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Resisting Care

Description of Behavior

Resisting care, sometimes called combative with care, is a common behavior that is different from agitation or aggression. A person who is resisting care may pull away, attempt to leave or become agitated or aggressive while expressing resistance to care. An example of a person resisting care may be saying “Stop that, leave me alone!” and pulling away from staff during a specific care activity such as eating.

Why behavior might occur

Resistance towards care usually occurs during hands-on care activities such as mealtimes, bathing, toileting, or administering medications. It is thought that resistance occurs because the person does not understand the care activity or why it is important or because they are afraid or uncomfortable with how the activity is occurring.

How to approach a person who is resisting care

• Assume a non-threatening posture: smile and speak in a pleasant tone of voice, keep arms open (not crossed), conduct care at the resident’s eye level and from the side.
• Don’t stand over the resident.
• Slow down care and ensure you are communicating clearly and explaining the task in a step-by-step process.
• Do not use “baby talk” (elder speak) when delivering care.

Strategies to try to reduce resistance to care

• Encourage the person with dementia to do as much for themselves as they can. Put objects necessary for the task within their field of vision so they are more easily located and remove objects that are unnecessary or distracting.
• Identify long-standing habits and adjust routines accordingly. For example, if the resident is used to doing oral care at the sink, take them to the bathroom to complete this part of their care.
• Consider whether the activity may be uncomfortable or painful and consider pain treatment before the activity.

Strategies to try for Resistance to Eating

• Make the dining experience consistent by having dishes, utensils and food in consistent places.
• Use white dishes to reduce distraction.
• Use non-stick surfaces and scoop dishes/plates to make it easier for the person to get food onto utensils.
• Adjust height of tables/chairs to make the task of eating easier for the person with dementia.
• Ensure the person is sitting upright as much as possible if they are wheelchair bound.
• Consider providing only one utensil to make the dinning situation simpler.
• Offer chopped or soft food if chewing is a problem and moisten foods with gravy or sauce if chewing is difficult for the person.
• Adjust portion size according to the person’s preferences.
• Avoid arguing if the person with dementia refuses to eat.
• Offer simple prompts about eating, such as, “please take a bite.”
• Reduce other distractions during eating such as television.
• Supplement with healthy between meal snacks if meal intake is poor.

Strategies to try for Resistance to Bathing

• Pay attention to complaints that water is too hot or cold.
• Consider using blue food coloring in the tub to make the water easier to see which may be appealing to some individuals.
• Use aromas that are agreeable to the person and make bathing/the bathroom a pleasant experience and place to be.
• Consider the use of relaxing music during bathing.
• Try to allow the person with dementia to take part in the bath by handing them one item at a time and offering simple step-by-step instructions about bathing.
• Consider allowing the person with dementia to hold the showerhead if possible.
• Avoid invading personal space and criticizing.
• Provide a towel to cover private areas and maintain privacy during showers as much as possible.
• Offer compliments during the bathing process.
• Schedule bathing at the time when the person is rested.

Strategies to try for Resistance to Eating for someone who requires extensive assistance

• If the person with dementia is generally fed by a staff person, ensure that the meal is paced appropriately and that they have time to swallow before another bite is introduced.
• Do not overload the person’s mouth or put too much food on fork.
• Encourage the person to use utensils or consider finger food.
• Offer gentle reminders about the steps of eating including chewing and swallowing.
• Stay at the table with the person with dementia.
• Try to keep the group of people at the table where the person is sitting small, ideally 4 people total.
• Do not combine all of the foods or mix them all into “mush.”

Strategies to try for resistance to grooming activities:

• Remove objects from the area that are not needed or used daily.
• Try to use only products that are familiar with the person if possible. If the family brings products in, encourage them to purchase several of the same product and to consistently bring those items in.
• Be present/provide assistance for all electronic appliances used in the bathroom or arrange for the person to use the appliance in a different area.
• Use bright color labels and instructions for some tasks such as shaving.
• Use simple statements such as “Please comb your hair now” rather than asking whether they want to comb their hair now.
• Provide the person with the items necessary for grooming step-by-step/as they are needed, which will help reduce distraction.
• Offer praise and comment on the social goals related to grooming such as “you will look so nice for supper tonight.”