Caring for Difficult Clients: A Case Study in Behavioral Modification by Care Partners

By Pamela D. Wilson, CSA, MS, BS/BA, CG
Introduction:

Client care situations typically involve various medical and non-medical providers (hereafter referred to as care partners), family caregivers or a responsible legal party who may be a power of attorney, guardian or conservator.  In many cases, care partners work independently to set their own goals for the care of the client without communicating with family caregivers or the responsible legal party.  When care situations are complex, heightened sensitivity to professional conduct and personal ethics supports teamwork and problem resolution by care partners.  Professionalism is especially relevant in serving care recipients diagnosed with dementia, a brain injury or other cognitive disorder who may appear capable to make their own decisions but who have a responsible legal party acting in the role of decision maker.Caring for difficult clients

When care partners are involved, there may be guidelines or parameters for the services provided through Medicare, Medicaid or other federal or state regulations.  If a family caregiver is the responsible legal party, inexperience in navigating caregiving and the health care system often results in significant frustration.  Family caregivers often feel that care partners lack understanding and compassion and that care partners fail to support the needs of the family and the care recipient.

Many family caregivers lack conflict resolution, problem solving and planning skills.  Family members are easily intimidated in situations of care.  As a result they fail to ask questions or to provide important information that might support planning for a loved one’s care.  Instead family caregivers wait for information from care partners and then are shocked and angry when Medicare fails to pay for care needs.  Other common surprises include notice from care partners that a loved one will be discharged from the hospital or nursing home to return home.

If there is a legally responsible party (a family caregiver or professional) who understands the duties and responsibilities it may be surprising that this role is rarely understood or acknowledged by care partners.   Care partners fail to question whether a client has the ability to make decisions for him or herself.  The role and responsibilities of power of attorney, guardian or conservator are not commonly understood or acknowledged by care partners.  Incapacitated clients are requested to sign hospital and care admission forms when they have no legal capacity to do so.

Medicare, Medicaid, federal and state regulations guide care situations:

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