Caring for an abusive parent brings immense emotional suffering.

Millions of American adult children are shouldering the burden of caregiving for parents who have shown little concern or affection towards them.

A distressing situation unfolded in January 2024 when Carole received an alarming phone call from her father's eye doctor. The news raised concerns about Andre's ability to operate a vehicle safely, despite his severely impaired vision. Driving with such compromised eyesight is strictly prohibited by law.

Her father's behavior was something she deliberately chose to remain ignorant and she genuinely couldn't muster up any concern for it.

Carole navigated his way through Santa Rosa's outskirts, down winding dirt roads lined with vineyards, to reach his parent's residence. The house, once tidy, now showed signs of neglect, its beige carpets and curtains dulled by dust. Andre, partly deaf, was oblivious to the constant scurrying above him, despite the presence of rats in the ceilings. Expired food sat on shelves, a testament to the disarray that had become his living environment.

Her father, aged 93, stood by the front door on a worn rug next to his maroon-colored walker, which he reluctantly used. His frail appearance was evident as he leaned on it for support. Carole felt trapped in her situation, unable to escape despite her reservations about staying. Her sister had long severed ties with Andre, and their other siblings were either deceased or too elderly to assist him. The thought of abandoning her father to the state's care was unbearable for Carole, who is 58 years old. She rationalized her decision by citing her integrity, saying "I have enough integrity" to withstand the guilt that would follow if she left her father to fend for himself alone.

Carole devoted a significant amount of time each week to assisting Andre, gradually increasing to daily hours. She accompanied him to his scheduled appointments, ensuring he received the necessary medical attention. In addition to these responsibilities, she managed his financial affairs and administered his medication regimen. Carole also took care of various tasks on his behalf, including responding to an overwhelming number of phone calls and text messages. Despite having a modest savings from his years as a newspaper typesetter, Andre refused to allocate funds for his own care. His doctor acknowledged the presence of dementia but informed Carole that she couldn't compel him to cover expenses for caregivers or other services.

In the spring, Carole took proactive measures by installing an outdoor security camera at her father's residence. The camera was programmed to send notifications to her phone whenever it detected movement outside his front door. A particularly alarming incident occurred when she checked the app during work hours and witnessed her father collapse while gardening, striking his head on the ground before briefly regaining consciousness only to slump back down again. Subsequent falls prompted Carole to seek medical attention for him at the emergency room each time.

Carole had limits when caring for her father. She wouldn't physically comfort Andre in public, even if he was frail enough to need assistance getting out of the car. Whenever driving him somewhere, she'd carefully position his walker by the door before helping him exit, but she drew a line at embracing him.

Carole occasionally caught glimpses of Andre through fresh eyes - a gentle soul with pale blue eyes and a hint of a French Canadian accent still lingering in his voice. His frailty, evident in his bad knee, stood out amidst the chaos of his declining mental state. A man struggling to hold on to memories.

As a child, she often recalled her father's behavior from those early years, when his anger would boil over into physical violence. He'd lash out at her with the same ferocity he might reserve for an animal, as if she were nothing more than a disposable object. A vivid memory etched itself in her mind: playing alone in the family room at age 4, surrounded by toys, until her father's angry voice demanded she pick them up. When she refused, he seized both her hands, rendering escape impossible. The scene unfolded with him holding one hand and then the other, his foot connecting with a painful kick to her groin area. She felt intense pain, and in that moment, her body betrayed her by releasing its contents, leaving her mortified and humiliated despite being potty-trained. After the ordeal passed, she cleaned up the toys and trudged upstairs to change into fresh clothes.

Carole's decision to care for her father led her to join Parenting Aging Parents, a Facebook group boasting nearly 40,000 members, predominantly women. However as she scrolled through the message board, Carole noticed that many comments didn't resonate with her own experiences. The caregivers in this online community seemed to have had fortunate relationships with their parents, who were well-loved and reciprocated affection from their children. In stark contrast, Carole felt isolated, burdened by a sense of duty without the emotional rewards.

