Navigating Healthcare Reform at the Bedside: Optimizing Clinical Outcomes and Reducing Readmissions through Collaborative Nursing Interventions

Similar documents
Good Samaritan Inpatient Rehabilitation Program

(310) For the latest course information and to register visit and click on CME courses.

Vestibular Rehabilitation: Theory, Evidence and Practical Application

Rehabilitation Where You Recover. Inpatient Rehabilitation Services at Albany Medical Center

Vestibular Rehabilitation: Theory, Evidence and Practical Application

Wound Care Institute MARCH 16-17, Chateau on the Lake Resort and Spa. Evidence-Based Guidelines in Nursing Practice. At the breathtaking

12th Annual Rehabilitation Nurse Seminar:

Reorganized and administrated a home health neuro intervention program.

Occupational and Physical Therapy Management of Spinal Cord Injury

Orthopedic. Nursing Symposium. Co-Sponsored by Hoag Orthopedic Institute and the Orange County Chapter of NAON FOURTH ANNUAL

2013 UCM Nursing Research and Evidence-Based Practice Symposium

Marianjoy Physical Therapy and. A Leader in Rehabilitation

REHABILITATION. begins right here

UW MEDICINE PATIENT EDUCATION. Your Care Team. Helpful information

KIM EBERHARDT MUIR MS, OTR/L 3422 N LEAVITT APT 1 CHICAGO, IL KEE512@YAHOO.COM/KEBER@UIC.EDU

Annual Interdisciplinary Brain Injury Course Brain Injury Rehabilitation: Management and Outcomes in Different Models of Care

Shepherd Center is a world-renowned provider of comprehensive, specialized rehabilitation for people with spinal cord injury, brain injury or stroke.

LIVING WITH ACQUIRED BRAIN INJURY

Examination Review Course

Tracheostomy and Ventilator Management Tracheostomy and Ventilator Management: Success Through Teamwork

CURRICULUM VITAE. Licensure Physical Therapy (since 2005) 2011 to Present Iowa # to Present Illinois #

CLINICAL PRIVILEGE WHITE PAPER

PREPARING THE PATIENT FOR TRANSFER TO AN INPATIENT REHABILITATON FACILITY (IRF) University Hospitals 8th Annual Neuroscience Nursing Symposium

Acute Medical Rehabilitation Surviving Health Care Reform

PARTNERSHIP HEALTHPLAN OF CALIFORNIA POLICY / PROCEDURE:

Annual Interdisciplinary Brain Injury Course Future Trends in Rehabilitation and Technology in Traumatic Brain Injury

Stroke Certification Program The Westin Lombard Yorktown Center Hotel Thursday, May 21, 2015 Lombard, IL

Neurotoxin and Headache Update

Inpatient Rehabilitation Patient Handbook

SAM KARAS ACUTE REHABILITATION CENTER

Wound Specialty Program Brochure VA Eastern Kansas Wound Management Academy

1st Annual AR Physical Therapy Association Optimize Conference September 26 & 27, Who Should Attend? Registration Fee.

April 9, 2013 Edwin W. Monroe AHEC Conference Center Greenville, North Carolina

Update on Brain Injury Rehabilitation 2015

University of Maryland Medical System, Corporate Quality Management Department

Motivational Interviewing: Quick and Effective Tools for Clinicians

Dr. Joshua D. Dion DNP, A.C.N.P-BC, R.N.-BC. Northeastern University, Boston MA, Doctor of Nursing Practice Degree (January 2014).

The Physician Leadership Institute Webinar Series

Motivational Interviewing (MI) Health Coaching Intensive

JFK Professional Development Series. Treatment of the Older Person with Vision Loss Saturday & Sunday November 15 & 16, 2014

Education Workshop Guide

SPINAL CORD MEDICINE HANDBOOK FOR PATIENT AND FAMILY

Deborah L. Downey MN, CNRN, ANP-BC Heidi Maloni, PhD, ANP-BC Cassandra Miller-Hardwick, MSN, RN, CRRN

National Stroke Association s Guide to Choosing Stroke Rehabilitation Services

Creating Strategic Alliances for Post-Acute Coordination of Care

12 TH ALL-OHIO INSTITUTE ON COMMUNITY PSYCHIATRY

Northwestern s Second Annual Advances in Pulmonary Medicine CME Symposium Friday, November 20, :15 a.m. - 3:00 p.m.

