Right to Refuse

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Specializes in Geriatrics.

Have a NIDD in personal care facility. Resident's family member doesn't understand or doesn't' want to understand that we can not make the resident eat only healthy foods, that if they want to eat cake, ice cream etc., that is their right and we can not withhold it from them. We offer and encourage healthy choices. Family member has gone as far as to have the physician write orders to have carb controlled diet.

Has anyone else run into this problem with a family member? Any success getting it across to the family member that the resident has rights?

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Who is providing, buying, bringing in all these sweets?

I am not sure what a personal care facility is. What is the patient disability that they need to be in a care facility?

Honestly if I were the family I would be annoyed, but again I have no idea what the patient's mental and physical capacity is, what the rules of the facility are, how much freedom the patients have, etc.

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Specializes in Critical Care.

Physician ordered dietary restrictions are a treatment recommendation, and like any other treatment recommendation a competent patient has the right to refuse them. If the patient is deemed incompetent to make their own decisions then their decision maker still has to go by the best understanding of what the patient would have wanted. So if the patient has declined to follow a strict carb controlled diet when they were able to make decisions, then that would be their last known view on the topic and would have to be followed, unless it could be established that their wishes would have changed. And cake and ice cream aren't necessarily strictly prohibited in a DM carb controlled diet anyway.

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I have had to explain to PCPs in the past that a LTC facility is the resident's home, and just like a home in the community, if the resident wants ice cream, pancakes with maple syrup, whatever, they can have it and we have no right to stop them (unlike the hospital where if it is not ordered they cannot have it.)

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Specializes in LTC.

I recently had a diabetic whose FBS was >400. He showed me why: 2 empty containers of single-serve pancake syrup and a regular Coca-Cola. Sooo, Mr. Alert-and-Oriented-Diabetic did 2 shots of syrup with a Coke chaser. His choice.

When I started nursing (only 10 years ago) residents were forced to comply a lot more than now. I had a fluid restricted resident who would take the back of the toilet lid off and drink from that after maintenance turned off the water to the sink, so they literally duct taped the toilet lid to the toilet.

These days, we allow them whatever and chart non-compliance and patient teaching. We can't "make" them do a thing they don't want to do.

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Specializes in Critical Care.
....

When I started nursing (only 10 years ago) residents were forced to comply a lot more than now. I had a fluid restricted resident who would take the back of the toilet lid off and drink from that after maintenance turned off the water to the sink, so they literally duct taped the toilet lid to the toilet...

I worked with a nurse when I first started who would do this, she would also put iodine in the toilet water to keep a patient on a fluid restriction from drinking it. A family called the BON on her, who then called the police, she was charged with felony abuse of a dependent adult, last I heard she was awaiting sentencing and likely looking at a year or more in jail.

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Specializes in Forensics, OB, QI.
I worked with a nurse when I first started who would do this, she would also put iodine in the toilet water to keep a patient on a fluid restriction from drinking it. A family called the BON on her, who then called the police, she was charged with felony abuse of a dependent adult, last I heard she was awaiting sentencing and likely looking at a year or more in jail.

That's crazy. If I'm understanding your comment correctly she was only trying to protect the patient and she didn't put it in faucet water, she put it in a toilet bowl.

What do you think of this CNN story of the patient refusing to go to the hospital after she hit her head?

Retirement home shut down after a death and a beating - CNN

Should the administrator been arrested?

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Specializes in UR/PA, Hematology/Oncology, Med Surg, Psych.
That's crazy. If I'm understanding your comment correctly she was only trying to protect the patient and she didn't put it in faucet water, she put it in a toilet bowl.

What do you think of this CNN story of the patient refusing to go to the hospital after she hit her head?

Retirement home shut down after a death and a beating - CNN

Should the administrator been arrested?

Was this an Assisted Living facility or LTC??

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Specializes in SICU, trauma, neuro.
That's crazy. If I'm understanding your comment correctly she was only trying to protect the patient and she didn't put it in faucet water, she put it in a toilet bowl.

What do you think of this CNN story of the patient refusing to go to the hospital after she hit her head?

Retirement home shut down after a death and a beating - CNN

Should the administrator been arrested?

It looks like there was a significant history of vios and citations, and if they are not devising successful improvements they needed to be shut down.

The amount of money and TRUST that families put into these facilities is absolutely mind-boggling. They have every right to expect their loved one is SAFE.

As for arresting the administrator, it's hard to say (although I admittedly only skimmed the last few paragraphs). Did she meet the legal criteria for criminal negligence? Did she prevent vulnerable adult reports from being made? Did she have prior knowledge that would lead a reasonable person to anticipate further incidents? The answer to the last point is "yes," as there were safety issues before this attack -- more than any other in the state, according to the article.

I do know that about 20 yrs ago in my LTC CNA days, we had one female resident enter the room of another resident and beat the woman's chest with her fists. It was considered a sentinel event. The assailant was initially transferred to gero psych, and then wasn't allowed to return. Her family had to make other arrangements.

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Specializes in Geri, psych, TCU, neuro--AKA LTC.

and nowadays, Gero-psych won't even take them without a bed hold...

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