Support for the family caregiver | CaringWise

You are juggling 4,569 metaphoric balls. You are keenly aware of how many of them you are dropping. You haven’t slept in weeks. And so the mere suggestion that you might be able to improve any aspect of your caregiving—even if that suggestion is something as innocuous as getting some help—tends to trigger a stalwart defense mechanism.

The message you signal: “You don’t know what you are talking about. I’ve got it all under control. Go away.”

Unsolicited advice is rarely welcome. And that goes double in a caregiving situation when the suggestion is coming from someone who doesn’t appear to be shouldering their fair share of the work.  But it may, in fact, be useful. So don’t dismiss it out of hand.

Three tricks to counter defensiveness:

• Be aware. Listen to yourself. Are you busy justifying your actions—maybe even before anyone has offered an alternative?
• Breathe. (This is always good advice). Remember, no one is suggesting you are a bad person; they are suggesting things that may make your life or the life of your care recipient easier.
• Put it in the third person. You know your situation best. But you may be too close to the action to judge some things accurately—that whole "not-seeing-the-forest-for-the-trees" thing. Try thinking about a friend in a comperable situation.  If someone gave them similar advice, do you think they should take it?
• Give yourself a break. Above all, recognize that you are doing the best you can, and that your best is all anyone can ask. Even you.

Being a caregiver interferes with every aspect of your so-called normal life. And just like toddlers and teenagers who rail against their freedoms being curtailed, we resent this intrusion. Oh, maybe not at first, especially in a crisis-caregiving situation. But soon enough, when the adrenaline has worn off and all we can see is an endless hijacking of our lives.

Who do we resent? Other family members who aren’t pulling their fair share. Friends whose biggest worry is whether to get the red dress or the green one. And, worst of all, the person we love fiercely who is causing so much turmoil.

But that’s kind of tough to admit. So we bottle it up and go back to screaming at the siblings. The trouble is, resentment won’t stay bottled up very long. It festers. And then one day it is full-blown anger. Our advice: Tackle it before you get to that stage.

Three ways to cope with resentment

• Let it out. To your trusted best friend. In the pages of a private journal. In an anonymous post in a caregiving blog (other readers will understand). In a caregiving support group. 
• Take a step back. When you start feeling resentment, ask yourself if it is warranted. Could your sibling do more? If so, ask for something specific. Have they stranded you for the fourth time running? Maybe they have never been reliable. And before you blow up, think hard about whether the situation is worth wrecking your relationship over.
• Forgive yourself. Know that feeling resentment—like all these emotions—does not make you a bad person.

Fear comes in many flavors: What is going to happen to Mom? How can I handle it all? Will I end up this way, too? It’s natural. And it can consume your days and nights and every thought. You turn things over and over, like a sore that you just can’t stop yourself from touching.

The trouble is, that fear only makes things worse. You accomplish nothing for your loved one. And you give yourself headaches and stomach-aches, sleepless nights and probably poor dietary habits. Everyone loses.

It is important to acknowledge your fear—and to manage it, before it manages you.

Two tips for handling fear.

• Stare fear in the eye. What is the very worst thing that could happen? How would you handle it? What are your choices? Have other people gone through something similar? Are there some proactive steps you can take? If you know how you will deal with the worst case situation, you can be comfortable dealing with anything short of that.
• Figure out what you can control, and let the rest go. Easier written than done, I know. But there is no use lying awake at night fretting over things you have no way to impact. Don’t borrow trouble; you have enough already.

I don't know a single caregiver who isn’t drowning in guilt. They forgot to do something. They remembered, but couldn't get to it. They got frustrated and said the wrong thing. They kept a lid on their emotions and didn’t say anything. They’re doing a great job with the caregiving, but have totally neglected their work, their family, their friends (err…and themselves?). They are letting some of the caregiving fall to others—PAID people!! Caring for Mom!—when they should be doing it all themselves.

Really, the sources for guilt are almost endless.

I am here to suggest strongly that you quit beating yourself up. Guilt is, at best, an entirely wasted emotion. It doesn’t help the person or people you are feeling guilty about. And it might, literally, be killing you.

Three Steps To Triage Guilt

1.     Every time you start feeling guilty, ask yourself if, realistically, you could be doing better. If the answer is “no” you are off the hook; nothing to feel guilty about. If the answer is “yes,” proceed to step 2.
2.     Why aren’t you doing more/better/differently? If it is because you have done some internal prioritization and the cost of perfection—in time, in money, in other sacrifice—is too high, you are off the hook; nothing to feel guilty about. If the answer is that you are a self-centered lazy slob, proceed to step 3. Please note that very few people are actually in this second category.
3.     Change whatever you are feeling guilty about.

In the end, you need to realize that in fact, you cannot be all things to all people. And that’s OK. You can let some things go; they’ll be there waiting. You can lower your standards to something achievable. You can ask for—and accept—help. 

You can simply realize that doing your best is enough.

Do you fume at stop lights? Does the salesgirl’s insincere ‘Have a nice day!’ infuriate you? Do you scream at the dog simply for existing?

Could you be experiencing caregiver anger?

Really, anger is a reasonable reaction on your part. It’s a stage of grief, and grief is certainly an emotion you are experiencing. Moreover, your life has been hijacked, you may be shouldering more than your fair share of the caregiving, you are scared—and it is entirely possible that the person you have just turned your life inside out for is busy yelling at you! Layer in sleepless nights and the frustration of having lost control of just about everything and you are well within your rights.

