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SE C T I O N SE V E N - W O R K IN G W I T H DI F F I C U L T SE NI O RS

Not everyone is a joy and pleasure to be around. At times, it can be a real challenge to be in the presence of some people, even for a minute. Their personalities, actions, Behavior andGor dispositions don:t even come close to the tolerable level but still we need to interact with them. Tolerance levels can be raised by understanding what they are all about. This section will show the Home Care Assistant how to deal with difficult clients. Difficult Clients Hhen individuals are laBeled “difficult”, it generally means that others have proBlems interacting with them. Since difficulty is all about unmet needs, the behaviors, which make people hard to get along with, are the result of their needs not being met. When needs are not met, people react in different ways. i.e. They may become:

withdrawn, wherein they retreat and refuse to interact;

passive, wherein they fail to take any action;

manipulative, wherein they use devices or dishonest means;

violent, wherein they conduct a physical act, which is intended to cause damage to themselves, to others or to property;

intimidating, wherein they bully others to make them do something or not do something;

cr itical, wherein they find real or perceived faults in others;

threatening, wherein they utter intentions of injury/punishment against others;

angry, wherein they exhibit strong dis$leasure or antagonism a0out real or su$$osed

in1ury on themselves or others5

uncooperative, wherein they are not willing to work with or be helpful to other people;

passive aggressive, wherein they get back at people indirectly, as opposed to confronting them head on -- they become increasingly more hostile and angry;

mistrustful, wherein they become openly suspicious and are unwilling to confide; and,

non empathetic, wherein they are not understanding and sensitive towards the feelings of others in

an emotional sense.

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Behavioral Patterns Displayed by Difficult Clients Difficult clients display certain types of behavioral patterns. By being familiar with these patterns, Home Care Assistants can better understand what is up with them, which will help Home Care Assistants to handle these clients more effectively. A difficult client might knowingly or unknowingly:

take the opposite point of view regardless of what the issues or opinions are. Most of these people are not aware that they are doing this or that it affects others.

complain, whine and blame others constantly. These people are playing the victim role, which causes

others to react as persecutors.

not let an issue go, even when situations are different. It affects other people by causing them to feel frustrated and drained.

avoid outright disagreements but instead take actions secretly. They have hidden agendas and attempt

to sabotage processes and interactions, which affects other people by compromising their trust.

Hold other people hostage, which can be in the form of abusive language, threats or emotional outbursts. This affects others by virtue of the fact that nothing else can go on while this behavior is being displayed.

Identifying and Dealing with Difficult Personalities Every client has some type of personality O some are enjoyable, others are not. Certain personality types can make life difficult for people who have to interact with them. By learning about the more annoying types of personalities, Home Care Assistants can better understand their clients. One way to deal with them is to determine where they are coming from and figure out what makes them tick. If Home Care Assistants take the time to understand their clients: viewpoints and change their attitudes aBout them, they will have a more effective and pleasant relationship with them. The following chart identifies some of the more common difficult personalities and how Home Care Assistants might react to them.

Personality Type Definition How to Deal With them

Deceitful

They use clever but often dishonest methods which deceive people in order to gain control. They are generally smart, calculating & determined.

They are the hardest individuals to get along with. If you can:t avoid them, then protect yourself & fight with politeness, as opposed to playing their games.

Manipulative

They only give half the story & will provide only pieces of information, which will be in their best interest.

Be prepared so when they start their game, you can counter with the facts. Challenge them in front of others to defend their suggestions.

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Personality Type Definition How to Deal With them

Bully

They try to threaten others into doing things they would rather not do.

Stand up to them and be ready to compromise between what they want and what you are willing to do.

Glory Snatcher They try to take all the credit when some of it belongs to others.

Don:t hesitate to advise of your contribution either orally or in writing.

Hot Head

They have bad tempers and need to spout off.

Listen to them privately, if possible. If others are around, don:t confront them but, instead, recommend that you talk to them later in private, once they have cooled down.

