Mrs. B, a chronically weak bed bound 78 year old woman was in the hospital for an acute change of mental status. Her baseline was that she was alert and oriented but needed assistance with activities of daily living except feeding herself. She had a 24/7 caregiver caring for her, but recently it was reduced to 6 hours a day because she was financially unable to pay for it. I was taking care of her and witnessed the social worker from Adult Protective Services speaking to her about her safety and trying to arrange for her to move into an assisted living facility. This would be paid for through a Medicaid waiver, but the patient refused. When the social worker left I tried speaking to my patient telling her that it would be best for her to move …show more content…
I didn’t understand how she could refuse if it was going to improve her safety and she was going be taken care of with no cost. Even when I tried explaining all the benefits that an assisted living facility has to offer, she continued to refuse. I tried to picture myself in my patient’s place and didn’t understand why she refused. It was her life we were talking about, we are trying to keep her safe so she can live longer. I continued to care for my patient by changing her linen and helping her bathe. I spoke to her in a friendly therapeutic manner making sure she was happy and in a good mood. The assembled multidisciplinary team of professionals came into the room and told my patient that her current arrangement at home was unsafe for her and that she was at a greater risk of developing medical problems which can be deteriorating. The patient understood completely what was at stake, her Mini Mental State Examination score was 28 of a possible 30. She also understood all the risks involved, but remained uncooperative. She explained that she would need to be dragged out while kicking and screaming if they want to put her in a nursing