Caregiver on Rye, Extra Compassion:
Choosing to Care for the Sandwich Generation
by Pastor Bert Copple, Community Service Representative for Home Instead Senior Care
Indulge this pastor for just a minute as I delve into our past, dusting off a story from the Old Testament in the book of Ruth. As you may recall from your religious upbringings, there was a woman named Naomi that had a husband and two sons who were grown and married. In Biblical times, Naomi’s life was blessed.
Something rather terrible happens, however, as the story unfolds. Not only does Naomi’s husband die, but her two sons pass away as well, leaving Naomi and her two daughters-in-law widowed. In the blink of an eye, their lives were turned upside down. In many ways, their lives would never be the same.
Like so many today, Naomi’s life seemingly fell apart around her. Perhaps you know of someone who can relate. The woman who suffers a stroke, leaving her once dependent husband to fend for himself around the jungles of their kitchen battling beasts such as the washer and dryer and waffle iron. The veteran who, after recovering in a rehabilitation facility, comes home to find a newer version of his basic training obstacle course in the form of stairs and throw rugs, trading in his rifle for a walker or his tank for a wheelchair. Or, as in Naomi’s case, they don’t come home, leveling a whole different set of issues both mental and physical.
However, right in the midst of Naomi’s loss, one of her daughters-in-law makes a bold decision. Instead of returning to her homeland to remarry and start a new life for herself, Ruth decides to stay with her mom. Her words are quite often quoted, “Wherever you go, I will go. Where you live, I will live. Where you die, I will die. You’re God will be my God.”
Ruth’s decision to put on hold her life and dreams to care for her aging mother is a perfect example of what caregiving is all about: putting the lives of others before their own. Mothers and fathers do it for their children. Daughters and sons do it for their aging parents or uncles and aunts. Elderly couples even care for each other as they age. The spirit of Ruth’s vocation spans across time, compelling us to do what we can for those who need companionship and care.
There’s just one problem. Ruth didn’t have to juggle soccer practice and her children’s homework while trying to manage her mother’s incontinence.
Caregiver On Rye
According to the National Family Caregivers Association, there are more than 50 million caregivers across the United States providing care to a rapidly growing elderly population. Each year, the number of people needing care over the age of 65 increases by 2.3%, while the number of family members able to provide care will increase by a mere 0.8%.[i]
So who exactly are these caregivers? The National Alliance for Caregiving and the AARP classify the typical American caregiver as “a 46-year-old woman caring for her widowed mother who does not live with her. She is married and employed.” The study continues to show that more than 60% of American caregivers are female.[ii]
One of those caregivers is Sandy Marks, a married 40-something-mother of two boys, sandwiched, literally, between the responsibility of managing the care of her two teenage sons and her widowed mother. She considers herself to be a decent caregiver.
“I do what I can, when I can. But it never seems like its enough. I’m trying to help my boys do algebra and grammar while trying to remember where my mother left her keys or sugar meter. I mean, my brain can only think for so many people.”
Marks is finding herself making decisions she never envisioned herself having to make.
“Do I care for my boys, or my mom? I mean, where do I put my priority? Something’s got to give.”
She is not alone in her dilemma. The cost of caring for a loved one can be staggering. Considering that 17% of American caregivers spend forty plus hours a week in their vocation, many are forced to stop working. In fact, women who are family caregivers are 2.5 times more likely than those who are not caregivers to live in poverty, and five times more likely to receive Supplemental Security Income (SSI).[iii]
“It has been tough, financially,” adds Marks. “I never want to neglect my mom, but I have to worry about my kids, too. We’ve really struggled with finances since I quit my job to be there for her.”
A study by the American Council of Life Insurers found that the typical family caregiver lost $109 per day in wages and health benefits due to the need to provide in-home care for their parents or loved one.[iv]
The toll taken on today’s version of Ruth goes much deeper than the pocketbook. In fact, the demand on the time of today’s caregivers may be killing them.
Extra Compassion
In churches we often hear pastors talking about this thing called a love bank. In order to give love and affection, we need to have been given, or shown, love and affection. And in order to receive love and affection, our account can’t be full – we need to have given some away so that it can be replaced. Giving and receiving is a normal, healthy lifestyle in a typical household. Throw in the responsibility of an additional receiver, and the love bank may become overdrawn.
“It’s not that my mother doesn’t appreciate what I do for her,” says Joan Girardi. “She loves me, she really does. But if she tells me one more time that I don’t dust like her, or cook like her, or take care of my children like she took care of her children…I just get depressed sometimes when I’m around her.”
Girardi’s frustration isn’t rare. In fact, caregivers who provide more than 36 hours of care each week experience higher levels of depression and anxiety than those who do not work as caregivers. For spouses who are caregivers, the impact can be six times greater. For those caring for parents, the blow can be doubled.[v]
When you mix in diagnosis such as dementia or some other debilitating condition, the stress to a caregiver’s immune system can actually last up to three years after the caregiving ends.[vi]
Is it any wonder why caregivers find it so hard to be compassionate all of the time? With demands on them for love and affection at home from their children and their spouse, with many still working a job that requires mental sharpness and some form of artificial compassion at best while on the clock, it’s no wonder why many caregivers burn themselves out. The Department of Health and Human Services in Washington, D.C. found that family caregivers report having chronic illnesses or conditions more than twice the rate of non-caregivers.[vii]
This can only lead to one solid conclusion: Being a caregiver is a demanding choice.
