Caregiver Abuse

There are two types of Caregiver Abuse:

1. Caregiver (usually a paid caregiver) abuses a care receiver.  Abuse can range from withholding care to physical violence.


2. Care Receiver abuses caregiver.  Most common is verbal abuse, but there can also be physical abuse.  Frequently abusive behavior develops with dementia, but abuse can also occur without dementia.  The abuse may or may not be related to previous abusive behavior.

Prevention and Response:

1. Caregiver abusing Care Receiver

• Presence – frequent visits, unpredictable schedule of visits, enlist other family members and friends to have other sets of eyes


• Attention – ask questions of care receiver and care staff, be observant, keep inventory, be alert for signs of physical and/or emotional abuse

1. Care Receiver abusing Caregiver

• Develop and use strategies to minimize care receiver agitation.

1. Adult-adult interaction


2. Dementia patient strategies


3. Avoid co-dependence

• Involve medical team in helping manage the situation (particularly psych or social work consult and counseling to develop strategies and work with both caregiver and care receiver).


• Implement alternative caregiving arrangements if abuse continues, particularly if physically threatening (paid caregivers at home, adult day care, etc.)

The Biblical Basis for Family Caregiving

The Biblical Basis for Family Caregiving

Principles

• Family members care for family members, whatever their need.


• One of the Ten Commandments, listed with not murdering, committing adultery, stealing, giving false testimony, defrauding.


• Giving a gift to God is not a substitute for caring for your family members in need.


• If family members cannot care for family members in need, then the church is to care for them individually and collectively.


• Wishing someone well is not the same as taking action to meet their needs

Honor your father and your mother, so that you may live long in the land the Lord your God is giving you.  Ex 20:12

Honor your father and your mother, as the LORD your God has commanded you, so that you may live long and that it may go well with you in the land the LORD your God is giving you.  Deut. 5:16

For God said, ‘Honor your father and mother’ and ‘Anyone who curses his father or mother must be put to death.’ 5But you say that if a man says to his father or mother, ‘Whatever help you might otherwise have received from me is a gift devoted to God,’ 6he is not to ‘honor his father’ with it. Thus you nullify the word of God for the sake of your tradition.  Matt. 15:4-6

You know the commandments: ‘Do not murder, do not commit adultery, do not steal, do not give false testimony, do not defraud, honor your father and mother.’”  Mark 10:19

If any woman who is a believer has widows in her family, she should help them and not let the church be burdened with them, so that the church can help those widows who are really in need. 1 Tim. 5:16

If anyone does not provide for his relatives, and especially for his immediate family, he has denied the faith and is worse than an unbeliever.  1 Tim. 5:8

But if a widow has children or grandchildren, these should learn first of all to put their religion into practice by caring for their own family and so repaying their parents and grandparents, for this is pleasing to God.  1 Tim. 5:4

For I was hungry and you gave me something to eat, I was thirsty and you gave me something to drink, I was a stranger and you invited me in, 36I needed clothes and you clothed me, I was sick and you looked after me, I was in prison and you came to visit me.’
37“Then the righteous will answer him, ‘Lord, when did we see you hungry and feed you, or thirsty and give you something to drink? 38When did we see you a stranger and invite you in, or needing clothes and clothe you? 39When did we see you sick or in prison and go to visit you?’
40“The King will reply, ‘I tell you the truth, whatever you did for one of the least of these brothers of mine, you did for me.’  Matt. 25:35-40.

Suppose a brother or sister is without clothes and daily food. 16If one of you says to him, “Go, I wish you well; keep warm and well fed,” but does nothing about his physical needs, what good is it? 17In the same way, faith by itself, if it is not accompanied by action, is dead.  James 2:15-18

Caregiving: Dealing with Rebellion

We had a good session last week discussing how to handle situations in which the person we're caring for refuses to do what they need to do -- take medicine, do their therapy, etc. -- and some ways we can effectively deal with them.

We talked some about why the care receiver may be rebelling and strategies that may help. Here's a brief summary of what we talked about, both as a reminder for those of you who were present and for those who were not with us.

Often, the care receivers are trying to find something where they can demonstrate control because they sense that they have lost control of so much. Even when the way they can exercise control is harmful, having control over something is important to them. Refusing to take their medicine, for example, is a way of exerting control. Often they are also struggling with loss of self esteem from not being able/allowed to do things for themselves. Another common cause of these kinds of actions is loss of position -- feeling like they are being treated like a child.
Here are some strategies that can help:

• Find another way to give them some control. "Would you like to take your medicine before you eat, or after you eat?" "Would you like to do your breathing treatment before Gunsmoke or after Gunsmoke?" "Would you prefer to walk around the block or walk in the mall?"


• Talk about what's really going on. Have an adult-adult conversation about why they are making bad choices. Don't allow the situation to become a parent-child interaction where you're telling them what to do and why and letting them move into the rebellious child mode. Treat them as an equal in their caregiving decisions.


• Help the care receiver take on as much responsibility as possible for his or her own care and well-being. Let the person you're caring for do as much for themselves as they possibly can, even if it takes a lot more time and effort. Let them dress themselves, bathe themselves, organize their day, etc. Our tendency is to want to do everything we can for them, but doing so results in loss of the satisfaction of being able to do for themselves. Anything we can do that helps maintain their dignity is a major contribution to their well-being.