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Posted July 27, 2006

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Caregiver Care: When Caregiver and Loved One Both Need Care

Q. Our family is having trouble dealing with what we think is "the perfect storm." My Grandmother is the full-time caregiver of her husband, my Step-Grandfather. He is confined to the use of a power wheelchair and slight use of a walker. He requires 24-hour care for diabetes, a fused neck and a recovering broken back from last year, along with all other common ailments one at his age would have.

My Grandmother is a recent breast cancer survivor, which due to lymph node removal must be extremely careful with the strain and use of her arms. She is in need of a rest from caregiving, and must have a bladder surgery that would require a month of recovery. Her son and daughter who live out-of-state would like to have her come to them to have the surgery so they can care for her during the recovery.

My Step-Grandfather is unwilling to go to a care facility and insists that my Grandmother does not help him to the extent we think. His children are bothered by the idea of caring for him and are not actively involved, but they have promised him they would never send him to a care facility.

He is very verbally abusive to my grandmother when her family steps in to make arrangements for her to take caregiving breaks or to handle her own medical needs. We are stuck watching her deterioration as a caregiver and elderly woman, as she stays in her situation out of guilt, love, and obligation, putting her health and needs last. How can we care for our Grandmothers needs in this situation, and improve the quality of life for both of them.

Jill H., Provo, UT

A. Anyone with hands-on caregiving responsibilities for a frail spouse needs a break. In your family, it sounds as if your grandmother is involved with 24/7 heavy duty, constant caregiving. Your grandmother may believe that she is the only person who can do the job, and as you stated, she stays with it out of a sense of duty and obligation. She may worry that leaving him to others to care for will cause him to fall apart or deteriorate.

However, she needs to put herself first, and go ahead with her surgery, allowing ample time for recovery. Your grandfather and other family members may not like it, but they must accept it.

I think it is a good idea for your grandmother to be with her son for her surgery and recovery. This would allow her complete respite away from her abusive husband. As for his care, his choice is either a nursing home stay, or 24/7 care in the home.

It is unfortunate that his own children are being difficult. Continue to support your grandmother's right to have time off. If she lets her own health deteriorate, she will not be in a position to help her husband at all. My advice would be to chose a date for the surgery, and present it as a "done deal" to the rest of the family. Then discussion can take place about the grandfather's care.
Start immediately to investigate the options that you may have. You also may consider consulting with a geriatric care manager in your grandfather's area. The National Association of Geriatric Care Managers can be reached at (520) 881-8008 or at www.caremanager.org. My best wishes to your family!

This answer is provided by Paula P. Tchirkow, MSW, LSW, ACSW, president of Pittsburgh-based Allegheny Geriatric Consultants and a certified and licensed geriatric care manager. She specializes in geriatric care management for elderly parents and relatives, and middle-aged adults who have chronic illnesses. In addition to working with families, she also works with attorneys, financial advisors, physicians, bank trust officers and human resource directors. She can be reached at paula@caregivingadvice.com.

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