Mr. and Mrs. B are a retired couple living in a large house in an affluent neighborhood. Mr. B, 86, is a retired naval officer who is orderly, controlling, and very "set in his ways." He suffers from hearing loss and severe back pain, for which he takes strong pain medication. Mrs. B, 80, always has been a housewife and caregiver for the family. Several bouts of cancer have left her weakened and frail. Though quite well off, the Bs always have lived a very private and isolated life, with no real support network. They have had a long-standing dispute with their immediate neighbor and are suspicious of the "newcomers" on the block. No family members live nearby, except their grandson Bob.

Bob is 37, divorced, and always "between jobs." He is estranged from his parents and siblings. He used to occasionally stop by and do odd jobs around his grandparents' home, but he spends most of his free time partying with his friends.

When Mr. and Mrs. B's needs increased, they hired an in-home caregiver. The caregiver quit after a few weeks, overwhelmed with the daily demands of the job. Acknowledging they again needed help, Mrs. B asked Bob to move in. He was eager to save rent money and agreed, although now he is responsible for grocery shopping, driving to doctor appointments (of which there are many), and some cooking and laundry. He accepted the responsibility, but quickly grew to resent it.

Bob has to raise his voice to speak to his partially deaf grandfather, who is often sleeping or seems confused and somewhat helpless. His grandmother is dependent and weak, and Bob hates seeing the one family member he was close to in such decline.

Bob has little patience and often loses his temper, yelling at, humiliating, and degrading his grandparents. Mr. B does nothing to stop this abuse. Mrs. B then starts crying, for which Bob feels guilty. Bob is threatening to sell the house and put both grandparents in a nursing home. He has begun having loud parties at their home that go late into the night. He feels he needs to unwind and relieve his stress from the demands of caregiving.

A neighbor has called the police to report the loud parties and yelling.