I see absolutely no problem with it as you have described it. I think, and I mean this gently, that the boundary is something that you have created. I would be glad to know that she is receiving such tenderness.

Well, there is certainly an avenue to find out if he's 'crossing professional boundries' - call the elder abuse hotline, give his name and the name of the adult family home, and give them the details - won't take long at all to find out!

I guess it's the fear of what could be happening when no one is looking. These 'outings' he takes her on aren't provided to the other residents.

Raven - we're in Seattle. Anthony is from Trinidad. I don't know anything about the culture in Trinidad.

Thanks suzieque - maybe I'm making a bigger deal out of this than necessary.

Our curiosity, I checked the ratings for this adult group home. There were numerous ratings, and from 1-5, the average was a 1 (poor rating). Multiple comments about the terrible treatment, abuse, etc. I personally haven't seen anything like this, and the place is immaculately clean.

In my opinion, the care-giver has crossed the line. There are appropriate ways to physically show compassion without kissing on the face.

Taking a resident on a drive outside the facility is fine if there are others along, and those other have approval of the person holding the power of attourney.

I see red flags. It could be nothing more than a friendship, but bears watching carefully. I have an uneasy feeling.

Most rest homes have very strict procedures for taking an Alzheimer patient outside the facility. Many do not allow it because it is too easy to loose the patient and the rest home is liable.

In the South, it would be all good.

Here in Seattle, where boundaries tend to be pretty high, it's unusual.

Good to be concerned.

Making such a big deal about a kiss on the cheek seems ridiculous to me. If there was anything inappropriate going on, I doubt he would do that in your presence.

Have we really sunk so low as a society that a kiss on the cheek is considered "unsavory"?

I would be much more concerned at the fact that There were numerous ratings, and from 1-5, the average was a 1 (poor rating). Multiple comments about the terrible treatment, abuse, etc. That is what you should be concerned about.

The kiss on the forehead or on her cheek wouldn't bother me, but taking her out of the facility to run errands with Anthony would worry me greatly. Just doesn't feel or sound legit to me.

if you are concerned make a later evening visit and see if your friend is in her room or?? it maybe that caregiver feels sorry for her being in a group setting at this stage...are you allowed to take her out for lunch, drives?

Yeah, call and turn him in for "elder abuse" ... seriously? SMH

My grandmother, widowed for 15 years, told me once that the thing she missed the most was her husband putting his arm around her shoulder, resting his hand on her leg, rubbing her arm as they sat next to each other, just having someone 'touch' her. "No one wants to touch old people" she said with tears in her eyes. Broke my heart. I make a conscious effort when visiting with elderly friends to make physical contact. I was friends with one gentleman for years and years. I would rub his arm, or rest my hand on his, when we were talking. He told me one time that I was the first person, besides his doctor, who had touched him since his wife died some 20+ years earlier. Am so glad I was able to show him some affection in his later years.

Anthony has requested any family / friends call before coming to visit. We can't just 'drop in.' We aren't allowed to take her out for lunch, coffee, etc. He says she gets too riled up afterwards so he's set a limit with her - the other 4 women caregivers know this too. The only time she leaves the facility is with Anthony, or when the entire group goes out with Anthony and the women caregivers. The men patients (there are 3 of them) don't ever leave the facility except on group outings.

Mind you, this isn't a large facility. It's an adult family home - there are 4 patients - one woman and three men. Anthony is the male caregiver, and there are 4 women caregivers. They rotate so there is always at least 2 on-site.

Anthony's other rule is that if we do come and visit her, we have to call 48 hours in advance, and he has to be there, not necessarily sitting in with us, but he has to be at the house.

As Angelaid said....it is so true. My mother, who showed no tactile affection to her children (that I remember) made it very clear to me when she was in a nursing home, that she wanted to be touched and kissed goodbye. I really was taken aback...it just seemed strange; but being "old" must make one more comfortable showing vulnerability. That said, I would not jump to any conclusions, but would be "aware" that the situation bears paying attention to. I do remember one college student who was the night caregiver in a 6 person home, who gave her so much "welcomed" attention, that in light of some of the comments here, I might have had reason to "worry"..... but I did not and he even sent a lovely note when she passed while living in a different nurseing home in another state. Hmmmmmm.
Strange thoughts. I always thought it was so very kind of him to have had such a sweet 'connection' to my elderly and alone Mom....since I lived 200 miles away and only saw her once a month. (which is why she passed away in another state near to my sister)

In the south that'd be good, why Amy?