As she navigated her challenging situation, she started noticing a pattern - many others like her existed, often keeping a low profile but occasionally surfacing in online forums. These individuals were scattered throughout the nation, each struggling with the emotional toll of caring for parents who had themselves been neglectful caregivers. Anonymity was crucial to their well-being, so they opted to share only their first names when speaking to me.

Parents who were emotionally unavailable or physically abusive inflicted immense suffering on their children. Their lack of effort and interest left deep emotional scars. Some children suffered from neglect, humiliation, and physical harm in the form of beatings with belts and fists. Others endured more creative forms of abuse. A father's violent swings of his daughter by her ponytail were a stark example. A son was repeatedly woken up at night by his intoxicated mother's verbal assaults, forced to endure hours of dehumanizing insults that made sleep impossible.

Caring for an abusive parent can be a heavy emotional burden. Family members often feel compelled to take on this responsibility due to a lack of alternative options. Financial constraints may limit their ability to hire professional caregivers, particularly in rural areas where resources are scarce. Some individuals are motivated by feelings of guilt or obligation, whether rooted in religious convictions or personal values. The sight of a loved one's decline can be devastating, leaving caregivers feeling unmoored and uncertain about their role. In Florida, a woman chose to care for her father after he expressed regret for his past actions. Meanwhile, in Delaware, another woman decided to continue caring for her father despite his history of abuse, as he later defended her coming out to their mother.

The motivation behind caring for an abusive parent often stems from a desire to inherit assets. This expectation is rooted in the misguided notion that a child's obligation to their parent is unwavering. The phrase "two wrongs don't make a right" aptly summarizes this flawed thinking. Many caregivers underestimated the emotional toll and financial burden of supporting a parent who has caused them harm. Some individuals may feel compelled to care for an abusive father due to his diminished capacity to inflict further pain. Others aim to be good Samaritans, but find themselves trapped in a situation with no clear escape.

Social-work researcher Jooyoung Kong, now a professor at the University of Wisconsin-Madison, investigated in the early 2010s an intriguing phenomenon: nearly one-tenth of American adults were providing care for their elderly parents, while over a fifth had experienced childhood physical or sexual abuse. Kong hypothesized that some caregivers might be supporting loved ones who had previously caused them harm. Colleagues predicted she would discover only small numbers of such cases.

A 2015 study titled "Caring for My Abuser" shed light on caregiver data, revealing disturbing trends among aging parents' caregivers. Kong and her co-author Sara Moorman discovered that nearly one thousand adults providing care reported experiencing childhood abuse at the hands of a parent: verbal, physical, or sexual mistreatment afflicted 18.6 percent, while neglect affected 9.4 percent. If these statistics hold true on a national scale, millions of Americans might be impacted.

In some cultures, caregiving is deeply ingrained as a societal expectation. Certain individuals, particularly within specific family units or communities, accept this responsibility without hesitation or question. Their role is seen as inherent and unwavering.

Structural issues also played a significant role in this situation. According to Howard Gleckman, a fellow at the Urban Institute, the US ranks among the worst countries globally when it comes to financing long-term care. A staggering number of Americans are surprised to discover that Medicare does not cover long-term caregiving services whatsoever, instead focusing on acute medical expenses such as hospital stays following injuries or illnesses like a broken hip or infection.

Caregivers with limited assets, typically around $2,000, may qualify for Medicaid assistance with tasks like bathing and toileting. However even in these cases, coverage is often insufficient, providing only a few hours of care per day. This can be woefully inadequate to meet the needs of loved ones. Others must explore the "spend-down pathway," where they pay out-of-pocket for at-home care averaging $35 an hour or nursing home costs reaching up to $115,000 annually for private accommodations.

The US healthcare system heavily relies on unpaid family caregivers, with adult children bearing a significant burden. Elderly individuals left to care for themselves often face dire consequences, including repeated visits to emergency rooms due to dehydration, malnutrition, pneumonia, urinary tract infections, fractures and falls. These hospitalizations are frequently followed by swift discharges and brief periods of respite at home before the next crisis arises. According to Gleckman, this cycle ends only with a person's death in a hospital room or their own home, often only discovered when someone outside, such as a mail carrier, reports an unpleasant odor.

