What policy/procedure does your LTC institution have regarding 'wanderers' who routinely enter the rooms of other patients and physically assault them. I emphasize the word, "routinely".
Thanks for the input that I know you will give me.
Jun 8, '02
This is a big issue. Basically, your duty is to protect the other residents. The rights of the "greater good" outweigh those of the aggressive resident. Your legal and ethical duty is to protect the other residents against harm.
What is the standpoint of the resident's family? Are they against using chemical restraints and/or antipsychotics? I have seen antipsychotics such as respiridone and quetiapine do a world of good for our aggresive residents with dementia. I suggest you spend time examining the residents behaviour. Does he (i'll just call him a he) target any one resident. Does he only assault those that confront him or won't back down? Does this happen at any certain time of the day. I am certain with some creative careplanning and medicating, these behaviours can be reduced.
- Ad. RN BN CNC(C)
Jun 8, '02
Remember, in LTC you have to try the least restrictive option and progress from there. Jumping straight to chemical restraints can put you in danger. Monitoring the situation is the first defense. Like adrienurse wrote, check when this occurs, who is involved, and who (s)he targets. Do they think it's their deceased spouse? Do they just get mixed up on which room is theirs? And is a psych consult called for?
Hope this helps.
Jun 9, '02
I am so sorry, after reading my own post I can see that I was vague: the person being assaulted is my mother who is a resident in a nearby LTC--and not just mom; this man has wandered into many rooms and terrified other residents--I know this because I personally care for several of the family members on an in-home care basis. I have had to 'shoo' him out of Mom's room several times--they tried the 'STOP' sign strung across the resident's doors but he walks right through it;
He has pushed my mother; he tried to pull her out of her chair claiming it is his. Other family members have told me that he has hit their male family members who are residents there. Complaints have been issued to the nursing staff and to the administration many times. My brother is so angry that he, as Mom's guardian, says that he will bring a law suit against the nursing staff and the administration if this guy isn't dealt with pronto.
I understand that this man is suffering from dementia of some sort. In my brief encounters with him I get the impression that he is un-aware that his actions are inappropriate....it seems to me and to other family members that this man has been given a 'free rein' to wander without regard to the safety and security of other residents. I need your input so that I can better undertand why this is so.
Thanks for taking time;
Jun 9, '02
Send a letter to the administration and keep a copy, send it certified with a return receipt. That way they cannot say they never received it. Outline your complaints, have others with such concerns do the same thing. Give the administration a time limit to remedy this situation and inform them that if not acted upon promptly, the state will be notified. Also, if you have a family attorney, a letter from him/her, listing the issues of concern with demands that the abuse cease immediately and informing them legal action will begin if it does not stop, could pull a lot of weight. Don't sit back to long. Your Mom deserves to be protected even if it means moving her to another facility. Good luck, keep us posted. God Bless.
Jun 9, '02
First of all if the staff is aware of the assaults and not acting upon them, they are in grevious neglect of there pts care!
Call your omsbudsman, there should be an 800 number posted by the front door, this is aggravated assault, and should be acted upon immediately!
Especially as this pt is ambulatory, who knows what pts he may have assaulted and know one may know?
I dont mean to sound negative about the staff, but our pts safty comes first, and there is always options, E>R> evaluation for 50/51 status, asmission to a geriactric psych unit to assess his behavior, etc. Yes in a LTC least restraint first, but not with an ambulatory, aggressive pt as this no way!
Jun 28, '02
have they consider sending him to a special needs facility?
also if this is a public nursing home complain to MEDICARE...this will get something done in a hurry as it does where i work now
Jun 28, '02
Thanks to All of You! Duckie, my brother took your advice right away and sent the certified letter. Next he spoke with the Administrator one-on-one and told him exactly what you suggested, --that if one more incident was reported to him by our Mother or anyone else he would have his lawyer contact Medicare and Medicaid.
The "wanderer" has since left the building.
By the by folks: I learned that several nurses have left. One of them told me that she was, "afraid for my license".
I also wanted to say that overall, the care my mom receives is quite good. The aides all seem very attentive to their patients. I'm thinking it's the same old story of understaffing.
Thanks again for all the great help.
Jun 28, '02
I'm glad the wandering person has left!
Jul 5, '02
what we do in our ltc facility is use velcro stop signs to stop the dementia residents from entering other room. This helps alot. There are occasional times when the person can and will remove the stop sign. You just velcro both sides of the door frame, and attach your stop sign. It deters them away.
Jul 5, '02
You know, it's amazing how quick one gets some action when "CC: John Doe, Attorney" appears at the bottom of a letter sent to the administration of a facility. Got this advice from an Ombudsman. She said even if it wasn't sent to an attorney, the fact someone else may potentially see the letter causes a reaction.
Glad everything has worked out.
Jul 6, '02
When the staff has 8,10,12 or more pts. to look after it is hard to
know where each one is at all times. This is a big problem in many LTC places.(You have to give care to each one, serve the meals, give the baths and tend to the ones who wander), I can tell you it is not easy by a long shot.
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