New neighbor slipped through the cracks. What do I do?

[fiveofpeep]

I am so upset. A neighbor moved in and one of his friends was telling me that he is wheelchair bound and just got out of a SNF and has no family resources in the community or health care professionals following up.

I went over and introduced myself to him and he was very withdrawn. Apparently, he won't let his friend help him. I don't even know how he will get out of the couch to his WC, but I don't know how much function he really has as the friend of his is a lay person.

He has no one from the county or home health coming to follow up on him. How did this guy slip through the cracks? How can I help him?

I plan on establishing a rapport with him and I already told him to come and ask for help anytime. I plan to check on him every couple days to make sure he is alive and has everything he needs but I am so worried he is going to suffer a complication because of lack of help.

I understand that I don't know his level of function. All I know is what the friend told me. I also understand I don't even know if he wants help.

How can I help him? Shouldn't he qualify for some sort of follow up care? Can I contact the public health department? What can I do?

As an acute care nurse, I've never seen what happens when discharge planning fails. It is shocking to me and breaks my heart.

[Nurse SMS, MSN, RN]

I would not suggest ANYTHING until he asks for it. It sounds like the one thing he still has left is his pride and the right to choose how he lives. Don't take that away or imply he needs help. If you build a relationship where he is comfortable asking for it or implying it, THEN you can be a do-gooder. Until then....be a neighbor. Be a friend. Invite him over to dinner rather than leaving him Meals On Wheels pamphlets.

Think. How would it feel if someone came to meet you and noticed you have problems that in their opinion you absolutely need help with...and start leaving pamphlets in your home? Would you trust that person? Would you feel grateful? Or would you feel violated? I am fairly certain people could easily visit my house and think I need to be left a vacuum cleaner, furniture polish and dish soap. If they quietly left these things for me after a "friendly" visit, I would no longer interpret that visit as having been friendly. It would have had an agenda and I would not want that person in my sphere. Because in truth their visits would be about them, not about me....about them feeling like they are doing good, not about them actually doing so.

Stop trying to fix him before you even know him. If you want to do something good for him, just be his friend and give it time. No pamphlets. No referrals. No calls to state agencies.

[BirdieBird, BSN]

Could you just call in an anonymous welfare check to your local public health agency? That way you've advocated for a vulnerable person, but not offended your neighbor.

[KelRN215, BSN, RN]

If he won't even let his friend help him, I'd say he's made it fairly clear that he doesn't want help. And adults have the right to refuse help.

If it were me, I'd stay out of it. You told him he can come ask for help and I'd leave it at that. Don't assume he needs you to check on him. He's your neighbor, not your patient and his well-being is not your concern. It certainly sounds like this person would qualify for a home health aide or PCA but he may be very aware that he qualifies for such things and he may not want them. If I were this person, I'd find it quite intrusive if a neighbor came over and tried to make me her personal welfare case. This person may be very capable of caring for himself, regardless of what his friend told you.

[Nurse SMS, MSN, RN]

Or may have never had opportunity and just wants to be left the heck alone.

[classicdame, MSN, EdD]

don't overplay this. Let him ask for help. If you feel he is incompetent or abused contact adult protective services

[nurseprnRN, BSN, RN]

" although i am worried for him, i have no idea what his level of functioning is and i definitely don't think it would be appropriate for myself to intervene unless in an emergency. independence is very important for patients. "

and acting as a nurse outside of your employment can land you in trouble if you exceed your scope of practice or if something goes wrong and it's his word against yours. it's more than his independence that's important.

if you think this man is in trouble, you can also call the state dept of elder affairs and make a report. however, it is possible that the facility that discharged him knows full well he's unable to care for himself but absent a legal determination of incompetence and a court-appointed guardian there's nothing they could do about it.

[wooh, BSN, RN]

Well if you go over there and he's stuck on the couch covered and urine and poo, you know he can't transfer himself to the chair. If he's not stuck, obviously he's either capable or does have someone to help him.

A "let me know if you need anything" is friendly. Dropping off pamphlets? Not friendly unless he asks for them.

[leslie :-D]

i agree with those who suggest that he make first move.

that said, if i were as concerned as you, i would probably send him hand-written note/card, sharing concern and offering services...

should he ever need/want help.

and then leave it at that.

you've gotten your message across and the rest is up to him.

fwiw, i know i'd be a *horrible* pt, declining all offers of help - even to my detriment.

it is that important to me, to not be a 'burden' to anyone else.

his autonomy needs to be maintained and respected.

leslie

[AMN74]

As a home health nurse of 20 years all I can say is if he is competent, and refusing help from his friend, then he is making his own decisions. If he seems depressed then a "friendly nurse" popping in to give him pamphlets may upset him. He may have left AMA just to get away from a SNF. That is his choice. If down the road he realizes he might need some help, before he ends up re-hospitalized for wounds due to not being able to clean himself, or broken bones from falls...then maybe he will start accepting some help. Some people have just had their fill of health care people trying to tell them what they should do, and get frustrated when it is dumped on him consistently. Sure MOW would be a great option to 1) have someone checking on him daily and 2) provide him with a meal. But maybe he doesn't want that. If he truly ca off the couch to get fluids, he will soon get dehydrated and get a uti and get sepsis and end up back where he started. Or he will fall and break a hip and end up where he started...but maybe he has a slide board that he can operate himself to transfer that you just did not see. Sure it would be great to have a home health eval to make sure he understands nutrition/hydration related to his disease, his meds and when to take them and having a phone number he can call when he gets into trouble would be nice. Even a life alert. But he has to agree and make those choices, you can't just chose for him because he looks so helpless. He made a decision to get into this shape, he has to spend some time in that shape to formalize a plan on how to get out of it.

In my party days of college years ago, my mother came to visit...she asked me, "do you own a vacuum cleaner?"... I was in the midst of writing mid term papers and studying. I was neck deep in study groups and she stopped by my unkempt apt and said "Don't you own a vacuum cleaner"..l I told her I did, I showed her where the vacuum was kept and she swept my floors. It was more than I could handle at the time, but I really appreciated it. I made it though those tough years, while my mother was still focused on cleaning. It was helpful, and I appreciated it. I allowed some help and it got me though. The point is I accepted some help, willingly...not because some agency stood over me and told me what to do. If he is competent, He will make right decisions for himself (once he might be able to work through the depression(

Basic line if if he is not receptive to care, he will have to learn to work it out on his own. Many people chose that opportunity. Many have been in these situations and if they are deemed competent by APS they get to make their own decisions bout how they want to lead their life. I see it every day in my line of care.

Be available but don't be pushy...let him ask the questions...let him tell you what he thinks he needs. Best wishes for you and your neighbor!

[MrChicagoRN, RN]

Thanks everyone. Yeah I don't know if I made it clear. Although I am worried for him, I have no idea what his level of functioning is and I definitely don't think it would be appropriate for myself to intervene unless in an emergency. Independence is very important for patients.

I really don't want to involve myself much more than to just build a neighborly rapport and refer him to other services or get them in contact with him.

He's not not your patient, he's not a patient, he's the new guy living a few doors down who may, or may not, need or want any help.

He's a man in a wheelchair. Apparently all you know at this point is that he's can't ambulate independently, no indication that he's helpless.

You wonder if he can transfer from couch to wheelchair. So, how'd he get onto the couch in the first place?

[fiveofpeep]

You wonder if he can transfer from couch to wheelchair. So, how'd he get onto the couch in the first place?

Friend

[fiveofpeep]

Thanks everyone. Now that I have thought about it and distanced myself emotionally I totally agree with the need to hang back.