I think I have an ethical work dilemma (nursing home-related).

In My Humble Opinion
1

I really need some what-to-do-next input. I really did try to make this short–sorry.
I’m a private caregiver for a couple of hours each morning for a lady who lives in a retirement home. I say “private,” but what I really mean is I work for an agency, which has placed me (and others) in this facility because the facility doesn’t provide companionship/caregiving/one-one-one type care.
One of my agency’s other clients is a very sweet woman who apparently rubs management the wrong way. They don’t like the way she dresses. They don’t like the way she eats. She’s too messy in the dining room. That kind of thing. I’ve heard from other caregivers that the staff and administration has “given her hell” about these issues, but never seen anything personally.
This morning I observed the administrator berating her–loudly, in front of probably 15 people in the front lobby–about the “mess” she made in the dining room. (She has very shaky hands, and I think the problem is that she leaves crumbs under her spot when she eats.) He was in her personal space, shaking his finger in her face, telling her that she is ruining their brand-new renovation, and he’s had enough of her, and he’s calling her daughter, and he is not putting up with this crap anymore. The whole time she stood with her head down, trying to wait him out and saying, “Okay, okay. Thank you.” She’s not hard of hearing, but his voice was raised enough that I heard and understood him while I was maybe 5 feet away from his turned back.
This happened in just a few moments–literally by the time I picked my jaw up off the floor, he was stomping off. I went over, hugged her, and told her not to worry about him, he has no right to talk to her that way. She was upset but is obviously used to this out of the staff and management.
I was absolutely livid–I mean stammering, shaking, furious. I haven’t been so mad since Dennis in the second grade made fun of Debbie because she was handicapped, and I slapped his face right in front of God and everybody.
Finally I calmed down enough to talk coherently (it took a while) and made a phone call to my boss, who happens to be Lady’s case manager. I explained the whole situation, and she promised to call Lady’s daughter and tell her what happened. I’m hoping that daughter will remove Lady from this place and put her in a better placement, but I’m not at all convinced that she will.
So, I’ve done my job as far as informing my boss/Lady’s case manager. But what about the basic situation? I witnessed an administrator (for God’s sake!) verbally abusing a clearly intimidated client who pays almost $2K a month to be in his care. If what he did is not plainly illegal, it would at least be outside the bounds of appropriate standards of care.
Should I contact Corporate? I would possibly be jeopardizing my job–not sure about that, but you never know. Certainly the jerk would make sure I never came in HIS facility again. I don’t know if contacting them anonymously would do any good, plus I’m not sure I could do it–I’ve done nothing wrong and shouldn’t have to be anonymous.
I can:
a. do nothing more.
b. contact corporate either after letting my boss know I’m doing so, or without letting her know.
c. contact corporate anonymously, which might do no good.
d. let it ride until I see if daughter takes steps, or if I see repeat behavior like this.

My main concern with further reporting is that, if Jerk gets in trouble but doesn’t get fired, he’ll just abuse her in private from now on. :frowning:

All I know right now is that I’ll be keeping my eyes open, and if I see this again I’m going to intervene.

Gah! Any advice?
karol

2

Is there some agency that oversees elder care? I remember when Granny was in a nursing home there were signs up about anonymous hotlines - I mean, I think they were more for things like “tie people to wheelchairs and let them sit in soiled diapers all day”, but it could be worth a try. Of course, you probably know a lot more about that than I do.

3

IANAN, IANAL but it would seem to me that you have an ethical duty to report the abuse of those you care for. Abuse can be mental. Next question, is this abuse?

I would guess that as people age, they become simpler in a way. As the old saying goes, “The child is the father of the man.” So to some extent, it’s like dealing with a child; you don’t want a big debate about when you’re going to have lunch etc. In that sense I would imagine the caretakers have to be more assertive than they would with younger adults.

It sounds to me like the administrator has dealt with her and reached a kind of wits end about her. It could be that the administrator hasn’t developed a thick skin or it could be that she’s very good at pushing buttons. In any case, there’s a big difference between being assertive and being aggressive and from your description, I’d say the administrator crossed it. There’s no need to humiliate.

I’d pick option A for the time being. Maybe the daughter will have a talk with the administrator and address the problem. Meantime, you might start documenting events in case you need to do more for her or CYA.

