Introduction




Introduction

As medicine and technology continue to improve, and baby boomers
continue to grow older, it is evident that life expectancy will
continue to rise. Today, there are 33 million Americans who are over
65 years of age. By the year 2030, that number will double. How does
this affect us? Finding quality and affordable care for our loved
ones will continue to become a crisis for family members. Eldercare
has become a multi-million dollar industry, and although there is a
growing number of living and caring alternatives, still the
responsibility of day-to-day care often falls to a family member.

Caring for an aging parent or loved one requires time, patience, and
energy, and almost always results in frustration and exhaustion.
Caregivers strive to meet the needs of the person they are caring
for at the expense of their own needs. Caregivers often experience
higher stress, illness, and burnout than non-caregivers. The reality
is at one point or another we will all be faced with what is often
referred to as the impossible profession: caregiving. There are ways
to minimize the burnout we may incur while caring for a loved one.

Becoming a family caregiver is a responsibility or job no one looks
forward to. In fact, it often comes about suddenly as a result of a
medical crisis. In my practice I often hear, "My father just fell
and broke his hip" or "my grandmother was just diagnosed with a
terminal illness and needs care." No one wants to think about or
prepare for these life-altering, devastating events. No one prepares
to be a caregiver. According to the American Association of Retired
Persons, the definition of a caregiver as "someone who provides
unpaid assistance to a second person aged 50 or over." The
assistance consists of help with at least one activity of daily
living (ADL) such as:

Bathing
Feeding
Dressing
And at least two instrumental activities of daily living (IADL) such
as:
Grocery shopping
Cooking
Cleaning
Transportation
Managing finances
Administering medicine
Today, more than seven million households contain caregivers. Most
often it is a child caring for an aging parent. The caregiver is
typically female although there has been an increased number of male
caregivers in recent years. The median age of the caregiver is 46
years old, who are often caring for young children too. This is
considered the Sandwich Generation caring for both child and parent
simultaneously. Most caregivers are employed, however caring for an
aging loved one is definitely more than a nine to five job.

Effects of Family Caregiving

The effects of family caregiving can place a tremendous emotional,
physical, and financial toll on all involved. Although the caregiver
is preoccupied and overly concerned with the changes taking place
with their ailing relative, there are changes that affect the
caregiver that often are overlooked.

Emotional changes
Role reversal: The parent being cared for becomes the child, and the
child who is the caregiver becomes the parent.

Role overload: Typically, the caregiver does two to three times the
normal workload of a non-caregiver.

Changes in the family system: The entire family is affected by the
caregiver's new role. For example, young children and the
caregiver's spouse may feel neglected and by the caregiver. In turn,
this causes friction and conflict for the family.

Normal routine of living is interrupted on a temporary to permanent
basis: The recipient of care may need to live with the caregiver,
which can restrict the caregiver's social life and infringe on
privacy.

Negative or positive feeling retrogressed: There may be negative or
positive feelings from the recipient of care and the caregiver. For
example, if it was a difficult relationship before you become a
caregiver, very often, issues or family dynamics often resurface
while caregiving. For instance, if you are caring for your father
who is fiercely independent, he may feel now that he is a charity
case, and having to ask for assistance makes him resistant and
resentful of becoming dependent.

Physical changes
Changes in home environment: Your aging loved one may have to live
with you. You may need to install medical equipment or make your
home environment accessible for your family member to get around.

More frequent travel: You may need to travel long distances to care
for a loved one or even relocate to another city. In my private
practice I have worked with caregivers who commute daily from Boston
to New York in order to sustain employment and meet their family
members' needs.

Financial changes
Lost wages, benefits and insurance: Elder care is costly. Many
caregivers have to miss hours of work or pass up promotions to care
for a family member.


Symptoms of Caregiver Burnout

Over time, these emotional, physical, and financial changes begin to
affect the caregiver. Caregivers feel overwhelmed, exhausted,
frustrated, resentful, and guilty. Do not ignore the following signs
of burnout if you are a caregiver:

Physical Symptoms
Headaches
Digestive problems
Sleep deprivation
Heartburn
Chronic back pain
Other muscle tensions
Loss of appetite
Weight gain

Emotional Symptoms
Depression
Increased anger
Emotional exhaustion
Fatigue
Increased anxiety
Preoccupation with death and dying
Low self-esteem
Apathy
Increased use of nicotine/alcohol/drugs
Isolation
Withdrawal
Memory loss


Strategies to Cope with Caregiver Burnout

Caregiving for a loved one will undoubtedly bring upon some of the
above-mentioned symptoms of caregiver burnout. The good news is that
there are strategies to manage the increased stress and help you
cope with this tumultuous period in your life. Caregiver burnout can
be controlled. Here are some suggestions to combat the caregiver
burnout you may be experiencing:

Set your own goals: You should decide what you can and cannot do. Do
not let doctors or other family members decide for you what you
should be doing. Be realistic. For example, it may be impossible for
you to leave your job every day to prepare lunch for your family
member that requires care, but it is realistic to go home to fix
lunch once a week.

