{"Short_Answer__76":"JT_Mary T-HC-2020-07","Date__77":"07\/28\/2020","Multiple_Choice__78":"Jill Tilbury","Short_Answer__80":"Mary T","Short_Answer__81":"Brent Krocak","Short_Answer__82":"brentk@marytinc.com","Short_Answer__83":"763-274-8463","Multiple_Choice__84":"Elopement","Multiple_Choice__85":"Hennepin County","Date__86":"06\/18\/2020","Multiple_Choice__96":"1","Short_Answer__91":"Staff assisted the person to leave for an overnight with people they had concerns about","True_or_False__94":"Yes","Date__97":"10\/13\/2020","Free_Text__98":"Staff #1: This staff has worked with this person for quite some time and this person has lived with this provider for over 14 years.  The staff informed during the debriefing she is the Manager and did not find out about what had happened until the Monday after this person left the residence on Saturday.  This Manager had received a phone call about that this person had left because she has the ability to do so, although this person had been asked not to due to COVID and the provider\u2019s policy was no visitors were allowed in the staff, even family.  The staff stated it was reported to her that this person had asked to get ready, her aunt and uncle were coming to get her for a visit, and she was going to go.  The staff reported to this Manager they did not feel comfortable, however they could not make her stay in the home and the aunt and uncle came to get her and assisted her in the process, as she is non-ambulatory.  The staff stated they did not know she had family in Duluth and did not know she was going when she had left the house on Friday before the weekend.  Staff reported they called the known uncle and asked who these people in Duluth were and if they indeed were family members and the known uncle reported they were not family.  The person had misinformed the staff working who allowed her to go.  The Manager also stated staff reported to her they did not feel comfortable allowing her to go, aside from COVID, because they did not appear to be family, however this person seemed to be happy when the individuals came to pick her up.  It was reported to the Manager the staff had taken pictures of the car and the license plate number and the people as they were leaving the home on Saturday.  The Manager drove to Duluth to pick up the individual at the hospital as she had been transported there via ambulance after sitting in the restaurant informing the server she needed help via her iPad.  The individual had given her check card to the people who had picked her up and they had financially exploited her when they took her to Duluth.  \r\n\r\nStaff #2\r\n\r\nStaff had arrived to work at 8am on Saturday after picking up this extra shift (at the time this was his first month working for this provider).  This staff was informed by the overnight staff and the lead staff that this person was to get ready, that she was leaving, and the staff would need to help her get ready as well as pack her things for the weekend.  This staff person has had difficulties working this individual in the past as she calls this staff person names and is verbally aggressive through her iPad to the staff person.  Due to the person being non-ambulatory, it is the house policy to reposition her every two hours.  On this day the staff was going to change her brief and get her ready to leave for the day, she would not turn off her iPad prior to the changing to occur.  The staff wanted to be respectful and it is HIPAA policies as well as house policy to turn off the video when the staff are assisting.  Staff stated the person they would assist when she turned off her iPad so staff left the room and came back.  The person still would not turn off the iPad and began to call the staff names.  This staff gave 30 minutes this time and the person still had not gotten off the iPad and continued to call him names and verbal aggressions.  The staff person had asked Manager previously how to handle these matters and was aware of what was happening and continued to try to work with this person so they would not call staff names and how staff could assist better.  The staff went into the person\u2019s room a third time and covered the iPad with a pillow during the dressing and changing process and continued to assist her with getting ready to be picked up for the day.  When the people arrived to pick up this person staff did not allow them into the house due to COVID and the new policies for no visitors.  The visitors assisted the person into the car with her and her wheelchair.  The staff did not say anything about it to anyone else as the lead staff had informed him what to do and the overnight staff had provided instructions on this was what was planned for this person\u2019s day.","Free_Text__100":"A factor into why staff assisted the person to leave for an overnight with people they had concerns about was that the person wanted to leave with the people (claiming to be family). The person she left with claimed to be the person\u2019s uncle, which the person herself confirmed and she appeared to trust him. There was a perception that since the person was a family member, visiting with the person would be less risky than if the person was unrelated. The lead staff at the home also determined this trip was important to the person. The provider agency trusted the lead staff in this home and had been working to implement a person-centered philosophy which prioritized weighing supporting things that were important to the people they served over what was important for them. This philosophy was impacted by the statewide emphasis placed on supported decision making and person-centered thinking, the latter of which was supported by provider requirements in the provider\u2019s licensing statute, Minnesota Statutes 245D. The provider had worked with this person for 14 years, so the relationship with the person influenced the provider to make supporting the person\u2019s own decisions even stronger.  Influencing the lead staff to determine the trip was important to supporting the person was that it appeared that assisting the person to have a safe trip seemed to mitigate risk versus allowing the person to leave without assistance. The person appeared to be determined to go, and without help from the provider, it seemed more likely issues might arise. Mitigating risk is a priority for all HCBS providers for a number of reasons: Case managers assign this priority to providers in Coordinated Service and Support Plan, Minnesota Statutes 245D requires providers to ensure the health, safety and well-being of the people they serve, and providers could be liable to lawsuits, investigations or insurance claims if a person they serve is harmed. If someone is harmed while in the care of a provider, that provider could be found in violation of the Vulnerable Adult Act and additional penalties may be brought upon a provider by the Department of Human Services. \r\nAnother was that the provider felt they did not have a choice but to assist her in leaving. The person was their own guardian and had the power to make many choices independently.  