Beyond “DEATH and Dying” – Part 3

Anger

Meet Harry.  Every building has one – the resident who is NEVER HAPPY.  “The oatmeal is lumpy.”  The building’s too cold; you keep the thermostat too low. You people don’t understand or care about the needs of old people!  I never had this problem at home.”

Sound familiar?  It might be Harry, or Mabel, or Mrs. Smith but the common characteristics are that you can’t seem to make them happy and they often lash out at employees and even other residents for no apparent reason.  They may be very vocal in complaining about other resident’s “disabilities” – e.g. he states loudly in the dining room “There are too many #*&^! walkers in this place; they’ve put me in a nursing home with a bunch of old, sick people!”

In “On Death and Dying”,  Dr. Elisabeth Kubler-Ross taught us that ANGER is a normal human reaction as a part of the process of grieving for a loss.  She says: “When the first stage of denial[1] cannot be maintained any longer, it is replaced by feelings of anger, rage, envy, and resentment.”  Many older Americans don’t understand WHY they have suffered this loss – i.e. the death of a spouse, inability to easily accomplish physical tasks that used to be second-nature to them, a reduction in mental capacity and clarity, or even the loss of certain bodily functions such as continence.  These cause a great deal of frustration for the individual who questions what he/she did wrong to now be faced with this loss.  They ask “Why me and not so-and-so?”  As a result, they often express their resentment towards others who are not similarly affected.

Dr. Kubler-Ross points out that anger is often “displaced in all directions … almost at random” and that family and staff members often find it very difficult to cope with.  Even worse, the anger often feeds on itself and leads to an increasingly problematic cycle.  Especially when the resident believes they have been forced to move into the facility, “the visiting family is received with little cheerfulness and anticipation, which makes the encounter a painful event.”  The family members “either respond with grief and tears, guilt or shame, or avoid future visits, which only increases the resident’s[2] discomfort and anger.”  And, of course, that just drops the problem in the lap of the on-site management.

Compounding this situation is the senior’s perceived loss of independence and control, coupled with their fear of the unknown.  They faced many challenges throughout their adult life and generally found a way to overcome or at least handle those concerns.  Now, they are being forced to deal with the effects of aging and their own mortality, while society and even their own family tell them that they need “help”.   So, if they can’t control their own situation today, what chance do they have to control it in the future?

We know that Harry uses a cane but we don’t know why at this point.  It could be arthritis, a joint replacement, effects of a stroke, or general weakness.  However, when he sees the walkers in the dining room, he knows that might be the next step for him.  He doesn’t want to be reminded of that potential or that he doesn’t know how to stop it from happening so he “acts out” his anger.

How Does this Concept Impact Marketing?

Consider the following points:

• Unhappy residents are not long-term residents. They will move themselves out, their family will get tired of the complaints and move them out, or their angst may lead to an earlier death.  Regardless, the community will have to find a new resident to fill the vacancy.
• STUFF HAPPENS in any building.  Most of the time, residents are relatively understanding and management can fix the problems and move on.  However, the “angry resident” stirs the pot with their irrational complaints.  Sooner or later, the rest of the residents begin questioning whether the complainer is “all wrong” and become less tolerant of the management and staff.
• Likewise, family members forget how difficult Harry used to be for them to handle and have a tendency to start blaming the staff for Harry’s attitude.  {They’re wrong of course, but who’s talking rationally?}  This can lead to negative publicity in the general community.
• You obviously don’t want Harry to interact with prospective residents during a tour or marketing event.

We once found a “disgruntled” resident who liked to sit outside the front door of a building that had a very low closing rate.  We then found out that the resident was expressing her anger to everyone that came into the building.

What Can We Do?

First, resist the temptation to take the quick move-in that is driven by the children instead of the potential resident.  You are risking a time-bomb if the prospective resident doesn’t take an active part in the tour, discussions, etc. and at least buys into the decision.   Don’t “gang-up” with the family members to force the prospect to move in before they have completed the psychological grieving process. [3]

As discussed in earlier parts of this series, communication is key.  The more you understand about the types of losses the individual has recently endured (See Part 1 for examples), the better you will be able to help de-fuse the anger.  However, this requires that you take the time and spend the energy to establish a personal relationship with the prospect / resident.

Understand that anger is a normal AND NECESSARY step in the healthy grief process.   Educate your staff to the importance of remaining calm and not allowing the resident to “bait” them into losing their temper.  Kubler-Ross advises: “don’t get into unnecessary arguments” over issues that are “often totally irrelevant.”  Remind the staff that the anger being displayed generally has nothing to do with them!

Avoid the tendency to ignore and further isolate the troublesome resident.  This gives them a legitimate reason for complaining and often leads to further “acting out” with escalating demands and louder and more public complaints.

Give them some attention.  Similar to a misbehaving child, their behavior is a cry for help.  They want to be “unique”, but still loved and accepted.  They need to know that someone knows they are there and cares for them.  At the same time, let them know that they don’t have to raise their voice to get your attention.

One of the secrets to managing grief is to generate HOPE for the future.  Recognizing the natural fears of the senior residents, focus on their CAPABILITIES instead of disabilities.  Encourage them to try new things, make new friends, etc.  The key is to get them to look favorably to the future which will cause the past losses to fade in importance.

PLEASE SHARE YOUR EXPERIENCE(s) WITH ANGRY RESIDENTS BY COMMENTING BELOW. A short background synopsis of the individual would be appreciated.  Indicate how you learned of the underlying losses that were driving their behavior and how you dealt with the situation.

---

[1] See “BEYOND DEATH” and Dying – Part 2 for a more detailed discussion of the denial stage.

[2] Changed from the original “patient’s”.

[3] NOTE:  I recognize that different rules apply for admissions to Alzheimer’s / memory care units.