Consent

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I wondered if other members could give me some pearls of wisdom on how to deal with this situation:
I go to a large care home very regularly and just recently I'm starting to run into problems with staff there appreciating my professional issue with consent. One particular resident used to be very amenable and enjoyed having her feet done, her dementia has now progressed and she doesn't particularly want to get out of bed or receive any care from the care staff. She has been refusing foot care. Last visit I went to her room accompanied by a member of the care staff, they persuaded her out of bed - she got herself to the armchair and put her foot on my stool unassisted - I take this as her consenting - we'd explained what I was there to do. I cut one nail and she started screaming and withdrew her foot from the stool at the same time swinging her walking stick back over her head aiming to wallop he with it as she brought it forward. Clearly this is someone withdrawing consent I'm sure you'd all agree. I jumped clear, was unhurt and left her in peace immediately.

The problem is the home are suggesting that to not cut her nails is neglect. My view is, unless she is Sectioned, there is no way I'm getting involved with any coercive measures to get her nails cut. I've told the home (in writing) they need to liaise with her doctor over this matter.

I wondered how other people handle this situations and any advice would be gratefully received!

 

That is a very difficult problem and one that I too have had in the past. I think that the patient is presumed able to give or indicate consent unless steps have been taken to appoint another person or family member to decide for them. In the case that you outline I too would take the view that they had refused to consent to treatment and leave well alone. The only time I've overcome this is when a family member held the lady's foot and told me they were deciding in her best interests and would I please cut her nails!

 

Good advice from Fronny, but If the relatives want her to receive t/t, I'd get it in writing from them and not put up with pressure from the Home.

All the best

Bill

 

Difficult situation, but quite a common one I would think. For agitated or aggressive dementia patients, sedation by prior arrangement might be appropriate in such situations. This certainly occurs routinely for other care procedures where cooperation is absent. The presence of a family member can also give the patient reassurance, but their written consent to provide treatment does not necessarily pacify an agitated individual. In addition to consideration of consent, there is also the matter of duty of care to complicate things.