I'm incredibly southern and kissing is taboo for many things. Which shocks the Europeans who visit here.

Yes, touch is incredibly important. But giving someone a touch of some sort, and even that should be limited in professional settings, and kissing are very very different.

I'd be more worried--a lot more worried--about Anthony's visiting rules. His insistence about calling in advance and visiting in his presence would send up red flags all over the place.

I haven't read all the responses, but frankly, why don't you just ask her. Say, "I noticed Anthony gives you a big hug and kisses your cheek when he sees you. How do you feel about that...? Ask her how they spend their days when they go out? Ask her in person so you can see her reaction.

When I read your post, my thought was that this is a caregiver who really cares about his patients. I suppose you haven't seen how Anthony talks to and treats the men. Surely, he wouldn't do that with males as people might get the wrong idea if you know what I mean. Women are more approachable in that way, thinking in terms of he looks at her as a "mom/grandma" type.

If Anthony has no way of "getting to" her cash, does this in public every time, he probably enjoys being around your friend and she likes the attention. He probably loves his job of caring for people and wants to make them feel cared for. But, I certainly would still ask to hear/see how she responds.

The affection doesn't worry me as much as the visiting rules.

Why does he demand you call ahead? 48 hours notice for a visit is weird. Find out what reasons he has for that rule.

We never called ahead to visit my grandmother when she was in a care facility.

Those visiting rules are very strange indeed, A facility might impose certain visiting times so residents aren't disturbed during meal times, naps, etc., but 48 hours notice?? That is worrisome. And the low ratings are also alarming. Maybe you can get her power-of-attorney friend to authorize the purchase of a hidden camera (the ones disguised as stuffed animals or trinkets) and leave it in her room. That could help to either prove or disprove any suspicions.

To me it sounds sweet, endearing. If it was meant any other way he wouldn't be doing it in public.

I agree with neesie.

I just remembered this from my v.n.a. days - a caregiver is required to get written permission from the supervisor to take a client in his vehicle - that supervisor is required, by law, to know where a client is at any given time. The 'home' is also required to have a written letter from the power of attorney, giving permission for caregivers to transport a client.

The person transporting the client is also required to have a commercial driver license to haul him/her around. Check with his supervisor and see if he's met these two law-required rules.

Sometimes people do things in public like you describe, only to find out they do much more that they should in private. They do this to establish a relationship that could or could not be good to the person. If you are concerned, especially due to the rules the person demands you follow, I would report it and have the home investigated. Some people from other countries are excellent caretakers, others are not. I would NOT discuss it with your friend, just have a outside source investigate it.

My question would be, why do they need 48 hours notice for any visitors? And why does he have to be there when anyone visits? I think it would be wise to keep a close eye on what is going on, it may be nothing, then again......? I know a nursing home is different than a care home would be but at the nursing home I visited my husband anytime I wanted to. I could even stop there in the middle of the night if I wanted to..of course never did but I did go at different times...not always the same time. I wouldn't like the idea of having to give them 48 hrs. notice of a visit! She may be better off at a nursing home where there is more activities.

I didn't think too much of the kiss on the cheek (kind of sweet IMO), but once you mentioned that he wants a 48 hour notice before you visit I have to wonder if something more isn't going on. Very strange.

Petra has a good idea about the hidden camera, although that may be violating some kind of laws too?

Is your friend's guardian/power of attorney aware of the physical affection, long trips outside the home with Anthony and the 48 hour pre-notification rule? If not, I think you should make them aware of those things. I really have a bad feeling about this situation.

Part of the problem is that we're in Seattle and her power of attorney is in Juneau, Alaska. As long as our friend is warm, fed, safe, her POA doesn't want to jeopardize anything, and have the group home decide they no longer want to have her living her.

