Question about calling Adult Protective Services...

  1. We have a lady in our LTCF who has a trach and a G-Tube. She is fully aware of what is going on around her. Her mind is still sharp as a tack, just her body is falling apart due to cancer. (Very elderly lady...)
    My question is...
    the husband (they've only been married about 7 years or so) was suctioning her quite frequently, even against the advice of the nurses and finally against a written order from the doctor. He would suction her, causing her to have bloody mucous at her trach site. Finally, the nurses have removed all suction equiptment from her room to keep him from harming her.
    She throws up her tube feeding whenever he is around, and grips the side railings of her bed when he stands over her. In other words, he makes her a nervous wreck...
    He cancels Doctor appointments for her, doesn't tell the facility until it's time for her to go (by ambulance). Facility has no contact with Doctors or Radiologists...all appointments are made by him...

    Finally, yesterday was the last straw, I guess. A friend of mine finally stood up to one of the Administrators against this man and made her call Adult Protective Services for this lady. Now he says he's going to move her out of our facility in 4 days....can he?
    He keeps moving her to different facilities so her family can't find her....her one daughter has been told by him that if she ever shows up, he'll have her arrested....(this daughter has the POA over her Mother). This man has been fighting her family in court since day one to gain control of her assets...

    I guess what I need to know is...can he move her? And...is it ok for a LPN to call APS if I feel the need, or do I have to go through my supervisor? I know I should go through my supervisor first, but I mean if nothing is done and I still feel a patient is being harmed by a visitor/relative. Because I complained for three weeks before anything was done about this man suctioning her...that we should call APS because he was obviously harming her...nothing was done until yesterday. Would I still be in my scope of practice by calling myself in order to protect my patient?
    Thanks....
    Julie
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  2. 10 Comments

  3. by   mattsmom81
    Wow, Julie...what a situation to find yourself in...this poor woman definitely sounds like she is being abused by her husband and APS should find out immediately to begin some actions to protect her.

    I don't know all the legalities of this situation...have you talked to your case managers about this? Your risk manager? Has there been a conference with this lady's daughter who has POA and does she have POA for healthcare? (or does the hubby have that?)

    Maybe some nurses more experienced in this type of situation can give you some good advice...all I can offer is support...hang in there...I know you're concerned about this lady and I would be too! (((HUGS)))
  4. by   Nurse Ratched
    You said the daughter is the POA - is she financial only or health care POA? Do you have the legal paperwork on her chart? Did this woman sign herself into the facility? If she wasn't able to, then there should have been someone with the legal authority to do so - the POA. The husband really has no right to move her if (1) she doesn't want to be moved and is what I refer to as "her own person" - that is, competent to make her own decisions or (2) if she isn't competent and the legal authority doesn't want her moved. So I guess what needs to be invesitgated is WHO exactly is the signator on all of her admission stuff - if it's not hers or the POA's, then I don't believe it's legal.

    If you have a license, it is risking it to allow suspected abuse to go unreported. We have a duty to report abuse and neglect of any patient of ours. However, I understand your concern not to jump the chain of command. I personally would ride the administration and insist on knowing that APS was called *that day*, or call them myself. But that's the long term care practitioner in me. I've seen too many of these types of situations and I won't stand for it anymore.

    Thank goodness there are people like you and your co-worker looking out for her.
  5. by   live4today
    You COULD make an anonymous call to the APS regarding your patient's well-being, that way your name can't be used during the investigative process (by the APS) when they come to determine if indeed the patient is being abused in some way by the spouse. Every citizen has the right to anonymously report abuse, or to have their identity protected when reporting abuse. You don't need to say that you are a nurse even. You just say from first hand experience that you have seen this patient abused by her husband while you were in her room VISITING her, or when you walked into her hospital room. Tell them you are afraid to report said abuse due to your own safety being at risk since you suspect her husband of having abusive tendencies. Your phone call will be respected and dealt with, so if you must, this is another avenue you can try...and you would still be doing what you think is best...looking out for the patient's well-being. (((((hugs)))))

    Oh, BTW: when the APS does come to investigate the ANONYMOUS CALLER'S complaint, they will need to question the nursing staff...and there you'll be to fill them in on everything you have witnessed and suspected as the patient's NURSE.