Choosing to Care
You read that correctly. Caregiving is a choice, not a requirement. Remember back to our story about Naomi in the Bible. She had two daughters-in-law. One decided to leave her in an attempt to rebuild her life, while Ruth made the decision to stay. Can we truly fault the daughter who left? Many reading this may say that we have an obligation to care for our widowed and the elderly. And you would be correct. But think about those out there who find the burden of caregiving simply too hard to bear. It can be. Do they still have a responsibility to provide a means to have their loved one cared for? They certainly do.
“I am one of seven daughters,” says caregiver Ella Hills. “We all have a pretty strong relationship with our mother, so there isn’t much fighting over who does what. I mostly do the house cleaning. Another sister runs errands. Another sister picks up mom and takes her to her doctor’s appointments. We all do different kinds of caregiving, and it just works.”
Perhaps that is the key for those who live across the country or simply can’t bring themselves to being a part-time in-home caregiver – finding a supportive role from where you are instead of having to rearrange your life and schedule to accommodate a new receptor from your love bank account.
“I don’t blame my brothers or sister for not being here with me,” says Roberta Johnson. “They have their own lives, and they help when they can. I guess I just stepped up to the plate because no one else would. It was my choice.”
Many like Ruth, however, choose the vocation of caring. They make it their goal and passion. They do so, because to them there is no other way. It is a choice.
Because so many of people choose to be caregivers, they also need to know that they have limits. One’s capacity to care is directly linked to one’s ability to be compassionate. In other words, if a caregiver doesn’t take care of themselves, they will have lost the ability to care for others.
Proactive Caregiving
President Bush on Thursday, November 1st, 2007, stepped out onto the White House lawn and announced that November is National Family Caregivers Month. The President read in his proclamation that “one of our Nation’s defining values is compassion, and we must do our best to see that every citizen is treated with dignity and respect. Family caregivers demonstrate this compassion, often at great sacrifice, to assist with everyday activities for family members who are elderly, chronically ill, or disabled.”
One way that our nation’s caregivers can maintain their vocation without paying the ultimate sacrifice is to be proactive in the ways they provide care. Most often, these simple steps begin with the caregiver and not with the person they are or may one day provide care for. A great resource on the topic of proactive caregiving is found on the National Family Caregivers’ website (www.thefamilycaregiver.org) with some helpful tips on how to manage the stressors of the caregiving vocation found at CareGiverStress.com (www.caregiverstress.com), where a simple assessment tool can provide caregivers with options to finding respite care.
Respite Care
The greatest asset a caregiver has in battling stress and burn-out is through respite. Through companies like Home Instead Senior Care, caregivers can be provided with the much deserved break they need, whether it be for a few short hours a week, or for an extended period of time, so they can rest assured that their loved one is being cared for even in their absence.
The benefit of using a company like Home Instead is that their CAREGivers are bonded and insured. They have passed a criminal and driving background check. In most cases, CAREGivers are only hired if they have personal experience and training in the skill set needed to be a compassionate and concerned caregiver.
“Many of our CAREGivers have been caregivers. They have cared for their mother or father while they battled cancer, they have first-hand experience with Parkinson’s disease or dementia,” says Tina Rowley, president and owner of the Birmingham, Michigan franchise of Home Instead Senior Care. “They come here to be a CAREGiver because they have something inside of them that allows them to give of themselves freely, and it shows.”
By using respite services, caregivers can avoid burnout. They can reengage their relationships with their children and spouses again on a more permanent basis. Respite care provides the caregiver with a less stressful situation, and in-turn has a positive effect on their health.
Respite care empowers caregivers like Sandy, Joan, and Ella to get out of the sandwich.
Respite care allows today’s caregivers to be more like Ruth.
To all of those who have taken on the vocation of caregiving – thanks for all you have done, and all you will do in making a difference in the lives of others. You have improved their quality of life greatly. Use this month, National Family Caregivers Month, to improve the quality of your life, too.
[i] Mack, Katherine and Thompson, Lee with Robert Friedland. Data Profiles, Family Caregivers of Older Persons: Adult Children. The Center on an Aging Society, Georgetown University, page 2, May 2001. [ii] National Alliance for Caregiving and AARP, Caregiving in the U.S., 2004.
[iii] Study conducted by researchers at Rice University and data compiled from the Health and Retirement Study funded by the National Institute of Aging and conducted by the University of Michigan, 1992-2004.
[iv] Stucki, B.R. and Mulvey, J., “Can Aging Baby Boomers Avoid the Nursing Home? Long-term Care Insurance for Aging in Place.” American Council of Life Insurers, March 2000.
[v] Cannuscio, C.C., C. Jones, I. Kawachi, G.A. Colditz, L. Berkman and E. Rimm, Reverberation of family illness: A longitudinal assessment of informal caregiver and mental health status in the nurses’ health study. American Journal of Public Health 92:305-1311, 2002.
[vi] Drs. Janice-Kiecolt Glaser and Ronald Glaser, “Chronic stress and age-related increases in the proinflammatory cytokine IL-6.” Proceedings of the National Academy of Sciences, June 30, 2003.
[vii] Health and Human Services, Informal Caregiving: Compassion in Action. Washington, DC: Department of Health and Human Services. Based on data from the National Survey of Families and Households (NSFH), 1998 and the National Family Caregivers Association, Random Sample Survey of Family Caregivers, Summer 2000, Unpublished and National Alliance for Caregiving and AARP, Caregiving in the U.S., 2004.
