Mrs. B.: “My Son Says I Have to Stay in Bed” - Autonomy, a DNR, and $200

Her son does not decide that, and neither do you. Work through it in order:

• A health care proxy acts only when the person cannot make the decision. Mrs. B. has early dementia but is still her own decision-maker, so her stated wish carries weight. Whether she lacks capacity is a determination for the provider, not for a family member on the phone and not for an aide.
• A DNR order is not a mobility order. DNR means no CPR if her heart stops. It says nothing about whether she may sit in the dining room, and treating a DNR as “keep her in bed and do nothing” is a common and serious misunderstanding.
• Safety still matters. Before she walks, check the care plan and physical therapy orders for her weight-bearing status and level of assistance. Ask the nurse to confirm - that is a question, not a refusal.
• Then assist as ordered: walker, gait belt, non-skid footwear, clear path, supervision, and a chair in the dining room near the door where staff pass often. If she cannot walk that far today, offer the wheelchair - that is still her going to the dining room.

Report the son’s instruction to the nurse the same morning. The nurse and social worker manage proxy disagreements; you cannot, and you should not try.

Be brief, calm, and do not argue.

• Do not promise what he is asking for. “I can’t keep her in bed against her wishes if she’s allowed to be up - but I’ll tell the nurse exactly what you said, and someone will call you back today.”
• Do not debate her competence with him, and do not tell him she “doesn’t know what she’s doing.” You are not qualified to make that call and saying it to him gives it weight.
• Do not discuss her care details at the front desk or over a hallway phone where other residents and visitors can hear. Move to a private area.
• Acknowledge the fear. He is worried she will fall. Say that. Then say what you are actually doing about it: gait belt, walker, supervision, checking on her.
• Escalate it, don’t absorb it. Report the call to the nurse, including the threat to sue, so the nurse and administrator can respond in writing and in one voice. A lawsuit threat changes nothing about the care you give - it changes who handles the conversation.
• Document the call, the time, what he said, and what you told him.

You report it, and you do not investigate it.

• Financial exploitation of an adult is reportable. You are a mandated reporter; your observation of a resident’s money being taken is not a private matter between her and her grandson, and her wish to protect him does not relieve you of the duty. She can decline to cooperate with an investigation; she cannot make your reporting obligation disappear.
• Report it immediately to the nurse in charge, who notifies the administrator and Adult Protective Services as state law requires. Do not call the grandson, do not confront him if he visits, do not question other residents, and do not go looking through her belongings to “confirm” it.
• Tell her the truth without frightening her: “I can’t keep that to myself, because you’re my resident and I have to protect you. I’m going to tell the nurse, and she’ll help.” Do not promise confidentiality you cannot give.
• Be careful with her son. He is her proxy, but this allegation involves his own child. Do not be the one who tells him; let the nurse and administrator decide who is notified and when.
• Document her words in quotes, with the date and time: “She said, ‘My grandson took $200 out of my purse last week.’” Do not write “resident claims grandson stole money.”
• Keep it need-to-know. Her financial affairs are confidential; do not discuss this in the break room, and do not tell staff who are not involved in her care.

If she is short of cash for a haircut, the newspaper, or a phone card, route that need to the nurse or social worker rather than handling money yourself.