Early in my caregiving journey with Mom, I attended a support group meeting that featured a speaker who was an elder law expert. In her talk this woman said, "If you are considering taking care of an elderly parent, you must give up this idea if you were ever abused by that parent in the past. You will become an abuser yourself."
I doubted her words then. I am a Christian and I know about forgiveness and walking in newness of life. I'd been raised by a mother who never hit me, but I believed that even if caregivers had suffered ill-treatment, they nevertheless ought to be able to keep from becoming abusive toward an elderly parent. But after ten years of caring for my own mom, I think I understand that elder law attorney's reasoning.
In the early stages of Alzheimer's disease, patients retain intellect, but lose memory. As the disease progresses and the patient loses the ability to perform daily tasks that were once routine, caregivers might not realize that although the patient's analytical skills are diminished, they may nevertheless still be in fairly good working order. For example, a dementia patient who has developed paranoia might still possess the skill to offer a bitingly accurate commentary on the caregiver's perceived failings.
When the care recipient is a loved one, he/she is able to draw upon long term memory for ammunition to make arguments and insults all the more upsetting; the barbs become custom tailored. If a new acquaintance tells me I am a hateful person and always have been, I might be able to smile and respond with gentle humor. But if my mother spews these words, the arrow pierces my heart.
I'm always surprised by the hurt Mom is able to cause me by just a few well placed insults. "Well," she says when I ask her for the third time to wash and dress for the day, "You have to get me to do what's most convenient for you, that's what you're like!" I'm sure that when I was 14 and practiced diligent avoidance of household chores, these words had some basis in truth, but now the injustice and ingratitude of her mocking deprecation is beyond upsetting.
"I've given you ten years of my life, I don't always do what's best for me--I spend a lot of time thinking about what makes you happy," I protest (maturity has fled, drama reigns).
"Ohhhhh poooorrr you. Big of you to try to make me feel guilty," she says.
And that's it. My switch is flipped, I clamp my lips tightly closed over the angry words I'd like to speak, and I leave the room, closing the door firmly behind me.
The possibility of these kinds of caregiver/patient interactions are why someone who has suffered abuse in the past should not become a caregiver; dementia patients often have great skill in eliciting anger of the sort that creates intense emotion. And when the care recipient is the former abuser, the chances for the tables to be turned increase exponentially. My mother never harmed me out of anger when I was a child--although she often raised her voice. To my shame, I sometimes am unable to keep from raising my voice to her now when she is sarcastic or rude. If she had hit me in anger when I was a child, how might I respond to her now?
I have come to believe that if a parent was verbally or physically abusive in the past, that it is best for all involved if a non-emotionally involved party becomes the primary caregiver for that person. There is no shame or failure in the acceptance that you are not the best person to care for your loved one. God's love does indeed cover our sins and removes them as far as the east is from the west. However, it is unwise to place ourselves in testing circumstances that could result in a tragic outcome for the physical well-being of the care recipient and the emotional stability of the caregiver.
Addend: The impetus for this article was a news report I saw about elder abuse in nursing homes. Although abuse is more likely to occur between family members with shared histories, I think it best if those who have suffered physical abuse avoid working closely with dementia patients as, say, nursing home attendants or hired caregivers. Family members should be aware of the signs of abuse and advocate strongly for their loved ones. Observe interactions between staff (including night staff) and your loved one and follow your gut feeling. Meet every person who provides your loved one care. I'm sure most facilities are safe. But just as we teach our kids about the the danger of interacting with strangers even though bad things don't often happen, we need to be vigilant to protect our elderly from the danger of abuse, even if the rate of incidence is low.