Protecting a patient at risk for abuse or neglect

[Lynx25, LPN]

I work in a LTC facility, and I have had one resident for quite a while, who seemed to be one of those who just gets dropped off by the family, and never thought of again. From the records, it doesn't seem like they had been to visit in about a year. The contact numbers were disconnected, the certified letters we sent out were returned... I even went to facebook and other social sites trying to match up the contact name, with some photos of the family left with the patient. No such luck. I have personally replaced her wardrobe as needed, bought her snacks, stocked her fridge, etc etc.

In the mean time, this patient contracted C-diff, multiple pressure sores, and had a tremendous change in function. During her latest stint at the hospital, I went to medical records and went through the things that had been thinned out of the chart, and somehow found a new phone # listed on the bottom of a 3 year old page from the hospital.

When contacted, the patients family sounded angry that I had contacted them and bothered them with all of this information, wanted to know why their mother was in a different state than they had left her a year ago... etc etc- you've all had difficult family members.

NOW- here's my problem. They want her pulled out of the nursing home, out of the hospital, and they want to take her home. This woman is incont, with pressure sores to the sacrum that's forever being irritated by the Cdiff stool. She doesn't walk, she can't sit up by herself, and she's on honey thick liquids and a puree diet, and I am suspecting she even aspirated on that.

There is no way this family can take care of this woman. She'll be dead in a week. I find it highly suspicious that you go from not seeing your mother for a year, to suddenly wanting to take her home with you. In a perfect world, I suppose they have learned their lesson, but it's not.

I've pushed and pushed our social worker to get DFACS, or adult protective services involved, but it's been a week, and she's done nothing. The hospital social workers seem to think I'm causing a scene because the family wants to sue my facility.

Is there ANYTHING else I can do to protect this patient?

[CrunchRN, ADN, RN]

With nothing but the best of intentions you have gotten too involved. You need to have your facility arrange for an advocate to be provided as an onjective person to evaluate this situation.

I think you are awesome for all you have done and have tried to do, but you went too far and now you are in the middle of a great big mess that will have much fall out i think.

Advocates are volunteers that are provided for just this kind of issue/need. The number to reach them should be posted at your facility. Call them and then step way, way back.

[Zen123]

You even went to facebook?

[Simply Complicated]

I'm just wondering what were you hoping to accomplish by going to such extremes to contact the family? Not trying to be rude, just wondering.

I've never worked LTC, so I can't say much about it. But I just read one of the stories the other day on here, about not always judging a family for not visiting. That you don't always know the story, and there could be good reasons they don't come.

On another note, are you not allowed to make your own complaint to protective services?

[Lynx25, LPN]

I'm just wondering what were you hoping to accomplish by going to such extremes to contact the family? Not trying to be rude, just wondering.

I've never worked LTC, so I can't say much about it. But I just read one of the stories the other day on here, about not always judging a family for not visiting. That you don't always know the story, and there could be good reasons they don't come.

On another note, are you not allowed to make your own complaint to protective services?

I thought that something might have happened with the family- and before she became a ward of the state- I wanted to make sure.

Then again, I work 16 hour shifts on the weekends, so I suppose I might have been bored.

[tyvin, BSN, RN]

How are you so sure that the family won't be able to take care of her? People like that are taken care of at home all the time. Be careful not to show your prejudice. People are dropped off and left at nursing homes all the time. I would have let it go. If she was a ward of the state why did you dig up the family?

I would be more concerned with figuring out why the C-diff isn't being treated properly and why you people can't heal her ulcers. What kind of bed is she on?

[wyogypsy, RN]

First of all, if the family wanted to be contacted they would have made sure that the LTC had their contact information. Secondly, why the heck did the hospital let you go through their records on her? That is NOT your facility even if you are a nurse, and those records should only be accessed by hospital employees with the 'need' to know. And going to facebook? I suggest you talk to a more experienced nurse or social worker about boundaries. You may be a great nurse, but you definitely have boundary issues. There may have been a very good reason why administration or social workers at your facility did not pursue the family. Basically you tracked the family down, told them their family member was not getting good care at the facility you work at, and so now they feel the need to take her. You are lucky if you don't lose your job over this, or even worse receive disciplinary action from your state's Board of Nursing.

[tvccrn, ASN, RN]

I work in a LTC facility, and I have had one resident for quite a while, who seemed to be one of those who just gets dropped off by the family, and never thought of again. From the records, it doesn't seem like they had been to visit in about a year. The contact numbers were disconnected, the certified letters we sent out were returned... I even went to facebook and other social sites trying to match up the contact name, with some photos of the family left with the patient. No such luck. I have personally replaced her wardrobe as needed, bought her snacks, stocked her fridge, etc etc.

In the mean time, this patient contracted C-diff, multiple pressure sores, and had a tremendous change in function. During her latest stint at the hospital, I went to medical records and went through the things that had been thinned out of the chart, and somehow found a new phone # listed on the bottom of a 3 year old page from the hospital.

When contacted, the patients family sounded angry that I had contacted them and bothered them with all of this information, wanted to know why their mother was in a different state than they had left her a year ago... etc etc- you've all had difficult family members.

NOW- here's my problem. They want her pulled out of the nursing home, out of the hospital, and they want to take her home. This woman is incont, with pressure sores to the sacrum that's forever being irritated by the Cdiff stool. She doesn't walk, she can't sit up by herself, and she's on honey thick liquids and a puree diet, and I am suspecting she even aspirated on that.

There is no way this family can take care of this woman. She'll be dead in a week. I find it highly suspicious that you go from not seeing your mother for a year, to suddenly wanting to take her home with you. In a perfect world, I suppose they have learned their lesson, but it's not.

I've pushed and pushed our social worker to get DFACS, or adult protective services involved, but it's been a week, and she's done nothing. The hospital social workers seem to think I'm causing a scene because the family wants to sue my facility.

Is there ANYTHING else I can do to protect this patient?

I have a question about the bolded part:\

How do you move someone to a different state without the permission of the family?

[tyvin, BSN, RN]

I have a question about the bolded part:\

How do you move someone to a different state without the permission of the family?

If you read the original OPs post the women is in fact a ward of the state. That means the family gave up their rights as so many do in LTC situations. That means her guardian is a state guardian who has POA to make any and all decisions.

[wyogypsy, RN]

I took 'in a different state' to mean 'in a different condition'.

[tyvin, BSN, RN]

I took 'in a different state' to mean 'in a different condition'.

You're right ... thanks.

[tvccrn, ASN, RN]

If you read the original OPs post the women is in fact a ward of the state. That means the family gave up their rights as so many do in LTC situations. That means her guardian is a state guardian who has POA to make any and all decisions.

If the patient is a ward of the state, why does the OP say,

"I've pushed and pushed our social worker to get DFACS, or adult protective services involved, but it's been a week, and she's done nothing. The hospital social workers seem to think I'm causing a scene because the family wants to sue my facility."

The family also pulled the patient out of the facility, which they would not be able to do if the patient was a ward of the state.

Also, in another post the OP goes on to say,

"I thought that something might have happened with the family- and before she became a ward of the state- I wanted to make sure."

Therefore, the patient was NOT a ward of the state and, as unfortunate as it seems, unless the patient was competent enough to consent they should not have been moved without the family's knowledge.