It can be very distressing for a live-in carer, as well as family, when a client refuses personal care. It may even feel as if the carer is not doing their job properly. However, the situation may often be adequately resolved with just a few simple adjustments.

Adjustments can work with most clients although carers should be aware that some clients with conditions such as advanced dementia may not react favourably to any suggestions.

Ask that question

To understand the thinking behind a refusal will mean that the carer needs to find out why the client refuses personal care. This can be literally any number of reasons, some logical and others having no logical explanation at all.

It is important to address the situation with empathy, patience, and de-escalation techniques to ensure your client’s dignity, safety, and trust are maintained. 

Below are some strategies to effectively handle such situations:

1. Understand the cause of refusal

• Assess for triggers: Determine if physical discomfort, fear, embarrassment, or past trauma might be causing resistance.
• Check communication barriers: Ensure the client understands the care process, as language, hearing, or cognitive impairments could lead to refusal.
• Respect autonomy: Clients may assert independence by declining care. Acknowledge their right to make decisions.

2. Build trust and rapport

• Approach the client calmly and respectfully.
• Introduce yourself and explain the task in simple terms.
• Reassure the client about their safety and privacy.

3. Use active listening

• Encourage your client to express their concerns.
• Validate their feelings to make them feel heard and understood.
• Avoid interrupting or dismissing their objections.

4. Modify your own approach

• Offer choices: Present options to empower the client (e.g. ‘Would you like to wash your face now or after breakfast?’)
• Adjust the timing: If the client is agitated, wait and try again later.
• Simplify the task: Break it into smaller steps to make it less overwhelming.

Using de-escalation techniques

• Stay calm and maintain a neutral tone.
• Use non-threatening body language (maintain an open posture and appropriate distance).
• Redirect focus: Engage the client in light conversation or introduce a calming activity.
• Avoid arguing or pressuring, as this often increases resistance.

Additional tips:

Involve your client in any decisions

Ask for your client’s input on how they would like to proceed.

Incorporate their preferences into the care routine to make them feel valued.

Discuss with other people

Involve family members or caregivers who may help provide comfort and encouragement.

Consult with your agency or other healthcare professionals if refusal is persistent or rooted in medical concerns.

Keep your own records

Record instances of refusal and the approaches taken to resolve them.

Review the care plan with your support team to help identify potential adjustments.

Stay professional

Keep calm, try to stay as patient as you can, and avoid showing frustration.

Prioritize the client's dignity and well-being over completing tasks quickly.

When to ask for help

If your client still refuses, and this begins to affect their health, you need to seek guidance from a supervisor or healthcare provider. Certainly it is a good idea to discuss this with a district nurse or even the doctor to see how to progress in the best way.

Final thoughts

By using some or all of these techniques, you should be able to foster a positive environment that respects your client’s preferences while ensuring they receive the care they need.

 

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