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UAB Disability Justice Program

UAB Disability Justice Program. Members: Jefferson County Medical Examiner UAB Dept. of Pathology Office of the Jefferson County District Attorney UAB Dept. of Justice Science Cumberland Law School Alabama Dept. of Mental Health and Mental Retardation.

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UAB Disability Justice Program

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  1. UABDisability Justice Program Members: Jefferson County Medical Examiner UAB Dept. of Pathology Office of the Jefferson County District Attorney UAB Dept. of Justice Science Cumberland Law School Alabama Dept. of Mental Health and Mental Retardation

  2. Outline of Civil Monitoring of Residential LTC Facilities

  3. Outline of Civil Monitoring of In-home Services

  4. Sites of Dying in the U.S. • 56% - Hospital • 21% - Home • 19% - Nursing Home • 4% - Other CDC Statistics 2002

  5. The Reverse Abuse Pyramid 1999 Statistics (n=17 states) • 32.0 / 1,000 – prevalence • 8.6 / 1,000 – reports • 5.5 / 1,000 – investigations • 2.7 / 1,000 – substantiation • ? - prosecution • ?? - conviction • ???- autopsy Am J. Public Health 2003;93(12):2131-6.

  6. Outcome of Abuse • X3  Mortality •  Nursing Home •  Medical Morbidity JAMA 1998;280:428-43

  7. 13-Year Mortality for Mistreated Elders (% Living) • 9% - Abuse victims • 41% - Morbidity Matched Comparison JAMA 1998;280:428-43

  8. Abuse Screening • 70% - abuse detected vs 30% self-report • 10 - validated instruments • 2% - report by MD JAGS 2004;52:297-304

  9. ME Facts on Nursing Home Abuse • 10% - Employees with criminal history • 1/3 – cited for abuse • 10% - employees admit to abuse • 44% - residents describe abuse/neglect • 1/2 - families unwilling to complain

  10. Conclusion • Confused persons don’t report. • Untrained workers struggle to gather information. • Law enforcement receives conflicting information.

  11. Nursing Home Survey Terminology and Procedures • MDS – minimum data set • RAP – resident assessment protocol • Incident report • Annual Survey • Deficiency • Jeopardy / decertification

  12. Psychopathology in NH Residents • 67-80% - cognitive impairment • 10-20% - depression • 3-7% - delirium Textbook of Geriatric Psychiatry

  13. Post Mortem Findings in 52 Demented Elders ARCH Path Lab Med 2004;128:32-38

  14. Seven Deadly Sins of Long-term Care 1. Dehydration 2. Malnutrition 3. Decubiti 4. Lethal Accidental Injury 5. Adverse Drug Reactions 6. Behavior Management Catastrophes 7. Systematic Abuse and Neglect

  15. Feeding Problems with Dementia • 50% unable to feed self at 8 years • 85% institutional residents refuse food Am. J. AD & Rel. Disor 2004;19(1):24-30

  16. Staffing and Feeding • 1:3 - Desired staff / resident ratio • 1:9 - Daytime • 1:12- Nighttime meal www.cmwf.org

  17. Accuracy of CNA Estimate for PO Resident Intake* • 22% - Overestimate • 53% - Missed residents with below 75% consumption *Video Technique JAGS 2000;40:209-213.

  18. Staffing in Nursing Home • No specific minimum for CNA • 3.5 contact hours for any nursing over 24 HS Burger et al. Comm. Fund Report, 2000

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