The Locked Nightstand: A Daughter, a Wallet, and a Chapel Service
Mr. Delgado, 82, is alert and oriented and lives in a skilled nursing facility after a fall. His daughter holds his durable power of attorney for finances; no court has declared him incapacitated, and his physician has documented that he makes his own decisions. His daughter tells you to take his cell phone, lock his wallet in the office safe, and stop him from calling his brother because 'he gets upset.' Mr. Delgado wants to attend the 10:00 a.m. chapel service. He is on fall precautions with one-person assist. He also tells you he will not take a shower this afternoon.
1. How do you handle the daughter's request about the phone and wallet?
Read the worked answer
You do not take his property, and you do not promise her you will.
- Mr. Delgado is oriented, has not been declared incapacitated, and his physician has documented that he decides for himself. A financial power of attorney does not give his daughter the right to control his phone or his money, and it certainly does not give a CNA the right to confiscate them.
- Say plainly and kindly: 'I can't take his phone or wallet. That's something to talk over with the nurse, social worker, or administrator.' Then actually pass the concern up so the team knows she is worried, likely about scam calls or spending.
- Do not argue with her, do not take the items 'for safekeeping' to keep the peace, and do not discuss it with other residents or staff as gossip.
Reasoning: taking a competent resident's belongings is a rights violation - his property, his communication with family, and his privacy. If the daughter genuinely believes he is being exploited, that goes through the nurse, social worker, or administrator, and possibly adult protective services, not through a CNA quietly emptying a nightstand. Chart that she raised the concern and to whom you referred her.
2. He wants to go to the 10:00 a.m. chapel service but is on fall precautions. What do you do?
Read the worked answer
Fall precautions are not a lock on the door.
- Tell the nurse he wants to attend and confirm what supervision the care plan allows. 'One-person assist' implies he can go with an escort; it does not mean he must miss the service.
- Arrange the escort, the gait belt, and a safe route. Leave early so he is not rushed, and take a moment to check his shoes and that his walker is beside him.
- If no one is free at 10:00, ask whether he can attend the next service, watch it on the room television, or receive a visit from the chaplain - offer alternatives rather than a flat no.
- If the nurse judges it unsafe, that is the nurse's decision to explain to him, not yours to hide behind.
Reasoning: religious practice is a protected right, and a resident who is a fall risk still has the right to move around his own home with appropriate help. Restricting him because it is inconvenient is restraint by another name. Safety is managed by escorts and equipment, not by confinement.
3. He refuses his afternoon shower. What happens, and what do you tell the daughter if she asks about it?
Read the worked answer
He may refuse. A competent resident can decline a shower.
- Ask why, once: pain, fatigue, privacy, or a preferred time. If it is simple, fix it - a different time, a warmer room, a washcloth bath instead.
- Offer, do not coerce. No threats ('you'll get a bed sore'), no bargaining with privileges, and no two aides holding him down.
- Document the refusal, what you offered, and that he was clean and dry at the time. Report the refusal to the nurse, since repeated refusals may signal pain, depression, or a skin problem.
- Keep providing the parts he does accept: a washcloth to the face and hands, clean clothes, oral care.
If the daughter asks: 'He decided not to shower today. He's clean and comfortable, and we'll offer again tomorrow.' Do not share clinical details beyond that, and do not blame him or paint him as difficult. She is not his decision-maker for personal care, and you should not invite her to override him.