4. How do I deal with changes in my client’s behaviour?

Challenging behaviour related to continence and dementia

Some behaviour can be hard to deal with. Try to stay calm and composed, avoiding showing frustration or disgust. Some of the common challenges that you may face include your client:

• Hiding faeces.
• Denying they need the toilet.
• Hiding incontinence pants/pads.
• Handling/smelling faeces.
• Voiding bladder or bowels where they are – i.e. not going to the toilet.
• Repeatedly going to the toilet.
• Excessively washing their hands.
• Unwilling to wash or change their clothes.
• Unwilling to go to the toilet.
• Lack of awareness of having been incontinent.
• Refusing help.
• Shredding toilet paper.
• Saying they have been to the toilet when they haven’t.
• Unable to control their bladder or bowel when walking to the toilet.
• Withdrawing from going out or visiting people.
• Becoming aggressive or rude.

“I had a client who would very often hide it around the house. She would take faeces out of her pad, especially if it was quite hard, quite solid, and you would often find it hidden around the house”.

“Experience will show that the living environment of that individual will affect their continence. We have a lot of clients who are hoarders, so they haven’t got the room and, certainly with dementia, they haven’t got the capability or knowledge to go to the toilet. So, unless they are shown, they will do it there and then, and that’s something I’ve seen quite a lot”.

Your client may not be able to tell you how they are feeling, especially if their dementia is advanced. Caring with compassion is difficult, especially when you are required to work within tight time constraints and may not be getting much feedback from your client. Focussing on their needs and the discomfort they may be feeling can help.

“I had a client who became very aggressive when her pad needed changing. Sometimes it would have seeped through and you could see her pad sagging, and there’s that shame there. She wasn’t able to vocalise anything, so her physical behaviour was all she had to communicate that (need and) sense of shame”.

Talking to colleagues and your manager about client visits you have found difficult is important to help you process the situation, receive support, hear how other colleagues manage similar situations and get practical advice on caring for your clients in challenging circumstances. It is also important to discuss the time you need to spend on a visit to your clients, when the allocated time is no longer enough to complete your care. This can be difficult to justify so keep a record of the things that have changed and take longer to do, such as a reduction in the client’s mobility and taking significantly longer to walk to the toilet; a client becoming unwilling to get up and washed, and taking considerable time before they will move.

“When faced with challenges like these, I find it helpful to remind myself to deal with one thing at a time, rather than getting swamped with trying to do everything at once”.