Caregiving: Dealing with Challenging Residents

Let this be your guiding principle, enter into the world of a person with dementia because these individuals can hardly enter yours. Similar words were stated at a Caregiver Support Meeting held in Ft. Worth, Texas in 2002.
It has become a golden piece of advice to give to caregivers of dementia residents.

DEALING WITH DIFFICULT BEHAVIOR

Dealing with difficult behavior in a dementia patient is par for the course. It is to be expected. The mind of a dementia patient is under attack, and sometimes they wage war against those who love them most. It is not personal – It cannot be helped.

What does a caregiver do when a dementia resident becomes difficult? Simple. Nothing. Most often difficulty arises when a schedule is not being adhered to or kept. The caregiver wants the dementia resident to prepare for the “next thing.” Oftentimes, the dementia resident is unaware of the “next thing,” and may be quite uninterested in it.

Why resistance? Dementia patients often understand when they are supposed to do something else, but exactly what is expected escapes them. The gravity of the activity eludes him. Thus, fear sets in and resistance rises to conceal a lack of knowledge they know they should possess. The continual insistence of the caregiver will only heighten the situation. The resident can become ashamed, even embarrassed. When a former Doctor of Engineering cannot remember to wash herself, a loss of control results in difficulty.

Think about it. She remembers being a professor or working at NASA but cannot find her way home from the grocery store. When she arrives at your residential assisted living home, it might be because she has become a danger to herself and others. She no longer has decision making authority, and this will certainly result in difficulty. This does not need to be exacerbated by the care provider. Simply relax and allow the resident to make some small decisions about their personal life in the RAL home.

Decisions that include activities of daily living such as:

  • What will she eat for breakfast?
  • When will she eat breakfast?
  • Will she engage in activities today?
  • Would she prefer gardening or reading?

By offering a menu of options, soon the resident will feel more comfortable. She will feel as if she has some say in her life. As such, difficult behavior may dissipate – at least for the time being.

COPING WITH A DIFFICULT BEHAVIOR

Do not allow difficult behavior to make your job difficult. Again, do not take it personally. You are caring for a mind under attack.

Remain calm in this battle and assist the resident by doing the following.

  • Control your response to the resident’s difficult behavior by remaining calm.
  • Do not blame or shame the resident.
  • Remember their anger is a response to fear.

Do not blame yourself as the caregiver. Relax. Speak peaceably to the resident. Things will turn around soon enough. Patience is key.

EXCESSIVE COMPLAINTS AND ANGRY BEHAVIOR

In the case of any disability, frustration can erupt. No one desires to be disabled. Sometimes the demands of a disabled resident seem petty and their irritability unfounded. Rage may erupt over a lunch meal, and a scene may be made. As you did with the dementia resident, do the same here. Relax.

Why do people fly into such a rage with those caring for them? The caregiver is a constant smiling reminder that something has failed inside themselves. The caregiver is a sweet, seemingly condescending mockery of their loss of strength, vitality and meaning.

When things calm down, ask simple questions that will take their focus somewhere else:

  • Where were you raised?
  • What was that like for you?
  • Where did you first live when you left home?
  • What did you like least about your career?
  • What’s the most difficult thing about parenting?

What are you doing here? You are getting to know the person who existed outside the confines of your RAL home.
You are getting to know the living, breathing, vibrant person, who raised three kids, moved six times and played the piano for the church choir. You are getting to know the real resident.

WHAT CAN YOU DO WHEN SOMEONE ACTS UNREASONABLE OR MAKES ANGRY DEMANDS ON YOU?

So often, residents know what demands will and will not be met. They know what is possible and not possible.
They make unreasonable demands because they are frustrated and want out. They want to go home. Do not allow this to disturb you.

Listen. Watch. Monitor.

Then, ask what you can do to make things better? Ask what it is that would make their stay more palatable? Empathy is the key. Think about yourself in thirty or forty years. Will you be in the same situation? And how will you want others to react in the same situation?

