POA / Guardian abuse

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Hello!

Im new to LTC. We recently had a family that discouraged us from feeding a hospice patient. In the families absence, the resident indicated that she was hungry and thirsty and would eat and drink.

When someone has a poa that makes requests that you feel border on elder abuse, how do you handle it. I know I'm obligated to report it. Legally are the poas wishes what we have to follow?

Thanks in advance for any help clearing this up!

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Specializes in Reproductive & Public Health.

Wait, what?! A POA cant direct you to withold PO fluid or nutrition to a patient that can indicate (verbally or through body language ) that they want it!!!! Even if they are at the bedside.

Right?!? Jeez i hope i am right.

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Is the family member to whom you're referring a POA or a guardian? There's a big difference. And is there actual paperwork documenting the legal status, or are we just talking about next of kin? In the case of someone who holds legal power of attorney for healthcare, the POA only becomes effective when the individual is unable to make decisions for her/himself. Is the client considered sufficiently impaired to lack the mental capacity to make her/his own decisions about eating/drinking?

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Specializes in Critical Care.

The POA's only purpose is to convey the patient's wishes when the patient can't do that themselves, so if the patient is able to convey they want something to eat or drink then it doesn't matter what the POA prefers. This does sometimes become an issue in end-of-life care where patients eventually can no longer communicate, although even then we are bound to follow the patient's previously stated wishes, the POA cannot replace those with what they want for the patient. Some states even have laws that clarify that family or POAs cannot refuse comfort measures at the end of life.

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They were her daughters and held POA. Papers were in the chart. The resident was almost nonverbal but nodded when asked if she wanted ice cream and juice so we gave it when the daughters weren't in attendance. Being the stubborn person I am, I asked her a couple of times in front of them but she was already going downhill and didn't reply. They also wanted her to have absolute peace and quiet and shushed us when we came in trying to engage it her. It was very disturbing to me.

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Thank you for this clarification.

would this be considered elder abuse and mandate reporting to the state?

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Specializes in Critical Care.

I think it's more accurately described as a situation where family education is indicated. I would convey to the family their role in decision making, which is to make sure the patient's wishes are being followed, and if they are opposing the patient's wishes then your role as the nurse is to protect the patient's right to have their wishes followed (ie that you can't abide by the family's wishes to refuse the patient food or water).

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Specializes in ICU/community health/school nursing.

Document the pants off of all of this...

There are many different cultural implications to consider when someone is dying in hospice. If it's the family's deeply-held belief that she needs silence as she shuffles off her mortal coil, I'd probably abide by that, or ask a few respectful questions to better my understanding.

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DOCUMENT EVERYTHING!!!!!!!!!

Family education comes next. Document that too, plus everything they say in response to your education attempts.

PoA is only valid when the PT can no longer indicate their needs. It appears this PT can, in which case the PoA is a moot point.

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Specializes in Short Term/Skilled.

if you mean HCP or proxy, you still have the obligation to meet the patients basic physical needs. They don't get to starve their family member because they said so. Were they asking you to wait for them to come back with food or something like that?

Otherwise, yes I'd report and I'd also go ahed and feed the patient as needed based on MD diet orders.

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I echo what everyone said above. POA only takes control when the resident is unable to answer for themselves. Do they have a living will that helps guide the POA for decisions?

What about the hospice agency covering? Have you reached out to them? Are they providing support and education to the family?

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