Overbearing or Caring Caregiver?

CaregivingBy Pamela D. Wilson, CSA, MS, BS/BA, CG

Overbearing or caring caregiver—how much care and attention is too much? As an aging parent or spouse who depends on an adult child or a spouse for care, when do you speak up and say “enough”? Is it possible to show appreciation and limit the amount of doting or domineering behavior by an overbearing caregiver? What happens when caregiving situations become potentially abusive or nightmare situations?

Caregiving is a stressful role impacted by the constant fear of losing a loved one. This aspect of fear may lead to caregivers exhibiting extremely controlling or overbearing behaviors. Long-term aspects of a relationship may result in the same behaviors and the relationship becoming co-dependent. 

A difference exists between being an efficient caregiver and an overbearing caregiver. Efficient caregivers juggle tasks to provide care but do not take away choice, independence, self-sufficiency, and self-esteem. The life of an efficient caregiver remains independent to the degree that they do not take over all aspects of care and decision making.

Other reasons for overbearing or dominating behavior may exist. Obsessive compulsive disorder, a desire to isolate a loved one from others perceived as bad or unhelpful by the caregiver, and lifelong controlling behavior patterns are other reasons. 

For an adult child caregiver—instead of fear of death—fear of being displaced from the parent’s home and losing financial support may be the reason for overbearing behaviors. The belief by the caregiver is “as long as I’m here to take care of mom or dad, I have a home and don’t have to work”.

Fear of loss, the duty to provide care, or guilt that I didn’t notice the care issue earlier, equals the spousal caregiver’s belief that “no one else can do what I do.” This is especially true of male veterans who take care of their wives. The duty and responsibility to provide care may result in the husband exhibiting overbearing or controlling behaviors. 

Dangerous Co-Dependent Caregiving Scenarios

Overbearing behavior may be manageable if the care receiver feels comfortable expressing concerns about feeling smothered or dominated. It is more common that a desire not to “make waves”exists with the care receiver attempting to ignore or excuse the overbearing behaviors. These situations may advance to become more concerning if there are no outside family or others to witness or express concerns. 

Worries exist by the care receiver. What would happen if the caregiver walked out? Who would care for me? These questions are asked even when other options exist. These concerns place the care receiver at risk of unintentional abuse by the caregiver.

When the care receiver ignores the overbearing behavior this condones the behavior. This is similar to allowing a screaming child to scream in public. The parent says nothing. The child soon learns that screaming is public is a normal activity and the screaming continues. Some high control caregivers are regimented and schedule every minute of the day. This scheduling seeks to alleviate anxiety felt by the caregiver.

For a care receiver, feeling vulnerable and worrying about a caregiver leaving is a dangerous scenario. Placing a caregiver in a position of power, supports a co-dependent relationship, if this is not already the situation. The situation is different for care receivers who do not have the cognitive ability to participate in the caregiving relationship. 

Instead of supporting independence, the caregiver with power fosters dependence. The caregiver’s belief is that “mom, dad, husband, or wife,” want me to take care of everything. A co-dependent relationship is created and continues to grow in severity.

Codependency is described as a helping relationship where one person, the caregiver. supports all needs of another person. The other person over time becomes totally reliant on the caregiver for all needs: physical, emotional, and decision making. This behavior accelerates to the degree that the caregiver speaks for the care receiver and makes all decisions, leaving the care receiver in a purposely created powerless situation.

This is most always the situation where wills and legal documents are re-written in favor of the co-dependent caregiver because “no one else loves or cares for you like I will.” Removing a parent or a spouse from this type of situation may require court intervention. The aging parent or spouse is so enmeshed in the relationship and feels powerless that he or she will do nothing to leave.

Dementia and Vulnerability

When an aging parent or spouse has a diagnosis of dementia or Alzheimer’s disease, self-advocacy or speaking up for needs is impossible. The care receiver is at the mercy and total control of an overbearing caregiver. Care instead of being supportive, can be harmful.

In this situation, as with the prior situation if removing the care recipient is not an option, establishing a system of outside oversight is beneficial to ensure that care is not being neglected. When isolation begins, caregivers may be trying to hide information, out of fear for self-protection.

Co-dependent caregivers feel constantly judged by family members which increases the desire to control or further limit the care situation. The thought is, “if I don’t allow you to visit you can’t judge the care I am providing.” The caregiver worries that the care recipient will be removed from care. Again, this is the concern of “what if I lose my living situation and mom or dad’s financial support?” For a spousal caregiver fear is loss of control, a daily routine and purpose in life.

