Combative Resident and Sitter Issues

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Specializes in LTC.

I work in an ALF on a dementia unit. We have a resident that has been extremely combative with staff and other residents. SHe has used a knife as a weapon against a caregiver, spits, hits, kicks, punches...it goes on and on. To boot, she is supposed to have a 'personal companion' with her from 9-7pm everyday. This companion has worked with the family for many years and they are very bonded to her. My problem is she comes in late, leaves early, is often missing during her shift, and just keeps the resident locked up in her room with her while she chats on her cell or watches tv. We have repeatedly asked that she bring the resident out so that we can engage her in activities and hopefully reduce the amount of aggression we see. The sitter won't do it!!!! I called a meeting with the daughter regarding all of these issues and the short version of it is that the daughter didn't believe me!!! The sitter tells her that all is well and that the resident is not having any aggressive issues and that she goes to all activities! LIES, all LIES!!! We keep a behavior log when she has these outbursts and the daughter says that she doubts that they are true entries!!!!! What do I do????

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Time to have another meeting with the family and give them 30 days notice to find another facility. Since the sitter is not an employee of your facility, it is hard to enforce your facilities policies. Also, family member is in denial.

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Specializes in ICU/ER.

My 1st thought is keeping on top of the logs. My 2nd thought is how can she get away with locking the patient in the room. Why cant you just go open the door and escort the patient out to the sitter who is on the phone or watching TV?? I would drive that sitter crazy if I were you, I would be on her like white on rice. By making sure that patient is at sitters side every min. sitter is there.

And at 9:01 if sitter is not there I would call the daughter, then I would call again at 9:10 and 9:20 etc etc till sitter arrived. I know that takes alot of your preciouse time but I think if the daughter was getting phone calls every day, many times a day, they would get the point.

I would also call every time the patient is not in activities. I would tell the sitter, it is 10am time for activities and if she does not take the patient down there, I would document and call.

It is much easier for the daughter to be in denial.

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Specializes in LTC.

I will go down to her room and get the resident and take her to the activity and the sitter will let her stay for a few minutes and then take her back down. Unfortunately, I don't have all day to play chase with this sitter. She told the daughter that I am always looking over her shoulder and that I am harassing her. Damn right I am! She isn't doing her job and she places the resident's safety at risk constantly! The daughter does not want to believe any of it! How awful is that?!

The daughter also said that she doesn't want to hear any 'commentary' from our staff on our her mother is doing. She wants it to all come from the sitter. The sitter doesn't give her an accurate portrayal because she just wants her to think everything is fine so she can keep her job. When I told her that the sitter was as much as an hour and a half late she just breezed right over it. The daughter actually raised her voice and yelled at me when I suggested that the sitter not allow the resident to nap during the day seeing as how she is awake much of the night. She yelled and said 'how dare you tell me my mother cannot nap. SHe is 90 years old.' LISTEN TO WHAT I SAID!!! UGH!!! I am so frustrated!

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Specializes in ICU/ER.
I will go down to her room and get the resident and take her to the activity and the sitter will let her stay for a few minutes and then take her back down. Unfortunately, I don't have all day to play chase with this sitter. She told the daughter that I am always looking over her shoulder and that I am harassing her. Damn right I am! She isn't doing her job and she places the resident's safety at risk constantly! The daughter does not want to believe any of it! How awful is that?! I am so frustrated!

I cant imagine how busy you already are, this may have to be a team effort amongst your staff. Yes I would call another meeting but in the meanwhile I would be making that sitters life a pain. She is getting paid to do a job she is not doing. She in turn is making your unit more difficult because the patient is not getting acclimated and is in turn becoming combatitive.

Whats the worst that can happen? The sitter convinces daughter to put her in another facility. Dream come true. Keep up the good work and stay on her. Document everything and involve mgmt when you need to.

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Specializes in LTC, MDS, Education.

Hey there! First, sympathy to you. Second, where is support from your Director of Nursing? Administrator? or even Medical Director? You might try calling 911 for altered mental status and let your local ER deal for a few hours. Just act very concerned. Keep us posted.....:twocents:

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Specializes in Nursing Home ,Dementia Care,Neurology..

Have you tried getting the daughter to come in,on some pretext,and seeing for herself that the sitter is not doing as she says she is?It could be that she is in denial because ,at the moment,having the sitter takes the heat off her.No sitter would probably mean having to find a new facility and cause her problems etc.

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This is such a tough situtation. The sitter doesn't work for the facility, so you can't to much with her. I would call the ombudsman on this one and be proactive in dealing with this. If you are a big corporate facility...call them too. All care should be care planned and the family should be included in on that meeting. If they want, have them sign a refusal of care ( not coming out of the room etc) I would also start the ball ruling and try to get them to leave.

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Specializes in LTC.

Okay, so I have somewhat of an update! On Monday, our Executive Director went onto the memory care unit where this resident lives and caught the sitter red-handed watching tv instead of taking the resident to an activity as she was supposed to. The next day the ED caught her her coming in over 20 minutes late. I think that, while our ED believed me, it helped that she saw all of this for herself. So then we were kinda waiting to see what the next move on the part of the daughter would be. Well........Wednesday we both got a nasty email from the daughter stating how unprofessional and disappointed in us she was. She contradicted herself many times in the email and flat out lied in other parts. My boss responded with, Thank you for taking the time to reflect on our meeting. We received the new medication orders for your mother today and hopefully this will help with the continued behavioral problems. I think the EDs response was the best way to handle. To try to defend ourselves would be pointless. I think the best response however would have been to say we obviously cannot make you happy, so in the best interest of your mother we are going to give you a 30 day notice. You need to find another facility.

Our plan going forward is to try the new meds, but if the family is truly not willing to work with us on the sitter situation and follow our recommendations its adios!

This situation has really just struck me has odd. MOst of our families are so caring and loving and appreciative of everything we do...Then to have this is just upsetting.

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Specializes in ER.
Hey there! First, sympathy to you. Second, where is support from your Director of Nursing? Administrator? or even Medical Director? You might try calling 911 for altered mental status and let your local ER deal for a few hours. Just act very concerned. Keep us posted.....:twocents:

Big thanks from your local ER on another bogus call. We have enough problems of our own.

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Specializes in Gerontology, Med surg, Home Health.
Hey there! First, sympathy to you. Second, where is support from your Director of Nursing? Administrator? or even Medical Director? You might try calling 911 for altered mental status and let your local ER deal for a few hours. Just act very concerned. Keep us posted.....:twocents:

What a waste of resources and a huge source of stress for the resident! It's not her fault the daughter is a wing nut.

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