10 Tips for Dealing with Manipulative Residents

1. Define clear expectations

Many residents cannot cognitively process or remember what we have told them. However, residents who are manipulative DO display an ability or have an awareness of their potential to control others. For instance, some will act out especially when there are new staff or only on particular shifts.

2. Communicate expectations positively and firmly

The KEY is to be consistent on every shift. This is usually where the break down occurs. Without this there is little chance of success.

3. Limit only those behaviors that negatively impact the well-being of the resident or others

For example, hitting others or being a danger to self.

4. Make sure the limits are in the residents’s best interests and are not punitive

For instance, even if a behavior is socially inappropriate or offensive to staff, it does not always warrant care planned intervention. Allow the resident to behave as they choose as much as possible.

5. Give brief rationale for limits

Offer a brief rationale for the limit, but do not engage in a debate about fairness or justification. Debating rarely, if ever, helps the situation.

6. Define the consequences of exceeding the limit

Consequences are quite limited in a long term care setting. But ultimately, a resident will be discharge to another setting if the behavior is a threat to the personal safety of others.

7. Keep discussions small

Hold all discussions related to limit setting on a one-to-one basis (or small audience). This limits the opportunity for the resident to “grandstand” and engage others in whether or not the limit is fair.

8. Communicate to staff

Good communication between staff is essential to consistency. Make sure all staff members on all shifts understand the limit and consequences communicated to the resident.

9. Be consistent

Residents will inevitably test the limits that are set. Consistency is key.

10. Provide encouragement

Provide encouragement each and every time the resident is able to meet the limit.

June 17, 2019

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