My patient and her abusive husband...Please advise

[Antikigirl, ASN, RN]

I posted this in LTC but think it is a good general question for us all! Long one but you will understand why...

So today I am doing my rounds in my assisted living facility, and I hear a man not yelling but screaming at someone about his wife who had just recently moved to our side of the facility. (We have an independent apartment side, and a dependant side...the lady had a stroke and she was moved to our side, he lives on the other independent side and visits daily and is known for yelling at caregivers).

So I ran to see what was going on, and my DON stopped me in the hall. "Don't get involved right now, we have it under control". I trust my DON, but it didn't sound in control! This man was screaming nonsense at a caregiver from what I saw, and I was furious! But my eye caught our administrator around the corner and then I knew that things were under control on a higher level (I mean, if Admin gets called...holy cow!).

This poor woman talked to me last week, and told me of how her husband belittles her so much, always has in their 60-year-old marriage. That she took care of him till the stroke and now isn't allowed to move an inch without him screaming at her to get help from a caregiver (we are talking not even adjusting herself in her chair!). That he tells her how feeble she is, how worthless she is, and that he wished the stroke had done its job. Then he will love her up, take good care of her for a day...then back to the belittling and verbal/emotional abuse. She also startles easily and puts her hands to her face...and I know that he must have hit her in the past or still doing it behind closed doors (no physical evidence yet, but we have a hawks eye on her for anything!). She made my heart cry so hard, and despite many faxes and calls to the MD, the MD says there is nothing we can do medically that will help. That she needs to get away from her husband and that is something she or her family must do at this point.

Still, here is this man screaming that "don't you guys care? Don't you know that a mind must be enhanced daily to grow, and you aren't making her sing! Why aren't you MAKING her sing...she use to sing! I make her sing to enhance her sick mind so she doesn't die! Are you trying to kill her?! You MAKE her get up, you make her sing at least an hour a day, you MAKE her do what I tell you to do or so help me GOD I will sue!" My admin tried to explain that we didn't know she sang, and we have a choir that would love to have her, but we just needed to know! He screamed at her about not knowing, she said...we were not told by anyone! Then he comes back with "well I knew so you should!" Oh yeah...I forget we are mindreaders right...OMGoodness I was furious...but left it be as my DON instructed so I didn't mess up a messed up situation! I also think he was drunk (we were warned by his family that he drinks all day and by noon is usually sloshed...would make sense after this scene!).

I hate this situation to the core. Unless we have some S/Sx of physical abuse not much can be done. I believe they are going to try to get the family to move her out of the facility and away from him, but that too will be so hard on her!

I will give my admin a week, then ask for a report on the situation (if they will even tell me, they usually tell me it is confidential and they are 'working on it'. But I am going to have to do something to help her. This is abuse, and it can't be tolerated!

Any suggestions? (I asked for geri psych eval, but to no avail...MD won't cover, and the family refuses antidepressants or anti anxiety meds, even despite knowing it will help her emotionally...but they say "drugs can't cover the problem...she has to deal with it...hmmmmm think there is some family dynamic here of 'karma' towards their mother/father???). At this point she is saying "Yeah, maybe the stroke should have done its job" and that kills me!

[Maxs]

he sounds like hanks father in the king of the hill show on the eposide where hank's wife was paralyzed and supposedly his father was giving her a military training.

[RoxanRN]

This is abuse pure and simple... domestic abuse to be exact. Because she is not able to adequately defend herself, someone needs to step in NOW!!! If admin gives you the run-around, don't accept it. As a caregiver, you are obligated to report abuse to the proper authorities - and it's not admin.

[barefootlady, ADN, RN]

Screaming at caregivers, screaming at wife for doing independent ADL's, drinking until he is sloshed, sounds like HE needs the geri psych evaluation.

I agree this is emotional abuse that could esculate and should be reported to ADP. If wife is not moved, how about him? He was probably an abuser in every way for most of those 60 years and has taught the family the wife is an easy target for their abuse as well. This poor lady deserves some protection and comfort.

[tridil2000, MSN, RN]

I posted this in LTC but think it is a good general question for us all! Long one but you will understand why...

So today I am doing my rounds in my assisted living facility, and I hear a man not yelling but screaming at someone about his wife who had just recently moved to our side of the facility. (We have an independent apartment side, and a dependant side...the lady had a stroke and she was moved to our side, he lives on the other independent side and visits daily and is known for yelling at caregivers).

So I ran to see what was going on, and my DON stopped me in the hall. "Don't get involved right now, we have it under control". I trust my DON, but it didn't sound in control! This man was screaming nonsense at a caregiver from what I saw, and I was furious! But my eye caught our administrator around the corner and then I knew that things were under control on a higher level (I mean, if Admin gets called...holy cow!).

This poor woman talked to me last week, and told me of how her husband belittles her so much, always has in their 60-year-old marriage. That she took care of him till the stroke and now isn't allowed to move an inch without him screaming at her to get help from a caregiver (we are talking not even adjusting herself in her chair!). That he tells her how feeble she is, how worthless she is, and that he wished the stroke had done its job. Then he will love her up, take good care of her for a day...then back to the belittling and verbal/emotional abuse. She also startles easily and puts her hands to her face...and I know that he must have hit her in the past or still doing it behind closed doors (no physical evidence yet, but we have a hawks eye on her for anything!). She made my heart cry so hard, and despite many faxes and calls to the MD, the MD says there is nothing we can do medically that will help. That she needs to get away from her husband and that is something she or her family must do at this point.

