So I'm not quite sure what I should do.  This is the situation:

I have a patient (I'm a hospice CNA), that is bedbound and can't keep ahold of a cg (caregiver).  The patient (age 76) lives with her daughter (55), and the son(52) has been living there too.  They are originally from New York, very direct & anal, and narcissistic.  They do have their kind moments and are not bad people.  I have no problem with their directness and do not take it as rude, although most people do.  In the last 6 months, they have gone through 4 cg's.  They are looking for a live-in that is on duty 24/7 and pay a mere $47 a day.  They feel that it is good pay since the cg does not have to pay rent, food, or utilities.  At the same time, they have no time off.  Their most recent cg walked out last night.

Now that you have some background, here is my question:

I arrive in the morning, giver her a bed bath, dress, brush teeth, wash hair, and give her a clean & dry brief (aka diaper), etc.  Without a cg, she will be in that same brief and position (tha tI put her in) until her daughter gets home form work.  Depending on the daughters work schedule, it may be 8 hours or it may be 12 hours before she gets changed again.  Sitting in one position that long, and in excrement, will break down the skin rapidly.  They have asked me to come back in the afternoon and change her again.  The company I work for said "no".  If I do it on my own time and the company finds out I will be fired and could lose my license.  At the same time, I feel that the moral thing to do is to come back and help her .......

The daughter says she has used all of her vacation time already looking for cg earlier this year.  She also says she was denied taking an emergency family leave of absense as the illness is not new.

So, what do I do?  the moral thing?  or protect my license (and income) even though it goes against my beliefs of right and wrong?

what to do, what to do   (bang)
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That is an awful decision you have to make.   If it were me, I would keep my job, and pray for the lady or even do a simple spell to try to make her situation better.   I know that I  can't save the world, and if I lost my job, who would take care of me?  It's  too bad that sometimes our paying jobs have to get in the way of doing what we think is right, but hard times call for hard choices.  You should spend some time in meditation about it, and try to come to the solution that makes the most sense to you.   Goddess bless you for your loving concern for this lady.

Well Thiodora, I don't evny your position one bit. However, like Rainbells, I believe you should first do what you need to and keep your job secure. Think of it like this: how many peoples' lives could you help if you were on the sidelines and lost your job? You can't feel guilty about them not being able to keep a caregiver. And just because someone is from New York doesn't give them creative license to be rude to others. I'm from NJ, AND I've worked in the county jail for 24 yrs. I can be rather aggressive when I have to be. I don't like it (being aggressive) But I can be  My point is that they are free to choose how they treat their caregiver. It takes just as much time to be courteous as it does to be rude. and they seem to be choosing the rude route. My suggestion is to confront them and tell them that they need to change their attitude and be polite to the very people that they depend on for assistance. Best of luck with this.

Blessings,

Draco

Oh <sign>, I know you two are both correct.  I pretty much knew that I have to cover my butt, its just a crappy decision to have to make.  I needed to hear a conformation to help ease my guilt.  Unfortunately I don't have the ability to tell the family about themselves ...... I so wish I did ....... but that would be a guaranteed termination of my job ~ LOL!  Thanks much, I feel better  
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I completely understand Thiodora. Sometimes (actually most times) I think people take being politically correct way too far. If the "powers that be" at your job weren't so concerned about liability (and they ARE justified in that concern) , you could let these folks know what pains in the butt they are and maybe they'd clean up their act  enough to be able to keep a care giver around.

Blessings,

Draco

Thiodora, I do not envy your job at all.  It takes special people fill that line of work.  You are one of those special people.
I agree with Draco and Rainbells, though if you feel the need to be helping, why not try a different approach?  Keep your eyes and ears open for another cg?  If you're sending out energies for the perfect cg to come along, then you might find an aggressive one that will help all members of that family.

MM Thiodora,
I spent the last 6 years of my career as a continuous care LPN w/ hospice. Is it safe to assume that this family's Primary Care RN is aware of this situation? It could be that, even though they may know that the family is again without a care giver, they do not realize that no other family member will be checking on the patient. Is the patient able to use a phone if there is an emergency? Is she confused? If she is not able to call for help or if she is confused, she should not be left alone under any circumstances. It would be the hospice's obligation to do *something* to address this if they are aware that an unsafe situation exists in the home. Now that *something* could be anything from offering the family inpatient respite until they find a care giver to explaining to the family that they will have to contact protective services if they learn that the patient is being left home alone.

I believe there is more going on here than just the lousy pay they are offering, since the people who have walked out on them took the position knowing in advance that the pay was poor. I would think it would be rather unusual for live-in help to walk out of a job at night unless something extreme was going on. While they come off as a bit abrupt and narcissistic to you, I suspect that the way they behave toward the care givers they are having to pay "out of pocket" for may be even worse - possibly even far worse. The fact that the daughter is not willing to risk her own job but is more than happy to ask you to risk yours speaks volumes about the mindset of the daughter toward other people. I also wouldn't be a bit surprised if she hasn't asked other hospice staff to do this when the other cgs quit in the past.

There is another child here. If the daughter has exhausted her leave, then why can't her brother take time off to care for their mother until a new care giver is found? It may not be ideal in terms of patient dignity, but leaving mom home without a care giver is not ideal in terms of safety or in terms of her mother's comfort and skin integrity, either. Extreme circumstances often call for extreme measures. When there is a family crisis, such as a parent being terminal and in need of care, you do what has to be done. I would definitely have a private conversation with the Primary Care nurse. There might be things going on behind the scenes that you don't know about. I would definitely make sure that the PCRN knows that they do not intend to take off work to attend their mother while they are looking for another cg.

What ever you do, please do not allow this daughter to play on your concern for her mother to get you to do this. This is a shit storm in the making. It could get far worse than *just* you losing your job. Once you go into that house, off the clock, with no one home but the patient, you become completely at the mercy of the daughter and the son. What if the mother passes over while you are at the bedside off the clock? What if you come in and find mom in the floor? What if she bumps her forehead on the bedrail while she is alone and ends up with a black eye? What if right after you leave, the house gets broken in to? What if they say some meds have come up missing? You are at their mercy as far as any accusation that they may make. And don't believe for a second that this daughter would not toss you to the wolves if she had to to save her own ass.

(((Thiodora))) I know it's so hard when you care so much. Co-workers like you, who cared for our patients with all their hearts and were more than willing to go above and beyond the call of duty for the good of the patient, are the very reason that I have always said that I have never had the honor of working along side a more dedicated, selfless and caring bunch of people than the people I worked with while I was at hospice. It was the most precious years of my nursing career. Take care dear one - and never forget that old nursing adage: CYA - Cover Your Ass!

Gotaa go with the moral majority on this one! I too have worked in the care field, as a CNA, and am currently the receptionist in a facility.

It is actually the responsibility of the primary care nurse to make sure that care needs are being met, and adjust the care plan accordingly, or make the needed referrals to make sure Moms getting her care, regardless!!! Can we say neglect here?

Yup, CYA!!! It will work itself out, promise!