Thursday, December 17, 2009

Threats

Doomsday warned us to be careful and document on a particular resident whose family had threatened to sue the facility earlier in the day if the resident developed an open area on her buttocks. I have several issues with that.
First, I do not understand why families feel compelled to threaten the people who are caring for their mother (sometimes father). I don't know if they think that it will lead to more or better care. What happens is that communication shuts down on all levels because the staff fears that their words and actions will be twisted around to make for a better lawsuit/action against their professional licenses. Then, as a defense measure, as soon as the resident starts to carry on about this, that, and the other thing hurting/not being attended to, the resident is transferred to the emergency room and not accepted back to the facility. As a result, the resident lacks continuity of care, never gets comfortable or familiar with her caregivers, and the family never develops a good relationship with the caregivers to the benefit of the resident.
Second, if the family was so good at caring for their loved one, she would not have ended up so sick or injured and in a nursing home instead of back home with this all-knowing family.
Third, skin breakdown happens for a variety of reasons, negligence being only one of them. The skin is an organ. Like all of the other organs that a 95 year old possesses, the skin lacks the resilience of its younger years. Skin breaks down just like all the body's other organs. It's like getting mad and blaming others because a 95 year old lacks full lung capacity or has high blood pressure from narrowing, hardening arteries.
Fourth, the threats drive up the cost of healthcare while decreasing the services. Instead of being at the resident's bedside or any other resident's bedside, the nurse must instead spend a considerable amount of time writing defensive charting, in preparation for the lawsuit and action against her license. Furthermore, the resident will be subjected to lots of testing as the facility attempts to demonstrate that it is very attentive to the resident's and family's every whim. Every little achy area is x-rayed, the negative results not believed, and follow-up ct scans ordered; specialists are called in for an episode of nausea following an unusually large meal; sudden dizziness when standing (orthostatic hypotension- quite common in the elderly) is met with an MRI and lots of blood work. Such tests and procedures are difficult for anyone to endure, especially an elderly person, and are not medically indicated and are very costly- to the taxpayers, not the family.
The administration needs to stand up to the threatening families and tell them that threatening the staff is unacceptable and that all legal action can be directed from the family's attorney to the facility's attorneys.

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