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I have been working as a caregiver at an assisted living facility for a month now. I previously worked at an assisted living facility for 5 years and am an occupational therapist by trade, waiting for my degree to post and to take my boards. While at the facility, I have been caring for a resident who requires max directional cues with moderate-severe cognitive deficits, mod assist x2 for all bed mobility and ambulation, and total assist x 2 for all rear peri care. The individual has a complete prolapsed rectum that is causing incontinence of the bowels, pain, and is setting the resident up for skin breakdown and infection. The resident is experiencing so much discomfort she continues to lay on her side throughout the day, causing muscle weakness. The husband and daughter are the only family members I am aware of. The husband I both physically and verbally/emotionally abusive, as I have witnessed him spank her hard on her bottom to move her forward at a faster pace. He laughs at her anytime we are working with her, saying she doesn't know anything and its hopeless. She eats in a reclining chair; there are only 2 staff members per 50 residents and we are not sufficiently staffed to assist her with self feeding despite the need. Often, we assume he eats her food. The daughter has been made aware, and after returning from doctors visits, etc. She hatefully states, "she's fine, besides the obvious!" Staff has continually notified management of the issues at hand, with management stating, "she can evacuate, so she can live here" I have continually questioned this notion with management with no adequate response. Management has finally agreed she is unable to evacuate and currently is requiring a daytime sitter for her from 8a-3p. I have heard that they have requested 24hr sitter assistance, with family stating they can not afford it. I feel as though I caught between what I ethically know is right. I am not sure of assisted living laws, but I know she needs a higher level of care and medical attention for her rectal prolapse. If anyone has advice on how to go about rectifying the situation, advice would be greatly appreciated. I only know what I am told and observe, but I feel as though the business itself could take further steps to get the resident the medical attention she needs. Anytime I make any recommendation or state medical necessities for the resident, I am told we are a non-medical facility and the care is reliant on the family.

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gertrude ,
you might at times see things that you believe could be better -- but -- if the usa is getting its elderly off the street and into a warm and safe place , thats a heck of a start . im a rural person . i can imagine freezing to death in a matter of hours if there was no elderly safety net at all .
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It is unfortunate that some ALs will keep a resident when their needs are clearly well beyond what they can handle. Did you know sometimes administrators are financially rewarded for keeping a high occupancy rate?
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About the family interactions ... they are what they probably always have been. That is very sad. Other than insisting strongly on no physical abuse, I doubt that any facility can fix that.

A visiting nurse told me once that she really enjoyed coming to our house. There was such mutual respect between my husband and me. At the time I thought that an odd comment. Of course there was respect. We were married. We were partners. We loved each other. Dementia didn't change that. Why would this be worthy of a remark?

I now know that many family relationships lack basic respect. Very sad. I doubt that a professional caregiver or a visiting nurse can change what has been going on for years. Keep modeling respectful treatment!
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It seems to me that the administration is right -- they are a non-medical facility. This woman needs more care than is available in Assisted Living. A nursing home is staffed to provide the level of care she needs. I don't suppose that you have any influence over where she resides, but I'd be hoping she goes where she will get what she needs.

If the family cannot afford the care she needs, they should look into Medicaid.

Continue to be an advocate for this resident. Sounds like she can use all the friends she can have!
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Babalou is right pick up the phone and call APS you are witnessing abuse both medical and physical of a vulnerable adult. I don't know if you are yet a mandated reporter not yet having taken your Boards, however you have a moral obligation to help this poor defenseless woman.
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You are a mandated reporter of elder abuse, are you not? Call APS.
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