I work in LTC doing wound care. We have this very cantankerous patient that came in with a small wound to a lower extremity. He is well known for verbally abusing many staff members (especially non-caucasions). On numerous occasions Ive gone in to do his wound care only to be verbally assaulted, called ungodly names and sent out with a big fat refusal to perform his care. He also refused meds, showers, baths, weights, and vitals. Well, without regular treatments to that wound it began to deteriorate and he of course blamed the facility. He called the 'state' with allegations of neglect. Would you believe, that although we had documented his refusals out the wazoo, his allegations were still found to be substantiated!! This man is completely alert and oriented, his own RP in fact, but because he has a dx of schizophrenia, we are not to allow him to simply refuse. Now I must go in and offer to perform care for him when he refuses I must leave and come back within 2 hours to offer it again and accept whatever verbal assaults he throws at me for bothering him again. When he refuses that time, I must ask another nurse to attempt. When he refuses that person we must contact administration at home if need be to come in and convince him to accept care. This is the only person we do this dance for because he caused that big stink with the state. Any other A&O person is allowed to refuse care, its their right, right? Is it just me or does this happen in other facilities? I feel like its a waste of my time trying to convince one person to allow me to care for him when there are so many more that want and need my help.
Document everything, and notify the MD of all refusals daily! Also he needs a psych eval, and some sort of sign in sheet in his room, so whenever someone comes in to give care they must sign a log with how many mintues they were there.
This guy has been in the system a long time and he knows how to work it to his advantage. He reported the facility because you wouldn't leave him alone and do it his way. With new medicare regulations his non compliance can get him denied claims so he blamed the facility, now the facility pays the bill. What a hoot.....
Esme12~You hit the nail right on the head!!! This guy has been in and thrown out of his fair share of facilities. He knows how to work the system and the part he has to play when state comes in to talk to him! If he were to happen to be sent out to the hospital and fail to pay his bedhold, the facility wouldnt blink an eye at refusing his return, but he knows he has this place under his thumb and what he has to do to stay there.
This guy has been in and thrown out of his fair share of facilities. He knows how to work the system and the part he has to play when state comes in to talk to him! If he were to happen to be sent out to the hospital and fail to pay his bedhold, the facility wouldnt blink an eye at refusing his return, but he knows he has this place under his thumb and what he has to do to stay there.
wonder if he'd qualify for a group home, under certain and strict conditions.
What needs ot be done is to get a psyche consult. If the Psychiatrist deems him capabale of making his own decisions about care, then it is his right to refuse. If they find him incompetent, then you have to do it.
Specializes in Leadership, Psych, HomeCare, Amb. Care.
You also need to explain the risks and document what you said, every time.
Exactly.
Sometimes caregivers want to avoid the mentally ill or those who won't go along easily with the program. I wondered if the substantiation wasn't in part because of a reluctance to deal with a difficult patient.
The easiest thing is to walk in & "Hey, Joe. Time for your dressing change." I don't want no G**-D*** dressing change! "OK. Refused...I'm out of here" (executing a precision mid-step turn worthy of a drill team)
Ok... agitated, verbally abusive, patient with a history of chronic mental illness and a non-healing wound. The admitting dx may be the wound, but is that the patient's primary issue?
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kids
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You also need to explain the risks and document what you said, every time.