Can you refuse to give care to a resident in LTC? - page 4

Hi there! I've recently refused to give care to a resident. His Dr. has said his behavior is not caused by any mental illness or brain disease, as he has visited with him multiple times due to his... Read More

  1. by   PricelessRN
    Try not to take it personal, I'm guessing you are a fairly new aide and will encounter this situation more often than not. Good Luck to you. For now, ALWAYS have someone with you! Speak with the charge nurse about possibly rotating assignments. Good news is this won't last forever.
  2. by   CNA2016:)
    Yes this won't last forever and it is a good learning situation for me. I've worked on this floor/been an aide for almost a year now and this resident is by far the most difficult ive encountered so far but its good practice for the future. Very thankful to get advice from you nurses on this as the nurses here tend to avoid the resident altogether. Thanks again!
  3. by   Kooky Korky
    Quote from CNA2016:)
    Okay thank you for your response. I was pretty sure that was the case. It sucks that there are no rights for workers in this situation. The patient/resident can be in his right mind and abusive and terrible to staff yet nothing can be done. I really thought we would have some type of rights but apparently we are just servants. I think residents/patients like this should be kicked out and that's their problem. But no let's keep him and let workers burn out and leave so the facility can get a pretty dollar from this ******! Anyways thank you for responses....any suggestions what to do if a resident screams at you that you're a ******* ***** and to get him ******* water and then get the **** out? Cause I've already tried saying I'm going to leave until you can speak calmly. I've also tried just simply leaving him where he's safe and has bell etc until he can relax. I've tried telling him to not yell or swear or I will not assist. Ive tried just taking his crap and doing what he asks while he freaks out. However he always ends up more angry no matter what or will realize he can treat you that way and will the following day. Any advice is helpful...any ha ha thank you
    Have you ever asked him why he is upset? Mr. Jones, I notice you are yelling. Why are you upset?

    Have you ever let him know that you are so sorry that he's having a very difficult time?

    Have you ever let him know that you really do want to know how you might help?

    It could be that this person has had some very big and painful happenings - loss of spouse, loss of other loved ones, loss of work, terrible health, become dependent upon you and other strangers for his every need or wish? Maybe he's got a roommate but wants privacy. Maybe it's the temperature, the food, being on someone else's time schedule, loss of control of his life. Maybe his pillow or bed isn't comfortable, maybe a million and one things, maybe he doesn't have his beloved pets any more and even had to send them to the Humane Society or put them to sleep.

    Try gently relating to him on a real person to person level. Try letting him know that you really do want to get along with him but that he scares you when he yells and it seems like there is nothing you can do to make him happy.

    Maybe he can't reach his call bell, TV remote, water, glasses, book, toilet paper, whatever, urinal.

    Maybe he doesn't know if he's going to Heaven when he dies - which might be soon, and he's terrified of The Great Beyond.

    If you can view him as Bob Smith, former welder and climber of girders on skyscrapers, fearless, self-reliant, who supported a family, not just see him as a patient, it will help. Maybe he served in the military and fought in a war, risking life and limb for your freedom or was ready to go at a moment's notice. Maybe he was a fisherman, a lawyer, a shopkeeper, a businessman. Now he's wearing diapers and depending on you to clean his excrement. How do you think he feels? Let him know that you know it's not easy but that he's probably been through hard times before and he can get through this , too.

    No it is not your fault, no you can't really change anything - except how you view him and approach him. And if he senses that you appreciate him as an individual, I think his behavior might change for the better. He might even come to really like you and then you can get others to see him in a new light and he will mourn his losses and be able to move past them somewhat. Enter into partnership with him. Ask him to help you do that. He might really like realizing that HE can help YOU for a change.

    Ask him if he ever had any dogs, cats, horses, turtles? Did he like the Rocky movies? The Beatles? Whoever.

    Get to know the guy a little. Don't wait for him to be nice. Try asking him what kind of music he likes? Then try to see to it that he gets to hear it sometimes. Maybe TV's going all the time drives him crazy. Maybe he needs some ear plugs.

    Show him a picture of Secretariat and ask him if he knew that this horse won the Kentucky Derby by 53 furlongs, I think it was, an utterly amazing feat.

