Resistance in Care | Explanation, Approaches & Strategies

Resistance can look like refusal, withdrawal, aggression, or silence. It often signals fear, frustration, lack of trust, or feeling unheard. It is important to understand what’s behind the behaviour before deciding how to respond. There are practical ways to recognise and handle resistance so you can maintain respectful, effective relationships and avoid unnecessary conflict.

According to a report published by TruePublica, an estimated 1.6 million older people in the UK do not receive the support they need with essential daily activities. In 2020/21, 14,000 elderly people a day were refused help, and 102 people died each day while waiting for care. These highlight why there may be a breakdown in trust and people may become resistant.

What is resistance in care?

Resistance in care is when a person receiving support pushes back against what is being offered. It might be obvious resistance, for example refusing to take medication, shouting, or walking away, or it might be more subtle, like ignoring instructions, avoiding eye contact, or remaining quiet.

Someone might need care when they can’t manage day-to-day activities on their own due to physical, mental, or emotional challenges. This can be short-term or long-term, and the reasons vary widely. Common reasons include:

Ageing which may mean reduced mobility, memory loss, or frailty.
Disability, this may be physical or learning disabilities that affect independence.
Illness or injury, this may be linked to recovery after surgery, accidents, or serious health conditions.
Long-term conditions such as dementia, Parkinson’s, MS, or diabetes.
Serious mental health issues.
Substance misuse where support is needed to stay safe and manage health.
End-of-life care, which may include support with comfort, dignity, and symptom control.

Some people need 24/7 support, others just need help with specific tasks like washing, dressing, taking medication, or getting around. Care is about supporting someone to live as well and independently as possible.

Resistance in care usually isn’t about being difficult for no reason. It usually comes from:

Feeling out of control or not listened to.
Fear, anxiety, or trauma.
Misunderstanding what is being asked of them.
A lack of trust in the particular carer or the system in general.
Past experiences of poor treatment or power imbalance

In care work, resistance is a signal. It tells you there’s a barrier to cooperation or communication that needs attention. How you respond to it can either defuse the situation or make it worse.

Some examples of how resistance can show up in different care settings include:

Children’s care

A child refuses to attend school or a scheduled activity.
They respond with physical aggression or run away during transitions.
They ignore or challenge rules or boundaries.
They make negative comments when you try to talk about something important.

Refusing personal care or support with daily tasks.
Shutting down during meetings or assessments.
Repeatedly missing appointments or not answering calls.
Saying yes to plans but not following through.

Elderly care

Rejecting help with washing, dressing, or taking medication.
Becoming angry or withdrawn when routines change.
Insisting independence even when it is unsafe.
Accusing carers or family of being controlling or unkind.

Foster care or residential settings

Testing boundaries or pushing carers away emotionally.
Making up excuses in order to avoid talking or engaging.
Refusing to unpack belongings or settle into a routine.
Sabotaging placements through behaviour.

In all these cases, resistance usually reflects unmet needs or a breakdown in trust or communication. It’s not always personal, but it does need a thoughtful, consistent response. Trust and good communication are important because they make care safer, smoother, and more respectful. When someone trusts you and understands what’s happening, they are more likely to accept support, speak up about needs, and stay calm.

It also helps carers’ spot problems early and avoid misunderstandings that can lead to resistance or harm. Spotting problems early in care is important because it helps prevent small issues from becoming serious, for example health problems can escalate quickly and early signs like weight loss, confusion, or changes in mood can signal that something is wrong and can mean that the correct treatment is provided as early as is possible.

How to deal with resistance in care

It is important to deal with resistance by focusing on understanding, not control. By observing what the person is doing, you can then think about what might be driving the behaviour. This is more productive than trying to fix the behaviour without understanding why it is happening. Focusing on understanding rather than control is important because care should be about support, and should not be a power battle. In care you should always be working with the person and not against them. When you focus on understanding, care becomes safer, more respectful, and more effective.

