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This is something you need to stay out of
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You need better boundaries. It is not your place to insert yourself between this husband and his wife in this decision. Does your work have any access to Employee Assistance Programs? You could use a few sessions with a therapist to discuss where your responsibility for this patient's life choices begin and end.

You sound like you really are a caring person. However, if you are going to work with ill people, you have to have better boundaries. You need to know what you can and can't control. Where this man is placed is not under your control. How you care for him in his current placement is completely under your control.
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gdaughter Jan 2019
What an insulting comment. The caregiver MAY need to discuss this with an outside professional to discuss the professional implications of their role for educational purposes, but to suggest they need a therapist? If anything maybe someone at the facility needs to better explain the course of the illness and the behavior it can cause to help the caregiver learn what the patient wishes is ill advised from a medical, if not personal perspective.
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Speaking from experience, I am completely against nursing home residence if it can be avoided at all. I have seen too much patient neglect and the dismay and unhappiness they too often experience. Be sure that his wife has not been assigned as his health care proxy before proceeding because she could stop it completely. He has the option to withdraw his assignment of health care proxy at any time, and probably you should be assigned as the health care proxy instead. Check to see that his wife doesn't have more legal rights to stop you. Make sure you are on solid ground, and make sure the nursing home hasn't taken over guardianship of the patient. As far as the mechanics of removing him, I am sorry I am not familiar with the process. I hope someone else here has some useful input in that regard.
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worriedinCali Jan 2019
He actually doesn’t have the option to withdraw his healthcare proxy if he’s been deem incompetent. The wife probably does have legally rights since she is his wife and all. Can’t believe you are supportive of what the OP wants to do.
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This person is contradicting themself. (We have no idea if male or female. I thought I read male.)

#1... "Also did I mention that his wife is resistant to him leaving the NH and going on the trip?" His first response to a reply earlier on was wife didn't know.

#2...Responded there was no Dementia but says in OP "My resident has a rare progressive brain disease that basically kills brain cells." I googled this and found it may be Huntingtons. Here is what the article said:

"Huntington's disease is a relatively rare fatal inherited condition that gradually kills off healthy nerve cells in the brain, leading to loss of language, thinking and reasoning abilities, memory, coordination and movement. Its course and effects are often described as Alzheimer's disease, Parkinson's disease and ALS rolled into one, making Huntington's disease a rich focus of scientific investigation."

It may not be Dementia but it looks like its worse. I know a man who had ALS. Near the end he was wheelchair bound. His wife was a nurse, not an aide.

We don't really know this patients history. There is no way this poster knows the patients finances. He is only going by what the man tells him. A man who has a rare desease that kills brain cells. I don't think he/she should be encouraged. If he feels there is abuse, then go up the chain of command.
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anonymous594015 Jan 2019
Re: Point 1. I believe he/she means the wife doesn't know about the "I'll hire the PSW full time and go home and travel and have my old life back" plan.

