Abusive client. Was I right to stop working with him?

Well, both of you have valid points. If it is indeed dementia, then he can't help himself and chastising him will do no good.

That doesn't mean you're required to take it. Everyone has their limits, so you are certainly free to say you can't take it any longer.

I think that not only are you justified, you were wise.   Has he ever been physically violent to you?   It wouldn't surprise me. 

If the family thinks verbal abuse is okay, to me that's a bad sign of what they would anticipate a caregiver to tolerate, and it wouldn't surprise me if it became worse.

Your mental health is important too.

If you've been working with dementia patients for some time, then you know that just because a family asks their family member "to be nice," doesn't mean that they will remember. That is part of dementia. Wouldn't all of our lives be much easier if our LO's with dementia, would do exactly what what we tell them to do. It doesn't work that way though. You say that you can usually let clients verbal abuse "roll off your back." What was different about this client that you decided you couldn't with him? Just curious.
Yes you have a right to pick and choose who you will have as clients, but if you're wanting just easy clients, then perhaps you need to stay clear of dementia patients as they can be quite unpredictable.

No, with all possible respect for you and your very difficult profession, I don’t believe that asking anyone to “be nice” is very helpful.

If you state SPECIFICALLY the BEHAVIOR that you wish to change, and the client understands what has been said, there is a 50/50 chance that they may be able to respond and do what you’ve requested. “Hands in lap” is potentially a little more likely to get the result you want than “Be nice”.

In most types of dementia though, the client won’t understand or remember what has been asked of them, so the chance of changing behavior is not great.

You don’t EVER have to accept what a client SAYS, but you also can make a choice not to be offended by it. Whether he calls you a bean, or a bear, or a vulgarism doesn’t make you any of those. You are who you are, someone who wants to be helpful and kind to someone in need.

You seem to have made the best decision in your situation. Hope you can pick up a new client with a better vocabulary very soon!

Nah, I don't agree that the family should ask this dementia patient to be nice. It wouldn't do any good. Once a dementia patient gets a thought stuck in their head, it can't be chopped out of there with an axe. You can repeat yourself a million times and it won't stop them from asking the same question or doing the same thing again and again. That's the nature of the beast which you should be aware of as a professional caregiver. It goes with the territory.

That said, you shouldn't have to tolerate any behavior that upsets you. No job is worth suffering over, in my opinion. I used to work for a very ornery Alzheimer's patient many years ago & he was extremely abusive. I tolerated him for about a month and then said ENOUGH. I was done. I called the agency & quit that particular job and they said I'd stuck it out longer than any of the CGs they'd had on that job.

This man's family is going to have to accept the fact that they'll be going through caregivers quite a lot if their loved one is acting abusive. Just b/c he has dementia doesn't give him a free pass to be abusive. They may think it does, but it doesn't. They should try dealing with him for a few days themselves to see how it feels, and perhaps then they'd change their opinion, huh? :)

Good luck to you!

I understand how you feel.
However, if he treats the other two caregivers the same way, in my opinion that supports this behavior secondary to his dx of Dementia.
I would assume the family potentially has caregivers to provide respite from the verbal abuse they receive.
Honestly, I don’t feel he’s capable of understanding what he’s saying, let alone the affects it has on others.
In this case, I would agree it’s not possible to change his behavior by asking the family to tell him to be nice, to stop, etc.
If the family has accepted his behavior & knows not to take it personally that’s a big accomplishment secondary to their emotional attachments.
I think you need to hear what the family is telling you & believe it has 0 to do with you.
You didn’t mention what he said or why you took it personally? I don’t mean that to be disrespectful of your feelings or boundaries.

The family is being realistic by stating it won’t help. It would be wasted energy & going backwards if they believed talking to him like he’s lucid will result in change.

You were right to cancel him as a client. My mother was abusive to her caregivers and they quit. I had talked to Mom about this and she said she wasn't doing anything wrong. So they quit. If they are not happy so be it. You have to take care of yourself and your sanity. So yes, I do agree.

It reads to me that you are most upset by the lack of support from the client’s family. Whether or not some ‘correction’ would change the behavior, you are instead being told that your feelings about it don’t matter. My guess is that you are not getting much positive feedback, from the client or the family, and the money alone is not worth it. If this sounds at all correct, and the family is upset to lose you, perhaps you could talk to them about your treatment generally.

