Caregivers -- so critical, so kind -- until they're not

Even now, he worries about her.
Even now, after she struck him and berated him for soiling his diaper. Even now, after she cursed him, mocked him and threatened to lash Robert Harkness, a 64-year-old quadriplegic, to his bed and leave him there. Even after she threatened him with his worst fear: Sending him back to the institution to which he was confined for 29 years. Even now Buddy Harkness thinks about his nurse of 14 years and he worries.
After all, she was like family.
On Jan. 7, the state sentenced Tammy M. Labrecque, a licensed practical nurse, to 15 months in jail after she was found guilty of cruelty to persons. Attorneys in the sordid case compared it to something out of "Misery" or "Dante's Inferno," and it was all that and so much more.
The eight years of abuse Harkness said he endured from Labrecque is a story of viciousness and vulnerability, of brutality and dread, of a man so desperate for his own freedom that he would endure a stream of ridicule and cruelty so relentless that it finally sapped his will to live. But it is also a story of one woman's inexorable and imperceptible slide into sadism and the horrors that ensue when someone that you love becomes someone that you hate.
"She went everywhere with our family," said James Beck, Harkness' conservator, fanning out a stack of photographs that depict Labrecque on vacation with the family in Florida, in Maine, along the Connecticut shoreline. Labrecque lopes her arms around Beck and his parents, and Buddy, her beloved charge. "I question myself and say, 'How did it go on right under our noses?'" says Beck. "We all had affection for her. I don't understand how the person that she cared for could be the object of her anger."
About 12 million Americans currently receive care from more than 33,000 home health care providers, a number that is expected to rise as home health care becomes a cost-containment vehicle for aging boomers. The overwhelming majority of these providers are devoted, benevolent, self-sacrificing caregivers.
Many become, as Labrecque did to Harkness, part of the family. But the relationship between patient and caregiver is deeply nuanced. It is complex, precarious and susceptible to abuse. "It's a highly stressful situation," says William Dombi, vice president for law at the National Association for Home Care & Hospice. "Many of these [patients] are not even able to communicate to you what's working and not working. That's where you'll see some workers take it out on the patients and some take it out on themselves."
Among the elderly, loneliness itself can be a disease. A friend who works with the elderly recalls alerting a supervisor to the fact that a caregiver was not doing her client's laundry, housekeeping or chores. When the elderly client heard about the complaint, she was livid. The caregiver, after all, made her laugh.
"Maybe that's more important to them than the stupid laundry," Ellen Rothberg, president and CEO of VNA Health Care, told me. "It isn't simple. They'll say, 'I don't want to get the girl in trouble.' We have situations where [the client] is like 'Am I going to rat on them?' It's complicated. Elderly people don't want to rock the boat. They're worried about losing everything."
Born with cerebral palsy, Harkness lived at home until he was 17 and his mother became pregnant again. Adhering to the counsel of the time, Harkness' mother institutionalized him at the former New Britain Memorial Hospital. He remained there for the next 29 years, until his move to Waterbury 15 <$>years ago.
"She knew his greatest joy was getting out of the hospital after 29 years," Beck said. "She constantly played on that fear. 'Nobody else will put up with you. Nobody else will take care of you.'"
"I hate Tammy," Buddy Harkness told Peter Zaniewski, his other nurse.
It is not easy for Harkness to talk. But Zaniewski was not mistaken. Harkness said it over and over again in the 10 years Zaniewski was his nurse. "Why?" Zaniewski would ask. And Harkness would go silent, rendered mute, Beck believes, by the paralyzing terror that he would be re-institutionalized, shunted away from his modest condo with its Red Sox banners, lime-green cockatiel and tabby cat named Romeo.
"I didn't want to put words into his mouth," Zaniewski said.
Tammy Labecque has lost her house. She has lost her profession. She has lost her freedom.
Beck wonders now if all of it [--] the deaths of family members, a job that she seemed to find thankless, deteriorating health [--] became too much for her.
He tries to rationalize a depravity he cannot understand.
"I still pray for her," says Beck. "Buddy does, too."
Harkness, his eyes moist with tears, mutters, "I do."