I am a home health RN, new to the field, and I just got a very disturbing call from my boss. I have been seeing a client with multiple problems (liver, ascites, HTN, DM 2 for 30 years, chronic pain, hospitalized last week for hyperglycemia) for diabetic education for a month now. When I started seeing her she had just moved in to an assisted living facility that is basically just a dumpy house that some folks started taking care of old people in. Two days ago client CO pain in her butt crack when her cheeks spread apart and I looked to find two areas of open skin 0.5 cm square facing each other. It was not over a bony prominence so i think it was caused by moisture and skin sticking to itself. I talked to an APN who OK'ed my suggestion of duoderm every 3 days, educated on drying skin after incontinence. and I thought everything was OK.
I get a call the next day from the assisted living facility's director who says she doesn't see any skin breakdown. Some more back story - nobody at the assisted living facility even knew she was on 1800 cal ADA diet or 1500 ML fluid restriction several days after she had been admitted to their care! The staff who was preparing food didn't even know how to read a food label and figure out how many calories she was serving. Next I get a call from my boss telling me to play politics and I should have consulted the director before calling the client's PCP for wound orders. I am male, and have not noticed ANY sexual overtones with the client's behavior, but now the director (of an all female staff) is claiming that she is very sexual and should get a female nurse to assess her butt! So, I've been taken off the case, they are sending an LVN, and my boss has not even talked to the client, who is A&Ox4 and totally responsible for herself, to find out if she wants me to come back or not. 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.
Is this a mandated reporter issue? They are at very least negligent for not know her diet. at worst they are risking the client's health to prevent putting a new wound on their books.
I have no knowledge about residential care....but elder abuse is illegal and mandated reported in all states. What everyone has said here is true and some places will retailiate against you for "stirring the pot" so to speak. DO what you feel is right in your heart. I hope these links will help.
Specializes in Peds/outpatient FP,derm,allergy/private duty.
They're called "group homes" or "board and care" homes. Of all the categories of adult facilities in California, they are the least regulated and seem to be a magnet for unsavory characters looking for the money. I've had friends solicited by unscrupulous individuals to pool their money to buy a house and start one of these. It was very clear to her the goal was to house and care for these people as cheaply as possible and profit off their SSDI, SSA, and other public funding for health care and living expenses.
In no way am I saying there are not good homes around, just that to be careful and follow Cali's advice to know your mandatory reporting law backwards and forwards.
Been there, done that and I did report it. I have no idea if anything was done about it but I know that I did the right thing and that is really all that matters to me. Fortunately, I had the support of my higher-ups, but I would have reported even without the support. I wish you the best of luck.
Esme12, ASN, BSN, RN
20,908 Posts
CALA - California Assisted Living Association
Elder Abuse Information: California Assisted Living Contracts
Residential Care/Assisted Living - What You Need to Know - CANHR
I have no knowledge about residential care....but elder abuse is illegal and mandated reported in all states. What everyone has said here is true and some places will retailiate against you for "stirring the pot" so to speak. DO what you feel is right in your heart. I hope these links will help.