Overbearing caregivers can be strong adversaries that require even stronger advocacy to change a situation that has gone too far to the negative. As a guardian I was involved in situations that took months to resolve because the caregiver in control refused to participate. Multiple steps and attempts had to be made to prove suspicions about poor care and neglect.

There were situations where a court order was obtained and police support required to remove the older adult from the home. These were extreme situations where the caregiver had total control over the older adult, made all decisions, and did not allow any outside access to the care receiver.

Imagine a constantly locked house, the telephone only answered by the caregiver, persons coming to the home being refused access. This type of  isolation is concerning and steps must be taken to ensure that the person receiving care is not harmed. .

Scenarios to Change Overbearing Caregiver Situations

What solutions exist to moderate overbearing and controlling caregiving situations? The earlier interventions occur the easier the situation may be to change. When co-dependent situations advance, intervention is possible, but requires significant effort. Below are scenarios and recommendations to change overbearing caregiving situations.

Scenario One: Intervention

  • When family exists, the first step is a family meeting to discuss concern for the caregiver and the care receiver. Know that this will place the caregiver “on notice” and control may increase rather than decrease. The care receiver will deny any need for other support due to a fear that if wishes are stated the overbearing caregiver will leave. The meeting is more of a formality and giving notice that “things will be changing”.
  • Discuss that scheduling time away or time off is needed for the caregiver and the care receiver. Everyone needs a break in routine.
  • The relief caregiver may be a family member or a paid caregiver companion.
  • Adding another caregiver for support allows another set of eyes on the situation to confirm that abuse or neglect is not occurring.
  • Discuss plans to move the care receiver out of the home as an “eventual” so that the co-dependent caregiver realizes the current situation is not a forever situation.
  • Plans for eventual emancipation from the role of the caregiver should be discussed. Discussions of the caregiver returning to work, finding an apartment etc. should occur.
  • Note that this scenario presents a difficulty if the overbearing caregiver is also the financial and medical power of attorney. In this case, abuse would have to be cited by police or adult protective services to allow and investigation. If the situation is deemed to be abusive or neglectful then steps can occur to have the aging parent or spouse removed from the home situation and placed into other care.

Scenario Two: Spousal Support

  • For a spousal caregiver, the issue may be control, guilt, a loss of a daily routine, and purpose of taking care of a husband or wife.
  • Discuss the same scenario of having caregivers come into the home.
  • Discuss the same scenario of the care recipient eventually moving to a care community.
  • The caregiving spouse will view removing my husband or wife as meaning I will drive each day to the care community to make certain that care is provided. The caregiving spouse will also have to develop a new daily routine which will be challenging.
  • When the move occurs, the control situation moves to another setting where interventions may have to occur to support care staff who are harassed by the controlling spouse.

Scenario Three: Counseling and Support

  • Help the caregiver understand that counseling to gain a different perspective about the solution may be beneficial.
  • Caregivers become stuck in the rut of their beliefs and actions and forget that there is a world outside of the role of caregiver. Fear and anxiety drive the daily control behaviors.
  • When caregiving translates to identity, a 12-step type program may be the only way to help the caregiver find a way out of the situation.
  • Joining a support group, like a 12-step program, will support establishing relationships outside of immediate family. The challenge is not repeat the same caregiving behavior with a replacement person.
  • Understand that rebuilding a life after caregiving is challenging. This situation is like starting over after losing a person who was part of your daily life. Everything changes.

The Last Resort

When all else fails to address the situation of control and vulnerability, a legal intervention may be needed. In this situation, retain the services of an elder law or probate attorney. The result may be granting guardianship and conservatorship to a professional who may be more comfortable in removing the loved one from the home.

Concerned family members often agree to the appointment of professionals as they do not want to add to the conflict already occurring in the family situation. Worry also exists that a parent may hate the adult child for initiating needed change. Professionals and family members working together in these situations often result in positive resolution of the concerns that originated from the behaviors of the overbearing caregiver. 

In the situation where you become the family guardian or conservator, be certain to understand your responsibilities and the reporting requirements. Also understand the power that you are granted along with the duty for “least restrictive options”. These appointments, while giving the appointed person, authority to care for a loved one, should not replicate the overbearing caregiver situation.

© 2018 Pamela D. Wilson, All Rights Reserved.

Pamela D. Wilson, MS, BS/BA, CG, CSA, is a national caregiving thought leader, caregiving expert, advocate, and speaker offering online support and programs for caregivers seeking support and advice for the care of aging parents, spouses, and other family members. Pamela supports adults, age 50+, with positive aging advice and on-line programs to advance health literacy and self-advocacy. Collaboration with professionals in the specialty areas of estate planning, elder law, and probate, financial planning, and healthcare raises awareness of and sensitivity to stressful family caregiving and healthcare issues.

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