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Refusing help
I have a client, “Ramona” who currently lives in an independent cottage housing at a facility. She’s been living there alone for almost 8 years and her daughters both live in other states. About 2 months ago, Ramona’s doctor told her that it’s time to consider moving to the facility’s assisted living since she is non-compliant with taking her medication as scheduled, she no longer leaves her cottage, is not taking out her trash etc. She told the doctor absolutely not. Her daughters had a conversation with the facility’s social worker about it and they came to the agreement that Ramona would be able to stay in her cottage as long as she received some help from a home health agency (enter me).
Ramona perceives herself as fiercely independent, and in knowing this her daughters knew she would refuse help from a home health agency. They came up with the idea to tell their mom that there would be a “nursing student” coming 3 days a week to learn bed side manner and nursing skills from her. (Ramona’s occupation was a librarian/teacher and she loved a certain university in her town where she grew up, so the therapeutic fib is that the nursing student is from that university).
It was working so well the first several weeks, the only problem being that Ramona was not taking her medication on the days when the nursing student was not there. The daughters were made aware several times, and they said they are not overly concerned nor is her physician because the missed doses are not affecting her lab tests at all. The last 2 weeks, Ramona has been refusing to let the nursing student in her door, and screams that she doesn’t need help. The nursing student is excellent at redirecting and getting Ramona to let her in, but it is no longer working. The nursing student also noted that Ramona is wearing dirty clothes and if/when she is able to get her to change, she will go back into her bedroom after about 10 minutes of wearing the clean clothes and put her dirty ones back on. She refuses to let the nursing student to do her laundry, change her sheets, bathe her, help prepare her meals, or take out her trash.
I went to visit Ramona and the “student” and posed as the nursing student’s school supervisor to do a site visit. In knowing the problematic area’s the student was having, I told Ramona that the new semester starts next week and gave her a list of area’s where the student needed to focus on–i.e. learning to bathe someone, learning how to brush someones teeth properly, learning simple home cleaning techniques like taking out the trash. Ramona said she did not wish to participate in having the student learn those things with her, and I instead asked if she could then show her how to properly do them rather than the student do them to/for her. She said no. While I was there, I noticed Ramona was wearing dirty pants and there was a strong foul body odor coming from her. I tried several different approaches in trying to see if she would comply with allowing the nursing student to assist her with personal hygiene, with no avail. I then directed the conversation to talk about the nursing students hours of requirements and said that she will only be successful if she has Ramona’s help, and that if she keeps dismissing her she will be at risk of failing the class. She said she didn’t need the help anyway and to have the nursing student go to another persons house who needs the help.
I called Ramona’s daughter after my visit to discuss the concerns I had with her mother not bathing and the potential future health risks associated with that. She asked if calling her mom to remind her that she needs to accept this help or else she’ll be asked to move to the assisted living could help, and I said that it is worth a shot to see if it would work. The daughter also said that if she continues to refuse help and is at risk for being ‘kicked out of her cottage by the facility’, the only next logical step would be to move her into the assisted living so that there is someone there ensuring she is showering, eating properly and taking her medication. I told her In the meantime, I would put together a “daily check list” of things Ramona needs to do so that she still feels that she is independent, and the nursing student will also check off that she is doing those things, and see if that works.
Today, the student called to tell me that Ramona sent her away again. I’m not sure what more to do, and I don’t want the family to feel like they just need to settle and place her in assisted living. Any other help you can offer would be MUCH appreciated!! There’s more to the story, as there always is, but this is pretty much the gist.
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