Reporting Neglect in Home Health

pinkiepinkPN · Mar 19, 2014

I was at a case the other day and this family is already being monitored by Child Protection. The 2 year old was left by mom to roam the house while mom slept. He is not my patient ! I told the agency and they didn't say much but I have to go back there and will they know I reported them? The baby I care for is complex but I couldn't not watch the 2 year old.

You're a mandated reporter- if you encounter a child being subjected to an unsafe situation, you have to report it.

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allnurses Guide · Mar 19, 2014

I agree it's probably your legal and the way I see it your ethical obligation. You can check your own state laws on that but the fact that there is already an open case on the family is all you need to know and if it were me I wouldn't worry about anonymity when a 2 year old is wandering around unsupervised. At that age they find ways to get into things that can kill them even when you are watching them!

For both kid's sake I'd skip the agency and go straight to the caseworker for CPS.

I'm just sorry these things happen at all. (Hugs)

xoemmylouox, ASN, RN · Mar 19, 2014

This is why PDN can be frustrating. So often parents expect you to keep an eye on their other kids while you care for your pt. I'd report it. Your agency may not want to rock the boat so they might not do anything about it. I've known agencies that let things slide so the family stays.

calivianya, BSN, RN · Mar 19, 2014

Maybe this is something I'm just missing, but what exactly should the mom have done with the two year old? If all of the outside doors were locked and the house was relatively childproof, is it really a problem that the child is wandering in his own house? Just curious - I'm not a parent so I really don't know the answer. I just wouldn't have thought anything of it if I saw someone free to roam in the place he/she lived in, regardless of age. Are parents supposed to lock children up when they are sleeping?

IrishIzCPNP, MSN, RN, APRN, NP · Mar 19, 2014

Maybe this is something I'm just missing, but what exactly should the mom have done with the two year old? If all of the outside doors were locked and the house was relatively childproof, is it really a problem that the child is wandering in his own house? Just curious - I'm not a parent so I really don't know the answer. I just wouldn't have thought anything of it if I saw someone free to roam in the place he/she lived in, regardless of age. Are parents supposed to lock children up when they are sleeping?

You can't just take a nap when you have a young child. No, the child can't just roam the house. A 2 year old needs supervision. So if mom wants to nap...she needs to make sure toddler is napping or there is somebody watching the child.

JustBeachyNurse, LPN · Mar 19, 2014

Maybe this is something I'm just missing, but what exactly should the mom have done with the two year old? If all of the outside doors were locked and the house was relatively childproof, is it really a problem that the child is wandering in his own house? Just curious - I'm not a parent so I really don't know the answer. I just wouldn't have thought anything of it if I saw someone free to roam in the place he/she lived in, regardless of age. Are parents supposed to lock children up when they are sleeping?

Would you seriously leave a two year old to their own accord because you needed a nap? They are crafty toddlers than can quickly cause chaos. The issue is that mom is likely assuming the PDN will be responsible for the 2 year old and the patient. This is neither ethical nor legal. If a child qualifies for in home skilled nursing care the nurse is ONLY responsible for the patient not the siblings. As a mandated reporter, the 2 year old left unsupervised to roam the house because the parent decides a nap takes priority over child care needs to be reported to the CPS case worker. At least to the clinical supervisor so that the parent can be reminded that they need to either stay awake or find alternative care for the toddler. The nurse is responsible for the patient ONLY. If the parent continues to neglect the toddler ( letting a toddler roam the house unsupervised is in fact legally child neglect) then further action must be taken to protect both children and the nurse/agency.

If the child was a 1 year old starting to walk left without a bottle to roam the house would you feel the same? Child proof is a misnomer. These toddlers can climb & get to stoves & knives. They can remove outlet covers and open doors.

calivianya, BSN, RN · Mar 19, 2014

Thanks for your perspectives. I guess I'm just coming from a different place - I had insomnia starting at a very young age. I slept less than 7 hours a day and didn't take naps even when I was still young and small enough to sleep in a crib, so according to my parents it wasn't uncommon for them to put me in my room still awake, for them to go to bed around midnight, and for them to wake up around 0700 to find me already awake and playing without them, so that's where my view is coming from. I think it would have been unrealistic to expect my parents to be awake as long as I was. There was no guarantee that even if they saw me fall asleep that I would still be asleep the whole time that they were sleeping because I almost always woke up before them. I wouldn't say I was neglected because they didn't decide to take shifts sleeping just in case I got into something, so that's why I don't see a huge problem with a parent being asleep while a child is awake.

allnurses Guide · Mar 19, 2014

Maybe this is something I'm just missing, but what exactly should the mom have done with the two year old? If all of the outside doors were locked and the house was relatively childproof, is it really a problem that the child is wandering in his own house? Just curious - I'm not a parent so I really don't know the answer. I just wouldn't have thought anything of it if I saw someone free to roam in the place he/she lived in, regardless of age. Are parents supposed to lock children up when they are sleeping?

Not sure why you added "doors were locked" and "relatively childproof" to your question since the only thing we do know is that the family is already being monitored by CPS, the mother was sleeping and made no arrangements to make sure someone else was watching her child. I doubt the OP would've considered it to be a problem worth bothering about if the child was in a safe situation such as in a bedroom with a baby gate and a baby monitor on or something like that. If a parent is sleeping it's no different from leaving them alone.

Would it be OK to leave her 2 year old alone if she locked him or her in the relatively childproof house and went shopping?

xoemmylouox, ASN, RN · Mar 20, 2014

I would never leave a 2yr old unattended. They can and will get into everything.

eeffoc_emmig · Mar 20, 2014

Maybe this is something I'm just missing, but what exactly should the mom have done with the two year old? If all of the outside doors were locked and the house was relatively childproof, is it really a problem that the child is wandering in his own house? Just curious - I'm not a parent so I really don't know the answer. I just wouldn't have thought anything of it if I saw someone free to roam in the place he/she lived in, regardless of age. Are parents supposed to lock children up when they are sleeping?

A child of that age is dangerous! To themselves! They're also incredibly smart. They can figure out door locks easily. Nothing is child proof. I don't care how tired a parent is... that child comes first.

As a nurse in this situation, I would gladly call child services. Right. Then. I would not wait for my agency to "do the right thing" because they are usually more interested in the money.

poppycat, ADN, BSN · Mar 22, 2014

I have a 2 year old grandson & know for a fact that I can't even turn around in a circle without him getting into something! He watches everything everyone does & learns very quickly how to open things (such as locked outside doors). There is no such thing as "childproof". Things we think are childproof are actually adult proof!

As others have said, this is totally unacceptable. The mom is neglecting the 2 year old & CPS needs to know (especially since they already have an open case). If anything was to happen to the 2 year old while mom is napping & a nurse is there for the patient, who do you think will go down? Not the agency; they will throw you under the bus in a heartbeat.