How do I deal with this patient's family members?

[morango576]

I am a CNA in FL and would like you nurses opinion on this matter, if you will.

I have been with this Home Health Agency since December, and have had this particular patient for 5 months now. She has Dementia, but mostly independent requiring supervision on a variety of tasks and activities.

We get along REALLY well. She likes me a lot and always tells me "thanks for making my day so bright" everytime I leave her house. I also like her a lot. We have fun together...

Anyway, she lives with her son who is bound to a wheelchair because of a car accident yrs ago. He does mostly everything for himself. At first he didn't bother us at all. But lately he's got into a crazy mood (I think he's jealous of us having too much fun :angryfire), and he's doing everything he can to either slow down my tasks or prevent me from doing it. The other day he said I could not wash her clothes, and she had wet her bed really bed. I stuck R (Refused) on my Daily chart for that day (laundry). Then another day he told me to go easy on the paper towels (he doesn't just say it.. he YELLS at me). Then I started using one of my patient's hand towel as a bib, instead of "wasting" his paper towels. He comes around her and SNATCHES the towel out of her chest... to which my patient turned to me in a desperate face... I told him to leave the towel where it was. He turns to me and yells "WHY?". I told him he had told me to not use the paper towels, he said "for this you can use". I said "I prefer using the towel because it shields it better all the way down to her legs"... because she makes a big mess especially on cereal days! Anyway, another day he came around the table, where my patient was sitting and eating lunch and I was sitting on the chair right next to her, he whams her against the table, trying to push her chair closer to the table (it wasn't that far away)... she screamed in terror! The only thing that came out of my mouth was "OH GOSH!". I could NOT believe what he had done. The way he treats his mom. The way he gets in between us.

Well, I told his sister -- my patient's younger daughter who lives 6 houses away on the same street -- all about this, that her brother is being an old fart, he tells me not to feed her this or that (things that she usually eats but now somehow he forbids her!), and the sister told me "please don't call your agency and tell these things, because if you do, I will have to drop your agency". I had told her I was unhappy with the conditions I was having now, all of a sudden her brother puts on a mood and creates a big problem for us. The one who pays for it is my patient and I'm very concerned. I'm there to do my job, whatever is on my aide Assignment sheet by my RN supervisor, I'm following it to the letter. I'm never late, I never miss work, I take my work very seriously, I enjoy what I do and excuse me -- but I do a DAMN good job! I'm proud of it! But at the same time I don't know how to deal with this old fart that is unhappy about life and is jealous that his mom and I are enjoying the time we have together... we walk, we watch TV, we play games together, we read, we laugh and tell jokes... I don't know why a family member could have a reason for a complaint about this! Anyway, I need the hours too as I am going to start nursing school now in May, and to be honest... I'm not ready to quit my job just yet, because like I said, I'm enjoying it very much. But I don't know how long I can stand this situation with the family members. I don't want to get in their business... the sister keeps telling me that her brother because of the accident, blahblahblah, that I have to have patience with him... I told her "I don't have to have anything for him... he's not my patient... I just want him to leave me alone so I can do my job properly"! Am I asking too much????

Tomorrow I have to go there again in the morning, and after that I'm going to my agency to drop paperwork for the week... but I am very tempted to tell the supervisor there about these things. But at the same time I'm afraid I won't have this patient anymore. I like her and I think she deserves the care I'm giving her. And I count on these weekly hours... I don't know if I can get another patient like her again.

What do you nurses think of my dilemma???? Should I put up with this problem or what?

Thanks a lot for reading... sorry it was too long!

[BEDPAN76]

Hi Morango and welcome to allnurses! First of all you seem like a very conscientious and caring aide. I agree with you that the son, in a juvenile way, is showing jealousy. You could try to include him in some activities, and get him "on your side". The other option would be to meet with the RN supervisor (at the office) and share with her what you have shared with us. She may be aware of the situation already, and may be able to offer suggestions on how to handle it. Seems like your client is "caught in the middle". Anyway, hang in there! And let us know what happens!

[HCSllc]

Wow! What a nightmare for everyone involved. What happens on my planet is often not realistic in the home setting but see how close you can get to this.

The jerk son is telling you something and likely it is not about paper towels or laundry. He is in a wheelchair and if he received good care after his car accident and is seen by good doctors, he is pretty independent. His care has been being told to, 'get it yourself' and 'you can do it'. And you know what? He just doesn't want to sometimes.

And here you come, little Mary Sunshine. From what I can tell you are not a good aide. You fall into the extraordinary category. How wonderful it is for you and your patient that you actually like what you do for a living and enjoy your patients! I bet you make your patient feel special because in your heart you believe she is special. This is what home health is all about whether you are a nurse, a therapist or a CNA. You make a difference.

But what about Bozo in the wheelchair with his less than sunny attitude? What can you do with him? Unfortunately, the most efficient answers are not legal.

So, you can do two things. The first is to take the bull by the horns and meet the conflict head on. Frankly, I think you would lose. There is an element of cruelty in this man's pain that you will never match.

The second is to give him a little time and attention. Try showing up ten minutes early with a newspaper clipping about something he likes - sports team or whatever floats his boat. Give him ten minutes of listening. I think the greatest gift we can give anybody is simply to be heard.