4

Is there an Adult Protective Services in your area? This is like CPS, only it’s for the elders who are in danger of being abused.

5

Maybe turn it around - if you saw someone you knew doing this to a child you knew in your facility, what would you do? Would calling the child’s parents be enough? Or would you still feel obligated to involve authorities? You know better than we do what level of abuse you witnessed.

6

To an extent . . . but there are also client rights. As I understand it (being the wife of a fairly new CNA who works in a nursing care facility; I wish he were here to clarify), clients should have the right to stay in bed in the morning, to stay up late at night, or not to eat lunch at a prescribed time, or to refuse baths, meds, or basically any type of care.

It doesn’t sound like this poor woman has done anything wrong, at least not that the staff are justified in complaining about or punishing* her for it. She should be allowed to dress how she wants (probably within the bounds of decency; not half-naked in public areas, for example) and eat as much or as little as she wants, or have her dessert first and refuse the peas, and if she makes a mess because she has tremors, well, then it’s the staff’s job to clean it up and/or find a way to help her.

Another thing is that personalities change so much when you are dealing with dementia, which this woman may or may not have; I’m sure that most “troublemakers” would be mortified if they were in their right minds and could see how they had been behaving. And then there’s the frustration of living in a facility and having almost no control over most aspects of your daily routine. People like Asshole Administrator are not helping.

Mr. S gets so pissed off about co-workers who toss clients around like rag dolls, giving them care against their will or in a rush so they can hurry up and get to their cigarette break.

bodypoet, thank you for being one of the good caregivers. Keep us posted. I’ll ask Mr. S if he has anything to add.

  • I initially mistyped “punching”. :eek: At least he didn’t do that!!
7

Aged care registered nurse here. Disclaimer: not your country but I hope I can guide you in the general right direction.

Does mandatory reporting* exist there? If so, does it cover verbal abuse? It may be that you are legally obliged to report what you have witnessed. I’d find out quick smart.

I believe that aged care facilities** in the US have similar Outcome Standards to that which we have here and are also answerable to a government body. IMO a standard (or several) have been breached by what you describe - do you know which government department to report to? Anonymous reporting is allowable here.

In addition, there may be an independent complaints body which you could report the incident to for further investigation. This is a government body but a completely independent organisation also exists for complaints. In your situation, I think this last sort of an organisation would be your best bet as they advocate in a broad way for the elderly person involved rather than act in a punitive manner toward the residential aged care facility.

Tread carefully and quietly. It can be a nasty industry. But you knew that already.

  • relevant bits of the legislation here:

In the Bill a ‘reportable assault’ is unlawful sexual contact, unreasonable use of force, or assault specified in the Accountability Principles and constituting anoffence against a law of the Commonwealth or a State or Territory that is inflicted on a person receiving Commonwealth funded residential aged care services. If an approved provider receives an allegation of, or starts to suspect on reasonable grounds, a reportable assault, the approved provider is responsible for reporting the allegation or suspicion as soon as reasonably practicable and in any case within 24 hours. The report must be made to a relevant police officer and to the Secretary.

‘Staff member’ is an individual who is employed, hired, retained or contracted by the approved provider (whether directly or through an employment or recruiting agency) to provide care or other services

** “retirement homes” may come under different legislation

8

Well, before everybody starts piling on the evil elder-abusing administrator, I’d like to point out a couple of things that pop out at me from the OP.

A. You don’t know what was the mess that she made. For all you know, she could have smeared feces all over the walls.

B. I doubt that dropping crumbs in the dining room would have generated such ballistic fury.

C. I doubt that dropping crumbs would have “ruined a renovation”.

Thus, I presume that she really did make a huge, difficult-to-repair mess, and perhaps the administrator’s anger was justified. Now, he probably shouldn’t have berated her in public like that–but then again, for all you know, maybe she does this kind of thing all the time, and maybe this is the only thing that works with her, is public shame.

So I don’t think you have an ethical problem here at all. I think it’s basically none of your business (she said tactfully :smiley: ), since you have no facts other than the fact that she got chewed out in public. Sure, she’s a paying customer, and sure, he was tactless, and props to you for being kindhearted, and if you wanna report it to Social Services, that’s your prerogative, but other than that, I don’t think it concerns you.

