My friend is a new caregiver and she told me about her new client's insistence on having late-night showers before bed. Her elder client hired her as a part-time caregiver since she has Parkinson's disease and her health is deteriorating.
This patient does not have dementia, but she has OCD and is a germaphobe and stubborn and self-centered. So her priorities, as it was explained to me, are not in her best interest, health-wise.
My friend told me that her patient's mobility has gotten worse and that she is at high-fall risk. Her patient is aware of this risk but regardless wants to be showered at night after my friend has worked non-stop for 10 hours straight. She has many times told her that she could give her a sponge bath but she refuses and wants to be walked into an all marble shower.
My friend is under the impression because she warns her client that if her client falls then she won't be liable for any injuries her client receives. But I told her that is not the case, in my opinion. I think because any reasonable person can see the clear and present danger of this situation this elderly person is putting herself in, because she is the caregiver it is her responsibility to keep her safe, even if it makes her client angry.
Because this is my opinion I have gone online to see if there are any laws that support this. I would like to give this information to my friend.
And what if my friend gets injured in this situation? It is a bad situation for both the caregiver and elder person to be in. I think that if my friend gets injured protecting her patient from falling in the shower my friend would not have a claim against this elder person who is clearly not making good decisions for herself, right?
Your friend, as a trained caregiver, is free to refuse to support an activity which poses a clear and unacceptable risk to her client or herself.
And it's not like there isn't any compromise possible. The shower could be done earlier in the evening, and the client dressed afterwards in warm nightwear. Or, there are shower commodes that can be positioned in the shower and will allow the client to have her shower seated. Consult an occupational therapist about the best risk reduction plan.
In your friend's position, we would decline to support a shower (or any comparable request) that seemed risky, document the reason, and feed back concerns to the office. The office would then speak to the client and work out a way to support her preferred routine. But I'm guessing that your friend doesn't have the back up of an authoritative employer?
I manage a boutique home healthcare agency in Boca Raton, FL, and deal with similar issues all the time. It seems like there are three questions or concerns to address:
1) If the client gets hurt, who is liable?
2) If the caregiver gets hurt, who is liable?
3) Should the Caregiver be showering her client before she goes to bed?
I am not a lawyer and I don't know the laws in your state. Please just take this as my personal opinion, not professional advice. Okay?
If the client gets hurt, who is liable? Unless the caregiver pushed her, tripped her, or pulled the rug out from under her, the caregiver is probably safe - at least from criminal charges. In America, anyone can sue anyone for anything. It's not likely any lawyer would take that case because the chance of a significant recovery would be small. It would be difficult to access blame and there isn't much punitive damage to claim on a 90-year-old. I explain to my Caregivers that the reason they need to have liability insurance is in case the children decide to file a civil lawsuit for any reason.
Pro Tip: If you get the sense that children are like vultures waiting for the inheritance and don't have much interest in mom's care, they are probably the ones who will be lawsuit happy. Personally, I would turn down that client...
Fortunately, Caregiver liability insurance is cheap ($88/year for $100,000/$300,000 coverage at www.cmfgroup.com) and will pretty much allow the caregiver to hand the case over to the insurance company and never think about it again. The Caregiver can be working privately but does need to be licensed or certified in their state to qualify.
If the caregiver gets hurt, who is liable? Probably the caregiver. The client's homeowners insurance may or may not cover the injury, and (in Florida) Caregivers who work as independent contractors (for Nurse Registries) are not covered by Workman's Comp. Caregivers that work for Home Healthcare Agencies are. If the (false) security of Workman's Comp is essential, you should choose an agency - and in my experience, you will get lower quality care at a higher price, but we can fight the Agency vs. Registry fight another time.
Should the Caregiver be showering her client before she goes to bed? The answer to that is quite simple... Yes. The caregiver is there to provide what's needed and wanted. You made it clear that the client is not demented. All seniors are fall risks. All seniors deserve to be bathed. If for whatever reason, the caregiver doesn't feel comfortable providing what the client needs or wants, they should step aside and allow someone who is more capable, professional, stronger, younger, or whatever to provide for the client.
And with that said, even if Hercules was her caregiver every possible precaution for the client's safety should be taken. Shower mats, shower chairs, grab bars, etc. are mandatory. If it is safer for the client to enter the shower in shoes or slippers, the caregiver should remove them after they are in the shower. If the client has a bathtub, they can have the tub wall cut out (google "bathtub cut out for seniors") so there is a 2-4" step, not the entire tub wall. The cost is between $400 for DIY - about $1500 for it to be done professionally. I have done this for clients with great success.
If the client is not willing to participate in smart safety measures, her POA or adult children need to take charge. Just get the work done. The first time she grabs onto the bar and feels a tad bit safer will be the last time she complains about it. Same with the shower seat, mats, and everything else. Old people can be stubborn, but they are also really smart people!
I am old and stubborn. I hope you think I'm smart. Did I make a difference for you? ~BRAD
I think your friend needs a new profession and this client needs a different caregiver who's willing to help her take a shower in the evening.
Your opinion is not helpful and lacks any useful LEGAL information for which I was asking. Thanks, but no thanks.
10-12 hours days are not part time. Hopefully she is being well compensated.
She has the right to tell her client that showers have to be done earlier because she is to tired after a 10 hour day to do this safely.
She should NEVER, NEVER try to stop a fall. Often times it causes more injury to the one falling and the human mat.
