Caring for a Difficult Older Adult

Try these strategies to remain effective and sane when you're taking care of someone who's difficult
Exasperated

Caring for a difficult relative or other loved one

Being a caregiver is never easy, but if you've spent much of your adult life trying just get along with a parent or another older adult you're close to, being thrust into the role of his caregiver may be excruciating.

The bad news is that if he's always been critical, grumpy, intrusive, or just plain mean, it's unlikely that old age and poor health will improve his personality much. The good news is that as an adult, you've probably become more confident in yourself and have learned to deal with him more effectively -- and if you haven't, now is your chance to learn. Believe it or not, it's possible to make your relationship work more smoothly so that you can help him through this stage of life.

Difficult people come in all varieties, from self-absorbed and demanding to angry and remote. Caregiving situations vary widely, too, of course: Your experience will be different depending on whether you're providing daily care, supplying occasional care, or coordinating care from a distance. No single approach will address every dilemma, but the following tips should make caring for the person a little easier.

Getting started

You've had the double "oh no" moment -- that is, it's become clear that your parent or someone else you're tied to needs help and that you have to take a greater role in his care, and this means you'll be spending more time with someone you find difficult to be around. Perhaps you'll need to help him move to a nursing home or arrange a treatment schedule for him after his cancer diagnosis. Whatever the details, the relationship you've had is about to change. Here are some steps you can take to ease the transition:

  • Take time to prepare yourself. Faced with a crisis, it's tempting to make decisions quickly without thinking them through. If you have a difficult relationship with your parent or someone else you're caring for, the pressure is even more intense, and every decision is fraught. Try to spend some quiet time before you jump onto the caregiving roller coaster. Write in your journal, talk to friends, and think about what has made your relationship difficult in the past and how you can approach it differently this time.
  • Line up support. It's important to have buffers so you won't be standing on the front line all by yourself. Meet with siblings, other relatives, or other friends who will be giving care so you can divide the labor early on, if possible.
  • Bring in the experts. If you don't have family support, you live far from the person you're caring for, your relationship is explosive, or his situation is complicated, consider hiring a geriatric care manager. She can help by providing support and concrete advice about community resources, skilled nursing facilities, and other such topics. If you live far away, the manager can help you coordinate care from a distance. Take the time to find someone that you and the person you're caring fo both trust. If you find the right person, she'll help you communicate more effectively with the person you're caring for.
  • Consider your own role. As you enter this new stage in your relationship with the person you're caring for, it's important to remember that you can't control how he acts -- but you can control how you respond. Take time to honestly consider your own role in the conflicts you've had in the past and think about how you can handle things differently. This might be a good time to see a counselor to sort through some of the guilt, fear, anger, and resentment that may have haunted your relationship -- and likely compromised other relationships in your life as well.

Coping day to day

Once he's settled and you've established a caregiving routine, he's likely to resume his usual patterns of behavior -- and may even become more difficult. Crises are frightening, but the long haul can be harder. It'll probably last a lot longer, too. You may require additional strategies to help you care for him on a daily basis.

  • Talk it through. Try addressing the situation directly as soon as problems arise. Say something like, "I know we've had problems getting along, but I'd like to do it differently from now on. Can we talk about how to do that?" Try to listen to what he has to say without getting defensive. Use "I statements" when you explain your experience ("I felt as if you were angry at me just now" rather than accusations such as "You act like you hate me").
  • Prepare to have your buttons pushed. If you consider the history of your relationship, you'll  likely find some recurring themes. Maybe your dad always compares you unfavorably to your siblings or blames you for your two failed marriages. Identify these common trigger points ahead of time and simply ignore him when he touches on them. Instead of reacting angrily or getting hurt, gently change the subject -- as many times as you need to -- until he gets it.
  • Try something different. If your interactions are uniformly negative, think about how to change the dynamic. Are there less stressful ways that you can spend time together? If sitting together and talking usually ends in an argument, offer to clean his attic, weed his garden, or cook him a special meal. If you visit him at the nursing home and all he does is complain, suggest taking him out for a drive or lunch. Or take a tape recorder and interview him about his past. Read a book together, if he's up to it, or help him put photos in an album as a legacy project. A tangible project that you can do together can help you be close without treading on perilous ground.
  • Set boundaries. It's important for anyone in a caregiving position to set and maintain solid boundaries, but this is especially true if you have a difficult relationship. If you're clear about how much you're able and willing to do and stick to that, you'll be less susceptible to guilt trips and manipulative behavior. You can also set limits for how much emotional abuse you'll put up with; if he  won't stop criticizing, maybe it's time to go make yourself a cup of tea.
  • Take care of yourself. If you're spending a great deal of time with the person you're caring for, make sure that you're doing things to replenish yourself -- body and soul. This will help you stay balanced and less reactive. Maintain a regular exercise regime to blow off steam, and arrange for regular weekends off and vacation time if you can. Some people find that being in nature or meditating helps them maintain their perspective.

