Demanding Resident

[abooker]

We've got a resident who constantly accuses us of not caring about her and not helping her enough with ADL's. She's frequently on the call light, sometimes before a CNA has even taken three steps down the hall. She is A&O x 2, and has trouble with depression, anxiety and paranoia.

Last week, she called her son and asked him to come put her to bed because "Nobody here is going to help me." She hadn't asked us for help. Her frequent complaints that we are cold, uncaring and unwilling to offer her enough are challenging to the CNAs, who are transfering to other halls, other employers, or even other careers. Last night, she was unhappy because there weren't two CNAs to help her. She wanted both of them, although she can independently use the bathroom, dress, and put herself to bed.

I know we are a good facility. We just can't satisfy this lady and her family. No matter what we do, it is not enough. She's insatiably needy.

Any suggestions about how to help a resident like this?

[Blackcat99]

Good luck. I remember I had a lady like that at LTC. She also had a phone in her room. She was constantly calling on her call bell and calling the nurses station at the same time!!!!!!:angryfire :angryfire :angryfire It was awful. The doctor ordered sedatives to calm her down but she refused to take them. She finally died. Does your LTC have any volunteers who would be willing to sit with her sometimes? Perhaps a psych evaluation could be done?

[CapeCodMermaid, RN]

First off, make sure she really is getting the care she need. Then get social services involved. Maybe some sort of contract would work. A staff member goes in every hour or so to check in. It helps to decrease her anxiety maybe. Get her son involved and explain to him that she is being cared for but because of her cognitive status, she feels the need to keep calling for help.

Make sure you care plan everything....just in case her next call is to the DPH!

[bshaw96]

Unfortunately, there are some patients who just won't be satisfied. But I don't say that lightly. I'd be anxious and depressed myself. Sometimes we tend to view the elderly as "a group", all alike basically. But this woman once had "a life". She was a young girl with dreams, someone's wife, becoming a mom for the first time, going on family vacations, buying a home, all the things we do today and enjoy. Suddenly, you find yourself with your spouse dying, your children have moved or are busy with their own lives, everything hurts, you can't even wipe your own bottom, you're totally dependant for everything. And the only time you see someone is when they come in to give you meds, change your diaper, or give you something to eat. I suspect she's very very lonely. Not to say there aren't some psych issues going on, but imagine being in her shoes. You're lying in bed, staring at 4 walls all the time. You never know who's gonna just walk in your door, if they'll be one that will truly take care of you, or if they'll treat you like you're on an assembly line, dry you, turn you, and walk out. I understand the staff's frustration. I've had those patients and families many times. Just try to encourage your staff. Everyone could spend 8 hours on edge with this woman, or spend 8 hours spending as much time as you can with her without neglecting others. You might see a huge improvement if someone could just spend time talking to her. Or if she could get consistent staff that she can get to know and trust. These are just suggestions, and I know easier said than done. Just try to imagine how it would feel to NEVER leave your facility. Imagine sitting in your bedroom, almost constantly. And the only interaction you get is with the nursing home staff. I have no doubt you are a great nurse, or you wouldn't even be bothering posting this. But you care, and that's awesome. I just find that when I take a breath and a step back and imagine myself in their shoes, I find MUCH more patience. She comes off as demanding. What she likely is is very sad and lonely. Hang in there! ((HUGS))

[VivaLasViejas, ASN, RN]

Unfortunately, there are some patients who just won't be satisfied. But I don't say that lightly. I'd be anxious and depressed myself. Sometimes we tend to view the elderly as "a group", all alike basically. But this woman once had "a life". She was a young girl with dreams, someone's wife, becoming a mom for the first time, going on family vacations, buying a home, all the things we do today and enjoy. Suddenly, you find yourself with your spouse dying, your children have moved or are busy with their own lives, everything hurts, you can't even wipe your own bottom, you're totally dependant for everything. And the only time you see someone is when they come in to give you meds, change your diaper, or give you something to eat. I suspect she's very very lonely. Not to say there aren't some psych issues going on, but imagine being in her shoes. You're lying in bed, staring at 4 walls all the time. You never know who's gonna just walk in your door, if they'll be one that will truly take care of you, or if they'll treat you like you're on an assembly line, dry you, turn you, and walk out. I understand the staff's frustration. I've had those patients and families many times. Just try to encourage your staff. Everyone could spend 8 hours on edge with this woman, or spend 8 hours spending as much time as you can with her without neglecting others. You might see a huge improvement if someone could just spend time talking to her. Or if she could get consistent staff that she can get to know and trust. These are just suggestions, and I know easier said than done. Just try to imagine how it would feel to NEVER leave your facility. Imagine sitting in your bedroom, almost constantly. And the only interaction you get is with the nursing home staff. I have no doubt you are a great nurse, or you wouldn't even be bothering posting this. But you care, and that's awesome. I just find that when I take a breath and a step back and imagine myself in their shoes, I find MUCH more patience. She comes off as demanding. What she likely is is very sad and lonely. Hang in there! ((HUGS))

