How should I handle this resident?

happydays352 · Nov 2, 2007

I had a resident exactly like this! When she would ask me to do something I would say "please" like you would to a little kid. I'd just stand there and wait until she said please if she didn't I wouldn't do whatever she had demanded unless it actually involved an ADL. Not the pillow fluffing stuff. When I was done and she didn't say thank you I'd always say "Thank You" again the way you'd remind a child of their manners. If she tries screaming just do the " let's use our inside voices". If she's going to act like a spoiled child treat her like one.

Or you can always say Louise you know I love helping you and I always treat you with respect, I would appreciate it if you could ask me please and say thank. Sometimes I feel hurt and disrespected when you talk to me. I'm sure that's not the kind of person you are. I'm sure you're a very polite and respectful person. Make sure to be sugary sweet!

I'm also very shy so I totally know where you're at. This worked with this VERY difficult resident we had.

FireStarterRN, BSN, RN · Nov 2, 2007

She sounds odious. I wonder why she lives in an ALF if she's so rich?

Altra, BSN, RN · Nov 2, 2007

I'm a CNA and have worked in a great ALF for the past couple months. I love my job. However, we have a very difficult resident, I'll call her Louise. Louise comes from BIG money and is used to having maids around. She treats all of the CNA's as her maids. When you go in to help her get ready (keep in mind she can do just about anything herself) she snaps orders at you, and never says please or thank you. The other day I was almost in tears because she was being so demeaning towards me.
Just to give you an idea, she makes you "fluff" her pillows, the other day she screamed at me because I didn't place her pillows at an angle after I fluffed them for her. (She makes everyone do this, not just me even though I'm new.) After that happened she made a snide remark to me, saying "Wow I guess you are new huh? I guess I'll do it myself since you obviously don't know what you're doing." The worst part is, she literally barks orders at you and NEVER says please or thank you. She literally treats you like you're scum. I mean, I've dealt with difficult residents but she tops the cake. I heard that when you give her showers, she makes you wash her arm, then dry. Wash again, then dry. Wash again, then dry. This goes on about 8 times, keep in mind for one arm. This is why she demands that you bring in about 10 towels. THANK GOD that she gets her showers in the evenings, and I'm on days- So hopefully I'll never have to shower her! I forgot to add that she's in a wheelchair. She's capable of walking, but doesn't want to. I think she likes having everyone push her around. She also goes to the bathroom and does everything else herself, but we have to come in and dress her??? Grrr.
I'm just wondering how you would deal with this situation?? I'm a very softspoken person and tend to not speak up when something's bothering me, but it's getting to the point where I don't even want to go into her room. I know I shouldn't let her bother me but she does!

Revisit the great Eleanor Roosevelt quote, "No one can make you feel inferior without your permission."

In your post I've highlighted the keys to the problem. You & the other staff enable this resident's behavior to continue. It's OK. Admit it, own it ... and now resolve to change the situation.

You don't list your exact job duties, but I'm guessing they entail assistance w/bathing, dressing & other ADLs. Pillow-fluffing is not an ADL. Repeat: pillow-fluffing is not an ADL.

Another great quote, with my own paraphrasing: if you keep doing the same thing, you'll continue to get the same results. So if you want different results, different interactions with this resident, then you'll have to change the course of the action.

What if the next time you care for this resident, you start the conversation (and therefore take some control of the conversation) by reviewing "The Plan." For example, "Hi Louise, it's time for me to help you with your bath. I'm going to get a few towels. Then you'll wash all of yourself that you're able to, then I'll help wash any areas you can't reach. If there's anything you need help with reaching to get dressed, I'll help with that." If she starts her neurotic-aggressive arm-washing routine you might say, "as you'll remember, we just washed that arm. Let's move on." Repeat this a few times, if necessary.

I can't say exactly what her reaction will be. But I can guarantee that it will be different than what you are dealing with now, with great potential for improvement. If you feel she may complain to management by misrepresenting the interaction she has had with you, be proactive, go to your supervisor, and explain immediately. Include phrases like, "I understand that one of the main goals of an ALF is to support the independence of residents. I clearly offered my assistance with aspects of ADLs that Louise might feel she has trouble with."

Remember, you are an employed adult with responsibilities. Take charge of those responsibilities, and be the great CNA that you can be. :)

Let us know how this goes.

nurz2be · Nov 2, 2007

She sounds odious. I wonder why she lives in an ALF if she's so rich?

Most likely she treated or treats her family the same way and maybe none of them could deal with her either. The hardest thing to do is to love the unlovable. Her heightened sense of harshness could be due to being "abandoned" not to say that this is her first go around with being hard. I, this is me, would put her little bupkis (butt) in a wheelchair and I would wander into a room with a patient that is bedfast and contracted. I would remind her that this is what happens when someone either cannot do for themselves and is not exercised daily or happens to someone who refuses to do what they can. I would then wheel her bum back to her room and place a pillow in her lap and tell her, I am here for your daily needs.... I will assist you with daily living but the rest is for you to do. I would promptly excuse myself from the room. She will either have an awakening moment or she will continue to be a nasty old bitter bag in which case she knows your stance on how she is treating you and the other staff. I am not bashful but I would not tolerate being mistreated by someone who has all their faculties. She is not a AD patient nor is she a brain trauma patient who doesn't have her senses. Hold her accountable and show her that she can have quality of life as long as she tries for herself.

