Experienced Environment Disasters?

[neonatal3]

Hello!

Wondering if any of you encounter home health situations where the patient's home environment is a progressive disaster situation with apparent need to move to a nursing home? I am currently working as a private duty home health nurse for an agency--patient is a quadriplegic from chest down and requires help with meds,pressure ulcer dressings, and all activities of daily living. The environment and care of my current patient has slowly deteriorated in the last couple of weeks to a very low quality due to a mix of decrease of nurse coverage associated with recent change of Tenncare Insurance rules(Medicaid--used to have 24 hour nurse coverage, now has only day shift nurse coverage) , a decrease in patient support by his friends, and unfortunate choices by patient to use social security disability payments for entertainment items instead of for basic care items(such as food, rent,utility bills)

Evidence Of Disaster: facts: (1)inadequate heat--only working heat system for patient's duplex apartment is turning on oven and opening the oven door(because he is behind in his rent and landlord has refused to repair heat system--outside temp. here this morning was 29 degrees); (2)notice to move--- two days ago patient's landlord brought him a written notice that he must move as soon as possible because he has not paid his rent;(3)inadequate help--- friend patient arranged to help at night bailed out yesterday

Potential Solution To Environment Disaster---I encouraged patient to call his case manager today to help with arrangements for him to move as soon possible to either a government subsidized apartment or a nursing home--patient made some calls today

Question---in working as home health care nurses, do you find that it is common to encouner such sad patient environment situations? Is this just part of the "home health world"? (have worked as nurse for decades but am new to home health type work) Your input would be appreciated!

[caliotter3]

This type of situation hasn't happened to me yet but I suppose it is not uncommon. There will probably be a lot more cases like this due, in part, to the change in regulations that you describe. I would definitely get your agency supervisors and social worker involved. You need to communicate with the patient's MD also. If you have to, because it is coming to a drastic stage, then make a call to Adult Protective Services. They should have a hand in watching out for the well being of dependent adults. Sometimes this is what it takes. Good luck in getting needed changes for your patient.

[caliotter3]

BTW, I believe the landlord can be taken to task for the lack of heating. He has a legal responsibility to provide a habitable rental. Your patient should complain to the housing authority or take whatever legal remedies are open to him. Place him in touch with a housing advocate. Of course, not paying the rent is not in his favor. There are rules for fixing something and withholding rent. He chose to use his rent for something else. If he does not watch himself, he will find himself in the not so pleasant position of being in the middle of a conservatorship. Then he will have no say. Someone should have an informed, blunt conversation with him before someone else takes the bull by the horns. But then again, perhaps this would be in the patient's best interest. Sounds like he is losing his ability to make appropriate decisions for himself.

[neonatal3]

Hello caliotter3 !

BIG thanks for your oh so helpful reinforcement about calls to involve resource people when one encounters major negative home environment issues!(Reading your kind messages is wonderful moral support because this unfortunate patient situation has been causing me to feel super depressed!) After reading your kind suggestions, in addition to previous call to involve case manager, I also called my nursing supervisor with more update info and made a request yesterday for her to work on speed up of nursing home placement for this patient.

Update On Patient Situation--another learning experience!--this morning I arrived at my patient's residence and knocked on the exterior doors for ten minutes with no response---then, I called my agency concerned that this paralyzed patient might be in bed alone with no ability to open door--agency staff person was apologetic to me and said that patient had just called him from a hospital to notify that he would not need an agency nurse today!(cause for admission was not given)---this unfortunate patient development will probably speed up the goal for admission of this patient to a nursing home--maybe new development is a "win/win" situation---a "win" for this patient to be more safe in a nursing home and a "win" for me to get the heck out of one messy patient assignment!

Would appreciate any stories others may have about negative home health patient environment "challenges". Thanks again caliotter3 for your helpful message! Peace to you.