When the Caregiving Dynamic Is Complicated
Gillian always felt she was Mom's least-favorite child. Yet when Mom suffered a stroke, Gillian was the only one of the siblings living in the area, so the lion's share of caregiving fell on her. Even now, Mom is short-tempered and critical of Gillian's care. Gillian sees her caregiving friends with their beloved, grateful relatives, but she doesn't feel that way. She feels guilty for feeling trapped—but what can she do?
Today, Americans are living longer than ever—yet they're not necessarily in good health during those "bonus years." So more adult children are finding themselves providing some degree of care for their aging parents. It might start with providing transportation to the doctor or coming over a couple times a week to clean the house a bit … and then, a health crisis quickly catapults an adult son or daughter into managing their parent's healthcare, dealing with doctors and medication management, even performing hands-on nursing tasks. They struggle to balance the care of their parent with their own jobs and other responsibilities.
Experts tell us that caregivers often put their own health in jeopardy due to the stress of the tasks they've taken on. This stress can be physical, financial—and in many cases, emotional. Juggling care tasks and worrying about their parent's well-being would stress any caregiver. And when the elderly parent and adult child have a history of a difficult relationship, the stress is magnified all the more.
We can't choose our parents, the old saying goes. We aren't all blessed with a parent-child relationship that was as warm and nurturing as we craved. Maybe Dad was hypercritical and judgmental. Maybe Mom made her disappointment known about your life choices and the things you considered central to your identity. Maybe you felt like the black sheep of the family. Sometimes a parent is mentally ill, dealing with substance abuse or is genuinely abusive. At the other end of the spectrum, maybe your personalities just didn't mesh—perhaps as evidenced by a sibling who recalls things in a much rosier light!
Whatever the reason, an adult child may limit contact with a parent, or keep it on a superficial level. Then what happens when the changes of old age mean the parent needs help?
An Important Note
If your parent is living with Alzheimer's disease or other types of dementia, their behavior is very much affected by the disease. Talk to their healthcare provider, the Alzheimer's Association or other experts to better understand what's going on. Recognize that lashing out, aggression, unfounded accusations and so forth are symptoms of the disease. Learning strategies for coping with these behaviors increases the likelihood that the time you spend with your parent will be peaceful and even meaningful.
See the box on the right of this article for a special note about dementia. If your parent does not have dementia, it's still important to consider the effects of other health conditions they may have. Arthritis, depression, stroke, osteoporosis and other common ailments can tax a person's temperament, so a loved one who always was snappish and demanding might become more so. Learn about their specific health problems, and empathize as best you can.
Here are other things that can help with the "old business":
Bring in an expert. A social worker or a geriatric care manager (also known as an aging life care professional) can help you sort through the issues and provide mediation if it's hard for you to communicate with your parent (and perhaps your siblings). These professionals also can help the family access support services for your parent.
Find a good counselor. The caregiving dynamic sometimes forces us to confront old issues that we had pushed to the back of our minds. A skilled therapist can equip you with coping tools for now, and a better understanding of how your past relationship with your parent affects the present. This might be the time to try something new. Asserting yourself might lead to an improved relationship with your parent—or at the least, with an important growth experience.
Set boundaries and ground rules. Tell your parent what you are willing to do, and when you will be available to do it. If your loved one lashes out at you or treats you with disrespect, express that it is hurtful and that you won't accept it. Some family caregivers report that this is the first time they stood up to their parent in this fashion—and that the new communication pattern improved a long-time dysfunctional dynamic.
Help your parent find other social outlets—and the same goes for you! A caregiving pair can quickly become enmeshed to an unhealthy degree. Perhaps disability or the passing away of old friends has isolated your parent. Perhaps your parent has moved to your community and doesn't know many people. Check out senior centers, the local aging services department and other social opportunities for seniors in your area. As for yourself, a support group can offer understanding, tips, the reassurance that you're not alone—and even a good laugh now and then!
Lighten your load. Are you doing it all alone when you don't have to? Ask yourself why that is. This is a time when some adult children unconsciously try to "prove themselves," but you don't need to. Can your siblings, your children, nieces, nephews and other relatives pitch in? Call a family meeting! How can others help? By staying with Mom when you are on business trips? By having Dad visit for part of the year? By chipping in for the cost of home care?
Hire professional care. If your parent's care needs are substantial, living in a nursing home or other supportive living situation might be the best choice. Some facilities also offer short-term respite care. If your parent lives at home or with you, professional in-home care can be a lifesaver! In-home caregivers can cut down on the sheer workload, providing housekeeping and laundry services and preparing nutritious meals for your parent. They can perform those emotionally difficult intimate tasks such as bathing, toileting and grooming. They can provide transportation to doctor appointments and elsewhere, all the while providing what you might think of as "companionship without baggage." The caregiver is a new person in your parent's life. Family are sometimes surprised to hear a professional caregiver praise their parent as "a sweetheart"!
When you have a history of friction with a parent, providing care can be a mixed bag. Sometimes elderly parents and adult children experience reconciliation and closeness during this time. Said one daughter, "As we sat together after Mom's hip surgery, I learned things about her childhood that I never knew before … it helped me understand the parenting choices she made when I was little."
Other times, things don't change. But it can feel good to know that you did what you could, while taking care of yourself as well.
For information on topics related to home care and healthcare, visit our Home Care and Healthcare Advocacy group on LinkedIn.