How Soon Should APS Be Called?

  1. We have a lady in our LTCF who has a trach and a G-Tube. She is fully aware of what is going on around her. Her mind is still sharp as a tack, just her body is falling apart due to cancer. (Very elderly lady...)
    My question is...
    the husband (they've only been married about 7 years or so) was suctioning her quite frequently, even against the advice of the nurses and finally against a written order from the doctor. He would suction her, causing her to have bloody mucous at her trach site. Finally, the nurses have removed all suction equiptment from her room to keep him from harming her.
    She throws up her tube feeding whenever he is around, and grips the side railings of her bed when he stands over her. In other words, he makes her a nervous wreck...
    He cancels Doctor appointments for her, doesn't tell the facility until it's time for her to go (by ambulance). Facility has no contact with Doctors or Radiologists...all appointments are made by him...

    Finally, yesterday was the last straw, I guess. A friend of mine finally stood up to one of the Administrators against this man and made her call Adult Protective Services for this lady. Now he says he's going to move her out of our facility in 4 days....can he?
    He keeps moving her to different facilities so her family can't find her....her one daughter has been told by him that if she ever shows up, he'll have her arrested....(this daughter has the POA over her Mother). This man has been fighting her family in court since day one to gain control of her assets...

    I guess what I need to know is...can he move her? And...is it ok for a LPN to call APS if I feel the need, or do I have to go through my supervisor? I know I should go through my supervisor first, but I mean if nothing is done and I still feel a patient is being harmed by a visitor/relative. Because I complained for three weeks before anything was done about this man suctioning her...that we should call APS because he was obviously harming her...nothing was done until yesterday. Would I still be in my scope of practice by calling myself in order to protect my patient?
    Thanks....
    Julie
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  2. 13 Comments

  3. by   boggle
    Oh Julie, What a mess!! I don't know where you stand legally, but my gut says to do SOMETHING too!!

    What's the worst that can happen if you DO call APS?? I know with kids, we are legally bound to call, even if the suspicion turns out to be a false alarm. Even neighbors can call for help from APS. You don't have to be a health professional.

    Yes, call you supervisor. Call and ask for advice from APS. This guy is going to move the patient anyway. Nothing you do is going to cause that. You can call even after he moves her. (People don't disappear that easily in the medical system)

    Better to get a "paper trail" started on this patient now. It may take a while (maybe too long!)for the next facility to get wise to the husband's behavior.

    Get something started!!

    Good luck to you. I admire you for speaking up for what you know is right!! That's being a patient advocate!!!
  4. by   meownsmile
    I guess this sounds like one of those cases FOR a room camera. I know there was a long discussion a few months ago about cameras in patient rooms but maybe this instance would be a good arguement for it.
    If the daughter has POA maybe it is time for the daughter to show up with the lawyer and make some changes legally to protect the care of her mother. If mom is of sound mind and can sign her name and communicate in writing hubby might get a big surprise next time he comes if she has signed Health care POA to her daughter. If staff sees her become so anxious when he is present it seems like the daughter could present that in court to gain control along with statements of medical interventions the facility has had to take to prevent him harming her. I dont think a judge would turn his back on it.
  5. by   NancyRN
    I can't see how the husband could have the daughter arrested. The police won't just arrest people because someone points at them and says "Arrest her!"

    He'd have to get a restraining order against her, and that restraining order has to be ordered by a judge. The daughter would have to appear before the judge and tell her side of the story.

    Why hasn't the daughter called APS? Have you tried to talk to the resident when the husband isn't around?
  6. by   nursemicke
    Julie,
    What was the outcome? Were you successful in getting help for this patient?
    Anne
  7. by   GPatty
    All I know is that the lady was in the hospital for a few weeks and now that she's back, she's worse.
    He still towers over her, and rules the roost (so to say). As far as I know, nothing has been done. I've heard thru the grapevine that it's a money issue....I don't know. I still am but a CNA. I can only say what I see and what I am concerned with, and hope that someone else sees it too.
  8. by   CATHYW
    Julie, I have never had occasion to call APS. I can only liken it to calling DFACS for suspected abuse in children. Working on my suspicions, I always ran it by the ERP first before I called, just to be sure our hunches were right. In GA it takes 40 forevers to get in touch with someone, because they are SO overloaded with cases.

