Dignity vs Safety

Specialties Home Health


Specializes in Surgical Specialty Clinic - Ambulatory Care.

So, I'm fairly new to HH...coming up on the 6th month mark. I'm a 10yr old nurse. The hardest thing about home health are these damn invisible guidelines that I hear about sporadically and aren't written anywhere, but mostly I like the autonomy and 1:1 interactions with patients.

Now recently I was assigned a patient who's husband has been on service with us a while. He has Alzheimer's and really bad balance. Falls pretty frequently even after 6 weeks of in home therapy. Let's call him Joe.

Then there is his wife, we will call her Alice, who is cognitively sound but also has poor balance and has fallen recently. It is obvious Alice is struggling on taking care of Joe. His clothes smell of urine at times. But she is still cooking and driving once a week to the store to get supplies...but leaving Joe alone which is bad because he needs 24 hour supervision.

Alice and Joe have two sons, one who wants to put them both in a nursing home and the other who is always saying "I would rather that had a quality of life than quantity." We will call the more involved son Pete.

Pete is aware his parents are in a bad situation, but his mom has been very resistant to moving into a rental house that is 300ft away from Pete. She and Joe have lived in their home for 60 years and it has been modified to where Joe and Alice do not have to use any steps to go to their bedroom, bathroom, or kitchen.

Pete works 6 days a week, his wife is a full time CNA, and they have 2 children in college. So I have a feeling that if Alice and Joe move into this house 300ft away they will be getting daily check ins and maybe dinners, but not 24hr supervision which is what they really need, especially Joe. Pete has gotten both of his parents a call button/fall button service but Joe does not have the cognitive ability to remember to wear it or how to use it, and Alice refuses to wear it.

4 weeks ago the MSW spoke with Joe, Alice, and Pete. The patients have enough financial resources that they do not qualify for much assistance. They can pay a caregiver service or move into assisted living, but the issue is that Joe's Dementia is bad enough he probably won't be acceptable for assisted living. Alice is not willing to be separated from Joe and they have a little Pomeranian puppy that makes them happy. Really well behaved dog that they couldn't take with them either.

My last discussion with Pete was that he had not started renovating the house his parents are to stay at. Pete is a little bit in denial about how fast his dad is deteriorating. But when I told him that he needed to do everything he could including cutting back hours at work to get the house ready he seemed to finally get it. He said he could have it done in 8 weeks.

I am the nurse for Alice but a different nurse is taking care of Joe. 3 days after my discussion with Pete Joe fell again and his nurse basically twisted Pete and Alice into "doing what is best and safest for Joe." Which then forced Joe to start being worked up for immediate placement in a SNF permanently.

I am still following Alice, I haven't gotten to see her since this all went down. She refused my last visit. When PT went to see her they noticed she had a lot of new bruises but she wouldn't tell them what happened. The other nurse was out there for Joe and noticed the bruises and is very adamant that I get her placed as well.

So I am pretty aggravated about all this. I truly feel that this is a situation that the 'safest thing' isn't the 'best option'. Alice is Ax0x3. Her son calls them every day at 2pm and 7pm and if he doesn't get to talk to both of them he drives over. She is alert enough that she knows she shouldn't be leaving Joe alone, but would have to leave to run an errand so instead of telling her son she would just make sure she was back home well before he called. I know this because I caught her one visit. I agree with everyone's assessment that she is physically poor enough off that she shouldn't be at home alone almost just as much as her husband shouldn't have. But she doesn't have dementia how can I force her. My co worker says if her son doesn't make her move in with him he is neglecting her...but really how can he force her either?

Futhermore, in forcing Joe into a SNF for his own safety, we have damaged her trust in us and thus she is now blocking us out of her life like she does her son when she feels like he is taking to much control. And, I have a suspicion, will start driving to see Joe on a daily bases now because he is not at home. Which means I will have to discharge her from nursing services although it is obvious she would benefit from therapy and it is a taxing effort for her to get out. So did we really make this situation better? If Joe had died from a fall in the next couple of month at home with his wife and dog, would that have really been such a bad outcome? Personally and professionally I don't think so. I feel that I had the family agreed with a plan of care, the son was looking at getting some paid help as well. Was it going to be enough, probably not. But in no way do I see anything they were doing as abuse or neglect. And frankly it really chaps my hide that the medical profession thinks it's doing a couple who have been married 60 years any ******* favors by madating us to rip them apart in the name of safety. I vehemently disagree that safety is the ultimate priority in every case. This would be a case that I think makes that clear. If Joe were a 3 year old kid I would feel differently, but really it is absurd for us to do this to people and think we are being helpful. And those who argue for this kind of meddling in elderly patients' lives are either to young or to socialistic to understand.

I agree with you 100%.

Specializes in Hospice.

I would have looked to see if Joe had a hospice diagnosis. Home hospice services up the level of care and with the son living so close may have done the job. Bottom line is Pete made the decision and Pete can unmake it. If Pete was adamant about keeping his parents together and caring for them then I'm not sure anyone could have twisted his arm to the degree that he is making his parents miserable.

Very common, sad situation. I agree with you. Well done!

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