Meet Them Where They Are





Unreasonable, misplaced anger, unrelenting fear, heartbreak from deeply felt emotional wounds, a lack of trust both of others and of their own capabilities, powerlessness, despair, frustration, feelings of abandonment, and utter lack of control over their own surroundings are only some of the negative emotions that those living in Long Term Care facilities face on a daily basis.  My residents who struggle the most with the above mentioned feelings are usually the ones who are the least capable of clearly articulating it.
So what happens? They act out. They become verbally and on occasion, physically abusive. They often yell or become obstinate over seemingly innocent little tasks. They manipulate situations in a way that they feel best benefits their needs. They are the residents labeled “difficult”, “trouble makers”, “problems”, not just by those of us on the floor but also by those in the office.
God knows, I’m guilty of it; inwardly sighing, as I make my way to a resident who is furious at me for something over which I have no control. Or a resident who is vengeful because I’ve had to set a boundary that she doesn’t like. Some days, I wonder if all of my uphill battle folks had a meeting and decided that they would join forces in order to make a shift impossible just for their own entertainment. Those are the days that I leave work questioning both my sanity and my capabilities; the days when I think I suck at this gig and wonder why I am so determined to stick with it.
The thing is, though, when I step away for a minute, I realize that I have a level of awareness that is desperately needed in this field. I really do know that these “difficult” residents are not behaving in such a manner simply because they’re “mean”. The powers that be may know that, but in all honesty they don’t care. They can’t possibly care because their only solution appears to be medication, a problem that I will be discussing in a future post. A facilities treatment of their caregivers directly corresponds to their level of interest in their residents’ quality of care. They are not invested in us, then they are not invested in them.
SOMEONE has to be, though. Someone HAS to see beyond the behavior, which is nothing more than a symptom to the greater underlying illness. That responsibility lies on the floor. We are the witnesses and the carriers of their emotional wounds. While we are unlikely to heal them, we can step outside of ourselves and use their behaviors to learn how to better care for them, much like the pain from touching a hot stove teaches us to not touch it again.

Unreasonable, misplaced anger, unrelenting fear, heartbreak from deeply felt emotional wounds, a lack of trust both of others and of their own capabilities, powerlessness, despair, frustration, feelings of abandonment, and utter lack of control over their own surroundings…that’s a lot for any human being to have to live with. Sometimes adding “fit into my concept of acceptable behavior” on top of all that is just too much to ask of them and they can’t meet US where WE are. That’s when our empathy and understanding needs to stretch in order to better meet THEM where THEY are.

4 thoughts on “Meet Them Where They Are

  1. aortigara

    Wow, this is an amazing reflection.. And not at all easy to keep this perspective when you are the one being kicked in the shower room. thanks for the commitment to keep seeing the needs of these elders and seeing their “behaviors” as meaningful and purposeful.

  2. thecnalife

    Nailed it! This is exactly the issue with so many of our ‘problem’ people and I find myself often frustrated trying to find a way to meet them where they are and redirect the behavior. I’m printing this out and hanging it at work. SO many aides need to understand this where I am working, and a few nurses!

  3. jberry99

    I agree, this is something that each and every caregiver, whether professional or family, needs to hear.

    There is always an emotional need behind ALL behavior. Challenging Behavior in a person with the disabilities related to any type of dementia, IS only the person’s attempt at communicating a need, and as dementia progresses, and is almost always an emotional need.

    It is critical we learn how to read the emotion behind the words. Often the words don’t actually correspond with the need. For example, A resident repeatedly saying “I want to go home” and trying to elope, usually means “I am Scared”, ” I feel lost and abandoned”, “I do not feel safe”, ” I miss my family” , ” I want to see a familiar face” etc.

    Most often caregivers get lost trying to address the words being said or trying to distract the person instead of recognizing and meeting the emotional need behind the words.

    Caregivers must learn to read the emotion and validate those feelings to eliminate the behavior, not just once, but every time the resident has the behavior and it must be done PRO-ACTIVELY, not after the person is so upset and distraught they are acting out verbally or physically.

    There is a CRITICAL need for Caregiver, Family & Professional Training in Seeing Dementia Differently and learning to discover the unmet need behind all behavior. That is why I offer this training to caregivers throughout the country. Often our caregivers, of persons with dementia, are often not given the appropriate tools to manage the care of this population.

  4. dizzylizzie72

    I have watched a day in a nursing home many times when I visit my brother. I have helped residents in small ways when I saw the staff overwhelmed. Nursing homes are definitely understaffed and each of you that work there pushed to the limit. I have been on the receiving end of anger from residents, even using a couch to run around to avoid getting hurt by a very angry resident. I cannot imagine working in a nursing home, It takes an extraordinary person to work in a care facility. God bless all of you caregivers. Thank You!


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