Lawyer Monthly Magazine - April 2019 Edition

however, the resident may not agree. Many people want to be involved in decisions regarding their health care and physicians need to spend time with the resident to educate them on different treatment options, side effects, and prognosis and allow the resident to make the decision that is best for them, even if the physician disagrees with that decision. Even residents with dementia have rights and the ability to participate in some decisions. For instance, a 95-year-old diabetic resident may want to forego a diabetic diet and eat a piece of pie now and then. A resident with cancer may want to pass on chemotherapy, even if there is a potential for a cure. All of these decisions are personal decisions and the resident should be respected and his or her opinions should be worked into a plan of treatment. At the end of the day, residents have to right to refuse care and this is a factor that has to be considered in legal cases. Do you think there need to be tighter assessments to ensure standards of care are met? I do think tighter assessments need to be made to ensure standards of care are met. The starting point of care is to observe the whole resident from head to toe with a comprehensive assessment. Once a good assessment is done and care needs are identified, caregivers need to understand what outcomes of care the resident wants or expects. The plan of care should include the resident’s desires when developing the interventions. Next caregivers should observe the resident for changes from the baseline. I am talking about non-medical observations of the entire person, such as: redness on pressure points indicating the beginning of skin breakdown, coughing frequently during meals, difficulty swallowing, changes in eating patterns, change in level of alertness, new or worsening pain, swelling of the feet, no bowel movement for four days, etc. Caregivers notice subtle changes sometimes long before they become significant medical problems, but they get so busy they often times forget to tell someone about an observation that may or may not be significant. I find when asking the caregiver, they know more about the resident than anyone about small subtle changes. For instance, I may ask, “How is Mrs Smith today?” and get a response back of “Oh she’s fine maybe just a little tired this morning.” But when I dig into more specifics and ask “How much did she eat at breakfast?”, or “Did her skin have any redness this morning?”, or “When was her last bowel movement? Is she more confused today than normal?”, I find that the caregiver can go into great detail and give me lots of information. Caregivers need to be taught the changes they should notice and have a designated person to communicate with so necessary medical treatment can be accessed quickly. What do you think makes a good expert witness? I think the best experts are the people with a lot of hands-on experience who remain active in their field. Many times I see an expert who is an academic, but has not practiced in years, and cannot relate to current practice. A good expert is impartial, focuses on the important aspects of the case and looks at the evidence thoroughly. The expert has to have the ability to write and articulate their opinions in a manner that is concise and easily understood to the layperson. Contact Cyndy Minnery RN, BSN RCFE Management Group cyndy@minnery.net 760 454-9893 About Cyndy Minnery Cyndy Minnery has been a Nurse for 38 years and started working in Inten- sive Care and Acute Care Hospitals in 1980; she then moved into Skilled Nursing Facilities where she became a Licensed Nursing Home Administrator in 1986. She also worked in Home Health Care for a short time, but the majority of her professional career has been working in the Long-Term Care setting. Between 2008 to the present Cyndy owned and oper- ated 4 Residential Care Fa- cilities for the Elderly. Cyndy started work as an Expert in Long Term Care in 2012 and has since been retained on over 175 cases and working 50/50 between plaintiff and defense. “I think the best experts are the people with a lot of hands-on experience who remain active in their field” www. lawyer-monthly .com 87 Expert Witness APR 2019