Tips for Handling Difficult C lients It is important for Home Care Assistants to know how to handle difficult clients in order that they can better understand what they are all about and to promote a peaceful environment. There are a number of approaches Home Care Assistants can use to deal effectively with challenging clients:

Don:t make the difficulty a personal issue. i.e. Try not to hold their Behavior against them But instead try to understand where they are coming from and provide assistance.

Avoid making value judgments against them as people. i.e. Show them that you look up to them,

that you value their opinions and that their thoughts deserve contemplation.

Be kind and treat them in the same manner that you would treat your friends. i.e. When behaviors become unpleasant, remain calm and nice, as this will pacify annoying situations.

Show an interest in them. i.e. Their self esteem is at stake here. By showing interest, you are

validating them, which should soften them up.

Identify who actually has the problem. i.e. People who complain that others are difficult, often have difficulties themselves. Ask yourself why you have problems with them and then take steps to address the problems instead of keeping things inside.

Change whatever you can with yourself. i.e. Since you cannot change what somebody else is doing,

concentrate on modifying how you handle the problem.

Ask them what they want. i.e. This will be a good starting point for developing an understanding and trust between you.

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Complaints A complaint is an expression of dissatisfaction, grievance or resentment, which can be communicated orally or in writing. Tips for Dealing With Complaining C lients It is inevitable that Home Care Assistants will face complaining clients -- some days the complaints will seem endless. For some complainers, complaining forms a part of their individual constitution. If Home Care Assistants know what to do, then they needn:t feel stressed or inadequate Because knowing and applying a few simple principles can often minimize or eradicate complaints completely. Following are some tips for dealing with complaining clients:

Recognize that the dissatisfaction is a complaint. Pay attention by listening carefully and objectively. Be sympathetic and be sincere in your desire to help. Repeat what you have heard to avoid misunderstanding. If there is a problem, admit to it and apologize for any inconvenience. Ask what they want done about the problem. Avoid any defensive reactions. Don:t give eLcuses or place Blame. Don:t make promises that can:t Be kept. Provide explanations. Offer solutions.

Steps To Take When Dealing With Complaining C lients Complaint handling is a process. The following guidelines will lead you through the steps of handling complaints clients may make:

Assure them you are there to help and be supportive. ZBtain the particulars of the complaint Ie.g. The “how”, “what”, “when” “where” “why” and “how”N. Learn as much about them as possible. Ask them what they want done about the problem. Suggestive appropriate options for solving the problem. Obtain their input and come to an agreement on the best solution. Implement corrective actions Iwith the client:s approvalN. Follow-up on any actions taken to determine effectiveness. If the solution is unsuccessful, consider an alternative and follow through again.

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DEamp2e of How $o Hand2e a C2ien$0s Comp2ain$ The following example illustrates how a Home Care Assistant (HCA) might handle a complaint from a client. Scenario: A Home Care Assistant has a new client. Arriving at his home, he/she is greeted by a

complaining client who tells the HCA to go away Because he doesn:t want any help. He has had it with Home Care Assistants.

Steps in Complaint Process Interactions Between H C A and C lient

Assure them you are there to help & be supportive.

HCA: “Mr. Client, I am sorry to hear that you are not satisfied. I am only here to help & would appreciate it if I could talk to you for a few minutes.”

CLIK_T: “Alright, but make it fast”.

Obtain the particulars of the complaint.

HCA: “I am sorry that you feel this way.  Would you like to share with me why you don’t want me to help?”

CLIK_T: “You are the fourth one I’ve had this month and I am tired of a bunch 

of strangers coming in.” HCA: “You’ve had three other Home Care Assistants this montha” CLIK_T: “You got it-- but they didn’t stay.  One had an operation, one moved 

away and one said she had too many people to look after.” HCA: “You must have found that to be very  frustrating.” CLIK_T: “Frustrating and upsetting -- they shouldn’t  treat me this way.  What 

do they think I am anyway -- a piece of chopped liver?”