Sorry but I don't agree that those with dementia don't know right from wrong - they may forget themselves and act out inappropriately but IMO that doesn't give them a free pass. If the client doesn't ever apologize and doesn't ever even try to behave, even briefly, and if the family doesn't apologize on their behalf and at least attempt to call them to task then it's all on them when the caregivers leave.
"Dad! That was mean, I don't accept that kind of language in this house"
turns to caregiver "I'm so sorry"

That is surely not too much to ask.

If you dread going to work everyday. It’s time to quit.

I hope you find a client that isn’t abusive in the future.

Perhaps you could ask questions that would give you a clue to their personality and hope the family doesn’t embellish the truth when they answer your questions.

My husband’s grandmother was a horribly mean woman. She didn’t even have dementia. She was that way her entire life!

She was so mean to my mother in law, her only child that her daughter would have never been interested in having her move into her home after her dad died. She insisted on staying in her large two story house.

She refused going into assisted living. She had loads of money!

So, my mother in law hired two women for daytime and two women for nighttime and paid them each double their normal salary just to keep them!

My mother in law said that it was worth every penny spent!

She still had tons of money left over after she died.

Maybe some people dealing with situations like this will have to end up hiring private care like my mother in law did an pay them lots extra!

You said he called you a name. Was it racial? We had an aide that this happened to. It was a n elderly client who had Dementia. I knew the woman and told the aide before the Dementia she would have never had said it. But that didn't help.

We all need boundries and this was yours. You did what is good for you.

Thank you all for your support. Everyone gave me great things to consider. One view was maybe dementia clients aren't the best for me. I considered that today too. I think what bothers me the most is that the family doesn't at say hey dad, that wasn't very nice. A previous client would get angry and insult me, but later say he didn't mean it. I loved him so much and could tell he couldn't control his emotions, but knew his words hurt and was sorry. Maybe not everyone can and we all do have our limits. As I read your responses, I have so much empathy for the many family caregivers who endure this and can't/dont want to walk away. Much love. Oh, i didn't say what he said because it doesn't really matter. It was a trigger for me due to past abuse and that's on me. But it was and always was with him a put down.

On the few occasions my husband has been rude to his caregiver,I have jumped in and told him not to speak ugly to her. He will then explain why he had to say what he did, usually because she moved something he thought should be in a different place. After he pouts for several minutes, he will say he's sorry and how much he likes his caregiver.
Dementia or no dementia, I will not tolerate him being ugly to her.
The family could have said something to the person who posted, apologizing for the client's rudeness , if nothing else. It's hard enough to find a kind, efficient, compassionate caregiver without allowing someone to just be hateful.

My father was diagnosed with quick onset dementia about 1.5 years ago. Just since January of this year (2021), he has become a Dr. Jekyll and Mr. Hyde. One minute he is talking up a storm about a subject that interests him at the moment (most don't make sense) and interacting with you and the next he is mad, cussing, fighting off care, refusing to take meds. I can tell him, 'That is not nice' until I am blue in the face but even if I tell him to apologize, he has already forgotten what he even said. I will usually apologize for him. I try to explain to the caregiver of the man he used to be. Caring, Kind, always offering help. He would talk to anyone and everyone. He was the person people would stop over my parents house to ask him his advice on a problem with a car, best place to get mulch, etc.

Prior to Feb 2021 we were able to care for him at home. He ended in the hospital for a UTI and ended up with a foley that is now going to be permanent. We knew he couldn't come back home. We worked with an AL facility that was aware of the catheter and moved him in March. Now the facility says he is in need of more care, because of the foley, combatativeness (mostly yellowing and cussing) and needs to be moved.

Since either my sister or I go to the facility every day, we see many of the different forms of dementia. We see the other LO's struggling, too. The statement of, " If the family thinks verbal abuse is okay, to me that's a bad sign of what they would anticipate a caregiver to tolerate, and it wouldn't surprise me if it became worse", comes from lack of knowledge of what that dementia patients' journey is. I was always taught (and by my dad, not doubt) to "never judge a person until you live their life for just 24 hours!"

You, as a caregiver, have the right to work with the types and forms of Alzheimers patients you can tolerate. And it's a disservice to the patient if the family isn't 100% open and honest with you.

