patient romance?

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There are 2 residents in my nursing home who have been getting progressively intimate with each other. The man (joe) has a girlfriend whom he goes out on pass with every now and then. The lady (jane) was a new admission and ever since she's been here she and him have been talking and getting to know each other. In the beginning it was fine, they were just sitting next to each other and talking in the hallway or the day room. One day the CNA saw jane's hand on joe's leg while they were chatting. When joe was sent to the hospital jane became agitated and in a bad mood the whole shift (which i'm sure had something to do with missing joe). Now I saw Jane and Joe in Joe's room at night when i come onto my shift. LIke last night Joe was lyinig in bed and Jane had her head on Joe's abdomen and they were watching tv in his room! I know this has to stop before something bad happens (pregnancy, rape, abuse, fight with joe's sig. other etc). But i'm not sure how i should be documenting this behavior? Thats where i need help. Has anyone ever had resident's like this? What did you do about it and how was it documented?

Sorry it's quite lengthy!

Specializes in Community Health, Med-Surg, Home Health.
I agree; unless there is some legal reason why they would not be free to make their own choices/decisions, it's not really anyone else's business. :)

(I hope "Joe" can handle juggling two lady friends!)

that is too cute! if they want to be together let them....its probably their last chance for a relationship. :) Seperating them would cause them to be more agitated than letting them be together if they are consenting adults

its perfectly acceptable, if they are capable of making their own decisions. However, if they have a power of attorney, they have waived that right which many LTC patients have. And someone better be making the POA's aware of this, because they may not be consenting to this behavior. Charges can be brought against the facility and I'd assume staff that allow it to occur. Been down this road before and KNOW that even though some people have their right minds and are capable of making decisions regarding intimacy with someone else, its a bit different if they have POA's that are not receptive to such said intimacy. Had this happen with a Bipolar pt. of child bearing age, and a young man with MS. Its a sticky situation but should be addressed by administration ASAP.

I say that if Joe already has a significant other outside of the facility and can handle both of them, then, :yeah::yeah:for him! I would let them continue, personally. It is a good question, though, if the power of attorney does not support the relationship...what can be done? It would be sad to me that this person may have found the love of his life, or if nothing else, a distraction from being institutionalized, to a bunch of interferring administrators! I can see why the elderly feel so reduced in a nursing home.

In the meantime, though, I would inquire about policy and procedure on how to document that Jane and Joe were kissing in the tree, since it is a requirement of your facility.

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Specializes in med-surg, telemetry,geriatrics.

another thing that bothers me is you use the term "psychotic" and middle aged. Which means they do most likely have a POA or guardian and can produce a child from such said intimacy. If staff is aware of the behavior and the POA's are not. All the documenting in the world will not help. It is the facilities job to make sure they are not intimate or become pregnant, and to make sure the woman is on birth control. I see it as negligence if someone who is described as "psychotic" is allowed to make intimacy choices, when they have been deemed not to be able to make decisions about their own health care due to the fact mental illness ect.

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Specializes in ER; HBOT- lots others.

the only thing i would ever worry about is the POA, family member or SO walking in one day and "catching" him and her doing something. that is the only thing that would bother me to no end.

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another thing that bothers me is you use the term "psychotic" and middle aged. Which means they do most likely have a POA or guardian and can produce a child from such said intimacy. If staff is aware of the behavior and the POA's are not. All the documenting in the world will not help. It is the facilities job to make sure they are not intimate or become pregnant, and to make sure the woman is on birth control. I see it as negligence if someone who is described as "psychotic" is allowed to make intimacy choices, when they have been deemed not to be able to make decisions about their own health care due to the fact mental illness ect.

