When we think of domestic abuse in a family where elders are cared for, we generally think that the elder is the most likely person to suffer abuse. Statistics would probably prove this to be a fact. However, there are many caregivers who can truthfully say that they are emotionally, verbally and even occasionally physically abused by their care receiver.
Being in a vulnerable state of health doesn't necessarily turn a person who was historically abusive to family members into a sweet lamb. Even the best of us can get cranky when we don't feel well. The frustrations of dementia can be even harder to cope with than physical pain. Good people can become hard to deal with when faced with these issues.
But we're talking about something different here. A mother who was always controlling, verbally abusive and a put-down expert to her daughter is quite likely to continue that behavior even if the daughter, who is probably on some level still trying to "earn" love from the parent, becomes her mother's caregiver. More probably, the mother's nasty personality issues, perhaps helped along with a history of having been abused herself or by a type of mental illness, will still be abusive to the daughter. She will still manipulate, scold, complain, put down, and in general try to make the caregiving daughter feel like nothing is good enough.
The father who beat his children when they were growing up or made it a point to tell the kids, in so many words, that they were not good enough, is likely to retain the same personality even if he is frail and ill. His ability to physically abuse may be limited, however this very limitation could actually make him more emotionally and verbally abusive than before.
The spouse who abused his or her mate emotionally, verbally or physically during the marriage is not likely to change, either. More than one spouse has told me that he or she is hanging on only because the end is in sight. What a sad way for a marriage to end.
_How much behavior can the care receiver control? _
Can the care receiver help his or her behavior? Sometimes yes, sometimes no. If the care receiver still has the cognitive ability to understand and change behavior, family counseling could bring about healing that would be wonderful for everyone, as it could end the abuse cycle some families find themselves in.
However, I'd estimate that in most cases, the cognitive ability, or the emotional willingness to change, are not present at this late date. It seems that if this is the case, and if the abuse is extreme enough to cause emotional and/or physical distress to the caregiver, outside help would be the answer.
Occasionally, hired in-home help can break the cycle because the care receiver is distracted by another person in the house. The reverse of that, however, is that many of these people abuse the hired caregivers, as well, resulting in a parade of hired caregivers who only stay a day or a week, leaving the family caregiver as frustrated - if not more so - than ever.
_What's the answer? _
The only option may be to move the person being cared for into a facility where professionals can handle the abusive behaviors, or if the behaviors a aimed at specific family members, the target is no longer there to be abused.
For the adult child trying to earn the love of the parent by caring for him or her in old age, this signals a time for reality. The adult child can still take care of the parent as part of a care team, but there can also be whatever distance is needed between them to minimize, if not eliminate, abuse.
No one should live in an abusive environment, even if the abuser is vulnerable. While forgiveness is generally the best route toward a healthy future, forgetting isn't generally possible, and often isn't even advisable. One can forgive without forgetting. With the elder in a safe but more distant environment, the adult child caregiver can set the boundaries necessary to give care in a way where he or she can feel helpful without feeling victimized. If the caregiver needs counseling to reach this goal, then counseling should be sought.