Dealing with challenging behavior during home health visits

Home health workers are critical in providing supportive care to individuals who require assistance with their daily activities. While providing care, home health workers may encounter clients with challenging behaviors. These behaviors can be difficult to manage, and if not appropriately addressed, they can impact the quality of care provided and the health and well-being of both the client and the home health worker. Therefore, home health workers must understand challenging behaviors and strategies for managing them effectively and safely.

Home health workers may encounter various challenging behaviors when providing care to clients. These behaviors can range from verbal aggression to physical aggression and wandering to hoarding. Understanding the types of problematic behaviors and different management methods to optimize care is essential. Home care workers should be educated on proper attention and management techniques for delivering excellent care and a properly executed safety and management plan. In this blog, we’ll go over eight common types of challenging patient behavior, and then discuss multiple strategies to deal with those behaviors.

Eight challenging behaviors home health caregivers may encounter

Eight of the most common types of challenging patient behaviors that nurses and caregivers may have to navigate are:

• Aggression
• Resistance to Care
• Wandering
• Hoarding
• Sundowning
• Refusing Food or Fluids
• Incontinence
• Sleep Disturbances

1. Aggression is one of the most common challenging behaviors home health workers encounter. Aggression can be physical, such as hitting, kicking, or pushing, or verbal, such as yelling, cursing, or threatening behavior. Clients with dementia or other cognitive impairments may exhibit aggression due to confusion or frustration. Some clients may also show aggression due to pain or discomfort.

2. Resistance to care is another type of challenging behavior that home health workers may encounter. Clients may resist care activities such as bathing, dressing, or taking medication. Resistance may be due to fear, embarrassment, or not understanding the need for these activities. Clients may also resist following a treatment plan, leading to complications and declining health.

3. Wandering can be common with clients who have dementia or other cognitive impairments, which can be dangerous and challenging to manage. Wandering can lead to falls, injuries, or getting lost. Home health workers must take appropriate measures to ensure the safety of clients who wander, such as implementing safety measures, providing supervision, or using GPS tracking devices.

4. Hoarding is another type of challenging behavior that home health workers may encounter. Clients may hoard items or refuse to let home health workers clean or remove clutter from homes. Hoarding can lead to unsanitary conditions and a risk of fall injury tripping over clutter.

5. Sundowning refers to increased confusion, restlessness, or agitation in clients with dementia or other cognitive impairments during the late afternoon or evening hours. Sundowning can be challenging for home health workers to manage, as it may occur unexpectedly and can be difficult to predict.

6. Food resistance is when clients refuse to eat or drink, leading to dehydration or malnutrition. Refusing food or fluids may be due to a loss of appetite, difficulty swallowing, or a lack of interest in food or drink.

7. Incontinent clients may require assistance with toileting, which can be uncomfortable or embarrassing for some clients. Incontinence can be challenging for home health workers to manage, as it may require frequent clothing or bedding and specialized equipment changes.

8. Sleep difficulties occur when clients have difficulty sleeping, leading to fatigue, irritability, or other issues. Sleep disturbances may be due to pain, discomfort, anxiety, or other factors. Home health workers may need to work with clients and their healthcare providers to identify the underlying cause of sleep disturbances and implement appropriate interventions.

Seven effective strategies to handle these behaviors

The following seven strategies can help home health care staff manage the aforementioned challenging behaviors in the home. These strategies are in addition to early collaboration and communication with other healthcare team members to develop a safety plan for optimal care.

• Practicing Empathy
• Using positive reinforcement
• Identify triggers for clients
• Learning and practicing active listening
• Learn and use distraction techniques
• Collaborate with other healthcare professionals for support and management
• Practicing self-care

1. Empathy – One of the most critical strategies for managing challenging behaviors is to practice empathy. Practicing empathy means putting yourself in the client’s shoes and trying to understand their perspective. Managing overwhelming or frustrating feelings can be difficult when clients are upset or agitated. However, pausing and considering the client’s feelings can help you respond more effectively. 
2. Positive reinforcement – A helpful tool for shaping behavior. When clients exhibit positive behaviors, it is important to acknowledge and reinforce these actions. This can be as simple as offering praise or encouragement. Home healthcare workers can help clients feel more confident and motivated to continue making progress by focusing on positive behaviors.
3. Identifying triggers – This is essential for managing challenging behaviors. Triggers are the underlying causes that can lead to problematic behaviors. For example, a client may become agitated due to a loud noise or an uncomfortable position. By identifying triggers, home healthcare workers can take steps to prevent or mitigate challenging behaviors. Identifying triggers may involve adjusting the client’s environment, modifying the care plan, or providing additional support.
4. Distraction techniques – These techniques can be helpful when clients are experiencing problematic behaviors. These techniques involve redirecting the client’s attention to something positive or engaging. For example, a home healthcare worker might suggest listening to music or building a puzzle if a client is agitated. By focusing on a positive activity, clients can calm down and feel more relaxed.
5. Active listening – An often overlooked yet essential skill for managing challenging behaviors. Active listening involves giving the client your full attention and acknowledging their feelings. When clients are upset or frustrated, listening and validating their emotions can be helpful. This can help them feel heard and understood, which may help to de-escalate difficult behaviors.
6. Collaborating – Working with other care providers is an important strategy for managing challenging behaviors. Home healthcare workers may need to work closely with other care team members, such as physicians, therapists, or social workers, to address complex issues. By collaborating with other care providers, home healthcare workers can develop more effective care plans that meet each client’s unique needs, which should simultaneously increase home health care patient engagement while strengthening professional relationships.
7. Self-Care – Finally, home healthcare workers need to practice self-care. Providing care to clients with challenging behaviors can be emotionally and physically taxing. It is important to take time to recharge and prioritize your well-being. This may involve taking breaks, seeking support from colleagues or supervisors, or engaging in self-care activities such as exercise or meditation.

Summary

In conclusion, managing challenging behaviors in home health care requires a compassionate and holistic approach. By practicing empathy, using positive reinforcement, identifying triggers, using distraction techniques, practicing active listening, collaborating with other care providers, and prioritizing self-care, home healthcare workers can provide effective care to clients with a wide range of needs.

Educating home care workers on management techniques for dealing with challenging behaviors can optimize client outcomes in addition to excellent safety surveillance and planning for the home care provider to support the client in their home.

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