Can you refuse to give care to a resident in LTC?

Nursing Students CNA/MA

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Hi there! I've recently refused to give care to a resident. His Dr. has said his behavior is not caused by any mental illness or brain disease, as he has visited with him multiple times due to his behavior (calling the ambulance over 12x since I started at this facility, screaming and swearing at care aides, unwilling to accept anything short of all staff doing anything he asks at anytime no matter how difficult it is or out of our scope or if he has to wait because we are busy). Yes I understand the resident is probably experiencing depression/anxiety etc etc, however, this resident has made accusations against me countless times, sworn at me when I can't give him what he wants because it is unsafe or frankly impossible, many more times I have dealt with this residents behavior professionally. I've taken so much abuse from this resident verbally and finally I had had enough. I told nurses and staff I refuse to be treated the way he was treating me because it was burning me out. Tonight my co-worker needed help with him because he is a 2P so I considered calling the nurse but felt I needed to assist so I did and the second the resident saw me he made a comment about me having an attitude and swore. I said nothing and helped turn him and left. Now I am feeling that I don't ever want to assist again but I'm wondering if I am technically allowed to refuse or not. He does not have dementia so it is a behavior and abuse he is aware that he is doing and choosing to do. I understand it's in my job to take some form of abuse if it's a demented resident who is resistive to care or a demented resident swearing at me but this man knows what he's doing and is targeting me for whatever reason he has remembered from when I have helped him. I just don't know what to do I don't want to put stress on the other aides but I don't want to put up with abuse directed at me like that. Nurses and management are little help with him and they've tried to send him to other facilities but no one will take him because of his abuse. So my question is do i have a right to refuse and for other aides to have to switch residents etc because he isnt always bad to them like he is to me? Thank you

Yuk..that would set me off!!.

Don't ENGAGE.

Don't recognize his bullying. Ignore it!!!

Don't criticize his behavior...say nothing!

Go about your business.

Turn off your mouth and your ears!

Let him rant....remember the adage...sticks and stones etc etc

Do what you have to do...(or leave quietly, if he won't allow it and say you'll be back in 10 min, period.)

Ask if he needs anything right now?

Leave.

Sounds like you may be trying to change his behavior...ain't going to happen...!

He enjoys antagonizing you because you react/engage....what fun!

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Thank you all for your responses. I spoke to the nurse once again about the issues and she hasnt done anything yet. We usually have to bring up issues multiple and I mean multiple times to all nurses on this floor before anything happens. However I made some good points and I made sure other aides were including in the convo as well so I'm hoping one of the nurses will work with me and the other aides to update his care plan so we are all more consistent. As far as yesterday's shift, I assisted a coworker in this residents care and resident was in a good mood. Didn't raise his voice or swear and was even making jokes. This is common for this resident to have days or even weeks were he is fine but the second anything happens that he doesn't like or agree with he becomes a different person. So basically just waiting for this to happen to see how the staff are going to react as a whole. I've taken alot of advice from your posts and I'm confident that the staff will be able to work together better regarding this resident. Thank you all!

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GREAT WORK!!!

Use this "good mood" of his to build a bridge if possible! Review the information above in post #31. Perhaps you can come to some kind of understanding with him so that next time his world becomes out of control for him, you will be someone he trusts as he works through it.

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Try not to take it personal, I'm guessing you are a fairly new aide and will encounter this situation more often than not. Good Luck to you. For now, ALWAYS have someone with you! Speak with the charge nurse about possibly rotating assignments. Good news is this won't last forever.

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Yes this won't last forever and it is a good learning situation for me. I've worked on this floor/been an aide for almost a year now and this resident is by far the most difficult ive encountered so far but its good practice for the future. Very thankful to get advice from you nurses on this as the nurses here tend to avoid the resident altogether. Thanks again!

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Okay thank you for your response. I was pretty sure that was the case. It sucks that there are no rights for workers in this situation. The patient/resident can be in his right mind and abusive and terrible to staff yet nothing can be done. I really thought we would have some type of rights but apparently we are just servants. I think residents/patients like this should be kicked out and that's their problem. But no let's keep him and let workers burn out and leave so the facility can get a pretty dollar from this ******! Anyways thank you for responses....any suggestions what to do if a resident screams at you that you're a ******* ***** and to get him ******* water and then get the **** out? Cause I've already tried saying I'm going to leave until you can speak calmly. I've also tried just simply leaving him where he's safe and has bell etc until he can relax. I've tried telling him to not yell or swear or I will not assist. Ive tried just taking his crap and doing what he asks while he freaks out. However he always ends up more angry no matter what or will realize he can treat you that way and will the following day. Any advice is helpful...any ha ha thank you

Have you ever asked him why he is upset? Mr. Jones, I notice you are yelling. Why are you upset?

Have you ever let him know that you are so sorry that he's having a very difficult time?

Have you ever let him know that you really do want to know how you might help?

