In this issue: • Welcome to Palm View pg. 2 • Chronic Disease Self-Management Program pg. 8 • Wound Care pg. 13
2013 Annual
Table of Contents Palm View Renovation . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Profile, Mission, & Values
Palm View Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Kissito’s mission is to exist for the betterment and care of human life. We are a not-for-profit healthcare provider committed to serving the needs of the geriatric population. We provide post acute care, chronic disease self-management, long term care, assisted living, Alzheimer/dementia care and specialized respiratory care in nine facilities in the U.S. We are committed to improving quality outcomes and lowering the risks of hospital readmission and mortality amongst the growing geriatric population - especially through the continued development of our Collaborative Patient Care Pathway™.
Rehabilitation: Kissito In-House Therapy . . . . . . . . . 5
Palm View Organizational Chart . . . . . . . . . . . . . . . . 4
Medical Director Profiles . . . . . . . . . . . . . . . . . . . . . . . . 6 Ronald Brooksher, M.D. . . . . . . . . . . . . . . . . . 6 Wissam Fayad, M.D. . . . . . . . . . . . . . . . . . . . . 7
Chronic Disease Self Management Program . . . . . . 8 Collaborative Patient Care PathwayTM . . . . . . . . . . 10 Steven Hahn, M.D. . . . . . . . . . . . . . . . . . . . 10 Angela Mattocks, RN, MHA, LNHA . . . . . . . . . . 11
As an organization that stays on the cutting edge, we are quickly developing the foundation for a continuum of care that will meet the needs of our patients. Through our collaborative efforts with leading academic medical institutions, we are designing Programs for All-Inclusive Care for the Elderly (PACE) that utilize home and communitybased services that allow patients to receive the care they need in their home versus the traditional facility model.
Melba’s Store. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Wound Care Program. . . . . . . . . . . . . . . . . . . . . . . . . 13 Kissito Healthcare International: Mission. . . . . . . 14 Where We Serve . . . . . . . . . . . . . . . . . . . . . 15
Kissito Healthcare Palm View 2013
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Welcome to Palm View
2013
ABOUT US
OUR PHILOSOPHY
The Palm View experience was uniquely designed to bring joy to the hearts of patients, residents, family caregivers, and our friendly staff. Newly renovated in 2011; Palm View boasts beautiful rooms, and spacious indoor and outdoor common areas. Therapy is available in a brand new 2500 square foot therapy annex and gives each patient 7 day a week access to the best equipment and therapy staff to insure their road to recovery is a fast and friendly experience.
Kissito’s mission is to exist for the betterment and care of human life. We are a nonprofit healthcare provider committed to serving the needs of the geriatric population in Yuma. Palm View patients have 45% less risk of returning to the hospital compared to the national average. This is because we have the most RN coverage of any facility, the county’s only board certified Geriatrician, and proven programs dedicated to keep patients out of the hospital.
3.5 million dollars will have been invested in renovating the 40,000 square-foot Palm View facility.
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Kissito Healthcare Palm View Services Offered Service for Moderate to Complex Medical Conditions
• Accommodates individual and cultural preferences
Rehabilitation Services • Occupational Therapy • Physical Therapy • Speech Therapy
24/7 Registered Nurse Coverage • Allows Palm View staff to administer IV fluids and IV medications at any time
Kissito In-House Therapy • Therapy designed exclusively for geriatric rehabilitation • Maximizes every patient’s potential and measures functional outcomes throughout the rehabilitation process • Measured outcomes related to performance-based goals
Flexible Payment Methods • Kissito is Medicare & Medicaid compliant • Kissito also accepts insurances and private pay
Secured Memory Care Unit • Includes memory care program to stimulate residents Collaborative Patient Care PathwayTM • Disease self-management, education and communication • Family-centered approach Resident Activities • Everyday activities structured around individual needs • Innovative programs designed to stimulate and engage each resident’s personal interests Unrestricted Visitation Hours
Wound Care Program • Certified wound care nurses • State of the art wound care equipment proven to heal wounds quicker than ever Four Medical Directors • Specialties include, plastics (wound care), geriatrics, internal medicine and family practice • Regular physician visits Private and Semi-Private Rooms Restorative Nursing Care Cardiac Management Social Services Respite and Hospice Care Vital Stem and E-Stem Therapy
Personalized Diet
Organization Chart
Kissito In-House Therapy Redefining the Road to Recovery
Chief Administrative Officer Medical Directors Director of Nursing Post Acute ADON LTC ADON MDS Coordinators (Post Acute & LTC’s) Post Acute Care Manager Director of Financial Services Accounts Receivable Accounts Payable/Payroll
Palm View’s rehabilitation program is created specifically for the geriatric patient. The program is designed to return patients to their prior level of function or optimal level of function as determined by a documented gathering of their history and a comprehensive screening of the patient’s current level. Based on the patient’s assessment, an individualized treatment plan is developed and integrated into an interdisciplinary care plan for that patient. In addition to a treatment plan, Kissito utilizes a motivational interviewing process to identify both patient and family caregiver concerns. These concerns are translated into goals and performance-based benchmarks are set. These goals and benchmarks become part of the patient’s road to recovery and becomes an integral measurement tool for determining that the patient is truly ready and safe to return home or to a lower setting.
