Need some advice please.

[OzBound]

Hello all..

I hope everyone is enjoying this holiday season.

Okay, I have some concerns and I've always been able to come here and get some really good advice, here I am again. I am currently doing home health for two elderly people with dementia/possible alzheimers ( the reason I say possible is because they've never really gotten a definitive diagnosis, since she refused to return to her memory clinic appointment ). However, she forgets words, says things that are completely off the wall, and has mood swings. The other care givers have been there for a year and a half and have this log book that they write everything down in. Well, if you read back, you see warning signs of a potential disaster. Yet the family removes these logs daily.

The woman who is 86 sits in her recliner 12 hours a day and pee's in her depends. She doesn't get up, she refuses to be changed and if you push the issue she calls her daughters and has you removed from her house. So she sits in urine all day. At bedtime she may change her brief. They have not had a shower in months because they refuse to take them. She has med trays and Lord only knows what meds are in there, but we are required to give them to both her and her 90 year old husband three and four times a day. His we crush and I'mnot sure if all are crushable. Again, I asked and they said they had no idea. He also sits in urine soaked depends, even tho he gets up every 10 min to go to the bathroom via his walker that nearly causes him to fall over.

She is a diabetic and eats candy, has 5 cans of whipped cream in the refrig because she likes strawberries and refuses to eat them without it.She sprays them, eats the whipped cream then repeats this 3 times. I've expressed my concerns over her being a diabetic and the masses of suger but the daughter says that she's 86 and can do what she wants. Both parents ( 90 and 86 ) sleep in their bedroom and the door must be cosed 98% of the way and if you go in there they scream for you to leave so basically, you have to listen during an all night 15 hour shift to hear movement. By the time you get there they are struggling up and are a potential fall risk. They've actually fallen several times.

A visiting RN came and sent her to the Er for Altered Mental Status and they sent her right back home because the daughter who doesn't like to spend time in the hospital tells them things are ok. So back home she came. They pay us cash under the table with no worker comp. I've already been bruised in my side by her nearly falling. Another girl was hit. There are 4 of us who come and go. I'm really worried about passing meds to them when I have no idea what they are. Neither one of them can take meds on their own. I also worry about them never moving all day. Isn't it illegal for them to pay us under the table with no workers comp incase something should happen. What about passing meds..them sitting in urine all day etc. They are a very wealthy family, and I think they worry that putting them in a safe nursing home will cost them more money.

Thank yor all for listening and for your help.

[itsmejuli]

Wow....aren't you worried about your license? I would be...talk about a lawsuit waiting to happen.

I guess I should ask if you are licensed.

If something goes wrong, guess who the family will blame....you.

I don't care how good the money is, I would never provide that kind of care nor would I risk my license.

[KateRN1]

I am seriously hoping that the OP is not a licensed nurse. If you are, then you are clearly not in a safe situation as a nurse. However, if you are an attendant caregiver then things are actually a little better for you as you are not held to the standard of a licensed nurse and at least you can recognize that this is not a good situation for these folks. If you are a nursing student, then you are stuck between both and may have some liability.

There are lots of different ways to look at the situation. First, there is clearly some mental health issue in evidence, whether diagnosed or not. However, the family cares enough about the parents to provide round-the-clock care for them, whether you agree with their methods or not. What is the alternative? Put them in a nursing home? What purpose would that serve? It is highly unlikely that they would receive the kind of care in a nursing home that they are getting at home now. It may not be an issue of financies but an issue of the patients' autonomy. I wouldn't want to leave my home for an institution, either. Often adult children promise mom and dad that they won't put them in a nursing home no matter what and then stick to this promise come hell or high water.

The diet issue is a whole 'nother issue. At 86, what strides do you expect to make with this woman's diet? Is a controlled diet going to make a hill of beans difference to her health at this point? She's long outlived her life expectancy and is now in the "gravy" years. Let her eat what she wants. Adjust insulin (if prescibed) as necessary. Besides, strawberries are full of vitamin C.

The lack of movement can have serious consequences to bowel and bladder habits and can set them both up for constipation and pressure ulcers. I imagine the family knows that, but if they don't, give them something to read. Do you have a plan for how to get mom and dad up and moving? Some swing or big band music that might make them want to get up and take a few saucy steps? Come up with some possible solutions.

The hygiene issue is one that often causes adult children to put their parents in a nursing home. Sometimes it takes a special set of circumstances to get a demented elder in the shower. A special visitor, a special occasion, a new gown or pair of pajamas, changing the sheets, etc. Or maybe they're afraid of the shower but would give in to a sink bath or a bed bath. Do not underestimate that fear of falling in the shower, that's what stops a lot of elders.

I can't blame them for not wanting you in their room at night. I don't want a stranger in my bedroom while I'm asleep either. And what would you do all night in the dark anyway? Do they have a bell they can ring or some other way to let you know they need help? And would they remember to use it if they did?

It sounds to me like this family is struggling between what mom and dad want and what they need, as we all do when it gets to this point. Having been in the position not too long ago, I can tell you that it's not as easy as you may think it is. For you, if you are uncomfortable with this position, then you should give your resignation. If you truly feel that these elders are in danger, then make a call to adult protective services. Otherwise, do the best you can with what you have. Good luck.