Need Advice-Willful fecal incontinence

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Hello everyone, I am new to this site. I was searching the internet looking for advice for a client and ended up here.
I work at a Residential Care Facility, we specialize in clients who have failed placement at other facilities due to behavior issues. I have a client in his 60's, he is big and burly with a deep booming voice. This client refuses to sit on the toilet to have a bowel movement, the caregivers use a sit to stand to stand him up as he also refuses to stand. He will yell at the care givers, call them names, curse at them and demand he be changed. As soon as the CG's get him up in the sit to stand, get his depends and pants down he will defecate on the floor in his room, CG's will clean him up, get him back in his chair or bed and he will demand to be changed again doing the same thing. He refuses to sit on the toilet or let them change him over the toilet or even in the bathroom. I have advised them at this point to verbally disengage from him. To clean him up the best they can then explain to him that they will return when he can treat them with respect and can comply with care. It is so hard for them to sit there and clean him up while he is cursing at them, calling them names etc. He is not unaware of his actions, he will purposefully do this. If they do not clean him to his specifications he will follow them around the facility cursing at them in his booming voice, upsetting the other residents. Does anyone have any advice for me. I am at my wits end.

 

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Wow that's a tough one given you and your co workers jobs. I would recommend a mental health facility. And they mak have to catheterize him and let nature take its course. I do know if a patient is abusive you do have rights to restrain them and force them into a position where they are not harmful to anyone. Look into your laws there and take advantage of them when you can.

 

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I agree, that is a tuff one. If this person has mental retardation, you can get help from your state office in Dept of Health & Mental Retardation. Sadly, but in the US, MR population has more resources than someone with just mental illness. The most challenging population to work with or assist, is people with both MR & MI. I hate labels, but they are needed. Being a caregiver is a very tough low paying job, but is personally rewarding, hang in there. It sounds like you need to get a behavioral specialist involved, maybe through the state or even a local mental health center. If he is already seeing a psychiatrist, maybe they can recommend someone. Good luck,
Lee

 

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Cattle prod??

Sorry, just seems such a waste for caregivers have to deal with such.

 

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I don't think there is an easy response. So much will depend on that man's special needs. I don't know if it is early onset dementia or some kind of mental illness. It may be helpful to bring up a discussion with a supervisor or as part of a team discussion. If he threatening and verbally abusive, it may be important to determine if he is appropriate for the facility. Also depending on the facility, you may need to get him stable in other areas first. The only other option to look at is to consider if standing is the issue. If standing is the issue you may find other ways to support and change him. Also find out if continence is a goal for him. If it is not you may not get anywhere trying to get him to use the toilet.

 

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Sounds like the care of the other stable patients is at risk over this one overly unruly man. I would file a report for his doctors to release him to his family for another facility before you start to loose other patients.

 

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Definitely needs a psychiatric assessment by a Psychiatrist that specialises in geriatric needs. Sounds like he needs some medication to calm his unruly behaviour. Sounds like he is a Bipolar Effective Disorder/ Manic Depressive Disorder where they swing from highs to lows. Looks like he's favouring the high side and becoming unruly. Or he probably is just a nasty and bitter old man who needs to be put in his place. Pooing on the floor is disgusting and sounds like dementia but some grouse old people who think society owes them do the same thing. Nothing like putting a bucket in front of them and say clean it up. If he can walk around and abuse you guys and feed himself then he can make an attempt to clean the floor he shat on. AND I would give him nothing until he made an attempt to clean it up. Only water.

 

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Wow CMcK, really!
All people have rights, that would be against the law, inhumane, abuse & neglect, & much more. We don't even know what his diagnoses are, his medication's, previous soc / med / family / psych / behav / educ / HX is / was. It could be learned behavior as a result of being in an overcrowded institution, where there was shortage in staffing and abuse to patients. This is one of the major reasons some states were forced to deinstitutionalize and integrate / mainstream those individuals into our normal everyday communities. I for one, am very proud we did. I don't intend to offend anyone, but we all should be treated with dignity, respect, good will, love, and so much more.

 

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Why are you not sedating him?

 

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I'm new to this site & thought I had found a safe place to come to for reasonable support, opinions, and experience; but now I'm s/w confused and a little disappointed. No offense to you Jeffswet, or anyone else here, but do you think we should really withhold anyone's food or even sedate them, just b/c we don't like certain behavior's. If so, do we do this to anyone or everyone that has behaviors we don't like? Who gets to decide this? What if people around us thought they didn't like to have to deal with our incontinence, should they sedate us or withhold food, or have us institutionalized?

I do want and need support for my fecal incontinence, but when I feel there's no hope for me & especially when I'm already down and very depressed, it hurts to read such negative advice. For some people, it wouldn't take much to send them over the edge. Just please keep that in mind when posting.

 

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Lee,

Perhaps instead of wasting your time typing what you did, and my time because I had to read it and try to figure out what you were on about, you could better read the entire thread. I did NOT suggest withholding food, nor do I agree with doing so. What I did say, in my ONE LINE response was to ASK why they were not sedating this man. It was a QUESTION. Please take the time, NOW, and review the thread. You clearly have NOT worked with difficult people before. READ the description of what this fellow's behavior has been. I'm not saying he should be ill-treated; what I would say is that the caregivers should be better treated. I have worked with people who were physically disabled who behaved this way, (though not to this extreme)and eventually their behavior disqualified them for the care we were providing. This guy may not have had the ability to know what he was doing, but that does not obligate ANYONE to provide the care he requires. Behavior is learned and can be unlearned. Management strategies that work and that many times are needed, including sedation are better than not receiving care at all.
If you don't have the mental capacity to handle this big bad world, please don't try shaming others for what you don't know how to cope with.

