Manage resistance to care
Caregivers commonly run into resistance from the person receiving care. This article offers several strategies for managing and lowering resistance, including being respectful, understanding the reasons for the resistance, and matching the solution with the problem.
Resistance to care
Caregivers commonly run into resistance from the person receiving care. Some seniors resist specific aspects of their care, such as eating certain foods or maintaining their personal hygiene. Others are resistant to the entire idea of care and insist that they don’t need anyone’s help. Many people will accept care from family members but strongly resist the idea of “outsiders” such as nurses or care aides coming into their home to help care for them.
Caregivers can manage and lower resistance by being respectful, understanding the reasons for the resistance, and matching the solution with the problem.
The guiding principle for managing resistance is to put respectful treatment of the person receiving care ahead of “winning” the battle of wills. Using this principle can help the caregiver find approaches that lower the person’s resistance.
One way to make a habit of respectful treatment is to follow the rule of “Ask, don’t tell.” In other words, consult with a person instead of expecting them to obey commands. Studies show that most seniors receiving care are shut out of decisions about their own lives1; it is small wonder that many of them feel resistant and resentful. As a caregiver, involve the person in care decisions, including routines and scheduling. Ask them what their preferences are and let them make as many choices as possible, even if they choose differently than you would have.
Understand the reasons for the resistance
A person’s reason for resisting care can be emotional, physical, or neurological. Instead of continuing to pressure them, it is a good idea to take a step back and try to figure out why they are putting up resistance.
Emotional causes of resistance
Fear is a major cause of resistance, and a person receiving care may be trying to cope with many fears. A common fear is loss of independence and control. A person may refuse to take someone’s direction because they see this as the only way to assert their independence. Those with limited finances may be deeply afraid of what will happen when the money runs out. Those who are ill may understandably be afraid of the prospect of pain, suffering, possibly memory loss, and death.
Other emotions that can make people resistant to care include embarrassment and guilt. Some feel embarrassed about their undignified state and loss of privacy. Others feel guilty at becoming a “burden” to their loved ones.
Physical causes of resistance
Physical pain and exhaustion can trigger resistance. It is hard for anyone to be at their most accepting when they are trying to deal with pain or severe sleep deprivation.
In addition, some actions, such as getting to the toilet or sitting up to eat, can be so painful that a person’s body reflexively resists doing them even if their mind is willing. Or, a medication may make someone nauseous or constipated, leading them to resist taking it even if the benefits outweigh these side effects.
Finally, if a person has diminished eyesight or sense of smell, they may not perceive that there is a reason to bathe or change their clothes as often as the caregiver wishes.
Neurological causes of resistance
Dementia can cause behavior that a person has no control over, including resistance and hostility. Acts of resistance by those with reduced ability to think or speak rationally might be random, but they also might be attempts to communicate pain, discomfort, or some other problem.
Another brain-based cause of resistance and agitation, especially in older people who don’t have dementia or any other likely cause for their behavior, is a urinary tract infection (UTI). In older adults, UTIs can cause brain inflammation and make them act in uncharacteristic ways.2
Match the solution with the problem
Once you have figured out why someone is resisting, you can develop a strategy that addresses the problem. It is a good idea for each caregiver to enter into the Maia Care Notes any conversations and strategies during their shift that seem to have put the person more at ease with aspects of their care that they may have previously resisted.
If the main problem is fear of loss of independence and control, emphasize the independence the person still has. Offer options instead of making demands. For example, instead of saying “Time to take your stomach pills!”, you can ask, “Do you want to take your anti-nauseant pill with your painkiller, or wait for a bit to see how your stomach feels?” This helps them realize that they still have choices in their lives.
Fear of change and the unknown can lead a person to stubbornly resist large moves, such as bringing in an outside care worker, starting to go to adult day care, or moving into a nursing home. You can ease this fear by taking things slowly. Float an idea, ask the person to think about it, and come back to it a couple of days later. Suggest a trial period for any major change, so they don’t have to fear being trapped permanently in a situation they dislike. Reduce the unknowns of a new situation by introducing them to the new care worker, or taking them to visit the adult day care or care facility, before asking them for a verdict.
If a person is resisting hygiene, exercise, or socialization because they are feeling depressed, you can initiate a talk with the person about seeing a doctor. If they resist care because they feel embarrassed or guilty, emphasize that you will take steps to preserve their dignity and privacy, and remind them that being able to “give back” to them by giving them care is a gift, not a burden.
If a person’s resistance crosses the line into verbal or physical abuse, remove yourself. Call someone else in to give care while you review options for protecting this boundary. You may need to hire a nurse or hand over primary care to another family member. If dementia is involved, ask a medical professional and members of your caregiver support group for advice.
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External supporting content
1A Synthesis of Knowledge About Caregiver Decision Making Finds Gaps in Support For Those Who Care For Aging Loved Ones. Health Affairs.
2UTIs Cause Unusual Behavioral Symptoms in Elders. AgingCare.com.