If you have time or if your MSW is willing, you can look for wheelchair activities he might be interested in to get him out of the house periodically.

When he impedes your progress, do not give in but do not engage in conflict, either. If he is upset about paper towels, explain that they are preferred for infection control and his mother may be at increased risk for infection due to age. Then ask him how he might go about procuring more paper towels. In other words, quietly and with a smile, lay the problem at his feet.

Again with the laundry. It is perfectly alright for him to refuse to let you do the laundry. It is his house after all. But quietly and with a smile, explain that if you are not able to do the laundry for his mother, you need to be assured that it will get done as soon as possible. Is he going to do it that afternoon? When the alternative to not letting you use the washing machine is to do it himself, he might have different ideas.

In my spiritual practice, being 'present' is emphasized. That means really hearing what the Bozo is saying and understanding that what he is saying reveals more about him than it ever will about you. You do not want to win this battle because in order to win the battle you must agree to fight.

If you decide to listen to him with your entire presence for ten minutes, end your conversation on schedule. Explain that you will be back. If his mother needs anything before you get back, he can call the agency. Again, you are giving him an option to 'get in touch' but not by giving him your contact information.

I think you are a remarkable aide based on what I see. Don't let this unhappy person get under your skin. It is really easy for me to sit here and tell you this but I know how very easy it is to let it bother you. I have been in your shoes many times myself and wished I had followed my own advice.

Congrats on a job well done and let us know how it turns out.

julianne

[muffin7]

All I can say is that your interactions with your patient are doing her more good than you can imagine. Keeping her mind stimulated is key with her dementia.

[nursel56]

The replies you've already received are great ones.

I've worked in the home of the same family for more than 4 years. It is really unique in that we spend hours and hours in close contact with the patient's family and there is a fine balance we have to strike. Sometimes it feels like I'm navigating icebergs, because often we're plunked in the middle of an unhealthy dynamic that's been going on for years. It's unrealistic for people to say "just focus on your patient". One of the best pieces of advice I got in the beginning was to not become any sort of go-between with other family members. I would just hazard a guess that the sister's overly defensive response and threat to change agencies means this isn't the first time complaints were made.

However, you love your job and want to keep it!!!! A good mesh between a caregiver and a patient is so incredibly rewarding. I've learned things in this area of nursing I could write a book about (but I won't because of HIPAA:D) I agree with everybody's suggestion that you try and connect with the son and include him in some of the fun things you do with his mother. It's that he feels left out.

I just have one thing that worries me. You mentioned that he snatched the towel away and that he shoved his mother forward in her chair. Do you think this is just a normal hissy-fit? Do you ever fear for her safety? If the answer is yes, then you really don't have a choice. :crying2: If it comes to that, you've got to report it, for her sake and yours. I hope all this resolves for you. You sound like you'll do great!!

[morango576]

Thank you so much, Bedpan76!

I am so glad that you wrote those words... it made a lot of sense.

I don't really know what he was thinking when he did these things. The sister said that "because of his accident he became like that, blahblahblah, but you have to be patient with him, he doesn't mean that way".... I don't care if he dances naked on the main highway, or if he bangs his head on the wall, as long as he lets me do my job with his mom! I would rather him not be included in our activities, he kinda creeps me up (he gives me the looks sometimes, he stares... I don't feel comfortable, but I'm not nasty to him, I always say good morning when I get there, etc... I just don't want to get involved with him too much). My patient and him have serious issues from the past, I understand and respect that, but he can't be stopping me from doing my job just because they've had issues in the past... I got nothing to do with it. I'm not a psychologist or therapist, I'm not there for him or to resolve anything, I just plain want to work! Well, again, I appreciate your answer, very thoughtful... thanks thanks!

[morango576]

will let you know how it unfolds

[HCSllc]

I'm glad you feel supported! I do want to reiterate what Nurse56 said about possible violence. It is a bit difficult to tell from the original post how severe pushing your patient into the table was. I'm sure it was horrifyingly rude. If it was dangerous as well, you need to go to the end of the earth to protect your patient!

j

[morango576]

I mentioned to the daughter about that, and had mentioned to my supervisor in the agency... the daughter said that her brother didn't mean that blahblah that old story of the car accident... I don't know what the agency will do about that, at least I told them -- did my part

[morango576]

another thing, my patient has complained many times to me -- at first she didn't say anything, but after a while she started trusting me more -- that she wishes she disappeared out of that house. I asked if someone is doing something bad to her, she said no... she said her son keeps peeking to see what she's doing all the time, and telling her off... I understand that dementia patients tend to want to wander off, but for her to look me in the eye and tell me "I don't feel comfortable in here"... I don't take it lightly. Again, have already informed my agency.

[caliotter3]

Write out everything that you talked about in your post and present it to your nursing supervisor without delay. It seems that the behavior is escalating and something bad could happen with your patient. You want to report this so that your supervisor and agency can take appropriate action. Also don't forget to tell your supervisor about the sister's threat to change agencies. That threat is blackmail and you shouldn't be subject to it.

[muffin7]

Morango,

Hang in there and keep notifying your supervisor. Be sure and document EVERYTHING!!!!!!!!!!! You can also put things in "quotes" that the patient says.