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How to Help a Client Who Does Not Want Care

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February 7, 2017

From the moment visiting nurse Juanita walked in to new patient Clark’s house, she could tell he needed more help than she could provide. Clark had entered her care after he had surgery to address a leg ulcer that wouldn’t heal. Juanita would be changing the dressing twice a week and monitoring his vital signs, but as an RN she would not be able to perform housekeeping or any other household tasks.

As Juanita looked around Clark’s bungalow, she noticed multiple plates with food remnants stacked on the coffee table and trash piling up on the floor. Clark’s clothes looked dirty and had an odor to them. Juanita suspected he was sleeping in his clothes because his wound and arthritis made it difficult for him to change into pajamas.

While performing her intake interview, Juanita gently suggested to Clark that he obtain some professional caregiving services. “I can see you’re having a little trouble keeping up with the housework,” Juanita said, “which is understandable, because this leg ulcer is painful and probably makes it hard for you to get around.”

“Oh, no,” Clark replied with an expansive hand gesture. “I’m doing fine. Those dishes aren’t as bad as they look. I’ll have all of this cleaned up this afternoon. I’ve always taken care of myself, and I don’t think I need help yet.”

Why People Reject Factual Evidence

As a senior care professional, you may recognize “Clark.” Many seniors refuse care even when they obviously need help. Why is this?

According to recent research, people resist information that undermines their identity. No matter how factual or voluminous the evidence, a senior may reject any facts that challenge his core beliefs about who he is as a person.

If this is the case, how can a senior care professional use the psychology of persuasion to help clients accept the care they need? Try this three-step strategy.

1. Identify the client’s core beliefs and values

Use an informational interview to assess the client’s feelings and attitudes toward key identity factors, such as her values regarding self-sufficiency, charity, gender roles and other relevant topics. The Aspects of Identity Questionnaire [PDF] offers an example you can adapt to fit your needs.

The client’s answers to these questions will help you understand her sense of identity related to accepting outside care. For example, if you discover she prizes self-sufficiency, then you will know you need to approach the caregiving subject carefully to avoid undermining her identity in this regard, since accepting outside help could be viewed as the opposite of being self-sufficient.

2. Take the time to develop trust

Effectively persuading someone to change their point of view requires a high degree of trust in the relationship. Unless the client’s situation is so dire it requires immediate intervention, take your time to develop a trusting bond. This allows you to continue gathering information about the senior’s sense of identity and may make the client more receptive to your gentle suggestions later.

3. Make suggestions that do not conflict with the senior’s sense of identity

If a senior client tells you she took great pride in being a housewife, and her tidy home always received compliments when friends visited, then do not present facts that indicate she is not doing a good job of housekeeping anymore. Avoid comments like, “You say you’re doing fine, but all of these dirty dishes in the sink obviously indicate the housework has become too much for you to handle,” as this directly undermines her sense of identity.

Instead, approach the problem from an angle less related to the senior’s closely held beliefs. You might say something like, “Didn’t you say one time that you loved housecleaning but hated cooking? Why don’t we have someone come in periodically to prepare some meals, so that you don’t have to waste your time on that?” A senior may be more receptive to this approach, since receiving assistance with cooking does not attack her self-concept as a skilled housekeeper.

Many seniors initially resist receiving outside care, even when they clearly could benefit from it. By understanding the psychology of this resistance, you can develop an approach that enables you to gently persuade clients to accept the help they need.

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