Aged Care Duty of care question

Nurses General Nursing

Published

Note: I am not a nurse but I am posting this because my gf who is a nurse has had this experience and the issue has annoyed me.

hi everyone

my gf works in an aged/palliative care and they have recently had a new resident arrive with dementia. About a week ago my gf was taking care of him when he violently attacked her. She pressed the emergency button, no one came for a while and when they did they were apparently less than useful or sympathetic to the situation. My gf was later told that the resident used to be a woman abuser and alcoholic etc. this was her first "attack" situation so she was pretty traumatised about it. She is okay now but was told to work a different part of the home for a while.

so a week later now, my gf has been told this man has been luring other women with dementia in the home to his room and kissing them and molesting them. My gf was upset and said to the managing RN nurse what should they do to which the managing RN replied "there is nothing we can do because he has dementia, the best we can do is keep an eye on him"

so my my question is - is this true? Can nothing really be done because this man (using the term loosely) has dementia? Doesn't the nursing home also have a duty of care to tell families of these other women with dementia that their loved ones are being repeatedly sexually assaulted and nothing is being done? And can my gf do anything to address this situation?

thanks for your time if you're reading this.

Specializes in Hospice.
Yes!

Thanks for cutting to the quick and for the wake up call reality orientation, heron!

I work in ltc now - one of the good ones. We are encouraged to take such issues very seriously.

Nursecard is giving good, timely advice. Something needs to be done now.

Clients or patients are not to touch others. Especially in a sexual way. One of our precautions, such as suicide, assault, etc. is "sexually acting out". All are illegal. No person can legally commit suicide, assault another individual, or sexually force themselves on another without having to deal with the ramifications, once the behavior is reported to the appropriate professionals.

Without going into great detail, the sexually acting out individual can be involuntarily admitted to an inpatient psych program and diagnosed with Psychosis nos. The criteria for admission is an altered mental status, which can be treated with medication and other therapies.

This is a side track..

Do you mean they can be admitted with psychosis because of the sexual assault behavior?

I ask because I had a patient with psychotic dementia and we couldn't get her admitted because her underlying condition was dementia and I was told by everyone I could get on the phone that Medicare doesn't cover psych admissions with a dementia diagnosis as the only precursor to the psychosis. They said this a was a relatively new denial issue (a couple of years ago now). It was extremely disconcerting as she didn't qualify for any in patient admission because of it but also couldn't be managed at home.

Specializes in Psych (25 years), Medical (15 years).
This is a side track..

Do you mean they can be admitted with psychosis because of the sexual assault behavior?

No, Libby, I don't think your question is a sidetrack- it's spot on question for how the system works.

Basically, Dementia is not an Axis III diagnosis, so patients cannot be admitted for behaviors associated with dementia. HOWEVER, patients can be admitted for behaviors stemming from an altered mental status and be given the diagnosis of Psychosis NOS, which is an Axis III diagnosis.

The good thing is that we can help people with these behaviors. Antipsychotics, dopamine antagonists, calm agitated behaviors. Coupled with antidepressants and/or antianxiety agents, these behaviors can be greatly reduced.

My explanation is oversimplified and focuses on medication, but I hope you get the gist.

Specializes in Long Term Care, Expert Witness.

This is sexual abuse and needs to be reported to the state agency. And the RN who said that nothing can be done needs to be reported to the state board of nursing. She is a mandated reporter. Shame on her! There should be a state number posted within the facility in several different places that ANY person can call to report abuse of any kind or other poor quality of care issues. Your girlfriend needs to use the number as she is also a mandated reporter. This behavior is wrong, dementia or not.

"there is nothing we can do because he has dementia,"...

That response from your girlfriend's nursing manager is (one of the reasons) why I choose to no longer work in LTC, Nursing Home, Geriatric Psych or any facility that specializes in Dementia care.... because things are never run in a way to properly meet the needs of the patients or ensue the safety of the staff. I think it's bollocks to say: violence is a part of your job, suck it up! Assaults on nurses by patients, visitors, and others are an unfortunately common problem, but it's a problem that a good facility will try to address.

Your girlfriend's manager and facility is dropping the ball big time on this one. Especially since you mentioned other residents are being abused by this patient and management is turning a blind eye to it.

