Any help for home care nurse in bug infested/dirty homes?

[homelpn]

I love my job working in homecare, but I am tired of going into certain homes that are not clean, are infested with mice, or roaches, or countless critters that I have to worry about bringing home with me, or taking to other clients' homes. The agency knows that I dislike these types of houses, but (!) guess where I keep ending up (!) I'm even thinking about switching to an agency that will allow me to be more selective of where I go, and keep me with a steady "usual" client, where I know I feel I am working in a clean and safe environment. But, since I do absolutely love working with clients I have with this agency (who maintain healthier environments) I'd like to avoid switching agencies... I guess that's how they get ya... I was wondering if anybody has worked in any types of infested homes, and how the heck you deal with it.

[HmarieD]

(Just a note - there is a home health forum here where I'm sure you would get tons of responses)

I have done intermittent home health in lots of really gross and infested homes. Of course there have been the usual suspects (roaches, maggots, etc), as well as flying bugs of some kind in the middle of winter (had to be breeding in the house), spiders, and other creepy-crawlies.

If you are doing intermittent home health in which you make several short visits throughout one day, this is just part of the home health arena that you will have to get used to. I can only recommend not taking anything into the home with you that you don't absolutely have to, and using PPE ifyou think it might help (shoe covers, scrub caps, whatever it takes). Shake out any papers or other materials that have been in the home before you get in your car.

If you absolutely can't deal with bugs (and they are hard to deal with), consider private duty HH in which you stay with one pt for an extended period of time (like an 8 hr shift). You may have to turn a few down before you get a clean house.

If this is a deal-breaker for you, consider another avenue of employment.

[mamamerlee, LPN]

1. Where is the social worker? Who is calling the health department?

2. Use shoe covers if necessary, and if you have it, spray bug repellent on your shoecovers and lower legs. Take the smallest amt possible into the house. Put it in two plastic bags. Open the outer bag, spread it out as much as possible, crinkling it. Open the second, inner bag as straight up as possible. when finished, take only the inner bag out with you.

3. If possible, take off the shoe covers and throw them in the outer bag.

Best wishes!!

[steelcityrn, RN]

Stand, don't touch anything. Where gloves, shoe covers. If odor is a problem, use vicks around nares.

[jbudrick, MSN]

When visiting a dirty/infested home, I spray my shoes with insect repellant. I take the minimum necessary into the home. Always wear machine washable clothing. I actually jump around and shake myself off before getting into my car. If its really bad, when I get home I remove my shoes and wash them in the laundry sink and remove my clothing and take a shower. Keep hair up in a bun. Use disinfectant wipes on items you must bring into the home. Use hand sanitizer - some homes are so bad you get dirty washing your hands. I have called the health department in severe situations - no running water, obvious insect infestation. The health department has been responsive. Other resources are Child Protective Services, if children are living in the home, and Elderly Services. Good luck in your home care career.

Diana:twocents:

[EmmyBee]

If you are going to continue working with this agency, definitely follow some of the advice that you have been given. That way at least you know you are protecting yourself.

I'm currently working hospice at night, while I'm in an RN program. When I first started doing it, about six months ago, I was sent to a house in a very bad neighborhood (government housing). My patient was bed bound and lived there with the ex-boyfriend of her granddaughter. Before the granddaughter left for the night, she suggested that I drive my car up onto the grass, and park it at the front door of the house (red flag). I thought it was an odd suggestion, but figured I better take her advice. She also informed me that there was no hot water in the house. :icon_roll

As I was parking my car, I noticed people outside drinking alcohol, smoking, talking loudly, and playing music. I was terrifed. To top it off, the ex-boyfriend would leave the house on his bike like every 15 minutes, and he would leave the front door unlocked. He finally came home for good after 1 am with beer. I was very uneasy with the whole thing.

Several times throughout the night, I saw two huge roaches (one from the closet and another from under the bed) come out looking for what I imagine was food. There were also dead roaches in the cupboards in the kitchen (saw them when I was looking for a pot to boil the water). I opened the microwave to try and heat up my patient's food, and it was smelly and filthy. The same goes for the refrigerator (spills, old rotting food, etc). The house was hot, bathroom tub and toilet were dirty...the whole situation was just a mess.

I was scheduled to work there the following night and flat out refused. Two days later, the nurse who replaced me complained to the agency. She stated that on the night she worked, the ex-boyfriend brought a group of guys in the house to play cards. They were drinking beer and smoking something. And they even had the nerve to ask her for money! Unbelievable.

Luckily, I have become close with the staffer at my agency. And she always gives me the chance to check out the area online before I commit to a case. And she often gives me cases that others have already worked (when available), where she knows what the environment is like. I am thankful for that! I plan on keeping this job for the remainder of my program. But I told her that if I don't feel safe or comfortable with a case, I won't go.

[systoly]

It depends on the situation. If the patient or the family choose to live like this, then I choose not to be part of this. If the patient is receptive to teaching and improvement, I will do anything in my power and enlist all available resources to

improve the situation. In general, one of the benefits of doing agency work is to be able to choose assignments. I understand that this may not hold true in every market or area, but I do believe in a safe work environment and I would expect the full support of my employer in improving the living conditions of the patient.

[tewdles, RN]

In filthy settings I do not take my full case bag into the home. Period. I leave my stuff in the car and bring in ONLY what I know I will need. I do not sit down and I do not remove things from the home unless absolutely necessary, then they are bagged. I get MSW involved from the first visit, when I discover the nature of the home.

I am clear with family...you may not drink alcohol or smoke pot when I am in the house...if you cannot follow that rule then your loved one is not going to get the care she requires. Sounds harsh, but it is sometimes necessary. If the family of a patient is threatening or frightening make sure to let your employer know so that arrangements can be made to have 2 staff visit together for safety. Some agencies have arranged with security companies to accompany staff to unsafe areas (I work in the greater Detroit area). Bottom line is if you don't feel safe you should leave the home and not return until something has improved.

[homelpn]

Thanks for all the advice. I think I'm just going to have to be more firm with the agency I am working for when I am asked to go to these homes. For the most part, children and youth is involved in these cases, and all safety concearns have been reported to c&y, but it seems like they are always taking a "sit back and wait" kind of approach, until something even more devastating happens. But as for me, a lot of times I work 8-16 hour shifts in the homes I work in, and I think I'm kidding myself to think that I will ever find any precautions that I'll feel okay with at the end of 16 hours.

[caliotter3]

You have the right to refuse to work in environments that you feel are unacceptable for any reason, but the agency is going to give you the assignments that they require of you to stay employed. You have less of a choice in the matter when you work intermittent visits. If your agency does not work with you to provide suitable work environments, you have no choice but to move on to another agency or another type of nursing job.

[Sweetiepie85]

I'm kinda in the same situation, I have a new client that I'm caring for just for the next 3 days. And hes such a sweet man but his house is in poor conditions, when you first walked in you smell sewage which he told me that the basement has a backup problem. The floors are very weak I felt like I was gonna fall through the floor. A roach jumped on me while I was in the kitchen making him a sandwich. Urinals all over the house full of urine, paint chips all over the floor, front door doesnt open which could be a fire hazard. He can't walk very well poor guy... I feel sorry for him cause hes actually a retired CNA worker and he doesnt want to live in a nursing home so he choosing to live in this bad house. Any suggestions how ti deal with this situation?