Friday, 14 January 2005 - 2:00 PM

This presentation is part of: Faith Matters, Social Support, and Coping in Late Life

Reclaiming Power in Formerly Abusive Relationships: Ethical Decision-Making for Women as Caregivers

Purpose: Gerontological literature virtually ignores the impact of abusive histories in caregiving relationships. The purpose of this presentation is to report on findings from a qualitative study that identified the ethical dilemmas and subsequent decision-making processes faced by two spousal caregivers formerly abused by the frail elder. Additionally, two examples from clinical social work practice provide further anecdotal evidence to strengthen these findings. Women do stay to provide care in formerly abusive relationships; however, they find ways to make decisions and develop empowerment-based coping strategies within these caregiving relationships.

Methods: This qualitative study explored ethical dilemmas, or hard choices, faced by thirteen female caregivers of frail elders. Using purposive sampling based on selection criteria of factors that contribute to caregiver stress, interviewees were recruited from a home health agency in the Midwest. Audio-taped, semi-structured interviews with open-ended questions enabled caregivers to depict detailed stories of decision-making processes which revealed information about the quality of the caregiving relationship (including the frail elder’s abuse of the caregiver before the onset of caregiving). Several strategies were employed to establish trustworthiness in this study’s findings including the use of a consultant panel consisting of agency staff and caregivers from the agency-sponsored caregivers’ support group; member checking; and, focus groups.

Results: Two women experienced abuse by the frail elder and described decisions they made as a way of reclaiming power in the caregiving relationship. A four-stage model based on a feminist perspective is proposed to help organize findings depicting caregivers’ ethical decision-making in dealing with formerly abusive relationships. This model includes (1) the caregiver/frail elder relationship before and after the onset of caregiving, defined as an initial position of powerlessness; (2) types of ethical dilemmas influenced by the abuse in which the caregiver develops a beginning awareness of her safety needs; (3) decision-making processes for addressing these dilemmas in which the caregiver begins to act on her awareness of the abuse; and, (4) the caregivers’ reclaiming of power by establishing boundaries and widening the circle of formal and informal supports.

Implications: Geriatric assessments should address the quality of the caregiving relationship prior to the onset of caregiving. Health care settings need to incorporate routine referrals to social workers whose role is to attain the level of trust necessary for the disclosure of intimate material such as a history of abuse. Social workers should advocate for changes in Medicare, Medicaid, and private insurance programs to support comprehensive social work services which incorporate caregivers’ needs.

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