Private duty client refuses all care

[Red Kryptonite]

I've currently given up with one hour of my 12 remaining, and am waiting for my day shift replacement to arrive. I will enlist her help for a complete brief, bed, and clothing change that I know is necessary because I'm sure my patient is soaking wet.

This woman is paying for around the clock CNA presence in her home, but will not allow us to change her brief, reposition her, etc. I wonder why we're here at all. She has apparently fired several CNAs from the case, called and screamed at my boss and half the main office, and caused some CNAs to refuse to work the case anymore. She screams in pain with any movement and curses us out, but refuses to take pain medication. She is A&O and can self-administer with help.

I've communicated these issues to my leadership and so have others, and yet they keep sending us into this mess with nothing changed. She's in her regular bed which does not lift, too, which complicates all cares. My back still hurts from 2 nights ago. Which is why I'm waiting for help.

I'm at a loss. This is a non-profit company, but private duty was something they came up with, after years of requests by families, as a revenue generator.

[Missingyou, CNA]

I'd ask to be assigned to another client.

You are going to hurt your back.

Once you hurt your back, it will ALWAYS hurt.

I'd tell my supervisor why I'm asking to be reassigned.

I'd make sure a supervisor is well aware that the client is refusing care....there must be some client care notes for care givers to make notes in. Note each refusal and that you notified your supervisor/nurse and any family that you may have contact with.

I guess you can try to look at the possible reasons for her to refuse care. Dementia? fear? depression?

The "leadership" you talked to, are they nurses or are they just people who schedule the caregivers??

Have you talked to the NURSE about the client refusing pain medication? Maybe there are side effects the client can't deal with??

~Protect your back

~Cover your butt

[Red Kryptonite]

Yes, not only the RNCM for the patient, but also her backup RN who covers her days off. And my team leader, who is not a nurse but a social worker.

The response I got this morning was that she's alert and able to make decisions, and so can refuse care. To say I'm p'ed off is an understatement. What I'd really like to ask is don't we have any rights? Such as the right not to destroy our backs, the right not to be verbally abused, the right not to violate our own training and ethics by leaving a patient lying in Lake Michigan of her own urine?

The nurse and one of the doctors have been to see her multiple times to discuss pain medicine with her. I have no idea why she won't take it, except that I sense it's a control issue. Both told her that since she's incontinent and bedbound, she might consider a catheter to reduce the need for turning her and the pain it causes. She refused that too. She's on her own double bed with a memory foam pad under her that, while we've done our best to protect it, is saturated with urine and stinks. (It also creates a ton of extra friction during a linen change.) They're gonna have to burn that bed after she dies.

She also has two dogs who pee on the tile floor and leave puddles which thankfully I've seen in time, but I also told my leadership about that and told them that someone eventually won't see it in time and will slip and injure themselves.

They're ignoring all of it. Usually I feel my employer treats me pretty well, but these private duty cases make me feel at times like they don't even see us as people. Just ways to fill a staffing hole.

I work Christmas night with this patient again. If things are the same I'll refuse the assignment after that. There are only so many of us and if we keep refusing and she keeps firing others, they'll run out of options and be forced to deal with her differently. I just really think it sucks that it may have to come to that.

[Purple_roses]

This happened with one of my clients and my company no longer sends me there and has put the client on probation until she behaves herself. It's a shame your company isn't being more proactive in this. Whenever I've had someone act like this, the root problem has ALWAYS been that they fear their independence being taken away from them. I let them yell and get it out of their system. Then I get down at eye level with them and tell them I'm very sorry they're feeling this way and ask them what's bothering them. Then I try to walk them through what needs to be done. I make sure they know that they don't have to do anything, only what they choose to do. This helps them feel in control. With you client I might explain why I want her to change, for instance, you don't want her to get a rash from the moisture. Then let her do as much as she can on her own and ask if you can help at times. This works sometimes.

[Missingyou, CNA]

Yes, the patient has a right to refuse care if they are of sound mind (and sometimes even if they are not).

Yes, you, as a CNA, have the right to protect your back (and your butt), to not be verbally abused, etc. Though, you also have to have the skill to know that not all "verbal abuse" from a patient is intentional (such as that from a dementia patient).

This sounds like a very difficult assignment and I still say, I'd ask to be reassigned.

Nothing good can come from this for anyone involved. It sounds like it is only frustrating you. Sometimes homecare agencies only see the cases as $$ and do little to support the staff. Sometimes, it is completely out of their control and they will keep the CNA there as long as the CNA is willing, simply because noone else will work it, and afterall, it is $$ in their pocket.

It sounds like this client could also be in need of a psych evaluation as well.

[vintagemother, BSN, CNA, LVN, RN]

Yup! I think she needs to be treated like a person with some mental health challenges. I'm sure this is very difficult for you. She sounds very resistant to care and you are there to provide care, which presents you with a moral dilemma.

In my positions, which have never been in home health, we can use a team approach to help a client who refuses to accept care.

[Red Kryptonite]

Oh praise the Lord. I am scheduled on the same case again tonight, and just checked in with the day CNA. The patient now has a catheter and is taking pain and anxiety meds. My co-worker says she's a lot more comfortable and pleasant. I had three nights off in a row and was hoping something would change.

Not gonna lie, I'm happy for us CNAs because this makes our job easier, but more, I'm glad for the patient because now we can keep her dry and her pain is mitigated. God bless whatever nurse saw her over the weekend because she must have had just the right words.

As to the mental status issue, this patient has brain mets, so I've questioned treating her as totally A&O from the beginning. But what do I know? I'm just the CNA.