Health aid worried about elderly woman's treatment from daughter. Advice?

Have your daughter suggest that the patient ask her daughter to put her into assisted living.

You say "I know that there is likely a lifetime of baggage that impacts the pair's current relationship". You don't say how long your daughter has worked for these people or if she sees and interacts with any other family members. It is possible that this kind of behavior is just par for the course in this family and the family dynamic is long established. Yelling, swearing etc can seem demeaning and hurtful and is difficult for outsiders to witness, but it could also seem perfectly normal to this family, the key I think is how the elderly woman reacts to it. Does she cringe and weep? Yell back? Totally ignore it/not seem to care?

As for not waking her for meds and letting her stay in bed all day, there are times when I have done the same with my mom, so again it all needs to be taken into context. If her needs are met most of the time a little flexibility is usually not going to be harmful.

I'm not saying your daughter should turn a blind eye to obvious abuse, but she is a brand new (idealistic?) young student nurse who perhaps has not had much life experience. The other caregivers seem to agree the caregiver daughter is pushy and can be unpleasant, but they don't seem to be concerned for the mom's well-being. Is there a school counsellor she could confide in and ask for advise?

This is a tough call. As Cwillie points out, neither you or your daughter are able to determine what the family dynamics are, especially how the daughter and mother interact when they're alone, or what other issues are influential.

I think I would take a different approach. Your daughter can speak privately with "J", emphasize that she's a nursing student and is anxious to learn all she can, especially about a caregiver's family dynamics as well as the relationship between the elderly person and her/his caregivers. Make it a general statement and inquiry, and a quest for advice and counsel for a young novice from an experienced caregiver.

Perhaps J will be flattered that her opinion is valued and be more candid in sharing her experiences and position. And it might even be the only compliment she gets for her labors.

Is there any way that your daughter can talk to the mother to see how she is with the treatment? Is she fearful or does she feel neglected. Can she ask the mom what she would like to happen? Is the mother lucid and able to make decisions?
If the mother is OK with the daughter's care then perhaps your daughter should look for a different position. There is a huge need for help for the elderly these days.

For Heaven's sake, she should make the call to APS. She is witnessing a crime in progress. RN's are mandated to report abuse, didn't they teach her that yet?

she said the woman asked her why her daughter doesn't like her so evidently there's something going on, though, granted, the daughter would probably just dismiss it as "just being in mom's head" or some such - what kind of meds is mom supposed to be on?

Always easy to make a judgement call from the outside looking in. To outsiders my mom is a sweet old lady. I know better. Stay neutral. J's got a life to live, so does the mom. Do your job and stop playing counselor(unless there is a physical reason)

Speaking as a full-time caregiver, I can say it is understandable to be irritated and overwhelmed at times...and impatient and snappy. But there's a world of difference between snappy and impatient and yelling, swearing, and demeaning. The latter is definitely emotional abuse and reportable under state statutes on elder abuse. Even if Mom was a total b**** with J in the past this is not a healthy situation for either Mom or J. I agree that your daughter should speak to her nursing supervisor (maybe presenting it as a hypothetical situation at first). Sounds like a change in living situation would be in everyone's best interests.

Find another job

Pam absolutely agree this is abuse in a big way. If this elderly woman were to die as a direct results of not being given her meds and, considering that you know, your daughter MUST know that meds have not been given then she would be regarded as aiding and abetting A CRIME which is likely to be involuntary manslaughter but could in fact be mush more.
THIS IS MEDICATION ABUSE at its minimum

There is no excuse for shouting at her mum none whatsoever. I never shout at mum - I do go and scream in the garage; I do rant in here; But never at her. If your daughter finds J intimidating just imagine how her vulnerable mum feels. THIS IS EMOTIONAL ABUSE

Equally leaving her in beds for extended periods is neglect and could result in a whole host of difficult to treat issues the least of which is probably bed sores. THIS IS NEGLECT

If you need further proof have a look at this site:
http://www.ilrctbay.com/upload/custom/abuse/content/factsheets.htm

Its a canadian website but abuse is pretty much universal

SHE MUST REPORT IT - SHE HAS A DUTY OF CARE TO

If this mother was in a nursing home and was treated this way, it would be reported as abuse. Perhaps the daughter is just giving up on her mom and is depressed and does not know how to handle the situation. Is there a support group in her area for care givers?

There is a fine line between what is the normal family dynamic and what is abuse. If you call APS they will certainly investigate. Most likely they will determine that she has a safe home with adequate medical care and food. The mom will never tell an APS worker that she is being abused by her daughter because the alternative is to go to a nursing home. Without that happening there are no obvious signs of abuse or danger to the mom. APS will have no reason to monitor her status.

and that's the problem there, isn't it - unless....possibly another guardian is appointed?