The prospect of caregiving can coerce even the most unwilling individuals into taking on this role. According to Allison Applebaum, a clinical psychologist specializing in family caregivers, many people believe that caregiving is an elective decision, but research suggests otherwise: over 50 percent of U.S. caregivers feel coerced into their position. This perceived lack of choice can lead to increased feelings of burden and resentment among those who are shouldering the responsibility.

Asia, a Washington resident, inadvertently took on the role of caregiver for her aging father. Initially, everyone seemed to think it was inevitable that she would care for him, given his declining circumstances. Her father's financial struggles had reached a critical point; he could no longer afford his rent payments. Asia and her then-husband made the decision to construct a small dwelling on their property, which they hoped would not only benefit them financially but also provide a temporary solution for her father. It wasn't until after his move that the full extent of his dementia became apparent.

Asia's initial reaction was one of utter dismay, as the prospect of caregiving felt utterly overwhelming. She couldn't shake off feelings of resentment and self-doubt, which lingered for approximately a decade.

Growing up with her father was a challenging experience due to his rigid adherence to religious principles and his tendency to discipline with physical punishment. His children frequently received beatings from a belt for minor transgressions, only for him to subsequently express remorse and beg forgiveness. This pattern of behavior was not limited to physical abuse; he also imposed strict silence on his family, forbidding laughter in his presence.

With no one else to turn he found himself isolated. Three out of four children refused to communicate with him and another resided elsewhere. Asia acknowledged that her own troubled upbringing didn't justify being cruel herself. The question remained: could she morally justify kicking a destitute, elderly man out onto the streets?

Asia's father gradually became an overwhelming presence in her life, eclipsing even the demands of raising her own children. His constant need for attention and assistance left her hesitant to step outside or perform even simple tasks like watering the flowers on their front porch. As his dementia progressed, he grew increasingly self-centered and judgmental, frequently expressing disappointment in Asia's choices, particularly those that didn't align with his own values tied to the church. Asia recalled feeling suffocated by the weight of her responsibilities, unable to escape the cycle of caregiving. She revealed to me that her situation had become so unbearable that she confessed to her husband about considering self-harm, although she didn't intend to follow through on those thoughts.

As Asia's father's health began to decline, his condition worsened significantly. This past year had been marked by multiple transitions, with Asia relocating her father from one facility to another and eventually into hospice care. His emotional outbursts were a recurring theme, with episodes of intense crying and pleading to be released. In contrast, he would sometimes ask about the whereabouts of his other children, expressing a desire for their visitation. Initially, Asia's responses were laced with a sense of detachment, telling him that her siblings weren't genuinely invested in seeing him due to past experiences. However as time went she began to feel guilty about withholding comfort and allowing him to pass away under the assumption that he was a good father.

Pat Berry's research into caregiving for abused individuals revealed a crucial oversight in clinical practice. Clinicians often failed to probe into the dynamics of family relationships, says Berry, a retired hospice nurse with expertise in family caregiving. Berry notes that during her early years as a nurse, she assumed children would naturally care for their elderly parents whenever possible and that this caregiving role would bring them joy. However nurses frequently made comments like "your mother is so sweet" or called adult children who hadn't visited recently, saying "your mom's been asking about you." These interactions overlooked the possibility that an adult child might be avoiding contact due to past trauma inflicted by their parent.

The term "loved one" is often used in healthcare to refer to a family member, but it perpetuates the misconception that family relationships are inherently loving. This oversimplification can be particularly damaging for those dealing with abusive parents.

Caregivers of abusive parents often sought guidance from therapists to navigate the complexities of their situation. They grappled with establishing healthy boundaries while fulfilling their caregiving responsibilities. Many caregivers wondered how they could cope with the emotional toll of caring for someone who had caused them harm in the past. Some caregivers hesitated to share their experiences, choosing instead to focus on the challenges of caregiving itself.