    If you can't enter through the front door of a situation, then there's nothing wrong in going through the back door. the important thing is...GET IN THERE AND DO SOME DAMAGE CONTROL, DARN IT!
    Last edit by live4today on Jun 22, '02
  6. by   NRSKarenRN
    Julie: Agree 100% with Nurse Ratched and cheerfuldoer.
    I served as Ombudsman in my area.

    Need to determine:
    1. Who signed consent forms for admission to facility? If not patient, Signer establishes themself person as to speak on pt's
    behalf ONLY IF patient is incompetent. Otherwise PATIENT can make her own desisions...would worry about undue influence from her spouse here.

    2. Dtr as POA-- 100 agree with Nurse Ratched. Ombudsman will help make determination of who can speak for patient. What is patients take on all this suctioning??? If husband attempts to move her before investigation done, Call Protective immediately and police.


    Adult Protective Services Units were established to investigate reports of abuse, neglect, or exploitation, and to assist in obtaining protective services for endangered adults. An "endangered adult" is usually defined as any individual over 65 years of age (some ststes ages vary, may start at age 18) who is incapable by reason of mental infirmity or other incapacity of either caring for themselves or managing their property, and is harmed or threatened with harm as a result of neglect, battery, or exploitation. As part of the Older Americans Act amendments of 1987, Congress provided for the Long-Term Care Ombudsman Program whose primary purpose is to "establish a regular presence in long-term care facilities to become well-acquainted with residents, employees, and the workings of each facility to educate and be observent for signs abuse".

    Mandatory reporting by health professionals is required in US under the Older Americans Act and is part of most states nursing practice acts. These "red-flag incidents" should have alerted your staff/management/doctor to contacting your ombudsman immediately. Hopefully this will be done in this casue in order to avoid spouse removing patient from facility. In PA "When there is clear and convincing evidence that, if protective services are not provided, the person to be protected is at imminent risk of death or serious physical harm, the agency may petition the court for an emergency order to provide the necessary services "



    PA's law...similar most states on based on federal law

    What is Mandatory Reporting?
    Employees and administrators of nursing homes, personal care homes, domiciliary care homes, adult day care centers and home health care. If the abuse involves serious injury, sexual abuse or suspicious death, reporters must also call police and the PennsylvaniaDepartment of Aging at (717) 783-6207 or the Pennsylvania Department of Health Nursing Home Complaint Line at 1-800-254-5164.

    Failure to report as required by Act 13-1997 can result in administrative or criminal penalties (especially to nursing staff).

    Every report of abuse received by the Area Agency on Aging must be investigated to determine if the reported victim needs help to protect him/herself from abuse, neglect, exploitation or abandonment. Each report must be classified as emergency, priority or non-priority. Emergency reports are investigated immediately, non-priority reports are investigated within 72 hours.


    Once the incident has been identified as protective and it has been determined that service provision is necessary the Area Agency on Aging in most cases must have the older adult's consent to provide protective services. Permission is not required if the services have been ordered by a court, requested by the older adult's court appointed guardian, or provided as part of an involuntary, emergency intervention court order because of imminent risk of death or serious physical injury.

    All services offered to victims of abuse, neglect, exploitation or abandonment must be based on a comprehensive assessment of the victim's needs and described in a written service plan presented to the victim for his/her approval.

    Finally, in the provision of protective services certain rights must be guaranteed. Those rights are as follows:
    Victims have the right to be told that someone has reported that they might be the victim of abuse and need protective services.
    Victims can refuse to accept services.
    Victims have the right to legal counsel when the Area Agency on Aging attempts to obtain an emergency, involuntary intervention court order.
    Victims have the right to a guarantee that all information concerning their case will be maintained confidential.
    Alleged abusers have the right to be notified after substantiation of a report and given an opportunity to challenge the findings of the investigation.