Evaluate the situation: Ask yourself realistically how much time I
can designate to caregiving.

Understand that it is acceptable to have mixed feelings: Your
emotions should be mixed. For example, allow yourself to feel angry
that your family member is not appreciating the care you are
providing and, at the same time, may be feeling guilty that you're
angry when your loved one is physically or mentally ill.

Understand that you cannot create or cure illness: As much as we all
would like to be capable of controlling our loved ones pain, it is
beyond our control. As a caregiver, we can only make it more
comfortable for our family member.

Talk about it: Do not keep your emotions inside—develop a support
system. Friends, relatives, or support groups can be a tremendous
benefit to you and your well-being. Due to the increase in
caregivers and the growth spurt of the aging population, there are
now caregiver support groups in most communities. Contact your local
Department of Aging for more information.

Be proactive: Plan ahead, although it may be difficult to do so, it
is important to be proactive rather than reactive. Begin to discuss
topics with your family that are directly related with the care of a
family member. For example, living wills, healthcare proxies, and
end-of-life decisions need to be figured out.

Share the care: You do not have to do everything on your own. It is
okay to ask for help. There are many caregiver services available to
assist your family member in need. For example, respite care
provides temporary relief to caregivers on either an hourly or daily
basis. There are services that deliver nutritious meals to your
loved ones. There are home health aides available to assist with the
instrumental activities of daily living such as cooking or grocery
shopping. Contact you local Department of Aging for more information
on the resources available in your area.


Summary

There is no doubt about it—caregiving for a family member is
difficult and often impossible. The stress of taking care of loved
one can take a toll on you quickly. Each elder-care situation and
circumstance is unique. Most caregivers, however, experience similar
symptoms of caregiver burnout. It is important to take care of
yourself during this time period. Caregiver burnout can be
minimized. If you are susceptible to high levels of caregiver
burnout, you will ultimately not be able to care for yourself or
your loved one.



and baby boomers continue to grow older, it is evident that life
expectancy will continue to rise. Today, there are 33 million
Americans who are over 65 years of age. By the year 2030, that
number will double. How does this affect us? Finding quality and
affordable care for our loved ones will continue to become a crisis
for family members. Eldercare has become a multi-million dollar
industry, and although there is a growing number of living and
caring alternatives, still the responsibility of day-to-day care
often falls to a family member.

Caring for an aging parent or loved one requires time, patience, and
energy, and almost always results in frustration and exhaustion.
Caregivers strive to meet the needs of the person they are caring
for at the expense of their own needs. Caregivers often experience
higher stress, illness, and burnout than non-caregivers. The reality
is at one point or another we will all be faced with what is often
referred to as the impossible profession: caregiving. There are ways
to minimize the burnout we may incur while caring for a loved one.

Becoming a family caregiver is a responsibility or job no one looks
forward to. In fact, it often comes about suddenly as a result of a
medical crisis. In my practice I often hear, "My father just fell
and broke his hip" or "my grandmother was just diagnosed with a
terminal illness and needs care." No one wants to think about or
prepare for these life-altering, devastating events. No one prepares
to be a caregiver. According to the American Association of Retired
Persons, the definition of a caregiver as "someone who provides
unpaid assistance to a second person aged 50 or over." The
assistance consists of help with at least one activity of daily
living (ADL) such as:

Bathing
Feeding
Dressing
And at least two instrumental activities of daily living (IADL) such
as:
Grocery shopping
Cooking
Cleaning
Transportation
Managing finances
Administering medicine
Today, more than seven million households contain caregivers. Most
often it is a child caring for an aging parent. The caregiver is
typically female although there has been an increased number of male
caregivers in recent years. The median age of the caregiver is 46
years old, who are often caring for young children too. This is
considered the Sandwich Generation caring for both child and parent
simultaneously. Most caregivers are employed, however caring for an
aging loved one is definitely more than a nine to five job.

Effects of Family Caregiving

The effects of family caregiving can place a tremendous emotional,
physical, and financial toll on all involved. Although the caregiver
is preoccupied and overly concerned with the changes taking place
with their ailing relative, there are changes that affect the
caregiver that often are overlooked.