At Kissito, the family is just as important as the patient. To keep responsible parties and families informed about patient progress, we offer outcome reports that showcase progress charts and therapist notes regarding each patient’s plan of treatment. This enables families and caretakers to see how their loved one is progressing in terms of their goals. Kissito is able to produce outcome reports for specialists, physicians and other involved healthcare providers. These reports feature outcome data broken down by patient, discipline, diagnosis and referral source. Outcome reports are available monthly and quarterly and are a great way to stay informed about patient results.
Palm View offers three major disciplines six days per week and by appointment on Sundays: • Speech Therapy • Occupational Therapy • Physical Therapy
Director of Food Services Cooks Director of Maintenance & Houskeeping Director of Marketing Director of Social Services Director of Admissions Director of Medical Records
Visit www.Kissito.org
Director of Rehab Director of Activities
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MEDICAL DIRECTOR PROFILES Ronald Brooksher, M.D.
MEDICAL DIRECTOR PROFILES Wissam Fayad, M.D.
Email: DocYuma@DocYuma.com | Phone: (928) 344-6263
Southern California native Dr. Brooksher almost decided to be a professional skier before he chose a career in medicine. Perhaps the rush of the slopes and the cool of the snow were just not as exhilarating for him as the rush of changing people’s lives for the better. The Center for Wound Care and Hyperbaric Medicine, where Dr. Brooksher practices, recently received the “Center of Distinction” award for exceeding national benchmarks in healing wounds within 30 days and for having customer satisfaction approval ratings above the 90th percentile. This award is given by Diversified Clinical Services, the world’s largest outpatient wound care management company, with nearly 400 centers across America. Four criteria were met for 12 consecutive months, resulting in the award and illustrating that Dr. Brooksher brings this same level of care to Kissito’s patients as Palm View’s Medical Director. Dr. Brooksher’s medical journey began at Chapman University where he studied biology and chemistry. His bachelor’s was followed by a doctorate degree in medicine from New York Medical College. He then did his residency in Grand Rapids Michigan, a Michigan State University affiliate, in general surgery and plastic surgery. By the time he finished school, he said he had “graduated from 25th grade”. He was recruited to Yuma by a plastic surgeon that he had known for many years in late 1991. Dr. Brooksher went into practice with Dr. Kerr until he retired 3 years later, at which point Dr. Brooksher continued in solo practice. As a volunteer, Dr. Brooksher began visiting Palm View’s elderly and training nurses how to prevent bed sores and manage wounds. He volunteered his time for over 15 years and eventually these volunteer visits became a job as a medical director as a form of thanks for many years of service.
Email: Fayad_w@yahoo.com | Phone: (928) 344-5565
As a child, Dr. Wissam Fayad envisioned himself doing something for the greater good of the world and eventually imagined that manifesting itself in the form of becoming a doctor and opening his own private practice. Currently, that is just what Dr. Fayad does in addition to his role at Palm View as Medical Director. It is worth noting that accomplishing the smaller goals along the way to get to where he is today was no small endeavor.
For three years around that time, Dr. Brooksher and a local P.A., Linda Conley, in Yuma operated a small business in which Conley assisted patients medically and Dr. Brooksher managed their wounds. The observation that geriatric patients in many nursing facilities were being neglected because their primary doctors wouldn’t visit them in a nursing home setting was the inspiration for starting the business. Dr. Brooksher did not gain anything from this experience monetarily, he simply believed in caring for this neglected population.
After receiving two bachelor’s degrees, Dr. Fayad continued on to medical school at Kaunas University of Medicine in Lithuania in 1998. He continued to complete his residency in internal medicine in 2005 at Wright State University in Ohio as well as his fellowship in geriatrics medicine in 2006 at Stanford University in California. Dr. Fayad is board certified in four categories, including internal medicine, and is licensed to practice medicine in four states. His research experience includes Yale University in the cytogenic lab, research in thoracoscopy and in prevention of contrast induced kidney disease.
