Caring for Those Who Resist Care.

This article on trying to care for those who resist care by Visiting Angels Founder and CEO Jeffrey Johnson brought back a flood of memories for me. I am a former EMT and when someone dialed 911 with a medical emergency they were usually very glad to see us and accepted our help and subsequent transport to the hospital with gratitude.

However there were a few incidences where the patient did not request our presence and wanted nothing to do with being transported.

By law we can not even take a BP or listen to lung sounds without the consent of the patient. When you see real paramedics in action they will always tell the patient what they are doing and that statement is always in the form of a question ending with “OK”.

When on scene, one of the first things I would do is take a set of vitals. I would kneel down next to the patient and say, “I am just going to take your blood pressure, OK?” If they did not refuse or pull away then that is “informed consent”.

If they did refuse or pull away and I still continued to wrap the cuff around their arm then I could be charged with battery.

If a person’s mental status was altered either through drugs, alcohol, head trauma or a blood sugar issue and we thought that any delay in treatment or transport could be life threatening then we could have have that person placed in custody (under arrest) and we could get on with our duties. However, as Jeffery points out, home care deals with the same resistance but on a different level.

Jeffrey Johnson, Founder/CEO

It is not unusual for those in the medical profession to come face-to-face with a patient who refuses treatment. At that point, most medical professionals (especially the nursing staff) work to obtain “informed consent” prior to any medical procedures being preformed.

Many nurses, who are in charge of obtaining this informed consent, use a combination of methods to reach their goal – being legally allowed to perform necessary medical treatments. Some of these methods are: the use of persuasion; information sharing; and avoidance (performing the procedure without the consent of the patient).

However, in home care, the life of the care recipient (patient) is not hanging in the balance, at least, not immediately. Yet, care givers must be able to perform their duties, to not only meet their job obligations, but to also protect and care for their charges in the proper manner. Below are several tips on how best to persuade a reluctant care recipient to accept the necessary care offered by the care giver and Visiting Angels:

1. Involve the loved one in the decisions. Approach the loved one with respect. If at all possible, the loved one should still be in charge of his or her care. Your role may be to facilitate decisions rather than to make them. Watch for openings in the conversation.

For example, “You mentioned feeling tired. Are you having trouble keeping up with your chores?” If the loved one doesn’t think he or she needs help, give examples of instances that have caused your concern.

2. Evaluate your loved ones specific care needs. Ask, “What kind of help do you need or want?” Say what you think. Suggest very specific needs, such as help with meals, household chores or personal care. Ask about needs for social support, transportation or medical care.

3. Ask the loved one about their concerns over accepting care. It may be easier to find solutions if you know the reasons for the loved one’s resistance. Acknowledge all concerns – they are very real for that person.

Some of the common reasons people resist care include: not wanting to give up independence; being afraid of strangers coming into their home; feeling that the care would be too expensive; and not wanting to burden others.

4. Present options. A loved one may feel more empowered – more likely to accept help – if he or she has options. For instance, a person who can no longer keep up a big house might choose to hire someone to help with the chores, only use a portion of the home (for example, just living downstairs), or move to a smaller space.

A loved one who needs comprehensive daily care might choose to have a caregiver come into the home, move in with a relative, or go to an assisted living home.

5. Talk about their needs too. Sometimes people will not accept care on their behalf but will accept if they believe it will lessen their family’s burden.

Say, “If I know you are cared for, it will ease my worry” or “I’m sure you could do it yourself, but it would make me feel good to do it for you.”

6. Some of the warning signs that indicate a person is no longer able to make decisions include: not eating, bathing, or providing basic self-care; not paying bills or answering mail; doing dangerous things like leaving stove burners on; and showing symptoms of memory loss or confusion.

7. All of these signs are subjective. Ask the loved one’s doctor to help you evaluate his or her ability to make decisions.

8. If the loved one still refuses care . . . If their health or safety is at risk, say gently but firmly, “We have to address this. We can’t put it off any longer.”

Bring in other people. Call a family meeting to strategize how to help the person accept care. Ask the person’s doctor, clergy or another outside person to step in. Sometimes, an outside person will have more influence.

Don’t give up. Sometimes, a person will refuse at first but over time may accept care. Keep offering and providing what care the person will accept. Take advantage of windows of opportunity.” For example, you may be able to start providing help during an illness or following a hospitalization.