Honestly, if this were an option for him his family would have pursued it. If he can still make his own decisions, he would have arranged this on his own. He wouldn't be asking a 20 year old to make this happen for him.
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I am adding to my previous post. If the NH gets a whiff of this you will be dismissed immediately. And you should. Unethical and unprofessional. The liability to you and the nursing home could be substantial.
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gdaughter Jan 2019
THE CAREGIVER WAS ASKING FOR GUIDANCE, here in a place where one would hope people would be kind and help educate, not accusatory of something that has not even happened. You are not judge and jury. There are many steps that would take place before the caregiver took off with the patient. Do you think no one would notice or discuss that? THe caregiver may be young and inexperienced, but at least they care about their patient and enough to ask a group who they hoped would share their wisdom not assault them. Unethical and unprofessional? Please. I'd be grateful to be able to hire a caring individual like this person, even if they needed to be educated, coached/supervised on their work role.
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Just WONDERING...if nothing else, if the wife did know...might it be possible for all to go on a journey for the patient to ultimately return to the NH?
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Gosh. You are such a blessing. Every one of us should be so blessed if we have no one to advocate for us. I so love your enthusiasm, your caring, your dedication and especially your advocacy to make sure your patient's rights are protected...but so many issues are raised by this. Reality sucks.
So, let's try to sort through it all.
You probably don't want to communicate about this possibility to coworkers or administrators and supervisors. Most nursing homes want the $$$ so they won't want to let go of someone who has the $$ especially if they are not problematic residents.
You must be cautious about professional conflicts/ethical boundaries etc.
If this even happened, who is going to pay you? If the spouse is opposed you're not likely to get very far...but, that said...
I wonder if his rights are being violated, presuming he has the cognitive abilities you say. Can you suggest to him (since wife is probably not present all the time...) that there be an elder law attorney consultation? Someone who could make a visit to the facility...maybe under the guise of getting important papers set up/reviewed?
Do you feel like he is being kept there against his will? Does he? Then I wonder how helpful, if nothing else, it might be to check in with Adult Protective Services....but perhaps first....if you have a local Long Term Care Ombudsman...that would be my first or second call as they are probably more familiar with the laws in your state.
By your age, you do not have as much experience under your belt...my guess is this is going to be that one case you will carry with you forever as you will learn much...just be careful and watch your own back:-)...We need more people with your spirit and dedication to advocate for the best interest of their patient. But the question is, is this the best decision for your patient? And what roadblocks will other family put up? It would be far easier if the spouse went along with the plan...Good luck...post a note and let us know how it all goes!
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GonzalezJ Jan 2019
Thank you sososososoooo much for this post. By far my favourite response. I dont understand why other people are telling me im doing something horrible when this is coming from the kindness of my heart and how much i care about this Resident..........
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Just to be blunt: Don't get between a husband and wife. At any and all jobs now and in the future, don't encourage married men to run off with you. If this patient starts blabbing about how you and he are planning to run away, it won't look good for you. It will in fact look quite bad and you may find yourself suddenly no longer employed and without a good reference for a future job.
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gdaughter Jan 2019
Clearly better to work cooperatively with all, but she is obviously doing this from having a good heart and not the one who encouraged any of this. As for being without a good reference...she would not be the first person to omit an employer where things didn't go well.
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If I found out that a caregiver was making plans with my parent to abscond from a facility to take a dream vacation or live independently, I’d call the police. Your seeming concern for your patient aside, you need to know your place.
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gdaughter Jan 2019
There's a lot to happen before it would get that far. Her dedication to her patient is admirable and she is only asking for guidance, not to be slammed as a potential criminal. She seems to know her place quite well.
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Ok, some here are saying you are a female, and some a male. Not sure which. Then you say he wants to go on a trip.. then mention being his full time caregiver. I don't mean to sound suspicious.. but how often on here do we read about some "young thing" trying to take over "elderly dad or mom's care" over family wishes.. ALL the time!! And the responces are never good or happy.. it's always about financial or elderly abuse. I am assuming that wife has POA and financial control, so even if he has buckets of money.. cough... how do you assume he will get ahold of it ? I doubt she will just happily hand over cash, when she has already had him placed somewhere she feels is providing him proper care. Perhaps she won't let him come out because she really does love him and want the best for him? I just feel something is off here. Sorry if I am wrong...
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GonzalezJ Jan 2019
You are completely wrong and unhelpful
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Something else to consider - you don't say where this holiday destination may be, but there is no way in heck this man will ever get affordable health insurance to leave the country.

I imagine that because you work at a NH and have been to school you think you know all the ins and outs of caregiving and placement in a nursing home - I doubt you do, I was often amazed at how ignorant many of the employees at mom's NH were. Other than rescuing him from the NH, how do you expect this to pan out?
The community supports available are never adequate, the hoops necessary to get into a preferred NH are often a formidable barrier. At the NH you work an 8 hour shift (with breaks) and then go home. You get days off, holidays and vacation time. You likely get a benefits package. It is nothing like caring for one client one on one 24/7.
Lets pretend he moves with you to an apartment - There will be no RN down the hall if there is a crisis, no doctor who makes house calls. Meals won't be provided in the dining room, that will be on you also. What about Lifts, grab bars etc? How will he pass his time, there will be no other residents and staff to visit or entertainment?
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CanIhelp Jan 2019
How do you know that other residents and staff visit and entertain him?? It might not be the case.
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I think you heart is in the right place but.....I don’t think you have any idea what you would be getting yourself in to. I also find it extremely inappropriate that you would even consider undermining the mans wife and the medical professionals that have determined he needs to be in a nursing home. That’s just a personal opinion though. I just have serious concerns with a PSW thinking they know better. If you have concerns over the care and treatment of a resident, report it. Don’t make matters into your own hands and try to “bust them out” of the facility.

