As our loved ones age and become ill, we as family members come into new roles as caregivers.  As I discussed in my previous article, “I Am a Caregiver,” this new identity comes with its own unique stressors that affect us on multiple levels (mentally, physically, emotionally, and financially).   As we struggle to adjust to these ever-changing responsibilities, how can we cope as caregivers?  What can we do to confront the uncertainties this caregiving role brings?

1.  Talk About Your Loved One’s Wishes and Preferences

We often put off having important conversations about our loved ones’ wishes for treatment, care, power of attorney, and end-of-life plans because we do not know where or how to start.  We also worry about having these delicate conversations because we do not want to upset anyone or think about the unpleasant parts of the road ahead.  We want to stay positive for our loved ones.  By putting off these conversations, caregivers place themselves in a more difficult position over the long run.  If we do not discuss our loved ones’ wishes and preferences, we set ourselves up for significant guesswork in the future.  Potential life and death decisions in the future may be further complicated by family members arguing about what is or is not necessary or wanted.

The organization Aging with Dignity produces a resource entitled “Five Wishes” (https://agingwithdignity.org/five-wishes/about-five-wishes) which helps individuals and families discuss and document plans for care.  Ultimately, these conversations give both caregivers and their loved ones peace of mind for the future.

2. Determine What You Are Willing To Do and Not Willing To Do

As caregivers, we assess numerous components of care as our loved ones age and need increasing amounts of assistance.  As we evaluate our loved ones’ needs, we must determine both what we are able and willing to do.  Realistically, what types of assistance are we able to provide and what tasks do we need to delegate elsewhere?

Below is an example of a daughter who determined her ability and willingness to perform caregiving tasks for her father and how she delegated responsibilities.

Cathy’s father is 85 years old and wants to continue living at home.  He is no longer able to drive and is often unsteady on his feet without his walker.  Cathy works full-time, and still has two teenagers living at home.  As Cathy assesses her father’s needs, she determines that she is able and willing to help with the following tasks: drive him to appointments, grocery shop, and perform light housekeeping.  Cathy worries about him bathing alone since he could slip without his walker, but she is not comfortable with the intimate tasks of bathing or dressing him.  She plans to find assistance for his showers and consult with a social worker about any special equipment that may help him remain independent at home.  She also plans to ask a young neighbor if he would be willing to care for her father’s yard for a small fee.

3. Enforce and Reinforce Your Boundaries

Once caregivers determine the tasks we are willing to do and not willing to do, we must be willing to set limits and enforce our boundaries.  If we find ourselves consistently performing tasks that make us uncomfortable or resentful, then we begin to feel overwhelmed, out of control, and at a higher risk for caregiver burnout.  Furthermore, if we continue to perform tasks that we have already told our loved ones that we will not do, then we lose our credibility.  We must reinforce our boundaries with consequences that we are willing to enforce.  Unless there are consequences, it can be more harmful to talk about a boundary because we teach others that we do not mean what we say.

Let us look at another example to better understand boundaries and consequences:

Greg moved his mother into an assisted living facility last month.  At first, he would visit every night after work and bring her favorite foods for dinner to help her become more comfortable in her new home.  Greg and the assisted living staff, however, are concerned that his mother is having difficulty adjusting to her new home.  She is not going to the dining room to eat and stays in her room.  Greg told his mother that he plans to call her every evening and visit three times per week, and he will no longer bring her dinner.  For three nights after, Greg’s mother told him she was not going to eat in the dining room and asked him to bring her dinner.  Greg enforced his boundary and told her that he would not bring her food (with the natural consequence being that his mother would get hungry if she did not go to the dining room), but he would be happy to talk on the phone with her after she comes back from dinner.  On the fourth day, after realizing that Greg would not bring her food, Greg’s mother began to go to the dining room for all of her meals. 

4. Understand Insurance Coverage and Benefits 

Many people assume that their medical insurance, especially Medicare, will pay for long-term care.  Unfortunately, this is not the case.  It is essential for caregivers and their loved ones to review the benefits of their specific insurance plans in order to understand options for care and effectively plan for the future.  These benefits are often very confusing.  When caregivers and family members have difficulty understanding their finances and benefits, it is helpful to consult with an elder financial planner or attorney to get an accurate picture of accounts and benefits.  Furthermore, understanding our loved ones’ insurance coverage helps us establish boundaries and determine what we are willing to do and not willing to do.

5. Seek Support Often 

Caregiving for a loved one is often fraught with frustration, pain, and isolation.  In order to stay healthy for ourselves and our loved ones, we need to reach out and gain support.  Talking with friends and other family members can help alleviate stress for many of us.  However, if you find yourself unable to gain the strength you need from these interactions, look to gather support from professional sources.  Therapists, geriatric care managers, social service agencies, support groups and religious organizations are wonderful sources of the support, guidance, and knowledge that caregivers need to strengthen themselves.

All of these suggestions take time and practice to implement into our lives.  They are not overnight solutions, but over time will help reduce stress.  Many of us need help sorting through how we think and feel about our situation as caregivers.  Do not hesitate to reach out to friends, family, and professionals for support and advice to integrate these coping skills into your life.

About the Author

Amy Neu

Amy Neu, MSW, LCSW

Amy Neu received her Masters in Social Work from the Brown School of Social Work at Washington University.  Amy provides private therapy for adults, families, and seniors who are facing a variety of issues including depression, anxiety, grief, coping with medical issues, and end of life.  She has significant experience counseling seniors, caregivers, and families within medical systems and during transitional periods from home to alternate levels of care.

In addition to Amy’s clinical practice, she provides on-site counseling and education to staff throughout the continuum of senior living communities.

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