You can train aides to handle difficult clients

Experts teach behavior management techniques

The Care Extender Model of Boston Senior Home Care depends on a clinical specialist, or expert, to train homemakers to work more effectively with difficult clients. International Health Specialists, a vendor of Boston Senior Home Care, has provided the training and the homemakers to deal with clients with mental health problems.

Many aides know how to do a task, but not how to deal with the difficult client in a way that makes their job easier and makes it more pleasant for the client, says Beverly Moore, RN. Moore is a family therapist, psychiatric nurse, and educator with International Health.

"We teach mental health behavior management so that people are able to problem-solve and understand and manage the behaviors they see in the home from elders," she says.

The training begins with a 15-hour behavior management course. Then the aides working in the supportive home care aide program meet in teams once a month to discuss cases and strategies for managing behaviors. Assisting in these meetings is a field supervisor who has master’s-level training in mental health.

"The training gives the homemakers confidence, especially with Alzheimer’s behavior management, that they can handle some of the behaviors that show up." Some of these behaviors include:

Resistance to care. "They are vehemently independent and don’t want to admit that they want help," says Moore.

Agitation. "They may have an anxiety disorder or get fearful because of confusion."

Mood disorders. "A person may be so depressed they just say, I did it,’ when referring to activities such as taking a bath or eating. But you can tell that they haven’t done them."

Personality disorders. "This is probably the most aggravating disorder because personalities don’t change," says Moore.


Aggressive behavior.

The training teaches care extenders to set limits on disorderly behavior while not upsetting the client. The aides also are taught negotiation skills. "For example, they were told, if you have a very controlling client allow them to identify the time of day you will come. Maybe they want you to come at 8 a.m., but you can’t make it that early. Tell them, OK. I can come in the morning, but I can’t make it 8 a.m. How about 10 a.m.?’" says Linda S. George, RN, CNA, MA, CMC, associate director of Boston Senior Home Care. "The care extenders are told they must be consistent and always do what they said they would."

Care extenders also were told a little about the history of the client they were to serve, George notes, but not about any issues that would be considered confidential. "Care extenders were just told the client’s history in home care. For example, they might be told that a client has a habit of throwing homemakers out of his house or accusing them of stealing. It helps the care extenders prepare, if they know what behaviors to expect."

[Editor’s note: For more information about International Health Specialists’ training in mental health behavior management, call Beverly Moore at (617) 328-3440.]