If your schedule doesn't permit regular breaks or time for yourself, you're headed for burnout and you need to do something to remedy the situation. If no one in your family or community can step in, check with your local agency on aging to find out if there are any respite care services available.

  • Join a support group. A caregiver support group gives you a place to unwind and share your story with people who are having similar experiences, which can be restorative.

What to do if a difficult person you're caring for gets even more difficult

  • Seek counseling or mediation. If the person you're caring for is able and willing, try seeing a counselor together. She can help you communicate mo re effectively and change some of the patterns that have poisoned your relationship.
  • The tough get going. If you've tried everything and your interactions are uniformly unpleasant or worse, it's time to consider other alternatives. Talk to family members or close friends and see if you can find ways to minimize your contact with the person. Offer to take on caregiving jobs that don't require much interaction, such as paying bills or dropping off meals. If all family members have problematic relationships with the person, pitch in to hire someone, if you can afford it. Caregiving is bound to be hard, but no caregiver should be abused.
  • Have reasonable expectations. With patience and lots of luck, you may be able to make a breakthrough in your relationship with the person you're caring for. But it's important to keep your expectations relatively low and to be willing to practice a little acceptance when things get rough.

     

    The fact is that most people don't change much: He's unlikely to grow substantially less difficult, no matter what you do. You could have years of caregiving ahead; if you go into it with an open heart, it can present an opportunity for growth and healing -- despite the many frustrations along the way.

  • Be open to a new relationship. In the movie The Savages , two adult children are wrenched from their respective lives and thrown together to care for their elderly father. The father was abusive and distant when they were young, and they haven't seen him in years. The movie neither dwells on this history nor glosses over it, and there are no tearful reproaches, apologies, or reconciliations. The fact is that the father is now a confused and helpless old man -- and his children rally to help him.

     

    In the same way, you may find that being a caregiver is different from being that person's child or niece. No matter how flawed he is, in the end he's still someone you're connected with, and he needs your help.


10 days ago, said...

These are great suggestions, but (yes there is always a but!), they are for those who have some insight into their condition. My 93 year-old dad has had major personality changes (frontotemporal dementia) for the past 8 years. He lives in IL, but is not independent. He hides used Depends, hoards money, and has no friends (was very social in past, a wonderful dad). I live 150 miles away and go up 2-3 times per month to clean, do meds, etc. I understand the physical changes with aging, but the major personality changes are making me crazy. No amt of talking is going to help. This may continue for another 10 years and feel horribly guilty that I just want it to end.


27 days ago, said...

To Fellow Commenter: Yes you have kept your promise to your mom, have remained a loving daughter even with your dad's challenging behavior and have been overseeing care at his facility. I commend you for that and you should as well, do not feel guilty or that you have failed in any way, you haven't. If you now feel you must set a limit for yourself in visiting him, do so., cut back in baby steps, sounds like you have started that already, limiting days and timeframe. I am a caregiver to my brother for 5 years now, and yes, I let my mom know I would not abandon him "if ever." He chose to live 1000 miles away forever and he developed ALZ. He was a "tough brother and son" his personality the same, but worse due to the disease. There is no filtering, he says what he wants, words laced with profanity. I have to be "on my guard" watching what I say and do, taking off his socks or glasses can be a challenge. I came to realize, just recently, I will be having to step back, make changes. Car rides, taking him out alone, are now more challenging, I need strong support. I know that changes are inevitable, there will be guilt and sadness, I will try to remember my Mom's words, "You'll have to be strong." I think it's crucial to realize our limits on what we are able to do no matter what it is at any age, and, I am finding our body and mind does let us know when we are pushing. We have to "give a crap" of ourselves and remember that each day is a blessing. I sense you will visit, for you, but I don't think there's anything wrong with your occassional one and then reward yourself. Caregiving is hard, physically and mentally, it can beat you up. Support is limited as well. Don't forget about you, take care of you! God Bless Caregivers