Still, here is this man screaming that "don't you guys care? Don't you know that a mind must be enhanced daily to grow, and you aren't making her sing! Why aren't you MAKING her sing...she use to sing! I make her sing to enhance her sick mind so she doesn't die! Are you trying to kill her?! You MAKE her get up, you make her sing at least an hour a day, you MAKE her do what I tell you to do or so help me GOD I will sue!" My admin tried to explain that we didn't know she sang, and we have a choir that would love to have her, but we just needed to know! He screamed at her about not knowing, she said...we were not told by anyone! Then he comes back with "well I knew so you should!" Oh yeah...I forget we are mindreaders right...OMGoodness I was furious...but left it be as my DON instructed so I didn't mess up a messed up situation! I also think he was drunk (we were warned by his family that he drinks all day and by noon is usually sloshed...would make sense after this scene!).

I hate this situation to the core. Unless we have some S/Sx of physical abuse not much can be done. I believe they are going to try to get the family to move her out of the facility and away from him, but that too will be so hard on her!

I will give my admin a week, then ask for a report on the situation (if they will even tell me, they usually tell me it is confidential and they are 'working on it'. But I am going to have to do something to help her. This is abuse, and it can't be tolerated!

Any suggestions? (I asked for geri psych eval, but to no avail...MD won't cover, and the family refuses antidepressants or anti anxiety meds, even despite knowing it will help her emotionally...but they say "drugs can't cover the problem...she has to deal with it...hmmmmm think there is some family dynamic here of 'karma' towards their mother/father???). At this point she is saying "Yeah, maybe the stroke should have done its job" and that kills me!

do you have these outbursts on video?

call the police and report it. you do not have to give your name.

the facility is allowing this to occur under their roof and is also responsible. the primary dr is reaponsible too for not ordering a psyche evaluation.

[leslie :-D]

you can always call up your local elder abuse agcy or if the facility has an ombudsman, then you can explain the situation to him/her. actually they should probably have a patient's bill of rights hanging up somewhere and give you contact numbers if their rights are being neglected. and it's something you don't have to share w/your DON or the administrator either.

contacting any/all of the above will tell you if anything can be done.

poor, poor lady......

leslie

[Hellllllo Nurse, BSN, RN]

Google Adult Protective Services and your state's name.

[studious]

do you have these outbursts on video?

call the police and report it. you do not have to give your name.

the facility is allowing this to occur under their roof and is also responsible. the primary dr is reaponsible too for not ordering a psyche evaluation.

I agree totally,

We had a very similar situation with a husband who ddin't deal very well with his wifes stroke (he was used to her doing everything for him), he used to shout and moan, even prod or grab her sometimes, still does to a certain extent. She was eventually rehabilitated back home, was still in her w/c though, she eventually came back to us (social admission) because of abuse. When I became his primary nurse, I told him in no uncertain terms(if I witnessed anything out of the ordinary) that it needs to stop. I also gave him counselling as well, because I really felt that a part of him was just plain scared of losing her. We have a responsibility to intervene when it becomes abuse, patients need to feel safe both physically and emotionally. If they are in your facility then it your responsibility to ensure this happens. Tell him to sue if he likes, that will give your facility the chance to stand up in court and tell the world what he is doing to his wife. He won't like that one bit if he is truly abusing her. Document and record if your allowed everything he does to her. Or phone someone anonymously to come and see for themselves. Is she not entitled to have some dignity or happiness before she dies.

[Antikigirl, ASN, RN]

Thanks guys, I looked at my states mandates on this, and will let my caregiver and Admin know that I will be happy to be a witness for them for their abuse, but I have personally not seen him scream or do anything to his wife...just her word (and they would say she was 'confused'...so I better witness it!). But if he even sneezes wrong at her! GRRRRRR~!

I have everything documented, and I have sent everything I document to her MD as well. But I will talk to my DON and see what is going on. She knows me well, and knows if I don't know what is going on, I will do something on my own so best to keep me informed of everything!

I do think they have plans to move either of them out of the facility. I hope so so she can have the freedom to live her life the way she wants to!

Thanks again...nice to hear imput always!

[Antikigirl, ASN, RN]

Today at 1200, I responded to a unconscious person down in a room in the other part of our facility. It was my little lady who was visiting her husband. I am pretty sure she vagaled out on the toliet, and I came in to see her husband doing an excellent job with CPR, and a caregiver and I took over for him.

Very faint pulse, apnec...cpr started. Never got her back...by the time paramedics arrived she had been in asystole for over 3 minutes. A few more mins of CPR and all attempts were stopped.

I comforted the husband for quite some time, he did try so very hard to help her! He kept crying out for his "little girl" to come back and appologized to the sky for his drinking and not loving her enough...he finally got it I guess...so now I had to turn to him and help and comforted him for as long as I could.

I went into her room with his permission and was alowed to say goodbye. I brushed her hair from her face and said that I would miss her and I did my very best...and that her husband really did too... After I said goodbye the husband felt that it was his turn and since I was the last of the folks he alowed, he did...I left him alone with his wife....

Family arrived shortly after...she was taken and a rose placed on her pillow. A lovely red rose for a precious soal...

Now she can go on I guess...no more frustration and stress...and I guess her husband gets to go on too..after a time. I will help him through as long as he is in my facility...the switch was made by fate...I lost one to gain another....

Thank you to all who helped me with advice...it will help me to deal with her passing suddenly, and to realize that I really tried...just time had the upper hand...