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We had a new move-in a while ago, and this particular resident has advancing dementia, she's difficult to redirect and combative with a lot of the caregivers here. She's frequently coming out of her room underdressed, or undressed entirely, and knocks on other residents doors asking them to help her because the door (their door) is locked. She also tends to be awake a lot of the night. She's incredibly confused and getting to the point where she doesn't remember anything anyone tells her for more than a minute.


With all the other residents to care for we were already stretched thin, and she really isn't getting the level of care she needs. Sometimes it seems like we have to choose between keeping her safe or taking care of the rest of the residents on her floor, which isn't fair to anybody. We have all told the staff in the office many times that she does not belong here, she truly needs memory care, but thus far they've not done anything about it. My question is, would any aspect of this be considered a form of neglect? Does anyone have any advice, any experience with a situation like this? Is there any way to help find her a better facility?

Keep in mind that there is only so much our OP can do. She does not have the authority to call family meetings, order evaluations, reassessments or consultations. She can suggest to her supervisor that, in her opinion, these things need to be done, but certainly sounds like it’s falling on deaf ears.

Worried, if what you write is true and your Director has placed this woman in your care with what sounds like little regard for what she or the other residents need, you now need to make sure you are covered in case something happens on your shift. Getting together with the other caregivers on your shift and presenting a united front that this woman doesn’t belong on your floor will most likely cost you your job or at least label you as a troublemaker. 

Start documenting what you see with dates, times and events; “On Tuesday, October 31st, at 10AM, Mrs. Jones was wandering around, agitated and without clothing, in the hallway. STNA Smith and I spent 15 minutes trying to get her dressed and calm her and try to get her back into her room. In the meantime, Mr. Roberts buzzed that he had to use the restroom. Mr. Roberts had to wait until we got Mrs. Jones settled.”

It would be great if you could get STNA and your charge nurse to sign off in this, but don’t pressure them. Then, if Mr. Roberts’ or Mrs. Jones’ family lodges a complaint about their care at a Care Meeting, you can pull out your notes. 

This sort of disregard of patient’s needs gives a bad name to facilities everywhere.

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Reply to Ahmijoy
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First thing to considered is to getting a medical consultation, or reassessed for clear medical diagnosis.
Secondly, If family is available staff to coordinate a family meeting to discuss care options.
Thirdly, staff to refer family to a care manager to help with coordinating appropriate care.( a private care giver, new activities for level of care, etc.).
Lastly, if all else fails staff will need to assist and prepare for transition to memory care facility.
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Reply to BeJaye
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If you and others have already, repeatedly voiced concern, and nothing was done about it, then, I'd be doubtful that they are going to do anything about it. Maybe, if it went to those over their heads, anonymously, it wouldn't come back on you. I'd be concerned that that they will do nothing, but, retaliate against those who are voicing concern for this lady. I'm not sure if complain can be made to ombudsman anonymously or not or the state regulating agency.
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Reply to Sunnygirl1
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Does she ever try to leave the building? If she were to get out, and,God forbid, get hurt, then the facility would be 100% responsible and it would make the news and give the facility a REALLY bad reputation, and bring in the state, hurting future business. Since your administrator doesn't seem to care about this lady's best interests (or the staff's for that matter), she may care about the possible loss of revenue, and the nightmare that state surveyors would bring down on her head!!! 
Good Luck and keep us posted!!
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Reply to katydid1
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This is not a situation you should have to handle without help. Except for the clothing issues, you are describing my mother. She wasn’t in Assisted Living but on the regular floor of the nursing home. The staff, administration and I spoke regularly about whether she needed to be moved to Memory Care. When she became combative and started to wander, we decided she needed to go to the locked unit. There were far less people there and twice the staff.

This is is a matter of safety for your resident and the other people in the floor and also the dignity of the lady you write about. There are almost always visitors in the halls, and to see this lady wandering around naked or half dressed is embarrassing to everyone even if she, herself is not aware.
My mother was also combative—to the extreme when she had a UTI. She would fight with anyone who came near her and make noises like a caged feral cat.

Speak with the Charge Nurse on during your next shift. Have it documented that you did speak with her. And thanks for caring. Your facility is very lucky to have you
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Reply to Ahmijoy
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WorryingInWA Oct 30, 2018
actually the nurse on our staff agrees, she fought the whole time to not have her moved in. the ED overrules her, apparently, and in she came.
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Yes, there must be an RN. This resident may need meds to help her. To do this the family should be made aware of what is going on so she can be evaluated by a doctor. I agree, she needs more care than an AL is able to give.
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Reply to JoAnn29
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Thank you for being a caring individual and wanting to do the best you can for the residents. I’m not sure what kind of “staff” you have brought your concerns to, but in my Moms NH concerns about escalating or deteriorating behaviors are brought up from the aids, to the LPNs, and then the RN nurse manager. Regular office staff can’t help, so I would suggest you and the other aids that have a concern go together into the RNs office and make sure she knows what’s going on. Does this person have family that visits? It’s the RN who discusses these issues with them.
If you don’t see any changes, bring it up to your union rep if you have one.
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Reply to rocketjcat
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