Caregivers often experience dissociation, according to Stephanie Muskat, a Toronto-based social worker and founder of the Compassion in Caregiving therapy group. This phenomenon occurs when individuals struggle to acknowledge the harm inflicted by their caregivers, instead compartmentalizing their emotions. As a result, they may downplay their feelings, revealing only superficial issues such as sleep disturbances or chronic irritability. Some patients have even suppressed memories of mistreatment, engaging in self-preservation mechanisms that temporarily shield them from emotional pain.

Five years ago, Debora relocated to live with her parents, whose care had become increasingly demanding due to her father's advanced age of 90. Her mother, now 87, was struggling to manage on her own. As the second eldest of ten siblings, Debora felt an inherent responsibility as the oldest daughter, a burden compounded by the loss of her husband at a young age. It seemed only natural that she would take on this role, with others assuming it was her duty. From childhood, Debora had been accustomed to caring for her younger siblings on their family farm, often working in the kitchen while being restricted from outdoor play.

Debora devoted herself to caring for her parents at their condo, tackling daily chores with diligence. Her father's behavior became increasingly childish as he pushed away meals she lovingly prepared. As his physical limitations grew more pronounced, Debora took on additional responsibilities, assisting him with personal care tasks such as using the toilet and showering. "I drew a line," she explained, "refusing to perform intimate hygiene tasks for my father, but I did ensure his overall cleanliness."

Childhood memories of Debora's life with her father were hazy, but she knew that as a child, he had inflicted physical harm on her. This painful reality remained unspoken, even to those closest to her - her mother and husband. However upon returning to live with her parents, fragmented recollections began to resurface. Certain scents could instantly transport her back to specific moments from her childhood, like the smell of car oil or lumber. As she pieced together these memories, Debora realized that her father had subjected her to years of sexual abuse. The truth was even more disturbing: he would often take her to the farm and allow other men - typically the farmhands - to exploit her in exchange for liquor, cigarettes or other vices.

Caregiving for an abusive parent can be emotionally draining, numbing one's feelings as a coping mechanism. "I went through the motions without emotional response," she recalls. Her numbness eventually gave way to intense anger, which she attempted to manage by self-medicating with increasing amounts of alcohol in the late evening hours after her parents' bedtime.

Debora's siblings confronted her about her drinking, prompting her to confess: "I finally came clean." Her family's reaction was explosive, as they struggled to reconcile their perfect image with this new reality - a family of 12 devout Catholics. The aftermath brought a mix of emotions, but some siblings made an effort to reconnect with Debora, offering physical and emotional support.

Debora's siblings remained tight-lipped about the abuse, with only her oldest brother seeking information on the matter. Debora herself chose to keep quiet, not wanting her mother to discover what they now knew. Her mother was revered as a saint, and Debora felt she deserved some tranquility in her later years.

Debora's life was marked by a cycle of emotional turmoil until January 2026, when her mother suffered an unexpected fall while trying to lift something from the coffee table. Her father rushed to assist but unfortunately also lost his balance and fell. This incident led to him being hospitalized and subsequently transferred to a nursing home. The newfound distance may have triggered a shift in Debora's perspective, allowing her to establish some much-needed emotional boundaries by choosing not to visit or inquire about her father's well-being.

Debora's mother had been oblivious to her daughter's absence from the nursing home for several weeks before commenting on it - prompting Debora to plan a discreet visit. Upon entering her father's room, she was met with a disturbing sight: he was disheveled and covered in food residue, struggling to access his drink due to mobility issues.

She harbored a deep sense of empathy.

She admits to it, her words laced with confusion still.

Carole's anger simmered just below the surface, a cauldron of seething resentment that boiled over into explosive outbursts directed at her son Andre. These tirades left him shaken.

