Saying no to the hugging resident

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Elizabeth Newman
Elizabeth Newman

While leaving my car this morning in our office parking lot, I noticed a gray-haired man shuffling towards me. I assumed he was heading towards his car, but he stopped in front of me and demanded, “Hey, where's my hug?” while holding out his arms.

I looked at him and said, “No, sorry,” and walked into my office, while warning my female coworkers to avoid the parking lot. What was weirdest to me was that I had a moment of feeling sorry for the man and thought, “Should I hug this random stranger who is clearly lost and probably harmless?”

Of course not. What I probably should have done is asked if he needed help, and I like to think I would have done that if we were on the grounds of a nursing home or if I were a healthcare professional. However, in the moment it creeped me out enough that I fled. There's nothing quite like a week of the GOP presidential candidate discussing groping women with impunity, and numerous women coming forward about it, that makes you feel as if being on high alert in public settings may be prudent.

The reason I tell you this story is I've seen dynamics like this play out in long-term care settings. Often it's not a stranger, but a male resident who wants a hug or a kiss from a nurse or certified nursing assistant. What's the harm, the staff member thinks? After all, most staff who work in long-term care are the kind people who want to be nice to residents.  

Here's the problem: It wouldn't be uncommon for someone in a nursing home to have cognitive issues that dampen a normal filter on behavior. It's similar to a friend of mine who had a patient with a traumatic brain injury slap her on the butt. My friend whipped around and yelled at him. As she explained, it wasn't just about the slap, but the boundary issues — or lack thereof — evident with this patient. Some people would have laughed it off, which is the wrong answer. This patient struggled to know what was acceptable. Pretending as if a slap or physically touch is no big deal means that patient, be it an adult or senior citizen, thinks that behavior is OK.

Second, if you are a executive, director of nursing or administrator, it's worth reminding your staff that no one is allowed to touch them, in any setting, without their consent. I can't believe I'm writing that in 2016, but given some of the rhetoric I've seen about grabbing someone by the genitals not being considered all that bad, it's worth a reminder. If you want to see a great public service announcement explaining consent, the Brits have you covered with an analogy about serving tea.

I understand the practical side of long-term care involves seniors who are not always at their best, and how many crave intimacy. I'm not advocating a sterile environment where no one ever hugs, touches or receives a literal pat on the back. What I'm encouraging you to do is remind your staff that it's OK to say no to any of that. For example, one line is, “I'm sorry, I don't hug my patients. It's just our policy. How about a handshake or fist bump?”

Common sense can apply. There is a subtle but notable difference between a grieving family member whom you know saying, “Could I have a hug?” and a strange man demanding one. Along the same lines, upper-level staff should understand how two CNAs hugging each other doesn't have the same power dynamic as someone's boss giving his or her underling a hug.

Remember, this isn't an issue only for nurses. In a 2012 blog post, a physician wrote about patients who lean in for a hug. Her point was that when they do so, she offers a handshake, stating that hugging crossing a boundary line. Embarrassing? Could be. But her point is twofold: One, hugs imply that you are a patient's friend. You're not. Two, a hug between a healthcare provider or a patient or resident opens up that provider to a claim of sexual harassment or abuse.

I suspect many of us in our day-to-day lives do what we think is easiest, giving that hug because we don't want to offend a resident, or because we are afraid of creating a conflict. But your boss should make it clear he or she has your back. A nurse or other clinician has a responsibility to provide dignified care. That doesn't mean he or she needs to open their arms.

Follow Elizabeth Newman @TigerELN.

Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Marty Stempniak.