Resident rights vs. Employee rights

  1. Okay, I've been a dedicated lurker here - responding every once in a while. Something happened today at work that has me particularly stressed. I work in a LTC facility, and have for the past six years. I love my job - I love the residents. I can take or leave some of the families. It's a hard specialty - having to nurse the family as much or more than the patient. Anyway.... At our facility, we have a particularly troublesome family. They admitted their 98 year old mother (current age) five years ago, and haven't stopped complaining - at first it was the temperature, the room mate, the wrinkled clothing from laundry, etc - relatively minor things that, unfortunately, when surveyed become much larger. I understand that they have LOTS of guilt in placing "momma" - they had always told her that she would never be in a nursing home, I understand that the guilt is the basis of their complaining. Unfortunately, DFS does not always understand that. Onto the problem - they made an allegation about an aide "abusing" their mother. (Please note that because of the various complaints that the family has submitted over the past years, no one is allowed to provide care for this person without a witness). Their definition of abuse is that the aide "touched her skin" while repositioning her. (we are forbidden to have skin-to-skin or glove-to-skin contact with this resident. we have to turn her using only the draw sheet, not our hands as support. If we are to lift her +4 pedal edema feet to get them off the bed, a towel must be slid under her ankles to provide a canopy with which to lift). The allegation of the abuse was reported to DFS, as per protocol. DFS went to visit the employee AT HER HOUSE!! They also went to visit the charge nurse at her house!! I am at a loss. I do QA/ ADON at our building. We can't ask the Ombudsman to intervene - they will only cite resident rights. We can't ask DFS to intervene - they also are for resident rights. What entity do we have to intervene on the behalf of employee rights? Any help/ insight would be greatly appreciated - thanks
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  2. 7 Comments

  3. by   Aerolizing
    I work both in a long term facility and in an inpt psych unit.

    Why not just ask them to find another home for their mom to live in? When we had frequent flyers (on the inpt unit) who said we were not doing anything to help them after a few years, we asked them to find help somewhere else. Our attending was actually the one who suggested this.

    He was great, he would just sit down with the patient and their family members and say, "I have tried to the best of my ability to help you and I am just not good enough to cure you. I feel like such a failure but I can't help you. Here are some names of other providers who may be able to help you with your health concerns. I wished I could have been more help. Let me know where you would like your records sent."

    The patients never took any responsibility for their own follow up or lack of follow up. They wanted a magic pill to fix it all. They did not want to have to go to therapy or work on assertiveness skills or stop self medicating.

    Do you have an administrator on site? Does he or she ever speak to the family? Why isn't she/he taking care of this? At the LTC where I work, whenever we have problem families, we send them directly to the DON or to see our administrator. We don't even get involved. That is why they make more money than we do. So they can take care of problems like these when they arise. I can't believe that it is cost effective for this one resident to have two caregivers at all times.

    I would have a staff meeting with administration and let them know that this is an impossible situation to win. If she stays, there will be more allegations of abuse. It may have been different if the administrator would have intervened sooner but since he did not, he has let this little hill turn into a big mountain. The family will only go as far as administration will let them go. I would not place the blame with the family, I would place it squarely where it belongs, on administration. They are the ones who are setting up their employees to be charged with abuse. Administration should have been firm about the services the staff is able to provide and about what could not be provided.

    The family is not being realistic about what services they are purchasing from you. We care for the dying. It sounds like they are looking for some place to make mama well again and they are not facing the reality that mama is going to die. Why hasn't your administrator talked to them about this? I have never heard of not being able to touch a resident.

    Good luck
  4. by   Slowone
    As a former director for an AL, I can completely understand and sympathize with this situation. There is always one difficult family, that no matter what you do, you still aren't doing enough.
    I know you mentioned the ombudsman as being a resident advocate, however I found that if used properly, they can be of help to you in the long run.
    The ombudsmans primary responsibilty is to the resident. However they can also be used as a mediator. They must remain neutral, especially if the allegations and demands are baseless as deemed by your state regulations. They can't make up the rules as they go. They must inform a resident of demands that are not the facilities responsibilty to provide. just because a resident loves filet mignon doesn't mean they have the right to have it served 5 nights a week, just for them. You are obligated to provide a well balanced, nutritonal meal working within thier MD's written dietary orders. I suggest talking to the ombudsman and pleading for thier suggestions in handling this situation. I found that if you give them the impression that you are speaking to the "all knowing", "God of all Ombudsmen" and that "they are your last hope", they tend to be more responsive. really butter them up!

