How to deal with verbally abusive client

[Baconsandwich33]

It is likely mental health issues and I do sympathise. I work in domiciliary care and we have a lady in her late 60s that I don't go to very often just because I don't usually work in that area. She has her team of 3/4 regular staff who know exactly how she likes things.
If you do not complete her personal care and tasks in the exact manner she likes them she will literally scream at you that you are fucking useless, you don't know what you're doing, you should know how to do this, and will just shout "For fucks sake!!" Or similar over and over.
Then in the next breath she will be chatting to you about your life and so on. She can flip suddenly.
She has no mental health issues listed on her care plan but it surely must be.
Unfortunately as I rarely go (I mean a couple of times a year) I can sometimes forget the particularities, whereas other carers go daily.
I do double check with her verbally to make sure, which just annoys her even further unfortunately.
I never retaliate and I just calmly say 'ok' , 'I apologise ' and so on.
I always document when she has been abusive.
The regular carers seem to have a fantastic relationship with her but the office are well aware of her behaviour with other carers. I understand it is also an anxiety/control thing.
I go out of my way not to attend this care visit. It is a shame as when she is calm she can be polite and you can have a conversation with her. Unfortunately because I'm nervous when I'm there it just makes me more prone to being clumsy which angers her further.
Just appreciate any advice should I attend to this woman in the future.

The lady appears to have full capacity as she is competent in managing her own finances and medical appointments etc. Still.

Have you asked her other carers how might be the best way to respond?

I would be tempted to go with 'Do not swear at me, I am trying to help you'. Is there scope to walk into another room if she's ranting?

In all honesty, I would refuse to go... but realise that's an idealistic viewpoint.

I did ask the office to not send me if possible but they continued to.
They said 'just make her a drink' which I did, but it's not a foolproof solution.
Maybe I should try to be more firm with her. I do experience similar behaviour from clients with dementia but it never bothers me as much as it's down to a lack of capacity in most cases.
I will just try to be firmer.

Just put it down to mental health issues, which it most likely is, and try not to take it personally.

Yeah, that's all I can do I suppose! If I were going regularly she'd possibly be more at ease and I'd be more familiar with her routine.

So why do you think that mental health is less of a reason than dementia? You've also got to be aware how the aging brain changes personality and a lot of older people won't have had access to any diagnosis, so if they were on the spectrum etc it won't be identified.

Just wanted to say that I am sorry you have to experience this when you are jus
trying to a. Just do your job and b. Help her.

💐

No, I'm not certain it's mental health, there's nothing on the care plan so it might not be. She's been with us for a few years now. It likely is but I'm not certain as to what. However if she has gone without a diagnosis that is a shame because it could have helped a lot.
Thank you. I know it is likely not personal but it is hard sometimes to deal with!

Would it help if there was a written process of what she likes? I know it is totally different, but a lot of the children in the hospitals we visit have their own personal 'rules' written on the door to their rooms e.g. please call me by 'x' name; please give me 'x' notice of procedures, no more than 2 healthcare professionals in the room at any one time, please talk to my parents about medical stuff outside my room etc.

If you suspect it's about anxiety/control, and her normal carers have a good relationship with her, maybe they could help her write up a daily carers plan? I'm afraid I don't know anything about caring responsibilities but, maybe it could be something like the order in which things have to take place to make her feel at ease?

My mum has recently started having carers going into her home, she didn't hit it off at all with the company that was providing care initially - she was vulnerable and felt pretty embarrassed at having to have intimate care provided and I think a massive part of the problem was that the people going in to her were often changing and obviously under time constraints so didn't really stop to ask her what she wanted or how she wanted things doing, they just rushed her. She was pretty awful to some of them - she did swear at times and I had to have a pretty strong conversation with her about it.

In her case she ended up going back into hospital and when she came back out a different company was assigned to her - she has had no issues at all with the new carers, but then she is seeing the same faces so has built a relationship with them. They are also doing more care for her, but the important part is that they are listening to her so they are getting the things she likes right. A basic example was her cup of tea - she's pretty fussy and only has a splash of milk, no one from the first company asked her how she drank it, or even queried that she wasn't drinking the ones they were making her. They just kept serving up what was essentially luke warm milk to her! When the new company team first came out the first thing they asked was how she liked hot drinks and they make sure that it's ok for her every time.

I don't have any answers at all but I know with my mum the feeling that she is being listened to is really important - she doesn't want carers in her home, she wants to be independent but unfortunately that is just impossible at the moment. I know it's hard if she's stroppy when you first go in but is there any chance you can just be honest with her and tell her that you feel intimated because you know you don't always do things in the way she wants you to? I know as bolshy as my mum can be, she'd be horrified to think that anyone was upset or scared of her - in fact a lot of her behaviour towards others is coming from her recognising how scared and vulnerable she is feeling.

If all else fails then maybe asking your manager, or a colleague who has a good relationship with her to speak to her and/or family to see if they can identify actually what is driving her behaviour?

I would approach it in an old-school matron/school ma’am type of way. In a firm but kind voice - “Now I’m sorry Anne, you don’t need to swear at me, I’m not always here to know how you like things… just be patient please. I’m trying to help you in the best way I can. If you want me to do something different just ask me nicely please. There’s no need to shout or get worked up is there? Now let’s start again….”

I'd make a point of noting down her routine the next time you go (if you do). Try not to take the shouting personally. It's likely that all of her carers have had the same from her in the process of getting to know her, you obviously won't have the same relationship and knowledge as her regulars.
I've had my fair share of being shouted at during my career. I tend to let people wear themselves out ranting and when they finally stop I ask what they would like me to do/how we should move forward. It's also totally fine to tell someone not to shout at you.

Ah, I have been this patient and you’re right, @Baconsandwich33 - it’s anxiety and control (for whatever underlying reasons). I’d been nursing for 12 years when I suddenly, instantly became a highly dependent pain-wracked inpatient after an RTA. Luckily I was treated in my own hospital and all my nurse friends did most of the looking after me, but OMG was I picky and demanding!?!? A total shocker, seriously, even though I and they knew why I was doing it - anxiety about pain and trying to maintain some semblance of control when I had none.

Unfortunately because I'm nervous when I'm there it just makes me more prone to being clumsy which angers her further.

Again, been there, both as a patient and as a nurse! Always hated looking after nurses or doctors, people who might know more than me. And there was one useless agency nurse on night duty who had no idea about my drips and drains and she absolutely terrified me, I couldn’t sleep in case she accidentally killed me.

Sorry, don’t know what to advise though, apart from maybe writing down everything she likes you to do, rather than keep forgetting because you don’t see her very often. Or take her head-on next time as you walk through the door, be kind and firm and say you understand she likes things done in a certain way, so to make this experience more pleasant for you both, you will do as she asks and in turn she will not berate you for not being the people she’s accustomed to.

Thank you for your advice, it will help a lot.

Maybe a more detailed care plan could be produced whereby all carers (particularly the regular ones) note down her specific nuances in order to help all carers assigned to her.

I wouldn't apologize if you're being a respectful carer and doing things right - even if it's not her 'right' especially if she hasn't told you.

Care is thankless work and you don't deserve abuse. Do things professionally, ask her what she wants, but if she is rude and abusive she doesn't get her carer that day. Tell her once to be nice and if not ensure she is safe and leave.

People have to learn care workers are people too, and they don't get to get away with treating you like shit.

I'd refuse to go.