Emotional changes
Role reversal: The parent being cared for becomes the child, and the
child who is the caregiver becomes the parent.

Role overload: Typically, the caregiver does two to three times the
normal workload of a non-caregiver.

Changes in the family system: The entire family is affected by the
caregiver's new role. For example, young children and the
caregiver's spouse may feel neglected and by the caregiver. In turn,
this causes friction and conflict for the family.

Normal routine of living is interrupted on a temporary to permanent
basis: The recipient of care may need to live with the caregiver,
which can restrict the caregiver's social life and infringe on
privacy.

Negative or positive feeling retrogressed: There may be negative or
positive feelings from the recipient of care and the caregiver. For
example, if it was a difficult relationship before you become a
caregiver, very often, issues or family dynamics often resurface
while caregiving. For instance, if you are caring for your father
who is fiercely independent, he may feel now that he is a charity
case, and having to ask for assistance makes him resistant and
resentful of becoming dependent.

Physical changes
Changes in home environment: Your aging loved one may have to live
with you. You may need to install medical equipment or make your
home environment accessible for your family member to get around.

More frequent travel: You may need to travel long distances to care
for a loved one or even relocate to another city. In my private
practice I have worked with caregivers who commute daily from Boston
to New York in order to sustain employment and meet their family
members' needs.

Financial changes
Lost wages, benefits and insurance: Elder care is costly. Many
caregivers have to miss hours of work or pass up promotions to care
for a family member.


Symptoms of Caregiver Burnout

Over time, these emotional, physical, and financial changes begin to
affect the caregiver. Caregivers feel overwhelmed, exhausted,
frustrated, resentful, and guilty. Do not ignore the following signs
of burnout if you are a caregiver:

Physical Symptoms
Headaches
Digestive problems
Sleep deprivation
Heartburn
Chronic back pain
Other muscle tensions
Loss of appetite
Weight gain

Emotional Symptoms
Depression
Increased anger
Emotional exhaustion
Fatigue
Increased anxiety
Preoccupation with death and dying
Low self-esteem
Apathy
Increased use of nicotine/alcohol/drugs
Isolation
Withdrawal
Memory loss


Strategies to Cope with Caregiver Burnout

Caregiving for a loved one will undoubtedly bring upon some of the
above-mentioned symptoms of caregiver burnout. The good news is that
there are strategies to manage the increased stress and help you
cope with this tumultuous period in your life. Caregiver burnout can
be controlled. Here are some suggestions to combat the caregiver
burnout you may be experiencing:

Set your own goals: You should decide what you can and cannot do. Do
not let doctors or other family members decide for you what you
should be doing. Be realistic. For example, it may be impossible for
you to leave your job every day to prepare lunch for your family
member that requires care, but it is realistic to go home to fix
lunch once a week.

Evaluate the situation: Ask yourself realistically how much time I
can designate to caregiving.

Understand that it is acceptable to have mixed feelings: Your
emotions should be mixed. For example, allow yourself to feel angry
that your family member is not appreciating the care you are
providing and, at the same time, may be feeling guilty that you're
angry when your loved one is physically or mentally ill.

Understand that you cannot create or cure illness: As much as we all
would like to be capable of controlling our loved ones pain, it is
beyond our control. As a caregiver, we can only make it more
comfortable for our family member.

Talk about it: Do not keep your emotions inside—develop a support
system. Friends, relatives, or support groups can be a tremendous
benefit to you and your well-being. Due to the increase in
caregivers and the growth spurt of the aging population, there are
now caregiver support groups in most communities. Contact your local
Department of Aging for more information.

Be proactive: Plan ahead, although it may be difficult to do so, it
is important to be proactive rather than reactive. Begin to discuss
topics with your family that are directly related with the care of a
family member. For example, living wills, healthcare proxies, and
end-of-life decisions need to be figured out.

Share the care: You do not have to do everything on your own. It is
okay to ask for help. There are many caregiver services available to
assist your family member in need. For example, respite care
provides temporary relief to caregivers on either an hourly or daily
basis. There are services that deliver nutritious meals to your
loved ones. There are home health aides available to assist with the
instrumental activities of daily living such as cooking or grocery
shopping. Contact you local Department of Aging for more information
on the resources available in your area.


Summary

There is no doubt about it—caregiving for a family member is
difficult and often impossible. The stress of taking care of loved
one can take a toll on you quickly. Each elder-care situation and
circumstance is unique. Most caregivers, however, experience similar
symptoms of caregiver burnout. It is important to take care of
yourself during this time period. Caregiver burnout can be
minimized. If you are susceptible to high levels of caregiver
burnout, you will ultimately not be able to care for yourself or
your loved one.