Main image courtesy of Tarantino Properties.

Working as a professional in a senior care community, chances are you encounter a variety of different residents on a day to day basis. Some of your residents might just need a little assistance, while others with mobility or cognitive issues might require a little more of your time and care. Because there are seniors who require different levels of care, you may find that some residents are more receptive to your help than others. While there are a variety of different reasons for this type of behavior, residents who resist care are a very real part of daily life in a senior living facility. No matter if you’re a nurse, CNA, or other administrator, you’ll likely find yourself in this type of situation from time to time. 

But what should you do if a resident resists care, and are there strategies to help you mitigate this behavior and get a positive outcome? We’re glad you asked, because in this guide, we’re going to cover:

• Why a resident might resist care
• Types of care that a resident typically resists
• Strategies to approach a resident resistant to care
• How to reduce the possibility of a resistance to care in your senior living facility

Consider taking a look at the online courses at Mariposa Training that deal with residents who resist care, why they might resist care, and how to support those residents with challenging behaviors.

Why Might a Resident Resist Care?

These are the common reasons residents might be resistant to care

You may find that some senior residents are less receptive to care than others for a variety of reasons. Image courtesy of Volunteers of America.

If you’ve been working in a senior care facility for some time, chances are you’ve come across a resident that seems resistant—or even combative—when it comes to their daily care. Many times this can be the result of their cognitive decline, or if they’re already dealing with a form of dementia. The senior may not understand what is being done to them, or why it is being done, making them cranky and resistant to anyone helping them meet their needs.  However, there are other reasons why seniors who are not dealing with a dementia condition may still be resistant to care.

• They are afraid. Aging and dealing with the reality of becoming less independent are very frightening to seniors. They may start to be resistant to care because they are afraid one day they will no longer be able to properly care for themselves. They don’t want to be seen as a burden by their family (or nursing home staff), and may insist on refusing care even when they need assistance. Some seniors may also be afraid that going through the motions of daily care will cause them to fall, and potentially injure themselves. Fear of what lies next in their life, and even death, can also be a reason that seniors become combative to care. 

• Loss of control. No one likes to think of themselves as not in control, whether it’s of our circumstances or of our own bodies. As we age, it becomes harder to complete the most basic tasks without assistance. Some seniors may feel that once they give up control and allow someone to care for them they are going to do nothing but continue to decline. It’s hard to give up the independence that comes with not only grooming and eating for yourself, but to be able to go wherever whenever you want to. Seniors could become resistant to care because they want to continue to think that they can properly care for themselves, even though they clearly need assistance. One way for a senior in a care facility to maintain some sort of control is to decide how, when, and by whom they are cared for.

• Trust issues or poor coping skills. Sometimes there has been an event in the past that makes the senior resistant to care. Perhaps they were treated poorly by a caregiver at one time, or someone they know has not had a good experience either in the hospital or in a senior care facility. This could lead to trust issues and make it difficult for them to be comfortable with receiving care. Adjusting to new routines also becomes more difficult as we age, and seniors who are resistant to new levels of care may just have a hard time coping with their new reality. 

• Personality. Oftentimes this may be overlooked, since senior care facility staff members typically did not know the resident in their younger years. If someone is stubborn and controlling for most of their adult life, chances are they will be difficult as a senior. As we age, personality traits don't just disappear. Sometimes it's just their personality to be stubborn or resistant to care.

• Physical issues. Although fear and loss of control are typically the most common reasons senior residents become resistant to care, there could be an underlying physical condition that is the cause as well. If a senior is dealing with an untreated condition, having a response to their medication, has depression/anxiety, or is in pain, it may cause them to be combative towards care. It’s important to also consider the physical when determining the cause for the resistance to care. Once the underlying issue has been addressed, the senior may be much more receptive and open to care.

Types of resistance behavior

Resistance to care can manifest in a variety of ways, although the most obvious one to caregiving staff is the tendency to pull away or to become agitated when staff is trying to administer care and assistance. Other types of resistance behavior can include:

• Arguing
• Making poor choices
• Isolation
• Not asking for help
• Not taking medications
• Not eating
• Not bathing
• Not participating in activities
• Hoarding 

Although these are not the only kind of resistant behaviors, these are what care staff in senior facilities typically deal with. Much of the resistance to care occurs around personal hygiene, taking medications, or eating, which we’ll discuss in more detail in the next section, as well as offer suggestions on how to approach a resident resistant to care. 

Types of Care that Residents Resist

Resistant behavior focuses around three areas

There are ways you can continue to offer assistance to seniors who have resisted care. Image courtesy of WeCare.

Although you may assist seniors with a variety of daily tasks, there are three main areas that resistance to care focuses around. These are resistance to bathing, eating, and grooming. In order to try and get the least amount of resistance out of these activities, it is important that you make it a point to be as helpful and non-confrontational as possible. This is especially true for residents who are in cognitive decline, and do not fully understand why these activities are necessary.