Learn as much about them as possible

HCA: “You are hardly a piece of chopped liver. You seem to be a sensitive and caring man.”

CLIENT:    “I am a nice guy.” HCA:        “I believe you.  Would you like to tell me a few things about yourself, 

as I would like to get to know you?” CLIENT: (proceeds to give HCA a summary of part of his life.) HCA: “What an interesting life you have led. I would enjoy hearing more

at another time. Ask them what they want done about the problem

HCA: “I am concerned that if you don’t accept help, your needs won’t be looked after. What would you suggest be done to ensure you get the care you deserve?”

CLIK_T: “I want the same person every time and they better be someone I can

get along with.”

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Steps in Complaint Process Interactions Between H C A and C lient

Suggest appropriate options for solving the problem

HCA: “That is not an unreasonable request.   Let’s see, I would like to be that person, if you agree, or I can refer you to somebody else.”

Obtain their input and come to an agreement on the best solution

HCA: “What do you think about those suggestions?” CLIK_T: “Are you sure you would stay on with me?” HCA: “I would not leave unless something unforeseen happens. What I can

also do is bring another HCA in one day and show her the routine. If you like her, she could be my backup just in case I can’t come in some time.  How does that sound to you?”

CLIE_T: “I guess that would be alright”

Implement corrective actions

HCA: “Now, how about today?  Should we give it a try?” CLIK_T: “May as well -- you are  already here.”

Follow-up on actions taken to determine effectiveness. (Over the next several weeks, both client and HCA can assess how things are

working out. Minor adaptations can be made as indicated.)

If the solution is unsuccessful, consider alternatives & follow through again.

(If either party is not satisfied, they can try the other alternative i.e. HCA will refer the client to someone else with the client:s agreement.

Anger It is the rare person, indeed, who never experiences some degree of anger. Therefore, the likelihood of Home Care Assistants facing angry clients is quite likely. By understanding anger, its causes, its impacts, and how to react to it, Home Care Assistants can constructively “maintain their cool” instead of “flying off the handle”, which would only worsen the situation. Anger is an emotion that can range from being mild to being outright furious and is a natural response to threats. It can be caused by people, events, memories and/or personal problems. It is a normal human emotion but if it gets out of control, it can create difficulties. Anger can cause the heart rate, blood pressure and energy hormones to increase. It can seriously affect relationships. The healthiest way for anger to be expressed is to talk about the reason for the anger in an assertive, non aggressive way. (Note: Assertiveness means being respectful of others and yourself while aggressive means being pushy or demanding.) If anger is not expressed, other problems can be created (e.g. passive aggressive behavior, being critical, making mocking comments). When helping clients to deal with their anger, Home Care Assistants would benefit by knowing the goal of anger management, which is to reduce emotional feelings and physical stimulation caused by anger. They can help clients learn to control their reactions, even though they cannot avoid or change their causes.

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Tips for Dealing With Angry C lients Dealing with angry clients can be an awkward and uneasy task, especially if you are not familiar with the techniques. However, there are a few things that Home Care Assistants can do to prevent them from becoming even more emotional. Home Care Assistants can:

Allow them to “spout off” at first and then gently start to speak.

Get the facts, which allows you to focus on the issue and not on their emotions.

Pay attention to their own body language.

Maintain an open, friendly and tranquil appearance by: o keeping a passive facial expression; o moving your head up and down from time to time; and, o showing that you are listening.

Speak in a normal, even tone -- by being calm, you are in control.

Utilize communication skills by: o repeating what the angry client is saying; o emphasizing statements by acknowledging you understand their feelings; and, o temporarily pausing the situation by stating their name.

Ask how you can help them.

Don:t make the situation worse by using statements such as: o Hhat is Bugging you anywaya” o “If you will ;ust settle down.” o “If you will ;ust hear me out.” o “bou are Being unfair.”