You are the one that decides what behaviour you accept.
If this client does not meet your standards, you are right to drop him.
Don't doubt yourself.
You did the right thing

Did you ever try to say.."Mr. Jones, I do not like it when you say things like that"
Yes it could be the dementia but even with dementia SOMETIMES repeated behavior can be changed. But it is not as easy as simply asking it has to be consistent.
As in ANY workplace or any job there will be personality conflicts
If at any time you feel uncomfortable you have the right, and I would say the obligation to yourself to stop the action that makes you feel uncomfortable.
If you work for an agency you report to your supervisor and ask for a change, if that does not work you go to HR.
If you work privately you tell your employer that you are uncomfortable and you give notice. (2 weeks would be nice but if they tell you "don't come back tomorrow" gather your things and leave at the end of your shift.)
YOU decide what is too much for YOU
There are all forms of dementia and some more than others come with behavior issues and that is part of the job BUT abuse does not.

Of course you have right to quit but you should have given family notice.
abusive behaviour very often part of dementia... you .. and family could say ... it’s very hurtful when you say that to me ... would you like apologize... and I’m sorry if I’ve done anything to upset you ... very often they will soon after.
working with dementia patients requires a lot of compassion ... many are aware of everything they’ve lost...dignity independence .. they’re confused angry ...fearful and helpless to reverse situation. Not all are passive and compliant ... dementia patients can be very aware .. so it’s good put yourself in their shoes ... some caregivers much better than others in these situations

You have the right to decide on which clients to stay with and which situations are problematic. Dementia can cause behavioral issues. If you have been patient with the client and always explaining what you are doing, that can help to calm the client during care. At some point, the client may not understand what you are saying or doing and become anxious, agitated, frustrated, and/or lash out verbally or physically. If you have addressed this issue with the family and they do not address it his the client's doctor, nothing will change. If the family asks what would get you to work with the client again, explain that the client needs something to help him/her to relax more - probably an anti-anxiety medication.

Good for you. Perhaps the situation can't change and perhaps the family can't get the client to do right by you or anyone else. But there is no reason to feel unappreciated or abused by anyone in any profession. It's a matter of what each individual decides what to or what not to accept. There don't have to be any "bad guys". It's just do you want this or not?

I don’t think you can reason with a dementia patient when they are really frustrated or angry, they are in another reality and doesn’t matter what you say. Mum can sometimes say very mean things to me when I get her ready for bed. I think it’s mainly embarrassment. It’s her being embarrast about changing in front of me, assuring me she has changed her pad, etc etc. it’s all very personal. When she full on lashes out she starts flinging her hands around. At that point I simply grab her hands and firmly say, ok I have had enough, I will not tolerate this when I’m trying to help. Then I walk out the room and return in 10-15min. I don’t know if I’m handling it the right way but typically by the time I go back she’s apologizing. It’s like she needs that peace and quiet to return to reality. However I don’t think there’s any point trying to coach them as when they are in that full on moment, it won’t matter. Only you can tell how much you can tolerate. My mum only gets like this around the more personal matters. Otherwise she’s usually fine. And she has her worse/better days.

First let me say that I honor anyone who has worked with dementia/alz patients and families. I would never have known the true dedication - love - kindness - strength etc that goes into caring for someone with this type of illness. My Moms stroke has shown me a world that I’m ashamed to say I didn’t know existed to the level it does.
My mom has not been diagnosed with the above but her massive stroke along with UTI behaviors - delirium’s - and just a broken brain has had me constantly apologizing for her or on constant guard to protect those who are helping us from feeling the hurt that I do endure at times.
I respect that sometimes people just are not a good match (it can be from their own life traumas or just their own burnout). I respect your decision but I am also so in awe of those who stay with us when things are harder. I truly would not survive without the few who stayed. If you feel it was taking away from what you could give someone else as well as your own life and family then I think you just have to trust that.
I have experienced through these 2 years verbal attacks from my mom (who was my best friend my entire life - world best mom - not perfect but just a good human) her behaviors usually arise from a UTI or infection and she says things my pre-stroke Mom would never say. She was a “helper” in the world and not unkind. Many of her outburst come around bath - changing and washing up or even times there is too much stimulation - noise - too many people talking or touching her cleaning wounds etc. Her stroke brain can become easily overwhelmed when too much is going on and she will lash out.
I recently just found out less than 48 hours ago she was sexually abused as a child. For 2 years some bath and wash up would create such anxiety and literally emotionally exhaust me. To hear her tell me this happened to her as a child - it was as if many of her struggles began to line up. First - I couldn’t believe the mom who told me everything (yes we were that close) held back and never told me this until now. We all have triggers from past traumas and I think you recognize that yours are not a good match with your patient. That’s okay and it’s honorable for you to admit it. Keep helping those who you can and know daughters like me appreciate anyone who is brave enough stay and be with us but also respect those who can admit their own weaknesses and recognize maybe they cannot give what someone else needs.
Any caregiver on any level is an Angel in my eyes. If your helping people - your a good soul.