Patient Information Guide. Getting you Back to Better

Creating Value: The Quality Care Reimbursement Connection Seminar

SATURDAY & SUNDAY January 23 & 24, 2016 Hilton Hawaiian Village Waikiki Beach Resort Honolulu, Hawaii

Kentucky Appalachian Rural Rehabilitation Network

CURRICULUM VITAE. Catherine Lauren Szot August, 2012

Nasseff Neuroscience Nursing Symposium 2013

11/16/13 HIP & KNEE DISORDERS IN THE TREATMENT OF INNOVATIONS CHAIR: JOHN CLOHISY, MD PRESENTED BY: WASHINGTON UNIVERSITY ORTHOPEDICS

The Art of Trauma THURSDAY, APRIL 4, and its changing palette. 7:45 a.m. to 5 p.m.

The ABC s of Pediatric Orthopaedics and Sports Medicine

Orthopedic. Nursing Symposium HOAG ORTHOPEDIC INSTITUTE AND THE ORANGE COUNTY CHAPTER OF NAON PRESENTS: 7 TH ANNUAL MONDAY, OCTOBER 26, AM 4 PM

Statement of Purpose for the Strategic Plan

Neurodegenerative diseases Includes multiple sclerosis, Parkinson s disease, post-polio syndrome, rheumatoid arthritis, lupus

Doctorate of Nursing Practice

Amputation Rehabilitation Center

An Evidence-Based Practice ToolKit for Bedside Nurses

Profile: Kessler Patients

Wound Specialty Program Brochure VA Eastern Kansas Wound Management Academy

Specialty Practice Master of Nursing Science (MSN) Programs

Stakeholder s Report SW 75 th Ave Miami, Florida

Advances in Headache Management

2015 Rehab Education Day

American Society of Addiction Medicine

Practical Management of Acute Stroke: A Global Perspective

R.B. TURNBULL JR., SCHOOL OF WOC NURSING. Dear Applicant,

By way of introduction. Inpatient Medical Rehabilitation

How To Become A Nurse Practitioner

Medical Rehabilitation. Rehabilitation Unit

AANN ADVANCES IN STROKE CARE CONFERENCE

The ABC s of Pediatric Orthopaedics and Sports Medicine

Coordinating Transitions of Care: It Takes a Village

Rehabilitation and Choosing a Rehab Center

TORONTO STROKE FLOW INITIATIVE - Inpatient Rehabilitation Best Practice Recommendations Guide (updated January 23, 2014)

Neurodegenerative diseases Includes multiple sclerosis, Parkinson s disease, postpolio syndrome, rheumatoid arthritis, lupus

REHABILITATION MEDICINE by PROFESSOR ANTHONY WARD

APRN/PA Pediatric Updates in Clinical Practice

NEPSY-II TRAINING: A FLEXIBLE NEUROPSYCHOLOGICAL MEASURE FOR CHILDREN Presenter: Alexander Quiros, Ph.D.

The Neuro Response Team: Improving the Rehabilitation Experience

L A U R A C. D R I S C O L L P T, D P T, G C S ldriscol@bu.edu

Traumatic Brain Injury for VR Counselors Margaret A. Struchen, Ph.D. and Laura M. Ritter, Ph.D., M.P.H.

Cerebral Palsy and Related Conditions

Course Faculty. Course Information. Annual Conference Topics Explored: Pediatric Surgical and Trauma Nursing. (continued)

Cameron S. Parker RN, BSN, CLCP

Homeward Bound. Amanda Melvin, MSW Emily Hartman, BSN, RN Tiffany Curtis, BSN, RN, CRRN Cindy Regan, MSN, RN - BC

Certified Professional in Healthcare Information and Management Systems (CPHIMS) Certification, 4/2015

Clinical Application of Brain Injury and Concussion Rehabilitation

Transcription:

