My Impossible Resident

CoffeeRTC, BSN, RN · Oct 4, 2005

Has psych been in to see her?

Don't give up on her, but realize that the only way she will change or start participating in her care is when she is ready.

Sounds like she is dealing with alot of issues. Medical and psych/ social.

I'm sure the IDT team is at wits end? Can they do some type of behvioral contract with her? Def set limits with her. Leave the room when she is name calling or throwing things....

SouthernLPN2RN, MSN, RN, APRN, NP · Oct 4, 2005

I agree with Michelle, I'd leave the room when things started getting ugly. This resident definitely needs a psych eval and possibly hospitalization related to that. There are certain folks who just can't be helped in a LTC setting without the psych element.

Kitkat23 · Oct 4, 2005

I posted a similar thread in the psychiatric forum but I got 0 replies. After thinking about it, I guess I should have put it in here.
I work in LTC as a CNA. I take pride in my work, and the nurses and "higher ups" are always telling me that I deserve more recognition for the great job that I do. I was employee of the month in August-finally!, after two years of service, and my regular residents are so happy to see me after I come back from my day off.
I have the same assignment every day, and I love knowing my residents well enough to know what they like and dislike. I also love to hear their family members compliment me on my techniques and such. But.....I have one problem. She is a very large woman, not quite 5' (with tape measure), weighing in at about 365 lbs. She cannot walk, or even stand, refuses to get out of bed even for her twice-weekly showers, and she is the meanest 47 year old woman I have ever met in my life. She came to my facility probably about a year ago and I was warned about her, but I was determined that I was going to make friends with her and reach the goal of helping her lose the weight so she could have therapy and learn to walk again. Her parents are her POA, and she treats them just as bad as she does us. She screams and swears every day, and all night. Her only focus in life is food, food, and more food. She says we are trying to starve her because she is on a restricted diet, and also just recently fluid restriction. She still gets plenty, but whatever she can't have, she wants, and she wont stop screaming and throwing tantrums until she gets what she wants. She has hit two of my fellow aides, and has been verbally abusing everyone that walks into her room ever since she first came there. I have tried talking heart to heart with her, but she is just the nastiest thing. Nobody has ever met anyone like her-guaranteed.....
Hi Nikki. I'm also a CNA working in LTC. I also take pride in my work, am well liked by most residents, their families, and staff, including the nurses. I love taking care of my residents and have my favorite ones. I get so attached to them, I can't help it. In the past few months I've lost several residents; two were quite young.
Anyway, I'm sorry your obese resident is such a nasty one. I guess she doesn't have enough willpower and doesn't care about life. I have a difficult resident that I care for except that she's an 85 year old anorexic resident who's cold, miserable, and is never satisfied in what we do. She's not combatitive or verbally abusive, but she's so cold and mean. She's my least favorite resident.
I try to be nice to her and do what she tells me to do. I know why she's so bitter and cold. She was admitted last spring by her sons and she hates it. To pay for her nursing home bills, she had to sell her nice house and give up her lifesavings. Now she lives in a small room with a roommate and the room isn't fancy, but it's kept clean.
When I serve her dinner tray, she glares at me and snaps, "I'm not hungry!" or something. She'll only eat her pbj sandwich, banana, and dessert with juice and milk. She'll go for days without eating and she's a weekly weight now. I try to encourage her to eat, but sometimes she will and sometimes she'll snap at me to go away and why should I care? She told me that nursing home food is disgusting for the high price she's paying for. I report her meal intakes to the nurse. She refuses most meds from the nurses. She hasn't had a bm in weeks and complains about it, but when the nurse offers her mom or a lax, she refuses it. She even refused prune juice.
I do feel bad for her, but she's so cold and whatever I do, I can never please her. She's an assist care patient, so when I help her to bed or in the shower, she always has to find a little problem in what I do. Such as the water isn't hot enough, I didn't bring enough washcloths, I'm always late putting her in, and so on and so on. She had told me a lot of times that she wants to die and the sooner the better.
She spends her days sitting in her w/c or laying in her bed glaring at the walls or glaring at everyone walking in the halls. She doesn't go to activities or the dining room for meals and she doesn't go out to socialize in the dayrooms. She doesn't even read or watch tv. Her sons visit everyday and she just glares at them. When I gave her a shower one day, I tried to tell her about the activities we have, but she snapped, "You can't make me go to activities!"
So I dropped the subject. I guess I can't reach out to everyone. I'm not God, but I wanted to help her get out of her bitterness. Nursing homes aren't the best places to be in, but the activities can stop the loneliness and keep you occupied. Any better advice to handle her? Sometimes she makes me so mad and I shouldn't take it personally. I have her for a shower tomorrow and she tries to keep me an hour saying she's not clean enough. For god's sake, how long does it take to wash her ass up? I mostly give her 10 min. tops but when I was new she kept me for about 40 min. I guess I can't win sometimes.