    PA Protective Services for Older Adults
    http://www.aging.state.pa.us/aging/c...gingNavDLTEST=|4364|4425|
    ----------------

    Understanding what Elder Abuse is:

    The Older Americans Act-Using Your State's Long Term Care Ombudsman
    http://www.keln.org/bibs/donner1.html

    Council for Older Adults, Delaware County, Ohio
    http://www.coaging.org/aps.htm
    --------------------

    National Center for Elder Abuse (NCEA) - www.elderabusecenter.org
    ----------

    Indiana Laws:
    http://www.clarkprosecutor.org/html/aps/apslaws.htm

    Adult Protective Services: Ethical Principles and Best Practice Guidelines http://www.elderabusecenter.org/publication/ethics.pdf

    ELDER JUSTICE: Medical Forensic Issues Concerning Abuse and Neglect http://www.ojp.usdoj.gov/nij/elderjust/elder_05.html


    [I] You were a true patient advocate in helping to get this reported. Make sure incidents regarding husbands behavior are documented in chart, even if late entries needed.
    Keep us updated. Patients spouse has a problem that needs to be addressed. Not an easy situation. Karen [I]

    Edited for spelling!
    Last edit by NRSKarenRN on Jun 23, '02
  7. by   hoolahan
    I agree w what everyopne said, but I also want to thank you for being a caring nurse, and for educating me. I have had APS referrals in home health, and I guess I never thought that it applied in a LTCF, so you opened my eyes to that, and I will now be armed with that info. That poor woman, how tragic. Thank God you are there to advocate for her. :kiss :angel2:
  8. by   boggle
    So Julie, what happened?

    Did this guy move the patient? Were you able to get any support?

    Hope it went ok fo you and the patient!
  9. by   pfleige
    You did the right thing, next time do it anonimously.
  10. by   GPatty
    She hasn't been moved as of yet, thank goodness.
    As far as APS goes....I know a complaint was lodged against the husband, and I know the area Ombudsman showed up, whether it was for her or not, I don't know. (I only work 2 days a week.)
    I can only pray for her well being...
    Found out the daughter has legal and medical POA, but isn't pushing the issue. And any time the lady is asked if she wants to visit her daughter, it's done with the husband or step family in the room. I personally haven't seen it, but have been told that the husband is either there or his children are, so I don't know what's going on there.
    Will keep you all updated....
    Thanks for all the great advice and info!
  11. by   NannaNurse
    OMG!!!!! The daughter is POA...Medical and Financial....if this woman loves her mother, she needs to know that when she comes to visit her mother, she has the right to see her alone AND to ask that the other 'members' of the family leave! Plain and simple!!!
    In fact...the dtr has the legal right to DEMAND that these people be kept from seeing her mother. Please talk with this dtr. and explain HER rights. If I were there, that 'husband' would not be seeing MY patient alone. I would plan all of her care at the same time as his visit. You basically know that he is abusing this woman and by letting it happen, you are obligated to report ABUSE. To know that this is going on and not do anything about it consititutes neglience! Watch yourself and document everything you see and hear. And by all means.....MAKE THAT PHONE CALL...CALL THE POLICE IS YOU HAVE TO BUT SAVE THIS POOR LADY!!
  12. by   GPatty
    The daughter came to see her Mom yesterday! HOORAY!!!!!
    You should have seen the lady's face.....she was beaming! Oh What a beautiful sight! Mr. Hateful wasn't there, and all the staff were on guard to see if he came in, just so we could warn each other...(kind of hoping he did, so we could have him removed...)
    Daughter is going to come back again to visit and complimented us on how nice the facility is.
    Keep her in your prayers...
    Thanks everyone!

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