The very anxious resident: A team approach

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Eleanor Feldman Barbera, Ph.D.
Eleanor Feldman Barbera, Ph.D.

“My mother was kicked out of her nursing home again,” my cousin told me. “They said they couldn't handle her.” I phoned Cousin Belle's new number in the afternoon. 

“They didn't give me my pain medication,” she said angrily. “They took away my walker and I need to use the bathroom. CAN SOMEBODY GET ME MY WALKER – I NEED TO USE THE BATHROOM!” She began sobbing. I heard another voice. “Did you hear what the man next to me just said?...You're not a man?.. .I'm sorry, I can't see…” Belle lost her vision several years ago, just like her father before her. “I helped people all my life,” she told her companion. Belle is a retired nurse. 

She shouted again and I heard a staff member say, “Have some respect for the other residents.” Belle responded immediately, “Have some respect for me!”

“Let's say the ‘Serenity Prayer,'” I suggested. “OK, let's,” Belle agreed immediately. When we finished, she asked to say it again. She sounded calmer. “The woman next to me said it with me,” she remarked.

That story is about Cousin Belle, but it's also the story of Gerry, Anna and a host of other residents I've seen over the years. Below are some suggestions for handling these challenging residents, coming from my perspective as a psychologist. I know there are many educated, experienced and compassionate people from other disciplines who will read this. If you have any additional tips, please add them in the comments section.

  • Start afresh: If the current staff members are burned out and no longer responding well to the resident, it can be helpful to move the resident to a new unit or facility with a clean slate and fresh expectations. Notify the new team in advance so that they can prepare for the anxious resident and avoid repeating the same situation.
  • Keep in close contact with the psychiatrist: The very anxious resident is likely to need medication for anxiety or depression, or at least to know that something is available if necessary. The early, frequent and regular attendance of the psychiatrist can reassure the resident and the team that an expert presence is guiding care.
  • Give meds quickly: If residents are in pain or on a medication upon which they've become dependent, give the medication as soon as possible. Waiting will only increase their agitation and disturb other residents.
  • Mollycoddle: A loud and anxious resident is likely to become louder and more anxious the longer they have to wait for their demands to be met. Just like with the medication, attend to their needs as soon as possible. Anxious people tend to be anxious because they feel out of control. Meeting their needs helps them feel more in control.
  • Assign your most patient and compassionate aides: Satisfying a very anxious resident's demands can be a never-ending task. Try to assign the type of person who will approach each call for assistance with a pleasant demeanor and not those who will let their displeasure be known with an unkind word or expression.
  • Reduce the aides' roster by at least one person: Acknowledge that one very demanding resident is like having two or three calm residents by reducing the number of residents on the aides' assignments.
  • Recognize the efforts of the nurses, aides and other team members: Demanding residents are often quicker to express their distress than their gratitude for good service. Make up for this lack of appreciation by recognizing staff efforts in various creative ways (verbal acknowledgement, a pizza party, etc.).
  • Refer anxious residents to the psychologist: It can be remarkably reassuring to the resident to know that the psychologist is coming by on a regular basis and that this professional is “on their side.” The psychologist can offer residents strategies to work with staff and vice versa.
  • Emphasize strengths: It's important to highlight a resident's good qualities so that staff members and other residents see them more fully and not just as an annoying person. For instance, talk to them about their interests and hobbies or interview them for the community newsletter and post their stories.
  • Keep them busy: Engage anxious residents in the types of activities they can tolerate for as long as they can tolerate them. Expect that they might need to leave early and seat them near the exit. Offer solitary pursuits such as knitting, reading, books on tape, etc.
  • Encourage connections with other residents: Friendships can make a world of difference. Try to foster relationships upon arrival, before negative patterns are established.
  • Recruit volunteers and other occasional visitors: While regular staff members are running the marathon of daily care, someone coming in for a sprint can bring new levels of patience and energy. Enlist as many helpers as possible.

Eleanor Feldman Barbera, PhD, author of The Savvy Resident's Guide, is an accomplished speaker and consultant with over 17 years of experience as a psychologist in long-term care. This blog complements her award-winning website, MyBetterNursingHome.com, which has more on how to create long-term care where EVERYBODY thrives.

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