Would you ask to be taken off this case?

[Megsd, BSN, RN]

I'm a HHA in kind of a weird position. I was given a pt to see on my assigned weekend about a month ago, first as a fill-in and then as a permanent assignment. When I called him the day before my first visit to confirm a visit time, we had a weird conversation. He told me he understood that we female aides need to be cautious when visiting single male pts who live alone, but he assured me he was harmless and since he is terminal with MS and other disorders he "can't get it up" and couldn't do anything to me even if he wanted to, so I had nothing to worry about. I thought this was bizarre, but didn't think much of it.

I saw this pt for two weekeneds without incident. He only asked me to cook breakfast/lunch for him and empty the trash, rather than any personal care, and I charted accordingly. I found him to be charming and a good conversationalist. He told me how much he enjoyed his aide who saw him bid Monday-Friday. He also told me about one of his old aides, who now works in the office. He told me that that aide might tell me he "assaulted" her, but that was a lie, and she was just bitter because he suggested she leave her controlling husband. I thought that was weird too, but again, didn't think much of it.

This past week I was asked to start seeing this pt some during the week because his weekday aide was fired. When I agreed to take the hours I was told I had to get briefed by a supervisor first. The supervisor told me the aide had been fired for fraudulent charting. She had recorded lots of personal care they do not believe was done since charting on weekends clashed so much with weekday charting. They were concerned that the pt had manipulated the aide into charting things she did not do in order for Medicare to continue paying for his visits. The sup told me to be very vigilant about my charting, and warned me that the pt can be very manipulative and shady, so to always be on my guard so I don't get lured into any of his games and end up losing my job too. This made me nervous, but because I was already familiar with the pt, I accepted anyway.

This weekend I called the pt to confirm starting the new visits. He was upset about the restaffing since he so enjoyed his other aide, but was glad someone he knew would come. He wanted me to come at a specific time, but this interfered with my school schedule, so I called the office to see if I should try to convince the pt to change the visit time for me, or if the case needed restaffing. The office person I spoke to turned out to be the "assaulted" aide. She told me that she thought he was creepy and that shortly after new year's she was doing a visit with him and he told her she needed a new year's kiss, came up behind her and started kissing her. She told me to watch every word I say and to be extra vigilant about him.

I went ahead and did the visit on Monday and he wasn't feeling well, so I just heated up some dinner and was gone in about 20 minutes, but now that I have all this extra, creepy, info about him, I'm not sure if I should continue the visits. Obviously I try not to disclose too much personal info to my pts as a rule, and I am always honest in what I chart, but I feel I am being forced to completely distrust this guy, and I'm worried that he might try something on me. I was very uncomfortable and on guard when I was there yesterday, and very relieved he didn't want me to stay long.

With all this in mind, should I ask for the case to be reassigned, or am I overreacting and just need to focus on caring for this pt unless and until he tries something inappropriate on me specifically? I guess I'm not sure where that line is. Thanks for your advice on this one.

[beautifulb]

Well, he does sound a little strange. Did the supervisor give you specifics as to why they feel he is manipulative and "shady"?

It is normal for you to feel uncomfortable taking care of him with everything that has been told to you. But if all this is true then I would think twice before working with him.

Remember what the supervisor said that you could end up losing your job because of this man's manipulative ways. You don't want to lose your job because of this man. And I think that if he truly assaulted the other aide, that right there would be a warning sign.

[LoriAlabamaRN]

I think you just need to keep the information you have about this man in mind and be religious about charting and documentation. Remember that it would not be wise to be too friendly with this man, and keep in close contact with your supervisor, report anything that you see that may be shady. Unless further problems develop, I would not ask to be taken off the case. It seems to me it would be a good opportunity to show your ability to handle difficult patients.