 

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Thank you everyone for your thoughts. We are a behavior health facility. We take on clients who have failed previous placements due to behavior issues.
We cannot sedate him or chemically/physically restrain him. We can give PRN anxiety meds if other redirections or interventions fail, if he has an order for it.
I believe when he came to us he was on such high doses of anti psychotic medications he was a zombie and it made him want to eat and sleep 24/7 so med management team titrated him off. He does sleep and eat less now so it was obviously for sedation
A little of his H&P- he was homeless and a meth user for many years, I am thinking he is used to not using the toilet because he didn't have one while he was homeless, 2nd, I think he may associate getting well with being discharged and back out on the street.
I have informed staff to tell him when he starts yelling "I am happy to help you when you stop yelling and go in to the bathroom, then verbally disengage.
As far as the willful fecal incontinence, I am at a loss. He does have some early onset of dementia.
This is a tough one for me and all advice is appreciated. Well, best go out to the barn now and get the cattle prod lol.

 

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Anytime working with people with mental health challenges it is important for you not to let your frustration or their difficult behavior get in the way of your empathy and support, which is essentially your role as a caregiver. I find it helpful to really think about needs. What need is the behavior fulfilling. It looks like you have some ideas, anxiety about leaving the facility. It may be helpful to find an alternative means of changing him, and finding out what he wants for himself. Overall I would reccomend start by helping feel supported, safe, and accepted. If he feels those things he will more likely work with you. Regardless what you do, you want to do it as a team. Consistency is incredibly important working with individuals with mental illness.

 

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Well said Mightychi!

Support, Teamwork, Patience, & Consistency are vital.

 

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So.......more of the truth comes out about this character. A Meth User, has lived on the streets, early onset dementia and Mental Health issues. I agree with Darlene, What about the safety of the others i.e. the other patients Inthat home . WHAT ABOUT THEIR RIGHTS and safety, Lee ????.
Did you stop and think about the other people in that home who might find this Man scary and frightening and who might think that he will come and harm them to. They also have the right to feel safe in their home. What about them.......

Well said jeffswet

 

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Despite all of that he still deserves human dignity and respect. That includes ability to make his own choices about his medical and mental health treatment. Just because he has used meth does not make him a bad person. I've worked with numerous people with meth in the past, many of them are good people not dangerous at all. Their lives are tragic but not bad people. Sedation is taking away peoples human rights. If he is not safe for the home, he will probably be moved to a higher level of care, however, just because he had struggles does not mean that he is different then the other people in the home. Overall I think the best approach would be stabilizing his mental health as much as possible before focusing on the incontinence. Even though this is an inconvience for the staff. Most important remember he is a person, think about how you would want to be treated if you were stuck in a similar situation. Whatever happens with this unfortunate man needs to be done with heart.

 

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OK people:

You want to battle, oh its on! I'm gonna let you have it, here goes:

- I love you guys, love everyone, but let's be clear about one political thing, I absolutely DID NOT vote for Trump. I know this has nothing to do with the forum topic, but I just wanted to get that out.

- We're not really that different in our views & thoughts, we're all brainstorming suggestions & truly concerned about all individuals (ALL- residents, staff, visitors, etc...)

- Without going into detail & repeating things already stated; please read the comment above, by Mightychi. I agree with him too, and believe his comment to be well stated.

In closing, I apologize to anyone who may feel I pointed them out as being uncaring. My intentions were not to personally attack anyone.

I do strongly believe this person's mental health needs should be addressed first, both by med Mgt & behav assessments.

Lee

 

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Thank you all, consistency at all times with all shifts seems to be working well. I have noticed if one shift deviates from the care plan and behavior care plan it puts everything out of wack. For those of you worried about the other residents, no need. The only clients we take on are behavior clients that have failed placement every where else. The other residents have behaviors just as bad if not worse. It is about changing their environment and the way we approach and handle their behaviors because we are not going to be able to change them.
Somebody has to care for these people that no body else wants.
I was just fishing to see if anyone else had dealt with a situation like this as I am fairly new to positive behavior support.

 

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I have not read in here if anyone has talked to him about how HE wants to be going to the bathroom. It may be impossible to take care of him right like staff want to but staff can be very cruel in their handling of patients. I am 82 but worked maintenance in a nursing facility and have seen some very bad care. The pay in nursing homes is so low the workers are angry and some take it out on patients and some are just lazy. I seen 1 nurse that got caught stuffing very strong paper towels into the butt so they don't have to clean so much and make more beds then when their shift is over the pull the towel and turn their patient over to the next nurse. When you find a concientous nurse their patients are lucky and show it. If you cannot talk or have no family to keep an eye out for nurses who will use every trick of the trade to make it easier for themselves or administrators who want bigger profits from medicare recipients. If a patient cant talk for themselves they end up with a feeding tube even if they can feed themselves OK. It is too hard for nurses to hand feed their patients sometimes and food is picked up and some never ate. That is the reason for weighing every week. Well I got that off my chest and I feel better. Jerry