Home nurse - busybody or caring?

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Home nurse - busybody or caring?

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Hi,

My mom is 92, has later stage dementia, but physically pretty healthy. Being treated right now by a home health nurse for a bedsore, which is healing nicely. I have not met the nurse, but I have phone conversations and, frankly, don't like her. I don't think I'm hypersensitive, but she just sounds like an overbearing busybody trying to interject her agency into providing all sorts of other services just to get her claws into us, aka, make money. Sorry if this sounds unhinged, but I believe in less medical intervention than more. I'm not in denial regarding my mom's situation, but I know her and what works best for her. I feel the nurse is looking for ways to point out things we aren't doing so she can interject why we need hospice and her agency's services. I get the "ideal," but she doesn't seem to get we are working with a person with dementia and that all bets are off. Again, not looking for specific suggestions, maybe just feedback. Have you ever felt you were in a battle of wills with someone involved in the care of your loved one?

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Can you ask the agency to send a different worker?

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Just to play devil's advocate - if you know what is best for your mom and are providing an adequate level of care how did she end up needing to be being treated for a pressure ulcer?

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I’m not a nurse but in many cases no one is at fault for a pressure ulcer. Skin breakdown can be part of the decline when an elder starts eating less. Protein status is compromised. Some people with more reserves never develop them. Others, no matter how often they are repositioned will I believe.

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I'd have more sympathy for your point of view if this nurse hadn't been called in to deal with a pressure sore.

This will sound a bit brutal. But I suspect that if you continue this battle of wills as you are doing you will soon find APS knocking on your door. Consider the possibility that she is trying to prevent what she perceives as possible neglect. Nurses, I believe, are mandated reporters.

You'd do better to have more respect for her experience. If you're not happy with what her agency charges, you can always shop around.

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I'm going to answer in a way you might find less confrontational (or not) - I don't get your assertion that this nurse is only offering advice so she can somehow get her claws into your family's business and sell a lot of unneeded services, unless she owns the agency it wouldn't matter to her personally whether you hire 10 hours of help or 100, and (where I live at least) most agencies have a backlog of people waiting for help so it's not as though they are needing to trick people into buying their services. Our home care nurse often asked whether I needed more help and I know she did it out of concern for me as a caregiver, not because she was a shill for her agency. That said, I had a homecare aide I never quite trusted that I had replaced and things ran much more smoothly after she was gone, so you needn't put up with having someone in your home who rubs you the wrong way.

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Here is my 2 cents!

Have you thought about the possibility that the nurse sees somethings that you don't? Drs and nurse are trained to see the human body as one system made up with many systems. What looks like just a bed sore to you, the nurse sees infections, muscle breaking down, tissue (skin) breaking down, circulation problems and etc.

I am with CM, I wouldn't put up to much of a resist you could lose that battle very quickly. The nurse has medical acknowledge and you don't therefore, APS or a judge will believe her over you.

Try to hire a different nurse or use a different agency. You might have the right to fire her; however, make sure you have someone to take her place.

You could be right that she is over stepping the line...but even if your right; what good is going to come out of it?

This is about your mom's health, not about who's will is stronger!

Something to think about!

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Your Mom is in later stage of Dementia? Besides this HC nurse coming in, who cares for your Mom daily? Your profile says she is at home. Hopefully, she is not left on her own. At late stage Dementia she should not be left alone at all.

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Later stages of dementia, along with pressure sores would qualify your mother for hospice. Giving your mother more care and support would only serve to help her. Hospice care is covered by Medicare, so there’s no additional cost. In fact, all of the care, treatment and services related to the terminal illness would be covered, so it would likely be a savings. I think this nurse is probably offering good suggestions for a more appropriate level of care.

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I'm curious on exactly What she is trying to push. Hospice? WHY is she recommending this? Did you ask her? The same applies for all her other recommendations. Did you ask her why she thinks your mom needs it?