Are you working for an agency and agency told you family is not happy? I'm sure client not happy about having to get a new person, but your agency may be unhappy to have to find a replacement for you for that particular client. He is mean to all 3 caregivers? Perhaps they just have more tolerance for dementia behavior. At any rate, it was more than you wanted to deal with and you have the option to no longer serve a certain person and you made it.

If this guy is mean to all the caregivers, there is a pretty good chance he is equally, or more so, mean to his family. You're dealing with a broken brain. You will find some posts here that tell you to correct the behavior and not tolerate it. Impossible. It's a broken brain. If they see a person sitting on a tree limb outside their window watching them all day, you will never convince them otherwise. Their brain sees the person in the tree. Yours doesn't. Some dementia patients get mean, accuse their own family of stealing an item (that they misplaced or hasn't existed in years), tell wild stories about the (devoted) spouse having affairs with the nurses or nonexistent visitors. So many families have their hearts broken over things a dementia patient said to them.

It is very possible this family has learned to refrain from arguing with him or trying to set him straight. The arguing can go on for hours and will just move from one subject to another with no end to the conversation. Patient gets more upset and family really gets upset at not being able to reason w/the patient

This is a very hard disease for the patient, and especially hard for the family who watches them disappear. Some grown rhino hide and accept what no one has control over. Others are just hurt on a daily basis and will probably remember the hurtful things even after the patient is in another world. It's very sad

There are people who are/were abusive, with or without dementia and from what you have said about the family, maybe they have never had high expectations of his behaviour and let's face it, it can only get worse!
I remember being approached by a caregiver once, about one of my relatives and I was not in the least surprised that they had been insulted. I was more surprised that they had been with my relative for months before it happened!
It doesn't mean it is acceptable of course but years of abuse, prior to the dementia, might mean a family who have been too scared to tackle him in the past, or just too used to it, to be offended.
You should not have to put up with abuse from clients. There is a difference between the random swearing of dementia and the really nasty aggressive stuff that is very upsetting - it sounds like you experienced the latter.
I think you did the right thing to walk away from it.

I believe that you made a good decision for yourself . In any profession you have to know when to back away and say this is
enough .However as the wife of someone with AD , someone I’ve been married to for over 54 years , someone who had only been kind and loving and complimentary throughout our marriage , I can only say that this disease can make them someone they’ve never been before .
I’m not superwoman and yes my feelings get hurt when he calls me names I never even knew he knew but unlike an outside caregiver I know the man that was . I love him for those years of love and joy he gave me . Could I do it for a
stranger ? Probably not . But from his Doctors , extensive reading and these groups , I know his brain is broken and he cannot control it . Reprimand him ? He doesn’t even remember saying nasty things so that would do no good . So that being said we do what we are capable of and sometimes more than we thought we ever could .
Since this is not someone you’ve shared an entire life with , and even for people who have , we all have different breaking points . But don’t expect the family to work miracles and cure a broken mind .

In my opinion, you did the right thing. You have a right to cut off a client who is abusive at a level you are unwilling to tolerate. And even if it wouldn’t help to have family speak to him about his behavior, I think it is still important that they do so. My husband is in a wonderful group home now (having just been in a terrible one, so I know the difference and appreciate the good caregivers), and once I was in his room waiting for him to be wheeled in and he had not seen me yet. He started cursing and yelling at the lady who was pushing his chair, just because she gently asked him to lift his feet a little. When he got in that room, I made him apologize to her right away. I also contacted the owner of the facility, told her what happened & apologized to her.

Caregivers like yourself are doing a tremendously tough job and you deserve respect. Even if the client themselves doesn’t change, it is still good for the family to speak up and let the caregiver know that their effort is appreciated.

Jojo45,

I'm an in-home caregiver for many years myself and will say that you were right to drop him from your service. I've dropped clients myself when their behavior became too abusive.
Your client's family should have been correcting him all along every time he behaves abusively to the caregivers. Even if they tell him later on after you leave it won't do any good because he may not remember his behavior from before.
What he might remember is a habit being established. If he's corrected by the family members every time he starts up with the caregivers, it may be that he'll come to expect it and will not be so abusive to them. The other caregivers should quit too. Maybe if the family can't get help anymore they will start doing their part of the care which in cases like yours is defending the caregiver from abuse.