Dr. Brooksher finds purpose, meaning and personal growth in his career. “Everything is easy when you’re cruising along in life,” he said. “The hard times and emergencies are when you are tested. That’s when you see what you’re made of.” He humbly acknowledged that he has learned everything he knows from someone else. “We stand on the shoulders of all the physicians that came before us.” He noted that it is simply a privilege to be in the line of work that he has pursued. Though he ultimately chose to be a doctor, Dr. Brooksher still skis all winter and sails all summer, never giving up what he loved.
In addition to his education, certifications and research, Dr. Fayad has experience in open heart surgery, intensive surgery and in the emergency room as a physician at two different medical centers. Furthermore, he has been the medical director for Life Care Center of Yuma for the past two years, and executive member at Yuma Rehabilitation Hospital for the past three. He has had his own private practice since 2006 which has allowed him to continue to serve the community of Yuma.
The focused care and dedication that he provides for his patients are prodigious.
He simply believed in caring for neglected populations.
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The doctor has also involved himself in extracurricular activities at The Cleveland Clinic in Vascular Medicine, the Royal College of Surgeons in Dublin, Ireland as well as in the Rush International training program in Germany. As a result of extensive experience cross-culturally in medicine, Dr. Fayad has been introduced
to a wide variety of patients, demographics, medical complexities, markets and practices that have helped him become a well-rounded and knowledgeable physician. A current patient of Dr. Fayad spent the past few months being transferred between a multitude of physicians and emergency rooms. Swelling and shortness of breath were symptoms that no physician seemed to be able to diagnose. After much suffering, the woman ended up in Dr. Fayad’s care and due to his knowledge and expertise was able to diagnose her accurately. Today the patient’s health has improved drastically and she is currently being monitored to continuously improve her health. Practice Manager of Dr. Fayad’s private office, Sam Eldanaf, receives a lot of feedback regarding patient experiences with Dr. Fayad. He says of Dr. Fayad, “He’s extremely passionate about his work. The focused care and dedication that he provides for his patients are prodigious. His patients love him and I’m delighted to be part of his team.” Long work days at Dr. Fayad’s private office are accompanied by evenings at Palm View visiting patients. Even with a busy work week, he still finds time to do what he loves away from the office: to spend time with his family. His hobbies include tennis and other outdoor sports. He looks forward to growing as a mentor for his children and to develop his knowledge in medicine and patient relationships.
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A Chronic Disease Self-Management Model For the Future Fact: 22.6% of Medicare patients discharged from hospitals are readmitted within 30 days for the same medical reason they were originally admitted. Furthermore, 75% of those readmissions were deemed avoidable. Preventable readmissions have multiple causes, but patients’ and their families’ inability to “selfmanage” chronic medical problems at home is the biggest underlying cause. Patients (and their caregivers) are often deficient in four domains of self-management competence: They may lack a necessary understanding of their illness; aren’t convinced that they need prescribed treatments; don’t adequately understand their medication and self-monitoring regimens; and have serious deficiencies in their ability to communicate in an effective and timely fashion with their doctors and healthcare team. Helping patients, families and hospitals, Kissito Healthcare has addressed this issue by implementing the Kissito Collaborative Patient Care Pathway™, a program designed to provide chronic disease self-management education and support. This new focus on patients’ and families’ ongoing disease self-management role will help
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return patients home armed with adequate support and essential knowledge, attitudes and skills so that they will be able to stay happy and healthy at home and not return unnecessarily to the hospital. The Pathway addresses four domains of selfmanagement competence during the patient’s post acute stay: Disease awareness, health care communication, treatment competence and adherence attitudes. Assessing and enhancing patient and family competency in these domains requires collaboration, coordination and partnership among patients, families, hospital caregivers and post acute healthcare teams. The benefits of the Kissito Collaborative Patient Care Pathway™ will be reflected in better disease outcomes, smoother transitions of care from hospital to post acute to home, reduced hospital readmissions and lower costs.
Figure 1: Collaborative Patient TM Care Pathway – Model
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COLLABORATIVE PATIENT CARE PATHWAY
TM
Visit www.Kissito.org
Steven Hahn, M.D.
Angela Mattocks, RN, MHA, LNHA
Kissito Healthcare has partnered with Steven Hahn, MD, Professor of Clinical Medicine and Instructor in Psychiatry at the Albert Einstein College of Medicine in Bronx, New York to develop Kissito’s Collaborative Patient Care Pathway™. This innovative program is distinct from those of other skilled nursing facilities, designed to prepare patients and their families to successfully self-manage the patient’s medical conditions at home after leaving the post acute rehabilitation setting.
became a nursing manager of a facility close to home.
