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HOSPITALS AND NURSING HOMES

HOSPITALS AND NURSING HOMES. Law Offices of Mary Brooksby, PLLC 3636 N Central Ave, # 820 Phoenix, AZ 85012 602-200-5810. VULNERABLE ADULT. 18 years or older Unable to protect him/herself From abuse or neglect Because of a physical or mental impairment. ADULT ABUSE AND NEGLECT LAWS.

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HOSPITALS AND NURSING HOMES

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  1. HOSPITALS AND NURSING HOMES Law Offices of Mary Brooksby, PLLC 3636 N Central Ave, # 820 Phoenix, AZ 85012 602-200-5810

  2. VULNERABLE ADULT • 18 years or older • Unable to protect him/herself • From abuse or neglect • Because of a physical or mental impairment.

  3. ADULT ABUSE AND NEGLECT LAWS • Federal Laws – OBRA • Arizona Laws – APSA • Privacy Laws • Criminal Laws • Assault & Battery, Rape, • False Imprisonment • Extortion • Etc.

  4. WHAT IS ABUSE? • Intentional inflection of physical harm • Injury caused by negligent acts or omissions • Medical malpractice • Unreasonable confinement • Sexual abuse or assault

  5. ABUSERS • CHILDREN/FAMILY/FRIENDS • CHARITY AND RELIGIOUS SCAMMERS • CON ARTISTS • FINANCIAL ADVISORS • GUARDIANS/ATTORNEYS • CAREGIVERS

  6. PHYSICAL ABUSE SIGNS • Bruises, welts, sores, cuts abrasions in places that they would normally be expected. • Fractures • Burns

  7. SIGNS OF SEXUAL ABUSE • Torn or bloody underclothes • Difficulty walking or sitting • Withdrawn, shameful, anxious and fearful • Unexplained genital infections • STDs • Pregnancy

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

  9. CAUSES OF ABUSE • Caregiver stress • Dependency/impairment of the adult • Intergenerational violence and abuse • Personal problems of the caregiver

  10. NEGLECT • A pattern 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.

  11. SIGNS OF NEGLECT • Pressure sores • Unkempt, dirty, body odor • Clothing is insufficient • Fleas and lice • Malnourished and/or dehydrated

  12. EXPLOITATION • The illegal or improper use of an incapacitated or vulnerable adult’s resources • Bank accounts • Property

  13. SIGNS OF EXPLOITATION • 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

  14. REPORTING ABUSE, NEGLECT, EXPLOITATION • Anyone can report • Healthcare providers have a duty to report • Report timely • Crime for failing to report

  15. Arizona Dept of Economic Security • Division of Aging and Adult Services • www.azdes.gov or • 877-SOS-ADULT

  16. Failure to Report Abuse • 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.

  17. REPORTS • Long-term Care Ombudsman • Attorney General • Police • Family Doctor • Family

  18. WHY IS ABUSE NOT REPORTED • 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.

  19. IF VALID COMPLAINT • APS Registry • Loss of facility license • Loss of professional licenses • Civil and criminal liability • Fines and other penalties

  20. IF A LAWSUIT • If a lawsuit is filed or an administrative action, notify Attorney General • AG keeps a registry of adult abuse and abusers

  21. ARIZONA DAILY STAR APRIL 2008 • 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

  22. VULNERABLE ADULT IN HOSPITAL • Requires a more thorough than usual initial assessment on arrival to identify: • Signs of abuse • Signs of neglect • Signs of exploitation

  23. HOSPITAL POLICY Should require examination of entire body Document findings Report signs of abuse immediately

  24. LOOK FOR POOR NUTRITION and HYDRATION • Indicators: • Albumin • Pre Albumin • Weight loss • Skin turgor • Dry mucous membranes • Concentrated urine

  25. LOOK FOR SKIN BREAKDOWN • 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

  26. DOCUMENT WHAT YOU SEE • Location • Stage • Size – length, width, depth • Exudate/drainage • Tunneling • Pain and swelling • Type of tissue • Odor • Color

  27. NPUAP PUSH TOOL • 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

  28. PHOTOGRAPH DEBATE • 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

  29. NEW STAGING

  30. STAGE 1 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.

  31. STAGE 2 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.

  32. STAGE 3 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.

  33. STAGE 4 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.

  34. UNSTAGEABLE 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.

  35. DEEP TISSUE INJURY 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.

  36. Nursing HomesLong Term Care:Welcome to My World Lynnette Sommars, RN DON

  37. What many think about Nursing Homes • Institutionalization of the Elderly • Restraints • Psychotropic Medications • Inexperienced Nurses • Disregard for quality • Odors, bed sores, falls, fractures, infections

  38. We call them Skilled Nursing Facility You may hear them referred to as • SNF’s • Nursing homes • Long term rehab • Long term care

  39. General Consensus • 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

  40. What many need to Know 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.

  41. 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!

  42. Reality …. Let me set it straight • 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.

  43. Reality… • 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!

  44. Reality…. • 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

  45. Skills NH Nurses MUST Possess • 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.

  46. And they must also…… • 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.

  47. And accomplish….. • 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.

  48. Skilled Nursing • 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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