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I used to work in hospice and while some of my patients were gravely ill others were not as sick and I encountered patients who, like yours, were unsure of what I could do for them. Having staff in their home was a new experience and they didn't really know what to do with me. When this occurred I would start by just getting acquainted with the patient. Sitting with them and talking. I'd ask about their family, or I'd compliment their home, I'd pick up framed photos and take them over the patient and ask who was in the picture. This is building rapport and is very effective.

If a patient actually refuses your help don't force it on them. After your shift is over contact your agency and discuss it with them.

However, if you see the patient struggling to get out of a chair for example don't ask if you can help just go to his/her side and lightly take his/her arm and give a boost. Once they're up back off.

And ask them: "What can I do for you?" as opposed to "Can I do anything to help you?" because the answer will always be no. If you see something that could use some attention jump in. If the area around where the patient sleeps or sits during the day is a mess straighten it up, get it organized. Wipe down the table. Just spruce it up a bit.

You don't need to talk the whole time you're there. Sometimes our patients feel as if they have to entertain us as if we were guests but this is exhausting for the patient so don't feel like you have to fill the void with chatter. And when you do chat keep it about the patient. Don't talk about your family or your kids. That can come later or when the patient asks.

Other un-intrusive ways of helping without having to be told is fixing a snack for your patient. Don't just dump some crackers and a hunk of cheese on a plate. Make it look nice. For example, slice the cheese into little bite sized pieces, fan out 2 or 3 crackers and if you can find a piece of fruit garnish the plate with a little strawberry or some blueberries or something like that. Make it pretty. Special. Put ice in the drink. Fold a napkin lengthwise and serve.

You get the idea. These are little things you can do that aren't overstepping your patient's boundaries but will build rapport and make the patient feel special. Someone obviously thinks your patient needs help or you wouldn't be there. Take it slowly, let the patient get used to you. Always keep one eye on the patient so you can see where he/she might need help once he/she is comfortable with you.
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Can you give a little more detail and some examples?
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