Tips needed on dealing with combative patients. Any suggestions?

Hi MrKev.

The first thing that does worry me is that it was left to family members to disclose to you that your client has been diagnosed with these additional disorders/illnesses - why in heaven's name wasn't that included in his initial assessment?

We have a box on our Daily Notes sheet that usually stays blank, but for you should be ticked in bold! - "Is a Review needed?" Answer: Yes, care plan should be amended in line with information about client's mental health.

Meanwhile, though. What tasks or routines in his existing care plan seem to be triggering resistance or hostility?

MrKev, my hat's off to you for tackling care of this challenging patient.   First, some questions:

1.   Is this patient getting psychiatric treatment, at any level?  I assume he's not in a professional facility but lives at home?  

2.   Is he medicated, by a medical doctor working in the mental health field?

3.   With Bipolar and MPD (assuming you're referring to Multiple Personality Disorder), if he's not medicated, I wonder if you can even interact with him on a rational behavior (depending on the intensity of his problems).  

4.   My sister was a psych nurse, working in a mental hospital until a Republican governor closed it down, and the facility was slated for commercial development.   A lot of good people lost their jobs.   And these were trained nurses.   The depth of their knowledge and experience was so impressive.

I found the psychiatric exam prep book after my sister died, and was overwhelmed at the extent of the training required.   

There's so much complexity to psych care.     If I were in your situation, I'd try to find some way to interact with the pros to get insights into your client's behavior.   Or try to locate mental health support groups at the hospitals that treat these patients.     I also would contact some local psych facilities, or even practices, to ask for suggestions from them.

God bless you for continuing to be this person's caregiver.
If a situation arises where you cannot deflect the anger he's focusing on you, that's when it's time to call 911 for the police and paramedics to handle it.
I don't care what mental conditions a client may have. Be it Alzheimer's/dementia, bi-polar, OCD, schizophrenia, whatever. It's never acceptable for any caregiver's safety to be put at risk. That can never be tolerated. If a homecare situation becomes unsafe for the caregiver, that's when the client belongs in a care facility.
When your client gets out of control leave and call 911.

This person is in his own home?

Since your a man, probably best suited for this job. But if this man is in a home setting he probably needs to be in a Psychic facility. If he becomes violent, then he needs to be someplace else. There is no way any aide should put up with this. Especially a woman. He really has too much, mentally, going on.

But if ur willing to stick it out, read up on all his problems. But I would make sure that family is aware if he gets violent. This is not exceptable.

Mr Kev, if you are mostly able to deflect this guy’s anger, it may be more what you can teach us rather than what our posters can teach you! I assume from your profile that you are reading around OCD, MPD and Bipolar, and know about support groups that are specific for those things. Our posters have great respect for the Teepa Snow videos on the net., which are dementia oriented. I’ve found that they are quite slow going, but the pace and content is clearly very helpful for many many people.

In general, I’d suggest the cup of tea (or coffee) when defection fails. As in ‘I’m just going to make a cup of coffee. Would you like one? I hope that you’ll feel a bit better when I come back’. As a carer, you can’t actually leave! Best wishes, Margaret

I wouldn’t stay in this position. Start looking to see what other jobs are available. When you find something suitable, give notice to your present employer. Life is too short to be miserable.

There is a demand for dedicated caregivers. You can easily find another job, perhaps that isn’t quite as demanding or challenging. Why stay in a job that you are questioning?

I am sure that you don’t expect to have a job where everything is ‘perfect’ because there is no such thing, but if you took the time to create an account to ask this question, you are most likely unnerved by your client.

Don’t continue to waste time going to a job that you aren’t satisfied with. As time goes by, caregiving becomes more challenging, especially for clients like you are caring for.

Give us more information. What do you like about this job? What do you least like about it?

Wishing you all the best.

You have a challenging assignment. Generally speaking all bets are off with an Alzheimer/dementia patient regardless of what other issues they may have.

This book is helpful
The 36-Hour Day: A Family Guide to Caring for People Who Have Alzheimer Disease, Related Dementias, and Memory Loss
by Nancy L. Mace MA (Author), Peter V. Rabins MD MPH (Author)

Also, Look up videos on YouTube by Teepa Snow. She has a positive approach.