Redefining "Abuse"

I have seen this (a friend caring for an abusive family member). We naturally think about the vulnerability created by age (and yes, that's very real). This points out the vulnerability to abuse created in some cases by caring.

For abuse to occur there needs to be be intent. A person with dementia has no intent to harm. I suggest you redefine your terms.

There may not be intent any longer, but the behaviors persist and have the same effect as intentional abuse. How would you redefine the dynamic?How do you support caregivers, whether family or staff, who are the targets of abusive behavior?These questions aren't random snark - I'm really interested in your thoughts, since I and my crew deal with this on a daily basis.

Quote from CapeCodMermaidFor abuse to occur there needs to be be intent. A person with dementia has no intent to harm. I suggest you redefine your terms.

Hi CapeCodMermaid,Actually, intent is not a requirement for abuse outside of legal situations. The only time intent matters is if you take an abuse case to court, the courts must prove "criminal intent" or "intent of harm".All of the terms used in this article are the current standard terms applied to abuse from various sources including the Merriam Webster Dictionary. Also, the article isn't only about people with dementia (and dementia doesn't always equate abuse!) but also those who are cognizant of what they are doing. I suggest you read the article more thoroughly . Thanks for your interest and reading nonetheless!

Hey heron,These are great questions you've posed! And I wish I could give you an answer to them, but unfortunately I can't. I wish to raise awareness. The first part of addressing a problem is recognizing it and I feel that the abuse some caregivers received is not recognized. I would be interested in hearing other people's ideas regarding these questions though!Thanks for all your comments!

Quote from CapeCodMermaidFor abuse to occur there needs to be be intent. A person with dementia has no intent to harm. I suggest you redefine your terms.

@CaringGerinurse: you make good points, but I think you oversimplify things a bit. First, an intellectual understanding of the disease process only goes so far when you've just been kicked, verbally abused or lied about out of sheer malice. The experience can be intensified if the caregiver is currently being abused in other areas of his/her life. Even if the caregiver is a survivor of past abuse, there can be a certain element of ptsd that makes particular behaviors difficult to tolerate regardless of one's "understanding".Secondly, we're not just talking about time-traveling elders who get frightened in situations they don't understand. We also have to deal with people for whom abusiveness has been a life-long behavior which is now enhanced by the disinhibition common in dementia.IOW, it ain't that simple. Neither professional nor family caregivers have the option of leaving the abusive patient. I read the OP as acknowledging this and asking for ways to support caregivers so that they are able to stop taking it personally.I want to be clear that, in my opinion, the workplace is NOT a therapy group. If someone is being abused or suffering from ptsd from past experiences, they need more help than a job can or should provide. I do believe, however, that there are reasonable, "job-appropriate" measures that can be taken to help workers cope and care properly for people with these problematic issues.

On this site I have seen a lot about "abuse" which is really not abuse. Unsympathetic care, and irritability while providing care are not abuse. I think the standard should be higher for professionals than for family members who provide care, but I have seen people label un-professionalism as abuse. It isn't.If we really want to help people have healthy relationships, we need to curb our usage of the word abuse, and our judging attitudes toward the people we want to help. Family dynamics are complicated and often rife with conflict. Conflict is not abuse. Major stressors on caregivers can lead to frayed nerves, and temper outbursts which are only compounded by abuse witch hunts. The solution is not to define unsavory behavior in elders as abuse, but to stop the judging and start supporting. When we use the term abuse, we separate compassion from the person who is losing their temper and we stop helping them. I am not suggesting that a caregiver who puts bruises on her mother, who truly abuses an elder, should not be punished. But one who simply yells or name-calls, or otherwise acts out in frustration that does not cause significant harm should not be labeled an abuser. Why is caregiver respite not addressing "the underlying issue"? We decided that there was such a thing as "underlying issue" when we stopped having compassion and decided to see overworked caregivers as monsters. If the research has shown that giving caregiver respite improves health for all concerned, why is there a need to find an underlying issue?So yes, I think we need to redefine abuse. But not this way. Abuse is a crime. It is not committed by a demented person who has no idea what they are doing. It is not a loss of temper, nastiness or inappropriate language. Abuse causes significant harm to the person who receives it, and warrants intervention from law enforcement. Family conflict is when family members fight, name call, it might even involve minor physical altercation, but no one gets hurt. In the case of paid caregivers, the standard should be higher, but abuse is still abuse and inappropriate behavior is unprofessional, and should be corrected without legal intervention.