to refuse to care for bariatric resident?

[Anarchyinateacup]

I work in a home with a resident who has a BMI of nearly 70. They are essentially bed bound due to their weight and require help with all aspects of physical care.Their weight is the main reason for them living in a care setting, and they continue to gain weight. This person has been assessed as needing two carers to complete personal care as they need to be rolled etc. We have access to slide sheets, hoists and other risk assessed equipment as per their care plan.

I've been working with this resident more often recently and I'm physically starting to struggle to care for them without hurting myself, despite following moving and handling as detailed in careplan. They have a bariatric bed which means even further to reach over to roll this person. They fill almost the entire width of the bed.

I'm at the point where I'm on a chiropractic waiting list, painkillers and my GP is referring me for physio and recommended I speak with my manager about the situation to come up with a solution. I'm under 30 and I don't want this to plague the rest of my life like it can do with so many care workers and I do not want to end up with a sickline.

My manager basically said there is nothing more they can do as care plan and risk assessment is all up to date and correct and that we don't have the staff to assist with my idea of 3 carers, 2 to roll and hold the resident whilst 1 carries out care. Many of my colleagues also struggle with this resident but are frightened to cause any "hassle" as care is famous for it's bitchiness etc so I have been the only one to raise the subject with management.

AIBU to ask to be moved to another area of the home, or to remain where I am and continue to care for this resident in other aspects but have another carer assigned to personal care? I really do love and enjoy my job but my health has to come into it somewhere surely?

Yanbu at all. Get a doctors note - you can't be injuring yourself!

Your health must come first. Always.

Do you have occupational health department? Speak to them. Write to your manager formally - letter/email

Go back to your gp and state your concerns

Go off sick if needs be. You only have one back and it has to last you a long time

I wouldn’t risk my health. Tell them you won’t do it unless they get an extra member of staff to help out. If everyone refused to do it they’d find someone.

I’m a care manager, you’re not paid enough to wreck your back for the rest of your life.

There are more care vacancies than carers to fill them - if your employer is not taking your health and safety seriously I would suggest you consider looking for a new job.

Does the bed have a turn assist function? I find this really helpful when doing bed changes. Is it a Hilrom bed?
I second getting occupational health involved also a moving and handling assessor in if possible to advise staff. And also a dietitian.

lurpack We are part of a large care home group so will need to look for more information regarding Occupational Health as we don't have anyone on site, thanks!

newshmoo749

Both manager and deputy are nurses so I am disappointed they don't seem to be all that concerned. I have considered getting out of care and if this situation can't be resolved then it might just be time unfortunately!

YANBU. If you're struggling then the care plan is clearly inadequate regardless of what they say. Perhaps stronger/larger carers would manage better? Don't risk your health for a job or a complete stranger. Ask to be moved or at least not allocated to tasks that you're struggling with.

drinkswine

It's a nexus bed, no turn assist, that would be wonderful but apparently as they are able to roll over still (imo they can't as someone is required to manually roll them)that when they ordered the bariatric bed a standard profiling style one was fine.

Resident still has capacity which has caused issues with getting help to lose weight or seeing the dietitian.

Have you got a repositioning sling and hoist that is suitable for the individuals weight?

Get your GP to write that you need "amended duties" to include not moving patients above a BMI of 50 (just a suggestion number esp if your back already bad)

Your managers are irresponsible having 2 carers complete this task and I am sure it must be undignified for the patient as well if the carers are struggling.

Please do not risk your back. I suspect the risk assessment has been done incorrectly - BMI over 70 does not equate to only two staff and the size/strength of individual members of staff is totally irrelevant when making an assessment of this sort. Not so long ago when I worked in ITU with the occasional bariatric patient we had to have 4 or 6 staff for turns, depending on airway safety and complexity of dressings. This assessment is most definitely incorrect and as a senior registered nurse myself I would question the competency of the trained nursing staff if they think this is appropriate - get them to show you how its done and if you are in a union, get a rep involved or a manual handling trainer in - this is not on!

ummmm i'm not sure you are allowed to refuse care (nurses and dr.'s are not). all you can do is request proper equipment and care planning in place to prevent injury.

