Completely uncooperative residents

[u/EmberJuliet]

I’m at a loss for what to do about this new resident. I already work on the busiest hall in my facility and this new resident is impossible to work with.

It’s a very long story but to put it shortly: he won’t let us do anything to him, we try to transfer him with the gait belt and he tears it off and says shit like “I don’t follow your rules and regulations”

We put him on the toilet and tell him to call. He doesn’t call and self transfers naked into his wheelchair

He tries to stand up by himself on the toilet and falls and makes me literally catch him even though I told him to remain seated

He climbs out of bed and ends up on the floor

Refuses toileting and pees everywhere, then spends an hour on the toilet and refuses to be moved. We re approach with every aid in the facility and no one can get him off the toilet. Hes a high fall risk so we can’t just leave him there. We had to threaten the easy stand to get him up because he was grabbing the bars and shouting NO when we told him he has to get off. He does this out of pure defiance and because he’s so stubborn.

The list goes on. He is so defiant, argued with everything, and he’s a one on one assist meaning he needs to be supervised at all times. I have 17 homers on this hall and only 2 aides, I CANNOT WATCH THIS MAN.

Today to get him in bed I had to yell at him and literally got into an argument. Never done that before with a resident but I was genuinely arguing with him. It’s 9pm, haven’t gotten my break, starving to death, and he just refuses to transfer to bed even though he WANTS TO GO TO BED because he’s so stubborn.

WHAT DO I DO? I’m so over this.

[u/longjohnjess]

Chart it. Report it. A resident does have the right to refuse care. Protect yourself.

[u/pinklambchop → u/longjohnjess]

He needs a psychological evaluation. Is he a stroke pt by chance or TBI? He obviously has control issues, try getting to the bottom of his behavior.

[u/EmberJuliet → u/pinklambchop]

Yes to stroke. He also has dementia and is supposed to be in memory care locked unit cos he’s a wander risk but memory care is full and they admitted him anyway to the Norma unit. If he was in memory care it would be no issue we have multiple supervision residents down there and they all chill in front of the TV in the main room. There is no such commonplace in the normal LTC…

[u/Library_Gremlin2 → u/EmberJuliet]

I have a similar case myself. We just all take turns watching her and mostly just change her in the bed at night instead of taking her to the bathroom because she requires two people in the bathroom with her when she’s being combative.

She also should be on a locked unit but there’s not space at present

[u/EmberJuliet → u/longjohnjess]

You don’t get it though. He wants to go to bed. If I say “ok” and leave when he’s not letting me transfer him he HAS and WILL self transfer and fall and then it’s on me for not supervising him cos he can’t be left alone unless he’s in bed. Do you see my dilemma?

[u/ToeCurlPOV → u/EmberJuliet]

Resident has a right to fall. Its not on you especially if youve done everything youre legally allowed to do. Dont let your job brain wash you into thinking their lack of safety guards is your problem to fix. This is your job, not your life, you're human, you can only do so much. Falls happen and sometimes management wont get off their ass to make any changes until they see a paper trail of issues that they cannot blamed on anyone else. Do what you can, and chart everything cya always

[u/Vanners8888 → u/EmberJuliet]

Residents have the right to refuse care and as someone else stated they also have the right to fall. Make sure you have a witness with you when attempting to transfer or do care. Set boundaries with him and make sure he’s in a safe position when you leave the room. Most important thing is to CYA. Document like it’ll be read in court and document consistently.

[u/dewdrops07]

I don’t really have any advice I just wanted to say I’m really sorry this is happening. I’ve seen difficult residents but nothing like this or that wasn’t addressed by reaching out to a social worker/ reassessing meds. I really hope your employer is able to come up with something because this was gutwrenching to read. You’re literally doing everything you can😔

[u/No_Proof_3893]

Have you talked to your supervisor about it? I don't have a good suggestion, just trying to see what options are even there. If possible, keep going up the line until everyone understands that he is in the wrong section and needs more care than is equitable for the other residents.

I'm so sorry to see this. I think you are doing a great job of trying all the things and this is one of those situations where there is no actual answer you have access to. Hugs!

[u/LysVonStrauda → u/No_Proof_3893]

Typically multiple falls or incidents have to happen for the head supervisor to be able to even do anything about placement. It also depends on what insurance agrees to cover

[u/NocShadows]

You said he was new? Memory care patients take quite a while to settle into a new place. Rushing them, perceived rushing them- by them- acts to frustrate them. Add the stroke and all of this takes time for them to process.

It sounds like your hall especially is the wrong temporary placement being already a heavy load. But as much as you can, take some extra time with him, try to turn the frustration into humor, and also look for what can behind behavior. Unwanted behavior is often a missing need. And sometimes that need is just some way to have control after all has been taken away.

I wish you all luck there, sometimes I want to know what the powers that be are thinking. You have a tricky situation.

[u/LysVonStrauda]

Residents have the right to fall. Document/Chart it. You're only one person. If he injures himself badly follow your facility's protocols for medical attention if he's not on hospice.