An appalling number of care receivers are abused, exploited and neglected. All too often, this maltreatment happens at the hands of their caregivers. Studies conducted by the US Department of Health and Human Services (HHS) reveal that more than 1 in 10 elder care recipients report having suffered physical, sexual or emotional neglect. This doesn’t include other forms of abuse, such as financial exploitation.

A large number of care receivers live in their own home or that of a family member. Sadly, family caregiver abuse offenses account for 90 percent of all cases. The overwhelming majority of those who file reports are women. The elderly or disabled person often does not want to create trouble for their family members, so it is estimated that only 1 in 14 cases are reported to authorities. For every identified instance of care receivers being abused, it is believed that an equal number of caregivers are mistreated as well.

What happens in the family stays in the family.

People vary in their ability to engage in and maintain positive relationships, and not all seniors and disabled individuals are kind and loving. People can react to being dependent on another person by resenting their caregiver and acting out in abusive ways. If there were previous issues within a relationship, these can become magnified with the stress of illness and disability. Oftentimes there was already a pattern of domestic abuse that becomes intensified with the pain and frustration of illness or disability. Neurodegenerative diseases such as Alzheimer's and dementia can cause changes in behavior and mood, agitation, and even violent reactions in some situations.

Abuse of caregivers also tends to happen within the home by family members and is frequently kept private and unreported. Women, usually spouses, daughters, or daughters-in-law, most frequently assume the caregiver role and are thus more likely to be targets. Evidence supports the health risks related to mistreatment of aging caregivers.

While there are many protections and safety nets for elderly and disabled individuals who file reports, the same is not true for caregivers. I contacted Adult Protective Services in two local counties and found that there are no services for caregivers who are being abused, short of reporting the incident to the police. Even if the caregiver will file a police report, they are subject to an investigation that may come down to a “he said, she said” situation, and the elderly or disabled person is more likely to receive sympathy and support.

Distance may be the only option.

I’m left to wonder what recourse there is for a caregiver in this difficult situation. There are not many options short of redefining their caregiving duties and physically separating from the aggressor. No one should live in a violent or unsafe environment, even if the antagonist is vulnerable. The only option may be to move the person being cared for into a long-term care facility where professionals can handle these unacceptable behaviors. If the behaviors are aimed at specific family members, then make sure to limit or eliminate interaction with these targets. Sometimes home care services will help the situation, but the care recipient may transfer their negative focus to the professional care provider. This can result in a constant turnover of outside employees and home care agencies, which can add to caregiver stress.

The caregiver can still play a role in the care team, but distance may be needed to minimize, if not eliminate, the conflict or abuse. With the elder or disabled person in a safe (but more distant) environment, the caregiver can set the boundaries necessary to give care without being mistreated.