Where Do Residents Rights End? Long, Sorry. - page 3

by Cheez-It! | 2,252 Views | 28 Comments

I've got issues at work. I work in an Assisted Living facility, in a secure Alzheimers/Demetia unit. One particular resident refuses to bathe. He's not oriented to time, or place. He stinks, none of the other residents want... Read More


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    Do you think that, even though he has alzhemiers (spelling dodgy) he still has the ability to know what's going on and play "games" with you all? Once you back off nagging him, it stops becoming a "game" and he will eventually comply of his own accord. It may not be to your standards, but who's judging? Its a thought anyway.
    He DOES play games. He will tell you he's not "going to do it, just becuase I want him too." If you leave him to do it on his own, it doesn't get done.

    If he refuses to bath, he is not going to becaome seriously ill becasue of it... its unpleasant for those around him. All you can do is employ all your poweres of persuasion and or try other alternatives as others have suggested. I'm not sure there is anything else you can do. You are not going to get 10 nurses (as someone else suggested - not maliciously I might add) and force him into the shower are you? Let him remain unclean... the other residents might object so much that they start to leave, then the administration will have to do something!
    As far as the other residents, the already run when they see him coming. At meals he sits alone. Everyone refuses to sit with him. He has no "friends" in the facility like most residents do. I'm at a loss. I have no idea what to do with him. I have spoke to the administration and all they say is, "Teamwork." It takes teamwork." What does that have to do with anything? They're missing the whole point. What it comes down to is he's neglected. If my shift can't get him done D/T behavior, the next shift will try. As soon as he raises his voice, they leave, write in the book refuse, and that's it. He's an issue, liabilitly, and I just plain do not want him in the facility anymore.

    As far as becoming seriously ill, I doubt that also. But what about skin health, and his UTI's? I just recieved yet another order last night to do another UA. This makes the third UTI in the past 3 months. The man won't get up out of bed but for, on an average, I would venture to say five to six hours a day. The rest of the time he lays in bed. I see ulcers in someone's future .......
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    Definitely sounds like a psych issue. Can you get him a psych consult?
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    Maybe someone is thinking that he is acting out like this because of a UTI. Has he ever had a follow up UA to confirm clearing of the bacteria? Just a thought. Otherwise I agree with Nurse Ratched that he has gone beyond the scope of Assisted Living. Is there a social worker at your facility? She surely would notice and be able to deal with this. What about the residents that complain about him, maybe give them admin's phone number. If they threaten to leave loss of more money. Good luck. It is very tough.
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    Not bathing a patient properly would be considered neglect in this country and would have very serious repercussions. Not only lawsuits but the facility could get in a heap of trouble too.
    This thread really concerns me...I have a mother with dementia who has deteriorated to a degree that she is just about ready to be placed, and a few months back or so I had posted a question about how does a dementia assisted living work. I have not worked in one, but had wondered how on earth could someone be safely watched in this condition in an assisted living environment. I could see if they were in the very early stages of it, but I kind of wondered how bad do they have to get before they are moved to a LTC. I just recently talked with a DON from an LTC who had told me she did not believe that dementia/alzheimer patients were appropriate for assisted living, period. I really can't give an opinion since I don't work in LTC or AL, but it definitely concerned me, at least for my own mother's sake.

    Quote from PamUK
    I would like to repsond to the original posting

    I'm not sure of the laws in the States, but doubt they are much different to the UK. If someone is not competent to consent to any kind of care and does not cooperate with you, you can only do what is necessary, in their "best interests". Clearly, toilet rolls stuffed down his pants that cause UTI's, must be removed. If he refuses to bath, he is not going to becaome seriously ill becasue of it... its unpleasant for those around him. All you can do is employ all your poweres of persuasion and or try other alternatives as others have suggested. I'm not sure there is anything else you can do. You are not going to get 10 nurses (as someone else suggested - not maliciously I might add) and force him into the shower are you? Let him remain unclean... the other residents might object so much that they start to leave, then the administration will have to do something!

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    I am currently doing clinicals in a LTC that is mental health only. It is interesting to say the least. For a high functioning dementia or early stages my Grandmother did assisted living. But she had a great place. It was one floor. The residents only had a room, with a bathroom. They all ate in a main dining area, so there were no concerns reguarding leaving the stove on or such. They did have their own furniture. It was wonderful. Once she started having to have assistance changing herself, and taking showers, they moved her to their LTC. Unfortunately that really messed her up. She passed shortly after. Instead of a gradual move (they were connected) they just up and moved her over there, and it was just too traumatic for her. In a regular LTC facility though the nurses get really frustrated with the wanderers. It was hard to keep them in, and when they did manage to get out it was hard getting them back in. I really hope you are able to find a good place for your Mother.
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    When I worked at an assisted living facility it had people who definately did not belong at that facility. Some of the residents needed to be in LTC. One of the male patients had dementia and beat up on staff on a regular basis. When I questioned why these people were at the assisted living facility I was told that they were "private pay patients." :angryfire It seems that if a patient is "private pay" they can do whatever they damn well please. :angryfire
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    OK I had a mental health Pt in a rehab hospitial and we called the Odbudsman and they stated a Pt could refuse to bath up to 30 days then it becomes a health issue .On Day 30 .We said we needed to see him a minute in the bath-room .We had every thing prepared clothes soap wash cloths towels warm room.
    He could sit in the hydro tub and soak feel the water to make sure it was warm enough ,wash his hair and we would keep the room very warm. Ours had not changed his clothes for 30 days litteraly. That the Odbudsman had been nofited .This is not a choice anymore its a health issue. So why we had his dirty clothes off we took the dirty ones .It litterally took 30 mintues of soaking in the bath to get the crude off .Then of course he was willing to shave and shuch.
    The next few baths we just had everyhing ready to go and then said we need you to step inside this room for a minute Can you follow me.Then once in the bath-room We would tell him we have everything ready, we really need you to bath. Didn't give him time to think about it. So he wouldn't refuse.
    Just try to prep every thing ahead of time before he has time to think.

    Good luck Check your Odbusman regarding this in Assisted Living situations.
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    These asst living homes are really getting out of hand. It used to be that a requirment for a patient to live in one of these is they had to be able to ambulate to the nearest door in case of a emergency....WHAT A JOKE!!! these folks need skilled care. But, when it comes to making promises and taking the ppl's money, they are nothing but crooks. I have been in some decent ones, but the bad ones just seem to be unforgetable
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    Currently, our guidlines for acceptance into our facility are that they must be able to "get around" by either w/c or ambulation or only x1 assist. Right now, most of our residents are high functioning Alzheimers/Demntia residents. Which is what assisted living was intended for. But, in order to please families, make money, etc etc, they just take whoever can walk, not thinking about the psych adjustments that may need adjusted/changed.

    I'm currently thinking of changing jobs. May have a job in a psych facility where I know these things do not happen. Job maybe harder, but anything to get out of that huge liability. Atleast until I finish school.

    It's really a shame. It's a great facility, and could be one of the best in the state as far as I'm concerned. But from where it's heading now ...


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