27 days ago, said...

this article may be good for some people and has some nice guidelines, but caring for a difficult person who is mean is harder than one says. I promised Mom, I would take care of dad after she passed, but he only makes it harder and harder. I am now the sole target of his abuse and criticism. My sisters have left me to take care of dad, who has always been difficult and emotionally abusive. Now in an assisted living, he is even meaner and I am the sole target. Visiting him every other day, went to 3 times a week and now is two times a week. Soon it will be one time a week if his abusive behavior continues. and then, who knows, I just don't deserve this. He has always been verbally and emotionally abusive and now it is more amplified and directly solely to me, It makes it hard to visit him, and honestly, at 63 I just don't deserve the abuse anymore. Sorry Mom.,,, sorry mom, but I tried.


2 months ago, said...

Thank you so much for this article and the people who wrote comments... I am just beginning this journey with my mother and I am anxious about how to handle the situation. It never was easy between us, not because we are mean to each other, but because we simply don't have the same approch and perspective about life. All my life, I tried and be the most positive and joyous person I can be, while my mom is more on the pessimist side. Since I moved part time with her into her home to take care and accompanied her, my biggest concern is that she'll drag me down on a spiral of bitterness and negativity. Could be a good time to start jogging to blow some steam... and get fitter by the same occasion


4 months ago, said...

Helping our parents lead to meaningful relationships. We grow old together. I am dad's caregiver and have a full-time job.


6 months ago, said...

Looking for support. I'm living with my father and care giving. I feel called to do this and am easily frustrated, especially after the recent passing of my mom. He has always been difficult. He thinks I have ulterior motives and our conversations often end up with him telling me to pack my stuff and leave. He often treats me poorly and like a child. This is taking a toll on me. He doesn't realize that I've given up quite a bit to do this, that somehow this is gravy and I'm on the gravy train. I've been frightened by his voice alone my whole life. Just looking for some sage advice from someone who has gone thru something similar. Thanks


6 months ago, said...

My father refuses to bathe. If asked, he will say that he did. My mother has tried to encourage him. It's been at least a year or more. Way back, when asked he said that he gets so sweaty after taking a shower that he doesn't even feel clean. That must have been two years ago. My Dr. said that it's one of the first signs of Dementia. He does have some kind of Dementia, but it's difficult to know when he's "with it" or not, because he's become so uncommunicative. He rarely talks. Part of that is that he can't find the right words and he's unwilling to appear 'infirm'. Has anyone had success getting a parent to bathe, who refuses to do so ?


8 months ago, said...

where do I find a geriatric care manager around allen park, mi?


9 months ago, said...

My 96 uyear olf dad lives with my hudband and me. He is becoming immodest So far I have not redpondef or reacted to him about this. However it bothers me enough to trigger episodes of IBS, irritable bowel syndrome. I would appreciate suggestions.


11 months ago, said...

No I did not find this article at all helpful though it could give others some insight and assistance. To a point I have enjoyed being of help with an occasional verbal thank you. Now it is going on nine years and I have given far too much to an self absorbed and mean person who just happens to be my father. At 103 years of age he was in the process of dying in July but no longer is. Caregiving as one of seven siblings, and the only one in the area where our father lives I would advise moving away to anyone who wishes to save themselves from such a horrific experience. He refuses any caregiving assistance as well as hospice care. He is mean, extremely self centered and can well afford to have care into his home. At this point I am angry and extremely resentful not only towards my father but also towards siblings who could manage to give some financial assistance to me as I also work full time, or at least attempt to.


about 1 year ago, said...

I am the sole caregiver for my 9-years older husband who is deaf and also has trouble with recent memory and understanding even when I am finally (by yelling at the top of my voice) able to make him hear me. He loses at least a couple of things every day. I have started to require him to wash the dishes after meals, and look for his own lost items, although I usually do end up looking for, and usually finding them at my convenience, otherwise he would never even get out of his chair. This is what I think. If young couples had any idea what old age would look like taking care of a spouse, many would probably choose not to marry at all; it's difficult enough dealing with one's own old age, pain, and disability. You are the caregiver; no one is taking care of you. Although everyone tells you to take care of yourself, they show their concern, by staying away. If you hire a stranger to come into your home to help, you run the risk of being exploited.I read the other day about a woman who had been a public guardian and then went into a private home care business who then exploited her elderly clients.You don't know whom you can trust. The elderly are sitting ducks for predators. At this age, love has very little to do with it. The caregiver spouse often dies soon after the spouse they cared for, not out of love, as the romantics like to think, but from sheer exhaustion. To survive, I do what I can when I can. I have very painful arthritis Housework is haphazard. I keep to the basics: meals, grocery shopping, laundry, yard care, medication administration,reminding him about taking his inhalers and nebulizing at specified times, transport to his dr.'s appointments, finding someone to do needed repairs that he neglected before he was disabled, bill paying, negotiating with the phone and cable companies to keep prices down, etc. It is all on me now, and I will survive, but believe me, love wears very thin. I am tired, angry, and irritable most of the time. I hate everything about old age.


