Hospital-to-Nursing-Home-Mary-Brooksby-2-18-11 by liuhongmeiyes

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									Law Offices of Mary Brooksby, PLLC
         3636 N Central Ave, # 820
                Phoenix, AZ 85012
                    602-200-5810




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 18 years or older
 Unable to protect him/herself
  ◦From abuse or neglect
 Because of a physical or
  mental impairment.



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 Federal  Laws – OBRA
 Arizona Laws – APSA
 Privacy Laws
 Criminal Laws
  ◦ Assault & Battery, Rape,
  ◦ False Imprisonment
  ◦ Extortion
  ◦ Etc.
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   Intentional inflection of physical harm

   Injury caused by negligent acts or
    omissions
     Medical malpractice


   Unreasonable confinement

   Sexual abuse or assault


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 CHILDREN/FAMILY/FRIENDS
 CHARITY AND RELIGIOUS
  SCAMMERS
 CON ARTISTS
 FINANCIAL ADVISORS
 GUARDIANS/ATTORNEYS
 CAREGIVERS



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 Bruises,welts, sores, cuts
  abrasions in places that
  they would normally be
  expected.
 Fractures
 Burns


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 Torn  or bloody underclothes
 Difficulty walking or sitting
 Withdrawn, shameful, anxious
  and fearful
 Unexplained genital infections
 STDs
 Pregnancy

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Ridicule/demean/threaten a
 vulnerable adult who is a
 patient or resident in any
 healthcare setting.



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 Caregiver stress
 Dependency/impairment of the
  adult
 Intergenerational violence and
  abuse
 Personal problems of the
  caregiver


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Apattern of conduct without
the person’s informed consent
resulting in deprivation of
food, water, medicine, shelter,
or other basic needs to
maintain minimum
physical/mental health.

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 Pressure sores
 Unkempt, dirty, body odor
 Clothing is insufficient
 Fleas and lice
 Malnourished and/or
  dehydrated

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 Theillegal or improper use
 of an incapacitated or
 vulnerable adult’s resources
 ◦Bank accounts
 ◦Property


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 Conned into withdrawing cash
 Not allowed to speak or make
  decisions
 Implausible explanations about their
  money
 Concerned or confused about missing
  money or property
 Identity theft



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 Anyone  can report
 Healthcare providers
  have a duty to report
 Report timely
 Crime for failing to report


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 Division   of Aging and Adult
  Services
 www.azdes.gov or


 877-SOS-ADULT




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 Four  Scottsdale Healthcare
  Osborn employees were charged
  with misdemeanor counts of
  failing to report alleged sexual
  abuse.
 If convicted, they would face fines
  of up to $2,500 and up to six
  months in jail.

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 Long-term  Care
  Ombudsman
 Attorney General
 Police
 Family Doctor
 Family


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 Fear of retaliation
 Fear of not being believed
 Fear of institutionalization
 Fear of the criminal system
 Fear of isolation
 HCPs do not want to get
  involved.
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 APS  Registry
 Loss of facility license
 Loss of professional
  licenses
 Civil and criminal liability
 Fines and other penalties


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 Ifa lawsuit is filed or an
  administrative action, notify
  Attorney General
 AG keeps a registry of adult
  abuse and abusers


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 Only 15 % of the time did Arizona
  substantiate allegations of abuse,
  neglect or other problems in how
  nursing homes cared for vulnerable
  adults
 Arizona fined poorly performing
  homes only 24 times in 3 years even
  though it wrote 958 citations.
 The fines were only about $1,000


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 Requires a more thorough than
 usual initial assessment on arrival
 to identify:
 ◦ Signs of abuse
 ◦ Signs of neglect
 ◦ Signs of exploitation



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Should require examination
 of entire body
Document findings
Report signs of abuse
 immediately


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 Indicators:
 ◦Albumin
 ◦Pre Albumin
 ◦Weight loss
 ◦Skin turgor
 ◦Dry mucous membranes
 ◦Concentrated urine
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 Pressure  sores, arterial ulcers,
  stasis ulcers, venous ulcers,
  diabetic ulcers, skin tears,
  dermatitis, deep tissue injury,
  and maceration
 And try to determine the cause
  so that treatment can be
  linked
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 Location
 Stage
 Size – length, width, depth
 Exudate/drainage
 Tunneling
 Pain and swelling
 Type of tissue
 Odor
 Color

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   Each parameter is converted to a
    subscore
    ◦ Surface area in centimeters square
    ◦ Wound exudate amount
    ◦ Wound tissue type
    The three sub-scores between “0”
      (closed wound) and “17”.
    The scores are graphed and show
      trends over time


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 Can  distort
 Follow policy of institution
 If use a camera, make sure
  it has a grid or you use a
  ruler to show the size
 Lawsuit exhibits


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   Intact skin with non-
    blanchable redness of
    a localized area usually
    over a bony
    prominence. Darkly
    pigmented
   skin may not have
    visible blanching; its
    color may differ from
    the surrounding area.
    The area may be
    painful,
   firm, soft, warmer or
    cooler as compared to
    adjacent tissue.

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   Partial thickness loss of
    dermis presenting as a
    shallow open crater with
    a red pink wound bed,
    without slough.
   May present as an intact
    or open/ruptured serum-
    filled blister. May present
    as a shiny or dry shallow
    ulcer
   without slough or
    bruising.