It could be that this person has had some very big and painful happenings - loss of spouse, loss of other loved ones, loss of work, terrible health, become dependent upon you and other strangers for his every need or wish? Maybe he's got a roommate but wants privacy. Maybe it's the temperature, the food, being on someone else's time schedule, loss of control of his life. Maybe his pillow or bed isn't comfortable, maybe a million and one things, maybe he doesn't have his beloved pets any more and even had to send them to the Humane Society or put them to sleep.

Try gently relating to him on a real person to person level. Try letting him know that you really do want to get along with him but that he scares you when he yells and it seems like there is nothing you can do to make him happy.

Maybe he can't reach his call bell, TV remote, water, glasses, book, toilet paper, whatever, urinal.

Maybe he doesn't know if he's going to Heaven when he dies - which might be soon, and he's terrified of The Great Beyond.

If you can view him as Bob Smith, former welder and climber of girders on skyscrapers, fearless, self-reliant, who supported a family, not just see him as a patient, it will help. Maybe he served in the military and fought in a war, risking life and limb for your freedom or was ready to go at a moment's notice. Maybe he was a fisherman, a lawyer, a shopkeeper, a businessman. Now he's wearing diapers and depending on you to clean his excrement. How do you think he feels? Let him know that you know it's not easy but that he's probably been through hard times before and he can get through this , too.

No it is not your fault, no you can't really change anything - except how you view him and approach him. And if he senses that you appreciate him as an individual, I think his behavior might change for the better. He might even come to really like you and then you can get others to see him in a new light and he will mourn his losses and be able to move past them somewhat. Enter into partnership with him. Ask him to help you do that. He might really like realizing that HE can help YOU for a change.

Ask him if he ever had any dogs, cats, horses, turtles? Did he like the Rocky movies? The Beatles? Whoever.

Get to know the guy a little. Don't wait for him to be nice. Try asking him what kind of music he likes? Then try to see to it that he gets to hear it sometimes. Maybe TV's going all the time drives him crazy. Maybe he needs some ear plugs.

Show him a picture of Secretariat and ask him if he knew that this horse won the Kentucky Derby by 53 furlongs, I think it was, an utterly amazing feat.

You get the idea, don't you, Friend? You can do this. Be the leader and help others learn how to assist this man and others you might encounter later who are just in terrible pain.

God bless you and thank you for caring about your patients.

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Specializes in Hospice / Psych / RNAC.

This needs to be care planned. Always two staff when givng assitance and your boss has the right to fire you. So what...you just throw the other nurses to the monster. Your facility took him knowing full well the behavior and now it's their responsibility to take care of him. Sounds like he doesn't like being there.

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Thank you for the wonderful response!!! This resident and I used to be on good terms...he was happy to see me, then he wouldn't like me for awhile then he'd be happy to see me, and now he is just not liking me at all anymore. He got upset towards me again tonight but it wasn't too bad. He is off and on with all the staff but for some reason he seems to hold grudges against me longer than others :p thank you for response

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Specializes in Gerontology, Med surg, Home Health.

And sometimes it means the person is just mean and abusive. Have you worked in a SNF or LTC? The CNAs often have 10-12 people to care for and one nurse can have as many as 30 people to medicate. The DPH will hound us if we use too many antipsychotics...atypical or not. "SW need to find placement for difficult patients??" Where would you suggest?

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Specializes in General Internal Medicine, ICU.

Ask your manager to implement a care plan for this gentleman. We have that for difficult patients on our unit. We inform the patient that we are leaving due to inappropriate behaviour and will attempt care at a later time.

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Yes I'm finding the biggest problem is getting the people who can do something about it to actually do something :p in that I mean management and nurses to take the time to work with the aides. I'm going to have to speak to the same nurse I did day before yesterday about us needing to adjust the care plan. She listened to my concerns but here we are 2 days later and no one has tried to move forward with it. It's discouraging because no one wants to think about the stress this resident is causing for the staff, especially the nurses and management because they hardly see the resident. The aides are having the biggest issues yet were struggling to get help from the people that can actually do something. Very sad :(

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Yes I'm finding the biggest problem is getting the people who can do something about it to actually do something :p in that I mean management and nurses to take the time to work with the aides. I'm going to have to speak to the same nurse I did day before yesterday about us needing to adjust the care plan. She listened to my concerns but here we are 2 days later and no one has tried to move forward with it. It's discouraging because no one wants to think about the stress this resident is causing for the staff, especially the nurses and management because they hardly see the resident. The aides are having the biggest issues yet were struggling to get help from the people that can actually do something. Very sad :(

In the meantime, try some of my suggestions. You say he has been decent to you off and on. ry to regain his goodwill. I think you can do it.

I really think he needs a Psych evaluation. Has this been done? Maybe he has a brain tumor.

Get a Neurology consult, too. I know you are an aide, but you can still maybe talk to the doctor or Manager and ask what would they think about a Psychiatrist and a Neurologist each seeing this man.

Hey, it couldn't hurt for these specialists to see him.

I wonder if you can possibly put the idea in his family's ear without getting in trouble - because he's so labile.

Meantime, work your magic with him.

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