Keep Your Cool
Don't Reward Seniors' Angry Outbursts
"Sticks and stones may break my bones, but words will never hurt me."
Whoever thought of that little ditty didn't have the opportunity to meet my very first client. She was 99 years old, 88 pounds soaking wet and mad as hell. She called me every name from "green" to "stupid" and threw things at me. (For a more complete list of names I have been called, corner me at a conference and I will tell you privately.)
I wanted to do well at my first social work job and I was afraid to visit my client at her home. She had macular degeneration and a personality disorder. She ended up being my client for four years. She even said thank you and I love you. And to tell the truth, while I never loved this woman, I have much to thank her for. She made me a better social worker and person. She was the overbearing bearer of an important caregiving lesson. This is what I learned from Ms. D.
What not to do when dealing with angry behavior
Do not take it personally. She was not mad at me. Rather, she was mad about what I represented-I was there because she could no longer manage on her own.
Do not let the outburst result in a reward for the person acting out. This was a major mistake of mine. I was so afraid of her angry outbursts I lost my own boundaries as a person and social worker. A few examples: I took out her trash and defrosted the fridge! This was not in my job description and probably was one reason she resisted in-home help-she had me!
Do not try to "fix" the angry senior. In the case of Ms. D, I was not such a brilliant therapist that I could help facilitate a complete change in personality at her age. I was not going to make her nice, nor was I going to help her transition gracefully into increased dependence. Rather, I focused on altering our interactions so I could help her with the tasks that must be done, such as helping pay her bills and arranging transportation.
How to handle angry outbursts
Stay calm. Do not let them goad you into similar bad behavior. I responded in a very even tone of voice and refused to react to my client's strong harsh words. . This exaggerated, calm behavior gave her nothing to feed off and actually calmed me down. It will seem strange when you do it-it is odd for one person to be screaming and the other to be calm and non-reacting. However, it works.
Keep your boundaries. Have a clear idea of what you will and will not do. Have a clear idea about the behavior you will or will not tolerate and what you will do as a result of it. If they are alert, communicate these boundaries to them.
If they are confused because of their illness, discuss acceptable behavior but in a simple way and only when misbehavior has occurred. In Ms. D's case, I tolerated her being angry - she had a right to her feelings. However, I would not tolerate personal insults and certainly not physical abuse. If she insulted me or got out of hand, I would calmly and swiftly leave. If you are an at-home caregiver, you can leave the room. I remember one time Ms. D. was starting to lose it and began to call me names. Then she suddenly stopped. "I cannot call you that," she said. "You are the only one who helps me." She didn't say she felt she shouldn't call me names, only that she knew I would not tolerate it.
Know when to disengage, ranging from exiting the room to ending the relationship if you are a professional caregiver. If you're caregiving at home, arrange for a respite: Hire a care manager. One reason I'm a good social worker is that I know I cannot work with or help everyone. Some clients were too abusive or too disturbed for me to work with them. I was able to identify that and move on to the next person whom I could help.
Take care of yourself. I rewarded myself after every visit with Ms. D with a nice lunch or an expensive cup of coffee. I scheduled visits with her on Mondays before lunch, so I could relax afterward. You do the same.