Caring For Toxic Older Adults

Welcome to Memory Care Support’s October 2015 newsletter!

There’s a new movie out with Lily Tomlin entitled Grandma and it really is about two stories inside of one movie.  The first story is concerned with what happens when a young granddaughter visits her grandmother to get some help dealing with an unexpected pregnancy and the second story is about why Grandma (Tomlin) is such a nasty, toxic woman, pushing everyone away? 

The first story is sweet and predictable but it’s the second story that is more interesting to me as a nurse practitioner who has worked in the field of geriatrics for a long time.  All of us professionals have stories to tell about those “toxic” older clients and patients, and even family members we’ve been charged with taking care of. 

I remember well, when I was a nurse practitioner working for a home health agency, I was warned before I went to visit a specific client.  I was told she had been a Hollywood “starlet” and treated everyone awful.  She had a private room in a Board and Care home with a full-time private caregiver, because the daily staff wouldn’t take care of her she was so insulting.  “Nothing will bother me” I thought, “I’ve seen and heard everything….”  When I entered into the Board and Care and asked which room was hers, the concerned staff rushed over and warned me again – “don’t go in if you don’t have to, she’s nasty, she uses awful language, she’s insulting, she’ll throw you out….”.  I knocked and her private caregiver cautiously let me into her room.  On the bed, was Nona, who began to scream at me as soon as I entered.  “You don’t know anything about me, you don’t know anything about nursing, you’re a F…….idiot, who do you think you are coming into my room, get the F…… out of here….” – the barrage was instant and harsh!  She had developed pressure wounds on her heels and I asked if I could check them.  Even though her stream of toxic language continued, she did pull back the covers so I could examine the wounds.  As I changed the dressings, her insulting language continued, but I could see she was watching for my reaction.  And the final, most personal insult occurred as I was leaving her room – I had my hand on the doorknob to walk out and she shouted, “And… you have a fat ass!”  I’m not denying that her observations were correct, but it made me laugh – I turned and laughed so hard that her caregiver couldn’t resist joining me and soon Nona was laughing too!

It’s great when you can literally “step back” and see some humor in the situation.  But sometimes it seems that it’s just not possible.  What is it like when you’re a professional and you are assigned to care for someone who is toxic (poisonous, noxious, venomous…) – it can be exhausting!!

We’ve all had that situation and the most common response is to run the other way when faced with toxic people.  We……

  • Minimize contact
  • Ignore call lights
  • Turn and walk the opposite direction
  • Keep conversations brief, one-word answers
  • Rush through any care tasks
  • Avoid returning phone calls
  • Avoid discussing anything that may cause questions or disagreement
  • Don’t initiate conversation
  • Keep topics to neutral subjects
  • Don’t inform if there are changes of condition
  • Always say ‘everything is fine”
  • Complain about the person to your colleagues
  • Request reassignment
  • Refuse to take care of the person
We may not know why this person acts so unpleasant and rude.  It could be a long-standing behavior trait or is it a new coping mechanism?  Are they experiencing pain, grieving, depression, is there a history of abuse or loss?  Are they frightened, afraid of loss of control, aware of their own debilities?

Do you work in LTC or Assisted Living?  Do you have toxic residents or family members you care for or interact with every day?  Are you a family member caring for a loved one who is rude and insulting to you?  Instead of avoiding the person, try these techniques:
  • Walk in the person’s shoes – what would it be like to be older and have their disabilities?
  • Do not take their behavior personally!
  • Take time to think about what could be the reason for their toxic behavior?
  • Examine your approach to them – sometimes it is human nature to be rude in response.
  • Take a moment to compose yourself before you approach them.
  • Do you increase their fears by avoiding them and/or minimizing information?
  • If there are cognitive changes, remember their behavior could be an attempt to communicate their needs to you.
  • Is there some small bit of conversation you can share with them each day that could bring them pleasure or make their day more interesting?
  • Don’t avoid them, instead initiate frequent interactions – move towards them, not away.
  • Is there anything humorous you can share with them?
  • Discuss with your co-workers or family members any suggestions they may have about how to approach the person.
  • Recognize your “limit” of tolerance and get support at work or from other family members before you “blow up”.
  • Get assistance – if possible, it would be helpful to “take a break” and resume care after an intermission.
  • Remember you are the professional and regardless of their behavior, you are there to care and advocate for them.

In Grandma, Lily Tomlin’s character pulls the viewer in to want to learn why she acts so rude and pushes everyone away.  If you see the movie, you can draw your own conclusions, but it reminded me that sometimes the most difficult people are the most interesting and if you give up on them, you’ll miss the best things!

Have a great day!

If you work in Assisted Living and want
To make your dementia care program even better,
Or if you need assistance in
Planning care for a loved one,
E-mail or call me for a free consultation.

Anne Ellett, N.P., M.S.N.
AANC Certified Gerontological Nurse
Founder, Executive Director - Memory Care Support
Ph. 949 933-6201

Anne Ellett

Dementia Care Specialist AANC Certified Gerontological Nurse
Founder, Executive Director

Memory Care Support
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