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Sunday, September 19, 2010

Challenging Behaviors, Chapter 2 - Understanding the Resistance

For resistant elderly, the more subtle or indirect the assistance is, the more likely you will have success. Please understand that these elderly are, at their core, terrified. They often have always been fiercely independent and prided themselves as not needing anyone. In reality, we are all interdependent but don't try to reason with someone who has lost the ability to reason. You will lose every time. Elderly folk remember nursing homes and other assisted living facilities [even though the concept of assisted living hadn't been thought of yet] as terrible warehouses of miserable humans who are not cared for properly. While nursing homes and other similar facilities still have their problems, they are nothing like they were in the 50's.

Almost every new client I get insists on staying home and I have to accept this and try to make this happen for them while trying to gently educate them by taking them for "tours" and not putting a lot of pressure on them. Also, natural consequences can be a great motivator.

Many times, family and others trying to help a resistant person help too much. Just how much help is too much help? Well, that differs from person-to-person, which makes it difficult to have a one-size-fits-all answer. If the "helpers" quit helping in certain areas and suggesting an alternate, the resistant person will initially try very hard to coerce, guilt trip or whatever has worked in the past to get the "helper" to continue helping. Once the resistant person realizes that the "helper" will no longer step in, he/she will either a) agree to the alternate solution or b) find another "soft-touch" somewhere to help out. There is nothing you can do if the resistant person chooses "b." Again, you just have to sit back until "b" either shows it works out or the "soft-touch" gets tired and beats a hasty retreat. Playing a rendition of "Good Cop/Bad Cop" can sometimes be helpful. If you can have others [Adult Protective Services, the doctor, etc.] be the "Bad Cop" and set yourself up as the "Good Cop" all the better.

Does it look hopeless? It isn't necessarily hopeless but you have to make a plan and be patient. Talk with Adult Protective Services, especially if the resistant person is being financially exploited or abused. Have a consultation with a Geriatric Care Manager with behavioral experience, who can help you make a plan and give some creative suggestions on how to handle the issue. Contact your local Area Agency on Aging for local resources. The key is to pick your battles and get everyone involved with the resistant person to agree to the plan. One weak link will make positive change almost impossible.

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