To answer your question, I rarely battle with someone over differences of opinions/advice. I tend to go with the flow. However, anything major - like going to the clinic or the ER, or for medications, I tend to ask a lot of questions. But I'm never confrontational. All of my parents' home caregivers and visiting home nurses in the past 25 years - were used to my constant questions. Why you're doing it that way? I do it this way.... What do you think I should take mom to the clinic? Ohhhhh…. If their reasoning sounds reasonable, logical, I follow them. If I disagree, I tell them so and why. Usually, they will give me more time to eventually see that they were right. Or wrong.

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Sometimes people simply don't care for a particular nurse so you always have the option of requesting a change. I did exactly that when an older nurse tired of working did a sloppy job and next visit was someone I really liked. Try and meet this lady and see what she is like in person before you flip out if she is doing a good job with Mom's bedsore. Some but not all nurses have special training in wound care which can be a big plus.
She may also feel that the family contributed to the bed sore by not moving Mom around enough.

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You say you never met the home health nurse which may indicate she is living alone. She needs 24-hours-a-day care and never be left alone. If she is by herself you need to impound her in a nursing home..or you be her around-the-clock caregiver. Otherwise you are being neglectful. If you cannot care for her around the clock, a nursing home is the only other alternative.

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I think this is not helpful. You do not know the OP's situation. She may only need the home healthcare nurse to treat the bedsore. It does not mean that her mother is living alone. It does not mean the OP is irresponsible. It does not mean she's neglectful. Maybe she has a job to help pay for her mother's care and provide for her family. There may be someone home with her mother during the day but the nurse comes when she's at work. Her situation may be very different than yours.
Making assumptions is not helpful. Being judgmental is not helpful. Telling her what she "needs" to do or not do is not helpful.
Let's try to help each other here. I'm sure the OP is doing her best, the same as the rest of us.

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Good morning.
Can I ask why your going straight through the (nurse,caregiver)in the first place. You should be working with her agency not her by herself. You have to be extremely careful about this bc you don’t just want anyone taking care of your mom. Whenever have a caregiver comes in to help you with your loved one you should be talking straight to her Homecare agency not directly to her! If you are getting bad vibes or feelings about this person get someone else! You have rights and so does your mom. Always remember that.
You can call her care coordinator ( not sure how it works where you live) You can ask for a different caregiver. You have to be very careful about whom ever you choose for the care of your mom. You never know what can happen when you are not there. Please listen to these feelings you are getting. You are getting them for a reason.
I hope you can find someone you trust. I know how frustrating it can be. I hope I have helped you some.

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From a caregivers perspective it is more likely your mother's caregiver just wants consistently good and proper care for someone she has taken some responsibility for. Caregivers that are hired and not family members more often than not have their clients best interests at heart. We may try to inform family members of services and care they may not know are avilable. We know families are in new territory when they have to make decisions for a parent or other family member. I will do research to find services my clients may need and inform the family. More than once it has been ignored, but in most cases it is appreciated for what it is ; a caregiver trying to do the best thing for those they care for.

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Excellent answers here, and good luck tornado. I would like to just echo the suggestion to meet this nurse in person as soon as you can. Just like email, a phone conversation can be less clear and less simpatico than talking face to face.

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I think we know our loved ones best as you feel too and that we know what is best for them. I think the hospital was way to quick to tell us my father needed hospice - why ? His kidneys were being affected but they hadn’t shut down !
Yes I do sometimes feel they want us to bring in the top brass when it’s not always necessary! Good to know they are there when and if we need them, I guess.
good luck to you and your mom!

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If you are located in the U.S., then a nurse that provides wound care is hired by a Medicare-certified agency and ordered by the physician. Medicare pays. And if Mom requires a level of care to involve Hospice, Medicare pays. So that nurse is not looking to have you pay. Hospice is not a bad thing; it's a very good thing and able to provide all sorts of additional services, equipment and supplies, paid for by Medicare, not your mom and not you.

The question is, does your mother like the nurse? The nurse is there for your mother; if the nurse's personality truly does clash, of course another nurse can be requested. But the nurse is looking out for your mother's best interests.

What the others on here have said about the source of the wound being questionable, nurses being mandated reporters (all in the health field are mandated reporters), and the possibility of APS being called if your mother is left alone with dementia, all of that is true.

