Rights of POA vs Resident

Specialties Geriatric

Updated:   Published

A wonderful, delightful elderly resident for whom I had great affection and rapport was found gasping for breath, ashen and moaning early one morning . According to POA directives, he was sent to hospital. When the POA was called to let them know what had happened they said he wasn't supposed to go, they didn't want that. ???? I felt terrible- it is my biggest peeve in LTC that we are too aggressive and should allow more natural deaths. However, one must follow family wishes. I thought back to the aggressive treatments this family insisted on only several months ago, the bullying tactics of family members trying to get this resident to eat, drink. The overwhelming picky directives staff were to follow about when he was to be up, what he was to wear or not wear despite the protests of the resident, he was TOLD he must do this or that... the numerous " stomping down the hall to hunt up the charge nurse to tear a strip off her".

I am disheartened with my nursing role right now. If I didn't need the money I would work somewhere else. Is it guilt, miscommunication, lack of knowledge that makes these families so obnoxious? When a family makes the decision to move their loved one to LTC, don't they see it is end of life care, not rehab. We have care conferences, set up nsg care plans but it doesn't matter, if Mary wants her mom dragged out of bed every morning for breakfast and put in a hot fleece track suit we have to follow her wishes -even though mom might be stripping in the hallway because she is so hot- if we change her and Mary finds out or God forbid comes in and sees her like that there is Hell to pay. I have families who ask every day why their loved one, who is in a locked alzheimers unit, is restless, confused, agitated? Or better yet, the ones who insist on the MD discontinuing all their meds and putting them on vitamins and then at night when the sundowning kicks in they get upset because their father/mother fell, or hit them or attacked a co-resident.

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I'm lucky...we don't see this that much anynmore. My "LTC" isn't a place that people go to die. We have alot of rehab..even the elderly long term residents have benefited from rehab. Maybe they aren't walking out of the place, but some may now be able to walk tothe bathroom in the room or transfer from the WC with min assist.

As far as the overbearing POAs. Your DON or SW needs to step it up. The resident makes the decisions for themselves, family or POA makes suggestions. If Mary is going to strip off that pink sweatsuit because she is too hot, I'm not going to make her wear it but instead will find something Mary is comfortable in wearing.

We had a dghter that insisted her mom wear a bra and dress or skirt because that was the way mom always dressed. Let me tell you...mom didn't want anything do do with a tight fitting bra and dress with hose etc. Even with dementia Mom told us (with some choice words mixed in) she didn't need to be all dressed up anymore and didn't want to..sweat suits were here favs.

Moral of the story..in all of my years..yes..I've seen families like this and

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Specializes in Med Surg - Renal.
wiley6coyote said:
Is it guilt, miscommunication, lack of knowledge that makes these families so obnoxious?

Nope. It's denial.

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wiley6coyote said:
A wonderful, delightful elderly resident for whom I had great affection and rapport was found gasping for breath, ashen and moaning early one morning . According to POA directives, he was sent to hospital. When the POA was called to let them know what had happened they said he wasn't supposed to go, they didn't want that. ???? I felt terrible- it is my biggest peeve in LTC that we are too aggressive and should allow more natural deaths. However, one must follow family wishes. I thought back to the aggressive treatments this family insisted on only several months ago, the bullying tactics of family members trying to get this resident to eat, drink. The overwhelming picky directives staff were to follow about when he was to be up, what he was to wear or not wear despite the protests of the resident, he was TOLD he must do this or that... the numerous " stomping down the hall to hunt up the charge nurse to tear a strip off her".

I am disheartened with my nursing role right now. If I didn't need the money I would work somewhere else. Is it guilt, miscommunication, lack of knowledge that makes these families so obnoxious? When a family makes the decision to move their loved one to LTC, don't they see it is end of life care, not rehab. We have care conferences, set up nsg care plans but it doesn't matter, if Mary wants her mom dragged out of bed every morning for breakfast and put in a hot fleece track suit we have to follow her wishes -even though mom might be stripping in the hallway because she is so hot- if we change her and Mary finds out or God forbid comes in and sees her like that there is Hell to pay. I have families who ask every day why their loved one, who is in a locked alzheimers unit, is restless, confused, agitated? Or better yet, the ones who insist on the MD discontinuing all their meds and putting them on vitamins and then at night when the sundowning kicks in they get upset because their father/mother fell, or hit them or attacked a co-resident.

Get the doctors, Directors, Nurse Managers, Social Workers, etc. to talk turkey with the families. Some families can't cope with losing their parents, some feel guilty, etc.

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MN-Nurse said:
Nope. It's denial.

You left one out - fear. I can't speak for the family that the OP refers to, but having been there it can be a very frightening experience for family members - between the legal ramifications of actions, internal strife between family members, caregivers suddenly having to make decisions that mom/dad/grandpa/grandma/etc. typically made, and the general lack of knowledge of exactly HOW to deal with managing end-of-life care it can be a maddening experience to say the least. And, unfortunately, in some cases the medical staff get caught in the middle of a whole buncha ugly when emotions are running high and higher-order brain functions are shutting down (not with the pt - the family members).

