My daughter is a nursing student working as a caregiver for an elderly woman living in her daughter's home. She often witnesses the daughter (call her J) yelling at her mother, intimidating her, threatening to throw her out if she doesn't do/not do various things, not giving her mom her 6 am meds because she "didn't want to wake her," and leaving her in bed for extended periods. Today, the woman told my daughter she really wished she knew why J doesn't like her.
More experienced caregivers in the home have just told my daughter that "J gets like that" and to just ignore it. My daughter is having a hard time doing that, but doesn't want to quit, hoping she is a positive in the lady's life. She also hesitates to make a report, fearing that investigation will worsen the woman's situation. She is also hesitant to open the subject with J, who is apparently pretty intimidating, for the same reason - as well as wanting to keep her job.
I've offered all the ideas I can think of - can anyone offer some advice? I know that there is likely a lifetime of baggage that impacts the pair's current relationship. As an outsider, the situation looks like emotional abuse to me, as well as possible neglect.
For those who are wondering, I am aware that me posting rather than my daughter is odd. She just texted me on a break while at work, upset about the latest interaction, so I thought I'd get the ball rolling.
Thanks!
Equally her daughjter may have told her terrible things bout care homes and while I dont want that for my mum I do think a lot of them offer far better care than she is currently getting from her daughter. She will also benefit from interaction with people of the same age
You are absolutely right to do something for if your daughter ignores it she is in effect telling the daughter that her behaviour is OK. It may well be your daughter has to find other work but better that than be an accessory to a criminal act.
Do let us know how she gets on xxxx
No, we haven't left the building! We've been talking and digesting all the information and opinions you've provided - thank you SO MUCH for taking the time to respond.
The main problem is that there isn't a supervisor to look to; "J" sent an email to the head of the nursing department at my daughter's college looking for students to help with her mom. The director sent it on to the students, and voila, an interview and a job. So J IS the supervisor.
After our last conversation, the plan is to discuss the situation with the nursing department head, since the job originated with her, as well as my daughter's academic advisor, and another student also working at the house who has more clinical experience.
It's been reassuring that many of the discussions we've read here mirror the ones my daughter and I have had about the situation, She doesn't want to make accusations that will create a more stressful or resentful situation both for J and her mom, but she is concerned with what she witnesses. She also knows Mom does not want to go to a nursing home (maybe that's why it's a common threat?) and that if APS determines that J's home is unsuitable, she will likely end up in one. I can already see where that piece of info is going to go!
Please know that neither one of us underestimates the stress of caring for someone in your home. Our own family has a similar situation. Everybody loses it once in awhile - God knows, my child has seen that! She feels that this is something different. If it were clear-cut, we wouldn't be discussing it - we're in that crazy gray area. She wants to help, to do what's best for the woman she's caring for, but isn't sure what that is.
Thank you all again for your input - it's great to know that people will reach out to help in the midst of your own difficulties!
I was also thinking that some posters respond with updates, some respond with more information and/or elaboration on the same initial issue, some respond with a thank you and others don't respond at all.
Fishing and SA, once again insightful answers. Observers also never know how the dynamics can be reversed in private and the caregiver harassed and/or verbally abused, gradually building up to the kinds of remarks J made to her mother.
We posters often never really know if our posts were even read.
A student nurse shouldn't feel as though she's put on the spot. And presumably the care organization has a chain of command.
The supervisor can consult with others on the team such as those who've advised the student nurse, and can draw her own conclusions. That's part of being a supervisor.
The student nurse isn't put on the spot for either causing trouble or ignoring abuse. And actually, as a student, she shouldn't have to make that call in the first place.
But that's not to say your daughter shouldn't report her concerns to her supervisor, and if the supervisor is experienced then no doubt she will have helpful advice to offer. A great deal depends on context, as cwillie points out. What are the 6am meds? If it's insulin, it matters. If it's a diuretic, it can wait. (Most can wait). And as for the staying in bed for extended periods of time, does the mother actually want to get up? And is there any clinical reason why the mother might be lethargic? For several weeks after her first stroke, my mother was sleeping up to 20 hours a day, and it would have been longer if I hadn't chivvied her.
I would strongly advise that your daughter does not directly approach J. Even the best-intentioned words coming from a student nurse new to the situation will go down like a lead balloon, and the likeliest outcome would be that your daughter would get her ear chewed off. But it sounds as if there is a whole team involved here, and I'm depressed that you write that the other caregivers are recommending that your daughter "just ignore it." No, she shouldn't, and neither should they. If the mother is getting the impression that her own daughter doesn't like her, that to me says burn-out and J needs support. Surely someone on the team knows a counsellor or mental health nurse who could offer it?
I am co-CG for FIL who waits til only one person is present before hitting and manipulating. Memory loss, my foot.
