Standard "Care of Seniors with a tendency to neglect"
|For the "reality TV" of the private television stations there are no better objects to be shown than "Messis": ragged people in littered apartments. If you can't stand the sight, simply press a button on the remote control. Many nurses also want a switch like this when they have to look after the elderly affected.|
- It is not the purpose of our sample to be copied unchanged into the QM manual. This standard of care must be discussed in a quality circle and adapted to the circumstances on site.
- It is always essential that the respective general practitioners and specialists are involved, as individual measures must be ordered by the doctor. In addition, some measures are contraindicated in certain clinical pictures.
- This standard is suitable for outpatient and inpatient care. However, individual terms may have to be exchanged, for example "resident" for "patient".
|Standard "Care of Seniors with a tendency to neglect"|
- The neglect (also "litter syndrome", "senile neglect" or "Diogenes syndrome") is one of the personality disorders. Sick people neglect themselves and let their home environment deteriorate. The extent of neglect goes beyond what is socially tolerated as mere "neglect".
- The triggers for the disease are often drastic experiences in childhood or later adult life, as well as loneliness and mental stress. Numerous mental illnesses such as schizophrenia, depression or addictions can also lead to neglect.
- There is no scientifically recognized assessment instrument to objectively assess the risk of neglect or neglect that has already occurred. It is therefore up to the nursing staff and the treating doctor to classify the patient's condition based on their own life experience and values.
- Littering a rented apartment is not only a hygienic problem, it can also have legal consequences for the patient. The landlord can, for example, terminate the rental agreement after complaints from neighbors. The patient would ultimately become homeless and would have to be cared for as an inpatient.
- We respect the patient's right to free personal development. If his actions do not represent a nuisance or danger to himself or to third parties, we tolerate his lifestyle.
- We do not see neglect as a self-chosen or self-inflicted fate, but as a disease. It is our job to alleviate the suffering of those affected.
- We are often "unwelcome helpers" for the patient concerned. Our endeavors to restore order and structure to the senior's life will sooner or later bring us into a conflict situation with the patient. We always have to be aware that offensive statements and passive or active resistance can then occur. It is part of our understanding of professional work that we always approach the patient with acceptance and benevolence in such dispute situations.
- We work closely with general practitioners and self-help groups.
- Consistency is important when we set up rules of conduct together with the patient. Agreements are consistently requested by the nurse.
- When caring for neglected seniors, there is a load limit for caregivers. If this is exceeded permanently, the maintenance order may have to be reconsidered.
- Overtaxing the nursing staff is avoided.
- Neglect is recognized at an early stage.
- The causes of neglect are correctly identified and, as far as possible, eliminated or mitigated.
- Social isolation is avoided.
- Skin damage as a result of inadequate personal care is noticed early and treated appropriately.
- Neighbors are not bothered by collected rubbish. Termination of the tenancy by the landlord is avoided.
- Inpatient care, for example in a psychiatric specialist clinic, is avoided.
- The patient is enabled to lead a self-determined and humane life again. His self-esteem is strengthened.
|Preparation:|| general measures|
- Our staff is regularly trained on the subject of neglect.
- Dealing with neglected patients is regularly practiced in role-plays.
- Two nurses from our facility have advanced training to become geriatric psychiatric specialists.
- We regularly expand our library with the latest specialist books on this topic. We encourage our caregivers to read these books.
| Self-assessment|| There is no scientific distinction between an "alternative lifestyle" and neglect. Therefore, caregivers should reflect on their own thoughts first before considering other people "neglected". Everyone should answer the following questions for themselves:|
- When is an apartment messy and when is it rubbish?
- When does collecting become pathological collecting?
- What level of personal hygiene is normal? When can a lack of personal hygiene no longer be tolerated?
- Can a person live in a self-chosen isolation?
| Requirements for the nursing staff|| Caring for seniors with a tendency to neglect is one of the most challenging tasks in elderly care.|
- The caregiver must be able to suppress feelings of disgust. Especially infected or maggot-infested wounds are an almost unbearable sight even for nursing professionals.
- The caregiver must be able to strike the right balance between assertiveness and interpersonal warmth.
- The caregiver should have experience as a reference caregiver.
- Young professionals should not initially care for seniors with a tendency to neglect.
|Execution:|| Assessment of neglect|
In the case of advanced neglect, several of these points are fully met:
- We try to estimate the extent to which the neglect has assumed. Our observations are relevant later, for example, when asked whether the patient needs a carer.
- In the early stages, neglect can only occur in certain areas. The patient himself can make a well-groomed impression while his living space is noticeably littered.
- Often, however, a strong sweat odor can already be detected. The hair is greasy. The clothes are dirty.
- Neglect of the living area: The rooms are filthy with dust, rubbish and possibly with excrement. There are bugs. A pungent odor can be perceived. The lighting and the sanitary facilities do not work. The food in the kitchen has gone bad.
- Neglect of the body: the hair, toenails and fingernails as well as the skin are neglected. The teeth are badly affected by tooth decay. The clothes are unwashed and in poor condition. Chronic wounds, skin diseases or parasites are common. The patient is malnourished or malnourished.
- The patient lives alone, for example because the partner has died or was divorced. Contact with relatives has broken off. The sick person rejects offers of help from acquaintances, friends or neighbors. The person concerned completely avoids contact with other people.