SuesquatchRN, BSN, RN · Nov 2, 2007

Her little tuckis belongs in her wheelchair. Bupkis is nothing, nada, zilch.

Dolce, RN · Nov 2, 2007

These types of residents are so difficult to work with in a ALF or LTC setting because they know that they can play staff members against one another. If one CNA starts to lay down the law and not permit manipulation then the resident demands to have another CNA help them. Or, they will flatter one CNA into being their "favorite." Residents like this are experts at manipulation.

It would be great if you could talk to your DON about having a group meeting with all of the CNAs and making an updated plan of care that specifies how each person will care for this resident. Consistency is the key. If all the CNAs set firm limits on her behavior she will have to comply (or move to a new ALF!).

naturalized · Nov 2, 2007

HI there :) I have seen my coworkers cried because some patients and their families think of us as maids. I think being calm can help a lot. Understand that there's a limit to what you can do because you also have other patient to take care of. I dont have a lot of exp as a CNA because I've only work since July. But, whenever I have difficult patient, I just told them "You can get your message across without being angry, I'm here to assist you." And, if they say hateful remarks or demeaning remarks, that's okay, because I'm there to do my job, not argue with them. Usually, in case like this, you will have other CNA and nurses who will support you. Try and talk to your coworker. Support is a great system in the health profession or any job.

mauxtav8r · Nov 2, 2007

These types of residents are so difficult to work with in a ALF or LTC setting because they know that they can play staff members against one another. If one CNA starts to lay down the law and not permit manipulation then the resident demands to have another CNA help them. Or, they will flatter one CNA into being their "favorite." Residents like this are experts at manipulation.
It would be great if you could talk to your DON about having a group meeting with all of the CNAs and making an updated plan of care that specifies how each person will care for this resident. Consistency is the key. If all the CNAs set firm limits on her behavior she will have to comply (or move to a new ALF!).

This is very true. A friend who is the director of a nursing home used to tell the "difficult" residents "Well, so and so, you know I guess we just can't please you here, so let's go get your bags packed. We've got a waiting list, you know."

All the staff knew he wouldn't take mistreatment from the residents. The facility is very highly regarded as the best around and constantly has a waiting list.

catlynLPN · Nov 2, 2007

You need to talk to all the staff, the nursing supervisor and come up with a plan to deal with this woman.

You need to agree on a time limit to spend with her doing her ADL's and within that time limit everything needs to be done.

Her shower, dressing, and linen change. Tell her she gets one towel, and one wash cloth. No more. You have to have linens for other residents, too.

And she needs to start dressing herself and fluffing her own pillows.

We have a gentleman in the LTC where I work. He is also very demanding.

When I go in there to give him his meds, he has to have a drink before the meds. Then the meds. The straw has to be a certain angle. He wants the med cup tilted so he can see the pills. Then he wants cough syrup, water before the cough syrup, water after the cough syrup.

Then you have to be sure and put the bedside table back exactly where he wants it. So many inches from the head of the bed at the side, where he can reach it. TV remote and call light has to be EXACTLY placed. The HOB has to be raised or lowered to exact height for anything.

The routine for getting him up and putting him to bed is very demanding on the CNA's.

I put up with it because he has severe arthritis in both arms and hands, with severe deformities of hands. It IS difficult for him to do much for himself, so I just try to remember to do everything when I'm in there so he won't have to call me back.

FireStarterRN, BSN, RN · Nov 2, 2007

You need to talk to all the staff, the nursing supervisor and come up with a plan to deal with this woman.
You need to agree on a time limit to spend with her doing her ADL's and within that time limit everything needs to be done.
Her shower, dressing, and linen change. Tell her she gets one towel, and one wash cloth. No more. You have to have linens for other residents, too.
And she needs to start dressing herself and fluffing her own pillows.
We have a gentleman in the LTC where I work. He is also very demanding.
When I go in there to give him his meds, he has to have a drink before the meds. Then the meds. The straw has to be a certain angle. He wants the med cup tilted so he can see the pills. Then he wants cough syrup, water before the cough syrup, water after the cough syrup.
Then you have to be sure and put the bedside table back exactly where he wants it. So many inches from the head of the bed at the side, where he can reach it. TV remote and call light has to be EXACTLY placed. The HOB has to be raised or lowered to exact height for anything.
The routine for getting him up and putting him to bed is very demanding on the CNA's.
I put up with it because he has severe arthritis in both arms and hands, with severe deformities of hands. It IS difficult for him to do much for himself, so I just try to remember to do everything when I'm in there so he won't have to call me back.

You are very compassionate. This man sounds like he has OCD on top of his debilitating arthritis.

Valanda · Nov 2, 2007

I'm not sure exactly what duties you are required to perform for this woman. I currently work in home health and have a patient exactly like the one you described. The ALF told the family that their mother is overly demanding of the regular ALF staffs time and insisted that if their mother "required" maid service above and beyond what was normally allotted to patients, then they would have to hire a private duty nurse or aide to care for their mother if she planned to stay in the facility. Considering the amount of money they have, they considered it no real issue at all.

It's much easier to deal with fluffing pillows and fighting the urge to yell at spoiled patients when I know they are paying $45 an hour for this "maid service".