Her anger was fueled by his consistent lack of appreciation for her efforts, as if she was invisible even when helping him directly. Carole believed a more considerate parent would strive to alleviate the weight on their child's shoulders. Meanwhile, Andre felt entitled to have others bear the cost, including gas expenses.

One day, she confronted her father about his refusal to use his walker. She made it clear that if he fell and suffered injuries like a broken leg or pelvis, the consequences would be dire: a life of misery in a skilled nursing facility, forced into diapers.

Her therapist's email conveyed a sense of urgency, expressing concern about Carole's well-being and the potential for further emotional distress.

Carole sought guidance from social workers at the Redwood Caregiver Resource Center regarding her father's refusal of professional assistance. Alexis Glidewell, program director, explained that older adults often exercise their legal right to autonomy, making choices that may not be in their best interest. In elder care, this phenomenon is referred to as an individual's "right to folly." However, sometimes the only way to intervene is by creating a crisis situation. Carole could wait for her father to experience a significant event, such as a serious fall or injury, which would necessitate hospitalization and subsequent treatment. Once admitted, the hospital would assume responsibility for his care, ensuring a safe discharge into their system.

Andre's fate hung in the balance if Carole declined his placement. He would likely be sent to a nursing home for rehabilitation, but given his age, it was improbable he'd ever be discharged. Glidewell observed that such scenarios unfolded frequently. In some cases, family members left elderly relatives, often with dementia, at emergency room doors, sometimes attaching notes like "Please care for my father."

Individuals who have endured abuse as children are more likely to become abusive caregivers themselves. This phenomenon is often attributed to the notion that hurt people tend to inflict pain on others. When elder abuse does occur, Glidewell notes that it typically manifests as subtle neglect rather than overt aggression. For example, a daughter may deliberately avoid assisting her father with his medication regimen due to his frequent resistance.

In August 2025, nearly two years after a crucial phone call from an eye doctor, Carole secured her father's appointment with a specialist in brain function, who conducted a comprehensive three-hour assessment and confirmed the presence of major vascular neurocognitive disorder. The evaluation revealed that Andre's verbal abilities remained "average to high average," allowing him to converse fluently and even exhibit charisma, but his ability to manage daily tasks was severely impaired. His performance on one memory test placed him in an extremely low percentile. As a result, the neuropsychologist determined that Andre was incapable of making simple medical decisions, necessitating Carole's involvement in this aspect of his care.

Andre expressed a sense of divine retribution.

Carole's words were a gentle reminder of life's inevitable progression towards mortality.

Carole's extensive therapy sessions and in-depth reading of psychology books had taught her a valuable lesson: that meaningful change is rarely, if ever, achieved through caregiving efforts alone. Her experiences had shown her that healing is not always a straightforward process. "There will be no redemption before his passing," she stated matter-of-factly. The last years of Andre's life would unfold without the possibility of moral transformation or awakening, a stark reality that left little room for sentimental expectations.

Carole's years of silence were finally beginning to unravel as she grappled with the weight of caregiving. Her reluctance to confront Andre about his past hurt stemmed from a deep-seated assumption that he would never acknowledge his own wrongdoing. However as his mortality loomed closer, Carole felt an overwhelming urge to seek closure. In a moment of quiet resolve, she broached the subject, saying, "Dad, you have this opportunity."

His denials were unequivocal: Carole's claims were entirely fabricated, he insisted. He portrayed himself as a devoted father, contrasting his own parenting style with that of his own abusive father. His assertion that he had done his best to raise Carole is now complicated by the presence of dementia, making it difficult to discern fact from fabrication.

By mid-January 2026, Carole had arranged for Andre's relocation to a retirement home, scheduling a meeting with a placement service in his name. At this appointment, Andre became visibly agitated and vocalized his discontent, requesting a room with a mountain vista as a compromise.

Leaving the doctor's office, Carole caught a glimpse of her father overcome with emotion suddenly.

Carole recalled a poignant moment when her father's emotional outburst left her feeling torn between empathy and self-preservation.

