Friday, February 21, 2014

Avoiding Elder Abuse

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. 


  1. It's good to be able to admit when enough is enough. We had to do that with mama, mainly because daddy was sick too. She actually became sweeter with AD, but Daddy, the sweet one, actually began intolerable. It's hard, so hard. I did it for practically 5 years and I wouldn't change a thing, but I don't know if I could do it 10. We do what we have to do, but you must take care of yourself. If not, like me, you may be dealing with things 3 years after. Prayers for you, sweet girl.

  2. Every Alzheimer's patient is different I am told, but they all get angry. Are you the main one interacting with your mother, Linda?

    For five years I have been the caregiver for my care receiver husband in our almost 14 years of marriage. He does get angry, but I guess I am fortunate in that his anger is not yet directed at me, but at some hallucinations he has from time to time.

    Others help me with him and I have come to accept that I need them. My husband fancied that our well water was out and it was becoming an obsession. I had our neighbor come over and assume him; she said, "Good news! The water is back on." Then and only then did he realize everything was fine--the nagging wife never works. When he wanted to buy a gun because of "those dangerous people in town", I found a police officer who convinced him that a weapon was not necessary. Our volunteer caregiver Christian neighbor Kenny has come alongside of this journey. He shaves and showers my husband, keeping me from being the nagging wife.

    Recently I had an argument with him that I did blog about. I learned a lot about me in that argument and how to avoid future arguments. I can only change me--not him.

    Hugs and prayers,

  3. White Lace and Promises, thanks so much for sharing and for your kind words. I've often remembered that attorney's comments and thought I should share them. See the addend to this post-- I recently saw a news report about abuse in nursing homes and felt it was time to write about this issue. I pray those in danger of being taxed beyond their ability to bear by the stresses of caregiving are able to free themselves from self-condemnation and seek the long term care solution for their loved ones that is best for all concerned.

  4. @Carol -- I am one of three "main ones" who interact with Mom regularly. She is most times easygoing. The purpose of this post is to help those who have been victims of abuse, particularly childhood abuse, to excuse themselves without guilt from a prospective assignment of caregiver. This is something that shouldn't happen for the sake of the welfare not only of the patient, but of the caregiver. A second purpose of the post is to raise awareness of this taboo subject for the protection of those who are receiving care in a nursing home. Abuse doesn't happen often, but if it happens at all we need to be aware and proactive for our loved ones who are unable to speak for themselves.