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   Full thickness tissue
    loss. Subcutaneous
    fat may be visible
    but bone, tendon or
    muscle are not
    exposed. Slough
   may be present but
    does not obscure
    the depth of tissue
    loss. May include
    undermining and
    tunneling.
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   Full thickness tissue
    loss with exposed
    bone, tendon or
    muscle. Slough or
    eschar may be
    present on some
    parts
   of the wound bed.
    Often includes
    undermining and
    tunneling.
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   Full thickness tissue
    loss in which the base
    of the ulcer is covered
    by slough (yellow, tan,
    gray, green or brown)
   and/or eschar (tan,
    brown, or black) in the
    wound bed. Until
    enough slough and/or
    eschar is removed to
    expose
   the base of the wound,
    the true depth and
    therefore stage, cannot
    be determined.

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   Purple or maroon
    localized areas of
    discolored intact skin,
    or blood-filled blister
    due to damage of
    underlying
   soft tissue from
    pressure or shear. The
    area may be preceded
    by tissue that is
    painful, firm, mushy,
    boggy,
   warmer or cooler as
    compared to adjacent
    tissue.
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Lynnette Sommars, RN DON




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   Institutionalization of the Elderly
   Restraints
   Psychotropic Medications
   Inexperienced Nurses
   Disregard for quality
   Odors, bed sores, falls, fractures, infections




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 You may hear them referred to as
 SNF’s
 Nursing homes
 Long term rehab
 Long term care




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   Negative attitudes towards nursing homes
   Groaning about nursing home patients
   Looked down upon nursing home nurses
   They “let” them fall out of bed
   They ignore symptoms such as dehydration,
    confusion, etc.
   Doctor doesn't’t have time for them




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Omnibus Act 1987
 Rules that were developed by consumers,
 federal and health care professionals to
 ensure that Nursing Homes become an
 environment to ensure that a “resident”
 receives medical, physical, and psychosocial
 services to achieve highest level of well-
 being.




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The Health Care Finance Administration
(HCFA), which today is known as the Center
for Medicare and Medicaid Services (CMS)
enacted those rules. From that point a 48
page rule book has evolved into over 700
pages, a structured inspection process, a
system where upon negative care outcomes
are penalized even if they do not occur but
have the “potential” to occur. And is ALL
transparent for consumers to review!




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   87% of America’s Nursing Homes receive
    State Medicaid monies, at approximately
    $122.00/ day for each resident. These
    monies must be utilized to:
    ◦ Maintain home, utilities, and functional building
      needs
    ◦ Hire qualified staff
    ◦ Maintain health and prevent negative resident
      outcomes.




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   Less than 8% of America’s Nursing Homes
    can not meet these rules and their stories
    make front page news.

   92% of America’s Nursing Homes ARE
    getting the job done but their stories NEVER
    make the front page news!




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   Staffing in a typical Nursing Home:
    ◦ 1 RN: 24hr/ day ( RN is usually in management
      position AND is responsible to assess change in
      condition per Scope of Practice rule) a Registered
      nurse is only required to be working 8/24 hours daily
    ◦ 1 LPN: per 24 residents on day/ evening.
    ◦ 1 LPN: per 40 residents on night shift.
        Night Shift- State Rules: “No more than 63 patients!
    ◦ 1 C.N.A.: per 10 residents on day shift
    ◦ 1 C.N.A: per 16 residents on evening shift
    ◦ 1 C.N.A.: per 25 residents on night shift



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   Ability to identify exacerbation of disease process ( each
    resident has >10 co-morbidities).
   Ability to administer medication to their assigned
    residents, who receive >9 medications each, and
    require special techniques for them to accept them.
   Ability to be compassionate at ALL times and
    understand that spitting, screaming, fighting,
    scratching and punching is a “form of communication”
    that means something IS wrong and the Nurse MUST
    figure it out.




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   Complete daily charting; there are no computers!
   Complete admissions, discharges, transfers,
    appointments and ensure transportation
    arrangements.
   Complete full comprehensive assessments on ALL
    residents every 90 days and write/ review care plans.
   Direct C.N.A.s to complete daily assignments, bathing,
    feeding, toileting, return to bed and also gather data
    and communicate changes in resident condition.
   Complete all diagnostic requests, draw labs, watch for
    results, and notify physician.




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   100% influenza/ pnuemovax administration compliance.
   Maintain < 5% occurrence rates for
    ◦ Pressure sores
    ◦ Falls
    ◦ Physical function decline
    ◦ Cognitive decline
    ◦ Infection rate
    ◦ Foley Catheter Usage
    ◦ Weight Loss
    ◦ Psychotropic Drug Use
    ◦ AND MUST not have a SENTINAL Event: fracture,
      dehydration or fecal impaction.


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   They communicate with the non-English
    speaking, mentally ill, and the deaf.
   They get their hair pulled, spit at, and things
    thrown at them.
   Skilled nurses are given the opportunity to
    develop loving and lasting relationships with
    the individuals and their families.
   They makes us laugh, they make us cry.




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   The law gives special protection to children,
    elderly and disabled
   If negligence found:
    ◦ Punitive damages
    ◦ Attorneys fee
    ◦ Institutional fines and penalties
    ◦ Criminality including jail time

    BE CAREFUL OUT THERE!


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   Representation of hospitals, nursing homes,
    home health organizations, and health care
    providers.
   Offices in Phoenix and Payson, AZ
   Attorneys:
    ◦ Mary Brooksby: Mary@Brooksbylaw.com
    ◦ Don Stevens: Don@Brooksbylaw.com
   Professional staff
    ◦ Lynn Sommars: Lynn@Brooksbylaw.com
    ◦ Dan Brooksby: Dan@Brooksbylaw.com

                                      February 18, 2011

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