I spent a couple years working with Adult Foster Care in a live-in facility in Michigan, and some of the sweet little old ladies were the worst hellraisers. And it was the most pitiful ones sometimes that the social workers would have absolutely no patience with anymore, because they would drag in innocent bystanders (like you), with the pitiful old lady act, when the social worker knows from bitter personal experience that she’s tough as nails and is manipulative psychopath into the bargain. And so the social worker would have to sit there dealing not only with the Problem Child, but also with this outraged bystander who knew nothing about the overall situation, but who had been appealed to by this old lady in distress, and who saw himself as standing up for this poor persecuted old lady. Which the social worker didn’t appreciate.

So, what I’m saying is, don’t get too involved here, because you may regret it later.

Especially if your bosses take a dim view of you getting involved in issues where the nursing home might not appreciate your company (as represented by you) butting in to the way they run their facility, and calling Social Services on them. The nursing home might not appreciate it to the extent of canceling your company’s permission to have their employees (like you) come in and perform your services.

You’ll do what? All this will still obtain. Are you going to risk your job for this woman, bearing in mind that you don’t have the facts, and that you may wind up being shown to be totally in the wrong, having misinterpreted the situation?

9

It sounds to me like bodypoet’s boss did have a good grasp of what the next step was in this kind of situation, namely to call the daughter. That at least is reassuring.

Bodypoet, before deciding what, if anything, to do now, first I would do some reality checking. You were not the only witness to the berating, were you? Ask other caregivers if that was typical and if they thought it was justified. If no one else was concerned, either DuckDuckGoose is right and you don’t have all the facts, or they are burnt-out zombies who don’t care anymore. You’ll have to make the call on that one.

If the other witness agree with you that the administrator was way out of line, next I would thank my boss for contacting the lady’s daughter and ask to be updated, unless there are confidentiality rules, on what the daughter’s reaction is.

I’d also ask my boss for some training on what the laws are in your location regarding reporting elder abuse (in fact, it is a bit odd that they send you out to work without training you on this subject first - even if they don’t care from a moral perspective, they should be doing a little CYA in their own self-interest).

Hopefully the boss will come through (not just for you, but by providing information to ALL the employees) on what constitutes elder abuse and what the reporting requirements are. If she doesn’t, you’ll have to find out on your own - it might take a while but a few phone calls to government social services offices and I’m sure you’ll eventually find the information you need.

I would also explain to the boss that you are very troubled by what you saw and, pending the daughter’s response, may feel that you need to take further action. Ask your boss what she recommends.

No further ideas for now because it all depends on what the law says, what the daughter does, and how the boss reacts.

10

If you look at the Medicare website, there is a section on nursing homes. They provide some information on complaints received and that sort of thing.

http://www.medicare.gov/NHCompare/Include/DataSection/Questions/SearchCriteria.asp?version=default&browser=IE|7|Windows+Vista&language=English&defaultstatus=0&pagelist=Home&CookiesEnabledStatus=True

We looked at this when one of the in-law relatives was going into a nursing home. I hate nursing homes. It helps to have caring professionals doing the day-to-day interaction with the residents, but in my experience, they are few and far between. The industry needs whistle blowers, and I hope the OP decides to go that route.

When my SIL went into the nursing home, the first day they sent in a woman who hugged her and cried with her, handed out business cards, compassion, blah, blah, blah…

The Reality of the Situation kicked in the very next day. Two workers per floor, tasked with assisting, changing, bathing, changing, cleaning up the room, and changing. Unfortunately, my SIL was fully aware of the Reality of the Situation (had her full mental capabilities). When you ring for a nurse because you have to be changed, they get to you in your turn. There may be an hour or two of other resident care happening in rotation. So you sit. And sit. And sit, waiting for someone to assist you.

I know it’s a huge undertaking, I understand the cost involved, etc. Even the best nursing homes face problems with manpower and high quality workers. Every little kindness makes the whole situation less horrific.