The family dynamics issues raised here are very important to the overall picture. Why isn't anyone feeling sorry for the daughter? Always the poor little old defenseless whatever gets all the attention while CGs should all know better. Teach mom to ignore inappropriate communication. The sae thing
PHYSICAL ABUSE
Physical abuse is the deliberate use of physical force for intimidation, or to inflict bodily harm. Some indicators of physical abuse or mistreatment of a person with a disability are: unexplained cuts, scrapes, and bruises or injuries for which the explanation does not fit the evidence. Behavioural signs include avoidance of significant family, friends or care workers. Other signs include a history of repeated injury/illness; delays in seeking treatment and unhealed sores and/or pressure marks.
So in real terms if you witness DELIBERATE acts that cause pain or injury or fear, cause sickness or stop the person getting treatment by either not calling for help or by physically stopping the person from leaving the house (or a professional entering the house) then you are clearly witnessing abuse - these are not mild things they are serious
However where you get to a grey area is when you witness forced feeding of undesired food and medications. Now I always ask Mum if she will take her meds and what she wants to eat. When she has been poorly and unable to even speak I have put the food I know she likes to her mouth and if she accpeted it I considered it to be consent. I am not sure I really agree with that but the law would be hard pushed to show abuse.
It is abuse however if you shovel food into her mouth in a way that causes her to vomit,if you hold her nose to get her to open her mouth to give food or meds or something similar. If mum refuses meds at any time I note it down and I ring the doctor and I record the date and time I rang so that I have done my bit. Then it is up to the professionals as to whatthey consider should be the next step.
SEXUAL ABUSE
This you should all be aware of because it exists for everyone pretty much not just for the elderly or those with disabilities. It is serious for all of us, should always be reported.
It is NOT SEXUAL ABUSE to apply creams to the genital area, or administer enemas/suppositories if they are prescribed and providing you have gained consent and if possible I would do it with another person present although in my case this is impossible
PSYCHOLOGICAL OR EMOTIONAL ABUSE
Psychological abuse is the infliction of mental or emotional anguish through humiliation, intimidation, or use of threats. Emotional abuse attacks a person’s feelings of self-worth and/or self-esteem. Use of verbal taunts, threats, insults, withdrawal of love/affection, or emotional support by the abuser over time affects how an individual with a disability feels about him/herself and is extremely detrimental to his/her well being.
So basically anything that makes the elderly person feel in some way dehumanised or less worthy han others
Overly familiar behaviour, e.g., use of word “dear” or other belittling references (now this does not apply the way most people think it does. nopte the word OVERLY I call my mum sweetheart, honey these are terms I use all the time to people in my family and they dont offend mum HOWEVER if a careworker were to use them it would be a whole different ball game - she likes them to call her by her given name and quite rightly so. EQUALLY if I said Yes Dear in a manner that told mum I didnt give a hoot then that could theoreticaly be considered abuse if I was ignoring her needs and making her feel less than by doing so
Speaking to third party rather than to the person (ie how is your mum today when mum is sat in the wheelchair you are pushing - plus its damned rude)
Treating adult with a disability as a child - now this is a toughy because I know I am guilty of this from time to time. I keep trying to remind myself that Mum may not know so much these days but she does still know what she likes and to that end I ask her what she wants for breakfast, what clothes she wants to wear. I dont chastise her for dropping something or tell her to pick it up BUT I do treat her like a child when she throws a tantrum like a child and I am not sure how I overcome this
Adult children moving home/living off (senior’s) limited income/assets - this is not about you doing full time care for free and not having any money to live off...it is accepted to expect some remuneration for the work you do even if it is only bed and board
IT IS ABUSE if you use her money for gambling or buying a new car for the kids or even new clothes for your kids. Outside of the remuneration you agree with whoever it is you need to agree it with moneys can only be spent in the best interest of the elderly person
MEDICATION ABUSE see how the various abuses slide over each other
Both over-medication and under-medication re problematic and when people go to see different doctors and get their meds from different pharmacies there can be an issue with the right hand not knowing what the left is doing. A pharmacist can only identify a clash of medication if they know it has been prescribed
Caregivers may use medication to reduce their work load, having the person with a disability go to bed earlier, be more “cooperative” or easier to care for. (This was very common until legislation put a real break on its usage but although it still does happen it is seen as abuse)
Some of the confusion seen in older persons may be due to medication rather than normal aging. Clear labelling will stop them sharing their meds theoretically but no guarantees. I keep Mums locked away so she CANT access it - she would take too much
The possibility of medication abuse should be considered when a person’s behaviour or mental status changes SUDDENLY, FLUCTUATES, or when the person shows either EXCESSIVE drowsiness or EXTREME agitation. Medication abuse may also be considered if the person’s normally controlled pain FLARES up without a medical explanation.
Elderly people can inflict their own over medication or under medication but so can a caregiver
Do remember that as a caregiver you still have a duty of care. I think the problem is that while family members may get off with witholding medication because they are not trained to know or understand the cponsequences, a trained caregiver would NOT get off
Whether they visit several doctors for same medical concern, and
end up double or even triple dosing the same meds for the same problem but prescribed by different physicians, or whether they are given medication given to make them more “co-operative” or “easier to care for”, the outcome is ABUSE
Doctors havbe to be aware that if the person is requesting more meds before they should then there is a problem but with the multiple doctors this is often not picked up until it is toolate so others need to be vigilant and check the prescriptions and what they mean. Many drugs have brand and generic names - in fact they almsot all do but that doesnt mean the elderly person isnt taking the samed meds twice over common example if your mum was taking Furosemide and Lasix you might think they are two different meds but they are the same thing
UNDER-MEDICATION
Person forgets to take prescribed medication, or Insists prescription has already been taken.