Her POA, since she's become my friend's POA, has also been making a lot more trips to Seattle since becoming POA. We're wondering how she's paying for these trips. But that's a whole different topic.....

Big red flags regarding the visitation rules. As I said in a previous post I have a lot of experience with loved ones in assisted living facilities and also residential care. The only rules ever regarding visitation was calling if you wanted to visit after 7-8pm so there is no disruption to the nighttime schedule. There is usually quiet time for most residents before bed. I have always been able to come and go throughout the day without notice. Of course most facilities do have their residents on a routine, but they should let you know when meal, activity and nap times are. The fact that you have to call 48 hours in advance is definetly not right. I would let the person who has POA know this.

When you went to visit the first time, did you call in advance? What would happen if you showed up without calling in advance? Do you think they would let you in?

My reason for asking whether she was lucid enough to change her POA, regarding health and/or business, was that if she could be proven lucid, she could change the POA to , maybe ... Anthony ... or a friend of his, if house rules wouldn't allow if for him.

If she's no longer lucid enough, then it wouldn't be possible.

The 48-hour warning/notice troubles me, as well - why? And the requirement that he be present seems unnecessary ... certainly isn't in place for most rest home visitors... and why is it in place there? Plus ... only for visitors to her, or for the other residents/(inmates) as well?

ole joyful

The law won't allow a paid caregiver to be a legal guardian, P.O.A. or any other position that could put the client's life in jeopardy.

All of these things trouble me too. I, along with several friends, have told the POA these weird things that are going on. I think as long as my friend is clothed, fed, warm, etc., the POA doesn't care. She lives in Alaska and doesn't have to get too involved because our friend is basically being taken care of. She doesn't see these things as red flags. My friend is still lucid - she knows who I am, along with others, but has trouble remembering things in conversations. I can talk about, say 4 different topics, and then cycle around and talk about the first topic again, and she doesn't remember that we've already talked about it. She still cares about her hygiene, and whether her gray roots are showing :>)

The kissing on the cheek or forehead doesn't bother me at all, BUT the visiting rules certainly do. Have never heard of rules like calling 48 hours in advance and I worked in a nursing home where visitors came and went daily at reasonable times that didn't disrupt bedtime, etc.

And taking a female resident out is a big red flag to me. Everywhere I worked, nursing home, state hospital, etc, a female going out had to have a female with them, be she the driver or just accompanying. A male DID NOT take a resident out by themselves.

You need to contact the licensing agency of this home to see what their rules are. That would be the place to go and find out about the visiting and going out during the day with employee.

The kissing on the cheek or forehead doesn't bother me at all, BUT the visiting rules certainly do. Have never heard of rules like calling 48 hours in advance and I worked in a nursing home where visitors came and went daily at reasonable times that didn't disrupt bedtime, etc.

And taking a female resident out is a big red flag to me. Everywhere I worked, nursing home, state hospital, etc, a female going out had to have a female with them, be she the driver or just accompanying. A male DID NOT take a resident out by themselves.

You need to contact the licensing agency of this home to see what their rules are. That would be the place to go and find out about the visiting and going out during the day with employee.

I, too, am trouble with the rules of having to give 48 hours in advance to see any of the patites in that adult home..
Also another thing is why is he the only allowed to take her out? I know you said they can be agitated but he said only he can take her out.
I would question that big time and find out why to those rules.
They need to have people around them and family or friends vist them and they the patient.
Yes, but the other question is he takes her out but what and where do they go and what do they do? And does he need money for things and is is her money that he asks for to have as she needs things?
How does that work? I would find out about that if you can.
As for the kissing, depends on it is given.
Like someone mentioned of being kissed when tucked into bed her family relative and that is endearing and yes, they do need affection.
Some people do kiss and hug everyone and they call them lovie, sweetie, etc. endearing names or what they jsut call everyone.

Is there a way you can find out if he takes her out and follow them and not be seen and watch from a distance where htey go and what they are doing????

I would want to know why only him to take her out when she is the only women in the whole place.

Remember there is raping that goes on when they can't tell or they would never be believed. Some do take full advantage of patients like that.