Yes. I think you should follow your instincts. I think you should probably not care for patients with dementia. My elderly dad could care less if I told him to be nice to someone and he doesn’t have dementia. I think you may be too immature to be a good caregiver. It takes more than compassion. Caregiving is not for those with unrealistic expectations. I think you should think of other related professions or rethink your expectations.

I agree that you do not have to work with a client if you are not comfortable.

I can't agree that trying to correct the client's behaviour is the right approach. For one thing it's very unlikely to make the slightest difference. For another, this man is in his home, and within legal bounds can speak and act how he pleases - he doesn't have to be "nice" (and you don't have to put up with his not being nice).

We - I say we because I know my co-workers would also do this - try instead to identify and avoid triggers. Our managers warn us in advance if a client is likely to be rude, verbally abusive or inappropriate in language; if there's any risk of anything worse, we work in pairs and are instructed not to enter the property on our own.

And we do see quite a lot of "problem" clients - we can often spot them at a glance, from the three joy-inspiring words "Agency Hand-Back." In all seriousness I see the challenge as one of the advantages of the team I work for. We have three categories of client - Reablement (which is our actual mission, and the majority of our work); Urgent Care (crisis support, which can include end-of-life care, bereavement, life-changing events, caregiver breakdown etc); and the above named Agency Hand-Back, which tends to be a bit of a revolving door situation - we sort a client out, another local provider gets conned or schmoozed into taking him on, three months later back he bounces onto our rounds to universal rejoicing hem-hem, and round we go again.

But there is huge satisfaction to finding approaches that such people can tolerate and are happy with, so that they can then be provided with the support they need in a way that they'll accept.

One lady, who'd bitten my head off for an hour straight, finally said "is it you again tomorrow?" It should have been (it wasn't, as it turned out, which I regret but couldn't help), so I said "it may well be, yes." She said "I suppose I can put up with that." There was a pause. Then she added quietly "if you can put up with me."

I took this as a great compliment, but it also made me sad. This lady was - okay, she was a bit of a monster - but also in pain, not able to mobilise independently, lively-minded but bored, and sick to the back teeth of cack-handed strangers barging into her room and knocking all her books on the floor. YES she would have done better to let us move the books. YES the answer to not knocking over the photo frames might have been not to keep them on the window sill behind her incredibly heavy curtains. YES there are all sorts of handy storage units that would have been much more user-friendly than an 18th century oak press. But at the bottom of her sour temper and uninhibited rudeness was the real grievance that people didn't really try to get it right.

It's almost to late to bother about it, and I stick to my first answer which is that if you're not happy with an assignment you absolutely don't have to accept it; but you say this gentleman has a short fuse, and that today he called you a name (how bad a name? Anything actionable?) when you stepped in to support a transfer. Would you be interested in theory in returning to this family if you could resolve the issue?

You are within your rights to decide to drop a client. Usually we all have a breaking point. It's your decision.

As for them asking him to be nice - you've worked with dementia patients, but they are not all the same. Many can be easy to work with. My mother was. She had her moments, but it goes with the territory. Sometimes they can be asked to be nice, but there's no guarantee. As noted in many posts, when we've met or worked with one dementia patient, we've worked with one dementia patient!

Perhaps the family has tried to correct him in the past and it hasn't worked. If they are present when he "misbehaves", they could be more supportive and understanding of how this impacts the care-giver. I had often expressed my thanks and gave them kudos for what they do. It is NOT an easy job. Clearly the family couldn't provide the needed care, which is why they hired you and the others. That doesn't mean they should ignore it, but again, more often than not trying to correct the patient's behavior or things they say usually doesn't work and often can result in even more negative behavior.

If you run into a similar situation, it might be worth having a discussion with the family. If they aren't open to discussion, it might be best to move on. If they indicate they've tried various correction methods and nothing has worked, this is likely going to continue to be an issue. The discussion might include asking if they've considered asking the doctor(s) for some kind of medication to help reduce the anxiety or difficulties. Not all medications will work, but it would be worth asking.

People with Alzheimer’s don’t even remember what they said 10 seconds ago. You have every right to quit, but reprimanding someone or expecting a person with this type of dementia to change seems unrealistic. I had a father and grandmother with Alzheimer’s who acted out angrily so I am speaking from experience.