have you considered that what you experience with him is just show timing? I think it’s reasonable to assume you aren’t with him 24/7. Even if he is still at a mild stage. Do you understand what is to come? Are you trained to deal with violent outbursts? You will be his sole caretaker. Are you aware that your physical well being may be put at risk? Not to mention the emotional toll this will take on you. Like I said, I think your heart is in the right place but this is a terrible idea. Not to mention the ethical and moral aspects.....
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GonzalezJ Jan 2019
Thank you so much
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A PSW is Canada's version of a CNA.

https://www.stonebridgecs.com/stone/latest-news/what-is-a-personal-support-worker-psw-and-what-does-a-psw-do
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worriedinCali Jan 2019
The Op doesn’t mention anything about Canada though. We have PSWs in Oregon
https://www.oregon.gov/DHS/SENIORS-DISABILITIES/HCC/PSW-HCW/Pages/Personal-Support-Workers.aspx and they aren’t CNAs. In the US, they are more commonly known as simply “caregivers”. In California for example, we do have PSWs that get paid through IHSS, they aren’t CNAs or MAs, just basic caregivers. They don’t need any sort training or certification to be one.
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You don't say how old this man is? That would make a big difference in our answers.

"Wife is resistant" is your answer. She holds the purse strings. You have no idea if he can afford to do what he would like to do. He is where he is because he has been evaluated and found this is where he needs to be. Maybe he is there because his wife could no longer care for him. Couldn't afford to place him in a Assisted Living so this is where she could afford to put him.

Here in the US a LTC facility costs on average 10k a month. If you are able to get Medicaid (State help) its because you have no money but maybe Social Security and that goes to offset ur care. Spouse will not be made impoverished but there will be no extra money for trips.

Sorry, this will seem condescending, but step back and look at the full picture. Your profession does not allow you to get this involved. You are going to have patients that you can't stand and you are going to have ur favorites. Thats OK. But as a professional, you cannot get involved with their personal life. If wife is resistant that means you have already talked with her. I think you have gotten your answer. If you want to keep your job, I would back off.
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CanIhelp Jan 2019
You are ASSUMING that some professional or other has determined that he should be there. Assumption is the key word here! I have seen too much abuse to just write this off as he needs to be there because of some professional opinion. Remember that nursing homes are in the BUSINESS TO MAKE MONEY! They do not exist to be warm and fuzzy nice to people, AT ALL. They are in business to make money and they will fight losing any of it, whether they deserve any of it or not. This is a horrible nationwide abuse. Period.
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Hello Gonzalez. Have you considered having a sit down with your patient’s wife outlining your offer? Perhaps if she knew she’d have 24/7 help in her home, she’d be willing to consider hiring you to live with them. Please remember that a person is sometimes placed in a nursing home, when the person who is their caretaker (his wife) can no longer be the caretaker due to her own physical health and limitations, burnout, and mental capabilities dealing with watching their loved one decline. If the gentleman was not married and had been living alone with no family to help and was placed in a nursing home, that would be different. However, he is married, his wife is responsible for his well being as well as her own. There may be a lot of dynamics you aren’t aware of that have your patient residing where he is. Unless you feel your client is being abused or neglected, it’s best to leave things as they are as I’m sure a lot of thought and conflict went into placing him in the nursing home in the first place. Best to you as you continue on keeping your caring side caring.
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shad250 Jan 2019
Maybe he does feel the client is not being treated well there, when he is not around.
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Go for it. Resident wants to enjoy whatever time he has left his way, not being cooped up in a NH room. NH are a business plain and simple. The goal of many is to make as much off a resident as possible, until the resident passes, plain and simple.

NH the resident is in is probably depressing and lousy, with the only bright spot being the resident seeing the young man. If Gonzalez is willing and able to be his 24 hour caregiver and the resident agrees, which seems to be the case, then again, Go For It. The wife may be glad that it is the NH responsibility for care at the moment and not hers.

As far as NH concern, only concern would be liability and money. Outside of that, they could probably care less what Gonzalez and the resident does as long as it could not be traced back to them.
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GonzalezJ Jan 2019
Thank you so much for this!!! You are the only one with a positive mindset like mine.
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OMGOODNESS... You need to remember you are there to support not to take over. I'm sure the wife has taken measures of not letting her husband out of the NH. I'm sure this patient has cognitive times and at other times he is not very cognitive. Please step back and look at the full picture there are a lot of factors that you need to consider, legal, moral, medical, ethics.
blessings
hgn
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shad250 Jan 2019
OP is looking for support for the resident. Resident wants to enjoy life the way he wants not wasting away in a depressing NH rioom.
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Gonzalez,

You don’t mention the type of Degenerative Brain Disease this man has. That info could help you get some specific information from members that have experience with specific conditions. For example, Alzheimer’s, Lewey Body Dementia, Vascular Dementia, PSP, etc.

