By my dear friend - K - also in the same space of caregiving her mother:
I brought Mom to live with me 3 years ago following Dad's death. Resisting the pull to free-fall from the loss of the beloved man who took care of everything, I was grounded in the need to take care of Mom. While she was (and is) in terrific physical condition, she is memory-challenged to the point of requiring full-time care. But she knows her family, loves activity and is operating at far too high of a cognitive level to leave her care to an institution (if there is ever a time when a sentient being should be institutionalized.)
As long as I was visiting Mom in her home, I was completely relaxed and patient with her at all times. I couldn't imagine ever being otherwise! Of course, I was always on vacation. Free of work, free of any responsibilities other than taking care of Mom.
Once the initial house prep was done and ready to bring Mom (that's another chapter), moving her in was a snap! Against all warnings from friends that she would decline and be disoriented with the change, Mom adjusted immediately. It was as though she'd always lived here, sitting in the chair I had brought from her home, preparing her coffee in her own coffee maker, going out for the newspaper in the morning. She blossomed from day one. The power of family at work!
I took a week off from work to orient her. I was pretty relaxed that first week. It was an adventure! But it wasn't long before my patience was challenged, and found myself snapping at her. My nephew was here the first time it happened, and assured me that Mom would forget it in 5 minutes. Which, of course, she did. But I didn't. I knew I didn't want to be treated that way if, God forbid, I should ever be in her situation. And that was my litmus test for my behavior.
I snapped at her (yelling or speaking harshly) several times that first few months. I hated it. I always felt so badly afterwards. But I was learning! The frequency of my outbursts lessened as I learned how to avoid difficult situations. Just like kids that act out when you don't have any attention for them, are rushing them or don't give them adequate information about what is going on - or give them more information than they can process - a person with diminished mental capacity is going to balk. And Mom can dig in her heels and make a 2 year old's stubbornness look like a cake walk.
Just when I thought I had mastered my cool, Mom decided to take a bath. She caught me in the bath, and came in to tell me that she would be in her bath. I told her that we weren't able to lift her out (been there, survived lifting her once, but never wanted to do it again!), and she said "okay" and left. I knew I needed to intervene, and jumped out of the tub . . too late. I found her sitting in the deep whirlpool in her bathroom. She said, "I'd already run the water and didn't want to waste it." "But Mom, we can't get you out of there!" "That's ridiculous, of course I can get out." she declared in a stubborn and defensive tone.
The earlier experience had taken place in my low-sided tub, and as tiny as she is, it was a real strain to lift her. I knew this was going to be even harder, and that I needed to avoid the side-angle by getting in the tub with her. I grabbed a friction mat that I had purchased in anticipation of Mom's arrival (for showers! Not baths.) and tried to place it under her. As I tried to lift, it slipped, but thankfully Mom didn't. My heart and mind were racing. I had visions of calling in the neighbors to help, but was able to lift her on the second effort.
When I had her safely out of the tub, I lost it, telling her that if she ever did that to me again I was going to put her in a nursing home. The minute it was out of my mouth, I was horrified. Her little face was so repentant and contrite, saying "I'm sorry, honey, I didn't know."
It was an all-time low for me. I couldn't believe I had threatened her in that way. Never, ever did I want her to feel insecure in my care of her.
That was in the early days. Over the three year period, I have yelled a few more times. Sometimes just so she could hear me on the 3rd or 4th time of repeating myself. My friends and family reassure that I'm only human.
But a recent info packet from an Alzheimer's respite care group reminds that abuse is not limited to the criminal acts of stealing an elderly person's money, hitting them, locking them up or restraining them, or neglecting them. It includes "using a harsh tone, screaming or yelling, threatening to stop caring for the person, handling the person roughly, and fearing being on the verge of hitting or hurting the person." In a study by the British Medical Journal, the most common forms of abuse reported were verbal, and more than a third of family caregivers said abusive behaviors occurred "at least sometimes" in the previous three months. (I tend to think the other 2/3rds are not being honest, or are saints.)
I think it helps for me to know that it's not just a failure to achieve goal behavior; it's not just "not the way" I want to be treated in a similar circumstance. It's abuse.
I know that all of the good that I do for Mom more than makes up for the few abuses I have perpetrated on her. I'm not turning her over to institutionalized care because I'm not perfect. 99.99% of the time, I'm loving, patient and kind. Reinforcing her confidence by asking questions that she can respond positively to, providing stimulating activities and a loving caregiver when I'm at work. Never correcting her. Reassuring when she's confused or concerned. Patting her on the knee as we drive along, asking her how she feels, hugging her when she wakes up in the morning and goes to bed and telling her that I love her. Standing with her in the hallway as she looks at the collection of family pictures and recounts her memories of a loving husband and her precious children, pointing out how pretty her mother was. Preparing her healthy food, and making sure that she always looks her best, and is therefore treated respectfully when I'm not there to protect her.
I'm good at caring for Mother. Maybe even great. I'm still a work in progress, and not perfect. But I do think it's important to recognize and educate others on abusive behavior.
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