The older we get, the more likely we are to have to provide some level of care to our aging parents. For some, this is an easy transition and an opportunity to deepen a lifetime of good memories. For others, however, it can stir up very painful, unresolved feelings and old resentments. Even under the best of circumstances, caring for our aging parents can stretch our emotional, financial and physical resources to uncomfortable levels, leaving us more vulnerable to physical and mental health issues.
In my private practice as a geriatric social worker, I see caregivers of all ages and circumstances. The adult children are usually the most stressed since they’re often juggling work and parenting, in addition to caring for one or both of their aging parents. Caregiving can, of course, take many forms ranging from long distance “oversight” to doing the actual hands-on care, with many variations in between. Another major variable in caregiving are the needs and personality of the person requiring care. The health and well-being of the caregiver are also a significant factor in determining the quality of the caregiving experience.
The need for the caregiver to take care of him or herself can’t be overstated. Burn out, increased levels of depression, physical illness and substance abuse are very real risk factors for caregivers. This is why the first right in The Caregivers Bill of Rights (www.theribbon.com/articles/billofrights.asp) by Jo Horne states, “I have the right to take care of myself. This is not an act of selfishness. It will give me the capability of taking better care of my relative.” Caregivers are often highly stressed by the time they find their way to me, and self-care is always where I start with them. Many of us have no idea how to take care of ourselves, even though we excel at caring for others. Setting boundaries, taking time for ourselves, exercise, delegation, good food and sleep are essential if we’re going to be able to provide high quality care for others over a long period of time. This is a time to get creative and innovative, to ask for help and to be open to trying new things, which is easier said than done if you’re exhausted and spread way too thin.
So how can you guard against the burnout that often comes with caregiving? Start by taking better care of yourself which may mean delegating your parent(s)’ care to someone else on a regular basis. The second right in The Caregivers Bill of Rights states that, “I have the right to seek help from others even though my relatives may object. I recognize the limits of my own endurance and strength.” If you have siblings or other available family members, work with them to create a realistic schedule. Ask those who are too far away to provide hands-on support to contribute to the cost of hiring someone for respite breaks (“those who can’t do can pay” as we say in the field). No, this is not a sign of failure on your part but rather a realistic assessment of your capabilities and limits. Here are some resource suggestions:
Contact your local Area Agency on Aging (AAA) for information about their programs, including payment for providing in-home care through the Medicaid Waiver Program. The website for southeast Michigan, http://www.aaa1b.com/, contains many resources for caregivers, including a Caregiver Self-Assessment (http://www.aaa1b.com/caregiver-resources/caregiver-self-assessment/) and information on free caregiver training. Many nursing homes and assisted living facilities offer up to a 5-day respite stay for non-residents which is usually covered by Medicare.
- The Senior Resource Directory for Washtenaw County, compiled annually by Catholic Social Services, is another wonderful resource for services and support in the area. Contact information for medical, transportation, counseling, chore services and many others are listed in a convenient 2-page document. It can be accessed online at http://csswashtenaw.org/uploads/File/ResourceDirectory.pdf. Check with your local senior center for similar listings if you live outside of Washtenaw County.
- When researching care options for your parents, www.ourparents.com provides a database of over 100,000 care providers. You can search by zip code, type of care, insurance coverage, etc. The website also contains helpful articles, online forums and other resources.
- Private geriatric care managers can be invaluable in coordinating and overseeing care, providing feedback to family members on a regular basis, being on-call for emergencies and acting as a liaison between older adults and their children or other family members. They are experts in different types of aging resources available in a particular area and can save tremendous time and frustration in finding the right service or facility for your parent when the need arises. Care managers can help develop a care plan, accompany your parent(s) to medical appointments and document the doctor’s recommendations, conduct home safety evaluations and facilitate family meetings, especially if things are contentious. Learn more about geriatric care management and find a care manager in your area through the National Association of Professional Geriatric Care Managers at www.caremanager.org.