: Optimizing Clinical Outcomes and Reducing Readmissions through Collaborative Nursing Interventions Intended Audience: Nurses, Discharge Planners, Case Managers, Nurse Navigators, Nurse Administrators and Leaders, Rehab Leaders, Social Workers Intermediate Level Contact Hours: 13 hours Day 1: 8:00 a.m. - 4:30 p.m. Day 2: 8:00 a.m. - 3:30 p.m. Presenters: ; John Brady, DHA; Kathleen Ruroede, RN, Ph.D., MEd; Amelia Bumsted, RN, BA, BS, CRRN, CIC; ; Lisa Boudreau, RN, APN, MSN, CWOCN; Angelique Strand, Ph.D.; RN, APN-CNS, CNRN, CRRN; Sarah Keller, PT, DPT, NCS; Susan Kometz, RN, BSN, CRRN, CBIS Course Description The Patient Protection and Affordable Care Act (PPACA) was enacted to improve the affordability and access to healthcare, reduce healthcare costs, and improve health and outcomes by shifting the focus towards prevention, wellness and the use of proven interventions aimed at delivering higher quality care. As the PPACA moves from legislation to implementation, nurses find themselves in the unique position to influence the above goals in their roles as direct care providers, discharge planners, and patient navigators. Foundational to these healthcare reform goals is the concept of patient centered care coordination which is consistent with nursing s professional standards and holistic framework of care. As healthcare reform takes shape, it is clear that nurses will be expected to contribute to improved clinical outcomes and the reduction of care complications through the knowledge and integration of early clinical interventions at the bedside. Key areas such as skin care, bowel and bladder management, early mobilization and positioning, pain management, medication management, and swallowing and speech disorders will be addressed in this course. Literature supports that early clinical interventions in these areas positively affect outcomes, reduce care complications, and promote earlier transitions to post-acute care (PAC) settings. In addition, nurses will be expected to have a solid understanding of the available levels of post-acute care (PAC) services in order to facilitate successful, cost-effective transitions and reduce unplanned hospital re-admissions and financial penalties. Rehabilitation is an integral component in most postacute care transitions, and nurses will need knowledge of how the wide array of specialized clinicians within the varied PAC settings can impact the long term success and outcomes of the patient. This dynamic and interactive course will seek to equip participants with a better understanding of what the PPACA means to them while also empowering nurses to apply early and collaborative clinical interventions at the bedside. The course further aims to provide lab based learning opportunities and tools that can be integrated by nurses at the bedside to optimize patient centered care, clinical outcomes, patient safety and successful PAC transitions. Course Purpose Statement: Participants will identify practice strategies that can promote seamless transition between acute care and post-acute care facilities. Contact hours will be available for nurses who have not previously taken this course. Course Objectives At the completion of the course, participants shall be able to: 1. Discuss the key components of and the Affordable Care Act and the implications for nurses along the continuum of acute and post-acute care. 2. Discuss factors that positively and negatively impact hospital re-admission rates. 3. Identify strategies that can assist in the prevention of re-admissions. 4. Describe the role of the nurse in the discharge planning process. 5. Identify post-acute rehabilitation levels of care that can assist in promoting patients to maximize health and wellness. 6. Identify collaborative interventions that can be initiated in the acute care environment to facilitate best outcomes for speech and swallowing disorders. 7. Describe effective medication management strategies. 8. List non-pharmacologic pain management strategies that optimize patient s outcomes along the continuum of care. 9. Identify and implement the components of an effective bowel and bladder program. 10. Discuss early skin and wound management strategies including the identification of risk factors, preventative measures, and management of impaired skin integrity. 11. Demonstrate safe and effective early mobilization and positioning techniques to decrease the likelihood of post-acute complications.