Respond instead of react by: o applying empathy, which will allow you to see their point of view; o being compassionate, which bring tolerance to the situation; and, o being assertive, which enables you to stand up for your rights without infringing on their rights.

Resist the temptation to fight back by keeping your own emotions under control. This can be

accomplished by: o counting to 10 before speaking; o taking deep breaths, which will promote relaxation and help focus to focus on the moment; o thinking more rationally; o avoiding jumping to conclusion; and, o changing your thoughts and attitudes by using humor.

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Conflict Home Care Assistants may become involved in a conflict personally or they may be drawn into one when their clients become involved. If they are armed with a basic knowledge of dealing with conflicts, Home Care Assistants may be able to help defuse the situation and thus reinstate/maintain stability in their clients: lives. Conflict occurs when people do not get what they want and are looking after their own self interests. Sometimes they are not aware of the need and unconsciously start to act out. Other times, they know exactly what they want and actively try to get it. Causes of conflict may include:

Wants or needs are not being met. Values are being tested. Perceptions are questioned. Assumptions are made. Knowledge is minimal. Expectations are too high or too low. Personality, race or gender differences are present. Having conflict with oneself.

Constructive and Destructive Aspects of Conflict

Constructive Destructive

Problems & issues are clarified. Solutions are found for the problems. Valid communication results. People are involved in resolving issues. Familiarity may result in people cooperating. Individuals develop understanding & skills. Emotion, anxiety & stress are relieved.

Irresponsible & harmful behavior can result. People become less cooperative. Differences are enhanced. Morale & self concept are damaged. Attention is taken away from other important things.

. Tips and Techniques For Dealing With Conflict There are tried and true steps for resolving conflict. They consist of people:

sharing information; hearing each other out; and, using power to raise an issue instead of to impose a solution.

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Techniques for resolving conflicts include:

Set a time and place to talk privately. Define expectations for the outcome. State the event, feelings about it, ending up with a question. Explore all relevant information concerning the event. Explore solutions that would benefit both sides. Offer fair exchange proposals. Test for commitment.

Note: It is important to acknowledge that in every conflict, both parties contributed to the problem and

they should face the issues as soon as they occur. Aggression Aggression is a deliberate behavior intended to inflict damage or other unpleasantness upon another individual. The possibility for aggression exists whenever there is a conflict between two or more individuals. Reasons why people may become aggressive:

They are frustrated: o with themselves; o for not being able to control their emotions; o with people they don:t understand C andGor, o with the world they face.

They feel inadequate due to:

o the perception that other people are looking down on them; o there is a lot going on in their head and aggression releases pent up energy; o they were exposed to aggression as children; o they were abused as children; and, o the possibility that they have a biological problem (e.g. reduction of certain chemicals in the

brain).

Tips for Dealing With Aggressive C lients Few people have never faced an aggressive person and Home Care Assistants are no exception. Regardless of past experiences, they are likely to encounter aggressive clients during their careers. A natural reaction when someone becomes aggressive is to fight back. However, that is not always the smartest way to handle the situation. A wiser alternative is to help these people to feel understood, to calm down and to discuss the situation reasonably.

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The following steps will provide a guideline on how Home Care Assistants might interact with aggressive clients:

Allow them to speak their peace without interruption. Ask for elaboration and clarification. Show concern. Speak in a soft and low voice. Summarize what has been said. Don:t argue. Agree with whatever you can. Be empathetic. Offer to share your information. Find out what is needed to improve the situation. Provide suggestions, if none have been suggested already. Suggest some down time for both parties to think. Make an action plan based on what has been agreed upon.

Violence Violence is an assault on someone which can be in the form of:

a physical in;ury Ie.g. the victim:s Body is in;uredNC verbal harassment (e.g. calling the victim names); or, property damage Ie.g. the victim:s windows are BrokenN.