Kitkat23 · Oct 4, 2005

Hey Nikki. You do sound like a great aide. Too bad you don't work with me. Congrats on being employee of the month. You deserve it. Some aides I work with are so lazy and uncaring that I don't know why they're still working. Anyway, I'm sorry about your difficult resident. She's so young. I had a patient who was 54, except he was a rehab patient with two broken legs. He died in August when he had sudden kidney failure. anyway good luck in your job and don't worry about the mean one. You can't reach everybody, you're not god. :wink2:

CoffeeRTC, BSN, RN · Oct 4, 2005

This is what I tell my staff to put things in perspective when we get frustrated with some res...

No one (normally) signs up to be in a nursing home when they are young. But for some reason they end up here. Its not like they decide to give up their house, freedom, privacy, favorite food, friends and most of thier worldly possessions to go to a nursing home and be told what they will eat, when they will get up, go to the bathroom, take a shower, sleep, when they will take their meds, who will be helping them. They give up thier comfy bed, couch, house and yards, maybe thier lovely garden, their car all in exchange for a lovely little room with an institutional bed, dresser, closet and lovely wheel chair. Lets not forget that we all have to place a beautiful bracelet on them, that they are forbidden to take off. Sprinkle in the occasional demented roommate or a guy wandering around stealing your stuff or peeing in the lobby.

Now add in their obesity, heart problems, etc.....Even though she's been their over a year, I'm sure she still isn't accepting all of this. She's only 57? and her two older parents are taking care of her.

Sounds like you are definatley doing the best you can, but look at what she is dealing with 24/7. Until she accepts her placement/ serious medical condition, she will not be able to move one to maybe doing something about it.

Jolie, BSN · Oct 4, 2005

God bless you for trying to reach out to this woman!

I have a similar situation with an unpleasant family member who resides in a nursing home. I'll tell you what I tell her caregivers: You are obligated to give my family member safe, respectful care. You are not obligated to be abused by her, either verbally or physically. When she "starts up", do what you would do with a toddler having a tantrum. Let her know that you'll be back when she is ready to behave appropriately. Then leave the room. Don't argue back, don't raise your voice, don't take any abuse from her. Check back in a few minutes, and repeat as necessary.

If she goes to bed in her clothes, so be it. If she misses her favorite TV show, so be it. If she misses a meal, so be it. Making her responsible for her behavior is the only way you can deal with her.

Thank you for your patience and caring!

LPN_mn · Oct 4, 2005

kitkat23

I had a patient in LTC that was much like your patient. I was a nursing assistant and had this little lady who no one wanted to give her shower, get her ready for bed or as little as possible for this lady. I was a brand new na/r and was ready to jump into my job and make everyone in LTC better. :lol2: Any way I started out with this lady and like you it would take me 40 minutes to get her bath in the beginning. You stated that now she gets about 10 minutes for her bath. I know how busy you get but don't you think 10 minutes is a little rushed. It takes that long to get their clothes on and off. Any way I am rattling. It took a lot of doing but I finally made friends with this older lady and learned a great deal about myself in the process. I have only one suggestion I hope it works for you because it did work for me. I began by setting aside at least one bath during the week (she got one every other day) in which we did not rush through the bath. I found out that she liked a certain scent of bath soap and used that on the special bath day. She also got a good rub down after getting out of the bath(legs, feet, back, and arms). Then her favorite pj's and robe. It wasn't long until these special bath days were the days or evenings when we began sharing things about our lives. I learned alot about the difficult old woman that no one else took the time to know. She died on day and I was their with her rubbing her favorite lotion arms and legs. I found myself even spending time with her when it was my day off. I know you are thinking that you do not have time for this. I guarantee you that you do somehow the time just seems to be there once you get started. If you want to know more feel free to pm me.

mediatix8 · Oct 4, 2005

Her initials aren't DL are they?

Antikigirl, ASN, RN · Oct 4, 2005

We do not force pills on people right..they have the right to decline....well, same with being friendly or not!

