Seven months pregnant with her first child, Chris McGill*, who lives 600 miles away, flew to her mother's rescue when the third in-home caregiver agency resigned in despair. Two long weeks later, a fourth agency was up and running and Chris returned home with a growing sense of dread.

That baby is now almost three, and Chris' mother is on her seventh set of caregivers. There seems to be no end in sight except to the number of agencies willing to give it a try. That number is dropping rapidly. Each time her mother fires another caregiver, or another agency withdraws, Chris flies in to start over. Obviously, the strain is taking a toll both on Chris' family and her relationship with her mother.

Has your parent fired yet another caregiver, because he doesn't want anyone but you? Is your mother so unpleasant to everyone who comes in to help that they've all quit, saying "There's just no way to please her?"

Welcome to the world of caregiver sabotage. It's a common problem created by fear, pride, lack of insight, the selfishness of illness, and sometimes just a lifelong nasty personality.

There are no easy answers when a parent won't cooperate with in-home caregivers, but here are some things that have helped other frustrated family caregivers:

1. Call a family meeting (without your parent). Sit down in person or via conference call with everyone involved in parental care and talk about your options. If you have no involved family, sit with a good friend, your pastor, your therapist, or someone else you trust so you can talk it out. The goal is to define when that last line has been crossed and care at home is no longer reasonable. If you need help defining your alternatives, call in a geriatric care manager to help you explore your options.

2. Avoid being sucked into a battle with your parent, but be prepared to stand firm about the fact that his or her options are disappearing. "Dad, we can give this one more try, but it it doesn't work, then the only choice we'll have left is to help you find an assisted living apartment." Your parent may be furious and try to manipulate your usual "buttons." Because his feelings are real, you owe it to him to listen with respect. At the same time, you owe it to yourself to remember that your duty as his grown child is to see to it that your parent has proper care, not to provide the care yourself or to make his every wish your command.

3. Interview your next caregiver agency off-site first. You want to be able to speak honestly about the challenges your parent will present to caregivers. You will want to hear their assurances that they have many experienced caregivers, and that they will not send any newly employed caregivers that they don't know well to your parent. You want to be sure that a manager will visit regularly to get to know your parent, and that the manager will be supportive when the caregiver needs to vent.

4. Once hired, make it a practice to regularly spend a little time with the caregiver(s) outside your parent's hearing. Go into the garage to clear out a corner, or into the yard to trim a hedge together. Do not encourage an emotional "dump," but do encourage the caregiver to talk about challenges and brainstorm together about possible ways to redirect or manage tantrums and unreasonable demands.

5. If you find a trustworthy, reliable caregiver who is willing to hang in there, do whatever you can to make her feel honored and appreciated. While her agency may not permit monetary gifts, they may permit you to pay for an extra afternoon off or a small hourly raise as long as she remains on the case. Check with the agency about what extras they will allow.

6. Accept that if your parent is of sound mind, you will not be able to force him to accept help at home. He may be unable to fix proper meals, groom himself properly, or take care of his home. But if he is able to understand the possible consequences of his choices, then you cannot force him to do what he doesn't want to do. There is nothing you can do to prevent the consequences of his poor choices.

On the other hand, if your parent is not able to be alone because of dementia or other cognitive disability, you will have to find her alternative living when it becomes clear that in-home care will simply not work.

Never, ever, consider moving into the home of a demanding, unreasonable parent who wants you to be her only caregiver.

And never, ever, bring a demanding, unreasonable parent into your home.

These "temporary" solutions almost always become permanent, and caregiving families almost always have serious long-term regrets about agreeing to these kinds of arrangements.

*pseudonym

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