What would you do if this was your patient?

  1. I received a patient via ambulance from home....elderly....covered in feces from head to toe....dx: Ams according to family. Patient had bruises all over her body, rash across her back, nodules on right leg, feces applied all over face and body "as cream to keep away the bugs", ambulance crew reports this is not the first time-patient just brought to a different hospital. Crew also reports feces all over apartment. I DIDN'T KNOW WHERE TO BEGIN!

    A few minutes later, DIL and GD show up dressed to the NINES! Don't know what happened, didn't see her on Tgiving, hadn't talked to her this week, reports patient won't go to doctor(and they can't make her), no caregiver, patient lives alone-NO HISTORY OF AMS. Patient's son finally comes and tells me there is no way mom can live with him due to hard wood floors and her falling all the time. At this point, I am burning up....don't want to talk to them at all....go in with a tech and clean patient from head to toe. Do my best with her mouth-she was obviously eating them...finally return for medical history....paperwork with meds last updated 1998....patient's teeth falling out, makes her own meals, provides own care, obviously no one there monitoring or helping.

    After patient is cleaned, despite best efforts and soaking....fingernails still have feces under them...and breath stinks!! No family member wants to touch her or get near her face...I am asked what am I going to do about it? I get additional cleaning supplies, mouthcare items and towels and hand them to family....they look at me aghast and ask me what they are supposed to do with it? I suggest additional cleaning...they do not take this kindly. Meanwhile, I am getting additional patients who need me. This family followed me everywhere, where could they get a nursing home (where they wouldn't have to payfor anything), what kind of home care was available, who would I reccommend to keep it cheap and under medicare? PERSONALLY, I JUST WANTED TO CALL AND REPORT ELDER ABUSE! For the next two hours they sucked my lifeforce as I ended shift.

    With no social worker on after 5pm, and no one to back me up I didn't report call . No one in charge wanted to get involved....what would you have done? I knew she'd be admitted...had a whopping UTI! I requested social worker and intervention from floor case management.

    That family really got to me! I was feeling violent around them and just wanted to slap them! I need some suggestions on how to handle this type of situation. It's horrible that a family with obvious means could let this occur to their mother/grandmother!

    Some suggestions please, murder is not an option.
    Maisy
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  2. 11 Comments

  3. by   ktwlpn
    Quote from MAISY, RN-ER
    they sucked my lifeforce as I ended shift....
    With no social worker on after 5pm, and no one to back me up I didn't report call . No one in charge wanted to get involved....what would you have done? I knew she'd be admitted...had a whopping UTI! I requested social worker and intervention from floor case management.
    That family really got to me! I was feeling violent around them and just wanted to slap them! I need some suggestions on how to handle this type of situation. It's horrible that a family with obvious means could let this occur to their mother/grandmother!
    Some suggestions please, murder is not an option.
    Maisy
    You did everything you could do in the er-you made the patient as comfortable as possible.We often see this type of scenario-Medicare/medicaid will take care of the LOL.She'll end up in an LTC and the family will suck the life out of that staff unless clear limits are set.Sometimes you just have to make it clear that you have done everything you can and be brusk with people like that.They seem to think the world revolves around them and their immediate needs.And they hate being told that it does not. Just remember that children are a product of their up-bringing.If you raise a selfish child then that is the kind of adult you'll get. They denied AMS -it's not uncommon for a raging UTI to cause that behavior.At her baseline she is probably stubbornly independent and no-one can get her to do anything.Maybe she has been as mean as a snake her whole life.The office of the aging will be involved now ( your social services dept. will take care of that) You did the best you could..Next time-be firm and end your communications with families like this when you have done all you could-refer them to the appropriate department and make it clear that the matter is out of your hands.
  4. by   Alois Wolf
    This post really hits a personal note with me. My parents are getting older and older every day and I can see it in them. It's scary for me, though I try not to think about the future too much, but I always worry how I will be able to care for them when they do become...