    You have rights as a caregiver and if a client or clients family interfers or sets standards of care guidelines that are beyond the abilities of your facility, you have legal grounds for discharge. Perhaps it is time for a care plan review, can you really still handle the care level for this resident in a safe manner? if not, you must discharge her based on that.
    Of course you must be prepared for a battle including a discharge appeal. In Washington State however, private pay residents do not have that right to an appeal, only State $ assisted resident do. In Washington, if they pay privately, you can discharge on any grounds and are only required to give a 30 notice of discharge.
    This resident needs at home one on one care. Lord help the Home Health Nurse that gets that assignment. BTW, why can she not have skin to skin/glove to skin contact? Does she bathe her self?
    I would also talk to your state surveyor, they love working with situations like this! It will also continuosly be on record that you are being proactive in her care, which will look good if/when another complaint comes in.
    My experience also has shown that if you let them complain enough, sooner or later DSH will catch on. You know the story about the little boy that cried wolf!
    I would also talk to the DSH about going to an employees home. That is way out of line and there must be some protocol on investigation prcedures. I can't imagine that this is acceptable! if they showed up at my door, they would soon be on the sidewalk or being charged with trespassing. That is harrassment!
    Good Luck!
    Sad part is, despite all my ramblings and best guess advice...fact is, you are in a no win situation and you will just have to wait it out. Sorry!
  5. by   deespoohbear
    No skin to skin contact or glove to skin contact? How on earth do you take care of cleaning this patient? How do you apply any kind of lotion or medicated ointments that may be ordered? How on earth do you bath her? This family is way out of line!! I think I would get the patient's primary health care provider involved on this one!! Surely, the family has complained to that person too!! This family won't be happy no matter what you may do. Is your facility's social service person involved with this case. Is the patient competent yet? If so, how does she feel about all this? I think the above poster was correct is suggesting that admininstration should be involved with this case. Also, I think suggesting another care providing arrangement should be made. This family ought to try and find 24 hour round the clock care at home for their Mom. Of course, the perfect CNA/LPN/RN has to be found yet! LOL!! I bet this lady is still a full code. Be kind of hard to do CPR without any glove to skin contact!! Families like these are just impossible. We had a family complain in our ECU because they didn't like the way their Mom's hair had been curled. The CNA had washed this pt's hair, and took the time to dry and style it. Well, the family complained because they didn't like the way it was curled. My answer would be, fine. Bring in your own hairstylist, and PAY for those services!! I wouldn't make a very good mediator because I would almost always side with the side of the health care workers!! Maybe the troublemakers in this family could accompany the employees at the facility when they are providing care for their Mom. Have them stay the whole day from the time the lady gets up until after she is put to bed. Let them see how much work is involved in caring for such a frail individual. Good luck. You guys are going to need it!! Let us know how it turns out!!
  6. by   hoolahan
    I don't know didly about LTC regs, but I do know pt's sign a rights AND responsibilities form. THAT is my catchall. For example, the client has a responsibilty to comply with reasonale rules imposed by the agency. They have a responsibility to follow the medical and nursing plan of care.

    I had one pt in homecare, who is a pig. I am sorry, I will not sugar coat it. This woman can only use one arm, but can walk, wash herself etc. She chooses not to. The aides were really grossed out by her wanting to cook first thing when they arrive, while stool is in her hair, on her hands, and all over her clothes. They felt, and rightfully so, that this was an unsanitary way to prepare food. I had to meet with her, and I reviewed every right and responsibility with her. She has the responbsibilty to provide a clean and safe environment, and I told her she was not. I explained I understood her right to live her life the way she wanted to, but if she did not allow the aides to clean her up first, I would have to d/c her. Then I had APS come out and they acted as the neutral mediator. The social worker was GREAT! We agreed to give it three months. Aide just told me she is starting again. I met with her and she told me a few things, which I thought I needed to speak to the aide about, but then I caught her in an outright lie. I let her know I realized it too. She told me she was stuck in her wheelchair all night long, and couldn't move from the doorway. Then a few minutes later she c/o that the aide made her leave the kitchen when she arrived to get cleaned up, and she was mad about it. I said, so, you were stuck in the doorway in your chair all night, until you got to the kitchen this morning? Her face registered the shock that she made a boo-boo in her story. Now I feel bad that I have doubted the aides on several occasions.

    I also recommend having a neutral mediator there. But the fact is, this has been allowed to become insane. It should have been stopped a long time ago.
  7. by   CoachCathy
    Thanks to everyone that has responded - it is really nice to get support! I work at a corporation of LTC facilities that has been burned in the past (and I suppose is still in the fire) with lawsuits from these types of families. Their response is to cow-tow and give the families 'whatever they want'. I don't know - that part is the most frustrating part of it all. And, yes, Momma is a full code - don't know what they'll do if they ever walk in on us doing compressions glove to skin!
  8. by   deespoohbear
    I would think there would be a difference between "catering" to a family's every whim and wish, and providing good, decent nursing care. How on earth does this family think you are to take care of Momma when you can't even touch her? Plus, I think touch is a very important part of nursing care for most pts. I am not talking about constantly touching someone, but putting your hand over theirs, or patting their shoulders. To most people it feels good to have the one on one contact with another human being. Touch is stimulating. This family has a screw loose. Heaven help them when Momma dies. Sounds like the apron strings are still attached!!! Think how the family will freak out when the woman codes and the medics come and intubate her!! Dam* near impossible to intubate someone without touching them. The medics will love this one!!!
  9. by   canoehead
    this family is cracked, but you must be doing something right or they would have moved on. I don't know whether to compliment you for your patience and caring, or kick you for doing the submissive waitress thing with your nurses.

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Resident rights vs. Employee rights