My “Impossible” Client

Grumpy Man

by Joan Blumenfeld, MS, LPC

I once had a client — let’s call him Jim, though it’s not his given name — who seemed impossible to handle.

He was verbally abusive and often violent.  Though he was an intelligent man who could be witty and charming when so inclined, Jim was also suffering from dementia, diabetes and mobility problems, and these issues seemed to make each day an angry challenge for him.

Conflict wasn’t a new situation for him, though:  Jim’s life history was rife with it.  He was a full-blown alcoholic until he was finally confined to a hospital detox unit.  He had alienated his children so irrevocably that they wanted nothing to do with him.  Yet, in spite of his nasty behaviors, he somehow managed to keep many of us invested in him.

When I was asked to manage Jim’s care, he was already living in a poorly run nursing home.  There were near-constant battles between him and his aides.  They would enter Jim’s physical space without warning and without ever bothering to explain why they were there.  They handled him roughly.  They demanded he eat, sleep, toilet and bathe on their rushed schedules.  Their faces and body language always showed fear and anger.  They were clearly not trained in dementia work and their actions positively invited resistance.

They provoked, and Jim retaliated. He spit, hit, kicked, screamed, cursed — and worse!  The police even had to be called when Jim lashed out at other residents.

But appearances can be deceiving.  In spite of all Jim’s problems, he really didn’t need the level of care the nursing home was supposed to be providing.  Assisted living was actually far more suited to his needs.

So I approached the director of a first-rate facility to ask if Jim could transfer there.  I knew the director well enough to be honest about my “impossible” client, and I offered to provide a private duty aide to stay with him to smooth the transition.

Much to my surprise and satisfaction, the director accepted Jim as a resident.  Instead of living in an unattractive, poorly staffed institutional environment, Jim moved to a handsome, homey studio apartment with a private bathroom and a lovely view.  Meaningful activities were available, and the staff was well trained in dementia care.

This story has a happy ending:  Jim lived in the assisted-living facility for the next few years.  It was his home until he died at the age of 91.  He won no awards for Mr. Charm, this is true.  But he never ever had another violent incident.

Pearl of wisdom:  Training matters!  ”Bad” behavior can be provoked by inappropriate interventions from poorly prepared aides.  Check out the commitment to staff training at any facility you’re considering for yourself or your loved ones.

Joan Blumenfeld is a Geriatric Care Manager based in Fairfield County, Connecticut. For information visit her web site  © 2010 Joan Blumenfeld.

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