Original Air Date: March 1, 1998

Who becomes a caregiver?

• All things being equal in a family...it's usually a woman: spouse, daughter/daughter-in-law. Often, it's as simple as geographic proximity to the one needing care.

  How does the caregiving experience affect people?
  

  • It's not objectively measurable; what matters is your experience of it. Professional caregivers tend to measure the experience objectively, but what matters is what affects us.

    How does the role reversal affect relationships?
    

    • If you feel you've "reversed" roles with your parent, when that parent dies, it becomes confusing. Who are you saying goodbye to? Caregivers need to be more objective. The things we do in looking after a parent are clearly parenting tasks, but the roles aren't necessarily reversed.

      What's an "unencumbered" child?
      

      • This term (aka the "entitled" child) means the sibling or family member who, of all of them, is "excused" from the role of caregiver. While there is usually only one primary caregiver in a family, most others lend a hand or help out when they can. This child is excused virtually entirely.

        Who is the unencumbered child?
        

        • It appears to be random -- not necessarily the youngest, favorite, son, etc.

          What's the unencumbered child's experience?
          

          • The family creates an unencumbered child by colluding to give this identity to the child. Then when the parent becomes ill, there is a tremendous loss of sense of self to the unencumbered child, as they're losing the person (parent) and structure that has defined them and entitled them to be different. So, contrary to what's commonly thought by other family members, they're not getting off "scot-free" in these situations.

            Should you try to change the unencumbered child?
            

            • It's better to try to understand the patterns that create the dynamic, and accept/respect them.
            • If you can recognize and understand who they are, it can possibly free you from feeling you have to try to change them.

              What about those family members who cover the spectrum between the primary caregiver and the unencumbered child?
              

              • These are the people who, for their own reasons, are involved, but not as primary caregiver.
              • The primary caregiver doesn't excuse them like the unencumbered child is excused. They are called on for relief, respite, etc.
              • When asked why they call on these people but not the unencumbered child, the caregiver often can't articulate the reasons.

                What's the role of daughters-in-law/sons-in-law? Do they become caregivers?
                

                • Daughters-in-law often get involved, but don't always do it out of love for the person they're caring for. They say they do it out of a sense of responsibility -- often because nobody else is doing it.
                • It's almost as if they're managing "unfinished business" for their husbands or "directing a play in which their husbands are playing sons."
                • Sons-in-law don't get involved proactively. They often come into the fray as buffers for their wives (providing transportation, etc.). They view the experience more philosophically -- as a learning experience.

                  What are the negative impacts of caregiving on a relationship?
                  

                  • Lack of energy to maintain the current family dynamic means possible breakdown of marital and other relationships. Children -- often used to being number one -- feel neglected.
                  • Women, in particular, tend to sacrifice their careers. They'll leave jobs, or scale their employment down to part-time, losing pensions and benefits.
                  • This can start a cycle of poverty and dependency in the family.
                  • It's almost as if they're managing "unfinished business" for their husbands or "directing a play in which their husbands are playing sons."

                    What's the positive side of these relationships?
                    

                    • The negative aspects get all the attention because those are the places we can intervene.
                    • What doesn't get talked about is how rich these relationships can be. People can become much closer, more respectful of one another, and, as a result, their lives aren't so externally focused.
                      

                      What makes a good caregiver?
                      

                      • Caring about the person.
                      • Being able to "read" the person and sense what they need.
                      • Being supportive.
                      • Being empathetic.
                      • resisting the urge to "take over." Allow the person to have as much control as possible in deciding what's good for them.
                      • Recognizing when you need help.

                        How do men and women differ as caregivers?
                        

                        • "Good" male caregivers tend to be very organized; rarely do woman come in with a briefcase full of files on the loved one's situation. Men, on the other hand, will be organized in this way -- they handle their caregiving duties like a job.
                        • Women are more spontaneous, more natural caregivers.

                          What does being a caregiver do to the relationship between the one giving care and the one receiving?
                          

                          • Problems in the relationship can manifest in a number of ways. If the caregiver feels too burdened, he/she can "burn out" and become unable to cope: the "too many balls in the air" syndrome.
                          • The caregiver can become resentful. This, in turn, can breed anger, abuse, passive-aggressive behaviour, neglect and even illness in the caregiver.

                            What should the caregiver do at this point?
                            

                            • The healthy thing is to sit back and decide how much longer you can keep this up.
                            • Can you broaden the network of caregivers?

                              What do caregivers fear?
                              

                              • That they'll fail as a caregiver -- that they won't be able to keep up the pace.
                              • Financial problems related to caring for the loved one.
                              • Loved one's pain/suffering.
                              • Loved one's incontinence.
                              • Loss of intimacy they once had with loved one.
                              • Loved one's dementia/failing memory -- that they'll be unable to recognize the caregiver.
                              • Seeing their own futures in their loved ones as they deteriorate.

                                What does our reluctance to talk about issues like death and illness do to the caregiving relationship?
                                

                                • That they'll fail as a caregiver -- that they won't be able to keep up the pace.
                                • It becomes a big secret that you all feel, but nobody talks about. It's like a wall between the caregiver and the cared-for.
                                • When this happens, the cared-for person feels they can't unburden themselves by talking about their fears, and this can be incredibly isolating.
                                • If family members shared their fears and concerns, it would bring them closer.

                                  Why are caregiving relationships so important?
                                  

                                  • That they'll fail as a caregiver -- that they won't be able to keep up the pace.
                                  • Our parent-child relationship (the most common type of caregiving scenario) is the template for all future relationships.
                                  • Children often carry guilt over the relationships they've had with their parents, and feel they can never repay the debt they owe for all their parents have done.
                                  • Alternatively, adult children can have anger or resentment over what they feel was a poor upbringing.
                                  • Caregiving relationships allow adult children to come to terms with these feelings. It's closure...and it prepares us for our own deaths.
                                  • Additionally, it's an opportunity to show our most human traits: compassion, kindness and physical evidence of our love for the other person.