I talked to a 68-year-old lady a few weeks ago. She was a full-time in-home caregiver for an 89-year-old who happened to be her mother-in-law, the mother of her husband who had died more than three decades ago. She never had a great relationship with her live-in patient in the first place, but she took on the responsibility of caring for her in her old age because she was the only person on earth who would; the woman had alienated nearly everyone else in her life, including several of her own children.
The question this lady, we’ll call her “Diane”, asked was simple: “What can I do about my mother-in-law’s abuse?” The unfortunate answer is that, as a family member and caregiver of a senior patient, the number of tools at your disposal is fairly minimal. That said, here are a few things you can do about abusive patients.
The Psychology behind Abusive Seniors
Some people seem to be inherently abusive, and the reasons why are complex and generally rooted in their childhood. Others are mostly normal throughout most of their lives, then become abusive as they age. To a degree, that’s understandable; it is not easy watching (and feeling) your body become frail, incontinent, and weak, and your mind become forgetful and confused.
Moreover, having a family member as a caregiver creates a relationship that is much more than “nurse-patient” or “mother-daughter.” The decision to take responsibility on a day-to-day basis for another person’s well-being is a major commitment, and when it is a family member, the commitment is usually permanent. This means that, in scenarios involving abusive patients, you are living with and/or taking care of someone who knows full well you aren’t going anywhere.
They can be as grumpy and irritable as they want to be, because you have already committed to being there for them at their worst. It is a situation that is absolutely ripe for abuse in BOTH directions; but if you are a genuinely good person and they are not, you can end up in an untenable situation.
There is an important distinction to keep in mind when we discuss abusive patients. For this discussion, we are talking about senior patients who do not have Alzheimer’s or dementia and are choosing to be abusive. If your aging loved one has either of these conditions, that is an entirely different situation.
Another important thing to remember if the patient is choosing to be abusive is it’s not you, it’s them. But it is on you to keep yourself protected.
How to Protect Yourself in the Immediate Term
There is a simple rule to keep in mind the moment your patient starts to become abusive. And it is a principle that comes from, of all places, the internet.
Don’t Feed the Troll
An abusive elder has a single goal in mind when they become abusive; they want you to engage with them. For this reason, deliberately not engaging is your single best strategy; in other words, don’t reply at all. Don’t change your affect (the attitude with which you are doing things) at all, simply do whatever is strictly necessary to be able to walk away without leaving a mess behind.
Do not come back for a full minute; and if they start back up, immediately walk away again and do not come back for two minutes, then four, eight, sixteen, and so on. Unless they find some way to put themselves in life-threatening danger, just let them wait it out until they figure out that being abusive is not going to get them what they want.
How to Protect Yourself in the Medium Term
The next important technique requires planning, but it works miracles. It is called Detaching with Love, and there is already a great article written about it here. I’ll leave you to read that and move on.
How to Protect Yourself in the Long Term
Diane came to me because she did not believe she had any resources that she could turn to for support in her daily conflict with her mother-in-law. I told her she could not be more wrong. Her family members were all young enough that they were busy with jobs, kids, and were hundreds of miles away, but I pointed her to help in other places, such as:
- The Caregiver Action Network, a group that provides enormous resources for family caregivers;
- A statewide phone support service for family caregivers;
- An online support community for family caregivers;
- A local in-person support group for family caregivers; and
- A Geriatric Care Manager who could, in turn, help her find respite caregivers.Ultimately, what Diane needed most, and what many other caregivers of senior parents (and parents-in-law) need most, is social support. Permission to do what you need to do to take care of yourself and some friendly ears to share stories with go a long way toward making patient abuse tolerable.