Ethics question....

[rholster]

I'm a Nurse at a geriatric long term care facility. A few days ago I entered the room of one of my residents and saw his wife attempting to make him write his name. My resident has advanced dementia and was just doodling on the paper. I asked his wife what she was doing and she said she was letting him practice writing his name so he could sign some papers in front of a notary. I told her that he would not be able to comprehend what he was signing and she just said that her lawyer told her it would be alright. She said the paperwork has something to do with some property. Evidently the two of them were fairly wealthy. Shortly after I left his room she wheeled him outside and met a notary in front of the building where my resident made his mark on whatever papers she had. I brought it to the attention of my DON and she said that she spoke with our CEO but it seems they either have no answers or do not care. I feel sure that what transpired was not legal but I'm not sure where to go with this. Any advice would be appreciated.

[Here.I.Stand, BSN, RN]

Saying she's "done with him" just for putting him in LTC is way harsh. I suspect she's no spring chicken herself and perhaps she's not physically capable of rendering care. That doesn't mean "done."

Agree completely, as someone whose two grandparents made the difficult decision to place their spouses. My grandpa lived at home until he was 102 years old and 65 years of marriage. After a couple of falls, some compression fx's, and some bouts of pneumonia left him weakened, my grandma decided to place him. She visited him nearly every day until he died, for the next two years. The kids brought him home for Sunday dinner whenever he was physically well enough; they rented a w/c accessible van to transport him with. My mom, aunt, and uncle all live within a mile of their house and offered to step up their hours of care to keep him at home, but Grandma felt that he wouldn't want them to burden themselves like that (he'd also gotten confused in this time and couldn't express his wishes.)

My other grandma had severe dementia and wandered (a tendency which did ultimately kill her, but that's another story). Her husband of 30 years was 90 himself and had had prior THA's and TKA's. As it was, he followed her constantly during her waking/at-home hours, but she'd started getting up at night also. His children weren't going to drop everything to care for a step-mother, and her children were all still working full-time. They live in Wisconsin where the elements can be extremely harsh. What was he supposed to do?

Those are just two stories from my own family. But I promise, it's not a perfect world of "if they really loved their spouse, they'd care for them at home." Love doesn't overcome physical realities. To make this statement is very simplistic thinking.

[JWG223]

Saying she's "done with him" just for putting him in LTC is way harsh. I suspect she's no spring chicken herself and perhaps she's not physically capable of rendering care. That doesn't mean "done."

I was going to say the same. My grandfather put my grandmother in LTC after her stroke. He would have myself or my father drive him up to the facility in the morning, and pick him up around night-fall every day. He did this until he himself was hospitalized and died. During which time he would simply sit by her bed, hold her hand, and tend to what needs of hers he could.

[KelRN215, BSN, RN]

Saying she's "done with him" just for putting him in LTC is way harsh. I suspect she's no spring chicken herself and perhaps she's not physically capable of rendering care. That doesn't mean "done."

Agree completely, I was going to address this comment myself. My grandmother was total care after having a hemorrhagic stroke at the age of 56. My grandfather was the most devoted husband I have ever known. It was simply not possible to keep her at home. He visited her in the nursing home every single day until she died. The day of her funeral was the only time in my life that I ever saw him cry.

[imintrouble, BSN, RN]

I just don't have a problem with what the wife did. Her husband in a nursing home is beyond being able to care about what happened to the money. Would it be better to let the "system" bleed them of every asset they have? Is it a mark of loyalty and love to sacrifice everything you have, instead of obtaining a signature from a spouse who no longer knows who you are?

Or is it just plain stupid?

[GHGoonette, BSN, RN]

There's a few questions hanging here which have already been pointed out - has the court declared him incompetent? If so, who has been named his guardian? Are there children involved? Even more to the point, is this lady his only wife or was he married previously to someone else who might feasibly have a vested interest in the disposal of his assets, or are there children of a previous marriage who might contest any documents their father "signed"?

It sounds way more than fishy, it sounds downright illegal. I'd find out more about his background, and if you actually saw him signing any documents, prepare yourself for the possibility of being called as a witness.

Think about it in the way you would informed consent: would you allow a person who is not compos mentis to sign for any hospital procedure? No, what this lady and her "notary" did was as illegal as fraud.

[mhusen5]

rholster,

There is so much you really don't know!

Rather than speculate that something illegal is transpiring, simply document what you observed in his chart.

'Wife visited. Attempting to get patient to write his name, so he 'could sign some papers in front of a notary' Reported to DON. Wife transported patient outside of facility where he appeared to sign papers presented by a male individual."

If anyone questions the event in the future, you've documented it and reported it.

Your job is done.

Speculation about the legality of what transpired may concern you, but you are in a very gray area that you are ill-equipped to handle.

You can report it to the Ombudsman, but your involvement ends there.

[Roy Hanson]

The alzheimer patient has money! Mom is trying to get it. He will have his lucid moments. As above report to the super, or hospital management.

[mapapete]

If your facility has an ombudsman I would bring it to his/her attention.

[mhusen5]

Roy,

These are very serious allegations, not really based on any factual knowledge...

This is a very slippery slope, and one every nurse should avoid articulating.

It comes under the heading of...gossip!

This type of speculation/accusation is beyond the scope of knowledge of the nursing profession.

I agree that factual documentation of what you observed, and statements verbalized in quotes, as well as reporting to Supervisor/DON, are in order.

[Roy Hanson]

yes, many hospitals or LTC do not have ombudsman, and its a political nightmare. They do not make it easy. But if I interpret the question, its all got to do with MONEY! Meaning, she knows the old man is worth money. Just waiting till he is lucid to get that golden signature. For you to get a legal opinion...aka Legal Fees..but is it YOUR business! How is his stay at the hospital being paid for..or financed.

OR check with your congressman, for leads.

Dementia aka ALZ is a nasty disease of the brain..we termed it: the worlds longest funeral. And its a sign of the times.

[notpuurfctbtgdenghns]

I would report this to the primary Doctor and I would write the whole incident in the nurses progress note including what I wrote to the MD for future reference.

My understanding of Ombudsman is that he is with whom nursing homes residents report complaint --not nurses report to.

[kbrn2002, ADN, RN]

Please look at this gentleman's chart to see if he has a POA or guardian and who this person is. If it is his wife, the decisions are hers to make. If it is not, reporting this to the ombudsman for follow up is in order. Yes, the ombudsman is there to address concerns, not only from families but from any individual that feels the need for their services. I am not sure about Texas, but in WI it is legally required for the ombudsman's contact information to be prominently displayed in a public area.