Course Agenda DAY ONE October 17, 2014 7:30 a.m. Registration and Continental Breakfast 8:00 a.m. Case Presentation: A Patient s Journey Begins 8:15 a.m. Keynote Address: The Post-Acute Continuum Implications for Nursing Practice RN, BSN, MS,MBA, Ph.D.; President and CEO Marianjoy Rehabilitation 9:20 a.m. Assessment of Patient Outcomes of Rehabilitative Care Review of a Current Study John Brady, DHA 10:00 a.m. Break 10:15 a.m. Re-Admissions and Prevention of Complications: What is a nurse s role in ensuring high quality, measurable outcomes and effective utilization of resources? Kathleen Ruroede, RN, Ph.D., MEd, and Amelia Bumsted, RN, BA, BS, CRRN, CIC 12:00 p.m. Lunch provided DAY TWO October 18, 2014 7:30 a.m. Registration and Continental Breakfast 8:00 a.m. Improving Clinical Outcomes Pain Management Using Non-Pharmacologic Strategies Angelique Strand, Ph.D 9:00 a.m. Improving Clinical Outcomes Medication Management 10:00 a.m. Break 10:15 a.m. Improving Clinical Outcomes Skin and Wound Management Lisa Boudreau, RN, APN, MSN, CWOCN 11:15 a.m. Improving Clinical Outcomes Bowel and Bladder Management 12:15 p.m. Lunch provided 1:00 p.m. Post ICU Syndrome Optimizing Outcomes 1:30 p.m. Improving Clinical Outcomes Through Early Intervention: Swallowing and Speech and Language Disorders 2:15 p.m. Break 2:30 p.m. Improving Clinical Outcomes Through Early Intervention: Swallowing and Speech and Language Disorders (continued) 3:30 p.m. Improving Clinical Outcomes Positioning and Early Mobilization with Lab Sarah Keller, PT, DPT, NCS 4:30 p.m. Adjourn 1:15 p.m. Discharge Planning and Post-Acute Care Treatment Settings Susan Kometz, RN, BSN, CRRN, CBIS 2:45 p.m. Break 3:00 p.m. Case Study: Pulling It All Together 3:30 p.m. Adjourn

Presenters RN, BSN, MS, MBA, PhD. Since 1998, Kathleen Yosko has served as President and CEO of Marianjoy, Inc., Marianjoy Rehabilitation and Marianjoy Medical Group. Marianjoy is a network of nearly 500 inpatient, subacute bed and outpatient rehabilitation clinics delivering a full range of services to both adults and children. Prior to joining Marianjoy, Ms. Yosko served as President and CEO of Schwab Rehabilitation and began her career as an RN/Neuro Rehabilitation Specialist. Ms. Yosko has served as Chair of the American Medical Rehabilitation Providers Association and the Commission of Accreditation of Rehabilitation Facilities. Over her healthcare career, Ms. Yosko has received a series of national and local achievement awards. Lisa Boudreau, RN, APN, MSN, CWOCN Lisa Boudreau is a Clinical Nurse Specialist (CNS). Since 2011, she has worked at Marianjoy to provide clinical wound consultation, wound program development, and staff education. As an integral part of her role, Lisa leads the pressure ulcer data collection, reporting and quality improvement initiatives. She has over 25 years of nursing experience but her focus on wound care began as the Wound Ostomy Continence Nurse (WOCN) at Northwestern Memorial. She attended the WOCN Education Course at Emory University and became certified by the WOCN Certification Board in 1998. In 2006, she earned a Master s degree in Nursing at Loyola University, Chicago. She is a member of the WOCN professional association. John Brady, DHA John Brady, DHA is the Vice President of Physician Services and Organizational Planning for Marianjoy, providing leadership in organizational planning and program development for the hospital as well as business planning for the Marianjoy Medical Group. In addition, he works to maintain and expand Marianjoy s external relationships with providers. Previously, he held a position at Discovery Chicago in which he gained experience in operational and strategic planning across a wide variety of clinical specialties including neurology, orthopedics, and mental health. In addition, he also worked for a member of the Rush System for Health in Chicago in which he was responsible for marketing, communication, planning, and business development. He holds an adjunct faculty appointment with Des Moines University where he teaches courses in healthcare management and finance and is an Illinois Licensed Nursing Home Administrator. He earned a Doctor of Health Administration degree from Central Michigan University, MA in Communications from Illinois State University, and BA from the University of Iowa. Susan Brady is a board certified specialist in swallowing and swallowing disorders with over 20 years of experience of working with patients with communication and swallowing needs. Currently, she is a clinical development coordinator and the research coordinator at Marianjoy Rehabilitation, Wheaton, IL. Ms. Brady is also a doctoral candidate in Health Education. Her research interest includes swallowing disorders following tracheostomy tube placement and she has published several times in peer reviewed medical journals. Ms. Brady has also lectured across the country and taught at the graduate level on the topic of artificial airways. Amelia C. Bumsted, BA, BS, RN, CRRN, CIC Amelia C. Bumsted is the Infection Control Coordinator for in Wheaton, IL and network sites. She has a background in critical care nursing and vascular access. As a Certified Rehabilitation Registered Nurse (CRRN) with clinical experience in acute inpatient rehabilitation, Ms. Bumsted has unique understanding of the continuum of care. She has presented at the Illinois Quality Initiative s Best Practices Symposium on the topic of care coordination. She has her bachelor s degree in psychology from Columbia College and completed her undergraduate degree in nursing from Northern Illinois University. She is a member of the Sigma Theta Tau International Honor Society of Nursing and is currently pursuing her DNP at Loyola University, Chicago in Population-Based Infection Prevention & Environmental Safety. The subject of her doctoral capstone is reducing readmissions in the acute stroke rehabilitation patient population. She is a member of the Association for Professionals in Infection Control and Epidemiology (APIC), currently serving on the National Practice Guidance Committee. She is the author of the Rehabilitation Services chapter and section editor of the APIC Text of Infection Control and Epidemiology (2014 edition).