But no matter how justified your anger may be, you also know that you can’t just go around harrumphing at the world. Nor can you bottle it up; you’ll explode. Plus you will end up with headaches, high blood pressure, heart disease, gastrointestinal issues—and some serious relationship problems, to boot. Better to diffuse it now.

Four Ways to Diffuse Anger

• Use the power for good. Throw all that energy into exercise; your health will improve and so will your waist line. Pour it into gardening or cleaning—any activity that requires hard manual labor. Physical work not your thing? Channel your energy into research; you may discover a useful clinical trial.
• Expend your anger peacefully. From a therapist to a support group to a journal, simply recognizing and expressing your feelings will help alleviate them.
• Minimize environmental angst. Now is the time to resign from the book club that bores you, to replace the toaster that keeps sticking, to quit wearing that itchy sweater—essentially to rid your life of all petty irritants. That may also include setting limits on how much fetching and carrying you are willing to do for your care recipient. Even when you love them to pieces, it’s all right to say ‘no' every now and then.
• Let it go. Ultimately, the only thing you can control is yourself. Breathe out your anger. Be conscious of the calm. Celebrate one small victory at a time.

Recently, a caregiver commented to me, “The hard part about caregiving is you lose so much of yourself—your time, your hobbies, your friends—that pretty soon you turn into a hermit because it is just easier.”

Yes, finding balance is tough. And yes, becoming a hermit may be easier in the short term. But it can be devastating in the long-term—to your psyche, your self-esteem, and most importantly, your health.

So put some time for yourself on the schedule.  And I mean schedule. On the calendar and considered just as important as the other things on it.

o   Schedule breaks. Ten minutes for a cup of coffee. Or the crossword. Or a shower.

o   Schedule exercise. Whether a trip to the gym, time with a workout tape, or a walk with a friend (double benefit) make sure you keep moving.

o   Schedule “self-care” appointments—the hair-dresser, the dentist, the annual check-up. The easiest thing is to plan these for yourself when you schedule them for your care recipient. Then you will be sure to go.

o   Schedule time to talk. Lean on your old friends, people who can lend an ear—and who can remind you of your non-caregiving self. You might also join a support group—you will feel less isolated and may even get some good tips.

And one more thing that makes it possible to keep all those schedules: Always have a Plan B and a Plan C. That makes it easier to roll with the punches.

In fact, falls are the leading cause of accidental death in people over age 65 (so while you are worrying about how to pry the car keys away from Mom, give some thought to talking her out of her high heels, too).

Older people are both more prone to falls and more vulnerable to their effects. Why? Changes in vision and hearing, reflexes and coordination. In addition, diseases complicate matters: hypotension can cause dizziness; Parkinson's Disease can affect coordination; Alzheimer's Disease impairs judgement. And medications can cause any of those issues.

Then when a fall occurs, older, more porous bones simply snap.

So what's a caregiver to do? You can swaddle your parents in packing blankets—or take more practical steps to help them stay well-balanced and not tempt fate. We've discussed some ways to improve their balance as well as offered practical tips for things you can do to make their home safer. Now, we offer a free brochure with good background information and more practical tips.

Met Life's Mature Markets Institute, in partnership with the National Alliance for Caregiving, have published this handy booklet entitled, The Essentials: Falls and Fall Prevention. We recommend that you download and read yourself.

Written in a friendly, Q & A format, this handy brochure details the most common causes of falls, as well as how to evaluate the risk of a fall and basic fall prevention techniques. It concludes with three pages of resources., organizations that can help keep your parents on their feet.

It’s a fact: The older we get the more likely we are to fall and the more likely we are to hurt ourselves on the way down. In fact, the Centers for Disease Control estimate that each year 30-40% of Americans over age 60 fall at least once. This is something you want to be very careful about when it comes to your parents.

Now, you are unlikely to convince the folks to replace that brick terrace with nice smooth concrete, and even more unlikely to successfully eliminate the step between the living room and dining room, but there are a lot of environmental factors that are easily controlled, as we discussed in our previous post.

There are also two key interventions regarding their person.

Help them practice good balance. Yep. Practice. There are a host of balance enhancing exercises, most of which can be done anywhere with no special equipment. For instance, try simply standing on one foot for 10 seconds, with your other leg bent back like a stork. Then switch legs. (Do this in front of a counter or a chair back, so there is something to grab if necessary). Not as easy as it sounds, is it? But with practice you will even be able to do it with your eyes closed. Tai chi is also terrific for balance and your gym should be able to show you other useful exercises. Don’t keep them to yourself; remember, this is about your parents, so make sure they do them, too.

Check their medications. The American healthcare system (don’t get me started) makes sure that everyone sees a lot of specialists. Every one of them manages to prescribe one or more new medicines. Very few first ask about what else someone is already taking. And let’s be honest: even if the doctor asks, practically no one actually knows the answer. Layer on our odd proclivity to take other people’s drugs (“This worked great for me, you should try some.”) and there is no telling what kind of internal stew any one of us is brewing. But I digress.

It’s a good habit to routinely rifle through your parents’ medicine cabinet, check expiration dates, note the full range of what is there, and cross-check for interactions. At the same time you can weed out the ones that cause dizziness or balance issues (a problem with several frequently prescribed sleep aides, for instance), then proactively ask the doctor for an alternative.

The bottom line: You need as much in your favor as humanly possible.

This post is part two in a series. Be sure to read Preventing a Fall (Part 1) with 6 simple ways to make your parent's environment safer, and Preventing a Fall (Part 3) with a link to a brochure with additional tips.