Wednesday, August 31, 2011

In over my head

This has been a tough, tough week over at the GreatRep. We got a new admit, and he arrived under less-than-ideal circumstances; his daughter, the primary caregiver, was out of town. His wife brought him in and dropped him off, not wanting to visit because he'd been hurting her whenever she tried to toilet him. He had orders for meds, but had been refusing all of them.

So he comes from living at home with his wife to us, a decent-sized facility (around 65-70 beds) where we expect him to take his meds, use the toilet, and not hit us.

None of that happened. We quickly realized, after he had one of our charge nurses pinned up against the wall, choking her and lifting her off her feet, that he was going to require at least 3 people to change him out of his soiled clothes when he was incontinent.

In a hospital setting, or a psych ward, when a patient does something like that, you can medicate that person by any means necessary. In our assisted living facility, they must agree to take their meds orally (unless they have an order indicating otherwise, which this guy does not).

Things seemed to be calming down a bit after that, and he even cooperated with care in the evening one time, after the nurses began putting his evening meds in his desserts so he would actually take them in.

Then, randomly, on day shift, he punched a female caregiver in the face, and then in the back of the head when she tried to run away. Knocked her down, cut up the inside of her mouth from her teeth. She didn't quite black out and yelled for help, dragging herself to the door. It was awful. If I were in charge, that would have been the point where I'd have sent this guy on his merry way to the hospital with police there to assist the medics during pickup.

Instead, they updated his care plan to require and assist of 2+ people with all care and implemented more behavioral meds.

I was livid.

We had a meeting, and the DON was able to state her case and change our minds, even mine. I swear that woman is tricky as all get out. Plus she personally had been doing his care all day long by herself and will continue to do so, which gained her a lot of respect from the rest of us.

She laid out a specific, comprehensive plan to help him acclimate to our setting, and promised that we are NOT expected to stay in a situation where he'll hurt us, and if that means something doesn't get done, then so be it. I also understand that a gero-psych eval is not out of the question if we're not able to resolve the combativeness in our setting. Okay. Stressful, scary, unfortunate, but okay.

Then the bad news kept coming; another new(ish) resident of ours, "Linda" has a husband who lives independently but within walking distance of our facility. And he's telling anyone who'll listen that his plan is to come to our facility, shoot his wife, and then shoot himself.

This is about the time when I seriously considered just getting up from this meeting and going home.

Apparently Mr. Murderer may or may not be hospitalized right now, but of course he can go home, and then to our place, at any time. The good news is, he can't figure out how to use the keycode to enter the building, even though from the outside, the code is posted right above the keypad. So that gives us a grace period in which to see that he's the one knocking on the door trying to get in and call 911. Unless another visitor is being helpful and just lets him in.

Working in dementia, there's a certain amount of "I'm tough" attitude that comes with the territory - we deal with people who get combative for no good reason. That's just how it is. And usually the benefits outweigh the occasional injuries.

But this week has been so screwed up I didn't want to go back to that place. I don't want to be punched and knocked out, or choked, or shot. And I feel about 88% sure that I won't be. Which isn't really sure enough to make me happy about going to work again on Friday. Ugh.

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