JudeAH53, thanks for sharing the link to the Independent Living Resource Centre website, which provides a listings of progressively abusive behavior. It seems that the Canadian and U.K. websites are always more straight forward!

I do think we need to tread lightly about what is abuse. Sometimes we can get caught up in a game of "Ain't it awful?" that can do more harm than good. We probably do things ourselves that could be seen as abuse. For example, I leave my mother alone for 2-3 hours at a time. Could this be seen as neglect? Should I make myself stay here 24/7 to avoid the appearance? Sometimes she asks me to pick up something at the store, but I know it is something to do with an obsession she is having, so I don't. Am I being mean or wise? I have yelled at her 2 or 3 times in the past year in response to her abuse of me. Is this being mean or is it being human? I'm normally a very passive person, so it takes a lot to push me to that point. My mother is mobile, so can get out of bed. She doesn't like to get up early and won't do it. Am I bad because I don't force her to get up early in the morning?

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.

Senior Advisor and Jessie very compassionately and insightfully described the pros and cons of becoming involved in abuse allegations and the determination if abuse really exists.

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 have had so intense moments with my mom and the quilt will kill you. I remember I took Lexapro during my divorce and it went pretty well, so I decided to take it again and I am handeling this situation much , much better. I let many things flow which would other wise I would go crazy over. It helped

mar126.... can you find this "abusive behavior" list and attach a link, please? I've been looking for it.... thank you. I think the first thing the nursing daughter needs to do is truly assess if this is abuse or not. She needs concrete info on the subject...

I totally agree with JessieBelle. I have one of those sweet to everyone but her own family mothers. She is so manipulating that she would come across as a saint and me the devil. She puts on a really good show. Your daughter should be listening to those with more experience instead of jumping to judgment and causing turmoil with authorities. It is so easy to pass judgment when you really aren't privy to all the facts. The simple fact that others with more experience and knowledge of the dynamics of the mother/daughter situation are not alarmed should have your daughter asking for them to school her on how they determine what is abuse. Remind her that she is the student and NOT an expert. She has a lot to learn and will benefit from not jumping to judgment.

Let's be a little kind.... she's trying to do what's right.

Have the care taker report it to the county dept. of aging as elderly abuse. Maybe she can record it discreetly to have proof for them.

I believe everyone is being very kind. I think the general thought is to make sure something is really wrong before taking authoritative action. She may even choose to talk to her supervisor to see what she thinks. If there is abuse, someone should move on it. If it isn't, then the woman may lose her home and support for no good reason and the daughter could also be harmed by making home and care available to her mother.

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 reread my previous answer and it sounded abrasive. I'm sorry for that. But we all had that feeling as students "I'm gonna change the world". Then reality his you. I suggest she tread lightly, factor in how dysfunctional the mother daughter relationship is as well as the harm that can be done if the mom is removed from the home, or if the daughter is not there. Good luck!

OK this is going to be long but here goes
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

Can the meds be rescheduled? Wake ME at 6am for anything short of a fire. I Double-dog dare you. If it isn't absolutely necessary, give it at a reasonable time. Once we wake people to be safe enough to swallow, the next 248 requests follow rapidly. Its not about the meds. It's about being held captive for what would have waited if mom was allowed to wake on her own.
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

The same thing Alzheimer sites teach. When I lower my voice while being yelled at, others usually follow suit. Good luck with the situation. Without personal knowledge I can't advise to sic the APS on anyone.

By contrast, if my mother's caregivers had reported me every time I blew my top or made a pig's ear of putting in eye drops, for example, or, indeed, shook her awake and insisted on medication when my mother didn't feel like taking it; well, then I wouldn't have had the last two years or so of caregiving to do, I suppose. And my mother would have landed in residential care, which was the one thing she didn't want.

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?

Call someone and report this immediately. I am almost certain care givers and nurses even student are mandatory reporters. Please have her do something before you daughter gets blamed for something she did not do.

Or your daughter finds herself fighting a Mandatory Reporting issue that she did not report...

All of you on the bandwagon to call in the authorities scare me for your jump to judgment without really knowing any facts or all of the situation. We don't know enough to be advising reporting and starting a hell storm for this family. This young student nurse has supervisors that are the best source of information for her. I hate that our society has taken to such extremes when jumping to judgments and making accusations. Also the rest of the support staff seem to be telling her to not worry for a reason. They have information that we do not. Maybe our little student nurse could benefit from asking them to explain to her how they have come to that decision and learn some valuable insight. After all she is there to learn, and asking the questions is part of the learning process. I don't see where anyone has been cruel on here, but advising anyone to jump to reporting without any real information is just careless. It also leads to frivolous reports being filed and social workers being over taxed when there is real abuse for them to address. Mandatory reporting is real, but this young nurse needs the more seasoned to help her take a look at the situation before she is causing a situation that could backfire on her and her credibility. She is building her career now and some things will follow you your entire career if not careful.