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

Nursing Students CNA/MA

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Hi there! I've recently refused to give care to a resident. His Dr. has said his behavior is not caused by any mental illness or brain disease, as he has visited with him multiple times due to his behavior (calling the ambulance over 12x since I started at this facility, screaming and swearing at care aides, unwilling to accept anything short of all staff doing anything he asks at anytime no matter how difficult it is or out of our scope or if he has to wait because we are busy). Yes I understand the resident is probably experiencing depression/anxiety etc etc, however, this resident has made accusations against me countless times, sworn at me when I can't give him what he wants because it is unsafe or frankly impossible, many more times I have dealt with this residents behavior professionally. I've taken so much abuse from this resident verbally and finally I had had enough. I told nurses and staff I refuse to be treated the way he was treating me because it was burning me out. Tonight my co-worker needed help with him because he is a 2P so I considered calling the nurse but felt I needed to assist so I did and the second the resident saw me he made a comment about me having an attitude and swore. I said nothing and helped turn him and left. Now I am feeling that I don't ever want to assist again but I'm wondering if I am technically allowed to refuse or not. He does not have dementia so it is a behavior and abuse he is aware that he is doing and choosing to do. I understand it's in my job to take some form of abuse if it's a demented resident who is resistive to care or a demented resident swearing at me but this man knows what he's doing and is targeting me for whatever reason he has remembered from when I have helped him. I just don't know what to do I don't want to put stress on the other aides but I don't want to put up with abuse directed at me like that. Nurses and management are little help with him and they've tried to send him to other facilities but no one will take him because of his abuse. So my question is do i have a right to refuse and for other aides to have to switch residents etc because he isnt always bad to them like he is to me? Thank you

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Specializes in Critical Care.

You're free to refuse to be involved in his care, but your employer is free to fire you for refusing.

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Okay I was thinking that. But I'm also wondering about work safety. This resident is constantly verbally abusive and could very well be physically abusive towards me. This is still fireable for an aide to refuse? Another aide on days has refused him for a totally different reason and she still works there. Given our facility is in the middle of no where and so short staffed that i doubt theyd ever fire anyone...we have a couple workers with countless complaints and reports that haven't been fired. Im just finding it hard to believe that consistent verbal abuse from a resident that is not suffering from dementia has the right to speak to aides that way and they are not allowed to refuse? The aide has no rights here and basically has to suffer abuse or lose their job?

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Thank you

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Well, is he "nice" to the other staff? Are they all aching to take him off your hands in exchange for one of their polite patients? I'm guessing not...

If you can refuse to take care of him, then the other staff can too. Then what?

You do have my sympathy, but unless he leaves the facility or you do, you're going to encounter each other.

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Specializes in ED, Tele, MedSurg, ADN, Outpatient, LTC, Peds.

Make sure you don't work with him alone. If possible get another assignment. Document the verbal abuse and inform your supervisor.Keep a paper trial. Do not put yourself in jeopardy of harm. Stay professional at all times despite the provocation.All luck!

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Specializes in Critical Care.
Okay I was thinking that. But I'm also wondering about work safety. This resident is constantly verbally abusive and could very well be physically abusive towards me. This is still fireable for an aide to refuse? Another aide on days has refused him for a totally different reason and she still works there. Given our facility is in the middle of no where and so short staffed that i doubt theyd ever fire anyone...we have a couple workers with countless complaints and reports that haven't been fired. Im just finding it hard to believe that consistent verbal abuse from a resident that is not suffering from dementia has the right to speak to aides that way and they are not allowed to refuse? The aide has no rights here and basically has to suffer abuse or lose their job?

I think there's growing acknowledgment that we are on the receiving end of more verbal and physical abuse than we should be. Some states have taken small steps, such as requiring training on deescalating these situations, but there isn't much that sides with the HCW in establishing a right to avoid these situations all together. It's possible that your managers are under the impression that you are one of the few that doesn't mind working with him, so it may be to your benefit to share your feelings with them.

Keep in mind that while his behavior may not be due to dementia or another "official" mental disorder, it's unlikely that it's not related at least in some way to their medical conditions. It's possible, but I sort of doubt that if he was healthy and sitting on a beach somewhere that he would have the same attitude, I'm sure some of it must be due to being chronically ill enough to be stuck in a nursing home (no offense).

