Caregiver sibling abusive to bed-ridden grandfather

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My older brother (36 yrs old) and I (25 yrs old) are the primary caregivers to our two elderly grandparents with dementia. My grandmother is still able to do ADLs with assistance; however my grandfather is completely dependent on us. He is on a pureed food/thickened liquid diet (due to being hospitalized for aspiration pneumonia a few months ago); has debilitating back pain due to a mild compression fracture in his spine (receives steroid shots for this) and cannot walk or get up on his own. My brother gets very impatient with the level of grampa's care; for example, I ask him to help me get grampa up to the bathroom in the morning -- he comes storming in -- yanks him off the bed and drags him to the bathroom cursing up a storm while grampa is yelping in pain. He just sits grampa in his chair all day long without changing his position; and at night also does not change his position or underwear. Grampa is completely soaked in the morning. As a result, he now has a stage 2 ulcer (size of a pea) on the inner part of his right buttock (we are addressing this issue now with the home care nurse and DR) . I have gotten on to him about re-positioning and changing his underwear but he is lazy and would rather play video games all day. This stresses me out as I work full time (peds private duty) and go to school and I take care of grampa on my days off. I tried talking to my Mom about it (she is POA) but she is oblivious to the level of care grampa needs and just writes it off. We do have OT, PT, ST, home health aide and nurse come in weekly but it is only for 30 mins at a time. Grampa is not getting the care or respect he deserves here because of my brother; any advice on how to handle?

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Specializes in SICU, trauma, neuro.

You need to advise your mom that you are a mandated reporter -- you are legally and ethically required to report the maltreatment of vulnerable adults. And that you will be forced to follow through if this isn't fixed immediately.

I'm very sorry you're in this position...but doing the right thing is difficult sometimes.

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

It sounds as if your brother is a reluctant, unwilling caregiver. I'm not here to judge because I know I'd be a reluctant caregiver as well.

My thoughts are this: a person should not be forced into the caregiver role, even if the person who requires care is a family member. In addition, the person who requires care deserves to receive it from someone who actually wants to provide it in a dignified manner.

If there's any way for your brother to be relieved of his caregiving duties, this would be the ideal situation. Your brother does not want to provide care for your grandpa, and we all know you cannot force people to do what they don't want to do.

Good luck.

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You're right, it is very difficult doing the right thing sometimes :( this has put a great strain on our relationship, as we were very close before we had to become caregivers. I keep holding out, thinking he is going to change, but it looks like he is still set in his ways.

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you're correct that he is a reluctant, unwilling caregiver. when he was laid off from his job a few years ago; my mom asked him to move in with me and the grandparents as I was the sole caregiver. he has remained unemployed since; because his "duty" is to watch the grandparents when I'm at work. he is not cut out to be a caregiver; however he is living comfortably off grandpa's money while he plays games all day. but if he were to be "relieved" of his care giving duties, he would have to get a job, which he does not want to do either.

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Specializes in Psychiatry, Community, Nurse Manager, hospice.

You need a sit down with your brother and your mom since she's poa.

Your brother needs a job. If he's going to continue working for your grandpa, then his duties and payment need to be clearly laid out. He should have a bedroom where his personal things, including video games, go. During his work time he should not be in that room.

His work time should be laid out in clear detailed tasks. For example, 7:00 feed grandma and grandpa breakfast of either eggs or oatmeal and tea. 8:00 bathe grandpa. He should be set up to work a certain number of hours per week which he will be compensated for. He should have at least one full day off.

Set up his compensation. He should be earning somewhere between what a home health aide would be paid and what you would have to pay an agency for a home health aide. Most people pay agencies 3x the wage of the HHA. This is what you're looking at if you lose him. So, be generous. If HHAs make $15 an hour in your area, pay your brother $18-$20 or whatever you can afford. Now that you know how much you're paying him, How many hours can you afford to have him work? How many hours do you really need him?

