Handling personal care refusals from private pay dementia clients

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    Working as an HHAide for a licensed Home Health Agency. Client has diagnosis of Alzheimers. No skilled care in the home. No Medicare licensed Home Health Agency in the home. Client is lucid, firm, and articulate in refusals of Personal Care... shaving, incontinence care, baths, brief changes etc. How should we handle this? Nurse manager states we are to assist and support family, and explains this is not like working at a facility. Family is very firm with, "Go shave him now!" or "Change his diaper now" which prohibits any "go with the flow... pick your battles" type one on one care. Client becomes combative when pushed. He will sweep our hands away, push us back.

    Where is the line between abuse and neglect here? We want to provide care but the family makes it hard. Most of us feel more confortable, when we have no support from Nursing Management or family, to accept clients wishes, mark the refusal, and leave him wet and unshaven.

    Thoughts?
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  4. 3 Comments so far...

  5. 1
    One thingI've learned in my 6 months of home health. You can't change how people chose to live. If they want to neglect themselves and are competent to do so, that is their right. If they want to live in filth and dirt, that's their choice. If they want to be non compliant with their meds and treatments, also their choice. All we can do is teach and educate on the ramifications of not taking care of themselves. If they chose not to knowing the consequences, that's their choice.
    imintrouble likes this.
  6. 0
    I'll add that if something seems abusive, stop. If you witness neglect, including self-neglect, report it.

    But I'd also like to ask, in the absence of strong Nursing Management support, what good ways can HHAides use to educate family members that their actions are hurtful to our goals of providing Personal Care.
  7. 0
    Firstly, for a private pay home health agency, no Nurse Manager is going to tell you it's OK for you to just accept a refusal from a client with dementia. A home health aide does not have the authority to mark the refusal as you put it without first notifying a nurse, without calling the office.

    Because secondly, for a private pay home health agency client, no family member of a client with dementia is going to pay for aides to come to the home and again just mark the refusal as you put it. What was unclear to you about your mamagers saying to assist and support family?
    You owe it to the family that they get value for their money. And you owe it to the agency that they keep their client's needs met, have every timely opportunity to help you suceed on a case, or find you another case.

    Chances are good, in my experience, that the family gave you or co-wokers before you many days or weeks to be proactive, pick your battles, and go with the flow. And mom or dad still need a bath or a shave or incontinence care or whatever.

    Ok here is a good way to educate the family! Walk in the door and do something that needs to be done without asking the client or waiting for the family member to ask you. Wash his or her face and hands or something. THEN can call the office and tell them how it went and what you had trouble doing. This will go a lot better if you call to say I tried to give her a sponge bath and all I could do was wash her hands and arms than if you just wait till the end of the week to turn in a chart marked with refusals. Or whatever that means.


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