The age-old conundrum of parental obligation has long been a weighty concern for families. While it's natural to feel indebted to one's parents, pinpointing exactly what this debt entails can be a daunting task. Perhaps common sense suggests that the extent of this responsibility is tied to how we were raised and nurtured as children. The philosopher Daniel Callahan once observed that each generation must forge its own understanding of the biblical commandment to honor one's father and mother.

In the 1970s, the growing number of elderly Americans, which had risen to 10 percent, sparked a pressing concern about the future of caregiving. As people lived longer, families faced the daunting prospect of providing support for years on end, a reality that was increasingly acknowledged as "the graying of America".

The introduction of Medicare and Medicaid in 1965 marked a significant shift in the state's approach to supporting indigent individuals. As these programs expanded, so did the notion that adult children have a responsibility towards their elderly or disabled parents. However prior to the passage of these laws, there was a contentious debate among lawmakers about whether children should be forced to deplete their own financial resources before the state intervened. The Medicaid eligibility guidelines ultimately clarified that only an individual's and their spouse's income would be considered when determining assistance levels, effectively excluding a child's earnings from being used to support their parents.

Historians like Hendrik Hartog argue that proponents of Medicare and Medicaid envisioned these programs as a means to alleviate the emotional burden on families, particularly children, who often bear the weight of caring for their elderly relatives. By transferring this responsibility to the government, they hoped to foster closer family bonds and even affection.

Forty states still had outdated "filial responsibility" statutes on their books, a legacy from colonial times that mandated adult children to financially support impoverished parents. These laws, though rarely enforced, were initially enacted not out of moral obligation but as a cost-saving measure to reduce government expenses. The existence of these old laws now created an awkward juxtaposition with the more recent public welfare initiatives.

While some states resisted the change, others remained unmoved by the push to abolish these laws. In 1970s California, Governor Ronald Reagan's veto power was exercised twice, blocking proposals to repeal part of the state's law. According to his reasoning, financially capable adult children should share in their parents' support, as a matter of family responsibility and welfare program integrity.

Concerns arose that public funding could erode the American family's moral standing. A 2002 Family Law Quarterly article noted a significant shift in societal expectations: whereas previously fathers who failed to provide for their children faced no consequences, they are now labeled "deadbeats" subject to wage garnishment and other penalties. This perception persists until filial-responsibility laws are consistently enforced, leading Americans to rely on the government to care for their parents instead of taking responsibility themselves.

Today, only about two dozen states still have filial-responsibility laws on the books, but enforcement is extremely rare nationwide. Pennsylvania stands out as an outlier in this regard. A notable instance of a son being held accountable for his mother's debt occurred in 2012 when he was ordered to pay $93,000 for her nursing-home expenses after she relocated to Greece without settling her bill.

Katherine C. Pearson, an esteemed law professor at Pennsylvania State University, delivers thought-provoking lectures on state legislation. Her presentations often leave a lasting impression on her audience, as one individual's expression reveals their deep-seated fear of being held accountable for their parent's wrongdoing. When these individuals approach Pearson after class, they share harrowing accounts of parental abuse, which she listens to with empathy and understanding. In response, Pearson clarifies that the law does not provide a statutory defense for victims of abuse, but rather considers it a mitigating factor in court decisions. She advises her students to hold onto their personal stories, highlighting that if a parent fails to meet societal expectations, the child is unlikely to be found liable by the court.

Adult children often struggle to determine whether they were truly abused. They may wonder if being physically retaliated against was a common occurrence in their household, or if their parents' behavior should be evaluated based on the norms of their time. Others grapple with the notion that even non-abusive parents can enable abuse by failing to intervene when it occurs.

Susan's realization about her mother's behavior came much later in life, around her late 40s. As a child, she had convinced herself that her father was the one responsible for their tumultuous home environment. Her father's imposing presence, weighing in at an astonishing 210 pounds, would often cause him to stomp loudly, causing the walls to vibrate with each step. The noise was so audible that it could be heard by everyone in the neighborhood. Susan's early years were marked by a deep-seated sense of obligation towards her mother, as if it was her sacred duty to care for her.