Wish I had a good answer for the OP - but I don't. I'm very sorry that you have to go through those experiences, but unfortunately when the H&P is signed off on by the attending MD, the POA's on the hot seat, and at least in California at that point what the POA says, goes.

Incidentally, I start orientation for my new CNA position tomorrow morning - LTC, with all the trimmings. And yeah, I expect to be getting my share of a$$ chewing, black eyes & bloody noses from family members lashing out at me because I'm a convenient target - but, better me than their loved one. Just hope I can stand by that statement 5-10-15 years from now. Or, for that matter - next Friday.

Wish me luck.

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Specializes in Trauma, ER, ICU, CCU, PACU, GI, Cardiology, OR.

Certainly, it could be all or some of the following...

Denial, guilt, fear, and at times greed, i'm sorry to add...since I have witness them all.

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Specializes in Geriatrics.

Some families are like that no matter who talks to them or what is said...the joys of LTC!

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Specializes in nursing education.

Gasping for air and moaning sound like a need for morphine at the end to decrease pain and air hunger. Could you have done this in your facility? Could you have applied oxygen or done other comfort measures? Alleviating the person's suffering should be the main goal.

Sorry you are having to be anxious about this. Can you have a debriefing at your facility? A "what should we do if/when this happens again?"

End of life is so hard.

Sorry for your loss.

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Specializes in Geriatrics, WCC.

Do you have a POLST in place? These are orders and would designate whether someone was to be sent to the hospital, DNR/DNI, etc. Do you have orders or care plans, assessments, etc. on how to care for your resident? Then you need to follow those. I have a family member that interferes with the care during the noc of a resident, she will not allow staff to change him for hours as she wants him to sleep. After several floodings of the bed and floor and she giving "pills" to get him to sleep... we are having a care conference with the family member this next week. she will not be allowed to be there after HS, is not allowed to give any meds, and it will be in a letter form. Ombudsman involved.

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Specializes in Hospice.

If the directives in the chart at the time of incident were to send the resident to the hospital, than that is what you do. If the POA has changed his/her mind, he/she needs to update the directives, not yell at you after the fact. Sounds like a failure on their part, not yours.

As for bending over backwards to please the POA, I will attempt to follow their instructions about mom/dad getting up, eating, dressing, etc. However......The resident has the right to refuse - regardless of what the POA wants. If the residents says no to getting up, putting on a certain outfit, even taking medications or eating, we MUST respect their right to refuse. The POA may be upset, but just because the resident does not make his or her own medical decisions, does not take away his or her rights. I will gladly explain to family member that mom is not up in her pink outfit, because mom chose not to wear that outfit and not to get up. She has that right, and I must respect it. If you as her family member want to attempt to get her to wear the outfit and get up, you are welcome to try, but she told me no and I will honor her wishes. The POA gives a person the ability to make medical, financial, and other major life decisions, but does not take away the rights specifically outlined in the resident bill of rights. (My pet peeve is POAs thinking they get to make every single decision for the resident without regard to their wishes and rights).

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I once put a overbearing POA/daughter, who was also a nurse in her place by telling her that "I'm sorry, I just can not do that. If your mom says no, then she has the right to say no...even with her dementia." POA puffed up (of course) but I simply smiles and said, I know you feel like it's the best thing for your mom, however, what you are suggesting could be construde as abuse/bullying. And I am sure you do not want to do anything that could possibley be considered abusive, do you? And I just smiled at her. It was like she had a big old fat light bulb click in her head...LMAO She was really easy to deal with after that. I am not afraid of over bearing families. I accomidate reasonable requests and I just am straight forward with unreasonable ones...and I always advocate for my patient's rights and try protecting them from all harm.

Just yesterday, I was getting report and the term "I feel so sorry for you...so and so's son is the biggest dick you'll ever meet. Nothing can make the man happy." The son was great... he stomped up to my med cart at 1000 demanding his mother's meds and I said...there you guys are..I went to searching the unit trying to find you, but someone told me you two were off unit, smoking. Are you aware that I cannot go off unit to pass medications? Son replied, "We were just down the hill in the court yard, I do not think it is unreasonable thing to expect you come to the court yard to give her medications since it's 30 feet away." My reply to that was, "I know, I think it's ridiculous too, but I legally can't leave the floor because I have 29 other patients I am taking care of and if I left the floor to track down your mother, then it would not be fair to my patients who are depending on me to take care of them by getting their medications on time and to be here to care for them, too. So, to help prevent you from getting frustrated in the future and so your mom can get her meds when she is suppose to, she has medications scheduled for 0800,1200, 1600 and 2100 and has to be on the unit. It is your mother's responsibility since she is not incompetent to be here when her meds are due." He was really nice to me after that... did not give me an ounce of trouble...even thanked me for being such a great nurse...lol

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Specializes in Care Coordination, MDS, med-surg, Peds.

A DPOA is only in effect if the resident is judged incompetent or unable to make decisions due to severe illness as determined by the dr to make decisions for their own care. That irks the heck out of some family members. I just tell them that the resident is still able to make that decision for themself and I will follow their wishes until they are unable to do this themselves or until the court appoints a guardian, or if the POA is legally in effect. If they want to make the decisions they need to get guardianship. Then it is a different ball of wax!.

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