combative residents and family. (kinda long)

[fairyluv]

I have a res. who is very combative, aggressive, loud, beligerent, and sexually inappropriate. He is his own responsible person. family will not take responsibility for him. Several times in the past he has not just hit the staff but beat them with objects. He beat one CNA with an wheel chair break extender so hard she had to leave work and go to the ER and was taken off work for 2 wks. He refuses care unless you perform sexual favors for him. (which of course no one does) Some nurses say he knows what he's doing, others say he doesn't. I'm not sure, one day he seems to be with it, the next he's not. He's on antipsychotics and antianxiety meds. All of his behaviors are documented. This has been going on for months and the dr. would have us send him out to the ER and the hosp will admit him based on a medical decline and not as a psychotic episode. they treat whatever medical condition they admit him for and send him back, mentally he comes back worse than when he went in. Have tried before to have him admited to the psych unit, but resident refuses and family refused to commit him. the other night he gets into an altercaton with another res. which escalates to a physical assult and homicidal threats. Dr wants this res admitted to the psych unit.and give order to give IM psych meds. Psych unit says to send him to the ER and they will evaluate him there but they need someone to commit him before they can take him. I try calling the family and can't get anyone, leave several messages. call my DON and tell her the situation, She reluctantly agrees to commit him the next day. I send him out. this took about 2 hrs of back and forth phone calls and trying to get him to settle down enough to where he wasn't a danger to himself or anyone else. finally get that done. stay over an additional 2.5 hrs to finish my med pass and all my charting. come in the next day only to find out that he was coming back to the facility on my shift. I called the dr. to remind him to call the pharm and give them verbal order for all the IM psych meds I gave. He asks if res was admited to psych unit and I tell him no that the res is coming back because no one will commit him , I guess so he can beat the crap out of everybody else, and I really don't want to be the nurse to have to deal with that again. I was not a very happy nurse. halfway thru my shift, the admin comes to me and asks me to write out a witness statement regarding the incident. res. did not come back and from what I have heard is that management is going to commit him. Just kinda peeves me that they were gonna accept him back. knowing that he continues to do this. and the poor doc, he has been called numerous times in the last 2 wks regarding this res. for the same probs.

[Blackcat99]

Welcome to the wonderful world of LTC. Sorry to hear about your situation. Many years ago, we had a LTC patient who was assaultive towards staff. He was allowed to stay. However, one night he started breaking out a lot of windows at the facility. After that, they got rid of him permanently.

[CapeCodMermaid, RN]

Any assaultive resident in my facility automatically gets a free ticket to a psych facility. We get the doc to sign a section 12 and work until we find someplace to send them. I will not tolerate anyone being physically assaultive with my staff or another resident.

[Elizabeth Renee]

I work with the 5 same dementia patients and they can get quite aggressive with me on occassion. Hit, punched, pinched, scratched and spit on. I totally get the frustration.

[VivaLasViejas, ASN, RN]

I feel for you, OP. And what's sad is, this stuff happens every day.

About a dozen years ago, I was an ADON for a mid-size LTC where we had an A & O resident who just beat the crap out of anybody he felt like, whenever he felt like it. That included other residents and even visitors! His family had basically just dumped him on us and headed for the hills.....they were no help whatsoever. We couldn't medicate him because he was supposedly responsible for himself and he, of course, refused. Yet when we called the police on him for tripping up a lady in the hallway, causing her to fall and break a hip, they wouldn't take him because he needed a psych eval, and psych wouldn't take him because he was supposedly medically unstable......well, you can imagine our frustration!

It took a few weeks, but I finally got him out of the facility and into the state hospital's gero-psych unit......I had to work through an entire weekend and make what seemed like a hundred phone calls to accomplish the thing, but it was well worth it for the relative peace and quiet......until Tuesday morning, when a case manager from adult protective services came in and accused me of violating this resident's rights!

Luckily I had plenty of documentation, but the whole experience was a nightmare......two full days of answering the same questions over and over, producing chart notes, calling doctors' offices for THEIR notes on our conversations---it felt like an inquest. It didn't matter that the rest of the residents and staff didn't deserve to get the stuffing beat out of them, this resident had all the rights as far as the state was concerned. Finally, they decided in our favor and didn't force us to take him back when the psych hospital discharged him a month later, but it was a bruising fight that taught me NEVER to expect government bureaucracy to do the right thing.

Hope you don't have to take your 'problem child' back when he's discharged, but don't be surprised if he does come back eventually. Sad to say, there aren't very many places left for people like him to go, and nursing homes have become the dumping grounds for all sorts of folks who really should be long-term residents of a psychiatric facility or state hospital.

[ktwlpn, LPN]

Sad to say, there aren't very many places left for people like him to go, and nursing homes have become the dumping grounds for all sorts of folks who really should be long-term residents of a psychiatric facility or state hospital.

More's the pity-our elderly and infirm should NOT be subjected to this crap. We see it with MR ,too. I've had 2 older Down's syndrome men who used to torment the LOL's, sneak up behind them and pull their hair, pinch them ,etc. They both were kept at home by their elderly parents until the parents died and never reached their full potential.They never went to any kind of day programs for training. Spoiled rotten, no limits had ever been set for them. We get them in LTC and what can you do? I'm dealing with an MR now who beat the stuffing out of an LOL a few days ago because she was rummaging through another ladies belongings.The LOL blacked her eye...good for her. We have some young train wrecks, too.They are busy sucking the life out of the staff with their non-compliance and manipulative behavior. These populations should NOT be warehoused....

[fairyluv]

I really think it's time for a change for me. I'm just getting really burnt out and I have to drag my self to work everyday. I feel that I'm putting my lic in jeopardy everyday I'm there.

[meanmaryjean, DNP, RN]

I do not pretend to understand the complexities of LTC- but if this resident assaulted ME or my family member- they would go to jail. An alert person committing assault is a crime- nothing more, nothing less.

[indiechic, LPN]

I would recommend calling your state's elder abuse line. If he is a danger to other residents you have a right to protect them. Also, I'd give a discharge notice. As long as you have plenty of documentation showing you've tried interventions for his behaviors and he is non-compliant, discharge is fine. That is, if your administration allow it. You can also call a designated mental health professional and ask for him to be evaluated. Looks good for documentation purposes, even if that's all that comes from it. Good luck!

[txnurse01]

Being a threat to himself or others should get him an auto at least 24 Hr psych evaluation in a hospital. Once he becomes violent he has given up his rights. The rights of one ends where another's begins. Poorly handled