Ethical/Legal Issue - Need Advice (HH)

[RN BSN 2009]

Hi all

I am writing on behalf of my mother who is a HHA, she is having a dilemma with one of her patients. My mom works for an agency. So she is scheduled to bathe this patient, so my mom works 2 hours per day with her. But this is through the senior alliance, that's where the patient gets her hours from, so it's not like there is a nurse there to re-assess her and stuff. It's not like a typical HH private agency.

Background: The patient is an elderly female, with COPD, Type II diabetes, Urinary and bowel incontinence and IBS. She also recently had a stroke and since then, her cognitive processes haven't been all that great.

My mom is scheduled to work in the evening with her, every single day that my mom comes, she has not taken any of her meds. Her blood sugars run through the roof. She's been in the hospital twice the last 6 months for DKA.

She is on oxygen. She smokes, and not only does she smoke but she will chain smoke, oxygen tank next to the couch.

She has several holes in her couch and her bed where she has fallen asleep with lit cigarettes. Small fires have had to been put out because she leaves food burning on the stove.

She falls at least 2-3 times per week. She keeps her cell phone in her pocket to call my mom in case of emergency. My mom usually goes to go help her up, if she can't make it, she'll call the fire dept and they come pick her up.

Every single time my mom is there, she spends AT LEAST 4-5 hours there because the patient moves at a snails pace and my mom ends up getting out the carpet cleaner and cleaning the turd trails on the carpet and pee spots from her incontinence (patient refuses to wear depends, saying that she doesn't have a problem.) My mom isn't paid for the extra hours (and the agency can't get any more approved), but it is just against my mom's ethics to leave her there sitting in excretement.

The patient has 2 sons and 2 daughters. Both of the sons won't speak to her. One of the other daughters will call ONCE in a blue moon. The other daughter comes every now and then to re-fill her meds and drive her to dr's appointments. The daughter that does see her is so stressed out because she's taking care of kids and working 2 jobs... one day she was at the apartment with her mother and just got so frustrated, she was giving her a shower, and leaned over to her and said "I just don't know what to do anymore. I just wish you would die!".

That daughter does the little that she does and only has power over her finances. She does not have medical POA.. she can't make medical decisions for her mom.

The patient thinks that everything is fine and dandy and that she can take care of herself... that's how "off" she is.

She currently lives in govt subsidized housing, so they are senior apartments, but it is not assisted living.

I told my mom she needs one of many things, either assisted living, LTC, or those kids and her need to put money together and get her AT LEAST a 12 hour per day private aide.

I don't really know what is going on with the docs, but I'm wondering what can be done in this situation? could a doc get her approved for an LTC? Can this patient really be allowed to smoke with oxygen tank? Isn't this putting OTHERS in the building at risk? Would it be appropriate to call adult protective services? The agency won't do anything, they don't feel like meddling into the family issues.

please help!

p.s. this is in michigan

[Atheos]

adult protected services... call them...

1-800-996-6228 - michigan aps

[caliotter3]

This is really the responsibility of the agency, your mom's employer. She should report everything to them in writing. If she wants to go the extra mile, with the chances of encountering problems from her employer, she can write everything out and send a copy of it to the doctor. If no response, or she is not satisfied, she can make a report to APS regarding the treatment and statements by the children. However, as far as the statement is concerned, it will be "she said, she said" when the daughter denies having made the statement. Your mom should probably leave this case. Her agency might pull her from it if she takes steps to remedy anything. I feel sorry for your mom. She is facing a dilemma that is too often found in home health.

[RN BSN 2009]

p.s. Also just found out the patient has been recently diagnosed with CHF, puffed up like a butterball turkey... non-compliant w/those meds too... can't get herself out of bed in the morning (mind you my mom comes in the evening, she can't move very well... can't cook for herself.

[caliotter3]

This lady needs to be evaluated. The agency is dropping the ball. Your mom needs to take steps to inform the proper people, her agency, the agency in charge of the lady, the doctor, and/or APS. Once she has done any of this, she has done all she can do. Since she is not a nurse, she can not do the evaluation herself. Advise her to look for a new case.

[RN BSN 2009]

Thank you so much!

[jnette, ASN, EMT-I]

Does the agency she works for have a Medical Social Worker? That's the first step... let this person take your mother's info and do what needs to be done to intervene for this pt.

Sad, sad situation, unfortunately, not too uncommon either. :stone

[RN BSN 2009]

Nope! NO social worker. Just one RN is the head of the entire company, they have over 75 patients recieving services... and the same RN that is the head only does office work, payroll, etc... she has one secretary.. thats it.

[Duckyaryj]

I would call APS like YESTERDAY!!! She is a risk to herself and her neighbors. its seems as though she is no longer capable of being on her own and if her children cannot provide the care, she needs either more in home care or to be placed in a facility that can provide for her needs.

[TexasNurse2008]

The nurse for this patient is really dropping the ball on this one. I had a case like this - I notified the doc of everything and the patient was placed in LTC the next day. Have your mother document everything, especially the falls. Then the nurse will have to do something about it. Wouldn't hurt to call APS, either.

[morte, LPN, LVN]

hmm can a little birdy report her smoking with o2 present...to the manager of the apt. complex?

[GrumpyRN63, ADN, RN]

I agree the RN apparently disregards the pt safety for the $$ for the agency. Bad for all involved, the pt especially, very negligent. I think you could call APS anonymously, sounds like a crappy agency, I would be OOT.