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thankyou, all true, if I had known to call MEDICARE before my brother died with Dad, being burned out, maybe a lot would have been different...…..my Brother needed help ASAP...….with Dad and his dementia..we did not ask
he was only on Aid and Attendance money which was first level 900.00
for only three years Dad was 96 when I applied for this WW2 vet...……….
and frankly the GP doesn't help....looks like they want all old people in a Nursing Home...…………...I mean you can barely get Dad to his Doctors office...….

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Well yes it is hard dealing with care providers ..If your Mom has a bed sore it is Very Important to get that handled...before it gets worse. Bed sores are very tough to get rid of. I worked as a cna in all the different settings and i can tell you horror stories about bed sores. The only way to get rid of them is to have someone to turn her every two hours through the night. Keep the pressure off that spot ...Some nurses are hyper vigilent ...but really a good thing if dealing with pressure sore! As for hospice this should not cost anything..it is a way to get professional nurse coming in and checking your Moms care ...her bed sore would be measured and treated so it can go away. If she has it on her backside or hip or heal anywhere there is a large bone pressing on skin she needs help to keep her self from continuing putting pressure there...and they can put a special dressing on it and change it. BED Sores are serious .... and painful. There are air mattresses that help if dr prescribes ins covers ..Dr is key. There are gel pad cushions and other things ... Hospice is not a death sentence they can have it 6 months and get better and go off it ...if they still need it can get another 6 mos of help. Maybe you can ask dr what he advises you ...and you can also request a different nurse by the way..if nurse is not a good fit ask she be replaced. Just ask agency for a more "quiet" person maybe?
You are daughter ...nurse is not. You have all the say...remember that and try to see they do their job. Hospice has RN come and check care...If mom is getting bed sores she needs more care ...either she is staying in her bed too much or was in ER for hours..
But you can help yr mom ...also hospice is more natural based care ..i think you might like it. I am caring for my mom and she has started to decline...is more forgetful and this happens with so many as they are getting very old and for some it is the beginning of the 11th hour of life...facing this is hard but I am commited to my Mom that i want to help her till the last as much as i can in each stage so she is not alone or afraid. None of us get out of here alive...one in one die. But you know you can help make it better for her getting her good help . My heart is with you in this journey you have with yr mom... My mom takes very little medication but she may need it to get through at some point and i just am playing it by ear as I understand my precious mother will not be here much longer ...it is the way life is.

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Whenmy husband got a bed sore, she did what she could, but also recommended a wound care specialist. These can turn into secondary infections and kill you!

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Like it or not, the home health care nurse is obligated to inform you of other services your mother may need. Sorry but If you mother has a bedsore, she is no longer "pretty healthy". A visit from a wound care specialist might be good idea. Please consider the suggestion for hospice with an open mind.

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As someone who just had Hospice for my mother for the last 3 months until she died I have to say Hospice (through the Visiting Nurses of VT & NH) was wonderful. If you are worried that hospice pushes people toward death don't be - their primary focus was to keep my mother comfortable. And because she was at home they picked up the charges for all her medications - I don't know if that is true in other states - but they covered medications, wipes, pads for pressure sores, and aide to bathe her a couple of times a week AND if I had needed it they would have covered 5 days respite care in a nursing home.

If you feel like you don't like that particular nurse certainly talk to the agency they are coming from and discuss your reservations. But I absolutely loved hospice and having someone to discuss decisions with and someone to lean on when I needed it. They took a big weight off my shoulders.

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If possible, meet the nurse during one of her visits to mom. She may be a very caring person who just comes across as bossy because she's passionate about her work.

I did that with my dad's nurse- on the phone she didn't have much in the way of personality and I thought her brusque, but once I met with her in person and talked with her about dad's care and treatment options, my opinion of her greatly improved. She never pushed for services he didn't need even though his insurance and Medicare would have covered them, but did make us aware of them. Between the 3 of us we came up with a rehab plan that best suited my fatner's needs for the few months he needed them.

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Question, has anyone been in the home when the nurse is there? I'm not siding with anyone but I would start there. Some agencies try and push services onto families. If your family find from their observations something is off, then I would call the office manager. I would find out approx. time of their visit and have somewhere there. Just saying that people have a tendency to be on their toes when someone is watching. See how they do things and maybe your suggestions of what the family does to make your mom comfortable when they are not their.

