June 19, 2008
The emotional landmines of family caregiving
Most families squabble. After a short cooling-off period, relatives tend to resolve spats and go on with their individual lives. But there are situations that make it difficult to restore harmony. For example, when an elderly loved one breaks a hip, suffers from dementia, a stroke or other disabling illness, spouses and adult children can become unglued. The frailty and dependence of a loved one often ignites emotional landmines, stirs up old family issues and uncovers personality traits best left buried.
A common situation goes like this: Sis worries that increasing forgetfulness threatens her mother's safety. Her brother, on the other hand, argues that a few Post-It note reminders placed around mom's home will remedy any "senior moments" she may have.
Sis replies, "You haven't seen the burnt pots and pans left unattended on the stove."
He comes back with "You are overreacting."
Both want the best for their mother, but their competitiveness gets in the way of their ability to execute a plan. Each one is trying to prove that they are the smartest, most reasonable and the supreme problem-solver. Sibling rivalry never dies.
The siblings' time would be better spent asking their mother what she prefers. Does mom want to remain in her home in the face of growing difficulties? Most seniors do. An assessment by a professional geriatric care manager (who is not a relative) would lay the groundwork for a plan to keep mom safe in her own home or, if that's not wise, help the family find a more suitable living arrangement. For an explanation of what a geriatric care manager does and the location of one near you, visit www.caremanager.org.
The Golden-Haired Child
A painful situation for the primary caregiver occurs when another close relative does little or nothing to help, but they are adored and praised by the senior anyway. This frequently triggers resentment in the mentally and physically exhausted primary caregiver.
Keeping uninvolved relatives in the loop about medical conditions, treatments and finances increases the likelihood of their involvement. At the very least, it prevents later complaints that "nobody told me" or "I'd have never agreed to that had I'd known."
It's infuriating when others don't do their share, but ultimately you can't force people to do anything they don't want to do. In the long run, you are better off not spending time stewing, a practice that results in more anger, bitterness and family feuds.
Before throwing in the towel, get together a family conference where the topic for discussion is "sharing the caring." Generally, people are more willing to participate when they can contribute in a way that's comfortable for them. Not everyone is willing or able to do hands-on care. Some relatives might have the know-how to help with figuring out and managing health benefits or home repairs or be willing to accompany the elder to doctor appointments.
The Scrooge is the family member who skimps on or neglects care. I recall a daughter who petitioned the court and was granted the conservatorship of her severely demented mother. The siblings welcomed the newfound kindness of their previously self-centered sister. Then the daughter moved their mother to an unlicensed, below-standard "cheap" facility far away from other family members. Soon, she began to mishandle her mother's finances.
Most Scrooges simply want to preserve their inheritance or "get it early."
If the older woman (when she was still well) had executed a living will or designated an ethical person to be her durable power of attorney for health care and for financial decisions, the Scrooge may never have been able to take over her mother's care for her own gain.
These documents can be downloaded and are explained online at www.caringinfo.org.
The Long-Distance Denier
Some relatives are well-meaning, but distance is an obstacle. In this group there are also a large number of deniers who insist that nothing is wrong with mom or pop. Almost as bad are the bossy long-distance relatives who issue inappropriate and unsolicited "advice."
Two solutions come to mind. First, discover what the distant person is willing to do from their own home. For example, research medications, health conditions, locate resources online, or provide emotional support via telephone or even financial support. Second, invite a denier to eldersit so the caregiver can take a break. A few days of duty may open their eyes to the "true picture."
The Sandwiched Caregiver
Some caregivers are squeezed between caring for an elderly parent and parenting a teenager. Every hour spent on eldercare represents an hour unavailable for children. The bane of the sandwiched caregiver is guilt. No matter how much they have done, they always feel they could have done more. Even worse is the guilt experienced when their frustration and exhaustion result in angry words directed at their spouse, teenager or even the older family member.
One solution is to include the entire family in eldercare. For instance, children usually love assisting with grandpa's exercise. They can count the repetitions and cheer grandpa on. Teenage girls may get a kick out of doing grandma's nails. Such activities lighten the caregiving load and help young people develop compassion.
Joining a support group is an ideal way to cope. To find a support group near you, start with the Alzheimer's Association at (800) 272-3900 or www.alz.org.
The overburdened are easily identified because the people they are caring for look better than they do. Overburdened caregivers are more inclined to have depressive illness, flare-ups of their own medical conditions and a higher mortality rate than those who are not caregivers.
The good news is that caregivers who choose their battles wisely, recognize that eldercare does not have to be perfect, and tend to their own health needs are able to provide better and longer care of their loved ones. While eldercare is often a thankless job, many caregivers report tremendous satisfaction when they reflect on the care they provided during the last years or months of their loved one's life.
The Super Caregiver
The classic "Super Caregiver" is an adult child or spouse who refuses offers of help, saying, "No one can do it better than I can."
When caregivers are unwilling to entertain the notion of outside assistance, table the subject for another day. Press the issue only when the health or safety of the caregiver or elder is at risk. Sometimes engaging a third person to make the suggestion is more acceptable to the older person, especially if the third person is the senior's peer or an authority figure. Parents often balk when adult children tell them what to do.