Presenters Sarah Keller PT, DPT, NCS Sarah Keller is a physical therapist who has been treating on the inpatient Stroke Rehabilitation Unit for 8 years and a Marianjoy Master Clinician with an emphasis on Stroke. In 2011, she became the Stroke Program Clinical Liaison at Marianjoy and led the team to a Joint Commission Stroke Rehabilitation Specialized Accreditation in 2013. She is active in research and publication with an emphasis on early mobility training and community re-entry following stroke. Ms. Keller has provided education about stroke and stroke recovery to clinical staff, nursing staff, and the community. She also helps facilitate Marianjoy s Stroke Support Group. Ms. Keller graduated from Saint Louis University in 2006 with a Masters of Physical Therapy and in 2007 with a Transitional Doctorate in Physical Therapy. She became a Board Certified Clinical Specialist in Neurology Physical Therapy by the American Board of Physical Therapy Specialties in 2009. Susan Kometz, RN, BSN, CRRN, CBIS Susan Kometz is the Admission s Department Supervisor at Marianjoy. Her current role in the admissions department allows her to use her expertise in helping patients, families, and referral sources navigate through the levels of post-acute care. Ms. Kometz has 33 years of nursing experience in both the acute and post-acute settings. Ms. Kometz has worked all levels of rehabilitation as a lead nurse, case manager and liaison. Ms. Kometz also enjoys facilitating educational programs on rehabilitation topics for referral sources. The rehabilitation nurse plays an important role in helping to prepare a patient for rehabilitation. The greatest satisfaction a rehabilitation nurse can receive is when a patient shows improvement after being managed with the appropriate resources. Ms. Kometz is a graduate of Purdue Calumet and Benedictine University. She is certified as a rehabilitation registered nurse and a brain injury specialist. Kathleen Ruroede, RN, Ph.D. Med Kathleen Ruroede, Ph.D. Med, RN is the Vice President for Quality and Research and Chairman of the Institutional Review Board at. Her career includes: an academic position as Associate Professor and Chairman of the Healthcare Risk Management Department at Rosalind Franklin University (formerly Chicago Medical School), a position in education services within a hospital and professional liability insurance carrier, several hospital administrative leadership positions, healthcare consulting, and clinical nursing roles within various academic medical centers. She holds a doctoral degree in research methodology and statistics (Loyola University, 1998), a master degree in adult education (Loyola University, 1988), and an undergraduate degree in nursing and allied health (University of St. Francis, 1981; Elgin Community College, 1973). Angelique Strand, Ph.D. Angelique Strand is a licensed clinical psychologist with a Ph.D. in Counseling Psychology. Since 2004, Dr. Strand, a staff psychologist with Marianjoy s Integrative Pain Treatment Center, has been part of the Marianjoy Medical Group specializing in chronic pain, spinal cord injury and subacute rehabilitation. Currently, she holds privileges at in Wheaton and Rush/Oak Park. She has over 15 years of experience working with people in physical rehabilitation. Prior to that, she was in independent practice and taught undergraduate and graduate courses in psychology at several universities and colleges. Sally Strong is a Clinical Nurse Specialist at in Wheaton, IL. During a career that has spanned more than 30 years, Ms. Strong has cared for patients with a variety of neuroscience disorders in the acute care, intensive care, inpatient rehabilitation and outpatient settings. She has lectured extensively at the local, state and national levels on topics related to neuroscience and rehabilitation nursing. She is the author of multiple articles published in peer reviewed journals as well as chapters in 5 nursing textbooks. Ms. Strong is a Board Member of the Northern Illinois Chapter of the Association of Rehabilitation Nurses and serves on several national level committees and task forces for both the American Association of Neuroscience Nurses and the Association of Rehabilitation Nurses. She holds certifications in Neuroscience and Rehabilitation Nursing. Ms. Strong holds a Bachelor of Science in Nursing from Northern Illinois University (1982) and a Master of Science in Nursing from Loyola University Chicago (1988).

Contact Hours Illinois Department of Financial and Professional Regulation (IDFPR): Registered Social Workers This course has been approved for 13 continuing education hours for registered social workers. The Illinois Department of Financial and Professional Regulation, Division of Professional Regulation has certified has complied with the provisions of the Illinois statutes and/or rules and regulations and is hereby authorized to sponsor the above named course as a Continuing Education offering. Registered Social Worker Continuing Education Sponsor: IDFPR License number 159.001019 Ohio Nurses Association (ONA): This program will award 13 contact hours. Marianjoy Rehabilitation -Professional Practice Committee, (OH-387, 10/1/2016) is an approved provider of continuing nursing education by the Ohio Nurses Association (OBN-001-91),an accredited approver by the American Nurses Credentialing Center s Commission on Accreditation. Attendance at the entire program and a completed evaluation form are required in order to be awarded continuing education credit. This educational activity s planners and the presenter(s) have indicated they have no bias or conflict of interest. has not received any commercial support for this program. Cancellation/Refund Policy A tuition refund less $50.00 administrative fee is available if your cancellation request is received in writing within 7 days prior to the program date. No refunds will be granted after that date. In the unlikely event that Marianjoy must cancel an educational event for any reason, you will receive a full refund of your paid tuition. Marianjoy does not assume responsibility for any other expenses incurred by the registrant.

REGISTRATION INSTRUCTIONS 1. Select the course(s) you are registering for from the menu below. Please Note: If registering for a group rate, please complete a registration form for each participant. All registration forms must be included with payment. 2. Complete participant and payment information and return this entire form. JULY 19, 2014 Tests and Measures in Rehabilitation Settings Registration Deadline: 7-11-14 SINGLE REGISTRATION FEE: $179 GROUP REGISTRATION FEE PER REGISTRANT: $159 AUGUST 22 23, 2014 Physical Rehabilitation of the Knee and Ankle: Integrating Structure, Function and Treatment Registration Deadline: 8-8-14 SINGLE REGISTRATION FEE: $450 OCTOBER 3 4, 2014 Thermal and Electrical Modalities with an Upper Extremity Focus Registration Deadline: 9-26-14 SINGLE REGISTRATION FEE: $450 October 17 18, 2014 : Optimizing Clinical Outcomes and Reducing Readmissions through Collaborative Nursing Interventions Registration Deadline: 10-3-14 SINGLE REGISTRATION FEE: $450 NOVEMBER 14 15, 2014 Vestibular Rehabilitation: Theory, Evidence and Practical Application Registration Deadline: 10-31-14 SINGLE registration fee: $450 PHOTO CONSENT: Please note that photos will be taken during these classes and may be used in marketing materials. If you prefer to not have your likeness used in photos, please let a Marianjoy Professional Learning Institute associate know and we will make the appropriate accommodations. PARTICIPANT INFORMATION: Name Organization Billing Address City/State/ZIP Phone E-Mail Check here to receive email updates on future classes. DISCIPLINE: OT OTA PT PTA Nurse SLP School Couns. Other Social Worker: license # Registration Questions? Call 630-909-6923 Require Special Accommodations (Please Specify): NOTE: Due to fluctuations in room temperature, please bring a sweater or light jacket. PAYMENT METHOD: CHECK made payable to VISA MASTERCARD AMEX DISCOVER Account Number Exp. Date CVV# Name on Card Signature RETURN METHOD: MAIL: Mail entire completed form to: Attn: Jaime Gorska EMAIL: Email completed form to education@marianjoy.org FAX: Fax completed form with payment information to 630-909-6960 PHONE: 630-909-6923 Cancellation/Refund Policy A tuition refund less $50.00 administrative fee is available if your cancellation request is received in writing within 7 days prior to the program date. No refunds will be granted after that date. In the unlikely event that Marianjoy must cancel an educational event for any reason, you will receive a full refund of your paid tuition. Marianjoy does not assume responsibility for any other expenses incurred by the registrant.