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Posted: June 23, 2004

Professional Caregiving

Threading the Self-Care Needle in Caregiving

Have you tried threading a needle lately? In good light, it isn?t easy. Without sufficient light, it is a nearly impossible task. Asking a caregiver to take steps to care for themselves if they are depressed can be more difficult than threading that needle in a dark room.

Yet, professionals and caregivers alike read the statistics that the rate of depression among caregivers is prevalent in more than half of caregivers, and one-third say their own physical health has deteriorated as well.

Don?t we say and read all the time, ?Caregivers have to take care of themselves if they are going to successfully care for their family member.? Where?s the disconnect here?

I have been involved with a number of different populations of caregivers for many years in my work in adult day centers and in my coaching practice -- those caring for adults with dementia, those caring for physically frail spouses, others caring for adult children with developmental challenges.

Each has some unique characteristics specific to the type of care they are providing. Some are providing health-related caregiving -- administering medication, giving baths, assisting with meals and personal care. Others are dealing primarily with behaviors that require supervision, redirection and specialized interactions to minimize behavioral situations. Each situation demands different skill sets, temperaments and knowledge.

Who helps the caregiver when they are spending 20-40 hours each week caring for an aging loved one? Asking the caregivers we see who provides their primary support is a good first step. Understanding the family system, the friendships and resources available to caregivers will help in successfully guiding them toward a balanced role between caring for their loved one and caring for themselves.

Regardless of the variations in caregiving situations, all caregivers need their own support system to lean upon, to be relieved from time to time, to be distracted from the day to day responsibilities inherent in the care they provide. Not all are so lucky, however. Some caregivers find themselves isolated and increasingly withdrawn from their previous life activities before the onset of caring for their loved one.

As healthcare professionals, we cannot glibly instruct caregivers to manage both their family member?s care and their own, knowing what we know about the incidence of depression in those providing care. As we explore the presence of depressive symptoms, changes in eating, sleeping, activity habits, loss or gain in weight, feelings of hopelessness that persist for weeks, we want to encourage them to see their doctors for a stress/wellness check-up. The system in place for women to remind each other about breast self-exams could be copied for the caregiver community. Partner with friends to ask, ?Have you checked out your health recently??

We know there are many anti-depressants on the market that go a long way in relieving symptoms of depression, especially when combined with some form of talk therapy. Making it ?okay? to tend to one?s own health needs is paramount to ensuring that the nation?s more than 25 million caregivers -- including the nearly 15 million who express their self-assessed depression -- remain functional and engaged with the world outside of the caregiving bubble. At the phenomenal growth rate of 9,000 new caregivers every day, we are positioning ourselves for an enormous opportunity to support those caring for a family member; if not, we are headed for a virtual train wreck.

Healthcare professionals and friends of caregivers should watch the health of the caregiver as closely as that of the person being cared for. Our country is saving billions of dollars a year on the backs of family caregivers who, if they are not treated for their own ailments, some of them caregiving-related, will lose their ability to provide the best care they know how and either end up in the hospital which may put their loved one in institutional care temporarily or even permanently.

One way to approach caregivers who have not taken steps to ensure their own health is being maintained properly is to employ a questionnaire technique that is commonly used in coaching practices. A two-tiered question survey can raise the issue of self-care simply by asking the caregiver to rate themselves between 1 and 10, with 1 being not at all, 10 being magnificently, in the following areas:

  • How well am I taking care of myself?
  • How committed am I to maintaining my health?
  • How ready am I to use the resources available to me?

If caregivers could be asked these three questions, by a friend, by their social workers, by the physician, by the healthcare professional working with their loved one, a light bulb would go on when they see how they rate themselves as self-caregivers. The issue of not having the time to get to the doctor because of caregiving responsibilities is a red flag. No caregiver can sustain the quality of attention they provide without keeping their own engines running smoothly.

If the answers are somewhere in the 8 or less area, ask another series of questions:

  • What does a 10 look like?
  • And what can you do to notch yourself up one number?

Expect them to tell you when you can expect to hear from them about the step they took.

Helping support caregivers in being accountable to themselves through an easy coaching paradigm can go a long way to turning on the light, as our caregivers attempt to thread the self-care needle.


Sylvia Nissenboim is a licensed clinical social worker and who has been working in the field of adult day services in the St. Louis area. She is the director of four adult care and enrichment centers for the American Red Cross and also operates a personal and professional coaching firm, LifeWork Transitions, specializing in caregiving concerns, adult day care management and other aging services, such as virtual coaching and family care giving support groups. She co-authored The Positive Interactions Program, is a national speaker, and has served as president of the Missouri Adult Day Care Association and as a member of the Missouri Governor's Advisory Council on Aging..

© 2004 Pederson Publishing, Inc. All Rights Reserved.
Commercial use, redistribution or other forms of reuse of this information is strictly prohibited without the prior written permission of Pederson Publishing.

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