Accommodating a crazed family

[bandaidexpert, BSN, RN]

What do you all think of this. I have a resident who is the sweetest, happiest, most positive lady ever. She never complains, has mild cognitive issues but can make her own choices and has NOT been deemed incompetent. My problem is her family. She has gained about 20 pounds in the year she has been with us. Weighing her in at 180#. She is non-ambulatory d/t severe OA of the knees. (Surgery is not an option) The problem is, her daughter wants us to put her on a diet. The MD has documented the weight gain does not put her at any health risk. The daughter wants to choose mom's menu via email weekly. She wants her weighed daily! Food is all this lady has left. We have a restaurant style dining room, she makes her choices at each meal. Am I the only one who feels the residents rights are being violated here? Lab values, mainly cholesterol are within normal range. When the resident is asked, she replies, "my daughter wants me to lose weight but I am 90 years old, I can eat what I want". Now this daughter has sent a letter alluding to hiring an attorney. Has requested a meeting with the care plan team on a Saturday. My DON has tried to reason with this woman, but she insists on the meeting time. Saturday at 3pm. I know the regs state you have to accommodate the family if they are unable to make the scheduled CPC, but how far do we have to go? Any thoughts? dawn

[canoehead, BSN, RN]

For heavens sake the woman is still able to articulate what she wants, she gets to decide, not her daughter. Why not get a psych consult to verify that she is fully competent to CYA, and then tell her daughter to mind her own business.

At 90 I plan on eating icecream and cake with lots of salty dill pickles every day, and would run over whoever tried to stop me in my "Rascal" scooter. Watch your toes.

[tex]

What a sin. Is her dgt her POA? From what I understand, if a resident can verbalize what they want & answer appropriately, the resident comes first...Tex

[KaraLea, LVN]

I'm sorry, but even if her weight WAS posing a health risk of some kind, THE WOMAN IS 90 YEARS OLD...she can eat whatever her heart desires in my opinion...

[kids]

Make sure the Mom attends the meeting, that is very definately her right, if the daughter "forbids" her Mom's attendance document that she was notified that to have the meeting without inviting her to attend is a violation of Mom's rights...and that the meeting will not take place unless Mom is invited to attend and Mom has to inform the facility if she chooses not to attend. In the meeting make sure Mom has a chance to voice her own wishes to her daughter in from of witnesses. Document Mom's expression of her wishes verbatum-and the daughters response.

I would also call in the ombudsman. While they can sometimes seem like a pain in the neck their sole purpose is to advocate for the PATIENT.

[TexasLori]

This is bad, after all, the women has lived to be 90 yrs. old eating what she wants. Even if the daughter has POA, mabe the daughter has some eating disorder issues that may need to be addressed. The only time I have had to deal with a situation similar to this was over a DM resident wanting a candy bar every now and then. She was also non-amblitory and gave the staff change to go get her a candy bar out of the vending mach. When confronted about the situation her point was that she had had DM all her life and did not get to be 87 yrs old letting people tell her how to manage her IDDM. Our staff was told due to the roles we play and what we stand for she could choose to have her candy bar but that she had to get it another way, because it was AMA.

[bandaidexpert, BSN, RN]

Thanks for all the replies. No, the daughter is not POA, her son is. And he could give a squat. Psych consult refused by son, I am assuming because he did not want to fork out the $$$. And yes, mom is invited to the meeting. So far crazy daughter has not made a fuss about it. And trust me I am the queen of documentation with this family. The daughter is very thin, you could have something. I suggested calling in the ombudsman, but DON opted to hold off. Thanks again. dawn

[Nurse Ratched, RN]

Then what I am hearing is that the daughter has no right, legal or otherwise, to be demanding anything or even to have this meeting. If the resident is incapacitated, then the POA steps in. If he doesn't object to your care of her, then there is no issue.

One day I'm going to think of a very tactful way to tell someone to "bite me." When I do, I'll PM you so you can pass it on to your administration for use in this situation .

Good luck. I know you only have the resident's best interest at heart.

[bandaidexpert, BSN, RN]

Too often we must "bite" our tongues in this business. I would appreciate a PM. I work with a wonderful nurse who gave me some socks for christmas and they say "bite me" all over them, occasionally I wear these to work to make me feel better. Thanks

dawn

[night owl]

The daughter is very thin....Maybe she needs the psych consult...

A diet at 90...she lived her whole life to be on a diet at 90???? I think I'd choke my daughter if she ever came up with that brilliant idea. I want to spend my last years eating ice cream, cake and cheetos!

[ktwlpn, LPN]

Deja Vu! - I experienced a very similar scenario with a resident of a dementia unit a few years ago.The family just did not get it.She also had DJD which caused painful ambulation and she had mild dementia.The son wanted us to make her walk the halls for exercise and the daughter wanted her on a strict diet.But-THEY never set limits with her-so if we would have put her on a diet (which we did not do) they would have blown it with the Wednesday night hot fudge Sunday and the Saturday afternoon home made fudge....And the Tuesday eclairs and the Thursday donuts...But the weight gain was our fault...righto...I do not believe in strict diets for these people-food is one of their only pleasures.....I hate giving handsful of meds to 99 yr old ladies,too.....And restorative ambulating them down the hall-with max assist of 3-crying all the way...What is up with that?

[bandaidexpert, BSN, RN]

Well, i took your advice and suggested we call in the ombudsman. This was rapidly nixed by the administrator. No rationale was given, of course. I also suggested the SSD do a follow up MMSE. She scored a 28/30. Does this sound like a woman who can't make choices? Maybe I am making too much out of this. I am most concerned with the idea the crazy daughter has consulted an attorney. Our documentation on this lady is right on top of things. I am so proud of the crew for such good notes, from dietary to nursing to activities. But, in our line of work the mere mention of "lawyer" sends everyone in a tizzy. Well, the countdown to Saturday is on. Thanks for all your replies.

dawn