I've worked in psych my entire career, and just that fact that someone is mentally ill, even suffering from a psychotic disorder or psychotic sxs, doesn't necessarily mean that the person has been found legally incompetent or has a POA. I would say that, in my experience, that has been the exception rather than the rule! Whether or not that's a good idea is an entirely different conversation -- but the fact is that, unless there is a legally appointed guardian or POA who makes legally binding decisions for the client, the facility is not in a position to prevent the people from pursuing a relationship. If there is a guardian or POA, then that person does need to be informed and involved in the situation!

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your really concerned? I think that is great, seniors are entitled to having fun and having a little romance just as much as us!! I think you need to relax. If its a mutual relationship, I see no problem??

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Specializes in med-surg, telemetry,geriatrics.
I've worked in psych my entire career, and just that fact that someone is mentally ill, even suffering from a psychotic disorder or psychotic sxs, doesn't necessarily mean that the person has been found legally incompetent or has a POA. I would say that, in my experience, that has been the exception rather than the rule! Whether or not that's a good idea is an entirely different conversation -- but the fact is that, unless there is a legally appointed guardian or POA who makes legally binding decisions for the client, the facility is not in a position to prevent the people from pursuing a relationship. If there is a guardian or POA, then that person does need to be informed and involved in the situation!

Then you understand what I am saying concerning POA and Guardians. And I don't have a problem with elderly having a relationship, but the OP said "middle aged" and "psychotic" in which the psychiatric institutes I know of do not condone or provide privacy for sexual intercourse. Although they may not be able to stop such behaviors, they certainly would at the minimum have the female on birth control. And I agree depending on the environment and circumstances of why these people are institutionalized or live in LTC would be a factor to consider, but forth most DO THESE PEOPLE HAVE POA's or GUARDIANS? All I am saying is if they do. IT MUST BE ADDRESSED BY THEM, not for the patients, facility or the staff to decide. I hope that makes my point more clear. I am not saying someone with no POA or guardian should not have relationships, heck I am all for it. But from a legal stand point if they do have a POA or guardian and this woman becomes pregnant, without their consent of the relationship, and the staff has been charting " we found jane on top of joe naked ect. ect" and the POA was never aware of this. It is negligence and criminal if interventions were not taken appropriately to let the POA or guardians know of the behavior. I KNOW this because we had a situation that occurred that the State was involved because, nurses were providing privacy for 2 people with POA's to have sex without their consent. I addressed that the POA's should be notified, and when they were neither side wanted their family members having sex together. In conclusion, the only thing I was bringing to the OP's attention is not whether or not the patients are both consenting ect., but if they have a POA or guardian it must be addressed toward them. By the way I am not talking about someone with a durable power of attorney, of course they can do what they want, until such time they are deemed no longer to make decisions for themselves.

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this is a sticky wicket, a woman was infected with aids virus at a facility where i worked at...administrator had to call family and notify them about that..not a chore i would relish

they had access to condoms but there was poor compliance

he may be making a fool of the woman who takes him out on pass but i don't really believe that it is the staff's obligation to inform her, if he transmitted a std to her i don't believe that she could hold staff responsible for not informing her of the danger

as for the pregnancy problem it might be prudent to talk with womans doctor and family to see if a birth control program might be ordered

in most of the ltc facilities where i worked women of childbearing age were given this option because most patients are unable to care for themselves much less a child

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Then you understand what I am saying concerning POA and Guardians. And I don't have a problem with elderly having a relationship, but the OP said "middle aged" and "psychotic" in which the psychiatric institutes I know of do not condone or provide privacy for sexual intercourse. Although they may not be able to stop such behaviors, they certainly would at the minimum have the female on birth control. And I agree depending on the environment and circumstances of why these people are institutionalized or live in LTC would be a factor to consider, but forth most DO THESE PEOPLE HAVE POA's or GUARDIANS? All I am saying is if they do. IT MUST BE ADDRESSED BY THEM, not for the patients, facility or the staff to decide. I hope that makes my point more clear. I am not saying someone with no POA or guardian should not have relationships, heck I am all for it. But from a legal stand point if they do have a POA or guardian and this woman becomes pregnant, without their consent of the relationship, and the staff has been charting " we found jane on top of joe naked ect. ect" and the POA was never aware of this. It is negligence and criminal if interventions were not taken appropriately to let the POA or guardians know of the behavior. I KNOW this because we had a situation that occurred that the State was involved because, nurses were providing privacy for 2 people with POA's to have sex without their consent. I addressed that the POA's should be notified, and when they were neither side wanted their family members having sex together. In conclusion, the only thing I was bringing to the OP's attention is not whether or not the patients are both consenting ect., but if they have a POA or guardian it must be addressed toward them. By the way I am not talking about someone with a durable power of attorney, of course they can do what they want, until such time they are deemed no longer to make decisions for themselves.

