Trust is the foundation for relationships between caregivers and the individuals they support. Most caregivers who provide support for persons with disabilities, older people, and children provide services in an atmosphere of mutual respect. However, there can be violence in this caregiving relationship, and most people with disabilities who experience domestic violence are abused by direct caregivers. Violence in a caregiving relationship is often perpetrated by the caregiver; it can also be directed against the caregiver by the person receiving care.
There are both formal and informal caregivers. Formal caregivers are those who are typically paid to provide a defined service in home, community, or institutional settings (e.g., nursing homes, group homes, state institutions). Some types of care they provide include medical care (e.g., medication management), home health services (e.g., bathing, dressing, eating), community-based support services (e.g., supported employment, recreation, shopping), transportation, and respite care. Informal caregivers are friends and family members who are not paid (although some do get paid under some circumstances) to provide care and/or support. These caregivers provide many of the same types of services as formal caregivers.
Risk Factors For People Who Utilize Caregiver Services
People who utilize caregiver services may have a high level of vulnerability for abuse for several reasons. Individuals who receive caregiving are often dependent on their caregivers for basic needs, including particularly personal activities, such as bathing, dressing, or toileting. This dependency may prevent a person from recognizing or reporting abuse. In circumstances involving informal care, a person requiring caregiving may also feel guilty, thus overlooking instances of violence and feeling such violence is deserved. Further, the person receiving services might believe that he or she has no other means to receive care and fear that reporting violence would result in either institutionalization or increased violence from the caregiver. People who utilize formal caregiving services may interact with multiple caregivers and may not see the same caregiver twice, thus never building a relationship of trust with the caregiver. This person may also fear increased violence and worry about losing his or her care provider agency if he or she complains. In both instances, the caregiver may control the means of reporting violence by limiting the person’s access to telephones or other means of communication.
There are numerous factors associated with the perpetration of violence by caregivers to people in their care. These factors vary depending on whether the support services are provided by formal or informal caregivers. While most professional caregivers provide excellent services and support, there are some work-related issues that may increase the potential for abuse. Formal caregivers are frequently underpaid, receive little training, receive no direct supervision, and are provided little employment support. For caregivers working with individuals in their homes or in community settings, there can be intense isolation. The job duties of formal caregivers can be highly stressful. Agencies that employ caregivers experience high rates of staff turnover and have high vacancy rates, resulting in higher levels of stress in caregivers. Because of the shortage of staff in these caregiver roles, some agencies do not screen their potential employees well and risk hiring those with violent backgrounds.
Informal caregivers may also experience high levels of stress, but perhaps in different ways. Family members and friends provide caregiving support to loved ones in addition to their jobs and other life activities, sometimes resulting in exhaustion, depression, and lack of time to provide appropriate care and support. Family members typically carry significant financial burdens associated with caregiving, and many families do not have access to respite or other supportive services. However, caregiver burden is not by itself a cause of violence, and most instances of caregiver abuse are not the result primarily of caregiver burden.
Interventions for preventing caregiver perpetrated violence may differ for formal and informal caregivers. Strategies for decreasing violence by formal caregivers may include better employee screening, better pay, more direct supervision, increased training, activities to decrease isolation in providing care, and the increased professionalism of these workers. Strategies to reduce violence by informal caregivers include respite care, family caregiving support groups, behavior management training, case management services, family counseling, and domestic violence awareness education.
Caregivers Experiencing Violence
Some people with disabilities or others receiving care may have challenging behaviors that may be a result of their disabilities or other limitations. This is often termed aggression instead of violence to avoid labeling people with disabilities. However, this does not minimize the impact of the aggressive behaviors on the caregivers. Violence against caregivers happens to both formal and informal caregivers. Examples of aggressive behavior in caregiving situations may include biting, kicking, flailing, hitting, pushing, spitting, and throwing objects. Aggressive behaviors can escalate and result in serious injuries that prevent the caregiver from being able to continue in a caregiving role.
Strategies to reduce violence and aggression by people who receive services vary by individual. Typical strategies center on positive behavior supports, an approach focused on assessing the root cause of the behavior and problem solving a strengths-based solution toward eliminating the violence. An example may be changing the way the person is touched while receiving help with dressing, or providing the person with tools for communicating so that he or she does not use aggression to tell the caregiver that something is wrong.
- Abramson, W., Emanuel, E., Gaylord, V., & Hayden, M. (Eds.). (2000). Impact: Feature issue on violence against women with developmental or other disabilities, 13(3). Retrieved from https://ici.umn.edu/products/impact/133/
- National Center on Elder Abuse. (2002). Preventing elder abuse by family caregivers. Retrieved from http://elderjusticecal.org/docs/Policy_Brief.pdf
- S. Department of Labor, Occupational Health and Safety Administration (OSHA). (2004). Guidelines for preventing workplace violence for health care and social service workers. Retrieved from https://www.osha.gov/Publications/osha3148.pdf
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