When my uncle had in-home health care, he liked a couple of the caregivers, he thought one was okay, and barely tolerated two others. I wasn't always there to witness his behavior, but I'd say that the caregivers he didn't particularly like were not thrilled with him, either. Yet they did their job.
My neighbor, Joe, had a similar situation. He locked one caregiver out of his home, let another one in but was rude to her, and thoroughly enjoyed one young man because they could discuss golf. Quality of care wasn't the issue. Joe resented anyone but me helping him, and the only reason he liked the guy was for talking about a shared sport.
Find an Independent Living Community »
Paid caregivers, hired by family members or even elders themselves, go into the elder's home as nurses, assistants (CNAs) and custodial help (non-medical help such as shopping and light house keeping). Often their best efforts are frustrated by anger and actual abuse dished out by the elder they are there to care for.
I believe some of this abuse comes from fear. The presence of an outsider suggests to the elder that their family can't (or doesn't want) to take care of their needs. It also magnifies the extent of the elders' care needs and makes them feel vulnerable. This fear, plus the denial of their actual need for care, can make them angry. If they are prone to lashing out when angry, then this person who represents the care they wish to deny becomes the target.
Add to this the paranoia that is common with many dementias, particularly Alzheimer's disease, and you have one explosive situation. Recently, on the Agingcare forum, a nurse asked what she should do about a client with Alzheimer's who thought she, the nurse, was trying to murder her. People were surprised and sympathetic, but unfortunately, this fear is not all that unusual.
Sometimes this paranoia can be side effect of a drug that the person with dementia is taking. I've seen this first hand. When my dad went into the hospital for the operation to put in a shunt to remove fluid from behind scar tissue in his brain, he had a nurse named Brad. My dad also went by the name Brad and they bonded over their mutual name as well as many other things. This young male nurse was exceptional. Dad was a humble, caring person and made friends easily.
Then came Dad's brain operation. Something went wrong and Dad came out of surgery totally demented. The doctor gave him the anti-psychotic drug Haldol. Suddenly, under the influence of Haldol, Dad was terrified of the nurse. Brad was trying to kill Dad when he was in the shower. He was trying to steal Dad's dentures. If we cared about him, we'd get him out of there. We, his family, were frantic. We knew Brad was doing no such thing, but Dad was terrified of him.