    The fact that this familly treated their mother this way. I wouldn't be able to live with myself if that was my mother. I really would not be able to live with myself at all.
  5. by   txspadequeenRN
    i would be for raising a stink about not having a 24 hour social worker. the patient needs to be declared unable to care for herself and let adult protective services come in and take over. they can get her placed after her discharge in a safe and healthy environment . as for the family....you did better than me....
  6. by   NicoleERRN
    Maisy, Thank you for taking the time and effort to do your best to care for that patient. As for the rest IMHO this is elder abuse or at the very least neglect.. pt prob needs some additional care whether Assisted living or NH, in my er this would be reported and social service to follow up. Depending on where you are from, we have an 800 # to report "suspected abuse " and it is reviewed from there. These situations are very frustrating and no one wants to be the bad guy. Again,least you cared enough for that pt, you prob made her more comfortable and treated her like a human for the first time in a LONG time .. Kudos to you !! Hope everything works out!!
  7. by   caliotter3
    You did everything you could at the time while having your blood pressure pushed upward by this family. You are to be commended. You could have done no better. I wish I could think that I could handle it as well as you did. You probably should discuss with your nurse manager or the social worker about making a report to adult protective services in this matter. They can advise you on your responsibilities here. By reporting the matter to the social worker, you may have done as much as you are required to do under the circumstances. If it was me I would be tempted to make an anonymous call to APS, trying to leave out anything that would implicate me as a hospital employee. Hard to call.
  8. by   nyapa
    My question is this: is this lady competent to make her own decisions? If she is, then family really can't do anything. But it sounds, obviously, that she is not. If the ambos have been picking her up all this time and taking her to different facilities why wasn't this reported to authorities earlier by them or the other facilities?

    Don't take this hard. You did the best you could. Good on you for making the family do a bit of caring themselves. If they want care for a family member in a nursing home, then why cant they arrange it? Why wait until this late in the day before they consider it?

    (((Hugs)))
  9. by   EmmaG
    No social worker on call? There's a 24 hour abuse hotline too. Probably wouldn't be necessarily urgent to call if patient was admitted, but I'd call it anyway to start things rolling and also so that her family visits can either be monitored or they kept away from her while she's in the hospital.
  10. by   ZippyGBR
    the other point to remember is that many peopel are in denial of their parents / grandparents eldery aunts + uncles etc quite obvois confusional states and also say ' they aren't confused at home' - where home is often the long standign family home thatm ight not have been substantially changed for the past 20 , 30 , 40 years since the children left home ...
  11. by   leslie :-D
    aps.
    persistent f/u from hosp sw.
    do not discharge this lady to home.
    poor soul.
    she'll likely be much improved after her uti's resolved.
    these 'children' need to be accountable.
    granted, we don't know the family dynamics.
    but no one should ever end up like this.
    no one.

    leslie
  12. by   MAISY, RN-ER
    Quote from dar15
    My question is this: is this lady competent to make her own decisions? If she is, then family really can't do anything. But it sounds, obviously, that she is not. If the ambos have been picking her up all this time and taking her to different facilities why wasn't this reported to authorities earlier by them or the other facilities?


    (((Hugs)))
    The family tried to pass her off as not wanting interference or help...it was hard to believe after speaking to the emts....they said it wasn't her first time with them in poor condition! Obviously, her son's excuse of not keeping mom due to his hardwood floors and how dangerous it would be since she falls all the time, kind of shows problems exist.

    Thanks to everyone who has answered so far....I was so angry the other night! ER can be tough....families like this make me feel almost violent! I really felt like putting some hurtin on them, just like mom/grandma. Even though it's silly...I wanted to smear feces on their nice clothes-or encourage her to give them a big fat kiss!

    I did follow up with our case manager today, and she assured me it would be handled on the floor with case management. There'd be no way she'd end up at home again. As one poster stated, she's gone to other hospitals, been cared for and ended up coming to ours. Hopefully this time, she will be followed.

    Thanks everyone,
    Maisy
  13. by   Ms Kylee
    You done good, Maisy. Bless you for being so caring. And like you, I'd want to smack son upside the head. I guess he's never heard of treaded shoes/slippers. I just hate it when people won't or can't be bothered to take responsiblity for their parents. :angryfire:angryfire:angryfire (We need a burns my butt icon on here. *LOL*))

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