Leaving a non-ambulatory client alone overnight

caliotter3 · Sep 3, 2011

I had the same type of situation with a totally paralyzed patient on a vent. I would walk into the home at the beginning of my shift with no one there, and when I left it was the same way. The other caregivers came and went as they pleased even though they got paid for the hours that should have coincided with me coming and going. I was always worried about my license while I worked there and rightly so. One time I went into the home to find the patient choking, the vent alarming, and of course, no one around. The patient said she had been that way for the better part of an hour. When I tried to discuss this mess with my agency supervisors, they blew me off. I no longer work for that agency. If I were you I would raise a stink or request off the case. It is not worth the worry, and believe me, I worried every day I was on my case like that.

jammycakesRN · Sep 4, 2011

I would not feel comfortable leaving that patient alone either. You could discuss it with your agency, or even make a call to the local Adult Protective Services.

Kyasi · Sep 11, 2011

I had the same type of situation with a totally paralyzed patient on a vent. I would walk into the home at the beginning of my shift with no one there, and when I left it was the same way. The other caregivers came and went as they pleased even though they got paid for the hours that should have coincided with me coming and going.

Just to clarify what I'm reading here Caliotter3, are you saying that this was a 24hr case with a nurse relieving the previous shift and the nurses are not there when you come... and the supervisors just blew it off??? If so, this is a clear case of patient abandonment and if the agency knew this was happening, all of their nursing licenses are/were in jeopardy! What you describe is a terrible case of patient neglect. The supervisors who ignored this situation and the nurses who were not where they were supposed to be should all have been reported to the State Licensing Board. I fired a nurse for leaving a patient during her scheduled shift and also reported her to the licensing board.

CabanaDay, Our agency has a policy to not even accept a referral for a client if amount of care we provide is not adequate to keep this patient safe when our staff is not there. I turned a referral down just last week for this very thing. The patient had an existing Medicaid PA written at another HC Agency for 2 hrs in the morning to get him up and 2 hrs in the evening to put him to bed 7 d/wk. The other agency had discontinued services for other reasons and the patient was seeking another agency for his care. He is also nonambulatory and has no support system to help him when our staff is not there. So what happens if there is a fire, he is hungry, needs to toilet?

All medical professionals are obligated to report to APS if they know an adult is being left in an unsafe environment. So if you have reported an unsafe situation to your employer and nothing was done and you continue to go to this client knowing that he is unsafe when you leave, you could be held accountable if something happens to him. If you have followed your chain of command and reported this unsafe situation and nothing was done, you should call APS yourself. You should also distance yourself right away from an agency that doesn't make client safety a priority. You said it doesn't seem right to resign a case like this. You are right, it doesn't make sense to just leave without doing something. But resign you should, AFTER you have called APS. Then don't just leave that case, leave that agency.

Kyasi

allnurses Guide · Sep 11, 2011

No. I couldn't do it either. I'd be a nervous wreck thinking about it.

I wonder why he doesn't qualify for another HHA for nights? It's been my understanding that in-home care is offered when the patient would otherwise be referred to an LTC because the person has been assessed as unable to live independently. So if he would have 24/7 coverage there, he would need the same at home.

Maybe Kyasi can explain that one!!

Want2binupperLP · Sep 11, 2011

You mentioned that SN and PT are provided under MC. Sounds to me like they need a social work referral (ASAP) as well. Are they part of your agency or do you have contact info for their agency? Report these concerns to them. I have seen cases where APS is involved. They're resources are very limited and they don't seem to take action like, removal from home, unless there is evidence of outright physical abuse or neglect-no food, no water, etc. Dire situations. A SW from the skilled agency can help family by spelling out situation, assist with further care planning, finding other resources, making APS referrals and continuing to work with them to ensure follow through. Hope this helps.

Want2binupperLP · Sep 11, 2011

You mentioned that SN and PT are provided under MC. Sounds to me like they need a social work referral (ASAP) as well. Are they part of your agency or do you have contact info for their agency? Report these concerns to them. I have seen cases where APS is involved. They're resources are very limited and they don't seem to take action, like removal from home, unless there is evidence of outright physical abuse or neglect-no food, no water, etc. Dire situations. A SW from the skilled agency can help family by spelling out situation, assist with further care planning, finding other resources, making APS referrals and continuing to work with them to ensure follow through. Hope this helps.

Kyasi · Sep 11, 2011

I can't speak for Medicare because I deal only with Medicaid. In my state, Medicaid will not provide care of any kind 24/7. It is less expensive to have a client in a Nursing home if he/she requires that level of care. From my understanding, Medicare is also limited in what they can provide but someone else will have to answer that. I do know that when we are providing Medicaid PA services to a client and a Medicare agency is needed for PT/Nursing, we can no longer provide those Medicaid services. (Medicare trumps Medicaid) The Medicare agency is required to provide the PA services while they are in the home. Most of the Medicare agencies in my town will not provide more then a bath aide for a few hours a week because their reimbursement is not enough for more then that.

I agree, APS (at least where I am from) is worthless. I once made a referral and it took them over 2 months to respond. But despite knowing that, my back is covered if there is a problem/lawsuit etc because I did what I'm legally required to do.

Kyasi · Sep 11, 2011

" In my state, Medicaid will not provide care of any kind 24/7."

I should clarify that I mean 24/7 skilled services in a home.

caliotter3 · Sep 12, 2011

I only did two weekend 12 hour shifts at night. The other 12 hour shifts were done by IHSS workers that the client hired off the street. They came and went as they pleased, and the nursing supervisor told me that what happened between them and the client was none of the agency's (and my) business. They did other things too, like use the client's credit cards, her phone, steal money. She told me that she felt sorry for the thief so she was giving her another chance. Baloney. I always knew better, but I was desperate for work and a good reference. Now I don't work for that agency and do not list that supervisor for a reference.

allnurses Guide · Sep 12, 2011

Thanks, Kyasi. It just may be that California covers more through our state system (Medi-Cal) than others do through their Medi-Caid - I've heard here that it's cheaper to have the patient have care in the home. I would think it would be a money saver in terms of rate of infections and/or falls but I'm not sure if anyone has studied the issue. In any case the costs are crazy. Just another reason why the California economy is circling the drain . . .

I'm pretty sure they'd cover the elderly man here for 24/7 if he is not able to get out of bed by himself and/or is not oriented well enough to use the phone or a Life-Alert button.

It's always difficult to leave agencies over cases like this, but the truth is we can't possibly do it all by ourselves without forfeiting our own lives and our families. It would be nice if the man had a social support group or family members who could check in just to make sure he's OK. Again . . . in a perfect world . . .

Kyasi · Sep 12, 2011

Caliotter3, Wow, that's terrible. It at least makes me feel better that an agency did not allow their staff to get away with that. Still, knowledge that a patient is being exploited, neglected, or taken advantage of should trigger an APS audit by the agency. Even though APS does very little (in my opinion) if that patient had died while the private care workers were not in the home and it became known that other medical professionals knew she/he was in danger and did nothing, they could be held accountable. Sounds like it was a good move to distance yourself from that agency.

Nurse156, in my state we have a governor who runs the state like a businessman. He's very concerned about the bottom $$. 24/7 would never happen here. He actually told the mother of one of my past patients that the families of special needs kids needed to be willing to relocate to the towns that have facilities for children on vents. That was just before he cut their nursing coverage.