How to Chart on Controlling Family

[Thanksforthedonuts, MSN, APRN]

We have a sweet little old lady in our LTC setting. Unfortunately her daughter has major issues with controlling and manipulating her mom's care.

Expressed desire to place her mom on a strict soy free, gluten free, sodium free, sugar free diet, we shot that down. Attempts to control WHICH caregivers are allowed to care for her mom, shot that down as well. Never wants to sign documents due to some imperceivable error, asks for 2+ adjustments each time. Sits at her moms beside 6+ hours a day, 6 days a week (has a spouse at home). Asks all providers to prescribe new medication orders weekly. Shows up with random prescriptions and administers that to her mom and then takes unknown medication back home with her nightly. The LTC does all house keeping and she takes her soiled laundry home with her to wash all her mom's clothes. Literally comes out of her mom's room and watches EACH AND EVERY person who walks on the premises. She combats many of our med orders by coming to staff and asking them to administer it differently, such as to give her 5% more or less of certain medications. Crazy!

I don't kiss her butt. I lay down the law hard and firm and set strict limits. I don't have time for this crap and you can tell she has an overwhelming need to control.

Funny thing is, her poor mom exhales a sign of relief when her daughter finally leaves for the night. She even played dead one day! Pretended to sleep the entire time her daughter was here, daughter thought she was dying (no signs of impending death whatsoever from assessment point of view) and cried at her bedside for few hours and called her spouse to come say final goodbyes. Once she finally left, little old lady open her eyes and asked, "is she gone yet? I thought she'd never leave!" We laughed so hard. OMG!

Today she stopped me from assessing her mom who was upset about something (didn't have a BM for 24hrs+ and was getting distressed) and asked me to leave because I was upsetting her mom... ? Nutters. I saw her mom for like 3 minutes.

Daughter often tries to confuse staff and reporting different things to each caregiver. She sets up "tests" for caregiver to see if anyone will catch something out of order so she could point out how imperative it is for her to watch every movement her mom makes.

She also frequently abuses the call button "for her mom".

Leaves door open to her the room to hear what people talk about outside.

I want to start charting her behavior as it is getting ridiculous. How would I chart family behavior in a way that is professional, non subjective, and makes it clear that we are concerned about her mothers' well being as the daughter is exhibiting significant control issues?

Or... am I wrong here?

P.S. Daughter never worked in healthcare. Did a lot of "volunteering" as an aid and apparently knows everything. ?

[DolceVita, ADN, BSN, RN]

These matters need to be discussed with the provider, a social worker and your manager. Specifically, medications being given that your facility and provider don’t know about. It’s simply dangerous for your patient.

Is the daughter the POA?

Chart factually any interactions you have with the family and observations (like prescribed medications being given).

Consider a formal care conference. This woman may simply be crazed with concern for her mother.

[Thanksforthedonuts, MSN, APRN]

We intend to have a formal care conference and to speak with a social worker who is starting to follow her case.

I believe it is more than just concern... there are a few things that stand out beyond just being "overwhelmingly concerned":

-She can't take NO for an answer and persistently tries to overstep regulations. If she feels "defeated" she will forget what the NO was related to and try again on another visit (such as administering meds).

- she becomes passive aggressive if you overstep her (aka set limits) and will ignore you, no eye contact, pretends you are not there, won't speak to you, and pushes you aside.

-manipulates conversations among the healthcare staff and will tell staff conflicting information on purpose.

We have delt with children who are "crazed" with concern, but here it appears different. It is odd and concerning.

[DolceVita, ADN, BSN, RN]

I’d have two staff members go in at a time and I would have your DON explain why. Of course, like most places you probably don’t have the staff for that.

[Glycerine82, LPN]

Just remember to paint a picture for the next reader without using sunjective data.

"Family member speaking loudly" Not "shouting", etc. "Educated family on xyz, understanding undetermined at this time"

Def. consult social work also. Sounds like it could be grounds for them to try to get custody but thats a long, convoluted process that most facilities wont undergo.