respond to the following:
- Review the Case Study: A Love Triangle, located on page 472 of your text. Next, determine the two (2) most serious issues that the administrator of this facility is presented with in this complicated case.
- Take a position on whether the facility holds any accountability for Nancy’s pregnancy in this case. Provide a rationale for your position.
- Summarize the lesson(s) this facility’s administrator and staff should learn from this case. Next, suggest one (1) change to this facility’s human resources policies in order to increase the efficiency of staff monitoring of residents. Provide a rationale for your suggestion.
A Love Triangle
Contributed by Elizabeth A. Berzas, PhD, MHA, FACHE, and Jacqueline Shellington, LCSW
Located in Opelousas, Louisiana (population 15,000), Maison de Fontenot is a 100-bed nursing home, the only such facility in the greater Evangeline Parish area. The facility’s large activity center is sometimes made available for meetings to some of the local civic organizations. On these occasions, members of the community also take the time to interact with the residents; several visit with family or friends living in the facility. Some of them also volunteer at the facility.
Joseph is a 66-year-old resident of the facility. He was admitted to Fontenot a little over a year ago after he had suffered several minor strokes. He requires close monitoring and some assistance with dressing and bathing, but is able to get around independently. Joseph is from Mamou, a rural community that has limited long-term care services. Hence, his sister decided that Fontenot would be the best place to meet his needs. Joseph never married but had a few long-term relationships over the course of his life. He participates in several activities and helps out with minor chores at the facility. He also enjoys transporting residents in wheelchairs to and from the dining room. Joseph is personable, outgoing, and friendly.
Phyllis was born and raised in Opelousas and has never lived anywhere else. She is an attractive and vivacious 70-year-old woman who has been living in the nursing home for the past 5 years, ever since she was widowed. Her husband died of complications in the aftermath of an automobile accident. Phyllis is a severe diabetic and has some cardiac issues resulting from her diabetes that had remained uncontrolled before she was admitted to Fontenot. Otherwise, she is alert, oriented, and mobile. She needs assistance with her insulin injections, monitoring of her heart condition, and treatment of occasional minor bruises. After the loss of her husband, she had no source of income and had to go on Medicaid. She is alone, with no children or relatives living nearby. Phyllis is an outgoing individual. Many of the male residents find her attractive, but she has not expressed an interest in other men since her husband’s death. She does miss having a man to take care of her, though. Before moving into Fontenot, Phyllis was an active member of the community. Now she enjoys helping out at birthday parties and other social activities held at the nursing home.
Joseph and Phyllis became friendly during BINGO games when Joseph would pay more attention to her game than his own and make her win. Gradually, they found themselves physically and emotionally attracted to each other. Joseph feels that Phyllis needs him because she had once stated that she liked men who take charge, which reminded her of her late husband. Joseph and Phyllis have started spending more and more time together. Now they commonly refer to each other as boyfriend and girlfriend. From time to time they get into arguments when Phyllis feels he is ignoring her or when Joseph believes she is not following his advice.
Nancy, a 36-year-old female, was admitted to Fontenot about 4 months ago after being in and out of the hospital a few times because of complications from her AIDS diagnosis. She was assigned to share the room with Phyllis. Nancy has four children between the ages of 3 and 15 who live with Nancy’s mother in another state.
Jealousy and Tensions
Joseph has been frequently visiting Phyllis and Nancy in their room. Phyllis, however, feels that he pays more attention to Nancy, which then leads to arguments between Phyllis and Joseph and creates tensions between all three. During the arguments, Joseph innocently points out that he is only helping a new resident better adjust to the nursing home environment. At times, Joseph has been found sitting outside on the swing with Nancy or helping her mark off her cards at the BINGO games. More recently, Joseph has been inviting her to join him during snack time. Nancy too likes Joseph’s company and enjoys her walks with him on Fontenot’s grounds where flowers are in full bloom.
Joseph has told some of the staff that Phyllis is too controlling and that they have broken up their relationship. Phyllis, however, still refers to him as her boyfriend and accompanies him to some of the activities and social events. Joseph and Nancy, on the other hand, have said to the staff that they are just friends and like to hang out together.
The other day, a CNA on her lunch break saw Nancy sitting in the garden with her legs crossed over Joseph’s lap, but she did not think much of it. Another resident told the social worker that she “caught them” sitting in a “lovers’ position” and they were startled. Two members of the Kiwanis Club also saw “something” and were a little taken aback and mentioned it to the administrator. One resident told the activity director that he thought Joseph and Nancy “go a little too far” in their public displays of affection. Another resident was amused when he recounted, “Just the other day Joe was grabbing at her as they walked down the hall.”
Spillover and Commotion
Phyllis accosts the administrator in the hallway and asks, “What kind of a place is this? Isn’t it against nursing home rules?” She has also commented to some other residents, “They both need to be thrown out of this place.” When Phyllis confronts Nancy about her relationship with Joseph, Nancy adamantly denies there is anything romantic and states that they are just friends. When she confronts Joseph, however, he retorts, “You have been giving me a hard time, Phyllis, and I have news for you—Nancy and I are gonna have a baby, and we’re gonna get married.” Phyllis could not believe it. She seems devastated, and the social worker has to calm her down. But, when asked why she was so upset, she simply refused to talk.
At the next resident council meeting, Phyllis makes a bold appeal that both Joseph and Nancy are a disgrace and must be ousted from the facility. In response, Joseph barked at her, “Just shut up.” The president of the resident council told the activity director that there were some real bad feelings between Joseph and Phyllis just because Joseph liked Nancy.
Later the same day, in a fit of rage, Phyllis throws Nancy’s few belongings out into the hallway and curses incessantly for several minutes. Several staff members, a few residents, and two visiting volunteers gather at the scene to witness the commotion. The social worker, activity director, and administrator are called to the scene; they take the three residents apart to calm the situation. The social worker, activity director, and administrator together hold counseling sessions with the three residents who are threatened with eviction for disrupting the facility’s living environment. The social worker is adamant that Nancy and Phyllis should no longer stay in the same room, but both residents have refused to separate.
Mother, I Am Pregnant
Approximately a month later, Nancy’s children and mother, Colette, arrive at the nursing home to visit Nancy. With great enthusiasm Joseph announces to them his plans to marry Nancy. Taking Colette aside, Nancy quietly whispers, “Mother, I am pregnant.” Nancy’s mother and children are shocked and infuriated. Without saying a word, Colette heads straight to the administrator’s office and demands answers. The administrator is equally shocked at the news, and the meeting does not go well. Colette wants to know why the facility has failed to fulfill its responsibility to protect its residents. She declares that she is ready to meet with a lawyer to sue the facility. Finally, in a burst of anger, she screams out, “Who will take care of this baby? You?” She stomps out of the administrator’s office. Taking her grandchildren, she leaves the facility.