It wasn't until years after the fact that Susan reflected on her childhood dynamics. Her mother's complicity in their father's behavior was a painful reality to confront. While it was her father who unleashed his anger, it was her mother who stood idly by. Born in the 1930s, her mother may not have been an outspoken advocate for women's rights, but she had financial independence and a successful career. A good mother would have taken action to protect herself and their children.

Susan's memories of her mother's behavior were etched in her mind like scars. Her mother was often preoccupied, leaving Susan feeling neglected. The evening routine was particularly painful, with her mother returning from work and simply sitting in silence, watching TV or dominating conversations about her husband and marriage. Susan recalled the dismissive tone her mother used to employ when she shared genuine thoughts, accompanied by a snort, sneer or condescending attitude.

Following the death of her father, Susan's life was further complicated by her mother's stroke in July 2019. This necessitated frequent trips from Denver, where Susan resided, to Portland, Oregon, where her mother required care. By 2022, Susan had established a routine of extended stays in Portland, allowing her to provide ongoing support. As she had no dependents and was receiving disability payments due to multiple sclerosis, it seemed logical for Susan to take on this caregiving role. In Portland, Susan managed her mother's daily needs, including medical appointments and financial affairs. However tasks that involved nurturing or caregiving, such as cooking or personal grooming, felt uncomfortable for Susan.

Her mother's behavior became increasingly provocative in old age, pushing her daughter to the edge. Initially, Susan struggled to manage her emotions, often losing control and reacting impulsively. This pattern of behavior was eerily reminiscent of her father's actions, prompting Susan to lash out at her mother with verbal aggression.

As her dementia progressed, her mother's demeanor underwent a transformation. Gone were the days of stubborn resistance; instead, she became increasingly submissive and courteous. Her "thank yous" became a frequent refrain, a stark contrast to her former self. Susan found herself caring for a woman who was almost unrecognizable from the one she once knew.

Caring for a parent with dementia can be especially challenging, leaving adult children questioning their responsibility towards someone who no longer resembles the person they once knew and may not even recall their own parental role. However for Susan, the disease had an unexpected effect - it simplified her situation, allowing her to continue caring for her mother without feeling overwhelmed by guilt or obligation.

Andre's application was approved by the retirement facility in February, allowing him to take up residence there. Carole ensured his room had a desirable view, as per her father's specific request. The western-facing balcony offered a stunning vista of sunsets.

Occasional visits were unavoidable, as she needed to ensure he had a steady supply of medication and monitor his well-being, although she aimed for intervals of no more than three or four weeks between each visit, if possible.

Andre's application was approved by the retirement facility in February,allowing him to take up residence there. Carole ensured his room had a desirable view, as per her father's specific request. The western-facing balcony offered a stunning vista of sunsets.

The rift between Carole and Andre widened after his relocation, as resentment towards him intensified, spreading like a stain across the newly created physical distance between them. Her mind replayed the countless times he'd disregarded her sacrifices, showing no genuine interest in acknowledging or valuing her efforts. By refusing to accept the harm he caused, he continued to drain her emotionally.

Caregivers often misinterpret behaviors associated with dementia as intentional actions. Families may mistakenly attribute malice to individuals with memory impairments, perceiving combativeness and gaslighting where there is actually only symptomatic behavior. This phenomenon is more pronounced in cases where the person has consistently displayed mean-spirited and manipulative tendencies. In such instances, family members struggle to accept that the disease has taken control, leading them to overlook the fact that the same problematic behaviors are now driven by a medical condition rather than personal choice.

Dementia's symptoms are uniquely distressing for individuals who have experienced abusive relationships in the past, notes clinical social worker Glidewell. However people with dementia lack the cognitive complexity to engage in sophisticated manipulation, which involves intricate thought processes and coordinated actions. Those who can orchestrate such complex behavior likely do not meet the diagnostic criteria for dementia.

