subjugates own need gratification to the greater good and, consequently, postpones,

     minimizes or forgoes it altogether.

     C. Rises above temptation for personal gain and avoids mutual benefit transactions

     available to private sector leaders that would pose conflicts of interest in the public


IV. Vision

     A. Uses knowledge of regulatory history, concepts and rationale, including law, rule,

     regulation, and administrative policy, to articulate ideas and plans for refining,

     enhancing and developing measures of public protection, standards of licensure

     and practice, and systems for regulating administrators.

     B. Acts as a role model for the profession and general public by discussing and presenting

     Board mission and function in the community whenever appropriate.

     C. Encourages public awareness of the standards and legal requirements of professional

     credentials, practices and conduct.

V. Commitment

     A. Understands and embraces the central mission of the regulatory board as protecting the

     public, not advocating for the profession.

     B. Demonstrates interest and ability in learning about administering law, rule, regulation,

     policy and the necessary protocols and procedures.

     C. Abides by the legal and ethical responsibilities associated with board membership.

     D. Remains current with cross-professional issues and trends inside and outside the


VI. Consumer Advocacy

     A. Has experience in consumer advocacy and/or civic or public service organizations.

     B. Actively seeks to provide relevant information about professional practice and regulation

     to the consumer public and its organizations, including the soliciting of consumer

     concerns and ideas.

     C. Provides appropriate nominations of individuals qualified to be consumer/public

     members of the board.

VII. Diversity and Inclusiveness

     A. Values diversity of board membership representative of the general population in the


     B. Actively promotes representative diversity in the profession with the understanding that

     such diversity not only ensures inclusive and comprehensive decisions and

     actions by the board, but also maximizes the opportunity for all people to be able

     to access needed services of the profession.

     C. Operates primarily on the basis of consensus-building, cooperation, conflict resolution

     and team efforts, not individualism, egotism, factionalism, charisma or


     D. Accepts conflicts as they arise in the normal course of events and approaches them as

     opportunities for greater understanding, team-building and improved functioning

VIII. Fairness and Balance

     A. Is deliberative, not quick to judge, and approaches the work of the board without bias,

     dispassionately, disinterested, and dissociated from positions on partisan issues

     B. Respects the rights of all parties

     C. Is mindful of standards and strives to interpret them to be as inclusive as possible, not


     D. Understands the difference between high and minimally acceptable standards of

     competence and practice

     E. Understands and applies processes and procedures uniformly to all

Board Decisions and Actions



    Board recommendations, decisions, and disciplinary actions constitute almost all publicly visible and legally scrutinized regulatory activity. Consequently, all such activity needs to meet with the highest standard of ethical conduct possible. Boards whose recommendations, decisions, and disciplinary actions benefit the profession at the expense of the consumer cannot sustain the public trust, and violate their ethical and legal charge to protect the public.

    The first of the following four sections, General Considerations, must be understood and referenced through the remaining three sections.

I. General Considerations

     A. Overall principle: Ethical conduct begins with each regulatory board meticulously

     following all laws which govern its recommendations, decisions and disciplinary


     B. Jurisdictions: All regulatory boards function under laws, rules, regulations written within

     their respective jurisdictions and/or “umbrella agencies”

     C. Scope: Such laws may be:

     ; International

     ; Federal or national

     ; State, province, territory, commonwealth, district

     ; County, parish

     ; Municipal

     D. Sources: Such laws may be found in different sections of each jurisdiction’s codes, and

     must be reviewed frequently:

     ; R.I.C.O., racketeering, or anti-trust

     ; Bribery or corrupt influence

     ; Criminal

     ; Administrative procedures or other “umbrella” agency

     ; Ethics

     ; Conflict of interest codes or guidelines

     ; Equal opportunity

     ; Americans with Disabilities Act

     E. Manner of conflict: All board recommendations decisions, and actions must be

     conducted in as fair, equitable, impartial, and non-partisan manner as possible. It

     must also be noted that each board’s reputation is largely created by the staff who

     first encounter the public and the profession.

     ; Board members and staff must represent the highest standards of ethical and

     professional conduct

     ; All board activity must be carefully documented and well organized for future

     reference and scrutiny

     ; Board members must ensure that both the professional and public members of

     the board are equal partners with unique perspectives, who value one

     another’s insights, comment, and experiences

     ; Board members must not serve as spokespersons for the board unless properly designated by the board

II. Board Recommendations

     A. Advice on legality and propriety: Licensees will occasionally query boards about

     the legality and propriety of certain procedures and activities. Whenever

     possible, boards should define clearly what is acceptable and

     unacceptable. Boards, must at the same time, refrain from pre-forming,

     pre-judging, or freely giving legal opinion or advice. Information can be

     communicated to the public through:

     ; Rules and Regulations

     ; Public forums or focused hearings

     ; Newsletters

     ; Attorney general or counsel office opinions

     ; Internet websites

     ; Position papers

     B. Establishing professional code of ethics: Boards may wish to consider helping

     to create a national or international code of ethics. NAB has adopted the

     American College of Health Care Administrators as the professional code

     of ethics.

     C. Equivalent licensure criteria: To fairly and ethically address concerns relating

     both to protecting the public and assuring access to qualified practitioners,

     boards may wish to consider recommending that their jurisdiction’s

     licensure criteria become comparable or equivalent across jurisdictional

     boundaries. This may serve to assure the public of acceptable levels of

     training and experience as well as potentially to permit greater

     inter-jurisdictional mobility.

     Areas of interest include:

     ; Adoption of national examinations where available and appropriate

     ; Adoption of uniform pre-professional criteria, with time-frames reflecting

     changing requirements

     ; Adoption of a standard number of years in practice for endorsement/reciprocity

     ; Determination of acceptable prior malpractice history through appropriate

     profession-specific or inter-professional databanks (e.g., CIN-BAD, NPDB)

     D. Criteria for removing members: boards may wish to consider developing and

     standardizing criteria for recommending the removal of non-contributing or

     ethically compromised board members. It is noted that board membership

     frequently occurs as an extension of the political process, along with

     its implied limitations.

III. Board Decisions

     A. Focused on mission: All board decisions must be made with the primary mission

     squarely in mind: Each board is charged, in some fashion or language, with

     protecting the public; all other considerations become secondary.

     B. Boards part of larger regulatory community: All board decisions must be made with the

     awareness of the responsibility each board has to the larger regulatory community.

     Board responsibility does not end at the jurisdictional or professional border.

     C. Reporting board actions: Whenever and wherever legally appropriate, information on

     board decisions and actions should be reported:

     ; To the general public (through rules and regulations, public forums or

     focused hearings, newsletters, Internet websites)

     ; To all licensees

     ; Appropriate profession-specific, inter-jurisdictional or inter-professional


     D. Reporting criteria: Boards must be aware of reporting criteria to each appropriate

     professional databank, and be aware of possible overlap when some licensees

     may be practicing in more than one discipline.

     ; Be certain that all board decisions and actions are reported to the appropriate databank

     in a timely manner

     ; Access the information in the inter-jurisdictional databanks on a regularly scheduled


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