Family Caregivers: How to Cope With a Challenging or Abusive Care Recipient

If the behavior is relatively recent, experts look at medication and dosage, pain or a new health issue such as a urinary tract infection. Research published this year in the medical journal Movement Disorders details aggressive behaviors from those coping with Parkinson’s disease and the need to create interventions for caregivers.

A pattern of abuse

But if the problematic behavior is well-ingrained, it’s even more complicated, the experts say.

Kathleen* tearfully talks about a situation she says is getting worse.

“He’s always been abusive,” she says of her 80-year-old father. “He used to punch and hit us all the time and my mother as well.”

Kathleen, 48, was born in Vietnam and came to the U.S. as a 1-year-old.

“I have very Americanized beliefs, but I hold dear some traditional values,” she says. One Asian value, though, has been ingrained since childhood: “You don’t put your parents in nursing homes.”

Her father, a retired physician diagnosed with diabetes, has lived with her and her husband and two children (ages 16 and 7) in their Tustin, California, home since 2018. Her parents separated more than 30 years ago. Kathleen says her two younger siblings are “emotionally traumatized,” and her father is causing strain in her marriage. One of her children is battling depression.

Clinical psychologist Sara Qualls describes such circumstances as a “long-term pattern of care recipients who have been abusive to family members throughout adulthood and now they’ve aged and need to receive care, but their pattern is to be abusive.”

“I’ve worked with caregivers who have been abused historically by the recipient who have managed to provide the care but often it’s inappropriate. Often it’s re-abusing the caregiver,” says Qualls, a professor of aging studies and psychology at the University of Colorado in Colorado Springs.

“If a caregiver is in a terrible situation and feels trapped in providing care to a person who is abusive and always has been, it needs to be shifted in terms of the care structure,” she says. “Usually, I help the caregiver think through, ‘What if you didn’t exist?’ Siblings have set a boundary for a reason. They’re accepting this assignment without reviewing their own boundaries. So often, the caregiver feels trapped by some rules in the caregiver’s head.”

Codependency and toxicity

Despite a toxic relationship, sometimes there’s a codependency involved, says Suzette Abend, a licensed clinical social worker in Long Beach, California.

Many care recipients drink, which she says “fuels the flames” of aggression and vitriol. Caregivers buy the alcohol because they fear what will happen if they don’t. And, she says, sometimes caregivers are financially dependent on the care recipient’s income.

“The adult child is living in the care recipient’s home and does not have a substantial enough income to live on their own. They’re typically unemployed and themselves could be on Social Security,” she says.

Elder law attorney Stephanie Townsend Allala of El Paso, Texas, says she’s very familiar with the dynamic.

“It’s the person who does the most for you and cares for you — that person is the one that takes the brunt of the abuse,” she says. “Whatever bile or anger has been saved up over a lifetime, something starts spilling out to the nearest person. When people start to lose the ability to hear well, talk and speak and communicate their wishes, they resort to physicality.”

Townsend Allala says, “The law doesn’t say because you have dementia you can’t be charged with a crime, but often it’s the element of intent that you’re not able to prove in a dementia case.”

‘This is the dementia talking’

Rob,* 57, of Manor, Texas, is caregiver for both his parents and his partner, in addition to working full-time at a nonprofit and at a part-time job as well.

Although his parents — both in their mid-80s and with health conditions but who can live independently with his oversight — haven’t expressed aggressive tendencies, Rob says his partner of 24 years has had a personality change because of early onset dementia diagnosed about five years ago.

“When he’s very tired, he goes into fight-or-flight mode. His base instinct is to be very argumentative. Many things become my fault,” Rob says of his 60-year-old partner. “At first, I took it very personally. But then, you start seeing a pattern and this is the dementia talking. It’s not me.”

Christopher’s caregiving “break” is a job. He works two weekend nights at a brewery and pays a neighbor to check in on his mother while he’s at work. He says having his mom live with him has helped him gain valuable tools to let go of some of the anger he has felt toward her. Still, he takes every day as it comes.

“I really don’t know how much longer I can continue to do this,” Christopher says. “It’s almost beyond what I’m capable of.”

*For privacy, last names have not been used.