Sadly, most of the time it always boils down to a shrugged shoulders, and a "there's nothing we can do...too-bad-so-sad about your injury" response. When I worked in gerontology, I endured all sorts of abuse at the hands of "confused" patients with dementia. It was all day, everyday hell for me and my colleagues of being physically attacked/beat-up by patients with dementia. Facilities catering to care for the aged are usually too money focused to staff their units properly. So, it's rare to find a 1:1 ratio for patients with violent tendencies... although even that isn't a solution to the problem. I feel sorry about the whole situation you described. Your girlfriend shouldn't expect things to change though. I would suggest seek employment in a facility with better protocols to address/manage abusive behaviors, or try a different area of practice altogether.

No, Libby, I don't think your question is a sidetrack- it's spot on question for how the system works.

Basically, Dementia is not an Axis III diagnosis, so patients cannot be admitted for behaviors associated with dementia. HOWEVER, patients can be admitted for behaviors stemming from an altered mental status and be given the diagnosis of Psychosis NOS, which is an Axis III diagnosis.

The good thing is that we can help people with these behaviors. Antipsychotics, dopamine antagonists, calm agitated behaviors. Coupled with antidepressants and/or antianxiety agents, these behaviors can be greatly reduced.

My explanation is oversimplified and focuses on medication, but I hope you get the gist.

You are 100% right. Only medication can address these kinds of behaviours. Where I used to work, family/POA would strongarm against the prescribing and use of anti-psychotics in treating their loved ones with dementia. If they allowed it at all, the family/POA would request the lowest possible dose (which would basically do nothing) because their rationale was they didn't want their loved one "doped up"... and this was after rigorous family confereses and education from the entire interprofessional team. So, these dementia patients behaviours were so poorly controlled it was like working in a zoo and we were assaulted every day. I wish more people would accept and realize that pharmacotherapy is the mainstay for psych patients. Drugs are the only solution.

Specializes in Pediatrics, Pediatric Float, PICU, NICU.
Honestly when it comes to doing something my gf doesn't want to be someone who "rocks the boat" and she's not a very proactive person when it comes to sensitive issues like this which is completely fine.

With all due respect, it is not completely fine in this situation. As others have stated, it is her legal obligation and her nursing license is in jeopardy if she doesn't "rock the boat."

With all due respect I think you have missed the entire point of everything I've said.

im sure you can understand that some people find it incredibly difficult to stand up to authority no matter what line of work they are in with a chain of command. Especially when your job = livelihood.

My girlfriend has already asked the current RN manager about it and after getting the response has now gone to a higher authority. She is doing what she is supposed to. My initial question was whether the homes response was valid and if not, whether she could do anything else after going up the chain of command.

Specializes in OR, Nursing Professional Development.
im sure you can understand that some people find it incredibly difficult to stand up to authority no matter what line of work they are in with a chain of command. Especially when your job = livelihood.

License = livelihood. No license = no nursing job anywhere. Failure to meet the standards of mandated reporting can indeed get your girlfriend's license in serious trouble. New jobs can be found; an unblemished licensed can't- and those with blemished licenses already have a strike against them before they even submit the job application (provided the license wasn't suspended or revoked- only disciplined). The right thing isn't always easy- she has no ethical/moral/license protection option other than to stand up to authority in this situation.

Specializes in Hospice.
With all due respect I think you have missed the entire point of everything I've said.

im sure you can understand that some people find it incredibly difficult to stand up to authority no matter what line of work they are in with a chain of command. Especially when your job = livelihood.

My girlfriend has already asked the current RN manager about it and after getting the response has now gone to a higher authority. She is doing what she is supposed to. My initial question was whether the homes response was valid and if not, whether she could do anything else after going up the chain of command.

And we answered that question: she is legally obligated to report the abuse to the appropriate state authority. If she does not, she could potentially lose her license and, thus, her livelihood.

Thanks for the replies.

Specializes in Med/Surg, Ortho, ASC.
With all due respect I think you have missed the entire point of everything I've said.

im sure you can understand that some people find it incredibly difficult to stand up to authority no matter what line of work they are in with a chain of command. Especially when your job = livelihood.

My girlfriend has already asked the current RN manager about it and after getting the response has now gone to a higher authority. She is doing what she is supposed to. My initial question was whether the homes response was valid and if not, whether she could do anything else after going up the chain of command.

Please don't bite the hand that is attempting to feed you.

Technically, it is you who has missed the point. Going to one's higher-ups does not = legally required reporting. No matter how "hard" your girlfriend finds it, she truly has no choice if, as you say, her job equals her livelihood and her preference is to retain her license.

+ Add a Comment