What do I do? Roaches, no heat...

[SDALPN]

I've started with an agency recently to do private duty. I was mislead from the beginning. I was lead to believe that I would have peds cases and was put on an adult case. I'm very uncomfortable with this. To add to that its a complex case. I had/have my hesitations but desperately need work (haven't worked in months). I've been trying hard to make it work and to learn what I can.

I've done private duty for years and I have seen roaches before and other unsanitary conditions. This is no shocker to me at all. So I arrive at this patients home to find that it is in the ghetto of the ghetto. The majority of the homes around this place are condemned. I still decided to give it a chance and not judge the book by its cover. What I discovered was a home infested with roaches. The family keeps the windows open year round and doesn't run the heat. Even the window in the patients room is open. The high temp has been in the 30's. My assumption is that they can't afford the heat. I addressed the roach problem with the agency and they claim they have discussed it with the family. I have to watch for roaches constantly to avoid having one crawl on me. The family is very sweet. They don't have much of an education and I see an opportunity to do lots of teaching. But I don't think I can work in this environment. The thought if it being that cold in the home and having to give the patient a bath is disturbing...so are the roaches I have to keep from crawling on the patient.

I desperately need the paycheck as being out of work has left me almost completely broke. I don't feel comfortable with the complexity of the case, but I can learn. I'm comfortable with very complex peds cases. I just lack the experience with adults. So I do feel capable of learning what I need to know. I'm not comfortable with the roaches or the freezing cold home. I can't work in that kind of environment. The agency doesn't have any other cases available. I'm not impressed with the agency at this point. They have mislead me and the training has been poor. The orientation for the company pushed safe driving and made us watch a video about it. I won't be driving any patients. I have had 1 ticket in 17 years of driving and don't need to be told how to drive! But they never taught how to do paperwork in orientation. I would think the paperwork would be more important to learn than safe driving since I won't be using my car for work purposes. Its obvious the DON wants a warm body with a license...but this warm (when not on the case) body has a brain in it!! There isn't much work around here and it took me months to find this job. Any options? I'm already back to looking for other jobs in case anything else comes up. But until then?

[Flare, ASN, BSN]

Yikes - just reading that makes my skin crawl. This family needs an entire overhaul. Is there a social worker involved with the agency? I'd ensure he/she knows what the living conditions are. A cold, roach infested house is no place for a person that needs nrsing care. I think an evaluation of their overall case needs to be done. If the agency doesn't want to take that approach, then go to the public level.

Is there a public health department that can help intervene in the case of the sanitary conditions of the house and the lack of heat?

In the meantime, keep looking for jobs - best of luck

[RNfaster]

I am not experienced in home health, but I wonder if a call to the health department and/or adult protective services might be in order...

[AnaCatRN]

I feel horrible for your patient AND you! You need to call the appropriate authorities to report that the family is keeping this patient in unsafe and unsanitary conditions. I don't know what state you live in, but in some states (should be all), those who are on state funding can get extermination services paid for by the state. I was told that when I started working in pediatric private duty, but I'm pretty sure it applies for adult patients, as well. I would get out of that job ASAP. If you can't find another agency, take a job doing something other than nursing until you do. Your license could be on the line if something happens to that patient (disease, frostbite, hypothermia) and you didn't do anything about it (since you clearly know about the situation). I hope you are charting that the windows are open and there is a roach infestation. That's absolutely unacceptable! Your health and safety are also on the line whenever you go there.

[SDALPN]

It is all being charted and reported to the case manager and DON. I'm very concerned about the patients safety and mine. I'm trying to find a way out and also avoid losing my home in the process. I'm looking for other work. But I also hate to leave knowing that this patient will still be there. Its so bad its keeping me from sleeping at night. No human should have to live like that! And no human should have to work in those conditions either! How do I find these crappy companies and cases? Or how do they find me??

[gonzo1, ASN, RN]

I understand that the family is sweet and perhaps just uneducated, but this scenario is wrong on so many issues. You must first protect yourself and your license cause nobody is going to do that for you.

You have got to report this situation to adult protective services. The person will most likely be placed at least temporarily in a nursing home till things are cleaned up at home. If you don't get some help for these people then you can be in trouble with the law for aiding and abetting.

Your agency is only interested in the money they make from this family. They do not care about you or your license.

After you get the pt taken care of, can you consider working as a peds travel nurse or move to a different part of the country. CA, alaska, texas, florida all have multiple nursing needs. Please don't sit on this any longer and hope it gets better, this is a serious situation you are in.

[wbdtrt]

A safe environment is not being given to this patient. Now that you know this, it is your responsibility to report it. Somehow if, god forbid, something should happen to this patient, it will fall on you. Your agency will not cover your behind, ONLY theirs. Hotline this family, may be the only way they will get intervention, and get out of there. I have been, and still going, through your financial hardships. You must take care of you first. It does not sound safe for you.

Be safe and stay strong

[AnaCatRN]

That is a rough position to be in. Contacting the public health department is a must. It seems you work for a very disreputable agency, indeed. You're right that no one should live or work in those conditions. The family may seem sweet to you, but they are neglecting and abusing the patient by keeping him in conditions like that.

Are there really no other agencies around you? My agency takes action for patients in cases like this, and would never force me to work in conditions like that. I, too, have found some crappy agencies, including two that misrepresented the work I would be doing (one was supposed to be a peds agency but asked me to take an adult who required me to drive him places and clean his house - I'm a nurse, not a chauffeur or maid - the other told me they had plenty of cases near me when I interviewed, but only ever offered me assignments two hours or more from my home). I finally found a real peds agency and am treated like gold. Your agency doesn't care about you OR your patient.

[caliotter3]

I think you know the answer. If you want to work, you will have to deal with this case. Document your efforts both with the family, and with your nursing supervisor, thoroughly. Wear thermal underwear beneath your uniform. Or, deal with the alternative of having no work. I go for weeks and months at a time with no work and end up with ghetto cases that I normally would not accept. As soon as I can finagle another case, I am out of there. Badger the agency for another case. Look elsewhere for another case. Meanwhile do your job if you want the income. Sorry this is the only answer I see.

[MomRN0913]

You really need to call social services. This is an environment condicive to sickness, not healing. I would call social services right away.

Pplease try to look for another home care agency.

[GLORIAmunchkin72]

There is also the possibilities that you may take one of those creepies home with you...

[Rabid Response]

You are a mandatory reporter. If you don't report this situation to APS and something happens to the patient due to these abominable conditions, you may lose your license and never be able to get any job again much less the crappy one you have now. I understand that you need the income, but this patient is at risk, and you have an ethical as well as legal responsibility to do right by him/her.