Home Health Aide Digest
March/April 2004

Resolving Conflicts with your Clients
By Suzanne P. Campbell MS, QRC, CRC


An entire industry has grown up to help people settle conflicts with others. Licensed mediators are available for everything from classroom issues over school bullying to disputes among nations. Obviously, dealing with difficult people is a widespread problem.

As a HHA, you deal with a variety of clients and some of them may be difficult. What might cause their anger and frustration and what can you do to resolve it?


1. FEAR: Sometimes your client may seem unreasonable when they are actually just fearful. A 2002 study by the National Council on Aging “American Perceptions of Aging in the 21st Century” provides some clues. Sixty percent of seniors said that they feared losing their memory. The next most common fear was being in uncontrollable pain.

Action Step: Encourage your client to talk with you about their fears. Perhaps they are afraid that a new exercise you want to do with them will cause them injury. Maybe they object to a change in routine because they fear not being able to master new skills. Talking it out can lead to better cooperation.

2. DEPRESSION: Eighteen million people in the U.S. are estimated to have depression at any one time. You are there because your client has lost the ability to do some of their self-cares. It isn’t surprising that they may be sad about there loss of independence. This could lead to feelings of depression and those feelings may show up as anger or non-cooperation.

ACTION STEP: Activity, especially physical exercise, is a good antidote to depression. Encourage the client to be more active, it may improve their mood. Sometimes it helps to “talk out” their feelings of sadness.

3. LACK OF INFORMATION: Is your client being asked to participate in a care program that they don’t understand? Ruth was 70 years old when she had a stroke which cause paralysis to the left side of her body. She was told her condition would be permanent. Her doctor ordered her home health workers to see to it that she bathed and dressed daily. She was also assigned a series of painful exercises. She refused to cooperate because, “what’s the use?” Ruth had understood only that she was paralyzed for life. No one had explained that the care plan would help her to become stronger and maintain good mental health.

ACTION STEP: Ask your client why they don’t want to cooperate. Be prepared to explain the value of the activity you would like them to do.

4. A FEELING THAT NO ONE IS LISTENING OR NO ONE CARES: We all like to feel that others respect us. Sometimes, illness or infirmity leave people feeling that they have little value. Fourth year medical students at the University of Minnesota recently took part in an exercise called “The Aging Game.” The idea was to help them understand what their elderly patients were going through. The students were fitted with ear plugs and then given complicated directions about how and when to take different medications. Some had to wear neck braces, or walk around with uncooked popcorn in their shoes to simulate osteoarthritis.

Doctors in white coats talked about them as though they weren’t in the room. At the end of the game students were asked for their response. “This is an experience in losing power,” said one man. When asked, afterward, what could be done to improve care for the elderly, the class had one word of advice: “Listen.”

ACTION STEP: Respectfully listen when your client is telling you about their feelings of anger or frustration. Don’t respond with anger of your own. This would only raise the level of tension. Help your client see that you value them by responding with understanding. If they say, “I hate this food!” you might respond with “It’s hard for you to get used to this salt free diet isn’t it?” You haven’t agreed to change their diet back to the one that caused their elevated blood pressure. You have simply let them know that you appreciate their frustration.


Of course, it is a good thing to be able to resolve conflicts with your difficult clients. But there are times when you need to seek help. These may include:

• A feeling that you are in danger from a violent client.
• Your observation that the client has a marked personality change following a change in medication (see the article by Joy Morton)
• When you notice symptoms of severe and persistent depression.
• When you suspect that the client’s reactions may be due to their being in an abusive situation in the home.
  
  

Remember that not all conflicts can be resolved. Some clients will remain difficult despite your best efforts. In that case, since you can’t control them, you can only control your response to them (See Because You’re Worth It! in this issue of HHA Digest).

© 2004 Home Health Aide Digest