Seriously? You’re not allowed to refuse to do something that could permanently disable you?

as a nurse and or dr no. and i expect a home support worker who refuses work to be fired.
your employer needs to provide you with the supplies tools lifts and training to do the job (assign to people to care or more as necessary).

christmascardqueen
Carers can always refuse to carry out tasks which they feel are unsafe. It cannot be compared to the duty of care doctors and nurses have - they cannot refuse to treat people but they can refuse to carry out unsafe manoeuvres.

OP you already have a back injury if you are on painkillers and waiting for physio/chiropractor treatment. OF COURSE you can refuse to "care" for a patient because in doing so you are putting both yourself and the patient at risk, for example, if your back "went" during a roll or turn. Please ensure you document your concerns and have witnesses who will testify you have voiced these concerns to qualified staff -they're registration is at risk if they are failing to keep you safe. And you won't get fired-what planet was that from?!

Sorry, "their" registration is at risk - I am just frustrated that some people think Drs/nurses/careworkers are just automatons who can be fired for looking after their own health!

The first step of the primary survey is "danger". You're not "refusing" to care for this resident, you're just ensuring it doesn't harm you. And that's what you need to focus on.

You're happy to care for this person if it can be made safe for you.

YANBU, you do have to take care of yourself first and foremost. It sounds as though the provision is inadequate and should be re-assessed. Maybe your manager should have a go if she thinks it's ok as it is.

I would not risk my health in this way.

Just thinking aloud here, but when I last had a sicknote it said that I did not have to actually be off work, but reasonable adjustments had to be made. Do you think your GP would write one of these, with reasonable adjustments being that any heavy lifting and such is no good for you, due to back pain?

I am sure that this situation is not right though from what you describe and there has been a fuckup with the risk assessment somewhere along the line.

Are you in a Union OP? If so, you need to contact them for advice also as suggested above, occupational health need to get on board too.

Your health is your priority.

Also OP, thinking on.
You are absolutely doing the right thing by raising this issue.
As well as your and your colleagues health, it may be discovered that your facility is not be the ideal place for the patient if there is not the equipment or staffing to meet his/her needs.
You are essentially highlighting a problem for both staff and patient health which is important.

Two carers is not adequate for assisting anyone with a bmi of 70 if you are having to support any weight. If they are unable to roll there are hoists that can assist with this and the sling remains under the person.

Your back has to last you your entire life, so many HCPs are retired off early with back issues.
How is she funded? If you can't get anywhere with home management maybe flag it to the funders (anonymously if needed), this situation is ridiculous. Risky for you, your colleagues, the patient, just awful!

of course you are allowed to refuse to give care to this person if you feel the situation is not safe, this is also putting the patient at risk. Your managers are incompetent. The patient was not correctly assessed in the first place, and you do not have the correct equipment. Two people to carry out personal care is ridiculous, and the size of the person carrying out the care is irrelevant, a large beefy man is just as likely to damage his back. This patient needs reassessing, and you are entitled to refuse care. This is your managers problem, not yours. I’m a District nurse and we frequently come up against such difficulties, we would certainly withdraw care, as would any care agency.

You need to ask them to get the Moving and Handling plan reassessed.

Do you have an internal moving and handling advisor? Or do you bring in OTs from your local NHS team?

I am an NHS OT and we do write plans with recommendations for people in care homes where the tasks are different from standard ones, so it might be worth asking. When we do the plans we make it very clear that it all depends on the users and the individual capabilities and if the plan isn't working - which it isn't if you are hurting - then you need to get it redone. Eg I am short and not very strong, so couldn't do the aspect of care you say either but my colleague is tall and works out so would have no problem at all.