Where Do Residents Rights End? Long, Sorry.

Nurses General Nursing

Published

Specializes in psych.

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 anything to do with him. He hoards his Poise pads, can't find them, so he stuffs toilet paper(and i mean half a roll to a full roll) into his underwear. Is this not great breeding grounds for a UTI? This man has had UTI's every month for the last three months straight, and off and on for the past year. I've tried everything I know to get him in the shower. His family members have tried talking him into it over the phone, as they live out of state. I've tried bribing him with his favorite snacks, catching him while he's already in the bathroom. I even went as far as reasoning with him, but he's already beyond the reasoning stage of Alzheimer's. So, the other night, it was his shower night. It had been one week and three days since he had had a shower. He stunk of urine and filth. His hair was so full of grease that it was matted to his head. His teeth had some severe plaque build up. He has almost a full beard from not shaving. His pants were on backwards and had not been changed since he had had his last shower. So, I tried everything I knew to get him in the shower. He still refused. So I made him get in. I forced him. He screamed and yelled and bellowed the whole time. Even took the shower head off and beat the aide with it. This guy has nothing to give as far as Ativan, Haldol, etc. I've been a nurse for a whopping two years now. I felt absolutely horrible by doing this to this man. I called my administrator, she said, it was OK, but since we are assisted living she was going to call the corporation and see what else could be done. I told her the other shifts are afraid of him, so they won't touch him. They won't clean his room because it stinks and he gets mad. They basically neglect him. He hoards things, his room needs to be checked everyday. I'm the only one that goes into his room and removes TRASHBAGS FULL of shredded newspapers, napkins, and toilet paper.

Well, I go into work today and find the nastiest note haning for all to see about how first shift does not neglect anyone. It also stated that they do give him showers and they do clean his room everyday, etc etc. So why am I being corrected? Did I do the wrong thing? Should I have just let him go for another week until he decided it was time to get into the shower? :confused:

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Specializes in ER.

Sounds incompetent to me. Does he have a POA? And would it be easier to do patches of cleaning twice a day rather than putting him in a shower?

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Specializes in psych.

Nope, as soon as you mention the word bathe, shower, shave, water, towel soap ... LOL ... it's like someone flipped the agitation switch.

Since this is an Assisted living facility, and an Alzheimer/dementa one at that, i'm not really sure what the laws state about a residents rights.

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Specializes in Geriatrics/Oncology/Psych/College Health.

I will tell you that the problem is that this person no longer fits criteria to be in an assisted living facility. It is *not* for the severely demented or those unable to primarily self-care.

Check with your super what the admission and discharge criteria are. Willing to bet if you truly are an assisted living and not a nursing home per se, he meets DC criteria.

He needs to be moved to a long-term care setting for those who need more assistance and supervision. His family should be advised immediately of the need to start evaluating facilities of their choice. If no one is POA/Health Care Rep with the authority to do that at this point, that's outrageous.

I'm sorry you're going through this :o.

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Specializes in Nephrology, Cardiology, ER, ICU.

I agree that he has gone beyond what you can supply. He is now long term care. The social worker/case manager needs to set up a family conference (even if only by phone) and get this issue addressed pronto.

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Specializes in Education, Acute, Med/Surg, Tele, etc.

Coming from someone that does work assisted living, I have complained about this and other types of residents that need further care and are not getting it in assisted living...but I have YET to see one discharged! :(

I have had folks like decribed, and ones that are far worse off and really need the care that assisted living just can not provide, but it is becoming quite clear that money does hold more weight than patients. As long as they have a patient like this, they can charge for more services, and just yell at staff to 'get it done!'..as if we are complaining just for the sake of listening to our own voices!

Even the nurses are absolutely ingnored in this respect! I have sang volumes about care needs and the need for more care for residents...to no avail! I have even gotten family involved, and about had my nose ripped off! I sadly have to give notice to the fact that families really DO think that assisted living is where their loved ones will stay till they die...and not understanding that is it a place to go till their needs outweight one CNA to twelve rooms and one floor nurse for the entire facility!

We try hard as well to screen the folks before they come in...but again the nurses are ignored and we have been left out of the loop in concerns to new admits! All the sudden we get a rush of new folks..all "independant" and we sigh...no such thing as we have seen over the past years..each time the patients are more complex, have issues not considered by the NON MEDIC administration that is saying "oh yes, they totally meet the criteria...move them in!"...