about 1 year ago, said...

An abundance of good points here. If you are a caregiver to someone suffering with memory impairment, dementia or Alzheimer's there are probably going to be personality changes that will occur at sometime. I think it's important to realize that all the books you may read, seminars you find the time to attend and coaching and support groups you seek out may not prepare you for behavior issues. It is said that personalities can or may change with the disease, but, I have witnessed, for the most part, the person and personality are really the old self, any negativity seems to be more pronounced, winning over positivity. I do believe it's because of the anxiety, depression and frustration of the disease. I am my brother's sole caregiver diagnosed with Alzheimer's 4 years ago, he is 69. He chose to live 1000 miles away, far from family and home, for 40 years, loving his independence. This choice didn't aid in brother/sister bonding then, and now, with his affliction, it's a challenge, yet I remain relentless. Yes, this makes for doom and gloom at times because providing him with the help and support he needs can be met with resistance. I made the decision to help him on this journey hearing, "Fasten your seatbelts," and "It's a roller coaster ride," not detouring me. Living alone was not to be any longer, him in denial, me comprehending that progression would win with time and a someday will come. He is still in denial, probably easier for him, the "A" word not mentioned since 2011 and "I don't need any help," being his favorite phase, so, my responses and words are chosen carefully and with thought. I have had to educate myself, knowledge is power, and I have had to stray off course at times dependent on circumstance, day, or moment. I learned, after many errors, that begging, reasoning, showing fear or tears was not the solution for helping him or me. I realized it was ok to fib, to not strive for reasoning, to avoid and ignore negativity and attempt to reinforce positivity. I've become a pretty good actress, it's constant work, but my goal has been to eliminate drama and stress for everyone, to remember we are all important. I learned that there is no shame in reaching out for support and that day programs, respite care, seeking out and having good help is a life raft. You proceed with caution as usual, but, it's ok to relinquish control at times and learn to trust decisions, instincts and yourself. You have to re-charge and take care of you without any guilt-trips. It's been trial and error, but, I'm not sorry about the decision I made 4 years ago. I Thank God he is holding his own with this terrible disease. I'm glad to witness his old feisty, independent personality and spirit. Family, love, memories matter. God Bless All Caregivers!


about 1 year ago, said...

This is all great information for someone who is taking care of mom, dad, sister, or brother, but what about a husband? My husband of 25 yrs. who is almost 69, has had 3 strokes, and has no sense of reasoning, or balance. So he falls a lot, and with his lack of reasoning, refuses to use a walker as he has been told, he also was told no more driving, but they never made it official, even though he has totaled out his jeep, which he rolled, and thankfully know one was hurt. He has always been stubborn, but now he is almost to hard to live with, I now have high blood pressure due to all the stress, and to top it off I have a bulging disc and a sublocation of a vertebra in my lower back, from picking him up or helping him up off the floor. I have asked the Dr.'s to try to help me but there isn't much they will do. He refuses to let anyone else help him so getting home health to help me is out of the question. We have a big house with 2 acres of land to mow, and I am the one who has to do it all now. He won't agree to move, because we have 6 cats and he will not let me get rid of them, at least 4 of them, so we could move in to a 55+ retirement community. Our house needs some repairs, but he says it is his money, and refuses to pay for anything other then the normal monthly bills. But it's okay to spend over $300.00 a month on the cats! I'm at the point of filing for a divorce just to keep my sanity! I have had to cut back to part time working as he has become a full time job. If I could get him in an assisted living place near here, that social security would pay for I would, but at this point I just don't know what I am to do. His children have told him he is lucky to have me and have told me they appreciate all I have done for him, but they don't have time to help me.