Home Health & Hospice

Dealing With "Difficult" Patients

Homecare Insider, October 8, 2012

Our lives are filled with relationships, places, events, and decisions that validate us and also help us feel useful. Your patient may have suffered multiple losses and may find it difficult to adjust, adapt, or develop new and supportive relationships. This can often lead to a patient being “difficult”.  It is important for clinicians, therapists, and home health aides to understand why the patient may be acting a certain way and critically think about how to address the situation without becoming frustrated.

Many patients have suffered multiple losses, which can be overwhelming and he or she may be reacting to these changes by lashing out at others, by withdrawing, or by refusing to eat or care for him- or herself.

Some of the losses may include:

Losing a spouse or significant other. This creates major changes in the way your patient lives each day. If mealtime was sharing time, he or she might lose his or her appetite or forget to eat. If the patient always woke up with someone else at his or her side, then waking up alone can be devastating. If the patient’s dog died or he or she is no longer able to care for a pet, he or she may have lost a confidant and also a reason for being active.

Changes in living space. This may be interpreted by some patients as loss of control. “I can’t even find my way around anymore! The closet was on the right of the bed and now it is on the left; the bathroom was down the hall and now it is off one corner of the bedroom; familiar furniture is missing from the living room.” In addition, chores that once helped to mark off time are no longer needed.

Losing employment. This can mean the loss of schedules and interaction with other workers. For many, work is associated with value and the patient who no longer has a role in the working world may not feel valued or that others are listening to him or her. It can also be a loss of income and purchasing power.

Loss of function to perform simple tasks. These tasks can include walking, getting in and out of bed, or driving a car. The patient might have deviations of sight and hearing that can be more stressful when the environment, workers, and schedules change. Not being able to move about freely means he or she may no longer be able to drive and must wait for someone else to take him or her to church or to a doctor’s appointment.

What are some strategies that might work in these situations? Remember that difficult patients may just need your attention or support. The patient may be afraid or feel insecure, may lack confidence in his or her own decisions or functional abilities, or be confused about surroundings and expectations. It is important to take action to understand and diffuse these behaviors and to help your patient choose more effective ways to demonstrate control.