When Elders Don’t Accept Outside Caregivers in the Home

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 were not particularly 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.

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.

Dementia Contributes to Elders' Fear of Outside Caregivers

Fortunately, after much begging, pleading and finally demanding, I got the doctor to take Dad off Haldol. After the drug wore off, Brad, the nurse, was once again perceived as he was, a wonderful nurse. If no medication can be blamed for the paranoia, the elder's basic personality needs to be taken into consideration. We knew Dad, and we knew how he had reacted to the nurse prior to the medication.

Not everyone will have had this head start. The first thing you will most probably witness is the anger and abuse spewing from the elder. The non-family caregiver doesn't know what to do. Neither does the family.

It's time to play psychologist. Is it only this particular person who upsets your elder? Maybe this person, through no fault of her own, reminds your dad of someone he feared when he was a child. With Alzheimer's, we have to remember that people are mentally at an age where they are young and vulnerable. If it is only one person that your elder reacts violently to, I'd kindly let the person know that this arrangement, through no fault of her own, won't work. Explain what is going on.

If she is a seasoned caregiver, she will likely have seen this behavior before. She may not like it, but she will understand. Of course, you will already have talked with the elder and told him repeatedly that you are still the caregiver, but that you need help. You've told him that this person is there to help both of you and you are watching over the process. Constant reassurance is necessary. Understanding the elder's fear and vulnerability is necessary in order for you to cope with this problem.

Trying a new caregiver may be necessary and even helpful. If, however, your elder is abusive to all outside help, I'd talk with a doctor about anti-anxiety medication or other medical therapy. For those of you who are on the receiving end of the abuse, I'd advise you to communicate with the family in a friendly way. Brainstorm about what may be frightening the elder. Try to find ways to interact with the elder in an informal manner.

Find out about hobbies and past work experience. Even your clothing may make a difference. Do you look too "medical?" Work with the family as closely as you can. If you are a medical person, and you think an anti-anxiety medication may help, or other medications may be causing this behavior, speak up. However, if the abuse can't be stopped, you need to give notice and walk away.

You are in this business to help people. There will be those you can't help, no matter how good you are. So, quit the position with an appropriate explanation, and look for a position that will fully use your talents. There are many others who need you. The family will then need to search for a different person to help. Let's hope they find someone who meshes with the elder, and you find an elder with whom you can do your work well.

Carol Bradley Bursack

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Over the span of two decades, author, columnist, consultant and speaker Carol Bradley Bursack cared for a neighbor and six elderly family members. Her experiences inspired her to pen, "Minding Our Elders: Caregivers Share Their Personal Stories," a portable support group book for caregivers.

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