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My 91 -year-old father has lived in assisted living for over a year and a half. He has diabetes and Parkinson’s with developing psychoses due to Parkinson’s. He has been fairly stable but had a recent hospital admission during an episode of intense delirium.


Just before going in the hospital, my dad’s PCP adjusted his insulin orders to meet changing needs. The nurse delegator didn’t like the way they were written and cancelled the orders on a Friday and didn’t get renewed orders. The orders for short acting insulin were very clear and it didn’t make sense she cancelled them. My dad’s blood sugar went high over the weekend and there were no orders to give him short acting insulin. EMTs were called and they called me to come over. This nurse delegator had been on the phone with my dad, trying to convince him he wanted to go to the ER. The EMT felt she was manipulating him. My dad didn’t want to go and I ended up giving him the needed insulin and the crisis was calmed. My hunch is she wanted him to go to ER because she had left him with no orders.


I did an inquiry about whether this was a case of neglect of a vulnerable adult, cancelling insulin orders and leaving him without help for high blood sugar. And also trying to emotionally manipulate him. It is possible she made an unethical decision . Does anyone know anything about nurse delegators and whether they can cancel physical orders and leave a resident with no orders?


The other concerning issue is now the nurse says she won’t let my dad return to his assisted living home because his diabetes is too unstable. This is not true at all. He has occasional highs and lows like any diabetic and he has been very stable in the hospital. But she is refusing to redelegate him and he is stuck in the hospital, which is making his psychoses worse.

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Contact your state department of health licensing board and file a complaint. They should open an investigation. There should be some sort of paper trail from the order to the doses. They can take your statement but they may need hers as well. See where this goes compared to speaking to an attorney. I assume you are not looking for financial compensation and you want to keep your dad in place.
The only thing I do not know is your state scope of practice with insulin because many ALs and MCs do not do sliding scale insulin, just whatever is written as specific doses.
I was told that for MA, CT, NC, and SC that If my mom's insulin needs changed from her specific timed dose that she would need to go to skilled nursing.
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From the article Lea submitted, is this "Nurse" a RN?
IMO she should not have overridden the orders of a doctor. I don't care what her credentials are. If she didn't agree, she should have followed the orders if she could not get to the Dr. and contacted him on Monday.

You need to call Dads PCP and tell him what happened and let him handle it.
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Has the facility ever spoken to you about the fact that your dad needs a higher level of care? Or have they spoken to dad about that?
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Sounds to me like this was the "nurse delegators" plan all along: to find a reason TO ask dad to leave Assisted Living and move into a higher level of care facility. Because how can it be considered "ethical" to cancel insulin orders written by an M.D. when a nurse delegator would have no authority to do such a thing, I would think? I have no idea but I'd call an elder care attorney to find out.

Here is a link to an article on what nurse delegation is all about:

Best of luck to you
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I don't think that, without charts, medical history, MD and RN notes, and testimony of the RN in this case, that anyone on a simple Forum of caregivers, hearing your side of this story, could come to any conclusions in this particular case. I am glad that you are there to follow this up and I would love to hear how your followup goes with the administration of the facility, and what explanations they give you are.
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