I don't like that you can't go in whenever you like too and being told 48 hours before you can go.

The place being really cleaned doesn't mean anything, there still can be things going on.

Can you when you do visit her check her out privately in the way of is there constant bruising on her arms, etc. that you can see innocently on her and not get her upset.

Elderly has thin skin and they bruise so easy.

I pray that nothing is going on and nothing is being done to her.

Please keep us updated. Thanks

You need to contact a Long-Term Care Ombudsman and relate your concerns. I wasn't too worried about the kiss on the cheek, but the 48 hour notice before visiting is a big red flag. Do not delay!

Here is a link that might be useful: Washington State Long-Term Care Ombudsman

I have been an RN for 30 years most of my time was spent in ICU, Labor/delivery, Trauma.
Recently I have worked Home Health.
I see many very elderly patients in their 90's. They have lost their spouse, many times have lost their children(who were in their 70-80's).
These people do not have any human 'touch'! Nobody gives them a hug, a kiss on the cheek or forehead.
Touch is a human need. It is a basic need. Dogs want a pat on the head or a stroke on their back. Cats want a long stroke down the back.
Babies that do not get touched are often 'failure to thrive' infants.
We need to be touched!
A kiss on the cheek is wonderful to this person. It does not matter that she is only 65. Her mind is many, many years older.
Bless the caregiver that has this touch and caring!
He could have been one of those caregivers that slap, starve, let a patient sit in urine/feces/vomit, sit in a chair all day with drool dripping down his/her face, stay in dirty clothes or be unmatched for weeks.
When I am no longer able to care for myself, I pray that I fall asleep and do not wake up- I hope Idie while sleeping, but the vast majority of us will not.
We will probably die of a disease related to old age...painfully..slowly...alone..in a nursing home or hospital.
Bless this caretaker and pray to whomever that when you need a caretaker to help you move on to the next level in life...death...pray that you had a caretaker who cared.
I kiss my old, infirm patients goodnight or goodbye when I leave. They love the touch and caring that I give.
Good job!

ILMBG, exactly what I was saying!

If this o.p. had a genuine concern about this lady's well being, she wouldn't have posted here, but gone right to the phone and filed a report with the state.

From what the o.p. has said so far, I don't perceive any 'danger' to this friend - if I did, I certainly wouldn't waste time gathering opinions from this forum - I'd head straight to a source that could do something about my concerns.

I don't agree with the above two posters at all! There are all kinds of wrong with the scenario presented, and I am also an RN (now an anesthetist) for 30 years and have also worked in all areas of critical care from neonatal to CVICU. It sounds to me like the caregiver is doing what an abusive spouse would do--that is isolate the "victim" and be especially affectionate when there were witnesses around. I would be very concerned about this situation, especially with a vulnerable older adult. I do agree with Kayjones regarding going to a source that could do something about my concerns, though. Which I would do ASAP.

If someone is worried about the 48 hour rule, which I will agree is strange, why not have a professional surveillance follow up?
That may make you more at ease, or give you rational grounds for reporting to the senior care of your state...
If you are truly concerned, contact the correct authorities.

Apparently, I missed the OP's comments about the visiting rules. That changes things in my mind and certainly has red flags waving. It makes no sense why 48 hrs notice is needed to visit, a rule for just this one person it seems, and why HE MUST be present in the home. I may be stretching my thoughts, but when I read that, what came to mind is that he wants to be present "in case" the friend says something to a visitor exposing potential abuse, and he needs to nip it quickly. I don't know, I could be completely off here, but still see red flags.

Those visiting rules sure are questionable to say the least.

Can you ask the other caregivers or even Anthony himself, why he needs 48 hours notice and why he feels he needs to be at the home when people visit? Why she is the only one to have day outings with only Anthony and no other caregivers? Just ask.

I sincerely pray that Anthony is just a good-hearted, genuinely caring person who looks at her like a mom and has a special concern for her health, and nothing else.

The visiting rules are a real violation. Please contact your state Long Term Care Ombudsman immediately. It doesn't have to be the person holding the POA reporting it. This is not a police matter, there is a federally funded agency that looks out for the interests of people in long term care.

