Neglect? What would you do?

JustBeachyNurse, LPN · Apr 24, 2013

As this is a minor child, you are likely a mandated reporter in your state and the onus will fall on you even if you notify your employer if your management team fails to take action. Is this a lack of resources? A lack of education about the client needs & challenges? Is the family overwhelmed with the care needed? Has the state department of children's protective services been involved previously? Is the child registered with your state department of developmental disabilities? Failure to provide adequate medical treatment is considered abuse.

What is your company policy? In many it is notify management and ensure a call is made to child protective services. The witness would call with the nursing manager (unless the manager went to the home to witness patient condition and document so the manager would have first hand knowledge)

allnurses Guide · Apr 24, 2013

I would definitely pursue the lack of resources, education aspect of this as a priority, seeing as how the behavior of the family isn't what you normally see with neglect cases, of course keeping in mind that advocating for all aspects of the patient/clients well-being is our responsibility.

amoLucia · Apr 25, 2013

To JustBeachy - please know that I enjoy reading your responses. Even being one of those 'crusty old bat' practitioners, I find your info spot-on and very enlightening.

To OP - I haven't been in your kind of present position. But thinking back to JustBeachyNurse's wise response, all I can think of is the Penn State/Joe Paterno and now our NJ Rutger's/Mike Rice scandals. The top authorities were not informed/involved.

Paterno terminated with his millions and Rice left with his big severance pkg. I don't think you'll have any of that coming and your license, and hence, your livelihood is at stake.

While Penn State & Rutgers involved older students, your pt is so much more vulnerable and there's so much more at risk. Please be careful. All that family hugging, kissing, joking & touching doesn't necessarily add up to competent care (as you've seen). Education and resource availability are necessary, but don't let this kid fall thru the cracks.

This kid and her family need to be on some official radar.

KATRN78 · Apr 25, 2013

Yup. I appreciate all of your guidance. I made the call. I am off until Monday so we will see what happens when I go in. I also educated the family (again) and wrote up a "skin saver project" on her chalk board wall. Something like "use geli-donuts on her armpits to protect from wheelchair supports, every day, anytime she is in the chair" "One hour in the chair = one hour on day bed, Right side 30 minutes, Left side 30 minutes" etc... pretty clear and easy to understand. She has no nursing today so its their chance to try it out.

I think the neglect is carelessness or something like that. They are very loving, so it just doesn't make sense.

I will update you all. And if I lose my job but she is helped.... WORTH IT!

salvadordolly · Apr 26, 2013

My agency had reported these types of cases as well. It's difficult. Why didn't your manager get involved? CPS in my county is great, they really focus on solutions. They will help the family with the resources aspect. It sounds like you identified the familiy's needs well and provided good education. You were also smart to document everything. You did everything you could do. For your own protection, it is sometimes best to remove yourself from the case until after the crap hits the fan.

kac425 · Apr 26, 2013

I think there are a whole lot of assumptions here. I do think its wonderful that you documented it, but to use the word neglect is a bit strong. there may be a lot of things you don't know.

you presume the parents are lax in scheduling things like a dental apt and a w/c reassessment. did it occur to you that its not as simple as picking up the phone? perhaps they cant find a dentist to take on the case. perhaps the risks outweigh the benefits, because more than likely we are talking about a sedated exam, or even an anesthetized one due to airway management issues. maybe the family has attempted to coordinate with another procedure and couldn't get people to cooperate with each other. you don't know.

maybe they have state aid. maybe the w/c is not due to be replaced for several years. its very difficult to just get a new chair on a whim-maybe they have tried and made adjustments where they could, but are still on hold for replacement. you don't know.

maybe a form sat on some doctors/administrators desk for a month causing an insurance lapse...it could be entirely possible that while it was the families priority to ensure continuity of care they were dependent on someone else to do their job. you don't know.

maybe during the 8 days you weren't there the family made do as best they could, but perhaps they were unable to focus 24/7 attention on one person. maybe they wiped her face as much as they could, but it wasn't enough since a household is more than wiping drool every five minutes. maybe the parents are unable to lift her as easily as you can and its difficult to get her in the tub so they gave her a wipedown and that was it...or maybe, since it was a weekend and they weren't going anywhere, figured they'd slum it for a few days. you don't know.

maybe they tried their best. maybe you are there for a reason as total care is difficult at best in a home setting.

so maybe this will change your perspective.

because you really don't know.

KATRN78 · Apr 26, 2013

The lesson that I have learned here is that abuse can be unintentional. As adults we need to be intentional about our responsibilities.

kac425: Mom has discussed with me that the girl, "Jane" goes to a local dentist that specializes in kids with special needs. This dentist sedates the kids to do the cleanings and such. Mom has admitted to me that its been 3 years and Jane is overdue. But Mom doesn't make the effort to actually make the appointment. She just hasn't made it a priority. Its not because she is mean or doesn't care about Jane.

In October 2012 Mom said that Jane's wheelchair is too small, she is qualified for a new one and she was waiting for a chance to "bundle" her appointments at the children's hospital. Dad adjusted the chair as best he could. Winter came and the parents decided "we will wait until after winter because weather has been so bad and Children's hospital is 1 hour away. School has sent home a note that the chair is too small. Still no appointment. Jane is getting pressure sores and marks. This chair is too small. It must be replaced.

While I realize that the household does not revolve around the care of one person, repositioning or even transferring her to bed and applying her barrier cream to her face (it goes on twice a day and it makes a clear coating that protects the face) would only take a few minutes. Sometimes we have to take a few minutes away from TV, making dinner, knitting, etc... to do vital chores for the good of our children.

lmccrn62, MSN, RN · Apr 26, 2013

I am sorry but this is neglect bordering on abuse! Sounds like they have excuses to justify that they need someone to come in and help the family.

MrChicagoRN, RN · Apr 27, 2013

+1 on the mandated reporter obligation

allnurses Guide · May 2, 2013

Curious to hear what happened as a result of the OP reporting this family to CPS. Hoping KATRN78 will give us an update, hoping it turned out for the best for all concerned.

KATRN78 · May 3, 2013

another nurse told me that someone visited this week. suddenly mom has made 5 doctors appointments including dentist. thats all that has happened so far.