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Welcome to CareNotes. In this special section we will feature a reader's letter and provide an opportunity for an interactive exchange that will help find some answers and possible solutions to concerns. If you wish to respond to this letter, simple follow the link provided at the end of the letter and add your comments and thoughts to our CareNotes Board.

This Week's Carenote - 7/14/10

I'm not sure where the best place I can find information regarding a certain situation that's recently come up at my workplace that's troubling me and I was hoping you might be able to point me in the right direction.  

I have been a caregiver for over 15 years and I've never had a problem like this before. One of my patients is an elderly man whom I've been caring for in his home for over 5 years now. He's always been the type to casually bring up topics every now and then about things of a sexual nature. I usually handle it by not encouraging or engaging in the subject further by changing the subject, which normally works despite my uncomfortableness without incident. Recently he really crossed that line where he attempted to slip his hand under my shirt to touch my breast. I know there is probably several ways to handle this, and looking back I know I should've handled it differently, but I was so shocked and taken back by his inappropriate behavior that my first reaction was to quickly pull away and leave immediately. I know I should've said something while pulling away to make it clear to him right then, that what he did was unacceptable and I will not tolerate it! But in the moment, all I did was react. I contacted his son right after the incident and said I needed a few days off, with the possibility of not returning.

I am so torn with conflicting emotions about this and if I could ever feel comfortable going back even if the situation was addressed. Nor do I want him to feel that way around me, whether or not he's confronted with what he did. Please help. Ive been asking around for advice, but evidently this doesn't seem to happen around here, and Im really uncomfortable talking about it. Any input or advice you could throw my way would be so greatly appreciated!!!!!!

Thank you so much for taking the time to listen.


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Name: Regina Czerwinski
Location: Huntsville, AL
Date: 07/27/2010
Time: 07:20 AM


All very good suggestions. I would add that the family try hiring a male caregiver.

Date: 07/21/2010
Time: 10:07 AM


I really feel for you. I've had the experience of a very elderly man grabbing my head and forcing his tongue into my mouth myself. It was my husband's grandfather! He was also in his nineties. Five years ago, my mother passed away. My father was devastated and visibly emotionally shaken. After a few months of living on his own, we got a call from his neighbor that our father had gone into his house and attempted to touch his young wife inappropriately. He denied it of course, and after that, we did everything we could to keep him from being alone there and eventually sold his house and took him in. While living with my sister who is the caregiver for my young grandchildren, he convinced my 8 year old granddaughter to let him tickle her and kiss her on the mouth and told her it was their secret. She thought it was just a funny game, but when we found out, it was clear that he could no longer stay in the house with her. Consequently, he moved in with me where the kids only visit infrequently and when our granddaughter is there, we are very watchful of his actions. In speaking about this to one of my older sisters who works in the medical field, she explained to me that when men get older and start having problems with dementia, as our father does, they sometimes forget what boundaries are, especially if their spouse is deceased, and do things they would never have considered doing before their minds were affected. I feel that is believable since I had seen it happen to me by someone whom I would never have expected it to. Our reaction with our father wasn't to dub him a pervert and throw him into a home, but to try and be understanding and to become watchful. Honestly, I'm watchful of myself when I'm alone with my father too should he also forget the boundaries between father and daughter. I don't know if this is of any help to you, but perhaps you could return making sure that he is clearly informed that you won't tolerate those actions and the next time it will mean the end of your time with him. I wish you very good luck.

Name: Marlette
Location: TN
Date: 07/18/2010
Time: 12:01 PM


Sounds as if this man is past his prime but he wants to see if he still desirable. He has become so very comfortable with you and in his mind you are taking the place of a past loved one. Stand your ground, Sister! Tell the patient and his family that you do not & will not tolerate such behavior and suggest counseling for him. Should you continue to be this man's caregiver, be sure to wear double layered clothing with modest apparel to prevent any type of future advances. Stay as far away as physically possible while still performing your job. Give the man board games using a card table to place distance between you. Also, limit the time that you engage in conversation with this man. Give him the Cold Shoulder approach. If any or all of the above doesn't work, GET OUT OF THERE FAST> He may not be as disabled as one thinks!