You are very young. You probably have a huge heart but, you have to understand, any plan you try to implement to get this man moved out of the NH will be looked at as very suspicious.

If the man is in a NH he requires 24 hour care. Are you prepared to provide 24 hour care. Alone. No days off for the rest of this Man’s life.

You would not only be interrupting a care plan that has been put into place you will be looked upon with great suspicion as to your motives.

No. Do not get involved.
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shad250 Jan 2019
What would be the harm as long as the young man is and wants to be his 24 hour caregiver?
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You are so wrong, young and naive. Actually you should leave this job and leave your patient alone. You are going to do nothing but cause trouble for the patient, as well as get yourself in trouble in regards to this type of work. Go get a totally different type of job and don't even think of messing with this family.
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Popsiclepete Jan 2019
Your response was rude and totally unhelpful. Perhaps you should take your own advice and leave town. I am a retired RN who worked 10 years in LTC and know just what the PSW (Personal Support Worker) is Concerned with as well as the client. He wants to live like a human rather than a caged animal and she sees the anxiety in his wishes and feels as need to help him.
I would love to have her as a support worker as she obvious has the ability to show compassion and caring for another individual. Too many care workers are burned out because they have too many patients and too much record keeping in addition to meeting family and patient needs.
Yes she could possibly get in trouble for helping him live his life free of the human cage. His family who obviously don't care enough for him to keep him part of their circle. He had become part of our disposable society. If he had enough money to move and hire a personal giver then I would suggest they get on with it but make sure they hire a lawyer who is well versed in such situations, get good advice and keep him on retainer until the feathers settle.
As for you Vegas lady, get more advice and compassion before you attack a person for trying to do something properly.
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Where are you Gonzalez? I'm curious because PSW is a term I don't hear used often outside of my province. The way it works here is that getting a space in your preferred nursing home is no easy task, in urban areas the wait list can stretch into years. There are also several people living at my local nursing home who are really only there because of a sleight of hand that has ticked all the boxes that allow fully funded care, technically they probably could live outside a nursing home but they would get less care and it would cost them more.
IF you and his wife were working together to help him fulfil his bucket list I would say go for it, but this really just sounds like a wonderful fantasy to me... aside from his physical limitations you have no idea if he (and his wife) could even afford it.
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Popsiclepete Jan 2019
Great advice cwillie.
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Either you are a very inexperienced care worker in your early 20s or you have taken leave of your senses.

If you have genuine concerns that your resident's rights are not being respected, report your concerns to your line manager.

If you can't do that, or it doesn't go anywhere, go to your state's care standards regulator and find out how to report potential abuse.

If you, as a support worker in a nursing home, take any steps to assist this man to leave the nursing home, or to undermine his wife's legitimate decisions made in his best interests, you will be in more trouble than can be easily explained.

I suspect you also have a lot to learn about dementia.

Look. By all means continue to have enjoyable conversations with your resident about the road trips he'd like to make, and encourage him to talk about his memories of travel, and then other aspects of his life too. That is fine, that is good work, that is enriching his quality of life.

But taking at face value what somebody with a progressive brain disease says about what he wants to do and acting on it would be so unbelievably irresponsible I can't think what you're thinking.
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Popsiclepete Jan 2019
Have you ever been young?
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Not surprised the wife is resistant. She probably put him there in the first place, right?

I think it would be very awkward to bring him home against her wishes, with you moving in to take care of him. Depending on her condition, sounds challenging.

Sad that he seems so capable yet is stuck in a nursing home. For him, could be better to be home, and could work if he lived alone. What about that? An independent apartment? But then the costs would be prohibitive.
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gdaughter Jan 2019
You do raise some additional good points about things, including missing info. Clearly this caregiver could not possibly do the work 24/7 indefinitely, and if burned out, could leave...the elders in a bad place. It's also feasible that the wife is clued in, and that the placement while he is still able to comprehend was done in his best interests, so he can adapt to the new environment while able.
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So you've told his wife about this plan? What does she say?
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GonzalezJ Jan 2019
She doesnt know
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