I have spent two months as a live-in caregiver for an 83-year-old gentleman experiencing cognitive decline, and I have become increasingly concerned about his well-being. About My Patient: Despite his cognitive issues, he remains fully aware of his situation and surroundings. He is a kind and peaceful individual who appreciates the help he receives. He is largely independent and requires minimal assistance with activities of daily living. The only concern I see is that he frequently wakes up confused at night, showing dementia-related looping, but he does not wander. Emotional Impact: He is aware of his wife’s controlling nature which deeply saddens him, but complies to avoid conflict. Her behavior amplifies his feelings of shame about his condition. She openly blames him for the life she now has. At Home: Breakfast Routine - His wife avoids being present during breakfast and often shows impatience with his habits, such as folding his napkins. She constantly tells him to leave the kitchen. When he resists, she resorts to shaming and blaming, often saying things like, "You can't do anything; your mind is gone; I have to take care of everything." Dinner Routine - Similar issues arise at dinner. The meal schedule is changed at her convenience, and on particularly bad days, dinner starts very early. Her impatience is evident as she repeatedly asks if he’s finished and ready to go upstairs. Nutritional Concerns: She serves him very small portions at dinner and has asked me to reduce his breakfast as well. I am concerned he is not receiving adequate nutrition. Isolation in the Home: The wife seems to deliberately isolate him from common areas, limiting his ability to enjoy his surroundings and creating an emotionally distressing environment. Inappropriate Xanax Administration: I am concerned the medication is being used to control his behavior, particularly in public settings, which undermines efforts to keep him active and engaged. Concerns Regarding the Wife’s Behavior - Manipulative Behavior: The wife is highly manipulative toward both my patient and me. She attempts to control my actions through emotional manipulation, making it difficult for me to challenge her for fear of affecting the patient’s well-being. She has made alarming comments as well like, "If I had enough of these pills, I would take them all to end this." Disregard for Caregivers: She dislikes having caregivers, calling each one "dumber than the last." She treats me as a subordinate, saying, "Dear lady, you won’t have any effect on my opinion." Once, when I intervened, saying, "Please don’t do this, you can’t," she responded with, "I know," and continued pressuring her husband, leaving me feeling helpless. Narcissistic Tendencies: Her behavior indicates narcissistic traits. She lacks empathy for both her husband and those around her, focusing solely on her own needs. She frequently vents her frustrations with no regard for others' well-being. Pressure to Institutionalize My Patient: Although he is largely independent, his wife is determined to place him in a facility. I disagree, as he only needs minimal support. She is deliberately twisting situations to portray him as incompetent, repeatedly telling me I will be the last caregiver before she moves him to memory care. Power of Attorney and My Concerns - As the power of attorney, the wife controls his care, limiting my ability to intervene. I am questioning whether I should report her behavior to Adult Protective Services. My main concern is preserving my patient’s dignity and ensuring his well-being, but I am unsure of the best steps to take. I am seeking guidance on how to protect my patient's rights and dignity, and whether reporting the situation to APS is the right course of action.
And I do hope that his wife will place him in a facility as he will hopefully then have more of an enjoyable life than he's having now with the wicked witch of the west.
It’s clear that her focus is more on the lifestyle she feels she is losing rather than supporting her husband through this difficult time. She consistently blames him for her dissatisfaction, failing to see that, despite his decline, she can still lead a meaningful life. I wish she were open to the support I can offer, but unfortunately, that’s not the case.
I appreciate your advice and acknowledge that there may come a time when I need to reassess my position. I do worry about reaching a point of burnout due to the constant stress her behavior creates. For now, I am committed to putting their needs above my own, but I also recognize the importance of self-care in this challenging role. Thank you again for your support!
Firstly, I am going to tell you that it is my GUESS that this gentleman has been controlled by his wife for their entire marriage, and yes, including when, where and what he will eat.
If she is POA and this gentleman has a diagnosis of dementia, then the wife likely will place him, and I honestly cannot think but that this will not be best for him. She clearly is quite frustrated.
Secondly: There are some questions here.
I do not see--correct me if I am wrong--an indication that this gentleman feels abused or is terribly upset by any of wife's behaviors?
I find it odd you don't mention whether or not that is the case. Does he show fear of her? Or shrug and say "That's the little woman for you".
You call this gentleman your "patient".
Are you an RN? Are you an LVN? Or were you hired as a caregiver and assistant in the household?
Do you work for an agency to whom you can report exactly what you have told us, or were you hired freelance?
You have described this woman as a Narcissist. To be honest, you are not a clinician and diagnostician of mental disorders I think? And given that less than 5% of the population is diagnosed as Narcissistic, as often as we see that word on AC one would think the world was fully 50% disordered. I think you must not be an RN/LVN or you would know that you chart and report objectively, not subjectively. That is to say you report what you see and witness, not what you believe motivates it, or any diagnosis of the action.
You call this gentleman still your patient. Are you still working in the home?
No threats were made other than placement for this gentleman, and I think any threat of self harm is for this clearly quite dramatic lady an exercise in venting her frustrations.
And now to Lastly:
ALL OF THAT SAID: You, as a caregiver, are considered in many states to be a "mandated reporter". That means that you must report when/if you feel that your client is in danger. You have suggested that you believe this gentleman is being deprived of food. That is reportable. You have suggested that his wife has mentioned self-harm. That's reportable. You mention that you believe that this gentleman is being threatened with entry into care when that may not be his wish. You have spoken of inappropriate anger and outbursts. That is reportable.
So, given all that you have said to us, yes, this is reportable.
If you do not have an agency I would call APS.
Do understand that you will no longer be either living in or working there on that day, so be ready to leave. Tell the APS worker what you have told us and anything else you can think of. Keep (as I hope you already did) a careful diary from now on and throughout your career.
To clarify, my patient has explicitly told me, “I know I am being abused and taken advantage of.” While he seems resigned to his situation, I work every day to protect his dignity and autonomy, which he deeply values. I refer to him as "my patient" because that’s the role I take in his care, and I treat him with the utmost respect. I apologize if the term feels inappropriate, but to me, it reflects the care and responsibility I take on in his well-being.
I hold an A.A.S. in Radiation Therapy, and while I am not a licensed mental health professional, I have discussed the ongoing situation with my own therapist, who has described the patient's wife as having narcissistic tendencies based on my experiences. Of course, this is not a formal diagnosis, but her behaviors align with those tendencies, and they affect both the patient and me on a daily basis.
Regarding the patient’s wife, I have made considerable efforts to improve the situation and her well-being, including initiating a group conversation with her daughter (an oncology surgeon) and my supervisor (a licensed nurse). It was during this conversation that I learned the wife’s behavior is a longstanding issue. Her daughter and others close to her have admitted they find her impossible to deal with.
I understand your point about reporting objectively, and I appreciate the importance of that. However, in a discussion like this, I believe it is also valuable to share both the objective facts and my subjective experience to provide a fuller picture of the situation.
Finally, while I am still working in this household, I cannot condone the wife’s venting of her frustrations in a way that damages both her husband and myself. While I have empathy for her struggles, allowing her to continue in this manner without addressing the underlying issue does not seem to be in anyone’s best interest. I firmly believe she needs help, and continuing to tolerate this behavior would only enable her, which is something I cannot support.
Thank you again for your input. I remain committed to ensuring the best possible care for my patient and will continue to act in his best interests.