Having served close to 400 people in one way or another I have seen my share of those who were convinced the presence of in-home staff was not needed. Some felt their privacy was being violated while others were simply in denial about their personal limitations.
Of course in the presence of dementia how can we really know what a person is thinking. Some may just be objecting internally to these sudden changes in their environment. One factor remains: Regardless of their refusal to accept the need for your presence, care must be needed over and above what this person can do for themselves. So how do you go about providing the needed assistance while avoiding a daily confrontational environment?
Here are a few tips:
I. Practice the Principle of “With”
Many, especially those from a certain generation or socio-economic background, may not be accustomed to people doing everything for them. They feel a sense of elitism with another human running around to cater to their every move. So when its time to make lunch how about, “let’s make lunch” instead of “I’m going to make lunch for you”. Of course there may be ways for you to really involve them in the process.
When you express yourself as a team member, creating the mental concept that you simply complement things they can do for themselves, you remove the stigma some may fall into of believing you see them as an invalid.
II. Provide Some Space
Of course you have to use discernment especially if the home care client is susceptible to self-harm including 
wandering outside into danger. Barring this barrier, how about going to a store, taking out the trash and talking to a neighbor on the street, etc. while your client is alone in the home. This gives them some privacy and eliminates the feeling they require another set of hands 24/7; even if they practically do.
III. Make Creative Use of Technology
There is nothing like a good distraction to take someone’s mind off what they perceive is a bother to them. How about using Skype and other applications to help keep your client in touch with relatives and friends who may live locally or some distance away. When doing so make sure they look their best before sitting in front of a computer and feel free to go away. Allow them some privacy, even if only to vent about that which may not be realistic.
Of course no strategy is likely to completely remove their indifference toward daily assistance in their home. After all I have witnessed quadriplegics try to dismiss the very staff needed to get them out of bed. However, if these approaches are made a part of your daily routine – while not removing the occasional rant – perhaps you can minimize the length and severity of them.
In the meantime you just need to focus on accomplishing that plan of care with dignity, completion and a spirit of peace and cooperation. After all, the job has to get done.
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