Unsanitary Condtions in Home/Can I refuse to take case

mamamerlee, LPN · Nov 1, 2009

Is your agency truly aware of the circumstances? Has anyone contacted the Board of Health? Who is the responsible adult in the house, and does that person have the wherewithal to deal with all of this? Have you contacted your agency's social worker?

You can not be expected to jeopardize your own health for that of the patient.

MayBoo · Nov 1, 2009

Thank you so much for your input. I went back and read my post. Boy oh boy, I was stressed when I wrote it. I think I was shakeing. Thanks for over-looking all the errors in the post and giving me sound advice.

KateRN1 · Nov 1, 2009

I agree with above. The first place to go is the agency's social worker. If this patient qualifies for in-home nursing care, s/he may also qualify for a homemaker service that can help with some of the filth, if the pt's family is agreeable. Is this also an issue of needing a little chlorine in the gene pool? If your pt is a child, then this may end up being a referral to your state's department of child welfare.

caliotter3 · Nov 1, 2009

People have left cases for a lot less reason than what you give. You can not be expected to work in these conditions. If the agency fails to provide you with work because you request off this case, then you need to find a new agency anyway.

FanofCamo · Nov 2, 2009

As an LVN there is usually an RN case manager. You have to report those conditions to the agency because its not good for your patient who has a trach. You have the right to ask for a new assignment but keep in mind it may not be the hours you want or even the days. I have done home care now for 13 years of my almost 15 yrs of nursing and have found a few bad cases (those are the ones that have the good day shift hrs and not weekends). I try to stick to a few cases since that keeps me from being short hrs if my pt goes into the hospital or anything else happens. Speak up not only for you but also for your patient.

erroridiot · Nov 8, 2009

Protective services in my area takes the position that a person can be as dirty/messy as they want because this is their right.

I have been in homes with stinking, slime covered garbage higher than my knees and have trudged through this mess to get to the patient. The patient was laying on the floor nude waiting for me to provide care for some very deep and very infected wounds. Social workers, government agency caseworkers had been there over and over and could do nothing. The home had such a stench that I had visions of decomposing bodies stashed somewhere under the garbage.

I went to another home that had at least hundreds of bedbugs all over and marching all over the patient and up the walls. I had at least 3 bedbugs on me that I know of including one that was trying to climb up my nose. One of the bedbugs bit me on the arm. Again, the patient had a government "caseworker", social worker, etc. and none of the agencies involved lifted a finger to assist with extermination, cleaning or anything the patient needed.

I asked my employer for personal protective equipment such as gown, hair and shoe covers (after explaining the bedbugs and my unwillingness to take them home with me) and was denied. I did not go back to see that patient, but turned it back over to the agency. It was time to move on. The agency would not change.

Hopefully, social workers and social service agencies in your area are more helpful and your employer is more enlightened than ones I have given as examples. There are a few decent employers out there and I hope you will find one.

mamamerlee, LPN · Nov 8, 2009

Dear erroridiot! where is the board of health??? Something is very wrong whereever you are practising. I've worked in 3 states, and none would put up with that kind of tragic living conditions. How very sad for all those involved.

And your agency not providing you with PPE? No, no, no. You had no appropriate surface to even step on, let alone put down your nursing bag/equipment. A call to the licensing agency might be in order, too.

Sorry for the yuckiness.

erroridiot · Nov 8, 2009

The nurses at one of those agencies had a little inside joke that if the surveyor showed up, we were going to use this case as a visit to show the surveyor what real home health nursing is all about and what real home health nurses do.

Not funny, but unfortunately so true at times.

tewdles, RN · Nov 8, 2009

I agree with all of the advice regarding notificiation of appropriate disciplines and agencies to investigate the situation. However, my experience is that nothing may change, especially if there is not a child involved. You may well want to refuse this case...only you can decide that. Honestly, too many people live in unbelievable filth...we get to see it all when we visit them in their homes. I will admit that there is a big difference between me visiting in that environment for 60 minutes versus spending 8 hours there. I can put up with a lot for an hour...

In this case, make sure you watch the trach closely for maggots. The flies will consider that dark, moist opening a perfect nest for eggs. Good luck.

bluejumperbunny · Nov 8, 2009

I agree that this client should be referred to agencies that may be able to offer some help. I also agree that you should not be expected to work in these conditions. If you're spending 8 hours a hay with this person, this tells me that they are probably quite vulnerable and may be unable to properly clean their home. Not to mention the risk to their trache. The key though is detailed documentation. I think you should put, in writing, your concerns of this person's living conditions to their health so that hopefully the home help can be swift and thorough. Of course, don't forget to ask the client whether or not they will accept people coming in to clean up for them and document this discussion also.

The reason I say to document everything, is so that if the patient dies of some horrendous infection they've picked up in their home, you can be cleared of neglect as there is proof you've done what you could to help. Also, if your employer starts to mistreat you because you've finally decided to refuse the case, again you have proof that you were put in unsanitary conditions and that it is wrong to be unfairly treated when you have your own health to protect. I hope this helps.

jnette, ASN, EMT-I · Nov 9, 2009

Wow... these cases are always reported at our agency. We hit every agency out there to step in. If all else fails, we try APS... whatever it takes.

The owner of our agency has personally had roofs put on homes that were leaking on the patient, she has personally had repairs done to old flooring which was breaking through... I can't begin to name all the things she has personally tended to for our more unfortunate patients.. just "because" She is an amazing woman.

But as to the sanitary conditions (or lack thereof)... yes... something must be done to protect the patient, first and foremost. Your MSW should be out there checking on the reported conditions and taking it from there.. that is HER job. She knows what resouces are available, what the options are.

This sounds, really, really bad. We've had a handful of bad ones, too...I believe all HH nurses have seen some shockers out there from time to time. Sad, really.