Three Hundred Dollars and a Request for Silence
Mrs. S, 88, is alert and oriented. While you help her straighten her nightstand she says quietly, "My nephew came by last night and took $300 out of my purse. Don't tell anyone - he'll get angry and stop visiting me." You notice her purse is open and she is wringing her hands. Ten minutes later she hands you a $20 bill and asks you to "keep it in your locker so he can't get it," and a coworker tells you, "Don't make a big deal out of it - just write it in the notes and let the nurse read it tomorrow."
1. How do you respond to the disclosure and the request to keep it secret?
Read the worked answer
You cannot promise confidentiality on this, and you should not investigate it.
- Reasoning: Taking money from a resident is misappropriation of resident property - a form of abuse. It is a mandatory report, and a promise of silence would make you part of the concealment.
- Say something honest and calm: "I'm glad you told me. I can't keep this to myself because I have to keep you safe, but I will only tell the people whose job it is to help."
- Do not question the nephew, call him, count the money, or ask her to repeat the story to you in detail - that is investigation, which is not your role and can compromise the facility's process.
- Report immediately to the nurse in charge, who notifies the administrator and follows West Virginia's adult protective services and facility reporting requirements. "Immediately" means now, not at shift change.
- Write down her words as close to verbatim as you can while they are fresh, plus the time and who was present. Do not add conclusions about the nephew.
2. She hands you $20 to keep in your locker. What do you do?
Read the worked answer
Do not take it.
- Taking a resident's cash into your personal possession - even with good intentions - makes you look like the person who took it, and it takes the money outside the facility's protected handling.
- Say: "I can't keep your money in my locker, but I don't want it sitting out either. Let's get the nurse and put it somewhere safe that's written down."
- Involve the nurse and follow facility policy for resident funds, typically a locked box or business office with a receipt showing the amount, date, and both signatures.
- Do not put it in a drawer, a pocket, or another resident's room as a workaround.
- Accepting gifts or money from residents is off limits in general; a well-meant refusal protects both of you.
3. Your coworker says to just chart it and let the nurse read it tomorrow. How do you handle that, and what does the chart note look like?
Read the worked answer
Charting is not reporting, and tomorrow is too late.
- A note in the chart is not a report. Charting does not trigger an investigation, and a day's delay can mean the money and the evidence are gone and the resident is left with the nephew again.
- Tell the coworker plainly and without lecturing: "I have to tell the nurse now - it's a property and abuse issue, not a note." Then actually do it, in person, today.
- If the nurse in charge brushes it off, you still have a duty: go to the director of nursing or administrator, and use the facility's reporting hotline if needed. Retaliation fears do not erase the duty.
- The note itself stays objective: time, the resident's statement in her words, that she was wringing her hands and her purse was open, that she offered you $20 and you declined, and who you notified and when.
- Leave out "the nephew stole from her," "she's confused about money," and any speculation about who else might be involved.