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10 Strategies for Handling Care Refusals in the Moment

Sometimes, no matter how hard you try, your family member may refuse care…sometimes right in the middle of the activity.  I’m going to show you some ways to handle the care resistant behavior. It is important to pay attention to what was going on RIGHT before the behavior happened, because the timing may provide clues for WHY your family member started to resist or refuse the care.

1. Enter Their Reality (“Dementia Land”)

Entering their reality is a good way to prevent care refusals, but it can also be used to handle care refusals. You may have to approach the activity in a way that makes sense to their past memories and experiences. For example, one woman would agree to being showered but became hysterical when her daughter tried to wash her hair. The daughter tried washing her mother’s hair last, but then her mother started trying to get out of the shower halfway through. After the daughter and I spoke, we both realized that her mother used to have her hair washed and styled weekly. The daughter, in fact, began recalling humorous situations where her mother took great lengths to prevent her hair from getting wet in-between hair styling appointments. The daughter decided to give mom a shower but used a shower cap. Mom stopped fighting the showers. For more on this strategy, click here.

2. Distraction

Distraction is another useful technique. One can try singing familiar songs or asking the family member to talk about a favorite memory. We have found that singing is a very powerful distraction, but it works best if you know your family member’s musical preferences. Or, favorite songs. Click here to see a brief distraction snippet.

3. Bridging

Bridging involves using an object related to the care activity at hand. In this video clip, we used a toothbrush as a bridging object. Bridging is similar to priming. You are trying to use familiar objects to access the memories around the activity you are trying to do.

4. Hand-over-Hand

Sometimes, you can help reduce care-resistant behavior by using a hand-over-hand technique. There are a couple of ways to do this. The first is to place your hands over that of the person with dementia, and guide their hands with yours. Another way is to place their hands over yours, and continue with the care.

5. Mirror-Mirror

mirror mirrorMirror-mirror works best with mouth care, but it can also work well for dressing. Helping the person in front of a mirror is similar to using the environment to support memories of self-care. Sometimes, though, performing mouth care serves as a type of distraction…especially if the person with dementia does not recognize him or herself in the mirror. If the person with dementia becomes upset and thinks the mirror images are strangers watching him or her, do not use this technique.

6. Caregiver Vibes

Sometimes, persons with dementia may refuse care because they are feeling rushed or may have forgotten, halfway through the activity, that they were in the middle of tioleting, bathing, or getting dressed. When you start to encounter refusals, first check your own feelings. Are you starting to feel anxious or rushed? Upset? If so, take a deep breath and tell yourself, “I’m doing fine.” Because, you really are. For more on this strategy, click here.

7. Ask for Help

Next, try asking for help, using short, 1-step requests.  For example, saying “Can you help me with this shirt?” while gesturing that you want your father to put his arm in the sleeve.

8. Apologize with Praise

Also, if the person seems to be getting upset, apologize.  An apology with praise can also short-circuit care-resistant behavior: “I am sorry, I don’t feel like I’m doing this right. You are so patient with me.” Think about it. How many times in a day does someone apologize to you AND give you a compliment? Probably not much.

9. Rewards

If none of these seem to be helping, you may want to bring up some positive type of reward. “Once we are finished, we are going to have some ice cream.” Or, “after this, we can see the grandkids.”

10. Rescue

As an absolutely last resort, and if you have another family member nearby, you can use the “rescue” approach.  If the care refusals are escalating, and this is something that absolutely needs to happen (like changing soiled underwear), have the other family member step in and tell you to leave. Then, have the new person remove the soiled clothes. Rescue needs to be used carefully—you want person #2 to be someone liked by the person with dementia.

These techniques, and others, can be found on my video about care-refusals and mouth care. Click here.

Categories: Dementia Mouth Care Refusal Behavior

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Dr. Rita Jablonski

Rita Jablonski, PhD, CRNP, FAAN, FGSA is a nurse practitioner, researcher, tenured professor, and former family caregiver. Her research and practice involve all aspects of dementia management; she is best known for non-drug strategies to address dementia-related behaviors.

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