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 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.
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.
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.
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