My philosophy is that caring for a loved one who can no longer care for himself is not a “burden” as defined by the dictionary: “a load, especially a heavy one; a duty or misfortune that causes hardship, anxiety, or grief; a nuisance.”

 My intimation is not that caregiving is easy or stress-free. It is not. But usually, it is the right thing to do. However, I am aware of some “toxic” caregiving situations caused by the care receiver that are not related to a disease process. I can only imagine how someone who was abused as a child might respond to the idea of providing care for an unrepentant, abusive parent. Some people are just naturally unpleasant to be around. Will they mellow with age or become more disagreeable, even cruel?

I remember a cartoon I saw in a Christian publication years ago. As the husband left for work, the wife remarked: “I’ve got an idea…today, why don’t you try being charming at home and cantankerous at work?” Ouch! Sometimes we do save our best behavior for others and tend to let those closest to us see our less-refined side. One of my patients was as sweet as syrup to the staff, but when her adult children came for a visit…boy, did she let them have it! We tend to take our frustrations out on people we feel will understand and not abandon us.

Various dynamics are in play in family relationships. Add to this the circumstances an elderly person is facing – loss of independence, a malfunctioning body, impending mortality – and it is inevitable that some caregiving situations become problematic. How should a caregiver respond?

Jacqueline Marcell has authored a book on this subject entitled “Elder Rage – or – Take My Father…Please.” Here are some of her points and my comments on what to do when the person you are caring for turns on you. (These refer to people who can control their behavior – not those with dementia or mental illness.)

• Don’t take insults personally. Many times, the words have nothing to do with you, but are expressions of overall sadness and loss. Try to be understanding of the feelings and frustrations your loved one is experiencing.
• Sometimes you have to walk away. Continued abusive words and actions should not be tolerated. Calmly state that you find this behavior unacceptable and leave the room. This is a first step that may cause a change in behavior. If not…
• Find backup and take a break. This step may be difficult, but in an intolerable situation it is necessary. Contact family members, friends, your pastor, an agency – asking for help when you need it is a good thing.
• Detaching with love – setting boundaries in toxic relationships. This is the step a caregiver should take when all else fails and the family member continues to exhibit abusive behavior. Marcell defines this step as, “Affirming that you love the person, but will no longer tolerate being treated with meanness or disrespect. You set boundaries and make them clear.”

If you are in an toxic caregiving situation, please seek help. Contact your loved one’s health care provider for advice.