Managing Resistance in Care Work
During my time at the High Care Center at a retirement village, working as a student member of the Care Team, I learned a lot about myself and my role as a Home Based Personal Care Worker.
At first I was apprehensive. How would the team members react to a 55 year old man changing careers and entering a profession he has little practical knowledge of?
Would I find any resistance from the ladies working there? How would the patients react?
Truthfully, there were one or two incidents where carers were rude to me on purpose. Luckly I am versed in human behaviour, thanks to my interest in acting. As a principle I don’t let my ego take over when challenged. Those who want to anger you are trying to control you.
It was clear that, on one occasion, a Carer at the Frail Care wanted to put me in my place, not understanding that I was preparing a patient’s food and not my own. I explained what I was doing and she gave back the knife she grabbed as I was buttering a slice of toast.
We soon became firm friends. She later complemented me on my humility. Not to blow my own trumpet. I only think it right to enter a new domain with a humble attitude. After all, the people who work there are the ones I hoped to learn from.
As time passed I noticed that some of the Carers would not help others, and I put that down to resentment informed by working together for a long time. I never had that problem. Whenever I made a mistake there was someone to back me up, to fix what I’d forgotten or misunderstood before it affected the patients or residents. I did what I could to help and to increase their capacity so my contribution would be valued. It was.
On the subject of racism: (well, I didn’t want to be blunt, but I am a white man studying a field where most of the workers are female and of other races. There’s no point in denying the simple truth.) There were incidents which had racial undertones, but I found that I could easily read these as cultural insensitivity, not malicious intent. Let me explain.
One of the long term high risk residents was known to be difficult and at first I wondered if they were reacting to the race of the Carers.
I was told they were probably schizophrenic (pronoun “they” used to protect their privacy, not to indicate a multiple), possibly racist, and agressively obstinate to the point of violence – and they did seem to be very contrary at first. Wherever they were asked to do something they’d refuse, or take their time and I saw the Carers becoming frustrated with their lack of co-operation. If they touched the resident, they were met with a tirade of words and arguments, told to let go.
“I can do it myself, just put it down over there!”, or “I can tie my own shoe laces.”, even “I’ll do it as soon as you leave the room.”
I watched as the other Carers pushed and pulled and manouvred them to get them washed and dressed, how the Carers teased them and intimidated them to get everything done. I had to find a way to work with the resident without insulting the Carers, but I wasn’t impressed by the strategies some of the Carers used. They were effective, but unkind.
At first, being new, I didn’t intervene. I’m also not keen on conflict. It seemed not to matter too much as the resident seemingly had no memory of what had happened moments before. I can confirm now that this is indeed true.
Still, treating someone like that made me uncomfortable. There must be a better way.
After all, we were rushing them through routine tasks so we could deposit them on a chair where they’d sit and while the time of day away. Of course there were many residents who needed care, so the need for efficiency was not unreasonable either.
I resolved to experiment with other approaches while I was tasked with their bathing and personal hygiene. It was a real challenge: given the opportunity to brush their teeth in the shower they spent 12 minutes brushing dentures repeatedly, even obsessively.
It was clear I had to choose my battles.
We (the resident and I) eventually developed a working relationship, and before I left I thanked them for helping me understand what they needed from their care givers.
My approach was simple: never lie to the person, always treat them with respect and ask for their permission and co-operation.
There were times when my approach failed, and sometimes we had to fall back on the harsher methods of manouvering them or overriding their objections, but these became rarer as they became more familiar with me. I did not respond to their insults or threats, but stood my ground calmly. Most of the time, we’d manage to get through without major upsets.
Some days, we’d opt for a bed bath in stead of a shower as the bathroom is shared by 12 people. We could let it slide when it just isn’t worth the argument.
One thing that was clear to me: if the person was angered early in the morning, the rest of the day would be fraught with arguments. I realized there is a hormonal component to emotions. The cortisol released during the altercation was still in their system, even though they’d forgotten the incident. The mood continued after they’d moved from one room to the other, so the doorway effect didn’t apply.
At first, my supervising Care Worker criticized me for being slow in working with this resident. I thanked them for their guidance and tried to find ways to improve.
When others took charge of the resident I did step in once or twice to help. I am as tall and a lot stronger than them, so when they tried using physical intimidation against a smaller female Care Worker by moving closer and staring, I would simply mimic their actions. I’d get close, pull myself up and make full eye contact. Yes, I can also play the staring game.
Once, to escalate even further the resident rushed toward my display and I backed off, allowing them to move. This worked well because they’d been refusing to move when I’d decided to help. Disarming the situation with humor often resulted in de-escalation. Not that there weren’t one or two days when the resident told me they’d be happy never to see me again.
That happens, but it soon passes.
The thing to remember is: they don’t.
All I could do was show up every day with an attitude of friendly, respectful service. I’d remind them that they were in a care facility, that we were there to help them to be safe, healthy and comfortable. I told them they were part of the team and we valued their co-operation. We relied on them to shower and dress quickly so we could get everyone to breakfast in time.
I know it’s tedious, but this is what I tried every day for a week and it worked about half of the time.
In my estimation, the resident doesn’t have a mood disorder, they simply react to what is presented to them in the moment. Emotions are instant. It’s a survival thing.
They can’t remember, so yes, you do have to tell them a million times, and ask for their help, every time, and get their permission every time you mean to help them do something.
Some of the other residents did mention that this resident used to be unpleasant most of the time, but they’d been smiling more often, so I count that as a little victory.
To be honest, when I left they started in on the new students in the same way, resisting and arguing and I almost told the new ones: treat the person with respect, mind their personal space and ask nicely. But then I though, where’s the fun in that?
On a clear day I chatted to the resident and asked them if they remembered the carers teasing and needling them and they said: “I let them have their fun.”
I have to assume that some of their bluster and resistance is a way of amusing themselves.
They remind me a lot of another aged person I used to work with in the community theatre. Margaret Todd had a reputation for making children and their mothers cry. She even scared off grown men that were too sensitive to take a little abuse. She certainly helped the home-schooled children learn that being shouted at couldn’t kill them – she provided some much needed amusement and resilience training.
In the end we had an understanding: if things got too rowdy she could shout at me in stead of the children and I’d act suitably cowed. That kept everyone else in line without the need to apologise to mothers and fathers. I’m grateful to her for the insights she provided, even if she was just amusing herself!