Three Common Family Challenges
And Strategies for Working It Out
By Laurie Fronek, Staff Writer
Bewildered by a relative who can’t seem to make time to help with care? Frustrated with a caregiver who orders everyone else around?
As if family dynamics aren’t tricky enough during “normal” times, caregiving for an ill family member presents a perfect opportunity for conflicts to arise within families. Time and again, primary caregivers and their cadre of helpers wrestle with the following challenges. If any of these happen in your family, you may want to try the strategies described below.
Challenge No. 1. Someone isn’t contributing to the effort or isn’t “pulling his weight” in the eyes of the others.Response: Find out why. Tell the person what you’ve observed about his participation. Try to set aside emotions, interpretations, and judgments about his behaviors, and simply describe what you’ve seen. Then describe how this has affected you. Ask him to explain how he sees things, and listen with an open mind. Once you know his perspective, you are better equipped to respond appropriately.
Here are some of the reasons one person may seem to be “slacking off.”
Strategy: If he’s open to it, give him support (or help him find it elsewhere), so he can accept what’s going on well enough to join the effort. If he’s not open to being supported by you or anyone else, you can’t force him. And trying to do so may only make him shut down more, says Helene Starks, PhD, MPH, associate professor at the University of Washington School of Medicine, who researches end-of-life care issues. So the best use of your energy may be simply to let it go and rely on the people who are available.
- He feels there’s no real opportunity to get involved, because someone else in the caregiving circle is calling all the shots. Sometimes a slacker would be willing to help, but he feels that an overcontrolling family member makes it hard for him to effectively step in, explains Starks. “And, of course, the person who’s being controlling may not see it that way,” she says.
Strategy: If someone’s controlling behavior is hindering the group’s effectiveness, read the strategies for
Challenge #2.
- He avoids getting involved because he’s not comfortable with the hands-on aspects of care, like feeding, helping with toilet use, giving medicines, and massaging.
Strategy: Let him know that there are other ways he can help and that it’s OK to “be” rather than “do.” Sitting and visiting with the patient is very important to her well-being, and it can give other caregivers a much-needed break.
- His availability is limited for logistical reasons, such as his work hours and transportation options.
Strategy: Ask, “What can you do? What are you comfortable doing? What’s in the realm of possibility for you given the other responsibilities you have?” suggests Starks. His contribution may not be the thing you wanted or go as far as you might like, but you may have to let those desires go. Both of you may need to set aside your preconceived notions about what help is “supposed” to look like, and think creatively about how he can be involved.
Challenge No. 2. Someone is trying to control the effort by doing everything alone or micromanaging what everyone else does.Response: Again, a good place to start is to find out why. Describe the behavior you observe. Give specific, recent examples. Then describe the effects. If you’ve felt controlled, state this clearly. Say how this interferes with your desire or ability to contribute to caregiving.
“That controlling approach can chase away other people, because they feel like nothing they do is going to be right,” says Starks.
Ask how the controlling person sees things. She may not realize that others feel controlled, or even chased away, by her approach. Ask why she feels the need to control caregiving to such a degree. Once she knows how it’s affecting others—and that it could leave her shouldering all the responsibilities alone—she might be willing to change.
Here are some other strategies that can help.
Strategy: Have a family meeting for all the caregivers, and use it to bring the focus back to the patient. Let the patient direct the caregiving effort by expressing his needs and desires, and let him decide as much as possible about what will happen and how it will get done. Get everyone else in problem-solving mode, so that you all develop solutions and arrangements together. Starks suggests asking yourselves two questions: “What can you do in your family to let go of some of that need for perfection?” and “What can you do to allow for differences?”
Strategy: Establish a caregiving schedule with different people covering different days or hours. As a group, agree that whoever is “on duty” has the latitude to provide care the way she sees fit. (You can discuss and decide together what degree of latitude is reasonable.) The Care Scheduler in your
Private Care Page is a useful tool to help organize family caregiving.
Strategy: Create a list of tasks that must be done in a specific way, such as tasks that involve safety issues. Make sure every caregiver understands the method for each of these tasks and the reason that method is important. Then list other tasks that need to get done, but not necessarily in a specific way. Make it clear that the end result is important, but the methods for achieving that result can vary.
Challenge No. 3. The primary caregiver feels pulled apart by the different opinions or expectations of the other people involved.
Response: This can be a tough one, because none of us can control the opinions or expectations of others. We won’t always like or agree with what they think, and we won’t always be able or willing to do what they expect of us. What we can do is control our own actions and deal with our own feelings.
If you’re a primary caregiver facing this challenge, here are some ideas for how to take care of yourself.
Strategy: A good first step is to set aside whatever everyone else thinks or wants (or what you think they think or want). Give yourself permission to disagree with them. And give yourself permission to not try to please everyone. It’s not possible; it can’t be done.
“You can’t make everybody happy, and it’s not your job to,” says Martha Davis, PhD, a Seattle-based clinical psychologist. Let go of the idea that you’re supposed to make everything harmonious or get everyone to come to consensus. If everyone is sincerely trying to reach consensus, that’s admirable and may even be achievable. But if folks are entrenched in battling and you’re getting pulled apart, step out of the fray. You don’t have to make it all right for everyone else.
Strategy: Give the patient as much control as possible over decisions about his care. This helps redirect everyone’s attention away from what you’re doing “wrong” and toward meeting the patient’s needs. If the patient is making the decisions, rather than you, you’re less likely to become the target of others’ judgments.
However, when it comes to matters that affect you, do assert yourself. Part of your task as the primary caregiver is to balance the patient’s interests and yours. As Davis explains, “It comes down to: What does the patient want? And what does the primary caregiver want?” It’s OK at this time to focus on the two of you, she says.
Strategy: Pick your battles. When something’s truly important, stand your ground. When it’s not, be willing to let it go. Don’t engage in a power struggle with others in the caregiving circle just for the sake of “winning.” Your energy is precious. The patient needs it, and you need it. Refrain from burning it up on things that don’t really matter.
Strategy: When opinions differ about how to meet a particular need or complete a certain task, agree to try one of the possible methods for a limited period of time, such as a week, and then evaluate it. When the period expires, take an honest look at whether the method is working and how to improve upon it. Sometimes people are willing to try a method that they have doubts about (or flat-out disagree with) as long as there’s a commitment to assess the results and a willingness to change course, if needed.
Resources
What You Can Do to Be a Supportive Caregiver
Guidance for working well with the patient, healthcare providers, and others in your caregiving circle.
http://www.hospicenet.org/html/supportive_how.html
Dividing Responsibilities in Family Eldercare
Ideas for how to tackle the division of labor.
http://www.ncdhhs.gov/aging/article.htm#a140
Holding a Family Meeting
Tips on arranging and running a productive gathering.
http://www.strengthforcaring.com/manual/20/136/holding-a-family-meeting.html