- In Washtenaw County, we’re fortunate to have two excellent geriatric clinics – the University of Michigan Health System’s Turner Geriatric Clinic (http://www.med.umich.edu/geriatrics/patient/turner.htm) and St. Joseph Mercy Health System’s Senior Health Services (http://www.stjoeshealth.org/seniors). Patients come to these clinics from all over the country for assessments and recommendations that they take back to their primary care physicians, while others choose clinic geriatricians for their primary care. Many other large hospitals have geriatric clinics in which skilled geriatricians, geriatric pharmacists and geriatric social workers provide interdisciplinary assessment, recommendations, counseling and referrals for older adults. It’s not unusual for health care to become more and more fragmented as we age – different specialists are often involved for each issue and rarely is the care coordinated well between them. The oversight of a geriatrician can prove invaluable in addressing potential medication issues and overlapping/conflicting treatment plans.
- Engaging a skilled elder law attorney to ensure that your parents’ legal affairs are in order can also bring peace of mind. Advance directives, wills, powers of attorney (financial and medical in Michigan) need to be in place before a crisis arises. A listing of elder law attorneys in Michigan can be found at http://www.lawyers.com/Elder-Law/Michigan/browse-law-firms-by-city.html. Legal aid clinics offer low or no cost options, as well.
- Adult Day Programs like Turner Clinic’s Silver Club Memory Loss Program (http://www2.med.umich.edu/healthcenters/clinic_detail.cfm?service_id=674) provide support for older adults with mild to moderate memory loss and respite for their caregivers. The program includes lunch, socialization, exercise, music, art and other activities. Silver Maples of Chelsea (http://www.silvermaples.org/adult-day-services.html) and Brecon Village in Saline (http://www.evangelicalhomes.org/Locations/MemorySupportCenteratBreconVil...) offer similar adult day programs. Check with your local geriatric clinic or senior center for similar resources near you.
- Transportation and driving often become significant issues for older adults and can be the source of considerable conflict for family members. Having the “conversation” about driving is usually never easy, especially if no good alternatives exist. “We Need to Talk” from the AARP and www.thehartford.com/talkwitholderdrivers are great resources for this topic. In addition, the local Area Agency on Aging 1B offers an excellent list of resources for how to talk to older adults about their driving, where to get driving evaluations and how to report an unsafe driver if they refuse to cooperate (http://www.aaa1b.com/programs-services/senior-driving/drivingtransportat...).
While working to ensure that your parents get the best care available, it’s important to also give your own needs high priority as discussed earlier. For some of us, this means overcoming unreasonable feelings of guilt, resentment or obligation which can lead to seeing ourselves as martyrs or victims. A caregiver support group like “Caring for Aging Relatives” offered by Turner Geriatric Clinic can be a great source of comfort, support and information on how to survive and even thrive as a caregiver. This support group meets monthly and Turner also offers a lecture series of the same name that features experts in elder law, pharmacology, Medicare/Medicaid, housing, etc. Visit http://www.med.umich.edu/geriatrics/community/Fall%202011%20Calendar-v4%... for more information about this and other programs.
In addition, I know many caregivers who find tremendous benefit from attending Al Anon (http://www.al-anon.alateen.org/), even if alcoholism isn’t a primary issue, because of the program’s focus on self-care no matter how the other person is behaving. Many of us were raised in alcoholic or addictive families and find that the stress of caregiving can trigger old, dysfunctional coping mechanisms. Meetings are plentiful in the Ann Arbor area and can be another source of respite and support for caregivers. Codependents Anonymous (www.coda.org) is another good source of support, especially for issues of excessive guilt and self-sacrifice.
Therapy or counseling with someone experienced in geriatrics and caregiving can also prove invaluable. Check with your local geriatric clinic or the online directory at Psychology Today (http://therapists.psychologytoday.com/rms/) for skilled therapists in your area.
I think that the third right listed in The Caregivers Bill of Rights sums things up nicely in the area of self-care, “I have the right to maintain facets of my own life that do not include the person I care for, just as I would if he or she were healthy. I know that I do everything that I reasonably can for this person, and I have the right to do some things just for myself.” By taking good care of ourselves, we are better able to provide high quality care for a longer period of time to our aging parents.