My patient has to walk 2 miles for exercise is this right?

[ladybug888today]

Hello,

Ihave been a home health aide for 6 months and for the same family. I love my patient to death and have become very close with the family and I do basic care like making dinner for him, bathing and dressing.. then comes the exercise.

For the past few months we either did short walks or leg strengthening exercises and this included squats too. My patient is 86 years old and has alzheimers disease.

But lately, the family has been telling me he needs to walk more, and a lot longer. I'm thinking, he has a hard time walking now, and they want him to walk more? Their greatest fear is that he ends up in a wheelchair, this is what they tell me, which I do believe them.

So, this past week, for the first time, his wife told me he needs to walk down to the

grocery store which is about 2 miles from the house... I'm thinking, you expect him to walk that far? They have been asking me to walk him this far for a while, but I have been hesitant to do so in fear of him getting stuck or something else...

anyway, yesterday was the first day we did walk 2 miles, and the first mile was okay, walking slow then resting, etc. but coming back was torture for him and I.

He was getting tired, or so he says... I call his wife and ask her if she can pick us up with her car since she is home. She goes to tell me he's being stubborn and he can walk home, its not that far. So to make a long story shorter, I ended up calling her again, and she doesn't answer the phone. So when we finally get home, she just tells me my patient is manipulative and very lazy.. Can you believe this? I couldn't. And also, the daughter tells me the same thing.. So sad. almost abuse in my opinion.

I would love to hear what you all think about this situation. She tells me he "used" to talk to the store all the time, then I said when? she said last year.. I don't believe her.

I need some advice and I would hate to leave this family, they are really nice to me.

Thanks in advance

[slilly]

I think that maybe a little exercise is okay for an elderly person, cause when I did home health I had a 91 year old veteran and he actually surprised me and said he wanted to walk from his house to the main road and turn around, and that was under a mile. I definitely think it may be best to get the office notified, and let them contact his doctor and see what they think. It should be written in the care plan if he really needs to walk. As for the wife saying he used to do that, well yeah he used to do that when he was younger. He got older. His wife should respect his wishes and let him walk as far as he wants, because 2 miles on a body his age is a lot.

[JustBeachyNurse, LPN]

What does the RN supervising you say? Activity restrictions or limitations should be part of a client/patient's plan of care. I'm a nurse in pediatrics and several of my patients have endurance limitations and thus have restrictions on distance/ amt of walking that is safe.

Perhaps the nurse needs to meet with the family to ensure appropriate expectations.

[elkpark]

I would not take "orders" from a member of the client's family. What does the treating physician, or physical therapy, or your nursing supervisor, say? Families can want family members to do all kinds of things that aren't medically indicated and aren't a good idea. (I have personal experience with this; my mother nearly killed my father because she thought pushing fluids and restricting salt was a good idea for everyone/anyone. He wound up in the hospital with life-threatening hyponatremia.)

I'm concerned about your comment that "I love my patient to death and have become very close with the family ..." You are there as a professional doing a job, not as a friend, and professional boundaries are your friends. Getting too attached to a client and too close to a family can create all kinds of problems.

I encourage you to talk with your supervisor before taking this gentleman out for any more long-distance hikes. :) Best wishes!

[llg, PhD, RN]

I strongly agree that you should talk to your supervisor ASAP -- before you do any more exercise with this patient. You need to be abiding by the official treatment plan made by health professionals for this patient -- and not going by the unprofessional opinion of his wife. If something were to happen (e.g. fall and broken bone, heart attack, etc.) during one of your exercise sessions, you could be blamed for pushing him beyond his limits.

[SoldierNurse22, BSN, RN]

Doesn't sound like "almost abuse" to me. Sounds like legitimate abuse. A 91-year-old who needs help with bathing and dressing and you tried to make him walk 2 miles? Puh-lease!

The family members need a wake-up call: dad/husband isn't a spring chicken anymore, and you need to make it clear that you will abide by the care plan/activity restrictions and give him exercises that are reasonable for his age and energy level!

[JDZ344]

2 miles there and 2 back, or 1 mile there and 1 back?

Anyway, the main thing would be what the patient feels about it. Does he want to walk that far? Is he distressed by it?

[elkpark]

Anyway, the main thing would be what the patient feels about it. Does he want to walk that far? Is he distressed by it?

I don't think that is "the main thing." He could be perfectly happy to walk that far, but that doesn't mean it would be a good idea for him to do so (esp. if he is already dx'd with dementia -- is he in a position to know what is and isn't good for him?) If he is injured in any way, and the HHA was operating outside the legitimate orders for his care, that would leave the HHA in a tough spot. I guarantee you that, in that circumstance, the wife would not say, "Oh, that's okay, I told her to do that." More like, "What were you thinking??? How could you endanger my husband's life and health like that???"