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We had a hospice nurse who would wait until we were out of the house to feed home cooked food to my ailing aunt. Turns out she put ingredients in the food auntie was allergic to and it did her harm. Needless to say that nurse never stepped foot in our house again after we discovered what she had done.

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Did you have the nurse fired from her job?

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Although I've found nurses to be the best of in home services, be careful. They sometimes over step without letting you know or make promises without fulfilling them.
But nurses are usually very comforting.

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Yikes, I didn't expect so many responses (thank you!) or so much drama. I think if you scroll through the comments Rosemary44 probably captured my thoughts best.

--My mom's primary doctor, who she sees every 3 months, says she is NOT yet ready for hospice.
--My mom's bedsore is small, healing nicely, and is her ONLY physical issue.
--She has someone with her at all times and receives great care - I am there myself 22 hours a week. Her best helper is the one who has dealt with the nurse.
--I have read online reviews of the agency from which the nurse comes and they are not exactly favorable.
--The nurse is obviously competent in treating the bedsore - the ONLY problem at the moment - so I have no problem with her skills.
--I have no doubt that the nurse cares about my mom and is making suggestions worth considering at some point.
--As Rosemary44 pointed out, I too believe that some agencies are trying to make as much money as they can from services.
--I view my job as advocate for my mom and her best interests.

Hope this clarifies things. Thanks for taking the time to respond.

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I am interested to hear what the doctor means by “not ready” for hospice. Hospice is not throwing in the towel and waiting for someone to die. I have had multiple clients improve on hospice because the focus is directed at quality of life. Your mother can still see her PCP and should have weekly/bi-weekly visits from a home nurse among a number of other amazing services. At 92 and having advanced dementia, is her doctor thinking she isnt ready because she will still want major medical intervention at some point?

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There are many ways to look at the situation:

1 - she may be just trying to do an efficient job & is letting you know what is available - obviously you need help because you called her in ... the agency just didn't appear & knock on your door out of the blue!

2 - while you are trying to do your best quite frankly something was missed because your mom has a bed sore - nurse has seen hundreds of them & may be just brisk/old hat about them whereas this is a first for you to deal with

3 - nurse may see that bedsore as a signal that maybe not everything is being done for your mom otherwise why did the bedsore arise in first place so she is trying to help you - but realize that you are now no longer the sole control/care giver that you are used to being - you may still have to adjust to new circumstances with new inputs whereas before it was only you

4 - meet with her in person not just phone calls & why hasn't this been done already? where are you when she is there? - these nurses want to be helping their patients not doing administrative work A.K.A. phone calls to family

5 - you just might be hyper sensitive because you have made quite a judgement about someone you have never met or is it a bit of guilt that the bedsore bloomed under your watch?

6 - your write-up sounds like you live near/with mom but don't see the nurse so I assume you leave for work & mom is alone for some time & that's when the nurse arrives - she is seeing red flags all over the place if this is the case & is probably not telling you in the best manner but mom needs more help than she is getting - what you see as 'extra' that you don't think is needed but the nurse sees as getting optimized care for her patient -

7 - these nurses don't get a commission for offering/telling you about what services are available so she will tell you as a 'newbie' what you might not know about to assist you & your mom - I think you are too sensitive about how you are taking her comments but she may not have the best bed-side manner either

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Some of those nurses need to be disassociated from their jobs

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As far as pressure ulcers go, please don't be too quick to judge. My previously fairly healthy for 92 yr. old mom fell and broke her arm, was hospitalized then they sent her to a nursing home for rehab. She went delirious there from a UTI and when rushed to the hospital I was shocked that the intake nurse there asked if I knew about the tailbone wound !! Turns out this occurred while in the care of the rehab facility. I took her home and with trips to the wound care doctor I was able to somewhat reverse the wound with protein foods and keeping pressure off. In no way is the family always at fault for a loved one's pressure wound. I was shocked and angry about what happened at that rehab facility.

