Most of us have seen evidence of people being harder on those they love than they are on strangers, or even people they don’t like. We tend to show our family members every side of ourselves, including the least flattering ones, because we feel safe enough with them to just “let it all hang out.”

This typically holds true for our care recipients as well. Age and illness bring a host of difficult emotions to the surface for seniors, and caregivers are subjected to their anger, fear, frustration and sadness regarding their circumstances. For some, though, there are deeper problems lurking behind an elder’s moodiness and outbursts. These feelings may turn into abusive behavior or exacerbate an already abusive personality.

We’ve all heard about the dangers of elder abuse, but there is an equally serious issue of abuse toward caregivers that goes largely unaddressed. Sadly, caregiver abuse is all too common.

Why Do Elders Turn on Their Caregivers?

I believe that care recipients target the people providing most of their care because they feel safe enough to do so. They are frustrated and need to vent about getting old, living with chronic pain, losing friends, forgetting things, being incontinent—all of the undignified things that can happen to us as we age. They turn on the person who shows their love by trying to take care of them because, on a gut level, they trust that this caring person won’t leave them no matter how badly they behave.

In other cases, a caregiver may have been a target of criticism and negativity in the past. For example, if an abusive elderly mother has been hateful to their child for much of their life, it is very likely that this toxic behavior will carry over into caregiving. Mental illness or a personality disorder (like narcissistic personality disorder) may be to blame. If other family members have decided that they do not wish to participate in the elder’s care, it complicates things further. There is a great deal of pressure on one primary caregiver to shoulder the burden of care and abusive behavior, and coping is an ongoing challenge.

How to Cope With Caregiver Abuse

When it comes to handling an aging loved one’s abuse, the best option is to remove yourself from the situation. But for many caregivers, that is not a possibility. Other family members may not be willing or able to assist. Some families may not be receptive or understanding when a caregiver is the one being abused. The family might lack the financial resources to hire a third party, such as a home care company, to take over, or the elder may vehemently oppose the idea. A mix of hope, love, fear, obligation and guilt typically compel the primary caregiver to continue seeing to their loved one’s needs personally. In order to make this arrangement work and minimize its detrimental impact, caregivers must learn to set boundaries, detach from their care receiver, and prioritize their own well-being.

Detach and Set Boundaries

The caregiver should do their best to not take insults or outbursts personally. Detaching with love is the best approach for interacting with a bad-tempered elder. My experiences with difficult family members don’t compare to many of the stories of caregiver abuse that I have read on the Caregiver Forum, but I was subjected to some pretty nasty treatment by my mother a few times.

She was a wonderful, loving person at heart, but her escalating physical frailty and frustrating memory issues would cause her to lash out at me. There were times when I was nearly in tears after my daily visits to see her in the nursing home. Several of my elders had lived in this facility over the years, and the staff knew me and my family very well.

One day, a nurse overheard Mom’s particularly foul behavior and suggested that I just skip the next day’s visit. I couldn’t imagine acting on her advice, so I ignored it. Things smoothed over, but eventually the same scenario transpired again. It was a Sunday and the nurse said once more, with added emphasis, “Carol, just skip a day.”

On Monday morning, I found I just could not make myself go to the nursing home. I didn’t do this to be stubborn or make a statement. I was just hurt and exhausted. I knew Mom was in good hands, so I gave myself a well-deserved day off. I didn’t even call her on the phone that day.

When I resumed my daily visits on Tuesday, Mom was sweet as pie. I couldn’t believe the difference. The nurse was right—I needed to stand up for and take care of myself. It also showed me that even people with dementia are sometimes capable of sensing when they have crossed the line. If the caregiver shows that they won’t tolerate abuse, the elder will often behave—at least temporarily. Use this to your advantage if you can, but understand that most dementia patients lose the ability to think logically and understand cause and effect as their condition worsens. With dementia, caregiver abuse is shockingly common and there is little that can be done to change this behavior.

Keep your boundaries firmly in place. If verbally abusive or disrespectful behavior continues, remove yourself from the situation and take some time for both of you to cool down separately. This is harder if you and your loved one live together, but there are ways to protect yourself while providing adequate care.

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Find Respite Care and Take a Break

Bringing in professional help can be beneficial for everyone involved. Seeking respite care may help your loved one gain a new appreciation for all you do, while still providing them with valuable social interaction and necessary care. Best of all, you will get a breather. Regardless of the type of respite care you choose, making preparations ahead of time is key.

Research home care agencies, adult day care centers and other care options before they are needed. If you have everything set up when your loved one acts out, you can calmly say you won’t tolerate such treatment and promptly arrange for an alternate care provider. If you can’t follow through quickly, the consequence is less likely to have an impact on your loved one’s behavior.

Acknowledge their pain and frustration, but stand up for yourself and make it clear that you are doing your best. Remind them if that isn’t good enough, then someone else will have to take over. You may be able to explain this change by saying that you are bringing in a professional since your company seems to be so displeasing to them. Follow through unless you see an immediate change in behavior.

Know When to Walk Away From an Abusive Elderly Parent or Spouse

Unfortunately for some families, no amount of counseling, boundary-setting, detachment or respite care will change an elder’s abusive behavior. Continuing to provide hands-on care for someone who refuses to show you respect and cooperate with their care plan will ultimately lead to caregiver burnout and jeopardize your physical and mental health.

Whether you feel you have been forced into caregiving or have voluntarily taken on this role out of love, it is crucial to know when enough is enough. Permanently handing off your loved one’s care to in-home caregivers, an assisted living facility or a nursing home will ensure they receive the assistance they need and allow you to limit your interactions as much as you see fit. It is a difficult decision to make, but sometimes the best option for both parties is separation—especially in cases where physical abuse is an issue.

Be strong and resolute. My flawed goal of trying to please everyone, no matter the cost, taught me many lessons that I hope I will never forget. It is common to feel trapped in a caregiving situation, especially an abusive one. But, I learned that I have feelings and I count. You count in the caregiving equation, too, so make your well-being a factor in your loved one’s plan of care.