Abusive behaviors in elders
by Isabel Fawcett, SPHR
Historically, regulatory scrutiny and practice focuses on abuse of the elderly, whether in long-term care or in residential settings. Such scrutiny is very much needed as many high-profile elder abuse stories have proven. Typically, unsuspecting and socially vulnerable elders have been subjected to predators, including financial sharks, gigolos, family leeches and unethical vendors.
While there is no doubt that some elders are abused in many ways, some individuals in our society seem to be less inclined to believe that sometimes the abuser may be the chronically ill elder.
Abusers Come From All Walks of Life
Abusive behaviors are not limited to elderly patients. Any psychiatric technician or nurse could share stories of abusive patients of all ages. These are patients who spit, throw objects, scream at those trying to assist them or at other patients, make unreasonable demands, and defy staff and/or family caregivers at every turn. Similarly, some elders also display out-of-control behaviors, including assault, in some instances.
When elders in nursing homes physically strike out at direct care staff, most workers remember that striking back is out of the question - regardless of what may have happened. In isolated circumstances, a staff person may temporarily yield to an urge to strike back. Ethical nursing home administrators have zero-tolerance for staff who retaliate or physically engage in such misconduct. There are criminal implications for any healthcare worker's lacking self-discipline in such circumstances.
Decades ago, my godmother started biting hospital staff while she was hospitalized. Her hands were restrained by hospital staff for everyone's safety. Even with her hands in restraints, she asked one of her visitors to move closer to her hospital bed to hear what she had to say. When the visitor leaned closer, she bit his ear!
When her hands were restrained, she became angrier and increasingly verbally abusive to staff and those of us who had cared for her throughout her period of chronic illness. Some of the things she said to others were hurtful. Most of what she said was not true. She was angry, in pain, denial, occasionally hallucinating, and otherwise acting out.
If there is any good news in such circumstances, it is that nursing homes generally have adequate checks and balances, and regulatory influences, to help protect staff, residents and visitors to the extent possible. When elders abuse their caregivers at home, all bets are off.
Family Members Caring for Abusive Elders at Home
Families grow older with emotional, social, financial, and sometimes psychological baggage. Strong bonds in a family may become stronger in time. Weak bonds may become intense when chronic disease and aging are suddenly front-and-center in the life of the family. Wounds from old, perceived wrongs, favoritism and every imaginable emotion come to life. Feelings of ambivalence come and go, only to return. Everything in family relationships is up for grabs.
Caregivers Must Somehow Manage
There are no simple answers to the dilemma of elders who abuse their caregivers. Caregivers' voices need to be heard when a caregiver feels abused by an elder. Such allegations should be taken seriously.
If you are a primary caregiver to an elder whom you perceive to be abusive in any way, here are a few thoughts.
- Share your frustration and concern with someone you trust, whether in a caregiver support group, your doctor or your elder's physician, or a representative from your state's aging agency.
- If your elder has been diagnosed with Alzheimer's, contact the Alzheimer's Foundation 24/7 hotline. A counselor should be available to assist you and offer helpful advice. Call (800) 272-3900.
- If Alzheimer's is not the culprit, there still may be an underlying medical or psychological disease process, including stroke or personality disorders, so be sure to let your elder's doctor know what is happening.
- If abuse ever rises to the level of an emergency, consider whether to call EMS for assistance, be it for yourself, and/or your elder's safety.
- Your elder may be better off in an appropriate long-term care facility where staff is trained to handle similar resident profiles. Is assisted living an appropriate housing alternative for your elder? If the answer is yes, contact a geriatric social worker or your state's aging agency to help you get started.
- Retaliation and elder abuse is never an option, of course. If nothing else, hire respite care that will allow you to get out and away more often.
- You do not have to love someone to assist or care for the person. If not love, think compassion and tolerance.
- Don't be afraid to invite other family members or visitors over. Random visits may be more helpful to you if you are an abused caregiver. A well-timed visit may expose strained relationships and yield possible evidence of bodily assault to the caregiver.
Most importantly, as the song says, there comes a time to know when to fold 'em and when to walk away. Ask for help and keep sharing!