The Daughter With Power of Attorney
Mr. Brant, 84, is alert and oriented and has lived in the facility for six months. He has refused his scheduled shower three days in a row, saying he washed at the sink and doesn't want to be 'bossed.' Today his daughter pulls you aside and says, 'He's not bathing. You people need to make him get in there. I'm his power of attorney and I want it done.' She also wants to know what he discussed with the social worker yesterday. Later, Mr. Brant quietly tells you, 'Don't tell anyone, but I slipped in the bathroom last night and banged my knee. It's fine.'
1. The daughter demands that you 'make him' shower. What do you do?
Read the worked answer
Do not force, threaten, shame, or bargain with a resident who has capacity. Refusing a shower is not neglect by staff when the resident is alert and oriented and understands the choice.
- Look for the reason and offer real alternatives: privacy, a warmer room, a male aide, a bed bath or partial wash, shampoo at the sink, a different time of day, a towel draped over him.
- Offer again later - a refusal today is not a refusal forever.
- Tell the nurse. The nurse is the person who talks with him about the refusal and with the daughter about her concerns.
- Answer the daughter without arguing: "He's alert and makes his own decisions about his care. I'll make sure the nurse knows what you're worried about." Do not confirm or deny details about his care, body, or conversations.
On power of attorney: it does not cancel his right to refuse routine care, and an aide is never the person who decides whether he lacks capacity. Document each refusal, what was offered, and who was notified.
2. He asks you to keep the bathroom slip a secret. What do you do?
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Do not promise secrecy - not even to be kind. Say so immediately, before he finishes: "I can't keep that to myself, because I need the nurse to check your knee. I'm not trying to get you in trouble."
Then:
- Report to the nurse right away. It was an unwitnessed fall with a possible injury, and it may have happened because of a new problem with balance, blood pressure, or medication.
- Chart the facts: the time he told you, his exact words, what you observed (bruising, swelling, change in gait), and who you notified.
Why this overrides his request: keeping him safe is the one thing that outranks a promise. A hidden fall can mean a fracture or a head injury that no one is watching.
Also tell the nurse he asked for secrecy - a resident who hides a fall is often afraid of losing independence or of being scolded, and the team needs to know that. Reassure him that you are not angry and that the nurse will be checking on him.
3. The daughter asks what her father discussed with the social worker. How do you handle it?
Read the worked answer
Do not tell her. What he discussed with the social worker is not yours to share, power of attorney or not.
- Say it plainly and without apology: "I can't share that with you. I'll make sure the social worker and the nurse know you'd like to talk with them."
- Then actually do it - tell the nurse and social worker that the daughter is asking.
- If she pushes or gets angry, stay calm, do not argue, and do not hint at the content with comments like "it was about his finances." Confirming or denying details is still disclosing.
- Do not offer to "find out for you."
Why: information about a resident's care is shared only with the people involved in his care, in the way facility policy and his permission allow. Redirecting her to the social worker protects his privacy and gives her a real path to her concern - which is usually fear, not nosiness.