Maunalani Nursing and Rehabilitation Center - Admissions Agreement

REALISTIC EXPECTATIONS

Maunalani Nursing and Rehabilitation Center is a skilled nursing facility (SNF). The majority of our residents are elderly, frail and unable to care for themselves. Many also suffer from confusion and may also have behavior problems and act in ways that would normally be considered inappropriate in general.

The purpose of this document is to give our residents and their representatives the information about the common risks that go along with living at this or in any nursing facility and understand how we care for residents with diverse needs.

RISKS

As committed and concerned as we are to protecting the physical, mental, and emotional well-being of all our residents, there are some risks that are unavoidable in any nursing facility. The following are a list of some of those risks. We have also included a short explanation of some of the most common interventions used by our facility to help minimize such risks. This information is to be used as a guideline only and is not intended to be a complete or exhaustive listing of risks, descriptions of risks or interventions used. These factors will depend on the residents involved, the individualized care plan, and a variety of other factors.

Skin Tears and Bruising

Description: Fragile and easily injured skin coupled with the use of equipment such as wheelchairs, lifts, walkers, etc, make the residents who are frail and unsteady on their feet prone to minor skin tearing or bruising.

Pressure Sores

Description: Pressure sores or pressure ulcers are injuries to bony prominences that break down when the area is pressed upon by the body’s own weight, depriving the area of blood and oxygen.

Falls

Description: Federal and state laws preclude Maunalani and other similar facilities from using restraints unless the resident is an immediate danger to himself or others. We have been actively working to become as “restraint-free” as possible. In this way, we believe that we are helping most residents to reach their optimum physical and mental potentials.

Mood/Behavior Problems

Description: While the facility may provide staffing at higher levels than State and National averages, and makes great efforts to provide as much staff supervision as is practicable, it is physically impossible for all residents to be directly monitored at all times. Therefore, residents with confusion and/or behavior deficits may occasionally pose a problem for themselves or other residents. This behavior can consist of walking into other residents’ rooms without being invited, touching property that does not belong to them and talking to residents who do not wish to converse. In some circumstances, confused or cognitively-impaired residents may strike out at others or be verbally inappropriate.

ALTERNATIVES

While the above outlines the risks involved in being a resident at any long-term care facility, there are alternatives. If a resident or a resident’s representative does not wish to assume the risks mentioned above, we will be happy to discuss the possibility of placement elsewhere. For example, there are facilities that specialize in caring for residents with behavior problems. In some cases, a home setting with assistance from home health agencies may be an option. Residents and representatives can also decrease the likelihood of the above listed risks by employing private duty “sitters” or even utilizing family members who will sit with residents around the clock or at designated times during the day at the facility. These services are not reimbursed by Medicare/Medicaid and therefore must be absorbed by the resident or other alternative sources.

One of the most important alternatives to consider is that of the resident’s representative remaining active in the care of their loved one while he/she is a resident at the facility. Participating in resident care conferences and communicating areas of concerns to us will help to accomplish this. We are always available to listen.

SERVICE LIMITATIONS

The services provided by Maunalani Nursing and Rehabilitation Center are not designed to protect the resident from the everyday, normal risks and responsibilities of living, including, but not limited to such general accidents and situations as falling or slipping from a standing, lying or sitting position, falling or slipping from surfaces (for example bed to chair) or other types of accidents such as choking on food. Additionally, the resident/family understands that the services provided by the facility do not include 24 hour, one-on-one, monitoring of its residents. If a resident’s or a resident’s legal guardian desires one-on-one private duty care, our social services department can assist you with information and guidelines on securing a private duty aide.

Even when continuous 24-hour one-on-one care is provided on a daily basis, such care can only help reduce, not eliminate, the risk of accidental injury or death of a resident. We will do our best to keep our residents safe but, we cannot guarantee absolute safety.

REFUSAL OF SERVICES

The facility will make good faith efforts to provide services to the resident as are routinely provided, including those prescribed by the resident's attending physician. However, the facility shall not be responsible for adverse outcomes associated with a resident refusing to comply with such services. Should a resident refuse food, fluids, treatments, therapies, medications, grooming, bathing, etc., and/or refuse to comply with the physician's orders, the facility shall in no way be responsible for the outcome associated with the resident's behavior. This shall apply both to mentally competent and incompetent residents. The resident and representative are strongly encouraged to participate in the planning of the resident's care, both with the attending physician and the facility.

The resident and resident's representative acknowledge that they accept and commit to a reasonable expectation of service and care to be provided by and received from the facility. Further, the parties hereto consent to the admission into evidence of this Admission Agreement Addendum, in the event of arbitration or any other form of legal or administrative proceeding.

I acknowledge that I have received the foregoing Admission Agreement Addendum for: