First day of CNA clinical - Elder abuse?

northernguy · Mar 4, 2012

Altra completely hit the nail on the head, and this is why I have to admit I dont automatically trust the judgement of someone who hasnt done the job for a while and understands what it entails to successfully take care of multiple patients and residents, as well as manage your time so that you dont create even more harm and neglect for others by taking too long on one person.

The fact the aide was making a big deal out of the resident wanting to wear a certain vest doesnt seem excusable though. When an aide does get hung up on something like that, it might be time for them to take some time off to destress. Also I think its important to help other aides out if you see them overreacting to someone, maybe offer to switch patients, or have them take a time out while you take over for the moment. Maybe that person and/or their family ran the aide ragged on previous shifts, caused them to fall way behind and the aide is reacting to that. Thats not to say you dont report abuse if it happens.

acerbia · Mar 6, 2012

I wasn't there, so I can only give an opinion on what has been said thus far, but there's a lot of things about this post that I find disturbing.

From disgusting water to not changing diapers to neglecting pressure ulcers and not getting someone a simple glass of water, there's definitely something wrong with this facility. I don't care how busy you are - there is no excuse for letting a pt sit or lay in her own filth, having a dirty emesis basin by their bed, not following a simple request to get a piece of clothing from the closet, etc. The descriptions about the pt being thrown around is subjective, however. Like what others have said, sometimes it looks "rough" when pts are being moved. But the other things mentioned in the post are highly suspect.

If you are concerned about this facility and the treatment of their residents, you have a few options here:

- Talk to your clinical instructor (which you did, and hopefully she will have some feedback for you after she talks to the faculty there).

- Google this facility and see what kind of reviews it has and if there are any lawsuits against it (pending or otherwise). You should also take a look at how the other residents are being treated. If everyone else is being cared for appropriately, but this particular resident is not, see if you can find out why. Talking to the family or even ask the resident herself may lend you some insight.

A quick Googling of "reporting elder abuse" led me to a website for The National Center on Elder Abuse. What I found out sums up your situation pretty well. Some info from the site:

Report suspected mistreatment to your local adult protective services agency or law enforcement. Although a situation may have already been investigated, if you believe circumstances are getting worse, continue to speak out.

Neglect typically means the refusal or failure to provide an elderly person with such life necessities as food, water, clothing, shelter, personal hygiene, medicine, comfort, personal safety, and other essentials included in an implied or agreed-upon responsibility to an elder.

Signs and symptoms of neglect include but are not limited to:
- Dehydration, malnutrition, untreated bed sores, and poor personal hygiene;
- Unattended or untreated health problems;
- Hazardous or unsafe living condition/arrangements (e.g., improper wiring, no heat, or no running water);
- Unsanitary and unclean living conditions (e.g. dirt, fleas, lice on person, soiled bedding, fecal/urine smell, inadequate clothing); and
- An elder's report of being mistreated.

They have a sate directory of helplines and hotlines specifically for elder abuse, and they can give you more detailed information about your state's laws, where to report suspected abuse/neglect and more. I highly suggest you call them and find out for sure, from a legal standpoint, what they consider to be as elder abuse. Maybe this case is, maybe it's not, but it's definitely worth looking into (an giving you a great learning opportunity).

As a future nurse, you will learn that you have an obligation to be a pt advocate, and part of advocating for a pt is standing up for them and making them central to your care. Based on what I've read, it does not seem like this is happening here. I am but a lowly nursing student (so what do I know, right?), but I find this situation concerning, and frankly I'm astounded at how many posters excuse it.

It's been a few days since you've update this post. Any news on what's happened so far?

psu_213, BSN, RN · Mar 6, 2012

This sounds like poor care in general...and the oral care situation is totally unaccepable. However, I must say, that it is a lot easier in CNA school when you have one resident all day as opposed to an assignment with 10 residents. It's great that you were able to spend so much time with this one resident, but it is just not practical during AM care when you have a full assignment. But it is also good to see that you care, and that you want to make yourself better than this other aide.

Unfortunately I have to close with two points of minor constructive criticism:

First, you did two things for which you would have been written up in my old facility: (1) using 'diaper' (it is a brief, depends, attends, etc...not a diaper) and (2) using a gait belt not an approved lift. A resident's 'lift' status was determinted by PT--up ad lib, stand and pivot, standing lift (a mechanical lift...I forget its name), Maxi lift, and there was one more that I forgot the name of. If you were caught using an unapproved lift (i.e. using a gait belt instead of a mechanicalo standing lift) that was an automatic write up. If they fell during the incorrect lift, chances are you would be gone...either way, just a word of caution.

Second point: please don't make fun of the way people speak (and the lack of proper English). Yes, it was totally wrong of her to yell at you, but you don't need to emphasize the point that she doesn't use the Queen's English...it really takes away from your overall message and makes you seem less credible. I worked with an aide who always said 'ain't' and ended sentences with prepositions. :eek: One of her 'best' when when she said "She don't walk too far cuz she has congenital heart failure." She was also a very good aide. In other words, poor English does not equal poor aide.

fuzzywuzzy, CNA · Mar 6, 2012

i'm not defending what this cna did, if it's true, but i do think that the op is exaggerating. a lot. and honestly, her superior attitude annoyed me. i don't see why it matters if she is intelligent or not and if she is, that certainly doesn't afford her the right to make fun of someone's speech. maybe the cna she was talking about was really that horrible-- it certainly sounds like she needs to censor the way she talks around residents-- but she may have had a reason for some of the stuff that comes off as neglectful. countless times i've had uninformed people come up to me and tell me repeatedly that so-and-so needs something. lady with a foley and a colostomy has to go to the bathroom (yes, this happened on an hourly basis with this lady). chf guy on a fluid restriction wants a water pitcher. diabetic lady on a puree diet wants some of those cookies i just gave to someone else. another lady wants to put her coat on to "go outside" but if her anal family shows up and sees her wearing it, they'll flip out. dude who can't walk keeps setting off his seatbelt alarm-- he just wants to walk around!-- why can't you people just do that for him? usually it's a volunteer or a visitor who is trying to get you to do these things and heaven forbid if you don't rush off to do it right away.

just this afternoon, we had a resident who kept saying she had to go to the bathroom. we couldn't take her right away, for a very legitimate reason, and the nurse, supervisor, and administrator were all aware of and ok with that. we would explain to this lady why she had to wait a little while but no approach worked, and she kept asking anyone who walked by. it was the end of the day and i was extremely busy with an admission, tons of paperwork, call lights, snacks, etc and i was racing against the clock. therapy and recreation volunteers kept coming up to me to inform me that this lady had to go to the bathroom. eventually i was so stressed out, and so tired of repeating myself, that i started saying to people, "yeah, i heard... when i get a chance." i probably sounded like the cna from the story, but most of the people who were badgering us about this woman were not entitled to an explanation because this lady's situation was none of their business. obviously i was not sitting around doing nothing...

some people are lazy but a lot of us do the best that we can under the circumstances. if the water is dirty and the facility had no toothbrushes in stock, what was this aide supposed to do about it? it sound like she was extremely stressed and this student tracking her down every few minutes was one more thing to add to the big pile of crap that was her day (especially if the student was as judgmental as she comes across in her post). as someone else said, the student hadn't taken care of this woman before and she may have been reinforcing some kind of behavior. some residents at my job, especially the more with-it ones, are very manipulative and the regular staff have care-planned approaches to the "oh poor me, everyone neglects me and beats me and steals my things from my room" stuff. and it doesn't sound like this cna said hurtful things to the resident- she said things that offended the student's sensibilities. while these things should not be said within earshot of the residents, i don't think it's so horrible to let your frustrations out to another aide in private.

lilliben1 · Mar 13, 2012

Unfortunately, that's what happens in a lot of understaffed, overpopulated, inner city homes. My training too was in a LTC facility back when I was 18 and still "green." I couldn't believe how the staff treated the residents. Then after I went to work for one of these facilities, not as bad as the one I was trained at but still, I saw how bad these facilities really are.

So much care gets neglected. They hire the ghetto-fab off the street who you know just want the paycheck and that's it, it's not because they're genuinely interested in helping people. The DON"s and charge nurses tend to look the other way and pretend they don't see what's really in front of their faces.

The OP is not wrong in calling it what it is, Abuse and Neglect. It's just become so common to people in these types of facilities, it's an unspoken "norm" and it's sickening. I couldn't work in a place like that after a year, so I left and went to a hospital and will never look back. We may be understaffed at times, but at least we have standards.

azcna · Mar 18, 2012

There are no excuses for how poorly this CNA treated you and your resident. I have had as many as 14 residents and can tell you that there are ways to be fast and efficient without being rude or neglectful. This place sounds like a hell hole and should be reported. There is absolutely no excuse for not performing oral care.

pnut8377 · Mar 19, 2012

WOW!! Everything the OP stated is everything our CNA instructor told us not to do and warned us about from other CNA's. I really don't think she was making fun of the other CNA's accent, I believe she was just quoting her honestly. Please don't listen to people making excuses for this woman's poor treatment. And I maybe a new CNA student but I have 8 years experience taking care of elderly disabled people in an LTR but wasn't required to be a CNA where I worked at the time. That being said..... exactly what you described I have seen time and time again and then the abusers making excuses about the overworked, underpaid, yada yada yada. Thats exactly what it is, an EXCUSE. If you can't be humane to a human being then you need to work in a different field because there are plenty of CNA's out their, happen to be friends with a few and I will be one soon, who do the same work in LTR's having 20 or more patients and manage to get their work done plus be decent to their residents.

interceptinglight, CNA · Mar 19, 2012

That's absolutely CORRECT!!! This thread I have found really frustrating, because too many CNA's are willing to jump to the defense of blatant abusive treatment of a very helpless person, citing...."oh man we're so overworked and underpaid and mistreated ourselves....maybe just a little bit of abuse is kinda sorta OK...of course I'd NEVER condone OBVIOUS abuse that leaves a mark... but maybe just a lesser degree of inhumane degrading mean treatment of an elderly person is really not something to make a fuss about, I'm sure the OP is exaggerating anyway...." When you've been a CNA long enough to grow such a thick callous skin that this issue doesn't even bother you as much as portraying someone's obnoxious speech pattern, you better get a different job. I will concede that maintaining a tender kind heart in the sometimes spirit-breaking environment of LTC can be extremely challenging.....nevertheless once you lose your compassion as a human being, you should get out of direct care and go work in a cubicle somewhere. ZERO TOLERANCE FOR ABUSE should be Job One as a CNA!!!! For those who are still a little confused about what constitutes abuse just think of it this way: if you don't want someone doing it to your grandma, or what about TO YOU????....c'mon you know what I"m talking about!!!

stefanyjoy · Mar 20, 2012

Thought I'd come back to this thread now that my 3 week CNA clinical is over.

This LTC was nasty, disgusting, HORRIBLE -- I would not allow my dog to live there. The treatment of the elderly lady on the first day was just the tip of the iceberg. I had to report this LTC to the state as soon as my clincal was over. I have never never in my life seen such nasty, disgusting treatment of human beings -- bloody, oozing decubitus ulcers all over every patient that were not treated, when reported they didn't care at ALL, people sitting in filthy diapers for days, incomplete medical records that had not been updated in 6 months, dried up turds on the shower floors, this one lady had the circulation in her feet cut off for a substantial period of time from too-tight, nasty socks that hadn't been changed in god knows how long and when I took the sock off her nasty, long long long infected toenails came with it, and when I went to get the RN to tell her this woman was in intense pain and needed to see a podiatrist immediately and the RN came in and told her to be quiet and stop crying. Her feet looked like something out of a medical dictionary. It looked so incredibly painful. RN's that would leave meds out on the med cart and just walk away for long periods of time. CNA's that would not change diapers or incontinence pads but just throw another pad on top of the nasty, soaking old one. God this place was awful. :cry:

interceptinglight, CNA · Mar 20, 2012

Thought I'd come back to this thread now that my 3 week CNA clinical is over.
This LTC was nasty, disgusting, HORRIBLE -- I would not allow my dog to live there. The treatment of the elderly lady on the first day was just the tip of the iceberg. I had to report this LTC to the state as soon as my clincal was over. I have never never in my life seen such nasty, disgusting treatment of human beings -- bloody, oozing decubitus ulcers all over every patient that were not treated, when reported they didn't care at ALL, people sitting in filthy diapers for days, incomplete medical records that had not been updated in 6 months, dried up turds on the shower floors, this one lady had the circulation in her feet cut off for a substantial period of time from too-tight, nasty socks that hadn't been changed in god knows how long and when I took the sock off her nasty, long long long infected toenails came with it, and when I went to get the RN to tell her this woman was in intense pain and needed to see a podiatrist immediately and the RN came in and told her to be quiet and stop crying. Her feet looked like something out of a medical dictionary. It looked so incredibly painful. RN's that would leave meds out on the med cart and just walk away for long periods of time. CNA's that would not change diapers or incontinence pads but just throw another pad on top of the nasty, soaking old one. God this place was awful.

Got a feeling that you are NOT exaggerating. Thank you very much for the update -- How can places like that continue to exist?! Please someone tell me that healthcare has not devolved to this horrific level!

northernguy · Mar 23, 2012

Reading the update, you have to wonder where the State was with all this going on.

When I worked in a LTC facility the State would be breathing down our necks at the slightest hint of neglect. Maybe the families play a role. The facility I worked at was one of the best in the state and had a long waiting list, so the families expected a lot. Many of them seemed to regard the facility as a five star hotel and expected what was almost one on one care.

I guess there are also facilities where the poor and indigent get dumped, or families dump elderly people they want to forget about. Its kind of sad when investigators are spending all their time at expensive high end facilities because those are the places where family expect perfection and will report the facility because someone didnt get their HS snack at exactly the right time, while the really nasty dangerous nursing homes are largely left alone and few people bother reporting them.

lalopop86 · Mar 23, 2012

While we're on the subject- when I read things like this, terrible, ATROCIOUS things that happen to these residents at LTC facilities I have to wonder where all of these people's families are. Are they really that ignorant that they don't realize that patient's haven't been bathed, changed, treated for decubitus ulcers, etc? I have never worked or set foot in a LTC setting so I have no idea. It just makes me curious to know what families say about these things when (assuming they do) they visit.