Demanding Client

[hhaide1123]

Hi, I am not a nurse but rather a private duty non-medical caregiver who works for a home care agency for the elderly. I wasn't sure where to post this but hopefully I'll get some answers/opinions here.

I've been with my elderly client for 7 months now. I've helped out on other assignments one or two times a week, but this one has always been my 5 day a week assignment. A few caregivers quit about a month ago and the other caregivers for my client and I have been working up to 65 hour weeks to fill in the scheduling gaps. My client had just returned from the hospital, and we quickly realized he was beginning to decline. Suddenly he developed a lot of anxiety and has had an ambulance called several times, though there was no true medical emergency. He even called once when a caregiver left the room to use the bathroom. He refuses the anxiety medication that was prescribed for him. I spend much of my shift calming him down and reassuring him. Mind you, I have experience with anxious people, but we are otherwise UNTRAINED when it comes to this sort of case. Some of the other caregivers struggle greatly with calming his anxiety.

The anxiety causes him to become very frustrated and demanding of us. He is very specific with how he wants things (as he should be, it is his home after all) but even a 2 degree temperature shift will send him into a fit. I spent the better half of my shift last week jumping up to hand him things he has always been able to easily grab himself (and is still able to) then being yelled at to take it and put it back down (again, within his reach). As soon as I sit, he's yelling for me to cover him, then uncover him, turn the temp up, turn it down, etc. It gets very wearing. I sometimes can't even shift my positioning as I stand beside him because he will shout for me not to leave him or leave the room. I guess he thinks I'm going to leave him alone, though I reassure him repeatedly that I am not going anywhere. He is very needy but rather than ask for everything at once, he has me running back and forth several times for things (he'll ask for water, then as soon as I bring it he'll ask for coffee too, then I'll sit down and he'll ask for a third thing from the kitchen, for example) and this will sometimes happen all day long. I try to have him do for himself as much as possible, but this got one of the other caregivers removed from the assignment because he didn't like her disagreeing with him.

So I guess I'm posting this to get opinions on whether you guys would keep an assignment like this or drop it. And whether other cases I come by will be as challenging. I like my schedule and hours here but I'm finding myself feeling so burnt out after 7 months of this. I don't know if I should ask for a different client and risk having the same problem but possibly worse hours, or if I should put up with the demands of this client. Am I just being too sensitive and is this normal for us to be treated like servants? Will I just have to put up with yelling and demands if I want to work in this job? I'm just very exhausted both physically and mentally!

[CrunchRN, ADN, RN]

Sounds like he is scared and fearful. Maybe try asking him what you can do to make him feel safer. Also let him know that you are there for him, and that you will not leave to the bathroom or whatever you need to do without letting him know and making sure he will be safe first.

[Kitiger, RN]

Hi, I am not a nurse but rather a private duty non-medical caregiver who works for a home care agency for the elderly. I wasn't sure where to post this but hopefully I'll get some answers/opinions here.

... My client had just returned from the hospital, and we quickly realized he was beginning to decline. Suddenly he developed a lot of anxiety ...

Has he been evaluated for adequate oxygenation? Stroke? My Dad had greatly increased anxiety/agitation that sounds similar to this patient; it was assumed to be caused by a stroke. (He died of an MI after a couple months of this.)

[hhaide1123]

Has he been evaluated for adequate oxygenation? Stroke? My Dad had greatly increased anxiety/agitation that sounds similar to this patient; it was assumed to be caused by a stroke. (He died of an MI after a couple months of this.)

Sorry to hear that about your dad.

Yes, he was on oxygen but his doctor told him he can discontinue using it. We monitor his oxygen levels and it is always good. But a stroke is something I will bring up to his daughter. We also suspected a UTI but his urine culture came back normal.

Thanks for this info!

[hhaide1123]

Sounds like he is scared and fearful. Maybe try asking him what you can do to make him feel safer. Also let him know that you are there for him, and that you will not leave to the bathroom or whatever you need to do without letting him know and making sure he will be safe first.

Yes, I agree he is most definitely fearful. I struggle because I tell him regularly that I am not leaving his side, that I've got him during transfers, etc and I always let him know exactly what I am doing when I have to leave the room, but he seems to demand that I jump immediately when he needs something. Sometimes just the few steps that it takes for me to get to him (literally two steps) can be too long for him and cause him to become impatient with me. I have a hard time with knowing just how much I should enable this demanding behavior because I do understand where it is coming from, but at the same time I am just not ok with doing every single thing for him (when we are supposed to encourage him to do what he can for himself) and having him barking orders at me.

I'm getting to the point where I think I just might be there too much and I'm just getting burnt out with the same struggle every day. I'm not sure what more I can do to reassure him. He does tell me sometimes that he likes when I'm there because I make him feel comfortable, but he seems to forget this most of the day.

