My first dump and run

[JBMmom, MSN, NP]

I know as well as anyone that has worked in LTC that we should not put ourselves in the position of judging the families of those that require long-term care. The sweet old man that no relatives ever visit may have been an abusive father that severed his own family relationships with a heavy hand. The cute little old lady might once have been a raging alcoholic that showed her children no love stronger than her next drink. And family members may have exhausted all other options for care before ever considering LTC as the final and safest option for a family member in the progression of an illness when they find themselves at our door. However, it was heartbreaking to play a role in the scenario that recently played out at my facility, leaving us feeling more like workers in a kennel that found an abandoned puppy.

As often happens with multiple admissions in a day, the supervising nurse didn't have time to thoroughly read all the admission paperwork, just knew we had a new resident with the primary diagnosis of dementia expected to arrive late morning. Well, late morning came and went, then early afternoon. Not long before second shift two women came in and went to the empty room. An aide overheard the young lady tell the woman, "I have to go to the bathroom, I'll be right back." The aide went to tell the supervisor that our new resident had arrived, and the care giver went to the bathroom but she'll be right back. A couple minutes later, the supervisor headed to the room and introduced herself to the new resident, I'll call her Molly. Molly asked where the woman was they were coming to visit, and the supervisor was a little confused. Molly said her niece told her they were going out shopping but they were going to stop in and visit someone for a minute on their way. At this point the supervisor comes out to find out where the caregiver was and an aide on the other wing said she left a few minutes earlier (no one saw her use a bathroom). Now the supervisor tries to tell Molly that we're at "**" and we're a long term care facility and she's going to be staying with us for a while. Well, that didn't go well.

Molly is a very convincing dementia patient. We've all seen them, they appear to be as competent as you or I in conversation. And for about half and hour we were pretty sure that there was a mistake and she shouldn't be staying. She was angry, but appeared competent, and said either we were going to call her a cab or she was jumping out that second story window in her room because she was NOT going to stay here one single night. Fortunately our social services professional is fantastic. It fell to her to spend a good bit of time after that trying to explain that she was going to stay with us for her safety. There were many tears, some threats, and definitely no acceptance long term, but she agreed to stay the night. We got a wandergard on her by telling her it's the wristband she will use to get her meals. She spent her evening wandering the halls, with her pursue, sitting in different chairs so she could look out all the windows. She agreed that she could use some help getting changed and ready for bed, she goes to bed at 9pm by her account and in the morning she would take a cab back home.

As the supervisor completed the admission the paperwork stated that the family decided not to tell her ahead of time about relocating to our facility because she would probably refuse to get out of the car. I can't imagine that hearing the news from complete strangers was any more comforting to her, but maybe her reaction to family members was potentially going to be worse. I feel badly for all of them, but Molly most of all. I'm trying not to judge, but I wouldn't even do that to a pet, forget a family member. The son is supposed to visit at some point- apparently when they called he said he would come in a few weeks. We'll do our best to get Molly settled and I think for a while we'll just keep a box of tissues on us, we used a lot of them last night.

I wish none of you had similar stories, but I'm sure you do. Thanks for listening to mine.

[studentnurse47]

I have witnessed situations like this, and much worse. I tried to think like you, we never know what went on in the past. It is still hard to see people being treated like this, but it does happen. Good luck with getting "Molly" settled in and I hope she adjusts well.

[Purple_roses]

Oh I hate these stories. I was shocked one day to realize that some families do not allow their loved ones to call. I met a LOL with dementia (I was not actually working with her) who was convinced that she had been abducted and was being held hostage at the nursing home. I asked for her daughter's number so she could reassure her mother that everything was ok, and the nurse said "let me make sure her family allows calls." I was shocked that some wouldn't!

[Red Kryptonite]

I know it seems cruel to restrict calls, but I remember one lady we had who would call over and over all night. Her son and his wife couldn't get any sleep. We ended up having to take her phone away during the night. One of the things she did remember was his phone number.

[THELIVINGWORST, ASN, RN]

I know it seems cruel to restrict calls, but I remember one lady we had who would call over and over all night. Her son and his wife couldn't get any sleep. We ended up having to take her phone away during the night. One of the things she did remember was his phone number.

I have a frequent flier that is THE SWEETEST LOL you would ever meet but every night without fail she cries and cries until you let her call her daughter to check on her husband because she is convinced he will die during the night without her. Then you have to try to comfort her when they don't answer because it's 2 am and they are sleeping.

It sucks.

[Purple_roses]

Well I guess that does make sense.

[Mavrick, BSN, RN]

Wow! Absolutely no judgement here but what a sucky situation for everyone. I would not do well with dementia patients that have no chance of getting better. If it's me I hope I go quickly.

[melissa2222]

Unfortianitly while working in a LTC I too had a similar situation. But the resident didn't have dementia or any issues as such. She was such a sweetie and we all felt bad for her because she knew what was happening but her family didn't tell her anything about her situation until the last minute. It made her very depressed so we had our ways of trying to cheer her up. The only thing we could do was try to help her cope. Its such a shame that these things happen. But like you said, you never know what happened in their lives and we shouldn't judge. Thanks for sharing and best of luck with "Molly"! :)

[motherof3sons]

Just recently we had a resident that took a sudden turn for the worse and family decided to keep her comfortable. So next day family comes in spends a few minutes with the resident. As they were leaving they told the staff, "we trust that she is in good hands, call us when she passes"

I don't know what type of life this lady led and I am not passing judgement....but I was floored. Thankfully she passed peacefully the next day.

[Red Kryptonite]

Some people really can't handle being there for the actual death.

Usually when we see that, the family's been through a LONG HAUL with years of disease process, or several weeks or days of a sudden onset and decline, usually with ICU stays and ER trips, and they just have nothing left.

[Purple_roses]

True. One man was only in his 60s when he was losing his wife. He took such good care of her and hardly ever left her side. He was actually not there the night she passed, and from our conversation earlier that day, it sounded like he had a feeling it would happen that night. After years of always being there for her, it was surprising at first that he wasn't there, but he was definitely worn out. He was tired and drained--you could see it all over his face every day.

[vintagemother, BSN, CNA, LVN, RN]

I know it seems cruel to restrict calls, but I remember one lady we had who would call over and over all night. Her son and his wife couldn't get any sleep. We ended up having to take her phone away during the night. One of the things she did remember was his phone number.

I can see this dilemma from the outside. My wonderful grandma who raised me for the most part, has dementia.

The family may not allow calls to them because the pt doesn't really understand things and is more likely to listen to staff at a faculty than her own family.

It may seem like we're ( we meaning families of pts with Alzheimer's) are dumping them, but we're not . Some times we've tried our hardest to provide care...but um..,. Pts with dementia can be argumentative, agitated and violent.

Yes my dear grandma was all of these things at one time. She just wouldn't listen to us family members when we tried to reason with her. BUT..... She's thriving at an alf.

It's a tough road to walk for all involved: nurses, aides and family members. 😓😢