    Regarding your question about being in a position to call as a LPN, I would say; be sure that you know the facility's policy, and try to follow it, to the letter. However-never let anyone or anything deter you from doing what you know to be right. If you go through channels and wind up with nothing, warm up that dialing finger! Good luck!
  9. by   Sadysly
    I would go through the chain of command. Go to the DON if he/she does not step in go to the administrator, if he/she does not step in go to corporate...a good facility will stand by its employees as well as protect its residents. If the daughter is POA this husband really has no say especially if the resident is able to state if she wants her daughter there. What a crazy mess...good luck!
  10. by   CaliNurse
    Julie,
    I can't quote Indiana law, but in California every staff member from the house keeping crew to the cook to the administrator to the nursing staff to everyone in the building MUST call APS/CPS if they suspect abuse. Actually in California for a resident in a LTCF we call the OMBUDSMAN office or 911. I have never been in an other state so I don't know if you have an OMBUDSMAN office there. But I know in California if you have a LTCF you must post the numbers for the public to have access to incase they suspect abuse. It is intending for physical abuse to Neglect to Fudiciary Abuse ( $$$ ). This summer all the LTC centers in my general area of California was sent an inservice from the Department of Justice, Office of Attorney General. It consisted of a handbook and a video. All the staff that worked in the area was required to attend.

    The time frame we work with is "Immediately" once we have reasonable suspicion that abuse has occured. Her reactions around him, his continuation to perform care for her that is harming her even after the nursing staff spoke to him and the doctors order was obtain to prevent him from doing it, and HIM MOVING HER FROM FACILITY TO FACILITY, and the POA - her children not having access to her these are ALL signs of possible abuse. So if this was occuring in my building it would be everyone's responsibility to report this immediately. This has been explained to us as being our LEGAL responsibility. There is nothing our administration department or anyone else in a supervisory position can do to prevent us from reporting or else they will be at risk for prosecution. I would report this right away! STAT! When it all comes out in the end you don't what to be one that is listed as "AWARE" of what was going on.

    Again, I can't quote Indianna law but in California if I do not report Abuse I can be find up to $1,000 and 6 months in jail or both. If the abuse results in great bodily harm or death the penalties go up to $5,000 and 1 year in jail.

    We are all mandated reporters! It was very clear in the package that was sent to us that facilities are not mandated INVESTIGATORS but mandated reporters. I hope this helps you.

    Good Luck,

    Cali
  11. by   LPN & EMT-CT
    Hi Julie,
    I had run into a situation once before while I was a CNA in the eR, WITH GERIATIC ABUSE FROM THE SON TO THE FATHER, NOT FEEDING HIM, NOT GIVING HIM HIS INSULIN AND SO FORTH!!!!
    I went through the chain of command and spoke with the charge nurse and then the charge nurse and myself spoke with the ER doc and he initiated the process, getting SS in there and they eventually had the father put into a adult home facility, where he could partially take care of himself, with a nurse being there 24/7.
    In VA the doc has to iniate the work, but like CATHYW said make sure you follow policy to the "Tee", cross all your "T 's" and dot all your "I 's ".
    hope this helps and keep us aware of what goes on with this.

    David
  12. by   Youda
    I'm curious about why your admin isn't stepping in. Have they given you any explanation? It would seem that if the daughter has POA, your social services should be calling her and discussing the situation with her. It also sounds like the husband intends to take her out AMA. Be sure and document, document, document! And, I agree with the others; you need to get something moving.
  13. by   Qwiigley
    Call the daughter. Be really quiet, make copies of reports to the APS and of documented cases of the staff and administration having to talk to the husband. The daughter can use this in court. Notify, confidentially other nursing homes in the area of this problem so they are aware. Make this a team effort to save this poor lady.
  14. by   New CCU RN
    I would not try and solve the matter on your own. While you may want to intervene, it seems as though this is a matter for the higher ups. I would find out what your facility's policy and procedure is. If you are not sure, contact your superior with the facts not your opinions on what is occuring. If your facility has some sort of risk management, I would also let them in on what is occuring. Best of luck to you and your poor patient!!!

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