Essential Conversations with Dr. Amy: Creating caregiving plans and boundaries

It’s a common situation I hear about from my clients: an older adult has an urgent need arise, such as a fall or hospitalization, that requires family to spend a great deal of time and energy providing them with care, often at the expense of other demands in their own lives. Adult children, grandchildren, nieces or nephews take time off from work, spend less time with their children, or give up their own free time to support their aging loved one’s health and wellness.

This near-total focus on caregiving may be necessary, important and happily done in the short-term; however, it is not sustainable in the long-term. If this sounds like your situation, I want to tell you that at some point, there needs to be a shift that will allow you as a caregiver to focus on other parts of your life again. Solutions need to be found that are good for everyone, including you.

Getting out of “crisis behaviour”

Although it may seem obvious that solutions need to work for everyone, when it comes to caregiving, families often don’t flip the switch and get out of “crisis behaviour.” Instead, they continue in a pattern that may ultimately lead to one or more family members burning out. The reasons for this are varied. One of the most common is that some families aren’t aware that there are other options available that will ensure their loved one gets the care and support they need and relieves some of the load for caregivers. For example, an older adult living in an isolated living situation may not know about the benefits of retirement living. There, they would have the safety and security of staff on-site 24/7, personal care options, and the opportunity to make friends and remain connected to family.

In other situations, adult children burn out from caregiving because their parents may expect them to be available constantly and provide all of their care and support, even if this isn’t feasible for the long-run. For one family I worked with, the mom started to need a lot of help with shopping, meal preparation, running errands and housecleaning. The adult children all lived nearly an hour away, worked full-time, and had young families. They were doing their best to provide all the care themselves, but could not keep up with their mother’s needs and wishes. One of the daughters, who was doing the bulk of the care, became exhausted and depressed. Though the daughter hired some home care help, the mother kept firing the workers and saying that her kids could do these things for her. It was a challenging situation for all of them.

Examining solutions

In these types of circumstances, it’s essential to step back and ask if the solutions in place allow everyone to have a good quality of life. The truth is, a solution that benefits one family member at the expense of another is not sustainable; everyone’s needs must be considered. In this family, the mother could not accept that her children could not meet all of her needs, despite their desire to do so. Sometimes having an Essential Conversation with all family members, even virtually, will get everyone to understand a new solution is needed.

Creating caregiving boundaries

Not all older adults are willing to accept that their adult children or family can not manage all of their care needs. Some people may insist this is the only help they will allow. If this occurs, you as a caregiver must create clear boundaries about what you can and can not do. Having good boundaries is not selfish; it is necessary self-care.

With the family I was working with, these boundaries were important for the adult children, but especially the daughter acting as the primary caregiver. She explained to her mother that she was neglecting her kids and her job trying to do everything for her. Also, her car was old, and driving back and forth an hour each day was causing too much wear and tear. She was very willing to help her mom, just not as much. She told her mother what she could realistically do. Unfortunately, her mom was not understanding and continued to insist her daughter provide her care. As difficult as it was, the daughter maintained her boundaries and soon her exhaustion and depression lessened. Without her daughter providing all of her care, the mom was finally open to other options and a plan was put in place that suited everyone.

It’s important to note that sometimes people will only make alternative care plans when family members are clear about what they can and can’t do – and then stick to that. This may create guilt for you as a caregiver in the short run, but in the long run, it leads to a more sustainable caregiving situation. The goal is always to provide the older adult in your life with the best care possible, while also allowing everyone to enjoy a good quality of life!