Whenever you set out to help a senior resident with any of these behaviors, make sure you approach them in a non-threatening way, and ensure that you speak to them at their level. This means if they’re in a wheelchair or a bed, you adjust your stance or posture so that you can speak to them levelly. Doing this in a friendly and welcoming manner with a pleasant tone of voice can go a long way. When you’re not standing over them, it may make them feel a little more comfortable, making them less likely to resist your assistance. 

You can slow down and explain exactly what it is that you’re doing, helping the resident understand why their care is important. You can even set up any tools that make the activity (such as bathing, grooming, eating) easier nearby to the resident so they can participate in their own care as much as possible. 

Eating

Sometimes residents resist eating, which is detrimental to their health. The meals that residents receive are designed to give them optimal nutrition, so it is important that if they need help eating, you’re able to help them ingest an appropriate amount of food. If a resident starts to refuse or resists eating, consider adding in these strategies to encourage them to eat.

• Use non-stick plates and utensils to prevent slippage
• Make sure to use chopped or soft food
• Keep the resident upright, whether in a chair or wheelchair
• Do not argue with residents, and use words that encourage them to eat
• Consider reducing distractions such as TV
• Supplement their meals with snacks if they’re not getting adequate amounts of food

Bathing 

Using the shower or bath is an important part of daily hygiene. While seniors previously did this task themselves, now they may require a little more help. Providing a safe, comfortable bathing experience goes a long way to keeping seniors happy and healthy. It may take some time getting used to having assistance with this personal routine, so if you find that some residents are resisting at bath time, there are some strategies you can employ to help.

• Make sure you listen and adjust the bath/shower temperature if it is too hot or too cold
• Allow the senior resident to bathe themselves as much as possible, and put the items they need to do so safely within reach
• Try to maintain privacy as much as possible
• If a bath/shower is not possible due to mobility issues and they are bed-bound, use a bedside method to help keep them clean
• Bathe the resident at the same time each day/night 

Grooming

Grooming, much like bathing, can sometimes be met with resistance from senior residents. Just like bathing, these were daily tasks that residents once did on their own, and they may be hesitant or resistant to accepting help with them. If you find this to be the case, there are a few ways you can encourage your senior residents to be more accepting of grooming assistance.

• Use products that the resident likes, picks out themselves, or has used in the past
• Encourage them to comb their hair, shave, apply lotion, or brush their teeth and allow them to do as much as they can
• Offer praise when they complete their tasks and compliment them on how they look

Following these tips each time you find a resident that is resisting care may help make these necessary processes go by more smoothly. 

Strategies to Approach a Resident Resistant to Care

Can you reduce the possibility of resistance to care?

Try out some of these strategies if you find yourself with a resident resisting care. Image courtesy of Regency Pacific.

Now that you know the best ways to approach resistant residents with three main daily activities, did you know there are other things you can do to help mitigate and even prevent resistance to care? That’s right, by taking the time to fully explain many of the activities that you are assisting with, you may just find less resistance the next time. In addition, here are a few strategies to approach residents that are resistant to care.

Listen to the resident

Sometimes all the resident wants is to be listened to. If they’re saying the bath water is too cold, then listen to them and make an adjustment. Just because it isn’t too cold for you, doesn’t mean this isn’t a legitimate concern for them. When you take the time to listen and value what they’re saying, you’ll also gain insight into what is really motivating their resistance (fear, loss of control, etc.).

Try to see their perspective

While you may not understand the exact reason the resistant senior resident is acting this way, try to take the time to see things from their perspective. They may be having a difficult time coping with their loss of independence, and want to hold on to what they have left, and if that means refusing assistance, that’s what’s important to them. You can try and make these easier for them by explaining why you’re helping and its importance. 

Stay focused

Staying focused on one resident and one task at a time will allow you to give the best care you can. Show the senior that they’re valuable and that what you’re assisting them with is important not only to them, but to you as the caregiver as well.

Don’t use threats

Never use threats with a senior resisting care. There is a reason for this type of behavior, and it’s more useful and productive to figure out exactly why they’re resisting than threatening them into accepting care. Threats will only make them more fearful and less trusting of future care and assistance.

Ask for help

If you are having a particularly difficult time providing care to a resistant resident, you can always walk away and ask for help from a supervisor or fellow staff member. Perhaps the senior will be more receptive to their care, and they can diffuse the situation.

There are many ways you can continue to provide care to resistant residents. The first step is understanding the reason behind the behavior, then you can work out ways to help prevent it or mitigate it in the future.

Get more training for staff so that they are prepared to help those residents who resist care at Mariposa Training, with courses on creative approaches to care.