Violence results from hostility and aggression when perpetrators feel they will get more satisfaction out of hurting someone than they would get out of out of resolving and/or tolerating a situation. Since it is almost impossible to predict when hostility and anger will lead to violence, Home Care Assistants need to be alert for any signs that clients may become violent. If they have some skills and knowledge, they may be able to defuse the situation. The first thing they should ask themselves is whether or not they feel they can handle the situation. If they feel they can:t, they should call “911”. If they feel they can, they could initiate defusing actions. They will have to rely on their better judgment to determine which option to take. Tips for Defusing V iolence in C lients There are some tips that Home Care Assistants can apply when attempting to defuse violent clients:

Understand where they are coming from. As they are compelled to talk about their dissatisfaction (real or perceived), be sure to take time to listen at that moment.

Create an atmosphere of cooperation.

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Do not display anger, fear or anxiety. Speak in a calm and low voice. Be totally truthful to maintain credibility. Expect and accept angry outbursts, as defusing will begin after venting. Listen without comment or judgment. If you do speak, ask questions that require a long answer, as it will show that you are interested and

will help the defusing process. Maintain eye contact to demonstrate that you are paying attention. Do not play down the importance of their concerns. Be understanding. Show respect. Don:t Be threatening. Ask what can be done to relieve the situation. Work towards a resolution that will benefit both sides. Allow them to maintain their dignity.

Note: If angry clients have mental problems or are on drugs, these techniques may not work because

their comprehension and understanding may be affected. Negativity Negativity is not uncommon in the general population. Some people are chronically pessimistic in that they are negative most of the time. Others may have episodic periods when negative attitudes take the forefront. Negativity can be due to dispositions, attitudes or it can be caused by certain events/ individuals. Although not usually threatening, negative people can be difficult to be around and can Become a “thorn in one:s side”. T ips for Dealing with Negative A ttitudes Home Care Assistants may have clients who are negative. To prevent their clients: attitudes from getting them down, there are some tips which may help Home Care Assistants deal with them:

Realize that it is useless to argue with them. Understand that they are feeling insecure at the moment. Don:t push them as they will only get worse. Wait until another time to pursue the task/discussion, if they find the situation stressful. Determine if they are always defensive or attacking others. If they are, it may not be possible to

change their attitude. Keep your self confidence. Don:t allow yourself to Be verBally aBused.

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Negotiations Negotiating simply means to consult with another for purposes of coming to terms with something. Negotiations occur between parties at all levels (e.g. between heads of state, corporations, companies, organizations, and individuals). Negotiating involves the following principles:

Focus on how both parties can win. Remember the other person must be satisfied with what they got. Focus on the problem itself and not on the emotions surrounding it. Know the negotiation style of the other party to promote a positive outcome. Focus on interest and not on positions. i.e. Positions may be set but both parties may have interests,

which need to be met. Keep your emotions under control. Listen and question the other person, as they may have a better option than what you are proposing,

Steps to Take When Negotiating With C lients Home Care Assistants may find they have to “negotiate” with clients in order to get something done. The following steps may help Home Care Assistants work through the negotiation process to reach mutually acceptable solutions:

State your point of view. Get the client:s point of view. Identity Both person:s goals. Offer and listen for possible solutions. Choose the best solution for both of you. Evaluate the outcome.

Summary

Just as people come with different physical traits such as color, size and shape, they also come with different personalities, dispositions, behavioral patterns and attitudes. One of the main sources of stress for anyone is dealing with people who are not easy to be around. This is especially true for Home Care Assistants. Their clientele primarily includes those who do not function at par due to age, frailty, illness or injury. If their clients turn out to be difficult as well, the challenge is compounded considerably. Hhile changing a person:s traits is not an option, Home Care Assistants can control and modify their reactions and attitudes towards them. They do this by understanding what their clients are about and what makes them tick. This knowledge empowers them to manage their own stress levels and to obtain more cooperation from their clients.