Estimate room and board for your area and give him a little discount because he is family. You take that out of his paycheck. You pay him the rest. For example, He works 20 hours, he makes $400, $200 of which goes to room and board. There are many ways to do this, but I suggest that if something needs to be cut, it is your brothers hours.

Draw it up as a contract. Ask your brother if he wants anything else in there. Try to accommodate him. Maybe he wants to not have to do baths. Maybe grandpa can be bathed a little less often or someone can take over baths. Maybe he needs you or someone else to teach him skills.

Try to make the meeting one of mutual respect. Have empathy for your brother. Make it a sit down, not an intervention.

You may find out that your brother doesn't want the job. If that is the case, give him 30 days to find another living situation and start looking for a home health aide.

If he decides to stay, give your brother time to develop confidence and skills. Correct him, teach him and remind him of professional behavior since he is now a professional. Instill in him a sense of pride. It is likely that he yells and curses because he hates seeing/putting his grandpa in pain during the adls. Teach him how to deal with this.

But if he can't or won't get himself up to a standard that is good enough for you and mom after a month or so, you will need to let him go. Be fully cognizant of what you will have to pay someone else. He is your brother, give him a recommendation letter for some position he really wants. Give him 60 days to leave if you're laying him off, he's family.

Good luck.

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Specializes in Psychiatry, Community, Nurse Manager, hospice.

Oh, I forgot the most important thing. If your brother's behavior did not cause you to call the police and throw him out right away, it's not abuse. Stop using that word. It will get you nothing but more poor family dynamic. That's number one to solving this problem.

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Your exaggeration probably isn't helping your credibility with your mom, who as POA is a more guilty party than the one "yanking" and "dragging".

And if you didn't call law enforcement when your frail grandfather was being "dragged", so are you.

It is rather amazing that someone who is left sitting in the same position soaked in urine has no more than a pea sized ulcer to the inner thigh, which again points to exxageration of the neglect.

I agree with the above posters, compensate willing caregivers to properly care for your grandparents.

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You need to stop providing care.You are a medical professional and your family is not taking your professional advice. That in itself is a hot mess.

Turn the issue over to the home care nurse and the doctor. They should be the ones handling his care, not you. Hopefully, your mother will respect THEIR medical advice.

Anyone that forces someone to ambulate when they are yelping in pain is being abusive. Your brother needs to be removed from the caregiving role... today. Providing a salary will not magically turn him into a good caregiver.

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Specializes in Healthcare risk management and liability.

If one of my clients called me with this story, using the same language as the OP, I would direct them to immediately call your state equivalent of Adult Protective Services. The OP is I assume a mandatory reporter. Knowledge of this situation and failing to report it likely means that unpleasant things can be done to your license, regardless of the fact that it is family.

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Specializes in Infection Prevention, Public Health.

To millmick30. This has me riled up. Do either of your grandparents have lucid moments? What do they want? It sounds like there is money involved and free room and board for your brother and I am not sure if you are living there too. Your mother is the POA, but it sounds like she is not supporting your views.

A few things:

Your surly brother cannot be forced to become a caring human being. If he isn't helping out with respect and decency,he needs to stop living there. He's getting free room and board and, in all fairness, likely owes your grandparents money.

About the money. It belongs to your grandparents. Your mother can be in deep trouble if she is not using those funds for their best interest.

Your grandparents deserve for ALL of their money to be applied toward their care with people who do not have a conflict of interest. It seems like a decent nursing home might actually increase their quality of life. If all their money and assets go toward their care in a facility, then that is as it should be. Better for them to be treated with dignity than for any of you to get an inheritance.

You are a mandated reporter. Please take care of it now.

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Specializes in Infection Prevention, Public Health.

Millmick30, since you are unable to care for your grandparents due to your work and school obligations, you shouldn't be living with your grandparents either if you don't pay them rent. With you and your brother gone, their home (if they own one) could go toward providing the professional and respectful care that they deserve. Don't allow their funds to be depleted to go toward housing you and your brother. That's not cool.

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