I am medical DPOA for my mother and she has dementia. She see's several physician's and I even though her signed official DPOA form is uploaded and I carry it with us, front desk people don't pass on information or give me access to her information. Luckily, most have the EMR charts I have access to, but I'm constantly floored at the lack of education for this form. My mother can't make decisions, but she will have a wonderful conversation with you she just doesn't retain it.
Last general physician's visit the woman at the front desk told me if my mother didn't consent verbally in front of her I could not go in with her to see her physician due to precautions. My mother pleasantly confused said no and that she had to use the bathroom. When the nurse came to get her I held up my forms and she took them just to tell me later they were in the system already. Then didn't update me and I found out through the EMR they changed her medication and she had no clue.
Why are you not getting a supervisor? And an Administrator if the Sup also has her head where it doesn't belong?
If that doesn't work, get your lawyer on speed dial.
If that fails, take your Mom home. Just cancel the appointment.
File a c/o with the Chief of Staff for whatever service is involved.
Get the ignorant, incompetent front line people schooled and then fired. They are not comprehending that YOU are caring for and speaking for your Mom legally.
That's a pretty good idea to just take mom home. Pretty unlikely to be a helpful visit if no one is going to communicate with the caregiver anyway; might as well leave.
I was with you up to the part about the incompetent front-liners. I guess I come from a relatively low enough station in life that I hardly ever see them as the primary problem in whatever positions they hold. In an office setting you're likely talking about people who probably have a high-school education and maybe a certificate or a little further vocational training (or maybe not). These are people who are solidly in the position to say "how high" when their supervisor says "jump." Short of rudeness and dangerous levels of ignorance about things they are supposed to know, I will almost always put their shortcomings on the ones supervising them and giving them their directives and workplace education.
That's a pretty good idea to just take mom home. Pretty unlikely to be a helpful visit if no one is going to communicate with the caregiver anyway; might as well leave.
I was with you up to the part about the incompetent front-liners. I guess I come from a relatively low enough station in life that I hardly ever see them as the primary problem in whatever positions they hold. In an office setting you're likely talking about people who probably have a high-school education and maybe a certificate or a little further vocational training (or maybe not). These are people who are solidly in the position to say "how high" when their supervisor says "jump." Short of rudeness and dangerous levels of ignorance about things they are supposed to know, I will almost always put their shortcomings on the ones supervising them and giving them their directives and workplace education.
I agree. That's why I said at the outset that she should get a Supervisor.
I will say that some frontliners are rude and officious. Or vapid and immature. These do get on my nerves, although I have learned to relax enough to be civil. I still get a Supervisor.
I will say that some frontliners are rude and officious.
Yes, there is no excuse for abject rudeness, and I do sometimes wish they wouldn't be so...uh...enthusiastic when they are wrong. Then I tell myself that if they knew they were wrong they wouldn't be doing X wrong thing in the first place. What I usually perceive behavior-wise (maybe this is gracious) is just sort of unrefined customer service combined with an enthusiasm to do what they believe they are supposed to be doing. They don't get a whole lot of info because employers believe it's just too complicated for them to understand and don't want them to use discernment anyway; they're just supposed to follow directions. So...if the main thing pounded into their skull is patient's rights and HIPAA and violations of these...that's what they go with. I can imagine that they mostly believe it is a "violation of [some xyz thing]" to allow someone back with the patient unless the patient insists they come back.
It's all just sad.
Agree with supervisor though. Practice manager, physician, someone who should know better.
Kooky - I usually find myself agreeing with much of your postings. You DO have a passion at times, but sometimes you seem to go just a weeeeee bit over the top.
44 minutes ago, Kooky Korky said:
Wish smish. Action is required.
Yes there is valuable info herein. I just get so frustrated when nurses don't take action.
I'm retired, so I have no audience with which to provide this info, so my comment was just an open suggestion that others, who SHOULD KNOW, be so provided with the info. Not all nurses have the ability or inclination to take action. Wish it weren't so.
Specializes in Physiology, CM, consulting, nsg edu, LNC, COB.
On 7/2/2020 at 6:38 PM, InSchool4eva20 said:
What is scary is as a nurse this is happening, but what are other people doing? This was at several facilities.
I made multiple copies on hot pink paper and had them notarized (took about fifteen minutes with a free notary at our bank). I had them put it in the front of the chart so it was easy to find ("If you look at that pink page in the front, you'll see my notarized authorization...") If it "somehow" got lost, I always had a few extras on me.
Sounds like a LTC place I worked. We had the POA/Adv Dir/lPOLST/DNR legal document stuff copied on hot pink paper also. Then it was placed in a plastic sheet protector in a designated chart section. Always was the quickest and easiest grab for emergencies.
We were VERY conscientious about code status, but I guess with HIPAA information release that could also be an excellent approach for LTC/NH residents or others.
And like you, we always had a few extra copies of the 'pink papers' in each chart for spares.
Specializes in Physiology, CM, consulting, nsg edu, LNC, COB.
On 7/20/2020 at 12:17 PM, Susie2310 said:
In regard to competency (I am not a lawyer) my understanding is that patients are considered to be legally competent unless a Court has determined otherwise; but that the determination of competency for health care decision making purposes is made by the physician, I.e. the physician determines whether the patient is capable of understanding their medical condition and of making informed decisions about their care.
