Concerned with patient in bad shape

[morango1076]

I have this home health patient and she is in bad shape. I have notified my nurse supervisor and the office manager on several occasions about the situation. My patient has Alzheimer's disease, and is going through its last stage. Last Monday I got there and gave her a bed bath and peri care, but once I turned her to take care of her back, I saw this half-dollar coin-sized BLACK bed sore on the top of her butt crack. I immediately called her husband to see it. Last time I had been there (Friday before the Monday I saw that) there was nothing there. So how could this have developed over the weekend so fast?? Her husband does have a neighbor that comes by and helps him on the weekend and in the afternoon/evening that I am not there anymore. This lady (neighbor) told me that her sore developed on Sunday. Anyway, since I am a CNA, I cannot apply anything on the sore so I just padded it dry. Then I thought about leaving her in bed instead of transferring her into the wheelchair to avoid more pressure, but her husband doesn't want her to stay in bed. If you do leave her in bed, he will transfer her to the wheelchair himself, and he has dropped her on the floor many times because of that (yes, I told my agency about that too). So it occurs that I go there Wednesday and also Friday, but Friday her sore was BLEEDING and deeper than it was on Monday and Wednesday. It looked bigger than it was before too. So I tell him again that she will probably need to be taken to the hospital, but he is adamant about that... he just WON'T, because he says he's afraid of "losing her", meaning they will keep her for a while then send her to a nursing home, and he dreads that. I told him if he doesn't get her the treatment she deserves, then he will definitely lose her! So, I tell my office manager again on Friday what happened, she said they have already called him that week to tell him how important it is to have her taken to the hospital, but he said "she is doing just fine". He got mad at me on Friday saying I should not be telling anyone about her because he "knows" how to take care of her. yeah . Anyway, my patient has COPD and has had this terrible mucus on her chest/throat, that sometimes she chokes really really bad and turns purple!! Her husband tells me to give her something to drink, and I tell him I cannot. Then he grabs the cup and SHOVES the drink down her throat!! Then of course she chokes even more! I have already told his to my nurse supervisor. He keeps giving her Mucinex because he thinks it's going to cure her. I told her this has passed Mucinex level, and she needs to be seen by a Doctor, but again, he refuses to do so. Also she is passing kidney stones and her urine is dark. Unfortunately the stage she is at not she cannot communicate if she has pain or anything, but I can tell by her face that she probably is in a lot of pain. I force liquids of her, but after I leave, I don't know if they give her much to drink. I am very concerned with her at this point. My office manager told me if I want to I can call DCF, to inform than that she needs the care and she is not getting. He chewed me out on Friday for not putting anything on her wound, but I tried explaining to him that this is out of my scope of practice of CNA, he was very upset with me. No matter what you tell him, he won't listen. Then Friday evening I called him and he said he decided he wasn't going to take her to the hospital anymore (he had told me Friday morning that he would). What can I do at this point?? Thanks for reading!

[ItsTheDude]

the court system/state has to get involved basically, i assume dcf is ur state agency that deals with mistreatment/competency/etc of ppl an so on. the state or another suitable person needs to be her guardian or whatever it's called n ur state.

the place u work generally isn't going to do jack, because they'll no longer have the patient, $$$.

forgot to add, be sure to document all this too.

[KimberlyRN89, BSN, RN]

It sounds like you've done everything you can do..I know that's probably not the answer you're looking for At one of my jobs (assisted living) all of our residents have a form of dementia & once they enter that final stage, no matter how much pain they are in, their family refuses to send them out to be seen by a doctor. We just do our best to keep them comfortable in their final days. Best of luck to you.

[morango1076]

Thank you both for your answers... I think whatever is best for my patient in her present condition needs to be addressed/taken care of now. I guess the DCF would be the one to step in at this point then. She has 2 kids but none are involved at this point, leaving all decisions to the old man.