Dr. Hahn has been an invaluable component in developing the Collaborative Patient Care Pathway™ and is well-prepared by his skill set and background. The first spark of interest in medicine came in high school in New York when Dr. Hahn was inspired by a biology teacher to pursue science in college. While in college, he discovered the teachings of Carl Jung which opened up the fascinating world of psychology and human behavior. He became torn on whether to choose psychiatry or medicine and to this day, he focuses on both, refusing to choose one over the other. The Collaborative Patient Care Pathway™ is the perfect arena for applying this dual focus. Dr. Hahn says, “I share Kissito’s
passion for understanding that our patients have to live on a daily basis with their chronic medical conditions, and the time we spend with them in
the office, hospital or post acute rehabilitation setting will be all for nothing if they go home and cannot successfully self-manage the many challenges that come with chronic disease.” Dr. Hahn
brings his expertise in helping patients and their families manage their medical problems and his expertise in education and program development to his partnership with Kissito Healthcare in fostering the Collaborative Patient Care Pathway™.
Dr. Hahn received his bachelor’s degree from Yale College in psychology and philosophy and went on to Yale School of Medicine for his medical degree. He completed his residency in primary care internal medicine at Montefiore Medical Center and a fellowship in behavioral sciences for primary care medicine at the Albert Einstein College of Medicine Department of Psychiatry. His clinical, teaching and research activities for the past thirty years have focused on helping doctors, nurses and physicians help their patients live with and care for their chronic medical problems as well as helping patients and their families successfully manage those problems. He has published research papers in prominent medical journals, authored chapters of medical textbooks and lectured all over the United States, Canada and Europe on these themes in medicine. He has been the Director of the Primary Care Internal Medicine Track
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of the Residency Program since 1999 and has trained a generation of medical residents in that three-year program. In his experience as Co-director of the Gero-Psychology Consultation Clinic, Dr. Hahn has addressed behavioral and psychological issues in older adults with combined medical and psychological problems from within the services of the Hospital’s adult medicine ambulatory care service. In addition to his medical credits, as substantial as they might be, the doctor has a life outside of medicine. Dr. Hahn has four children, two still at home and two out in the world. He loves gardening, country western and ballroom dancing, outdoor sports and has studied tai chi for the past forty years – with the same teacher. At the end of the day, it is valuable to him to stay grounded, centered and relaxed.
Though Angela Mattocks admired the nurses who cared for her grandparents, she did not consider pursuing the nursing field at first. She started as a business major at Hampton University, but a pull to do something meaningful and purposeful with her life led her to graduate as a nursing major. This decision would later lead her to play an integral role in the development the Collaborative Patient Care Pathway™ at Kissito Healthcare. Nursing school at Georgetown Medical Center in Washington D.C. was the next step during which time Mattocks held an eight-year position as a floor nurse in a medical neurology unit. Patients from all over the world would come to Georgetown and for that reason, Mattocks was able to receive a wellrounded experience in neurology. However, the scheduling eventually did not align with her lifestyle which led her to consider other possibilities in the nursing field. She decided to work part time at a research clinic and part time as a floor nurse at a nursing home and discovered she loved her work at the nursing home. Eventually, she
At a different nursing home, Mattocks later had the opportunity to completely revolutionize an Alzheimer’s unit. She created and implemented a brand new program and became the Director of Nursing. Later she went back to school to receive her master’s in health care administration and became the Nursing Home Administrator. At some point during this process, Tom Clarke, CEO and President of Kissito Healthcare, discovered Mattocks and “snatched her away”, as she endearingly referred to the switch.
Mattocks was hired as the Chief Nursing Officer in which position she streamlined operations of all Kissito facilities by creating and implementing new, universal policies and by developing a method by which to evaluate facility performance, later known as the Clinical Scorecard. She
successfully implemented a clinical pathway; a day-by-day rehabilitation plan for patients after surgery. The concept for this pathway became the rudimentary concept for the Collaborative Patient Care Pathway™ that Kissito would later develop and implement. Since a Kissito facility could admit a patient that had already started the rehabilitation process, Mattocks knew that a program designed phaseby-phase rather than day-by-day would be most practical. Later, Dr. Steven Hahn took the Pathway to a new level, making it an evidence-based model based on patient self-management. In the future, Mattocks hopes to obtain a Ph.D. in public health and continue to impact people’s lives in a positive way. Even outside of the workplace she does this in her church as the leader of the church’s health ministry. She feels what she does is her calling. To do what is right and to change people’s quality of life for the better is God’s work.