- The patient collects various objects in an exuberant amount. Cupboards, shelves and chests can no longer hold the quantities. The objects are stacked up to the ceiling and reduce the living space to narrow corridors.
- The items come from the street and are obviously worthless.
- The patient refuses all offers of help.
- The patient reacts in a panic or aggressive manner as soon as the nurse tries to clear away the garbage. The patient fears that "something valuable" could be disposed of in the process.
| Information gathering|| We collect further information that can be important for the assessment. About:|
- Are there any biographical indications of neglect in childhood?
- Are there any biographical indications of traumatizing life experiences, such as displacement, war experiences or sexual abuse?
- Does the patient provide relevant information for the self-assessment? Does he say that he is overwhelmed with the way of life?
- Does the patient suffer from dementia?
- Has the patient been showing any signs of depression in the past few months?
- Are you addicted to alcohol, drugs or medication?
- Does the patient suffer from restricted mobility or chronic pain?
- Is the sensation of pain reduced?
| Acting in the event of neglect|
- We seek contact with the patient. Only when there is a relationship of trust can the nurse assess the true extent of neglect.
- In the case of compulsive collecting, for example, we can be explained what relationship the patient has to the respective objects.
- We try to make arrangements with the patient. These can include:
- Regular personal hygiene, i.e. a fixed appointment for a bath during the week
- Regular changes of clothes, which are provided by the caregiver
- adequate nutrition
- Tidying up the room and closets
- Disposal of rubbish and dissolution of collection points
- If there is malnutrition, we check the necessity of an external food supply ("meals on wheels").
- We seek contact with the relatives. Often they reduced their dealings with neglected senior citizens to a minimum years ago. Nevertheless, they are most likely to have an impact on the patient. We use the remaining ties to enforce agreements and understandings.
- We check whether the patient accepts other figures of authority with whose help we can push for behavioral adjustment. This can be the attending physician or, in the case of religious people, a clergyman.
- We check whether the neighborhood help or similar associations can intervene in a supportive manner.
- We will contact the landlord. It often makes sense to clear out the apartment completely, to renovate it and in this way to make a clear cut. However, it is to be expected that the relationship of trust between the nurse and the patient will be permanently disturbed.
- We check whether the initiation of a supervision procedure makes sense.
- In the case of unsustainable hygienic conditions, we document this and inform the patient, possibly the partner, relatives, the treating family doctor, the cost bearers and the health department in writing. In this way we secure ourselves against any accusations.
| Maintenance measures|
- Checking the condition of the skin is especially important. Skin defects and local infections are to be expected, which may have to be treated with ointments. We observe the relevant standards, such as "Care of the elderly with mycoses (fungal infections)" or "Intertrigo prophylaxis and treatment".
- We check whether there is a parasite infestation. In this case, the relevant standards must be implemented, such as "Caring for seniors with lice infestation" or "Dealing with scabies (scabies)".
- The umbilical stone must be carefully removed.
- Due to the inadequate intimate hygiene, increased urinary tract infections are to be expected.
- The hands must be freed from fingernails that are too long. If the length is appropriate, these grow downwards and form claws.
- The toenails are also cut. We check whether the toes have been damaged. Inflammation often shows up here.
- It is very important to remove the most serious caries damage. Seniors with poor dental status often do without oral care because of the pain. Malnutrition is also often due to toothache when eating.
- We always remain tactful in dealing with the patient. Allegations about the condition of clothes, room hygiene or personal hygiene could offend the person concerned. Better to make him offers instead. So the person affected can be offered a full bath on the grounds that this would relax him. At the same time, such a bath is of course also used for personal hygiene. In addition, the caregiver can record the skin status.
- We check whether the neglect is the result of a mental illness that responds to drug therapy. Antidepressants can also alleviate the tendencies to neglect in the case of depression or obsessive-compulsive diseases.
| Self-protection||Our options for caring for the neglected are limited. In addition, the safety of our employees comes first. We will therefore immediately initiate admission to an inpatient psychiatric facility if the patient|
- Threatening violence in a credible manner or actually becoming violent
- Sexually molested persons
- continued to use drugs or large amounts of alcohol.
- In around 50 percent of all cases, those affected accept the need for psychotherapy. As a result, there are mostly minor improvements in behavior, although a complete cure remains the exception.
- The other half refuses to help. Since psychotherapy without cooperation is pointless, the last option is compulsory measures such as admission to an inpatient psychiatric facility. If this is not done either, there is a risk of further neglect, illness and death.
- The forced cleaning of an apartment usually only has a temporary effect. If the collection of rubbish is not consistently countered from the start, renewed littering is to be expected.
| further measures|
- We regularly offer our nurses supervision to deal with the mental stress of dealing with neglected patients.
- Any problems that may arise are discussed in the quality circle.
- All observations are precisely documented. The description is neutral. We pay particular attention to changes in the patient's behavior.
- The maintenance planning is regularly adapted to the current circumstances.
|Documents:|| Care documentation|
|Responsibility / Qualification:|| all employees|
| Keywords for this page||Aggression; Violence; Dementia; Geriatric psychiatry; Neglect|
|General information on using the magazine: The purpose of our samples and text templates is not to be copied unchanged into the QM manual. All samples must be discussed in a quality circle and adapted to the conditions on site. It is also often essential that the respective general practitioners and specialists participate in the content, since individual measures must be ordered by the doctor. In addition, some measures are contraindicated in certain clinical pictures.|