She should demand that workman's compensation and unemployment are in place. As well as all the other employee benefits to be legal and protected.
If she chooses to work without all this in place, she should definitely have her own health insurance and get an AFLAC policy to help cover living expenses in the event of an injury.
Good luck figuring out if she has legal liability or is protected.
Just an FYI. Facilities aren't responsible for falls resulting in injury to residents.
your friend is part time but works 10 hr shifts?
missing something. Is the caregiver job IN ADDITION to another job?
my 2-cents
determining health (I.e hygiene) needs isn’t the job of part time caregivers. I had to sign a contract for mom at assisted living, clearly outlining scheduled meals, showering, meds, housekeeping etc. I didn’t let a part time aide tell us what they would do. Nope.
if the elder wants a bedtime shower, maybe that’s the only way she can sleep well after, ya know, 80-90 years?
the whole ‘she might fall, I think it’s unsafe’ vs the I’m exhausted at ‘end of a long shift’ seems questionable as to WHY exactly it’s a bad idea. Germaphobe? Bad attitude? Those descriptions seem to be blaming the elder. For wanting to shower. Which she’s paying for.
spill something on her intentionally to change her habit?? What? As a family member I’d boot you out the door.
My first thought, like others, is you (SHE) needs to talk to a lawyer/insurer AND family members/care directive/doctor about these “concerns”.
A new to the field person? Heck no, I’d assume her liability is extremely high if she’s making all these decisions on her own. Is she trained? Is there an agency? Or is she just “helping out”???
My second thought was maybe this elder needs additional help if indeed 10-12 hours are required FOR her. If this is an extra income job for “friend” and she cannot or will not provide the assistance, she needs to re-evaluate the situation
Gramma wants a shower at bedtime? Give her the help she needs to allow the sliver of dignity she is asking.
HOWEVER that may be negated by the fact that the patient is unsafe to shower and the caregiver KNOWS this. In that case, the caregiver, who has a duty to know (and you indicate DOES know) has done something that may/could injure her patient, and yes, she may be sued. Generally no such suit would be carried forth against a caregiver, who likely doesn't have deep pockets OR insurance to defend herself.
Your caregiver is working on her own, or with agency. If with the latter she can take this to her supervisor and she will be told NOT to shower patient. Also know that it is likely this agency that would be sued if showering done at their insistence. If caregiver isn't with an agency, but on her own, sorry but the answer is NO, absolutely not. No shower. If she is fired for this she is well shed of this client and the world currently is full of folks in need of her care.
Best wishes and good luck, but advise this caregiver that the answer is "NO!" period and full stop.
Why is the client falling? There should be grab bars, a non slip mat on the shower floor (or better 3M safety strips), and a sturdy height adjustable shower chair (or transfer bench if needed).
I can't see how the time of day makes any difference unless they are attempting to shower solo after the caregiver is off duty.
And frankly I can't see that a properly done sponge bath would get your friend's day finished any more quickly than a fast shower.
A trained caregiver would know what safety measures need to be in place for everyone's safety.
1. Our homeowner's insurance would NOT cover any injuries sustained by a caregiver while on the premises. Factor: she would have been invited to be there, and perform services. She's an employee, and should be treated as such. Insurance coverage distinguishes between invitees and those who are not.
2. HO (per our agent) would NOT cover anyway; we would need to take out a commercial liability coverage policy with specific liability clauses for paid employees. At that time (about 5 years ago, the cost would have been about $700 annually), and definitely would increase annually.
We decided against hiring her, especially since based on my observations of her, she was a very young and immature individual who needed guidance.
3. Basically, as I understood the situation based on the facts including that our coverage was typical HO, and was NOT professional, with a liability clause, we would be responsible if the caregiver was injured. But we weren't interested in getting involved with commercial coverage with a liability clause.
4. Filing a claim against a caregiver who's not insured for the accident would likely go nowhere, other than requiring the caregiver to retain an attorney to challenge the lawsuit. And... most likely encouraging the caregiver to find a new employer.
'FULL STOP' is right. Your friend should be giving notice, including stating that she is being put in a position to perform duties which she knows are dangerous, and the client knows or should know that as well. She should provide that qualification in writing, with a copy for the client, and the original for herself.
wall. Once the chair seat was fully within the bath the mechanism engaged and the seat was locked in position for a shower using the adjustable (or hand held) shower head. My mom liked to stand at one point during the shower (using grab bars) and have me spray her back and rear end. This worked well as long as mom could stand and turn 90 degrees to sit down in her wheelchair or shower seat. When she became unable to do that, mom allowed me to wash her in her chair or bed.
Once every few days a family member assisted us in using the step in tub since the whirl pool action relieved a lot of mom's pain from spinal stenosis and osteoarthritis. We were very lucky her grandson lived next door and was strong enough to pick my mom up and carry her to the tub seat. I would work her nightgown off, close the tub and run her bath. When she was done, we would dry her off and put on a clean gown, then her grandson would carry her back to bed.
Although my mother had MCI and some dementia like confusion at times, she remained adaptable to reality and we were so lucky to have the support of family members who lived close by. Near the end of her life when she could no longer stand (and basically became bedbound because I could not safely transition her alone) I had reluctantly began the arrangements for an MC but mom died before that happened.
I hope the bath chair (available on Amazon) might help now and the client becomes more adaptable in time.
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