What I say to my CNA's is to be as professional as they can, report behaviors in their charts and to the RN on duty, stay safe by having another person in the room when able (hard to do some times..but there are some of those patients where you find the way!!! LOL!), and document document document!

I read that you want to be her "friend"...that is not your job! You are a professional treating a patient...a very common and easy thing to overlook! I find myself in that delema all the time...but I have to step back and say..what can I do professionally for them in a nice and respectable mannor that does not cross the line of professional relationship! NOT EASY..but can be done.

I have a male patient that is exactly like this...rude as the day is long, as if he loves the negative attention (which looking at his Hx is not to far from reality). I accept this as a part of his overall personality, and felt a TOTAL professional relationship was more benificial! So now, I come in and address him by Mr. first/last name, and he must call me by my title "nurse" and my LAST NAME (not my first at all!). Now he understands the relationship between me helping him professionally by putting up boarders in a way...and now appreciates it more when I do social chit chat while I am working! Took a while but well worth it!

Sometimes we all have to take a step back..realize that caring isn't controlling or changing someone even if WE feel it is in their best interest...but acceptance of the person, realistic expectations, probelm solving on a reality basis not an implied one rt ones feeling of what is right, and a whole lot of documentation!!!

We deal with humans folks, they come in all shapes, sizes, colors, histories, coping mechs, feelings, humor and ailments...our job, to work with ALL of it realistically and do the best PROFESSIONAL job we can! (and document document document~!!!).

LPN_mn · Oct 4, 2005

I think that you are reading to much into what is being discussed here. While I understand about professionalism I also understand that some of the people in the nursing homes have had to give up everything. You would be bitter, crabby, and mean if you had to sell everything that you own, give up any freedom that you may have had, be told when, where, and how everything is going to be done for/to you from now own. None of us are stepping out of our professional boundries by giving a little extra and trying to help someone adjust or letting them know that someone is willing to go the extra mile for them. I do believe that you learn something from everyone that you meet. If I had not taken the time to spend with the old lady in my situation I would not have known anything about the history of the town that I had moved to or about some of the local folks and how their families started the town. No one is trying to control or change anyone the ladies are simply trying to find the best way to approach and get to understand their patient. They only asked for a little advice not a lecture on professionalism (which I don't think they need)

Nikki69 · Oct 4, 2005

We do not force pills on people right..they have the right to decline....well, same with being friendly or not!
What I say to my CNA's is to be as professional as they can, report behaviors in their charts and to the RN on duty, stay safe by having another person in the room when able (hard to do some times..but there are some of those patients where you find the way!!! LOL!), and document document document!
I read that you want to be her "friend"...that is not your job! You are a professional treating a patient...a very common and easy thing to overlook! I find myself in that delema all the time...but I have to step back and say..what can I do professionally for them in a nice and respectable mannor that does not cross the line of professional relationship! NOT EASY..but can be done.
I have a male patient that is exactly like this...rude as the day is long, as if he loves the negative attention (which looking at his Hx is not to far from reality). I accept this as a part of his overall personality, and felt a TOTAL professional relationship was more benificial! So now, I come in and address him by Mr. first/last name, and he must call me by my title "nurse" and my LAST NAME (not my first at all!). Now he understands the relationship between me helping him professionally by putting up boarders in a way...and now appreciates it more when I do social chit chat while I am working! Took a while but well worth it!
Sometimes we all have to take a step back..realize that caring isn't controlling or changing someone even if WE feel it is in their best interest...but acceptance of the person, realistic expectations, probelm solving on a reality basis not an implied one rt ones feeling of what is right, and a whole lot of documentation!!!
We deal with humans folks, they come in all shapes, sizes, colors, histories, coping mechs, feelings, humor and ailments...our job, to work with ALL of it realistically and do the best PROFESSIONAL job we can! (and document document document~!!!).

You are definately right about being professional, and I agree that there are all types of people, but being an aide, spending 3/4 of 8 hours a day in that room with someone who is abusing your care one minute, and screaming for you to come to her rescue the next minute, you just can't help but feeling a little more than "professional". Yes, I am a very professional person, but it takes more than going by the book to get through to people-that is, if you really put your heart in what you do. After you lose touch with "what it's really like" to hear a patient crying for long periods of time, or screaming out, or pouring their hearts out to you, all you do is get report that that's what is happening. You don't have to deal with it but us aides do. I know that passing pills and doing paperwork is stressful, but do you think our job is a walk in the park? It's easy to instruct your aides to act in a way, but if they are good, they'll be just a little more than "professional". Thank you for your thoughts.