    You get the idea, don't you, Friend? You can do this. Be the leader and help others learn how to assist this man and others you might encounter later who are just in terrible pain.

    God bless you and thank you for caring about your patients.
  4. by   tyvin
    This needs to be care planned. Always two staff when givng assitance and your boss has the right to fire you. So what...you just throw the other nurses to the monster. Your facility took him knowing full well the behavior and now it's their responsibility to take care of him. Sounds like he doesn't like being there.
  5. by   CNA2016:)
    Thank you for the wonderful response!!! This resident and I used to be on good terms...he was happy to see me, then he wouldn't like me for awhile then he'd be happy to see me, and now he is just not liking me at all anymore. He got upset towards me again tonight but it wasn't too bad. He is off and on with all the staff but for some reason he seems to hold grudges against me longer than others thank you for response
  6. by   CapeCodMermaid
    And sometimes it means the person is just mean and abusive. Have you worked in a SNF or LTC? The CNAs often have 10-12 people to care for and one nurse can have as many as 30 people to medicate. The DPH will hound us if we use too many antipsychotics...atypical or not. "SW need to find placement for difficult patients??" Where would you suggest?
  7. by   MPKH
    Ask your manager to implement a care plan for this gentleman. We have that for difficult patients on our unit. We inform the patient that we are leaving due to inappropriate behaviour and will attempt care at a later time.
  8. by   CNA2016:)
    Yes I'm finding the biggest problem is getting the people who can do something about it to actually do something in that I mean management and nurses to take the time to work with the aides. I'm going to have to speak to the same nurse I did day before yesterday about us needing to adjust the care plan. She listened to my concerns but here we are 2 days later and no one has tried to move forward with it. It's discouraging because no one wants to think about the stress this resident is causing for the staff, especially the nurses and management because they hardly see the resident. The aides are having the biggest issues yet were struggling to get help from the people that can actually do something. Very sad
  9. by   Kooky Korky
    Quote from CNA2016:)
    Yes I'm finding the biggest problem is getting the people who can do something about it to actually do something in that I mean management and nurses to take the time to work with the aides. I'm going to have to speak to the same nurse I did day before yesterday about us needing to adjust the care plan. She listened to my concerns but here we are 2 days later and no one has tried to move forward with it. It's discouraging because no one wants to think about the stress this resident is causing for the staff, especially the nurses and management because they hardly see the resident. The aides are having the biggest issues yet were struggling to get help from the people that can actually do something. Very sad
    In the meantime, try some of my suggestions. You say he has been decent to you off and on. ry to regain his goodwill. I think you can do it.

    I really think he needs a Psych evaluation. Has this been done? Maybe he has a brain tumor.
    Get a Neurology consult, too. I know you are an aide, but you can still maybe talk to the doctor or Manager and ask what would they think about a Psychiatrist and a Neurologist each seeing this man.

    Hey, it couldn't hurt for these specialists to see him.

    I wonder if you can possibly put the idea in his family's ear without getting in trouble - because he's so labile.

    Meantime, work your magic with him.
  10. by   Kooky Korky
    Quote from CNA2016:)
    Yes I'm finding the biggest problem is getting the people who can do something about it to actually do something in that I mean management and nurses to take the time to work with the aides. I'm going to have to speak to the same nurse I did day before yesterday about us needing to adjust the care plan. She listened to my concerns but here we are 2 days later and no one has tried to move forward with it. It's discouraging because no one wants to think about the stress this resident is causing for the staff, especially the nurses and management because they hardly see the resident. The aides are having the biggest issues yet were struggling to get help from the people that can actually do something. Very sad
    Who has actually done what?
  11. by   CNA2016:)
    so apparently he has been started on an antipsychotic and the SW has talked to him about his behavior and his Dr and the doc numerous times. Only family he has is daughter. Nurses say she has issues as well, becoming hysterical in fights with her dad at the facility and coming to visit drunk. Aside from that, there is no current care plan and I think that is the biggest issue. I think everyone deals with him a different way nurses and aides. I'm optimistic though he has been good today so that's something I guess
  12. by   CrazierThanYou
    He should be discharged.
  13. by   CapeCodMermaid
    Easier said than done. Where would he go? The MA DPH would be all over us if we discharged someone for being difficult. There are very few times we can issue a discharge notice.

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