This is a superb post. Thank you for caring enough about our frail elderly to share these suggestions with us.:yelclap: :flowersfo

[Rizpah]

Nice bshaw! If you don't mind, (abooker and bshaw) I'm going to print your response and use it in my next CNA class during the sensitivity training portion.

[abooker]

Excellent responses!

Thank you all for your help. I'll share these insights and suggestions with my own CNAs, and see if we can improve this lady's loneliness and anxiety, or at least our own responses to it. Maybe we can ask about moving her closer to the nurses' station; she's currently in the last room in the last bed at the very end of a long hall, which is adding to our frustration and her own isolation.

[SuesquatchRN, BSN, RN]

Or sse could just be a demanding spoiled brat. Just because she's old doesn't make her a candidate for canonization.

You have to document, document, document. "Answered call bell 8 pm. Resident stated, 'No one here will help me.' Reassured resident that we will help her. 8:05 pm answered call bell. Resident stated, 'I want Mary and Lucy to help me get washed!' Writer explained that Mary and Lucy were busy, and that resident is capable of washing herself. Resident then stated, 'You just don't care about me!' Writer reassured resident that we do. 8:20 pm call bell rang. Resident wanted ice water. Writer pointed out the three full glasses and pitcher on her tray table. Resident stated, 'That's warm now. I need fresh.'"

[marjoriemac, LPN]

I hear you!!! I have a resident just now and between her and her family, I could go mad. The resident is manipulative, wants to go home and keeps making up untrue stories about the staff. The family, one of whom is a nurse, BELIEVES her and keep filing complaints. The doctor is fully behind the nursing staff as he knows the family and the facility but we are still beating our head off walls trying to cope with her. Moral is down and the family are so two-faced. They speak nicely to you and then go and report you. The other night, the resident claimed two carers refused to comply with her requests which was total nonsense as I was in the room with them (she did not mention this to her family). The family came to me to complain and when they heard my side of events, I got dirty looks as if I was a compulsive liar. We may as well have our own complaints book just for them! What gets me is that if they truly believe we are abusing their mother, why have they not taken her out the facility???

[nightmare, RN]

Sounds so familiar! In the case of truly demanding residents(as opposed to the demented ones who don't actually know what they are doing)it's document,document,document.We have a computerised call system which can prove that a carer/nurse etc has entered the room so we can often placate relatives with the proof that someone is checking on their mum/dad every hour etc(although that doesn't prove the carer/nurse actually did anything while in the room!)

Different countries same d@@n problems!!

[SuesquatchRN, BSN, RN]

What gets me is that if they truly believe we are abusing their mother, why have they not taken her out the facility???

Why, then THEWY'D have to deal with that nasty old bat. This way they can assuage their guilt by busting YOUR chops, or however you guys across the pond would phrase it.

[squeakykitty]

Or sse could just be a demanding spoiled brat. Just because she's old doesn't make her a candidate for canonization.

You have to document, document, document. "Answered call bell 8 pm. Resident stated, 'No one here will help me.' Reassured resident that we will help her. 8:05 pm answered call bell. Resident stated, 'I want Mary and Lucy to help me get washed!' Writer explained that Mary and Lucy were busy, and that resident is capable of washing herself. Resident then stated, 'You just don't care about me!' Writer reassured resident that we do. 8:20 pm call bell rang. Resident wanted ice water. Writer pointed out the three full glasses and pitcher on her tray table. Resident stated, 'That's warm now. I need fresh.'"

This is a very good idea to CYA in case the state gets involved.