set the bar and raised it, set the bar and raised it – little by little bringing Kissito facilities to operate at the highest levels and to produce the highest quality of care. In her experience with a staffing agency, Mattocks was able to see many hospitals and identify strengths and weaknesses in them. She was most impressed with one that had
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Melba’s Store Resident of nine years, Melba operates her own snack shop within the Kissito Healthcare-Palm View facility. The shop opened just about three years after her admission alongside two other women, but now it’s a “solo practice”. The store’s humble beginnings started in a closet about five by six feet where CNAs and other staff would squeeze by Melba’s wheelchair to reach for a snack to buy. An old refrigerator and some dilapidated shelving helped the store to function.
Wound Care Program The Wound Care Program at Palm View is unique to the Yuma region and many referrals to the facility are for this program alone.
The staff shops for snacks at Sam’s Club and helps restock alongside volunteers. Melba says the store is important as it gives residents the independence to shop and it’s convenient for staff. Melba’s shifts are also between meal times, making for ideal snack traffic.
Upon admission, a head to toe assessment of the patient is performed to examine wounds that might have been caused as a result of open heart surgery, a diabetic ulcer, a pressure ulcer or one of several other possible reasons. Once assessed, the certified wound nurse develops and coordinates a treatment plan with Dr. Brooksher, Medical Director and Palm View’s physician specializing in wound care. Dr. Brooksher is the only wound care specialist in Palm View’s market and Kissito is fortunate to have him on our team.
Melba enjoys running the store, even during slow hours. “It gives me a chance to read all the time, and getting to interact with everyone who buys is nice too.”
However, to the joy of staff, visitors, residents and Melba, the store was renovated in addition to the rest of the facility into a room twice as large with large glass windows and a glass door. With more visibility comes more traffic and Melba has seen about $600-800 more in monthly revenue that goes to the resident activities fund. “It’s like a 7-Eleven in there now. All she needs now is a slurpee machine,” said Josh McGilliard, VP of business development for Kissito Healthcare.
Above: Melba’s Store before the renovation. Below: The NEW Melba’s Store.
The store boasts brand new cabinetry, shelving, lighting and flooring, all installed by Kissito subsidiary, JMS Builders & Developers, Inc. The activities fund purchased a brand new refrigerator to replace the old one. “Melba was thrilled about the store,” said John Surprenant, president of JMS.
An innovative aspect of Palm View’s wound care procedure is the use of the Wound Care Vacuum System, a system that functions within a closed system, minimizing risk of infection and promoting healing tissue, allowing a much quicker recovery. While recovering, the nursing assistants are an integral part of the process, keeping patients hydrated and repositioned. Patients have healed from, for example, serious chest wounds in as soon as a month and some have gone home as early as two weeks after surgery – Normally, these types of processes take months. Palm View’s Wound Care Program is just one more reason to entrust a loved one to Kissito’s care.
Melba says, “The store is important as it gives residents the independence to shop and it’s convenient for staff.”
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Where We Serve Our Simple Solutions Save Lives
Visit www.Kissito.org
Our sister organization, Kissito Healthcare International, operates as a non-profit in Africa, the Philippines and Haiti – serving the world’s most vulnerable populations. Whether it is a training program that teaches the people of Haiti how to care for the displaced elderly, the development of a teaching hospital in Ethiopia to serve over one million people that currently have no access to basic healthcare or serving hundreds of mothers with HIV and malnourished children every week in Uganda, Kissito Healthcare International shares the common mission to exist for the betterment and care of human life. Unlike a for-profit company, Kissito is committed to reinvesting in our people, our communities and efforts around the world to make healthcare available for those in need. We are firm believers that great organizations exist because of the quality of their people, so we participate in many different collaborations and programs to enhance our people’s skills, competency, education, support, benefits, career development and quality of life. We do this because it is the right thing to do and we believe in our people. All of our programs and services serve a common goal: a better quality of life for the patient. Ultimately, isn’t that the goal we all have for ourselves?
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Kissito’s Engagement Areas in East Africa : • Maternal and Child Health/EmONC (B and C) • Malaria Prevention, Training and Intervention • Pediatric Diarrhea Research, Intervention and Treatment • Community Based Health and Referral Interventions • Health Sector-Human Resource Strengthening • Nutrition and Acute Malnutrition Management • HIV/AIDS PMTCT-ART Management
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2222 South Avenue A Yuma, AZ 85364 P: 928.783.8831 www.Kissito.org