Large tip from dementia pt - unethical/illegal to accept?

enuf_already · Dec 28, 2014

Don't know if she works for an agency or not and their rules but in my own opinion, it is ethically wrong. If she was a nurse, it could be considered a boundaries violation by the board of nursing.

Taking money from a patient who may not understand what they are doing could come back to bite her. The family could notice money missing and accuse her of theft. I have seen stranger things happen.

We don't work in a profession where tipping is accepted.

Purple_roses · Dec 28, 2014

I'm not allowed to accept that at my company because the elderly often make mistakes, such as forgetting they gave the cash or accidentally giving a high amount when they meant to give a much lower amount, like a $50 instead of $500. I would never dream of taking that from any of my clients, ESPECIALLY if that client had dementia.

toomuchbaloney · Dec 28, 2014

Hello,
I have a family member who works as a home health aid (CNA level). She often brags about the tips she receives-some of which are substantial cash amounts. Most recently, she bragged about accepting a $500 cash tip from a pt requiring 24hr care (I believe this pt has dementia, but I'm not sure).
My question is this: is this illegal? Even if it's not, I would definitely feel uncomfortable as I know that many of these types of patients do have some form of dementia. It seems unethical to me to accept tips like this....what are your thoughts? I have heard that gifts are common, but usually they are not monetary...
The family member has also frequently mentioned that the patients' families have no idea these tips are being given...

My bet would be that her employer has a policy about this sort of thing and she is not in compliance. It is typically considered unethical. If she is accepting valuable gifts from an elderly patient who is dependent upon the care this could be considered a form of manipulation. If the individual is not mentally competent to make reasonable decisions for his/herself then the CNA may actually be breaking laws in the state of practice.

anh06005, MSN, APRN, NP · Dec 28, 2014

My home health agency knows that the patients may come to think of us as family so we are able to accept small gifts. I have gotten a box of chocolates, a card with $1 in it (for the vending machine down the hall), a hand made doilie, a small wood figurine a patient carved, etc.

If a patient gave me a card with $5 yeah if they were well off I might get a coke and candy bar with it. Anything much over that I'd feel very uncomfortable.

As PP's have said if she works for an agency they probably have a policy similar to the one I mentioned or to not accept anything at all. Also as others said a patient with dementia may not realize what they are doing with that amount of cash.

In face just saw a patient today with dementia who was excited his daughter had found the $4,000 he had "hidden" and couldn't find.

caliotter3 · Dec 28, 2014

I suppose your friend wants to be charged with theft from helpless people in her care. Good way to ruin her life. You should advise her to excercise some common sense if she is lacking in professional or moral scruples.

JustBeachyNurse, LPN · Dec 28, 2014

Definitely unethical, crossing professional boundaries, and can be considered a form elder abuse, whether the person suffers from dementia or not. Your friend is in a position of power. Accepting large amounts of cash "tips", especially if the family is unaware can result in criminal charges, loss of CNA certification, listing on elder abuse alerts (barring future employment with senior citizens in any capacity) and a ban from working from any facility or agency that accepts federal funding, medicaid or medicare (OIG exclusion).

If you have first hand knowledge (even bragging by your friend can be considered first hand knowledge) and a licensed professional that is a mandated reporter you have a duty to report (even anonymously) to the appropriate agency. May be dept of senior services or a division of the county prosecutor or elderly ombudsman/chancery division.

GabesMommy2014 · Dec 29, 2014

I agree with all of your replies. I definitely think it's unethical...however it's hard because I also don't know the full circumstances (ie when mentioning the $500 tip, she didn't say if the family knew about it or not).

What gets more confusing is articles like this, which state gifting a weeks or months pay on cash for aids is acceptable (she doesn't technically live with them, but does provide 24hr care for 3-5 days a week)...

https://www.caring.com/blogs/caring-currents/what-to-tip-home-health-aides-at-the-holidays

JustBeachyNurse, LPN · Dec 29, 2014

A better source would be your state department on aging or senior services and/or the agencies that certify CNAs and CHHAs than a non specific blog. Private inhome care is not always by a certified individual or through an agency.

elkpark · Dec 29, 2014

What gets more confusing is articles like this, which state gifting a weeks or months pay on cash for aids is acceptable (she doesn't technically live with them, but does provide 24hr care for 3-5 days a week)...
https://www.caring.com/blogs/caring-currents/what-to-tip-home-health-aides-at-the-holidays

You start your original post by saying that your friend is employed as a home health aide. The blog you link to states quite clearly that tipping home health aides is appropriate unless it's prohibited by the agency's policies. What's confusing? It is probable that your friend's employer has a policy prohibiting her accepting gifts/tips from clients (in fact, it's hard to imagine a healthcare organization not having such a policy).

I'm with the other posters here -- it's definitely unethical, could endanger your friend's future in healthcare, and could possibly be considered criminal elder abuse.

GabesMommy2014 · Dec 29, 2014

Again I understand and agree with the assertions on this thread that it is unethical. I just wasn't sure if it was illegal - I'm not sure if she works through an agency or if she is specifically working under her CNA certification. And given the personal relationships involved, I just wanted other opinions on the situation before I did anything.

Thank you all for taking the time to share your opinions on the matter.

caliotter3 · Dec 29, 2014

If she has a CNA certification, then anything she does or fails to do, be it illegal or unethical, pertains to her certification. That is why scores of CNAs, nurses, and other health care providers have their professional credentials disciplined or even revoked every year. "Crimes against the person, crimes against property, moral turpitude, etc., etc." It all counts. Common sense.