BE OBSERVANT OF OUTBURSTS

When a resident erupts in anger or frustration examine if a pattern exists.

  • Do outbursts occur at a certain time? After a certain activity?
  • Alter patterns that tend to create frustration.
  • Relax on requirements to eat, exercise, rest etc. The resident may be offended by this.
  • It’s okay to step away and give some space. A cooling off period will do just as much for you as it will the resident.
  • Make sure the resident is not exhibiting any symptoms of a urinary tract infection, low blood sugar levels or pain.
  • If the resident is not resting well, determine what may be inhibiting their sleep pattern.
  • Ensure the resident has adequate privacy and personal space.
  • Slow down the pace of care, as the resident may be too proud to tell you things are moving too quickly for them.
  • Surrender some decision making to the resident. Remember, the resident is an adult, not a child.
  • Be respectful.

KNOW THE FOUR RESIDENT TYPES

Residents come to your residential assisted living home in all shapes, sizes, ethnicities, racial backgrounds, and life experiences. They are as diverse as America. However, with such diversity comes some similarity. Below are four common resident types.

Knowing these types will help you address concerns quickly and understand the root of them.

1. Stubbornly Independent

This resident demanded specifics. Do not speak in generalities or this resident will “have your lunch.” This resident is tough and can do it all by themselves. Except, they cannot. So, tell the truth, respectfully, with specifics.

Tell the resident:

  • I have witnessed you stumbling in the hallway.
  • Last week you nearly fell backwards after lunch on Thursday.
  • I want you to get stronger again. Let’s do physical therapy. I’ll go with you.

a) More than likely the resident will not want you in attendance but will go to keep you from attending and openly discussing the matter.
b) The resident knows they need physical therapy but cannot bring themselves to ask. They are independent.

It helps to keep the family of this resident type on speed dial. The resident does not want the family making more decisions for them, but without their involvement they may never arrive at the decision themself. Remember, they are not weak. In their mind, they do not need to be in your RAL home.

2. Steadfast Denier

According to this resident type, nothing is wrong. She had one little episode, and the kids lost it. She is fine. Nothing’s wrong. Deniers do not discuss much of anything. They are fiercely private because it protects their secret, that is no longer a secret. Thus, they live in your RAL home. But, to them, you do not know, and they deny there is anything at all to know.

Remember, nothing’s wrong. It’s okay to go along with this performance. This patient attends physical therapy as an exercise activity. This resident speaks with her priest, not a psychiatrist. This resident prefers a soft foods diet because she is dieting, not because of the massive stroke she had last year. Empathy is key with the denier. This resident type is really salvaging dignity.

3. Overly Controlling

Listen. With this resident type simply listen. The overly controlling resident feels he has lost all control of his life.
What can you do to break through to this resident type? Ask questions about his life. Ask for advice with your kids. Inquire about strategies or tactics used when he was the Chief Executive Officer of Company ABC to assist your spouse with his business. In other words, let this resident type be of value. They miss being valued and providing value.

4. Cognitively Challenged

This resident really needs your help. She may not think so, however. She may think she is still a functioning mother and accountant as she once was. A wise woman once said, “enter into their world because they are unable to enter yours.” Therefore, allow her to balance a checkbook, just not a real one. Allow her to offer motherly advice. She is a wealth of wisdom, especially on coherent days or in coherent moments. Again, be empathetic and respectful.

QUALITY CARE STARTS AND ENDS AT YOUR RAL HOME

The most challenging residents are really the ones that are hurting the most. They are suffering from a loss of life.
Not the involuntary breathing life, but the meaningful purpose filled life. They had careers, houses, cars, experiences, love, loss, and now they have your RAL home.

Make it a place where they want to be. A place where aging can be dignified, and friendships can be built.
The Residential Assisted Living National Association will help you in this process. RALNA provides professional tips, guidance for legal expertise, continued education, national marketing, group purchasing power and support to members.

Find the support and ensure your success with all the help you need by clicking here.