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Can you refuse to give care to a resident in LTC?

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Yes I'm finding the biggest problem is getting the people who can do something about it to actually do something :p in that I mean management and nurses to take the time to work with the aides. I'm going to have to speak to the same nurse I did day before yesterday about us needing to adjust the care plan. She listened to my concerns but here we are 2 days later and no one has tried to move forward with it. It's discouraging because no one wants to think about the stress this resident is causing for the staff, especially the nurses and management because they hardly see the resident. The aides are having the biggest issues yet were struggling to get help from the people that can actually do something. Very sad :(

Who has actually done what?

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so apparently he has been started on an antipsychotic and the SW has talked to him about his behavior and his Dr and the doc numerous times. Only family he has is daughter. Nurses say she has issues as well, becoming hysterical in fights with her dad at the facility and coming to visit drunk. Aside from that, there is no current care plan and I think that is the biggest issue. I think everyone deals with him a different way nurses and aides. I'm optimistic though he has been good today so that's something I guess :p

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Easier said than done. Where would he go? The MA DPH would be all over us if we discharged someone for being difficult. There are very few times we can issue a discharge notice.

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We have an abusive resident in our facility. My advice is to file an occupational health and safety report each and every time you are verbally abused. Encourage all staff to do the same. PTSD for health care workers is real and does not have to involve physical harm. Your employer probably cannot move him anywhere until there is formal reports of his degrading behaviour. I for one refuse to take this residents crap and file a report every day. We shall see how many reports it takes before something happens

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I agree with this mind set. I'm probably one of few staff that actually charts every single time this resident raises his voice or swears or complains about the staff. I dont believe that taking his crap is going to improve anyrhing but make it worse. I've spent many months trying to "understand the resident" "use compassion" etc etc. that only takes you so far until you realize maybe this person is actually just an ******* :p not much anyone can do about it except chart and for every staff member to respond the same

thanks for response

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Who should be making the care plan?

When it finally gets made, part of it has to be that the dtr is not allowed to visit while intoxicated. Also, if she starts fighting with her father and it's getting loud and maybe dangerous, she will be removed from the facility. This might involve police, as you likely have no security personnel at your facility.

The physician, social worker, DON, Administrator, and owner all need to be apprised of this fellow's behavior and of his daughter's behavior. The staff has to

all get together and approach the powers that be together because if only you or you and only 1 or 2 others do the speaking, you will likely be fired. I know this is a tough situation, so good luck.

I guess it does get old being compassionate, but try to keep doing the right thing.

What do they fight about?

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in never personally seen it just heard about it. as far as I know, the daughter appears to have issues of her own and I've personally seen her drinking a beer and crying in the parking lot across the street from our facility. I guess the resident gets annoyed with her or something she has said and they end up screaming at each other. But then the resident begs for his daughter to be able to sleep at the facility in his room all the time but she has brought him rx meds before that the resident took in an attenpt to kill himself apparently so she is only allowed to stay the night a few times a month I guess. One aide said the resident begged her to make his daughter leave...saying something like "get this ******* ***** away from me don't let her touch me" or something so it appears this behavior is normal for the resident and his daughter.

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I feel like a total nag and that the nurses on this floor get tired of my suggestions and "pushing" to change things but it has to be done. No one wants to deal with it just pretend it isn't happening. However some aides think it's absolutely ridiculous that nothing is being done. Aides still go in his room and listen to his talk badly about other staff and they just kind of play on that so it's all just a load of crap haha just waiting for "The Day" this resident is no longer an issue as terrible as it sounds

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Easier said than done. Where would he go? The MA DPH would be all over us if we discharged someone for being difficult. There are very few times we can issue a discharge notice.

This is a large part of the problem that really has no easy solution. Where indeed do these difficult residents go? It's not an easy process evicting somebody from a care facility. It can be done, but it's a process. Before these difficult residents can be moved it's necessary to find alternate placement and it can take a long time to find another facility willing to take on a person like this.

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Keep a small tablet, jot down each occurrence, who you spoke to about the occurrence (your supervisor/charge nurse.) Don't use it as an 'I told you so' moment, but a source to protect you. Continue to be professional and seek to be placed in another unit, or with a different group. Be very aware of speaking of a patient in social media, (outside of your work area). If you give enough information where someone could recognize that patient, you could be in huge trouble. Remember HIPAA. I empathize with you, dealing with patients who were similar. I know your frustration and feel you may not be heard, but please be professional and possibly work on policies that protect medical personel. Hang in there! Good luck.

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Wow, what a handful! My sincerest sympathy for your plight. He sounds like a miserable, cantankerous old coot hellbent on making everyone else's lives who come in proximity with him miserable too.

It sounds like your facility is just letting him call all the shots without any repercussions for his bad behavior. That's too bad, because if he really is able to ascertain right from wrong without an organic brain impairment, or behavioral health disorder, then not putting an end to it sends him the wrong message that his behavior will be tolerated.

It seems like discussing this with your immediate supervisor, and perhaps HR may be the right step if you haven't already done so. And I agree - keeping documentation of everything is essential. It sounds like all the staff are as miserable caring for this nasty piece of work as you are.

Maybe this resident's MD and the social worker can make a behavioral contract with him specifying what is allowed behavior while at this facility, what is not, and consequences for stepping outside of those parameters? If other facilities won't accept him then there has to be a limit to what yours will accept before he is discharged against his will (wherever that may be)? After all, there has to be some place less pleasant that he may not want to end up?

I wish you the best of luck with this. Going to work everyday shouldn't make you feel sick with dread, and I empathize with the situation you find yourself in right now. It sure sucks when a patient gets it in their head that you are their servant and whipping post. It's unfortunate that there are people out there that are so mean spirited.

Buck up - there may be hope yet.

Edited by 3ringnursing

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