Practical steps include:

Pause and observe and don’t escalate the situation by pushing harder against what the person being cared for wants.
Be aware of your tone and body language. This includes remaining calm, being non-threatening, and open.
Use clear, respectful language and avoid any instructions that feel like orders.
Give choices which includes offering two acceptable options so the person feels some control.
Listen first and find out what the person wants, not just what they need.
Pick your moment and don’t try to provide care when someone is upset, tired, or overstimulated.
Document incidents, noting down what happened, how they responded, and what you tried to do to resolve the situation.

If the situation becomes unsafe, you should step back, get help, and revisit the issue when things have calmed down. You should act quickly and calmly. Your priority is safety, for the person, yourself, and anyone else nearby. You should:

Step back and create space between you and the person.
Stay calm, speak in a low, steady voice, avoid sudden movements
Don’t argue or try to reason in the heat of the moment.
Call for help, alert a colleague, use an alarm, or follow the emergency procedure.
Remove others if needed, especially other vulnerable people.
Do not use force unless properly trained and only if it is absolutely necessary to do so.
Wait and observe until the person calms down or help arrives.

After the incident, you should:

Report it. This includes logging the event factually in the care record or incident system.
Debrief with your manager or team members.
Review the care plan in order to see if anything needs to change to prevent a repeat situation.
Access support for yourself, especially if the incident was distressing.

Why might someone resist care?

People resist care for many reasons. It’s rarely about being difficult and often rooted in unmet needs or past experiences. Common reasons include:

A feeling of losing control – being told what they should do without feeling like they have had any involvement in the decision.
Fear or anxiety – especially about personal care, medical procedures, or unfamiliar staff.
Cognitive issues – things like dementia, learning disabilities, or mental health problems can affect someone’s understanding of the situation and affect their ability to trust.
Experiencing pain or discomfort – people may not be able to explain what’s wrong, but they may show it through resistance.
Lack of trust – due to previous bad experiences or a lack of consistent relationships, people may find it difficult to trust the people caring for them.
Cultural, personal or religious values – this may happen when care practices don’t align with the person’s beliefs or background.
Communication issues – difficulty hearing, language barriers, or staff not explaining things properly can contribute to issues with communication.

Care can be more inclusive by recognising and respecting people’s individual backgrounds, identities, and needs. It’s about making sure no one feels left out or misunderstood.

Key ways to do this includes:

Asking questions, don’t assume. You should find out how someone wants to be addressed and what matters to them.
Support different communication needs, use interpreters when needed, easy-read documents, or visual tools.
Be aware of cultural and religious practices. This may be around food, clothing, routines, and personal care.
Respect gender identity and sexual orientation. This includes using the correct names and pronouns, and avoiding making assumptions.
Make environments physically accessible, which may include having ramps, considering what is needed in regards to toilets, lighting and noise levels.
Train staff properly on equality, unconscious bias, and what inclusive practice means.
Include people in planning their own care. This includes giving real choices and not just tick-box options.

Inclusive care treats each person as an individual, not a category. It builds trust, improves outcomes, and helps everyone feel respected.

How to approach a person who is resisting care

If a person is resisting care, you should approach slowly, respectfully, and with empathy. Empathy is important in care because it helps you understand how someone is feeling and why they might be behaving a certain way. When you see things from their point of view, you respond with more patience, respect, and kindness. Rushing or using force will usually make things worse.

Good practice includes:

Introducing yourself every time you meet, especially with people who are confused or anxious.
Explaining what you’re doing and why. You should use clear, simple and neutral language.
Asking for permission, even if the care is necessary, it shows respect for the person you are caring for and can help to build trust.
Using active listening and giving space for them to speak and acknowledge what they are saying.
Mirroring their pace and body language as this can help to create a sense of safety.
Stepping back if needed and pushing forward when someone is resisting can create conflict. If possible, you should wait and revisit later.
Offering reassurance especially during intimate or distressing tasks.

You should always aim to tailor your approach to the individual you are caring for. What works for one person might trigger another. People have different ways of communicating, some people need clear instructions, other people may need extra time or visual cues. A one-size-fits-all care approach often leads to resistance, personalised care makes cooperation more likely.

