I've been working with my client now for six months, and when I initially started with her, she was fully independent and able to care for herself. Here we are today where every shift I leave I leave worried if she'll be okay. Her health has declined to a point that she lays helpless in a bed all day, unable to move even her arms. Medicaid feels she is too much of a risk to be home and tried to stop care with the company I work for. The company then went and had my client apply for hospice--which she was approved--so she could continue to live at home. She does NOT have round the clock care. In fact there are 12-14 hours a day where she's completely alone aside from her husband, who's incapable of caring for her beyond getting her a pudding from the fridge. I, along with her doctors, and insurances, feel she needs to be in a nursing home. However she and her husband refuse. I'm deathly afraid that one night when I leave, something will occur and she will not be able to get help. She is unable to push her life alert, or dial on a phone. Her voice is on a downward spiral and the most she can do is whisper a raspy word.
I've addressed my concerns with my company and the care manager told me "This is what SHE wants. It's your job to just make sure she's comfortable". But I can't do that when everything inside me is screaming that she's unsafe in her home and that my company is being money-hungry. I'm increasingly dejected by this situation on a daily basis--so much so that I'm wanting to leave my company. I don't want to work for someone who doesn't have the right values in mind. (Safety over money).
So basically, is there ANYTHING I can do whatsoever? Do I contact APS? Do I contact Medicaid/Medicare? I'm stuck.
You, on the other hand, are a mandated reporter, yes? You've reported your concerns through the proper channels at your agency?
I would put my concerns about this case in writing to your agency, and ask for a letter from them documenting that you've expressed your concerns. That may force their hand.
You have done sterling work with this couple, and I would bet that they value you more perhaps than you realise. You sound upset that the company is telling you that your job is "just" to make her comfortable. But that's the most important thing anyone can do for her at this point! And you're doing it. Please don't leave!
Since this lady is declining so fast and is now in hospice care, it seems clear that her wish and her choice is to die at home. Many people express that wish. Not so many get it.
If her husband is able to get up and go to the fridge, then he's able to pick up the phone and call for help, yes? Perhaps you could discuss with your line manager how to advise him about when he *must* do that, and explain to him what he needs to look out for.
What exactly are you afraid might happen? What do you feel could be done for this lady in a nursing home that isn't being done in her own home?
What does seem very unfair is that your company is expecting you to work in this situation without giving you adequate support. Have you had training in end of life care? Have you worked previously with hospice teams? If not, talk to your manager - they owe you support to do the work they're asking you to cope with.
Bless you for your conscientiousness and your care for your client. Don't underestimate how important you are to her.
After that you have done your job. While you are there the patient is ..Safe, Cared for and pain free (as is possible)...this is all you can do that is within your scope.
After you have exhausted all avenues to correct the situation as best as you can you have one other option. Ask your Supervisor to replace you as you can no longer watch what is happening. But I will tell you that you will probably see this again and again.
Someone reported my mother shouldn't be living by herself in her senior complex because she was getting dementia and wandering the halls. What they didn't know was she was on a waiting list for AL, had a companion 3x a week and myself and a sister also going to visit every week. The case manager came to interview and said we were doing everything we should be and found nothing negligent. But because a case was opened he had to visit several more times to get the case closed. This was a lot of stress for my mom who didn't understand who this person was and why they were there.
Please just treat this woman as she wants to make her and her families last days as stress free as possible. Until you are in this situation you have no idea what a toll this takes on a person emotionally and physically.
God bless you for choosing this profession, we need many more like you.
So as long as the woman you care for is clean, cared for and relatively pain free that is the ultimate goal.
If your client is in Hospice care, somebody should be checking in now and then, that is my only concern. For one thing, she is probably receiving some very strong pain meds and those have to be monitored.
Can you voice your concern to the husband? Sounds like he is maybe not there while you are (perhaps when you come, he leaves as he needs to get away? I don't know.)
Is she'd in hospice, comfortable and left to pass quietly on her own timeframe, then you must respect that. I can imagine this is breaking your heart, but this is a common situation.
When you say she is "unsafe" do you mean you feel she is neglected by her husband? Some people, at the end of life, don't want ANY fuss or drama. I sure don't. If her husband is actively hurting her or ignoring her, that's a different matter.
Someone reported my mother shouldn't be living by herself in her senior complex because she was getting dementia and wandering the halls. What they didn't know was she was on a waiting list for AL, had a companion 3x a week and myself and a sister also going to visit every week. The case manager came to interview and said we were doing everything we should be and found nothing negligent. But because a case was opened he had to visit several more times to get the case closed. This was a lot of stress for my mom who didn't understand who this person was and why they were there.
Please just treat this woman as she wants to make her and her families last days as stress free as possible. Until you are in this situation you have no idea what a toll this takes on a person emotionally and physically.
God bless you for choosing this profession, we need many more like you.
It would also be a very good idea to have the patient mentally evaluated to see whether or not she really is competent to keep making her own decisions. I think it's very possible she's probably wanting to die at home and I don't blame people for wanting to go in the comfort of home and in their own beds and not in an institution. Yes, it would probably be a very good idea to see if her illness can be treated. Sometimes common illnesses can be especially hard on the elderly and sometimes their bodies may not be able to fight it off like a younger person. A good bit of this may be a poor diet. If you have a poor diet, you can actually get very sick easily. When you get very sick, that's when you most need to start eating a better diet and start eating healthy. It would be a good idea to see if you can actually get some very healthy foods such as raw veggies and liquefy them in a blender and just make her a veggie juice to see if she starts getting any better, you may be surprised.
I'm not sure if you realize this, but people back in Bible days actually lived well into their advanced hundreds of years simply because they ate better than we do now. Back in Bible days people would go right on with their normal lives right up to the moment they got tired and they would lay down and just simply fall asleep right on that day. Yes, they were just simply lay down as anyone else and just go to sleep like normal. This was just how it was back in the Bible days when people lived well into their hundreds, several hundred years. We were originally designed to live much longer than we actually do but our bodies need the building blocks to do so
As a caregiver you have to do what is right for you, follow your gut. Staying for the long term and helping this family would be an awesome outcome. Also, it never hurts to ask questions of others who are supplying care to the family. You never know what may come out of asking those questions.
I would not suggest calling APS, as was stated above, it ends up creating a lot of unneeded stress on the couple. It happened to me with my mom and I can say from personal experience, the call to APS was unwarranted. They came out several times, found nothing to be concerned about, and they closed the case.
Take care of yourself.