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   The Scary Part of Caregiving

The following is an excerpt from an article written by Jim Schuster, a Certified Elder Law Attorney. The scary part of his treatise is how he lumps all of us caregivers into one cloudy, murky soup of malcontents and ner-do-wells, after only one thing - our parents' money.

The problem with the self-serving generalization, of course, is that the VAST majority of informal caregivers do it out of the goodness of their heart, or from honoring a commitment to a long-time parent. Very few are in it for the money. Most realize that there simply won't be much left when the parent passes anyway - mainly because most of us simply didn't realize how much it was going to cost to grow old.

I think what amazes me is how this article exposes for me how vulnerable I am from any third party accusation of impropriety even though I am squeaky clean in my dealings with my parent. Remember that a parent suffering dementia is likely to say and do anything, and possibly catch the attention of well-meaning but misguided outsiders. So be prepared to be shocked as you read this article, as I was, and start looking into elder care legal agencies that can set up a program to protect you as a caregiver.
"The Caregiver Trap" by Jim Schuster

National studies find that elder abuse is often committed by family members. Many times these are Caregivers. The resulting conflict and alienation can be avoided. A "caregiver contract" can eliminate problems of financial elder abuse before they occur.

There comes a time when an aging parent needs a full time caregiver. Many times a child, usually a daughter, steps up and either moves in or takes mom in her own home. Everybody knows that being a full time caregiver for an elderly person is a difficult job, but not everybody appreciates how dangerous it can be for the caregiver and the elder. Too often elder abuse becomes a part of the relationship. While there is a wide array of abuse, one form may easily be avoided and that is financial abuse by an exhausted child caregiver.

Reports have shown that elder abuse is most often committed by persons known to the elder. Spouses and children are the top perpetrators. There are abusers who are caregivers for only one purpose - to get the elder's money. When financial elder abuse is committed by children, it is often by those who have a history of financial problems or addictions. The great majority of caregivers are not in it for the money. They don't want any of a parent's property and if asked will say "if I wanted money I would have gotten a job." Yet there are times when these well meaning children dip into their parent's accounts to benefit themselves.

A short definition of elder abuse is any taking of a vulnerable adult's property for self use. If a parent is dependent on a child for full time care then she is vulnerable. Even if she is of sound mind her will can be overcome by pressure from the caregiver. A simple statement such as "I will have to put you in a nursing home and get a job" can cause the elder to give the caregiver almost anything.

There is a complex interplay of fact and emotion that can drive a caregiver to financial elder abuse. Studies show that the stress of full time care giving causes serious health impairments. The stressors are many. The parent may be a demanding, unappreciative patient. The child may be on 24 hour duty for months without a break. The caregiver may become emotionally exhausted and angry at the parent for her loss of health and lack of appreciation. She be angry with siblings who do not do their share to help out.

A child caregiver's services, no matter how valuable, are presumed to be rendered gratuitously. The unpaid child caregiver who lives in the parent's home often has very little financial means. The caregiver may only be available because she is not employed. She often has no spouse and very little in savings. The caregiver may note that the siblings are doing well financially while she is tottering on the brink of financial ruin. She may become aware of the commercial value of her care. A live-in aide may cost over $7,000 per month. Finally feeling at the end of her rope she may conclude that all her effort has merely saved mother's money for the inevitable nursing home.

Driven by these factors the caregiver may appropriate a parent's money to pay her bills or to buy things that salve the hurt. Without voluntary and informed consent by a competent parent, these appropriations are elder abuse and the daughter could be subject to criminal prosecution. While even the smallest taking is criminal, it is often that the money taken is small at the start and then rapidly grows. The result is an elder who loses her caregiver and has no money left to pay for commercial care.

Dysfunctionality of the family is another factor often at work in these situations. While there are many causes, a commonly overlooked component is that of the dependent personality of the parent. It sets up a psychodynamic between the parent and those upon whom he or she depends. I describe it as the pattern of the dependent person who needs others for support. This type of person marries a spouse with a "strong" personality who proceeds to be the "one in charge who takes care of everything."

The "weaker" spouse develops ways of manipulating the stronger to get his or her needs met. When the strong spouse dies the weak spouse needs somebody to depend on. The pattern, including manipulation, continues. This is a setup for conflict. Then comes the drama where the parent has "scripted the parts" and the children play their roles. The setup in the caregiver context is the the parent's message "I'm so thankful for you. Nobody else cares about me." At different times the parent may have said the same thing to other children. Compounding the difficulty is that one child may adopt the personality of the weaker parent and the sibling adopts the stronger. For example, the oldest son may not be suitable for care giving but may have the personality of the deceased stronger spouse. In that case then he often "comes to the rescue" of the parent against the "abusive" sibling caregiver.

The best way to avoid this type of conflict is to act before it happens. An elder law attorney should set up the business relationship of care giving. All interested persons should be involved. There should be an independent, professional assessment of the extent of the need for assistance. The commercial cost of these services should be identified. The persons who perform the services are identified. A contract is completed specifying the services to be provided and the compensation for those services. In this way nobody is taken advantage of, not the elder nor the caregiver. There would be no charge of financial abuse of an elder or the permanent alienation of the caregiver as a thief.

Dysfunctional family relationships are a common cause of caregiver conflict.

Jim Schuster is one of nine Certified Elder Law Attorneys, Chair Ex-Officio of the Elder Law and Advocacy Section of the Michigan State Bar, has published many articles on elder law including the Patient Advocate Guide to Nursing Home Care, The Parkinson's Answer Book and the Alzheimer's Answer Book.