11

I appreciate all the points everyone has made. Of course, DDG, I don’t want a pile-on (else I’d have posted in the pit), but in response to some worthy issues raised by various posters:

Yes, I do know what the mess was. This administrator has a history of berating this resident over this very problem (mess under the table), as other caregivers and residents have told me. And I do know–for an absolute fact–that she did not smear feces, set fires, break lamps, or any of the other millions of behaviors that you might assume would set off a tirade of the magnitude that I witnessed.
As to items B and C: exactly. One would doubt that such fury could be directed at someone for making a mess under the dining table, and it does seem (it IS, actually) impossible that such a mess could “ruin” a renovation. Of course it didn’t ruin the renovation. Of course he was acting way out of proportion with the event. Which is, in part, my very point.

I appreciate your work with Adult Foster Care, and I know the very type of manipulative hellraisers you mention. I believe that’s not the case here–I don’t see her manipulating anyone–I see her having trouble keeping her toast on her plate and her cereal on her spoon and then getting yelled at for it. She didn’t ask anyone for help, and she doesn’t ask anyone to intervene with Admin.
Regardless of what she did, short of actual intentional vandalism, this man’s behavior was absolutely unacceptable.

I believe I do have the pertinent facts, and that I have not misinterpreted the situation. At worst, perhaps she spilled coffee instead of toast crumbs. I checked under her table this morning and it didn’t look any worse than anyone else’s.

So yes, I guess I’m willing to risk my job to do what I think is the right thing. It’s not about just this woman; it’s about doing the right thing and being a responsible advocate.

I haven’t looked at specific laws yet, but I doubt that Admin’s behavior constitutes a legal definition of elder abuse. That doesn’t mean his behavior wasn’t abusive or that it shouldn’t be reported. CairoCarol is right: much depends on the daughter’s reaction and what happens over the next few days. At the very least, I think it’s appropriate to contact Corporate just to give them a heads-up: Hey, do you realize that one of your administrators is behaving this way? How might that affect your bottom line?

bathsheba Thank you. Some very good links that I will look into more extensively.

One important concept I learned as a teacher: It’s my job to report. It’s someone else’s job to investigate. That made the decision-making process much easier for me–no agonizing about suspicions like was it actually abuse? was mom in a bad mood? did kid instigate it?

I need to do some research. Thanks for all the input.

12

I think you have gotten some good advice - the only thing I would add is this - if you intend to pursue further, you might want to consider which “other caregivers” that you mentioned might be willing to corroborate your story. Since this is the first time you have witnessed the abuse, in order to create a better paper trail or case of evidence, it might help to know that these others are willing to stand with you.

Also, make sure that you consider that the agency you work for is compensated by the nursing home (I assume) or recommended by them - so they might not want to burn their meal ticket.

I worked at a nursing home as a social assistant (re: companion) and this was a flashback for me. By all means, stand up for her and for yourself (who knows but you may be in one someday too) but do so wisely.

13

I should’ve clarified before, but I kept forgetting…now it probably isn’t important, but still.

This place is actually a “retirement facility” which means nearly everyone lives independently. There is no nursing or caregiving staff other than the housekeeping, dining room, and administration, and I think an activities person. Any direct care is provided by private (agency or independent) caregivers. I shouldn’t have called it a “nursing home”, but my brain was still stammering with outrage at the time.

At any rate, melodyh, it sounds like you did the same type of work I do…basically provide companionship and monitoring. I work for a private agency that provides companionship caregivers to individuals–we aren’t employed or compensated by the facility, but by the client herself. I don’t think we even contract with facilities, at least with this one.

Okay. Now I feel like I’ve been clearer.

14

Just call me mel - everyone else does :slight_smile:

I was rather young at the time, and I was employed by the facility I worked for and it was a nursing home.

But since you have clarified, I feel more confident that your agency would have no corporate dilemna about seeing this through with you.

AND - given that you are employed for the residents’ benefit - it is your obligation to act on their behalf where they might be no longer able to, whether out of fear or insecurity or dimentia, etc.

imho, fwiw.

15

Holy shit.

Document, document, document. In objective language, please: "director observed to wave forefinger in near proximity to resident’s face, speaking in loud tones, said:“blahblahblah.”(instead of “he got all up in her face and I could tell she was scared.”) etc. Keep a copy of this-date and time, please. Names, positions etc, too.

