Ms. Caceres has been providing care for a wheelchair-bound incomplete quadriplegic veteran for quite some time. She would go into his home providing wound care weekly and attending to his suprapubic catheter monthly. During one of her visits, she noticed changes in his home environment which included people moving into his home. After a few months, she noted the Veteran would be lying on the sofa and she would have to provide care on the sofa. She also noticed that he was quieter but would say all is well.
Additionally, the patient had changed apartments several times without a reason. Whenever she needed to contact the patient via phone, the gentleman who was identified as his grandson would have his phone and intercept all communication. Again, on her visits, the Veteran would say all was well. Ms. Caceres felt something was not right with the Veteran. Upon one of her visits, the "grandson" was not present, and the Veteran confided that he didn't feel safe and wanted to leave. He stated he didn't have access to his monies; when his check would come, the "grandson" would take him to cash his check but would keep the monies. Ms. Caceres informed him she would seek assistance in helping him.
On her next visit, she brought the Home Care Coordinator for SCI, she spoke to the Veteran who verified that he wanted to leave the environment. Ms. Caceres informed the MD and asked if the patient could come in as respite but due to the circumstances, it wasn't felt to be the best thing. So, Ms. Caceres was able to coordinate a clinic appointment for the Veteran to come in and from there go to his new home environment. The Coordinator found a Veteran Foster Care Home for him. The Veteran did verify that the "grandson" was not a blood relative but someone who had come into his life and manipulated himself into the Veteran's life. The Veteran was assured that this guy would not have access to him; he was afraid of him. Ms. Caceres coordinated with the VA Police, Social Worker, Nurse Manager, and MD to develop a plan to assure the veteran was taken out of this mental and financially abusive environment. The Veteran was safely removed and sent to his new residence and is doing very well in the new environment.
Ms. Caceres's persistence in observation of the patient's nonverbal behavior and change in living areas was key in getting him out of an environment that was not to his benefit mentally, medically, and physically. The patient is in a much better situation because of her!