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Did you tell them that they need to go out of business? Oh, how I love to bark orders

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Yes. It may be her tone or how she expresses the situation to you, but I’d put the “rubbing” aside of her voice. She could say nothing at all, but then if something occurs, there could be more questions ( and accusations) regarding the quality of her care would still be there.

If she is suggesting services her company provides, there’s two ways to look at it: either you prefer to find those services when the family is ready to see what’s needed, or one can take advantage of the idea you already have someone in place to offer quality care for your loved one and is letting you know what’s available “when that time comes” without the need of finding services and interviewing others.

Despite the horrific media surrounding care for our aging family members, not every person hired sees a elderly client as a “walking paycheck” to siphon off as much as they can. Technically, they are there to help - temporarily or permanently. While I get that this woman rubs you the wrong way, those that care for our family are in a tough job to handle not just their care, but to inform the family of any changes in the most compassionate way as possible.

if you do not feel she is capable of doing so, then the option of finding someone who can would be would make the family feel comfortable.

My mother has Alzheimer’s/dementia and is as strong willed in her illness as she ever was when she was healthy. Problem is that the disease they have will and does alter their behavior, and what was active before can be a safety risk (getting lost) when dementia is involved so the services she is suggesting may be something worth considering..... if one is open to hear the message behind the busybody / nosiness we would attach to conversations that WOULD be, in other circumstances.... would elicit a “mind your business” comment (with / without profanity 😊).

She is a nurse... I’m certain she’s aware of what a dementia patient can do...she’s not going to be as intuitive as a family member who know her prior to the diagnosis... so I would agree with the rest; give this woman the benefit of the doubt. I think the nurse is just flagging issues that can crop up in her care.

I hope this helps.

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I had a difficult time with a person who was hired to go to my parents' condo 3 times a week around midday to cook a hot meal for them. She seemed extremely pleasant and my parents liked her but over time she seemed to start making decisions for them. If I happened to visit them during the time she was due to be there she seemed very prickly and hostile to me while still being charming to them. My mother had a extreme pain due to complications of osteoporosis but they were both mentally alert and my father still drove to and from various social and medical appointments. The last straw came for me when she phoned me up at home one day. In an irate tone she demanded to know why I hadn't made sure to get my parents their eye appointments because they hadn't gone in two years and were in danger of losing their sight. I informed her that I did not and never had made my parents' medical appointments and as far as I knew they took advantage of the eye examinations which were done on site in their seniors only condo building. I was furious because I felt she should mind her own business. How did this woman go from being a cook/helper to thinking she was their custodian and what right did she think she had to tell me what to do? (rhetorical question :) )

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My question...how did she know how long it had been they hadn't had an eye exam? Must have been going thru bills.

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I can sympathize with busy body caregivers . Have had to deal with a few.
You can tell the difference by the level of professionalism. I would suggest
you contact agency via email and keep paper trail. I've had a several care
givers and "friends" chum up my Dad who craves constant attention. Next
thing I know they're quite hostile towards me, although I take care of all
care coordination and hospitalizations, etc. All the red flags I've experienced
from boundary pushing care givers were unprofessional behaviors and either
just looking to be in control or make money (or in a few cases attempt to
access his bank accounts) . Trust your gut, document, but don't take anything
like this personally. It will affect your health.

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You may find yourself thanking this home health nurse for the found bedsore. It sounds like your classification of your mother as "physically pretty healthy" may be slightly skewed because late stage dementia means that her brain function isn't well, though I do understand that you are talking about her other organs.

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My Mom was healthy as a horse. Even when hospice was called in Mom would fight when touched. The nurses couldn't get over how strong she still was. A week later shevwas gone at the age of 89.

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Thanks again for those who actually took the time to answer my original question: Have you ever felt you were in a battle of wills with someone involved in the care of your loved one?

As a footnote, I am the one who found the bedsore and through my mom's doctor, arranged for home care of the bedsore. My mom is getting outstanding care in her own home and by all accounts (including the home nurse) is doing quite well. We will continue to provide the best care possible. Happy Thanksgiving to you all.

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I think this thread has taken off and most people aren't bothering to read your replies TJ. I hope you, mom and the rest of your family have a happy holiday!

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