Caregiver not aware of person’s medical needs.
Prescription runs out, and person forgets to renew it, or Is unable to afford needed medication on a tight budget.
Withholding of necessary medication by caregiver, or Medication not administered when needed.
NEGLECT
Neglect is the often-DELIBERATE failure of a caregiver to provide goods, services or other necessities, to avoid physical harm, mental anguish or mental illness. Neglect may take the form of abandonment, denial of food or health related services.
Active neglect…
Is the intentional withholding of basic necessities or care. Absolutely is abuse there is mens rea (intent or malic aforethought)
Passive neglect…
Involves failure to provide basic necessities or care because of lack of experience, information, or ability. (is still abuse but rarely actioned in the same way)
Inadequate clothing USUALLY taken to mean there has to be sufficent suitable cloting for the environment and it has to be clean
Lack of hygiene - self explanatory
Poorly maintained living environment - simply you have to keep the area clean and minimise risks of infection or cross infection
Poor physical appearance - does the person look dirty, smell or have hair that is unkempt
Lack of food in cupboards/refrigerator
Withholding nutrition/fluids - will lead to UTIS
Dehydration, malnutrition
Withholding medical services/treatment - not calling the doctor when it is clear the person needs medical professional help
Lack of comforts of living – i.e. radio, television, telephone - these 3 only applicable where this would be the norm but other things can be the norm in other situations
Insufficient medication - Caregivers have the responisbility to ensure there is sufficient medication
Inattentive health care – i.e. untreated sores, lack of, or dirty bandages
Lack of needed safety precautions – i.e. railings or ramps -
Abandonment and/or confinement of person
Neglect, leading to hospitalization or death
THESE LAST 3 CAUSE A LOT OF CONFUSION
let me give you an example you have to go out for whatever reason. If you leave mum at the top of the stairs, knowing she cannot manage stairs unaided and without having some sort of safety gate in place and she falls - ABUSE
If you lock her in the house with no means of escape and there is a fire - ABUSE
If you leave her in a room with a gas fire that has not been serviced and it is faulty and she dies or is hospitalised as a result - ABUSE
If however you leave mum downstairs with her care alarm and resting on a day bed with her walker to hand and a commode nearby, in a room where the fire has been tested and deemed safe and with some form of guard round it, with a drink and a sandwich to hand, providing you are not leaving her for long periods (or doing this every day all day) without means of communication etc, providing she could get out or others could get her out (we have a key safe and the emergency services have the code) then this is not abuse. You have not met the criteria of abandonment, you have not restrained or confined and you have considered the safety risks.
Heavens she could fall and hit her head while you were in deep sleep and you wouldnt know until you woke. The professionals arent stupid they do recognise that noone gets 24 hour round the clock one to one care - notin a care home not in a nursing home and not even in hospital
I read over the link with abuses that were on the site that Jude gave. These included calling people "dear" or making them do things they didn't want to do. So making them bathe or eat would be emotional abuse. I do think that list needs reworking, because some things that are counted as emotional abuse in one area are also listed as neglect in others if they aren't done. Should we make them bathe or not? Should we keep encouraging them to eat or not? Should we let them eat ice cream and cookies only or give them nutritious meals? It depends on which abuse section you're reading at the moment. :)
Fortunately, most of us know when we are doing something we shouldn't. If someone isn't able to stop it, then they need to stop being involved in care.
On a lighter note, when I read the emotional abuse part, almost every one of the things are something my mother does to me every day. Should I report her for elder abuse? I mean, after all I am over 60. I guess since she is 88 she can do it to me, but I can't do it to her.
I suspect many of us caregivers have at one time or another become exasperated and said things we later regretted. It happens. It's a tough job. No one knows how tough if they're not viewing it from the caregiver's perspective, and that includes people who see the care from a clinical perspective.
Those who aren't caregivers haven't been up all day caring for someone, nor have they been up all night in an ER waiting room and then a hospital room when conditions arise that could have been handled earlier if an elder person hadn't been uncomfortable, frightened, or unwilling to get help.
It is to the nursing student's credit that she's concerned, but things are not always as they seem to be, and it's not easy to get beyond appearances to determine what the real situation is. That's why I suggested she try to become more friendly to J to get more information before acting.
And sometimes intervention can backfire; if APS determines there's no abuse, the trust between the nursing student, J, and her mother have been permanently damaged.
I know I'm not abusive or neglectful. I know I just have a difficult mother that I have no way of controlling. But she seems so sweet to everyone else, so if they took a single snapshot, it could make me look bad.
It may be that the daughter is tired and resentful and really shouldn't be a caregiver for her mother. But it could be something else entirely different. We can't tell by getting a snapshot of their lives. I would look longer and harder to see if the arrangement is beneficial or hurtful before I would cause potential damage.