I am not all that familiar with NH/ALFs care (or lack thereof) and the ramifications, however, it is one of the most regulated industries out there. Google nh hotlines in your state and call. It sounds like they want her gone, for whatever reason.

This guy is way over the line. One thing that seems to have escaped some poster’s notice is that this a type of assisted living facility. It exists for the sole purpose of catering to the increasing dependence and decreasing capacities of its residents. This IS the place where Grandma is supposed to be able to spill w/o fear of retribution etc (not that she should face that kind of thing at home, either, but I digress). If this place can’t handle crumbs under the table, it certainly cannot handle sex among residents, the smearing of body secretions and excretions, the kleptomania, and petty feud wars that arise at times among residents.

And you know what? IF Grandma HAD smeared shit or lit a lamp on fire or whatever, doesn’t matter (well, if it did, it should be stipulated in the contract prior to her admission). I know of a woman whose mother was placed in such a facility and she deteriorated into profound Alzheimer’s much more quickly than anyone had foreseen–the place called the woman and said your mother must be moved into the special “neighborhood” for AZ pts. She was and is there now. This woman (from the scant amount here) does not seem to meet that sort of criteria. Either way, intimidation, and verbal abuse is no way to treat ANY pt-I don’t care what they’ve done. :mad:
Hmmmm… it seems this is more of a retirement community. I still can’t believe that such behavior is acceptable. Would it fly at a condo’s homeowner’s assoc.?

16

I don’t have anything to say, except…

…thank you for that.

And thank you for caring.

17

bodypoet- whatever you decide to do, will you let the lady involved know?
I think she has a right to know what steps you are planning to take.

My vote, FWIW would be to ensure the consequences come down like a ton of bricks on that guy’s head in whatever way seems most appropriate to you.
My 92 year old mildly confused and decidedly eccentric grandmother moved into a residential home last year. She gets to wear whatever she wants (usually woolly hats, a big cardigan, several jumpers and slacks).She eats whatever she wants (she has wheaten bread, tea with condensed milk and chocolate for most meals, with the occasional boiled egg) either in her room or the dining room. She goes to the chapel when she feels like it, chats to other residents when she feels like it, pockles about the grounds, wears her teeeth only when she wants to and tells the staff off if they don’t dust the skirting boards properly or put hospital corners on her sheets. She has never been treated with anything other than respect, kindness and understanding, and loves all the staff dearly.
That’s what a residential home is supposed to be like. It’s not supposed to be institutional and regimented, it’s supposed to be home.

This guy was so far over the line it isn’t funny.

18

I worked in a nursing home for almost 11 years, started sweeping floors when I was 15, then slopped food in the kitchen, worked my way up to a cook/supervisor through high school and college and then quit.

They trained us very well on what was abuse, and what Bodypoet described would land anybody on the curb in about 2 seconds. I don’t know if it was a state law(though I guarantee it was), but per our handbook I was required to report it.

I reported quite the # of people over the years, personally about 6 that I saw, 1 that one resident I used to visit with told me about, but was scared of retaliation, and several times, when my people came back from delivering meals, if they told me about something, I would drag them straight to the administrator or nursing supervisor to make a report. Quite a few times people lost their jobs because it was not an isolated incedent.

My mom is also and RN and was the 3-11 supervisor of the facility I worked in, she quit I stayed(how do you think I got a job at clost to double minimum when I was 15, I kept it on my own merits though), so I had somebody I could trust to bounce things off of, this was key in me not having any fear in reporting abuse, though the first time I did, until she really explained it to me.

Duck Duck Goose, these are not children, these are people that have raised children, fought in wars, run companies(we had one guy in our facility that owned and was still very active in a very large multinational company, he was there mostly because of his wife, but he also needed physical help, his brain was sharp as a tac though), invented things, played professional baseball, they don’t need “discipline”. You aren’t going to teach them a damn thing. They are there because their brain and/or body is going down hill.

When they are just purely nasty, and there are some. There are legal procedures to have them removed. You have no right to yell at them like they are a child, this poor old lady is in this administrators care, and he is getting paid to care for her, not berate her, not to mold her young mind, not to discipline her.

Retirement home or nursing home, that is abuse.