When we hear the phrase crisis in relationships, the first thing that comes to mind is marital strife and problems between parents and teen-aged children.  There is, however, another crisis that is facing numerous families; when an older adult parent is experiencing a health or mental health situation that requires family caregiving.  One person usually becomes the caregiver. The ensuing crisis can literally tear a family apart!

The Family Caregiver

According to the National Alliance for Caregiving, in 2020;

• There were 53 million unpaid caregivers providing care to a family member up from 43.5 million in 2015, and growing each year.
• 42 million Americans are caring for someone aged 50 or over.
• 79% of the caregivers are, themselves, 50 or older. 
• Women make up 63% of the caregiving population and 37 % are men.
• 89% of these caregivers are providing care to a blood relative or a parent-in-law.
• On average, family caregivers spend 23.7 hours per week providing care for a loved one. 
• A majority of caregivers report that they have received no training and have been caregiving for more than 2 years with many reporting 5 years or more doing caregiving.

Caregiving often begins with simple tasks like helping with the checkbook.  It can quickly progress to more complicated and time-consuming tasks as people live longer and lose abilities for self-care. Family caregivers are involved in diverse tasks that could include activities of daily life, helping in medical/nursing tasks, cleaning, financial tasks, and, at times, advocacy for services with external agencies. Social workers and counselors, when discussing this topic, bring up the issue of the sandwich generation.  Caregivers are taking care of older adults and simultaneously taking care of their children and families.  Another important aspect is the relationship change between the caregiver and the recipient. The role transitions can have an enormous emotional impact on the caregiver (and the recipient as well). The balance of power changes with the child now being the parent, with a spouse being confused and frustrated and possibly resentful over the new relationship. Caregivers report suffering from anxiety and depression and feeling overwhelmed by their new responsibilities.

Who receives family caregiving?

Adults over 50 make up the vast number of family care recipients and they encompass a very diverse population.  26% of the over 50 plus population suffer from some form of dementia or Alzheimer’s disease. Adults over 70 and 80 years of age are a significant part of the recipient population.  Obviously, older populations can present a vast array of health and mental health issues.  These multiple issues can make caregiving more difficult, complex, and stressful.

The family crisis in family caregiving

The Family Caregiver Alliance states emphatically that providing care for an aging or ill older adult can bring out the best or the worst in family relationships.  Whether it is at a party, dinner out with friends, or any social gathering, the conversation can shift to someone, usually a woman, discussing how difficult it is to take care of mom or dad, or both!  The conversation then moves to how the siblings just won’t help and won’t get involved.  Typically, one sibling says they live too far away. Another says they are too busy with their work and their own family, while another will say it is just too hard for them to see their parents this way.  Finally, one gives up any responsibility by saying they belong in a nursing home.  This leaves one child feeling obligated to take responsibility, and the entire burden then falls on their shoulders.   And to add insult to injury, the husband and children just don’t seem to understand and constantly complain that mom is no longer available to them.

This pattern can bring out old unresolved issues from the past, historical roles and resentment toward siblings and other family members.   When a caregiver takes on a martyr-like role, others can feel left out or pushed out.  Strained relationships can develop and conflicts can manifest that can last way beyond the caregiving experience. Professionals report there has been case after case of these difficult and painful situations, sometimes leading to an entire breakdown of relationships between family members.   This is not limited to siblings.  They can become intergenerational and affect relationships between spouses and grandchildren as well.  As people live longer, this is a situation that will only continue to expand and impact family’s well-being.

Survival tips for family caregiving

Fortunately, there are strategies to address this crisis.  Let’s start with the caregiver.  In the last decade, there have been many ways for the caregiver to receive support.  For example, Ohel Children’s Home is one of many agencies that have a support group for caregivers.   AARP has a virtual support group.  United Health Care and several other health care providers have support groups for caregivers and even nurses that provide information and advice.  Support groups allow caregivers to express their feelings and emotions in a supportive and understanding environment.  Using technology, caregivers can receive training which can help them become better prepared and more educated for their new role.

But how do we engage the family? That is so critical.  Thomas, Liv, and Umberson, in a study, demonstrated “that family involvement and strong relationships, marital, siblings and intergenerational have an important influence on the person and the family across the life span.” The positive impact of a family working together can strengthen the family for years to come. These thoughts can provide real value and meaning to family caregiving. The Family Alliance echoes those sentiments, “Caregiving for a family member provides a sense of purpose and connection and reinforces the values of helping the elderly and respecting parents, grandparents and older relatives.”  Sharing these values and resources can provide meaning and motivation for family members to become involved.  It can also address some of the fears of caregiving.

Communication is the key

Most professionals encourage family communication as the key to address the crisis and perhaps avoid one in the first place.  The use of a facilitator, such as a social worker, counselor or religious leader, can help the family begin and maintain a dialogue and create a support network. The support network is not only for the caregiver, but also to encourage and get other family members to participate in the process.  Education, understanding, and awareness can change the whole dynamic.   That is why an outside mediator is helpful to steer the conversation from anger and finger pointing to positive strategies that can be accomplished.  The beneficiaries include the recipient of care and the caregiver but more importantly the family.  Using a strength perspective approach, seeking solutions and utilizing individual skills identified in family members is a powerful tool for the facilitator. This is not easy and it can be extremely difficult just to get everyone together.  However, it is important to realize that the problem did not materialize overnight and will take time, patience and a commitment to resolve.

Final thoughts

• Google search “family caregiving”.   It will open the doors to a myriad of services, resources and information.
• Research local services. Many non-profit organizations have programs, support groups, etc.
• Develop a family communication mechanism, e.g., a family group app, zoom conference calls, family meetings.
• Don’t be afraid to ask for help.  Be specific.
• The caregiver should always express appreciation for whatever assistance is provided..
• Family members should always express thanks to the caregiver and any other family member that helps, regardless of how big or small a task.
• Be forgiving.  We cannot control others but we can control our reactions.
• Be forgiving to yourself.
• Remember, this is a long-term process so start small and keep expectations in perspective. 

Rome wasn’t built in a day.  Do things in the meantime that will help you enjoy life, take a break, join a support group, go out for dinner with a loved one. Watch a comedy!!

Douglas Balin, LMSW, MPA has a specialized practice for adults 50 years and older and their families. He can be reached at Douglasbalin18@gmail.com, 646-206-3968.

Photo by Jason Goodman on Unsplash