Here is a link that might be useful: Long term Care Ombudsman - Washington

Another RN here... Kissing a patient/client is considered a "boundaries violation" & puts ones nursing license in jeopardy. You can touch a patient, of course, like a pat on the back, arm, holding a hand, etc. without kissing. Those nurses who think this is ok really ought to check with their State Board of Nusing. This is something that has come into effect in the last few years. Some actions that are *much* more subtle than a kiss are boundaries violation. Might want to read up on it.

It is surprising to read the comments of those who are reassured that because Anthony kisses this patient in the OP's presence, he therefore would have no likelihood of being quite the opposite when no one is around. I think it could just as likely be a "display" to assuage any doubts about him.

The visiting restrictions are huge red flags IMO.

I think your instincts are spot on Sephia.

I wouldn't find it disturbing to know my mom is getting that extra touch of TLC. such as a forhead kiss.

I would like to know about the 48 hours to visit. I''m guessing there is at least one person there at all times. Maybe the extra person needs to come by while visitors are there just in case there is a problem. Two hands can only take care of so many problems of 4 people who have Alzheimer. Having a second or third person will be available for the care of the visiting pair.

My mother in law kept my FIL with Alzheimer at home till almost the bitter end . He was a handful!! Like having a giant two year old as strong as an adult running around her home. It was so tough for her. He died with in the week of being in the nursing home because he was ill with bone marrow cancer. One of the toughest little guys I ever met! He did get pretty riled up when we would visit. One time I had to take care of him, while he was still able to go outside to his shop. He did the weirdest things out there, but it was his love and I just followed him around. Oh, he really didn't want me there (or anyone for that matter) but we had to be there.
Soooo, I'm guessing this is why the 48 hour rule is there. It seems sad that a person can't just pop by if the time is good but there would be some liability on their side if the helper wasn't able to do the job because they were to busy helping the visitors.

There is no way a home would allow only one person to be with 4 Alzheimer' Disease patients - there is always 2 or more.

I agree at least two just to take care of their daily needs.

Thanks for all the input. I've been at work and haven't had time to respond.

Just a clarification. This adult group home has 4 patients, 2 with mid-stage Alzheimer's (my friend plus a man), and then a developmentally disabled man, plus another man who appears to have had stroke - he sits in a chair and doesn't speak or move much.

There are 4 women caregivers plus Anthony. There are always at least 2 caregivers present. Anthony's rule that anyone visiting my friend must give 48 hours notice, and the he must be present, I believe, is only for my friend.

Thanks for the Ombudsman link - I plan to call and get information on this.

My friend was divorced many years ago and has no family. That's why she has a childhood friend as her POA. It feels like her POA is shutting my friend's friends out and making it difficult for us to see/visit with her.

Thanks again. I appreciate all the different points of view.

kayjones - "If this o.p. had a genuine concern about this lady's well being, she wouldn't have posted here, but gone right to the phone and filed a report with the state."

Not helpful advice - a tad bit snide. I'm soliciting feedback because I wasn't sure if my suspicions were accurate or not. Several people did post constructive feedback, leading me to take action.

You didn't.

Sephia, I'm sorry you took this attitude. Seriously, if you even THINK there's a possibility of abuse of ANY KIND, you MUST call the proper authorities. Why wait? I am all about protecting the elderly and disabled, and who are you to second guess the situation? If you think you have any reason to suspect someone is doing anything to harm your friend, CALL and report it!

Wow, kayjones, calm down! You're getting a little too worked up over a website posting. Sounds like you have the attitude - none of my comments were aggressive - like yours.

I notice you take this "attitude" occasionally with other people at this forum . Might want to take a look in the mirror. :>)

Wow, kayjones, calm down! You're getting a little too worked up over a website posting. Sounds like you have the attitude - none of my comments were aggressive - like yours.