We have also become a hospice drop off! Most of our newer patients are hospice whom need more attention for various issues and really are far from independant! We have had so many that I wonder why they just don't call us 'hospice house' and start hiring hospice nurses...this is assisted living????

I could go on...but yes, please talk to your admin and the family about moving this resident to a alzh facility..but be aware, I have done this and was labeled a troublemaker and unloyal to the company....sheesh!!! But go with your gut, I do still..no matter what they call me...it is my job as a nurse to my patients...and that comes first and foremost.

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How about "swimming" in a bath tub? Let him get on a "bathing suit" aka boxer shorts.

As far as moving him to a LTC...He needs more than that...a specific Alz/ Demetia facility. We wouldn't be able to get him to shower any more that you would. He is incompetant tho...

As much as I'd hate to...I would see if low doeses of an anti anxiety could help....may also need other medication management. Maybe a specific alz facility would be able to work with him for a routine, but short staffing etc makes it dificult in the general LTC.

As far as Res Rights...I prob would "force" not sure if thats the word..clean him, too. At some point uncleanliness becomes a danger..esp the infection control issues from his room.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
I will tell you that the problem is that this person no longer fits criteria to be in an assisted living facility. It is *not* for the severely demented or those unable to primarily self-care.

Check with your super what the admission and discharge criteria are. Willing to bet if you truly are an assisted living and not a nursing home per se, he meets DC criteria.

He needs to be moved to a long-term care setting for those who need more assistance and supervision. His family should be advised immediately of the need to start evaluating facilities of their choice. If no one is POA/Health Care Rep with the authority to do that at this point, that's outrageous.

I'm sorry you're going through this :o.

I agree w/this. My FIRST thought is, this person no longer qualifies for "assisted living". He sound like he needs a notch higher level of care now (LTC).

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Residents have rights staff don't.

Many Alzheimers patients have water phobia's its part of the disease. Management knows this, however its always up to the actual caregivers to figure out how to deal with it.

Any level of care with the elderly is becoming a minefield for staff. Management will promise the family the world and get p*ssy if the workers can't deliver. I remember one care manager agreeing to let the family bring in a double bed that Mum was used to sleeping in to make the room more "homelike". Staff had to point out that it was a worker safety hazard because we couldn't raise it to working height and how were we to safely provide pericare....

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Specializes in Utilization Management.

I agree with Ratched. To respect this man's right to be filthy is to neglect his care completely. That's inhuman.

If this facility does not get the man the proper care, it might be possible that the facility could face liability for neglect. Odds are the man will eventually get some type of decub and that'll really rile up the relatives.

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This week I cared for a morbidly obese woman who'd been at a local "rehab" (more LTC, really) after bilateral ankle fractures. She's been refusing PT and personal care, and had been lying on her left side for god knows how long. She has decubs on the left side of her belly/pannus, from that position, and foul-smelling yeast all over her body. Someone must have been bringing her food though. Even if she hadn't been intubated and out of it I would have MADE her turn and get washed, with ten people if needed, but then I am in ICU where it is sort of assumed that most patients are delirious or otherwise incompetent. I really feel for her caregivers, who probably can't MAKE her do anything without legal/lecensure ramifications. Her records did say she was hallucinating in LTC, so maybe they would have had grounds to declare her incompetent, but I know it's not just a matter of saying "you're incompetent, so you're getting bathed." The system is obviously seriously f*cked.

I try not to feel this way, but she did make me feel disgusted. It's not an appropriate way for a nurse to feel about patients, and I am sure she had many difficult issues leading her to this state, but the smell and the decubs really bothered me. In any case, it is doubtful she will ever leave the unit, with sepsis, encroaching DIC, and 15% ejection fraction.

Her situation is less clear than the filthy guy with alzheimer's. He is clearly beyond any independent functioning and it's abusive to let anyone live in that state. To the original poster, you did NOT do anything wrong. It's just the usual nursing turf wars. I'm sure the other shifts were quite defensive when approached about their care, and so fired back at you. I personally am glad the man got a shower and clean clothes, and I hope he goes to an appropriate facility soon. Does he have family? Do they know what's happening?

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Usually - this is out of the realm of assisted living whent he patients require more extensive care such as a bed bath - however, perhaps he would be willing to have one rather then a shower. Or, you could try giving him a wet washcloth and he will instinctly wash himself. It's not a shower, but its' better then nothing

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