A fellow we will call “Ernie” had moved his entire family from Ghana to the United States some years ago.  He was told from his relatives to obtain his certification as a CNA or certified nursing assistant, in order to jumpstart his nursing career. collateral damageHis ultimate dream was to one day become a registered nurse. 

 Ernie’s first job was in a long-term care setting. He quickly adapted to caring for 8-10 residents with dementia inside a locked unit within a nursing home. Ernie helped the residents with bathing, dressing, and eating. In other words, Ernie assisted with their ADL’s (activities of daily living).

 Three months into his new career Ernie was sent home unexpectedly. He had to inform his wife that he had been accused of raping a male resident within the dementia unit. His wife did not understand dementia and Ernie was about to lose a lot more then just a few day’s work.  His wife threatened to take the kids and leave him.

 So, what is a delusion? A delusion is a fixed false belief. Delusions are common in patients with various types of dementia.   A common scenario is the delusion of theft.  The nursing home resident with dementia may accuse a staff member of stealing. Often the object in question may be an old sweater or something that doesn’t hold much value, which in turn helps downplay the accusation. In other words, nobody truly believes that the CNA stole grandma’s 5-year-old shabby sweater.  Case closed.

 But, what happens when the item is of value? For example, missing cash or jewelry. This becomes a big problem for the nursing home, the nursing home administrator and all of the direct care providers. An investigation often comes up empty and most assume that the missing item never really disappeared.  Unfortunately, the rare thief can make a theft delusion a reality and muddy the water. This is what validates the need for thorough investigations. 

 So what happens to these “stolen” items? Many times the item was never there to begin with, or the resident misplaced it (years ago) and cannot recall where he or she last placed the item. When this behavior or accusation is repetitive and the family supports that this is more than likely a delusion, the collective worries dissipate during the investigation.

 In Ernie’s case there was much more at stake than some old jewelry. In his case, his reputation, career and marriage were riding on the unfortunate psychological distress of an 87-year-old male with moderate dementia with delusions. (The previous delusions were never documented in the resident’s medical record).

 Fortunately, for Ernie, the patient’s family finally stated that their father had reported false claims of rape during his previous stay at another area nursing home.   Family embarrassment prevented this information to be brought forth until they heard what happened to the employee.  To further verify that this claim was a delusion, a thorough physical exam was completed and showed no evidence of rape. Ernie was to return to work, but shared how frightened he was that this could happen again. 

 Ernie; “What if I’m ever falsely accused again?” “Will people believe me?”

 The delusions associated with dementia can be damaging for every party involved. This includes the patient, the family, the direct caregivers, the nursing home staff and any other additional parties involved.  Understanding the type of dementia, the history of delusions and former accusations can help with future problems.  Documentation and open communication with the family remains critical.  

 The great challenge we all continue to face lies in educating the entire world about the intricacies of dementia. Hopefully, by 2015, folks like Ernie’s wife will have the knowledge of what dementia is and  be more open minded and supportive of their spouse during an investigation. The role of the C.N.A remains a difficult and heroic occupation.