An appalling number of vulnerable care recipients are abused, exploited and neglected by professional caregivers and even family caregivers. A 2015 article on the topic estimated that 10 percent of seniors have experienced some form of elder abuse. Sadly, it is suspected that this number is an underestimate, as data suggests that only 1 in 14 cases of abuse are reported to authorities.
Due to the growing popularity of the concept of aging in place, an increasing number of seniors are receiving care in their own homes or living with family members who provide assistance. As the burden of elder care increasingly shifts to informal caregivers who have limited access to supportive resources, the likelihood of conflicts between elders and family members grows. In fact, perpetrators of elder abuse are most likely to be adult children or spouses. Even more shockingly, for every identified instance of a senior being abused, it is believed that an equal number of family caregivers are mistreated as well.
When a Caregiver Is the One Being Abused
In some situations, seniors are the ones who become emotionally and/or physically volatile with their caregivers. Elders can react poorly to their increasing dependence on others and may therefore express nothing but resentment for their caregivers. If there were previous issues within the relationship, these can be magnified due to the added stress of caregiving and declining health. Oftentimes there was already a history of domestic abuse or narcissistic behavior that only intensifies with the pain and frustration of illness or disability. To make matters worse, neurodegenerative diseases like Alzheimer’s disease and other forms of dementia can cause changes in behavior and mood, agitation, poor judgement, and even violent reactions in some situations.
Abuse of caregivers tends to happen within the home by family members and is frequently kept private and unreported. Women (usually wives, daughters, daughters-in-law and granddaughters) most frequently assume the caregiver role and are thus more likely to be targets.
While there are many protections and safety nets for elderly and disabled individuals who report their abusers, the same is not true for caregivers. As part of my research for this article, I contacted Adult Protective Services (APS) in two local counties and found that there are no supportive services for caregivers who are being abused, short of reporting the incident to the police. Even if the caregiver chooses to file a police report, they are subject to an investigation that all too often comes down to a “he said, she said” situation. Typically, the elderly or disabled abuser is more likely to receive sympathy and support. Often when caregivers take action against their abusers, they risk being the target of retaliatory accusations of abuse, which can have very serious implications even if they are false.
Distance Yourself from the Abuse
I’m left to wonder what recourse there is for a caregiver in this difficult situation. There aren’t many options available short of redefining one’s caregiving duties and physically separating from the aggressor. No one should have to live or work in a violent or unsafe environment, even if the antagonist is vulnerable and requires outside assistance to lead a safe and healthy life of their own.
The only option in an abusive relationship is to distance oneself from the situation and the abuser. If the abuse is aimed at specific family members, then make sure to limit or eliminate interaction with these targets. Even if you are the senior’s sole caregiver, this also applies to you if you are being mistreated.
Sometimes hiring in-home care services will help the situation. Seniors who refuse to respect or cooperate with their family members are often known for putting on their best manners for strangers and non-family. However, there is a risk that the care recipient may transfer their negative focus to the professional caregiver. Home care companies strive to carefully assign strong aides who are familiar with handling a senior’s bad behavior, but if the abuse is severe enough, it can result in frequent turnover. This will only add to a family caregiver’s stress.
In particularly volatile or challenging situations, the healthiest option may be to remove yourself completely. Depending on the living arrangements, this may mean that you move out of your loved one’s home or make the decision to move your elder into a long-term care facility, where professionals can handle these unacceptable behaviors.
It may not be easy or cheap, but there are ways that caregivers can still make decisions and coordinate care for their loved ones from afar. For example, geriatric care managers (also known as aging life care professionals) can be instrumental in overseeing caregiving. The bottom line is that distance is likely needed—even if temporarily—to minimize or eliminate the conflict or abuse.
If an elder is still of sound mind, then their health is their own responsibility and they are free to make their own care decisions, even poor ones. There is likely nothing you can do to convince them to stop their abusive ways. You may arrange for alternate sources of care so you don’t have to endure maltreatment, however competent seniors are free to refuse your efforts to establish a care plan. The decision to redefine your relationship ultimately lies with you.
Abusive seniors who are incompetent are harder to simply walk away from. Their caregivers will either need to arrange other sources of comprehensive support for them or seek out an alternative person to manage their affairs (usually by stepping down as power of attorney or filing a report with APS that the senior is a danger to themselves and hoping for guardianship proceedings to make them a ward of the state).
The decision to stop enduring abuse is often a scary and difficult one, but it is crucial for your well-being. Once you choose to distance yourself from the situation, you will be able to see things more clearly, put a plan in place and work on setting the unique boundaries you need to lead a safe and healthy life of your own.
Sources: Elder Abuse (https://www.nejm.org/doi/10.1056/NEJMra1404688?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dwww.ncbi.nlm.nih.gov); Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America (https://www.ncbi.nlm.nih.gov/books/NBK98802/)