Carole questioned whether she was misjudging her father's capabilities. However in many instances, she believed Andre deliberately manipulated her, with a force so potent that it could overpower his physical limitations. "Without any doubt," he insisted firmly.

As she tackled the task of cleaning out her father's old farmhouse, Carole was met with a staggering amount of clutter. Weeks turned into months as she methodically disposed of decades' worth of plastic bags and paper napkins that had been used multiple times. Amidst the chaos on the porch, paint canisters dating back half a century sat untouched, while the back office revealed an astonishing collection of eyeglasses belonging to her father. During this process, Carole would occasionally feel a pang of sympathy for her father's circumstances. However whenever these feelings arose, she would revisit her mother's old journal entries, which documented the hurtful insults he had hurled at her in front of their daughters - "[expletive] blockhead," "[expletive] idiot" and "dumb, ignorant and gullible" among them. Her mother's journal also revealed instances where Andre threatened to physically harm Carole's sister.

Carole's eyes welled up as she read the handwritten notes, a poignant validation.

Carole's visits became a daily occurrence, not just every few weeks as initially planned. The sheer amount of tasks required to help her father settle in was overwhelming, she explained. To keep him entertained, Carole spent hours transferring old family photos onto a digital picture frame, which he could easily view from his armchair. She coordinated appointments and communicated with his medical team on his behalf. Personal care wasn't forgotten either; she made sure he applied cream to soothe the itchy patches on his back. Even when she couldn't be there in person, Carole kept a close eye on her father's whereabouts using the Find My iPhone app, checking for movement between his apartment and the restaurant at lunchtime and dinner.

On Mondays, Carole typically visits her father at the retirement facility, carrying essential items to his apartment. This particular morning, she had gathered a few plastic bags filled with his requested mail, a knife sharpener, and a jar of honey for his daily coffee ritual. As she entered his apartment, Andre greeted her warmly, expressing gratitude for her thoughtfulness. He thanked her in French, using the phrase "merci beaucoup".

As Carole busied herself rearranging the apartment's layout, Andre interjected with news about his recent mishap in the bathroom. He had accidentally bumped into the counter the previous day, bruising his rib in the process. Carole's expression turned concerned as she asked him to rate the severity of his pain. Andre downplayed its significance, but Carole was determined to alleviate his discomfort, first by offering a bath mat and then a glass of water.

Andre's gratitude was palpable as he spoke about Carole, crediting her with being a beacon of hope in his life. His words were laced with sincerity as he expressed his deep appreciation for his daughter.

Living in this new residence has its advantages, with an outdoor balcony that brings some comfort. However the physical toll of aging is taking its toll - at 95 years old, as recently confirmed. His words betray a deep sadness, recalling his former adventurous spirit. Tears well up in his eyes as he reflects on his current situation.

The question hung in the air, a piercing inquiry into her state of mind.

Words fail me.

As we strolled down the lengthy hallway near lunchtime, a digital sign caught our attention, promoting bingo, yoga, and "Mocktail Monday" at the facility's restaurant. Andre ordered a bowl of lentil soup accompanied by a coffee with precisely three sugars. He whispered to me, "I'd rather not have Carole overhear this," before continuing, "She has an authoritarian streak." Her behavior was domineering; she frequently raised her voice. Andre explained, "My situation is complicated – I'm trapped in a cycle of dependency."

He instructed to respond positively if asked about his comments on Carole's character.

Carole placed a pair of slippers in front of her father at Andre's apartment. The gesture was an attempt to prevent another accident. With the task complete, Carole announced it was time for her departure. As she prepared to leave, Andre extended his cheek for a kiss. He affectionately expressed his love for her.

She winced momentarily before responding warmly. "I love you as well."

On June 3, Andre's life was tragically cut short by a fatal heart attack. His loved ones are now grappling with the difficult decision of how to honor his memory.

Contributing writer Katie Engelhart has made significant contributions to the magazine's coverage of medical ethics. Her notable work, which earned her a Pulitzer Prize, centered on a family's struggles with caring for a loved one afflicted with Alzheimer's disease.