It's MY License....Made Report to Adult Protective Services

[tencat]

Hi all. I have an elderly patient who recently had a stroke, lives in a mouse and roach infested house, lives alone with no family able or willing to help out, is weak and confused, can't keep self clean, can't remember to take meds, very unsteady on feet, can't remember to use oxygen or walker. Patient was at a long term care facility, but was discharged back to that house. According to the powers that be, patient didn't want to stay at the facility, so they had no option other than to let patient go back. Facility never performed a psychiatric evaluation or competency evaluation on patient. I made a report to APS. I called my boss to report that I'd made a report and got an earful. According to the boss, I had no right to do that, it was a social worker issue. When I made the report, the intake worker couldn't find patient in the system, though I'd been told repeatedly that the social worker has filed reports prior to mine. Boss was very upset with me. I said, "I'm sorry that you're upset with me, but I feel that I have to file a report to cover myself should anything come up legally." Was I wrong to do this? I suppose boss is peeved because my filing a report makes our agency look bad, but what choice did I have???? It is MY license. Any feedback would be appreciated.

[Noryn]

Ultimately you have to do what you feel is right. I would notify my in house social worker first but if they were not doing anything about it I would then notify APS.

Why is your boss mad? Because you reported an unsafe environment for an elderly person? No, because it may cause hard feelings with the nursing home hence loss of potential money.

I have done the same thing before. Made a nursing home really mad at me but want to know how much sleep I lost--heh NONE.

You have to not only protect your license but your conscience as well.

[missnurse1]

I would have done the same thing you did. The client was not safe and we have to be their advocate. It shouldn't be about how the agency feels, it should be about keeping the client safe. If a person is recieving care from an agency or nurse in any sort of way and they are not in a safe environment, it needs to be reported for the welfare of the patient. Good job and keep being an observant nurse!

[RN1989]

You followed the law and did nothing wrong.

Have been in your exact situation. Was informed I was not allowed to make APS referrals because the facility wanted to have a meeting with hospital leadership and S.W. to decide if a referral was needed. This was to cover facility's butt because they did not refer the pt to APS and I did and then APS wanted to know why the hospital didn't. Got pretty ugly but I know I did what was right and I will do it again if the need arises.

[kmoonshine, RN]

This was your patient and you had every right to advocate for them. We need more nurses like you - and I am sorry you are getting slack. I believe that you acted apporpriately, considering our RN licences are issued by the state, not by facilities (and it is that way for this very reason). Best of luck.

[santhony44, MSN, RN, NP]

You did exactly the right thing.

[namaste_71]

What's right isn't always what's easy. Thank you for having the courage to do what's right. I wish there were more nurses like you.

:bow::bow::bow::bow:

[NRSKarenRN, BSN, RN]

kudos for being a patient advocate.

when i was a field staff rn, on first name basis with aps in my county. as manager, referred a case few months ago.

you are describing self-neglect and covered under elder abuse/neglect laws.

national center on elder abuse: types of elder abuse/neglect

the basics: major types of elder abuse

self-neglect is characterized as the behavior of an elderly person that threatens his/her own health or safety. self-neglect generally manifests itself in an older person as a refusal or failure to provide himself/herself with adequate food, water, clothing, shelter, personal hygiene, medication (when indicated), and safety precautions.

the definition of self-neglect excludes a situation in which a mentally competent older person, who understands the consequences of his/her decisions, makes a conscious and voluntary decision to engage in acts that threaten his/her health or safety as a matter of personal choice.

signs and symptoms of self-neglect include but are not limited to:

pa: institute on aging - older adults - elder abuse/neglect

getting help/reporting abuse

the pennsylvania department of aging protective services investigates cases of suspected elder abuse. any individual that believes an older adult is being abused, neglected, exploited, or abandoned should:

• call 911, the police, or hospital emergency room if they believe the individual needs immediate protection.
  
• call the state-wide toll-free elder abuse hot line at 800-490-8505
  
• or, file a report with the pennsylvania association of area agencies on aging.

anyone can report elder abuse. because elder abuse can occur anywhere, including at home or in a nursing care home, the person reporting the abuse has legal protection from retaliation, discrimination, and civil or criminal prosecution.

in confirmed cases of elder abuse, the department of aging undertakes ongoing case management services in regard to financial management, court-ordered interventions, and guardianship determination.

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national center on elder abuse (ncea)

the national center on elder abuse provides basic information and fact sheets on elder abuse and neglect with the goal of enhancing understanding, awareness, reporting and prevention of the violation of the rights of older adults. supported by the us administration on aging, the ncea also offers the latest statistics and legislation as well as links to other useful resources.

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in pa, nurses are mandatory reporters: [color=#0000cc]aging: protective services for older adults

mandatory reporting

• employees and administrators of nursing homes, personal care homes, domiciliary care homes, adult day care centers and home health care are mandated by act 13 of 1997 to immediately report any suspected abuse of a recipient of care to the area agency on aging. if the abuse involves serious injury, sexual abuse or suspicious death, reporters must also call police and the pennsylvania department of aging at [phone]. in addition, the reporter may also call the pennsylvania department of health nursing home complaint line at 1-800-254-5164.
  
• failure to report as required by act 13-1997 can result in administrative or criminal penalties.
  
• the older adults protective services act (oapsa), mandatory abuse reporting requirements have been amended. effective february 9, 2003, facilities that provide services to individuals with mental retardation in residences licensed by the pennsylvania department of public welfare (dpw) or that are funded through a county mental retardation (mr) program shall not be required to report abuse if the recipient is under the age of 60 years. specifically this includes:

1) community residential rehabilitation services;

2) community homes and family living homes for individuals with

mental retardation;

3) intermediate care facilities for individuals with mental

retardation, including state and non-state operated facilities

and homes; and,

4) state mental hospitals

[FireStarterRN, BSN, RN]

I think you should have rather said "I must report this in order to protect the patient, in my role as a patient advocate". Saying you did it to protect you license sounds self serving and a little paranoid actually.

Bottom line, you as a healthcare professional have an obligation and right to report something like this, you shouldn't need to clear it with your manager or anyone else, in my opinion.

[MichaelFloridaRN]

I think you did the right thing, I would have reported this also.

Glad your taking care of your patients, keep up the great work!

[rjflyn, ASN, RN]

The OP had mentioned that she was told that a report was never made when she made hers. I dont know about were she is at but here in FL they can't tell you if another report has been made or not. One night I had additional information I wanted to add to a potential child abuse situation, I even got the same intake person on the phone. I pretty much had to make a second report to include the added information.

Rj

[rn/writer, RN]

Your immediate boss might give you a hard time, but I think the Ultimate Boss would say, "Well done."

As would the patient if she had her wits about her.

Do what you know will allow you to sleep at night.

Thank you for making the report.