I agree with you (except that, again, if the person is legally able to make her/his own decisions, then you can't force the person to use birth control, same as you can't force any other medication or treatment against the person's will outside of an emergency situation -- you can encourage the use of birth control, but it's the person's choice to make).

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with many of the patients birth control was discussed with poa and md and the decison was made by them..this ensured that the family was aware of activity and that pregnancy protection was provided

the thought of a soft cuddly baby might appeal to a woman with a mental impariment but that does not mean that she is capable of making a decision involving becoming pregnant..

some of the residents were self admit but most were court ordered at t so decisions had to be made by family

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Specializes in Ante-Intra-Postpartum, Post Gyne.

IF there is a policy against it there should be a policy on how to write it up

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Specializes in med-surg, telemetry,geriatrics.

absolutely elk and chat. I was merely bringing up the issue of POA and guardianship. Not implying that anyone should be forced treatment against their will, however if someone is having sex and the POA is aware( key word here is AWARE). They might opt for birth control. My scenario I speak of was staff allowing 2 people with POA's to have sex without their knowledge. In this case the woman immediately had a serum Hcg drawn and was started on Depo, because it was very difficult to keep them from sex. Once the 2 knew they no longer were able to, it made them try just that much harder to get the job done.

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Then you understand what I am saying concerning POA and Guardians. And I don't have a problem with elderly having a relationship, but the OP said "middle aged" and "psychotic" in which the psychiatric institutes I know of do not condone or provide privacy for sexual intercourse. Although they may not be able to stop such behaviors, they certainly would at the minimum have the female on birth control. And I agree depending on the environment and circumstances of why these people are institutionalized or live in LTC would be a factor to consider, but forth most DO THESE PEOPLE HAVE POA's or GUARDIANS? All I am saying is if they do. IT MUST BE ADDRESSED BY THEM, not for the patients, facility or the staff to decide. I hope that makes my point more clear. I am not saying someone with no POA or guardian should not have relationships, heck I am all for it. But from a legal stand point if they do have a POA or guardian and this woman becomes pregnant, without their consent of the relationship, and the staff has been charting " we found jane on top of joe naked ect. ect" and the POA was never aware of this. It is negligence and criminal if interventions were not taken appropriately to let the POA or guardians know of the behavior. I KNOW this because we had a situation that occurred that the State was involved because, nurses were providing privacy for 2 people with POA's to have sex without their consent. I addressed that the POA's should be notified, and when they were neither side wanted their family members having sex together. In conclusion, the only thing I was bringing to the OP's attention is not whether or not the patients are both consenting ect., but if they have a POA or guardian it must be addressed toward them. By the way I am not talking about someone with a durable power of attorney, of course they can do what they want, until such time they are deemed no longer to make decisions for themselves.

I have the POA for my mother and it really is not my business if she becomes involved with another man. I have both the financial and the MPOA for her. She is still entitled to happiness and it is not my posstition to say yes or no. Being POA does not give you the right to make all decisions for a person. The right to which you have is spelled out in the POA itself, and do not forget people who are of the right mind and being "psychotic" does not make them ineligble to make those descions, can revoke a POA at anytime.

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