[canoehead, BSN, RN]

It sounds like he's lost his short term memory. No matter how much you reassure him, he doesn't remember. And without a memory his anxiety builds because he doesn't feel secure. I wonder if some LTC nurses would have ideas on how to deal with this. Sticking with a routine would help, but it sounds like you are doing that.

[hhaide1123]

Thank you all very much for the advice, I am going to try to work with the family and my manager to come up with a plan to reduce his anxiety.

I guess I'm also looking for some tips on how to handle the way I'm treated by him sometimes. If it's not what he is interested in or wants to hear, I am literally hushed and he puts his hand up to silence me. He is a very sweet man usually and to new caregivers especially, but I suppose he is more comfortable with the caregivers who have been with him longer (me and one other girl), and so he doesn't cover up his frustrations with us. Though they are not caused by us and we literally do everything that we can to ease his pain, fears, etc with little compliance on his end (he refuses to take his prescribed anxiety medication and disagrees with or argues about many of the things we offer to do for him). I know that he feels very ill and I have great sympathy for that, but I am still a human being who deserves to be treated better.

I chose the private duty forum because I know many of you go to the same assignments regularly and might have tips on how to handle demanding patients. I find it hard because I know what I'm walking into every single day, and there's not much variation. What I loved about this job to begin with (a regular routine with one client who I can learn all of his needs and give him all of the attention he needs), is what I'm disliking now. Does this get better or am I likely to feel this way until I eventually change assignments? Im probably asking a question that's not easily answered, but just looking for some insight or to hear others' experiences.

[canigraduate]

I am not a private duty nurse, but I deal with all kinds of difficult people. You do not have to put up with this. Assess yourself and decide if this situation is something you can handle on a day-to-day basis. Judging from your post, it is not.

You have three options: change him, change you, change assignments. The first is better for the patient in the long run. The second is the most detrimental. The third is the quickest fix.

1) Change him: Decide if you can handle even more stress. If you can, start by gently and firmly setting limits on his behavior. Start small and work up to the big things over time. This will make him, and you, uncomfortable in the short term. However, it will pay off huge dividends in the long term by changing his behavior towards you and other caregivers while helping him to relax. An example is telling him that you are only going to make one trip out of the room per hour and to combine all his needs into one trip. Another example is telling him that everything within arm's reach is his responsibility. You must be firm and stick to your rules. You must also communicate these rules and make sure everyone else is on board. I would also start out by saying that your working relationship is suffering and have him give suggestions as to how he can repair his side of things. He doesn't want to break someone new in, I'm sure, since he has you waiting on him hand and foot. If you tell him that you can't tolerate the way things are and that you would prefer to work with him rather than leave, he may be motivated to change his behavior.

2) Change you: This isn't doing him any favors, is enabling his bad behaviors, and will cause you large amounts of resentment in the future. Keep accepting his inappropriate behaviors and stop getting upset that he is behaving badly. He will be ecstatic that his manipulative behaviors are working and you will be less upset in the moment. You will, however, slowly begin to hate the patient. Not a good outcome.

3) Change assignments: If this situation is bothering you to the point where you dread going to see this patient, then it's time for a change. Life is too short to live like that.

[hhaide1123]

I am not a private duty nurse, but I deal with all kinds of difficult people. You do not have to put up with this. Assess yourself and decide if this situation is something you can handle on a day-to-day basis. Judging from your post, it is not.

You have three options: change him, change you, change assignments. The first is better for the patient in the long run. The second is the most detrimental. The third is the quickest fix.

1) Change him: Decide if you can handle even more stress. If you can, start by gently and firmly setting limits on his behavior. Start small and work up to the big things over time. This will make him, and you, uncomfortable in the short term. However, it will pay off huge dividends in the long term by changing his behavior towards you and other caregivers while helping him to relax. An example is telling him that you are only going to make one trip out of the room per hour and to combine all his needs into one trip. Another example is telling him that everything within arm's reach is his responsibility. You must be firm and stick to your rules. You must also communicate these rules and make sure everyone else is on board. I would also start out by saying that your working relationship is suffering and have him give suggestions as to how he can repair his side of things. He doesn't want to break someone new in, I'm sure, since he has you waiting on him hand and foot. If you tell him that you can't tolerate the way things are and that you would prefer to work with him rather than leave, he may be motivated to change his behavior.

2) Change you: This isn't doing him any favors, is enabling his bad behaviors, and will cause you large amounts of resentment in the future. Keep accepting his inappropriate behaviors and stop getting upset that he is behaving badly. He will be ecstatic that his manipulative behaviors are working and you will be less upset in the moment. You will, however, slowly begin to hate the patient. Not a good outcome.

3) Change assignments: If this situation is bothering you to the point where you dread going to see this patient, then it's time for a change. Life is too short to live like that.

Thank you very much for this advice! You really helped put it all into perspective for me.