I notice you take this "attitude" occasionally with other people at this forum . Might want to take a look in the mirror. :>)

A peck on the cheek is quite a bit different than full-on tongues down each others' throat. And that's what some are suspecting so might as well put it out there. People who care for elderly (read "dying") people have a strange life and dealing with it day to day is something I couldn't deal with. I would think that becoming close to them is natural and wanting the person to be comfortable would be foremost. Since she is lucid, ASK HER! Is there anything more? Does she like it or not? I'd gamble that most of the ladies in this forum would wet their Depends to get a kiss from a caregiver and a show of affection. And who knows, if the males in there would appreciate a kiss now and then maybe he cares enough that he's give them one too but wouldn't dare because of the allegations that would come up. This part is small potatoes.

Now for taking her out of the facility, I'd want to know more about that. I'm shocked that he would do it. I certainly wouldn't just to remove any possibility of an accusation. I've been in various situations where I've refused to be left alone with someone just to make sure there's no allegations.

Each state has its own laws so you'd need to investigate that. If you have concerns you should seek counsel from and elder care attorney *and* a good private investigator, which the lawyer could refer. I would think a camera would help settle your nerves a bit, and the investigators could follow and see what's going on during the outings. This part is mysterious. Not suspicious at this point with so much unknown but I think I'd want to know more. First, I'd ask some questions. Is this normal? Is this legal? Is it proper? I imagine with such a small staff they can't send two caregivers with since there's only two on at a time. I'm also concerned with leaving just one caregiver there while he's gone. Who knows what the women caregivers are doing to the men while this guy is gone? Might as well use the goose/gander cliche for the ones who want to call in the troops.

The 48 hr thing is a concern to me too. I wouldn't honor it. I would go when I wanted to. Something there doesn't smell right. I'd definitely investigate that. Is this the home's rule or his rule? If the home, I'd want to know why. I'd also want to know if it's legal. If it's *his* rule, he'd need to explain why. Perhaps there's a legitimate reason but I can't think of one offhand. Had it been a certain hours thing, for instance, not after 9PM or before 9AM or whatever, that'd be reasonable and understandable.

His being there when guests are there *could* be explained but I'd ask. Perhaps it could be a concern that he is primary caregiver for her and if there's any questions about it they'd need to go through him so he should be there. However I don't like the notice and he be there requirement. My questions probably could wait. I'd want an explanation.

Is this "POA" person merely a person with a power-of-attorney or are they a guardian or a conservator? There's big differences. If a guardian or conservator, the trips there would be a legitimate expense charged to the person as long as properly documented.

Kayjones, is the law a Federal or State law (about paid caregiver being a POA or otherwise. I'm guessing state since my brother was paid and I believe he had POA on my father.

The gray roots comment is priceless! I know a lot of people like that but that makes me wonder, maybe that's where they're going on their outing? Get her roots touched up? This is why you need to ask some questions first before assuming the worst.

sephia, I want to commend you for keeping a rational head on your shoulders and thank you for giving as unbiased a presentation as I've seen here in a long time. Most come in with wild allegations and not questions or concerns and then certain people rally and gather rope, horses and pick out trees without knowing any facts. You have concerns. I think they're legitimate. You have questions. You deserve answers. The way you've presented this tells me you'll be able to deal with people and ask questions without making them too defensive so you can GET answers. I hope all is well. I hope all is innocent. It could be a problem or it could be nothing big. Only one way to find out and that's to start asking some questions. Here's how I'd approach it: Get the laws and rules first. Ask those questions first, then go to the home, get their rules. I might even go in with the pretense of a future occupant coming in and you're looking for a caregiver. They'd likely open up to you far better than if you ask why do I have to give notice... After researching and examining them thoroughly, then move on. It might be worthwhile to consult an ombudsman person for some guidance.

I guess the flags I see aren't raging red at this point. To me there's a couple dark pink ones though.

Good luck.

I'd first ask one of the female workers there is a 48 hour notice is required, if they say "no" then your discomfort with the situation needs to be explored. Call elder services, every city has one. You can ask without saying who you are and probably get some good info.

When your "inner voice" is telling you something is wrong, something is wrong. The peck on the cheek doesn't bother me either but the "field trips" and the 48 hour notice does. Asking your friend isn't going to help either if she's frightened of him.