Name: Sharron Johnson
Location: Nashville, TN
Date: 07/16/2010
Time: 08:21 AM


Inappropriate from either a man or a woman can be a result of an increase in control in the part of the brain that regulates this behavior. It can be a sign of the onset of dementia, an increase in the level of dementia, or even the result of prescription medication. You should have reported the incident immediately to a family member and your agency (if applicable). The gentleman needs to be assessed by a geriatric paychiatrist or at least his family doctor. The answer could be as simple as a medication adjustment or as necessary as an inpatient stay in a geriatric psychiatric hospital. Any deviation from normal behavior (that is normal for your patient) is a warning sign that something is wrong. Just like a facility caregiver, home-based caregivers have the right to be protected from sexual harassment. Good luck.

Name: beverly jones
Location: florence,sc
Date: 07/14/2010
Time: 03:17 PM


This incident is not an uncommon one, especially when the caregiver is a woman.You did the right thing by notifying his son,if you hadn't know telling what he may have told his family members and most assurantly you would've been fired. That is a very dangerous black mark on your record if you were not smart about it. If you are going to continue to worked with this patient you need to have a talk with the family member and make it perfectly plain and clear that this behavior is inappropriate and it is up to the family member to explain this sort of behavior to the patient. Remember you stand to lose,not him, because the argument will be "well he didn't know any better" but you do.

Date: 07/14/2010
Time: 10:50 AM


I can understand how upsetting that must have been for you- especially since you have been caring for this gentleman for so long. My first questions is whether this man has been diagnosed with Alzheimers or related dementia. If he has or if it is suspected, then I will tell you that this behavior is part of the disease. The part of the brain which normally maintains the boundaries of understanding that this is inappropriate is malfunctioning. This occurs in both and women and men. Usually I hear about women disrobing and the "touching behavior" is often reported by female home health aides- especially those who are involved in bathing etc. Your initial response was excellent to ignore the behavior and redirect the person. He obviously has less control due to the illness.Some caregivers have asked if there was something they did or wore that illicit-ed this behavior. I assure them as I do you that you did not do anything wrong.This often can be a misplaced emotional response to some stimulus that can be uncovered and dealt with more appropriately. One case the man who was widowed would act out rather than talk about his grief. Looking at pictures of his wife and their kids usually provided a release. If the man doesn't have a cognitive issue, then one has got to wonder why he think his relationship has changed with you and perhaps his son could talk to him about that and how badly he made you feel.The son and father have to maintain proper boundaries and you cant be expected to stay if there is even any semblance of a re-occurrence. Leslie ahern -family Care Advisor

Name: Lisa C.
Location: Port St Lucie, FL
Date: 07/14/2010
Time: 10:49 AM


Unfortunately, things like these do happen and many people turn a blind eye to this occurrence. It is inappropriate behavior that needs to be addressed with the family and your supervisor (if you work for an agency). This is a learning incident to take with you on future assignments to listen to your "gut" and advise the client initially that you do not appreciate the sexual context of the conversation and not interested to discuss it any further. It is your decision whether to return to care for your patient, but if you do, you need to set limits or advise that you can no longer care for him as a patient if he is not agreeable. Good luck!!!

Name: Roxanna Webb
Location: Champaign, IL
Date: 07/14/2010
Time: 07:37 AM


You didn't say if you are with an agency or working independently. If with an agency they will handle the situation for you once you report it. If on your own the decision is yours if you feel comfortable addressing the problem or just not returning. If you think you can tell the person and his family that will not be tolerated give it a try. If the person has dementia it probably will not do any good. The solution really is in your hands.

Name: Jaleyn(jaye) Dobbs
Location: Creston Ia
Date: 07/14/2010
Time: 07:28 AM


I am sorry this has happened to you I know that it is disturbing!!!I have had this happen to me seriously more times than I can tell you... I sometimes think that when you go into someone's home to care for them they begin to feel that they have the right to treat you any way they choose. I had an elderly man get VERY sexually suggestive with me (in a clinic setting) and made me so uncomfortable! I actually talked with the Dr who I was working for at the time, the man was his pt. and he told me that I never had to go in a room with him again. I would strongly suggest that you not go back to care for this man. If you have to tell him that is NOT appropriate and you will not tolerate it!!!



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