10. How Patients See Home Health Aides – The Aide as Persecutor (3)

In this blog I want to discuss aides who are actually deliberately malicious in their behavior. These are serious situations and require drastic actions.  In some cases the aide is performing criminal actions and may even pose a physical or financial menace to the patient.  There is only one solution here, and that is to remove the aide as quickly as possible.

Firing an aide under these circumstances can be problematic for several reasons. Establishing the problem can take time and a truly malicious aide can also charm or frighten the patient/family into waiting or doing nothing.  If the patient is somewhat confused, it may take a while for others to realize that there actually is a problem.  Some patients may even doubt their own memories and let slide lies and mistakes.  In this important relationship, the patient and other involved individuals, have to monitor the situation closely early on.

In the examples given below, some deserve one chance for correction, other need to be addressed immediately.

• Aide as liar:

I have seen and have had reported to me incidents in which the aide has lied to the patient. Sometimes it’s out of a defensive fear or concern with being fired; at other times it was to cover up damage or theft of property.

“No, I didn’t burn anything.” – meanwhile, a smell of burning pervades the kitchen.

“I was only out for an hour doing your laundry” (after an absence of 3 hours).

“I didn’t move that.”

“That pot already had a crack.”

• Aide as “gaslighter”

Sometimes the aide compounds the lie by implying the patient is demented or crazy.

“How could you not remember that? You must be losing it!”

This is a difficult situation to fix. The patient, if courageous, might confront the aide about the first lie but if the aide is defensive and refuses to admit to wrong doing the relationship is damaged beyond repair and the aide must be replaced as soon as possible.

• Aide as thief:

There are aides who steal. There are also patients who misplace things and believe they’ve been stolen.  There are patients who give things away and forget they’ve done so.

This is a difficult situation to deal with. Patients with memory problems may hide or move things and forget where they put them.  One doesn’t want to needlessly damage the reputation of a person who might be the sole support of a family.

Again, the time to deal with this is before it happens.  If there are expensive items (jewelry, precious ornaments, expensive clothes, delicate objects) pack them away in a locked closet or lock box before the aide arrives or give them to a trusted friend or family member.  This safeguards everyone.  While it is a shame to have to live without some of your possessions around, it is better than losing them permanently.

• Aide as Menace:

I have heard about and even seen aides who have threatened their patients.

“You know, I am a practitioner of Santoria,” said to patient with paranoid psychosis.

I have had patients so terrified that they were paralyzed and unable to act to end the persecution. When the aide is a private one and may have been given a key, this is even trickier.  The locks will have to be changed, doormen or building staff alerted, if there are any, and Adult Protective Services or the police called.

If I feel a crime is being committed I encourage the patient, or family, to call the police or APS. If there is suspicion but no certainty, I encourage them to call the agency or their nurse to have the aide replaced (and have even on occasion done so myself at the request of the patient or family).