As advanced medical technologies stretch out life spans, more and more family members, particularly women in their forties, fifties, and sixties, are finding themselves caring for fragile, elderly parents. The resources to support what can often be a marathon effort of ongoing care are more difficult to locate than one might expect, given that 50 million Americans now serve as family caregivers. Here are some practical suggestions therapists can make to help clients get their feet under them while they develop strategies to deal with the long-term care of a parent.
*Find somewhere to vent. Honored as your clients may be to help out, this work takes its toll. Long-term caregivers struggle with anger and guilt, and are unusually vulnerable to insomnia, depression, anxiety, neck and back pain, and even illness and premature death. Encourage them to vent to a friend, partner, therapist, electronic bulletin board, or formal support group, such as those run by the local Alzheimers Association (1-800-272-3900 or www.Alz.org) or Family Caregiver Alliance (www.Caregiver.org).
*Acknowledge past wounds. Was your client the family's irresponsible black sheep, its peacemaker, or its heroic, uncomplaining firstborn? Did he or she feel slighted in favor of another sibling? If clients paper over old emotional realities, they may find themselves reverting to roles they thought they'd outgrown. Point out that taking care of an elderly parent gives them a chance to continue along the same path they've always trod, carrying the same load of hurt feelings, or to branch out in new directions by acknowledging the past, working to resolve old wounds and disappointments, and doing things differently this time.
*Assemble a support team. Help your clients plan for a long-distance race, not a sprint. If they don't plan ahead, the burden will probably land on the child who's closest geographically. Encourage siblings to convene regular meetings, either face-to-face, or via e-mail or conference call, to coordinate help. They can make a list of tasks that need doing, and find out what each sibling is willing to do. Those living far away may give money or handle administrative tasks or medical advocacy, while those nearby can offer hands-on care. Encourage clients, especially women, to be cheerfully assertive, rather than letting their siblings off the hook too easily.
*Clarify limits and balance commitments. Without intervention, clients will sometimes sacrifice their relationships with partners or children to their obligations to their parents. Encourage them to strive for imperfection. Some good advice to share is, Do what you can, when you can, and say no when you must. Its better for them to do a little consistently than to exhaust themselves and withdraw altogether. Local members of the National Association of Area Agencies on Aging (www.n4a.org) often offer respite services for families in lower-income groups.
*Pay attention to inequities of work, money, and power. Many are the possible nightmares if issues of money and power don't get raised. Sometimes a child can sacrifice a decade or more to caring for a parent and then receive the same inheritance as siblings who did nothing but give advice from afar, says Terry Hargrave, author of Loving Your Parents When They Can No Longer Love You. In other cases, one sibling (usually one that isn't actively caretaking) will secretly pressure an aging parent for money. To guard against this, Hargrave suggests giving the money and power to whoever is doing the active caretaking. That person should be in charge, with the rest of the children forming a support group. If there's money available, he advocates openly paying the primary caretaker for time and lost wages--either via a regular paycheck or in a bigger share of the ultimate inheritance.
*Consult an elder lawyer. Referring clients to a good lawyer can do wonders for reducing emotional complications. If families get comfortable talking directly about money, inheritances and gifts can sometimes be structured to pay for long-term care and reduce the bite from the Internal Revenue Service later on. A power-of-attorney-in-fact document (revocable by elderly parents as long as they are competent) gives offspring the right to handle their financial affairs without formal conservatorship. A durable power of attorney for health care is crucial when its time to shift from high-tech medicine that extends life to easing a parents pain and discomfort at the end of life.