Additionally, the person had attempted to leave with this person in the past, and the provider determined they would weigh what was important to the person over what was important for the person. This decision was impacted by the provider\u2019s person-centered philosophy, which in turn was impacted by statewide emphasis on supported decision-making and person-centered thinking. This emphasis came from a number of sources including advocacy organizations and DHS, which released best practice guidance on both and enforced person-centered planning requirements governing providers in Minnesota Statutes Chapter 245D. The provider\u2019s concerns about the person leaving with the person did not seem to outweigh the provider\u2019s desire to empower and support the person.   \r\nAn additional influence into why the staff assisted the person to leave an overnight with people they had concerns about was that the staff wanted to empower the person during this time since they had attempted to leave with this person in the past. Although the provider had a practice in place to not allow people to take overnights at the time due to the threat of COVID-19 and MDH guidance on COVID-19 for residential programs, the provider determined they would weigh what was important to over what was important for the person. The provider\u2019s person-centered philosophy, influenced by the statewide emphasis on supported decision making and person-centered thinking influenced this decision by the provider. Additionally, the provider staff determined the concerns they had about the person leaving weren\u2019t enough to take restrictive actions and weigh safety over the person\u2019s own choice. Implementing restrictions on a person\u2019s rights could create the liability of providers being incompliant with the conditions of Minnesota Statutes, Chapter 245D enforced by the Department of Human Services.","Multiple_Choice__101":"2","Free_Text__102":"A factor into why staff assisted the person to leave for an overnight with people they had concerns about was that the person wanted to leave with the people (claiming to be family). The person she left with claimed to be the person\u2019s uncle, which the person herself confirmed and she appeared to trust him. There was a perception that since the person was a family member, visiting with the person would be less risky than if the person was unrelated. \r\n\r\nMore??","Multiple_Choice__103":"0","Multiple_Choice__105":"0","Multiple_Choice__107":"0","Multiple_Choice__109":"0","Multiple_Choice__111":"0","Multiple_Choice__113":"0","Multiple_Choice__115":"3","Free_Text__116":"A factor into why staff assisted the person to leave for an overnight with people they had concerns about was that the person wanted to leave with the people (claiming to be family). The person she left with claimed to be the person\u2019s uncle, which the person herself confirmed and she appeared to trust him. There was a perception that since the person was a family member, visiting with the person would be less risky than if the person was unrelated. The lead staff at the home also determined this trip was important to the person. The provider agency trusted the lead staff in this home and had been working to implement a person-centered philosophy which prioritized weighing supporting things that were important to the people they served over what was important for them. This philosophy was impacted by the statewide emphasis placed on supported decision making and person-centered thinking, the latter of which was supported by provider requirements in the provider\u2019s licensing statute, Minnesota Statutes 245D. The provider had worked with this person for 14 years, so the relationship with the person influenced the provider to make supporting the person\u2019s own decisions even stronger.  Influencing the lead staff to determine the trip was important to supporting the person was that it appeared that assisting the person to have a safe trip seemed to mitigate risk versus allowing the person to leave without assistance. The person appeared to be determined to go, and without help from the provider, it seemed more likely issues might arise. Mitigating risk is a priority for all HCBS providers for a number of reasons: Case managers assign this priority to providers in Coordinated Service and Support Plan, Minnesota Statutes 245D requires providers to ensure the health, safety and well-being of the people they serve, and providers could be liable to lawsuits, investigations or insurance claims if a person they serve is harmed. If someone is harmed while in the care of a provider, that provider could be found in violation of the Vulnerable Adult Act and additional penalties may be brought upon a provider by the Department of Human Services. \r\n\r\nAnother was that the provider felt they did not have a choice but to assist her in leaving. The person was their own guardian and had the power to make many choices independently.  Additionally, the person had attempted to leave with this person in the past, and the provider determined they would weigh what was important to the person over what was important for the person. This decision was impacted by the provider\u2019s person-centered philosophy, which in turn was impacted by statewide emphasis on supported decision-making and person-centered thinking. This emphasis came from a number of sources including advocacy organizations and DHS, which released best practice guidance on both and enforced person-centered planning requirements governing providers in Minnesota Statutes Chapter 245D. The provider\u2019s concerns about the person leaving with the person did not seem to outweigh the provider\u2019s desire to empower and support the person.   \r\nAn additional influence into why the staff assisted the person to leave an overnight with people they had concerns about was that the staff wanted to empower the person during this time since they had attempted to leave with this person in the past. Although the provider had a practice in place to not allow people to take overnights at the time due to the threat of COVID-19 and MDH guidance on COVID-19 for residential programs, the provider determined they would weigh what was important to over what was important for the person. The provider\u2019s person-centered philosophy, influenced by the statewide emphasis on supported decision making and person-centered thinking influenced this decision by the provider. Additionally, the provider staff determined the concerns they had about the person leaving weren\u2019t enough to take restrictive actions and weigh safety over the person\u2019s own choice. Implementing restrictions on a person\u2019s rights could create the liability of providers being incompliant with the conditions of Minnesota Statutes, Chapter 245D enforced by the Department of Human Services.","Multiple_Choice__117":"0","Multiple_Choice__119":"0","Multiple_Choice__121":"0","Multiple_Choice__123":"0","Multiple_Choice__125":"0","Yes_or_No__432":"Yes"}