85% right- the physician may or may not be able to make that on-the-spot determination. The physician or others in the care situation may throw the “competence” word around but it has a specific legal meaning that’s not the same as the lay meaning. The previous points about staff and others not knowing there’s a very real difference between assent and consent, and competence and capability, underlies a lot if confusion and hurt feelings
You might look up the famous NJ case of Candura for some interesting points regarding these distinctions on consent. Briefly, Mrs C was old and diabetic but making her own decisions, and told her drs she did not want that gangrenous leg off and was ready to die, as they explained that she would. She got sicker and was no longer with the program; they refused to amputate. Her dtr didn’t want her mom to die and took them to court to say Mrs C was no longer able to decide, so she(dtr) as next of kin wanted to consent to the surgery and compel them to do it. The court refused her demand, saying it was unconscionable to know what Mrs Candura wanted and clearly expressed consistently, and then to do something they knew she refused when she was no longer able to express herself. The amputation did not take place and Mrs C died in peace.
For me, a DPOA means nothing if the patient is competent and requests to do the visit alone. She has the right to do that, or even revoke the DPOA verbally. BUT if you also have a court paper that says she can't make her own decisions, then you become as essential as her right arm.
We get a lot of POA folks that think they are in charge, but the patient still is competent and retains decision making power. Usually the POA comes into effect when they become unable to make their own decision, not before that. So, I still won't give a detailed report to family without the patients permission.
My financial POA took effect the day my very competent Dad signed it. He didn't want me to have any trouble should something happen to him. I never utilized it until he had a serious stroke and became physically incapable of taking care of his finances (though mentally he understands everything). I pay his bills and consult him on anything that would need his input. I send him detailed financial statements every month so he sees where his money is and what it is being spent on.
His MPOA requires that he be declared mentally incapable of making his own medical decisions by two physicians. Though he has trouble with expression of his thoughts, he understands everything perfectly, so I have never attempted to make decisions for him, with the exception of the actual stroke incident. Because he could not communicate at all, docs could not assume he was competent. Once he began to improve with speech therapy, it became clear that he understood and had the ability to consent or refuse treatments.
Surprisingly, the hospital staff treat me as though I actually have MPOA over him and I have to advocate for him to be treated like the competent adult he is.
Specializes in Physiology, CM, consulting, nsg edu, LNC, COB.
Horseshoe's account underscores the need to have a clear understanding about what, exacty, any advance directives mean in the jurisdiction. Terminology is different in different places.
Generally speaking (not an atty, not giving legal advice), a POA (power of attorney) gives the right to a person to make legally-binding decisions. This is usually voluntary, as when someone wants a child or other person to manage finances, bills, or other contractual things like rent, car payments, or the like.
A MEDICAL POA is usually invoked only when the person is unable to give an opinion on what care is approved. This is usually when somebody is brought in unconscious or otherwise unable to respond coherently. Somebody who is able to speak for himself can revoke this verbally (document, document, document).
These both are to be distinguished from a guardianship (sometimes called a conservatorship). This is a legal determination that the person is not competent to manage his own affairs. This is NOT a physician decision; competency has a particular legal definition. A legal guardian (or conservator) is granted by the court after testimony about the patient's status. There may be a POA and MPOA, or those two may be given to two different people or entities.
Complicating all this is the fact that sometimes there are no arrangements in place, but somebody clearly has to step in either temporarily or permanently. How this works out depends often on family (see Candura, above). Most jurisdictions have a judge on call who can make an emergency order if needed; the hospital risk manager should know who to contact.
Sometimes the patient's attorney will be of assistance particularly if there is a longstanding relationship. As an example, we had an elderly relative whose dementia was progressing to the point where he needed home care for his own safety; finances were not an issue. I sat down with the attorney to discuss this, and he said John could sign a VNA/etc contract. "But how can he do that? He doesn't even know what year it is!" I remonstrated.
"Do you think that if we explain it to him he will understand it in the moment, even if he forgets it in ten minutes?"
I had to agree that I thought he would.
"Are there any family members who would have a problem with this?"
Thankfully, no, we all loved him, wanted the best for him, and knew John had made sufficient appropriate financial arrangements for his old age for exactly this purpose.
So the atty and I went in to his bedside, he signed the auth, and all was well.
If there is ever any question, or if any family member is problematic one way or another, don't guess and don't take anybody's word for it. Ask to see the actual documents, have the hospital risk manager look at them if needed.
There is such a misunderstanding in facilities, especially LTC in regard to Medical POA's. Since my Dad died I am now Mom's health care proxy. I have a cousin that is just too busy trying to get in their business, and thinks that she is in charge. She is on the Medical POA as alternate number 4, with my brother being third. I was second after my father. Once Dad died, my cousin tried to obtain information, and make decisions for my mother's care. I called the facility, and told them that she was not to make any decisions. My cousin countered that simply because she is on the proxy form that she is just as entitled to make decisions as I was. I was floored when the MSW in the facility agreed with her. I tried to explain that there cannot be more than 1 proxy at a time and we were listed in order of preference. They refused to listen, so I had to pay an attorney to get involved and explain exactly what I had told them. The MSW and the administrator had to be educated in NY law on proxies. How can a LTC facility, who must deal with these documents all the time not be aware of this???
JKL33
7,038 Posts
That's a pretty good idea to just take mom home. Pretty unlikely to be a helpful visit if no one is going to communicate with the caregiver anyway; might as well leave.
I was with you up to the part about the incompetent front-liners. I guess I come from a relatively low enough station in life that I hardly ever see them as the primary problem in whatever positions they hold. In an office setting you're likely talking about people who probably have a high-school education and maybe a certificate or a little further vocational training (or maybe not). These are people who are solidly in the position to say "how high" when their supervisor says "jump." Short of rudeness and dangerous levels of ignorance about things they are supposed to know, I will almost always put their shortcomings on the ones supervising them and giving them their directives and workplace education.