noncompliant resident in assisted living care

MoopleRN · Dec 26, 2014

How is it "noncompliant" to be on their call light for the stupid/annoying/waste-your-time requests? That's not "noncompliant"; it's simply annoying and wastes your time. How can you you stop it? You can't. Not every time.

What you can do is know them/anticipate their needs. For example, they call you in there to give them some fresh ice water and you notice (based on previous requests) that the kleenex box is on the table under the window instead of the table next to their recliner/chair. Move it to where there are currently sitting and verbally state you're doing that "Bob, I'm going to leave your kleenex here right next to you so you can reach it when you need it". Bob might hit his light as soon as you leave to ask you what time it is but chances are, he ain't gonna ask for the kleenex. If he DOES ask you what time it is, bring him a huge digital clock that sits right where he can see it. It he's already got one, point it out to him when you're answering his light and ask him to read the time to you. If he doesn't have one, call his family and ask them to bring one.

The best way, IMO, to cut down on the time-wasting requests is to anticipate their needs based on their history and provide for those requests when you're in there. Granted, there will always be those who call you in to bring them a blanket and then 2 minutes later call you back in to close the drapes. Telling them before you exit that you anticipate being busy with something else and wanting to make sure they have everything they need before you leave may also be effective.

If all fails, keep in mind that they are the boss and you're there to help them even for the stupid stuff. They're bored, they're lonely… and they have a button/pendant they can push. You have a life beyond that button/pendant and when your shift is over, you can get back to it. They can't.

Gooselady, BSN, RN · Dec 26, 2014

Yep, anticipate their needs.

Frontload them before they begin their endless requests that it may take some time for you to come in and look for their reading glasses, but you'll be right there for important medical needs like SOB, pain meds.

When I worked psych, this was a constant issue. We'd put people on hourly 'check ins', where they'd get fluffed and listened to once an hour for five minutes (and no more).

In your situation, with 66 residents and one aide, you just AIN'T GONNA. Apparently the people running facility do not expect you to either, otherwise they might hire another staff. You can't be in six places at the same time. It's not on YOU, it's impossible. Complaints can be forwarded to the management :)

It's likely only a handful of the 66 people are on their callbells constantly, I'm sure there are many who snooze through the night. So focus on those who (think they) need more attention, EDUCATE them how their needs will be met, and then live up to your word.

nurseprnRN, BSN, RN · Dec 26, 2014

And lose the idea of "compliance." Patients have every right to choose adhere to or not to adhere to a medical or nursing or therapy plan of care. Compliance has the connotation of being bent to someone else's will, and we do not have the right to do that in a care role. if the patient chooses not to adhere to a plan of care, it behooves the nurse to figure out why and see what needs to happen-- but forcing compliance (in an adult) is not an option without a court order.

rehctelf · Dec 26, 2014

Hello MoopleRN, thank you for your suggestions. All are greatly appreciated. To clarify the non-compliant resident care: example is the resident that wants bi-pap on at 8pm sharp and refuses the bi-pap at 9pm because it was not put on at the time R wanted it to be. Or the R that refuses wound care because it was not done when they wanted it to be done. That is just an example of course. As for the "stupid stuff", I have tried all of thoes suggestions. Nothing is effective. Resident will push call light when Aide or Nurse is in the doorway walking out of the room. I do appreciate your comments. Have a great day.

rehctelf · Dec 26, 2014

Oh yes indeed you are correct, there is only a handful of residents that are using their callbells constantly. Thank you for your suggestions, they are greatly appreciated. Have a good day.

rehctelf · Dec 26, 2014

Thank you for your comments. I would never "force" anyone to do anything they didnt not want to be done. Providing excellent patient care is top priority for me. I simple was looking for suggestions to make it better for the resident and more efficient for the staff.

Long Term Care Columnist / Guide · Dec 27, 2014

Sometimes you have to gently set limits with these folks, at least if they're A & O. When you go into their room, set a time limit for how long you can stay and ask them what you can do for them while you're in there, then tell them that you'll be back to check on them in x amount of time. (Of course, a clock they can see is a necessity.) Then be there! It doesn't work overnight, but when their needs are met consistently, most call-light abusers eventually learn to trust staff at least somewhat.

A good question to ask is, why are these folks up all night? Do they sleep all day? Are they sundowning? Do they have more pain at night? Do they lie in bed awake and ruminate? Are they taking a medication (e.g. Lasix after 2 PM) that keeps them up late? Getting to the bottom of why they're leaning on the call bell all night long would be a good thing. Sometimes it's just the way things are and you can't change the person or the reason why they're doing it, but it's worth doing a little digging to find out the cause.

jadelpn, LPN, EMT-B · Dec 27, 2014

This is assisted living, is it not? This is an odd situation to begin with in assisted living. Perhaps there are more than a few residents who do not belong in assisted living, but require a higher level of care? If this is the case, you could bring that to the attention of the case manager.

There's also a few assisted living facilities that advertise a 24/7 "we do it all for you" mentality, that residents take to the hilt and literally. "I am paying GOOD money for you to do as I want you to" stuff.

Finally, there is a sense of loss of control. Residents are used to doing what they want, when they want, and can get quite stubborn about it if it all doesn't go as they plan. Again, I reference a usual draw to keep assisted living filled--either with residents who require more, or residents who expect more.

Is it at all feasible for other discipline to come in (such as a home health agency RT) and teach a resident how to put on their own bi-pap? Or to do wound care during day?

If the residents are on the call lights over and over in my opinion they either A) Need a great deal of care that is usually beyond the usual assisted living or B) They have been told that the call bell is their BFF to get what they want, when they want it, much like acute care or skilled/long term care.

Alisonisayoshi, LVN · Dec 27, 2014

Thank you for your comments. I would never "force" anyone to do anything they didnt not want to be done. Providing excellent patient care is top priority for me. I simple was looking for suggestions to make it better for the resident and more efficient for the staff.

Just as an aside to the idea of non compliance. Excellent care (imho) doesn't include the term non compliance. As someone who wore the scarlet letter that is non compliant, when the issue had very little to do with willingness to comply, the term is harmful. It is harmful for adults to be told they aren't complying with directives, without acknowledging that adults should be given education/empowerment, not directives, that, if deviated from, brand them as 'bad' non compliant pts. I know it may seem rather trivial, but to the pt, it puts up another blockade to them actually appropriately understanding their care and participating actively in it.

I'm not a nurse yet, I'm finishing school very soon. I do work actively with a charity that deals directly with a pt population that is often deemed non compliant, when that is actually far from the reality. I'm sure my work with them over the years, as well as my own experiences, have shaped my perception of the term. Perhaps my perspective will change when I'm in practice.

morte, LPN, LVN · Dec 27, 2014

i am thinking several persons, excepting jade, have missed the point that this is ASSISTED living, not long term care or SNF. these requests sound like the person has skilled out of assisted living, OR wants company.

psychnursie · Dec 27, 2014

the ones that only want to do things on "their" time are doing it because that is the only control that they have at this point in their lives, and it is likely to stay that way. it must be very frustrating to have once been a productive member of society and now can no longer do what you want when you want to do it. give them some control if you can, ask them what time they would like things done and how. that may help.