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In-Home care can help stem elder abuse

by Carol Bradley Bursack, Editor-in-Chief

While elder abuse in nursing homes is a definite concern in some areas, there is a type of abuse that often goes undetected. That is abuse in the home. This type of abuse can mean spirited and intentional, and should be reported to authorities immediately. But a subtler type of abuse can happen because the primary caregiver is pushed beyond his or her emotional and physical capabilities by the around-the-clock care needed by many elders.

Picture this scenario. A 46-year-old woman, Pam S., has quit her part-time job to take care of her father-in-law in the home. She has two teenagers living at home. Her husband has a good enough job that they can get along without her income, though it's a stretch. However, they all love the widowed grandfather who is in mid-stage dementia. They do not yet want to put him in a nursing home, so the family brought him to live with them.

Pam was close to her in-laws and loves them as she does her own parents. She's good-hearted. She's been a good wife and mother. Perhaps, she was so good-hearted that she was naïve in taking in her father-in-law at this stage of dementia.

Caregiving stress leads to breaking points

Pam is now so isolated by her father-in-law's needs that she barely sees her friends from her past life. Her husband tries to help with his dad after work. Neither gets a full night's sleep anymore because Dad is sleeping less and less and he's also prone to wandering. Stress in this once normal household is palpable.

One day, when Pam is alone with Dad, and Dad asks repeatedly to go home, Pam snaps back at him, nearly shouting, "You are home! You moved in with us. This is home!" Pam catches herself, and feels bad and says she's sorry. She hasn't had a good solid sleep in weeks and she's barely been out of the house.

Is this abuse? Some would say yes, others would say it was understandable, but unkind. I would agree it was unkind and say this behavior is a sign of potential abuse and if Pam doesn't get respite help and time to herself, she could turn into an abuser.

Two caregiving approaches, with different endings

I see one of two things happening in this case, depending on what Pam chooses to do with her insight into her unkind behavior.

1. She can make no changes

She apologizes to Dad but continues on with him in the same manner, rarely doing anything for herself. She feels it's her duty and she will stick to it. Things go okay for a week or so, but then Dad begins the common sundowning routine, where he is agitated toward the end of the day. He seems to need to "go somewhere or do something." This adds to Pam's stress.

As time goes on, Pam finds herself shouting at Dad more often. Gradually, she doesn't even catch herself when she "loses it." She also has gotten rough in handling him when she's angry and he needs physical attention. She finds bath time horribly hard, and now her husband has to wrestle with this issue when he gets home. He's short with Pam because--in his words--'she has all day to get this done.'

The kids are walking on egg shells because both parents are stressed and short tempered. Pam no longer goes to their concerts and ball games. Their father rarely does either. Eventually, Pam and her husband, both kind by nature and with a once happy marriage, find they are often fighting. Their marriage is in danger, their kids are unhappy, and poor Grandpa is truly in danger of verbal or even physical abuse.

2. Pam realizes she can't provide care by herself

Pam realizes, once she catches herself losing patience with Dad, that he can't help his behavior and she can't care for him alone. She humbles herself enough to explain this to her husband and they decide they either have to put Dad in assisted living or a nursing home, or get some outside help to come in. They decide, for the time being at least, to bring in help.

They research in-home care agencies in their area and choose one they heard good things about from a friend. They figure out a block of time, three times a week, where this agency has a caregiver come to the home for a few hours.

The time the hired caregiver is in the home relieves Pam and becomes her key to her own mental health. She uses one day to catch up on errands. She uses one block of time to go to some yoga lessons. She uses the third to have lunch with friends or whatever else she needs or wants to do. This goes so well, they even occasionally hire a caregiver to come in when the kids have events so they both can go watch the kids perform.

These blocks of time give Pam the energy and peace to once again find her love for her father-in-law and be the kind of caregiver she wants to be.

Eventually, Pam and her husband look into adult day care once a week for Dad. This frees up Pam enough so that she takes on some work from her old company that she can do from her home computer. She feels this added money, plus money Dad has since he doesn't have to pay for an apartment, pays for the extra care they bring in.

Getting caregiving help is often the answer

Pam and her husband are once again enjoying their marriage. The kids are happier. The family feels Dad is cared for and they are no longer afraid of the time when he may need so much care that a nursing home will be the only safe choice. They are researching the area homes, so when that time comes, they will be able to be involved in the transition and still be Dad's caregivers. 

Pam and her family chose the second route and are happier and healthier for it. Dad resisted at first, but has now become very fond of his caregiver who comes three times a week. The whole family has benefited from reaching out for help before Pam snapped and became an abuser.

There are, of course, caregivers who can do it all themselves. However, they are generally caring for people who can still be alone for at least brief times. Also, they are rarely caring for children at the same time. Most people need a break when caregiving becomes long term. In-home care is a great first step to getting needed breaks that can have a positive effect on the whole family.