Strategies to try to reduce resistance to care

Long-term strategies that can help to reduce resistance to care include:

Building consistent relationships. Regular carers can help to build trust and reduce anxiety. This helps to build a rapport and the person being cared for knows what to expect from the carer.
Using person-centred planning. This includes involving the person in all decisions and respecting their preferences.
Offer control wherever possible, even small choices for example when to shower, what to wear as all of these things can make a big difference to how the person feels.
Creating routines is important as predictability can help people feel safe and less threatened.
Being aware of sensory needs, including noise, lighting, touch, and clothing as this can all affect someone’s comfort on a daily basis.
Training and support for staff, so they know how to spot early signs of distress and how to de-escalate if needed.
Use of distraction or redirection. This can be especially effective in dementia care, for example changing the subject or offering an activity.
Adapting communication to suit the person being cared for. This could include using pictures, plain language, or visual cues where needed.

It is also important to check that care plans are regularly reviewed as resistance often signals the current plan isn’t working. A care plan is a written document that sets out the support a person needs and how it will be provided. It’s used in social care, health care, and education settings to coordinate care and make sure everyone involved is working to the same goals. It is based on an assessment of the person’s needs, strengths, and preferences and it should be created with the person and, where appropriate, their family or advocate. It should be person-centred, not service-led and should be reviewed and updated as needs change.

A typical care plan includes:

What is important to the person being cared for?
Both their physical and mental health needs.
Daily support including eating, dressing, medication and mobility.
Communication needs or preferences.
Risks and how they are managed.
Who is responsible for each part of the support plan?
Review dates.

How does resistance affect care?

Resistance affects care in several ways as it can contribute to:

Delays and disruption as tasks may take longer or need to be repeated.
Emotional strain as carers may feel frustrated, rejected, or helpless.
Safety risks for the person and for staff, especially if resistance becomes physical.
A reduced quality of care if staff back off or rush through tasks to avoid confrontation.
A breakdown in relationships as if trust erodes, it can be hard to rebuild.
Missed health needs, if medication, hygiene, or nutrition are refused.
Increased isolation as resistance may be misread as non-compliance, leading to avoidance.

More resistance can lead to more forceful care, which increases distress and further resistance. Breaking that cycle starts with understanding, patience, and adapting how care is delivered.

Being a carer is a difficult job because it involves constant emotional, physical, and mental pressure, often with limited support or recognition. You are expected to meet someone else’s needs which are often complex, unpredictable, or distressing while also managing your own responsibilities and wellbeing. Nearly half of care workers in England earn less than the living wage, with around 400,000 paid under £12 an hour and around 25% of the adult social care workforce in England were on zero-hours contracts in 2023/24, including 47% of home care workers. According to a report published by PMAC UK, 77% of UK carers have experienced symptoms of burnout, including emotional, physical, and mental exhaustion.

Carers can take steps to protect their own wellbeing and reduce the risk of burnout, but the system often works against this. Some things you can do includes:

Setting boundaries with your employer.
Use support systems including speaking to other carers and accessing mental health support if it’s offered.
Take regular breaks and using any holiday entitlement.
Notice early signs of burnout which may include irritability, tiredness, sleep problems, or feeling disconnected.
Focus on what’s in your control and you can’t fix everything, but you can manage how you respond.
Prioritise the relationship with the person, and not just the task in front of you.
Prioritise your life outside of your caring job.

If you are an unpaid carer, make sure you’re registered with your GP as a carer so you can get support. Carers UK offer unpaid carers expert advice and support.

When carers look after themselves, resistance in care often reduces as staying calm helps de-escalate situations, more patience means you’re able to listen and adapt, not just push through tasks. Clear communication builds trust and helps people feel involved, not controlled and slower, more personal care feels less threatening, rushed care often triggers pushback and fewer mistakes mean less distress or confusion for the person receiving care. Better relationships lower the chances of repeated resistance and generally when you are less stressed, you provide better care. This all makes resistance less likely.

Dealing with resistance in care

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