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Okay thank you for your response. I was pretty sure that was the case. It sucks that there are no rights for workers in this situation. The patient/resident can be in his right mind and abusive and terrible to staff yet nothing can be done. I really thought we would have some type of rights but apparently we are just servants. I think residents/patients like this should be kicked out and that's their problem. But no let's keep him and let workers burn out and leave so the facility can get a pretty dollar from this ******! Anyways thank you for responses....any suggestions what to do if a resident screams at you that you're a ******* ***** and to get him ******* water and then get the **** out? Cause I've already tried saying I'm going to leave until you can speak calmly. I've also tried just simply leaving him where he's safe and has bell etc until he can relax. I've tried telling him to not yell or swear or I will not assist. Ive tried just taking his crap and doing what he asks while he freaks out. However he always ends up more angry no matter what or will realize he can treat you that way and will the following day. Any advice is helpful...any haha thank you

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Specializes in Psych (25 years), Medical (15 years).
his behavior is not caused by any mental illness or brain disease, ... screaming and swearing at care aides, unwilling to accept anything short of all staff doing anything he asks at anytime no matter how difficult it is or out of our scope or if he has to wait because we are busy... the resident is probably experiencing depression/anxiety etc... no one will take him because of his abuse.

These behaviors indicate an altered mental status and need to be dealt with by a psychiatrist and appropriately medicated. Usually, a small dose of an SSRI antidepressant and atypical antipsychotic will stabilize the mood. Sometimes, even mood stabilizers are indicated.

We often get Patients from LTC facilities with these types of behaviors. Being loud, threatening, refusing care is criteria for a psychiatric admission. The facilities who send these Patients often refuse to take them back. The SW's often need to find placement for difficult Patients.

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Yes I've shared my feelings with them and basically they can't do anything. And I agree I'm sure he wasn't like this before living in a home. I can definitely understand the feelings he must experience and how frusterating they must be. That being said...i can't wait to be a resident/patient because it seems like the perfect way to do absolutely anything you want without consequence.

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Yes his Dr gave the okay to send him to psych next time he calls the ambulance but he did it again and they didn't send him. The SW told us that he won't be going anywhere unfortunately so I have no idea why. But it's motivating to know that if they ever did send him to psych that our facility could refuse to take him back. Just hard to take so much from a resident and no that you have no other choice unless you want to leave your position or facility. Thank you for your response

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Yes his Dr gave the okay to send him to psych next time he calls the ambulance but he did it again and they didn't send him. The SW told us that he won't be going anywhere unfortunately so I have no idea why. But it's motivating to know that if they ever did send him to psych that our facility could refuse to take him back. Just hard to take so much from a resident and no that you have no other choice unless you want to leave your position or facility. Thank you for your response

My suspicion/answer is based on my ED experience: He won't be leaving you for an acute psychiatric facility because (in my recent observations) his situation is not really a reason that people get placed into an acute psych bed. Honestly we've been flat out told many times in recent years that if there's no real concern about suicidal or homicidal ideations and there's no ACUTE psychosis problem, there is just no case for securing an acute in-patient psych bed. If he gets sent to the ED or wherever, they will face the issue I just wrote about, they will "medically clear" him (rule out any new/acute physical problems, screen him for the above-mentioned acute psych concerns) and send him right back to you.

It's ridiculous for his physician to say there's no mental illness involved in this situation...it is either a behavioral health issue, a psychiatric issue, or a combination (assuming physical causes have been ruled out, such as organic brain disease). People who constantly behave as you describe are not merely "stressed about their circumstances". He needs a mental health eval and a PLAN. Probably medications as mentioned by a previous poster. He also needs a nursing care plan put together between HIM and his care team. He needs some boundaries to be made a part of his CARE PLAN.

Okay, so now, what will you do about it. You shouldn't have to "take abuse"; let me be very clear about that before I go on.

I must ask if there has ever been a situation that got the two of you "off on the wrong foot". Have you done anything to legitimately offend him (which would NOT excuse his ongoing behavior, but still needs to be considered)... OR, do you have any insight as to why he seems to have singled you out?

I have no easy solutions for you, I'm sorry you're faced with this every day. How about having a very calm, low-key and open-minded discussion with your DON or SW about it, explaining that you want to provide good care to him and need some realistic ideas and suggestions about how to make that possible. If you can - and I know it's not easy - try to start putting yourself in a frame of mind to focus on "good care" as opposed to conflict. Think about how to be the best at what you do. His behavior is very likely not personal at all, and if you weren't there he would find someone else to treat this way. So separate yourself mentally and emotionally from this.

Here's a (hug)

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