Vicki Rackner, MD
Vicki Rackner, MD, a board-certified surgeon based on Mercer Island, Washington, and caregiving expert who is currently a family caregiver. She is the author of Caregiving Without Regrets.
What you may not know: There are greater risks to the caregiver’s health than previously recognized.
Troubling research finding: Caregivers are 63% more likely to die within a four-year period than people without this extra burden, according to a study published in the Journal of the American Medical Association.
Compared with non-caregivers, people who provide care to a loved one tend to exercise less and eat less nutritiously and are at much higher risk for physical exhaustion and depression.
Family members are responsible for about 80% of the elder care in the US. To meet this challenge, caregivers must care not only for a loved one (and, in many cases, other members of their family), but also maintain their own physical and emotional well-being.
As a medical doctor and longtime advocate for caregivers, I know how crucial it is to tend to your own needs while caring for a loved one. My advice…
Know what you can — and can’t — change. Every caregiver wants to create a different reality and to “fix” things. If you’re caring for a stroke patient or someone with Alzheimer’s disease, for example, some part of you will think that you can prevent the person from getting worse just by working harder. That’s simply not true.
There are some things that we can’t change. People who think that they can change the natural course of aging or disease are the ones who are most vulnerable to depression, self-recrimination and even alcoholism or drug addiction. You can make a loved one happier by engaging him/her in conversation or planning activities he enjoys — but remember that you cannot change the overall course of his disease.
My advice: Understand that caregiving is usually a long-term process and identify not only what’s important, but what’s possible.
Example: Suppose you’re caring for someone who is disabled by rheumatoid arthritis. He won’t care if the house is perfectly clean. What’s likely to matter are the more personal things, such as preparing a favorite food or giving an affectionate touch. You’ve fulfilled your job every time you create one of these special moments.
Learn the “51% Rule.” Most caregivers will do anything for their loved one. They prepare meals, go to doctor appointments, get medications, change linens and clean the house — and then, when they’re ready to collapse, there’s always something else that needs to be done. This approach doesn’t work.
Most caregiving situations require more work than a full-time job. All too often, people strive to be a “super caregiver”… to do everything perfectly, setting aside their own needs. It’s not uncommon for caregivers to wind up in the hospital themselves — or, worse, to die before their loved ones.
My advice: Follow the “51% rule” — accept that you will make mistakes and will disappoint your loved one at times (maybe even half the time). You will have to make choices and decisions that are in the best interests of your loved one but may make him unhappy. You may even lose your patience at times. Treat your loved one with respect, compassion and kindness, but accept that you will fall short of perfection as a caregiver.
Important: People who become martyrs while caregiving invariably burn out. They also tend to become worse caregivers because they don’t have the emotional reserves to stay focused.
Get — and give — help. A lot of caregivers don’t realize that accepting help from others is one of the best gifts you can give those who are closest to you.
For people who feel guilty accepting help without returning the favor, bartering is a great solution. We all have activities that we enjoy and activities that we don’t. Suppose you hate doing laundry but love walking the dog — and one of your friends is great with laundry but dreads going for walks. You can help each other.
My advice: Consider forming a caregivers’ bartering community. It might include neighbors or people from your church or synagogue. Or you could post an announcement on the bulletin board at your local health-food store or doctor’s office to recruit people in similar situations who will trade chores, such as yard work or grocery shopping.
It’s easier to ask for help if you know that you’ll pay back the favor in your own way — especially if it’s an activity you enjoy.
With caregiving, not all issues have clear-cut solutions. Here’s my advice for navigating some of the trickier challenges…
Reluctance to talk about health problems. As a caregiver, you most likely already know — or will learn — intimate details about your loved one’s health that the ill person may be reluctant to share.
Example: Many older adults won’t discuss bodily functions with their doctors.
My advice: You might say, “Don’t you think we should talk to the doctor about this issue? If you want, I’ll bring it up so that you don’t have to.” Most patients will say, “Okay.”
A doctor’s disregard for quality-of-life issues. I knew a woman who took her elderly father to the doctor because his knee was hurting. The doctor glanced at the knee — then sent them home with a prescription for blood pressure medicine.
The doctor was worried about this patient’s high blood pressure because it raised the man’s risk for stroke and heart attack. A “simple” bad knee didn’t concern the doctor, even though it was preventing this patient from doing the things he enjoyed.
My advice: Sit down with the person you’re caring for and make a list before each doctor visit and include not only the key issues, including drug side effects, the presence of pain or other symptoms, but also your loved one’s mood and lifestyle issues, such as his level of social and physical activity. If the doctor won’t take the time to discuss all your concerns, consider finding another doctor.