problem in home health. mandated reporter issue?

SuesquatchRN, BSN, RN · Feb 4, 2012

Is she in a care home or ALF? Either way the laws that govern them are far less restrictive than LTCs or SNFs. I would tread carefully.

nurse2033, MSN, RN · Feb 4, 2012

"i thought my job was to observe care givers and protect the client, but my office seems more concerned with protecting business relations with an agency that doesn't even provide us with references."

i'd say your assessment sounds spot on. the previously poster is right, you need to check you local state laws regarding mandatory reporting. many states are only in the process of including the elderly. the bigger problem is the lack of regulations on "nursing homes". this sounds like an inappropriate placement based on the poor level of care in the home. they may however, not be violating any laws, even if they are violating standard of care. best of luck.

caliotter3 · Feb 4, 2012

I would also advise you to get very familiar with your state reporting laws. This sounds like it is in a grey area to me. If nothing else, you now have a good perspective of how your agency approaches things. You can base your future with this employer on your present perceptions.

GapRN · Feb 4, 2012

I am not sure what the official classification of the facility is. My secretary called it an assisted living home. They are just a normal home converted to care for stable client's after SNF DC. I am in So Cal if that helps. In school they said, if you're not sure call the county, but real life doesn't seem that cut and dry, especially as I don't have anyone else familiar with the client that I can compare notes with.

RachRN66 · Feb 4, 2012

I know that the "care homes" or "group homes" that are established by individuals in the community have different laws and regulations than to SNF/LTCF/ALF. About 8 years ago I was assigned this "home/ALF" group of residents that consisted of about 35 beds. The living conditions in this place were HORRID. Most of these residents were people that couldn't live on their own, but had no money to go any place else to get care. Basically it was a DUMPING ground, located in the worst part of our City, and the residents had nobody to stick up for them. This was at a time when our agenc was making money on patients that had medicaid and we could go assess them q60 days and supply them with incontinent supplies. So, generally my visits there were to do q60 day visits (general assessment and documentation of incontinence) and order diapers and chux for the upcoming 60 day period on the residents. It was not fun and games, the visits were always recert visits which included lots of extra documentation, (not OASIS though, because we were providing "unskilled medicaid care" and time. This Horrid place had residents with scabies,lice, roaches crawling on the walls and no "real place" to wash your hands, to say the least. Since there were so many incontinent residents, and not all of there "cert periods" fell on the same day, I spent many days in this place. We also provided "skilled" care to residents if needed. I got a call from the "head CNA" that worked at the facility one day that Mr X had a bedsore and could I take a look at it. After securing orders from the MD I made my visit. His entire sacral area was a hard, black eschar area that measured >30 cm in diameter. I called the MD and asked if he would see the patient and eval, and the MD told me to put hydrocolloid on it, and change it q 3-4 days and PRN. I did that. I also instructed the CNAs about proper care for this wound..turning, changing, cleaning etc and tried to get the MD once more to see the patient. Every time I went to see this gentleman he was laying in the most horrid pile of incontinent mess I had ever seen. So I would clean him, change him, do wound care, and turn him. And one day I put my initials and date on the tab of the diaper. I went back 3 days later to find the SAME diaper on this man. I was LIVID. I called my supervisior and said NO more...I called the MD and reported the issue, and I called our social worker to get some advice on how to contact Adult Protective Services. Two days later the man ended up in the ER with a temp....duhhh??? I got called into the office and was told that the "ALF" was in charge and that our social worker could most certanly NOT call APS. I told my supervisor I wanted a meeting with OUR director, human resources, the social worker etc. I told them all my concerns about this place. And they most graceously took me out of the facility and assigned a new nurse. I called the abuse hotline and reported the situation. The facility got shut down about 3 months later. A year later, they were back in business. I don't go there, and I don't know if they have better practices, but someone in the "powers that be" let them open back up. I pray that they let them open with stricter conditions, but I don't know.

I don't know what to tell you, but I know I've seen some awful things in Home Health in the 18+ years that I've been in practice. My agency did not pick them back up as Medicaid suppliers when they did re-open. I was told that the ALF chose a different provider. Occasionally we get "skilled patients" in this ALF today, but I will not go back there, and my agency knows NOT to send me there.

MN-Nurse, ASN, RN · Feb 4, 2012

So, I've been taken off the case,

Ah, the magic words. If you have a concern about a vulnerable adult being mistreated, report it to the state.

If not, then move on and care for the patients you do have.

sweetsugar · Feb 5, 2012

From personal experience, if the patient is A&OX4, oftentimes, nothing happens with the State. They will talk to the resident; and, if the resident feels okay with her environment, they are going to back out quietly. What happens to you is another story. Your current employer may see you as a "troublemaker". It oftentimes is better to tread lightly on these situations; some agencies place the almighty referral source above God sometimes. Just be careful with calling in the State. Just my humble opinion.

caliotter3 · Feb 5, 2012

I reported abuse that I witnessed. I was fired. The abuser was a nurse who was very "special" to the DON. I found out more than two years later that NOT ONE THING WAS DONE by the authorities. However, I had the written copy of my submitted report to cover my rear. Nobody could take action against my license for not following the law. Too bad the abuser was rewarded. Have often wondered how many people she has abused since that incident.

kcmylorn · Feb 5, 2012

I was thinking of going into Home health- after reading the above, I'm not so sure. This is scary. politics and elder abuse and no support from your management.

Kidnurse1963 · Feb 5, 2012

I have worked in acute hospitals and SNF's in my 28 years of nursing. And I have made many reports to the state. After trying to go through the proper channels I have made many annonymous reports to the state. I am there for the patient and not the BS and politics of the facility. Several times when I reported abusive situations it was pushed under the rug. They can't stop me from reporting what I feel is an abusive situation annonymously. Especially when it comes to kids. I hope you get some satisfaction from the "higher-ups."

elprup, BSN, RN · Feb 5, 2012

I reported abuse that I witnessed. I was fired. The abuser was a nurse who was very "special" to the DON. I found out more than two years later that NOT ONE THING WAS DONE by the authorities. However, I had the written copy of my submitted report to cover my rear. Nobody could take action against my license for not following the law. Too bad the abuser was rewarded. Have often wondered how many people she has abused since that incident.

Nusing and Medicine is soo dysfunctional!