At Brookdale, we are acutely aware of the crucial need for caregiver support. Consequently, we are committed to supporting caregivers and helping them navigate the sometimes rocky terrain between caring for someone else and taking care of oneself. If you are an unpaid family or friend caregiver, this blog post is intended to equip you with information that will benefit you and the person in your care.
If you are a healthcare professional, please share this resource with the unpaid caregivers within your sphere of influence.
Even in the best of circumstances, caregiving can be a challenge. The very need for care is an indication that an individual is living with physical and/or cognitive challenges that complicate their day-to-day life and activities. When the person living with dementia has constant and/or complex needs, those can take a heavy toll.
Caregivers sometimes feel pressure to be almost superhuman. Yet no one can be. All too often, the expectation of perfection is a burden that caregivers impose on themselves. Perhaps they assume that the individual in their care, or the family, expects them to help provide unceasingly cheerful and compassionate care around-the-clock. It is easy to become overwhelmed by such impossible expectations. Though well-intentioned in their efforts to be available at every moment and meet every need, caregivers can set themselves up for failure.
When caregivers don’t pay proper attention to their own physical, mental and emotional needs, their ability to care for someone else will eventually suffer as well. If a caregiver becomes incapacitated by illness, exhaustion or anxiety, the person living with dementia may end up in a bigger predicament than before.
Compassion, a vital attribute for any caregiver, can unfortunately increase the emotional weight of the role. Caregivers often feel responsible for circumstances and issues they have no control over. They can fall prey to spiraling stress, frustration, shame and guilt, constantly questioning and criticizing their own efforts: “Am I doing all I can to help?” “If I had been there at that moment, this might not have happened.” “Shame on me for feeling irritated by that request!” “I’m just not cut out for this work.”
For the struggling caregiver, the path to a solution may begin with reframing their perceptions of their caregiving role, getting back in touch with their own identity and setting a few boundaries.
Roles are clearly necessary, but they can be limiting. At Brookdale, we take care to use person-first language. For example, we say a person is “living with dementia,” not that they “have dementia.” The distinction may, on the surface, appear inconsequential, yet it carries real weight. The language we use shapes our perception. Since we strive to recognize and honor the dignity and worth of every individual, we don’t define or limit a person by their disease or condition. They are so much more than that!
Similarly, caregivers can lose touch with their own identity. They might feel that their identity has been consumed by their role as, say, “the person who takes care of Mom.” The demands of this role might have forced them to relegate other aspects of their life, including work and hobbies, to the back burner. Still, it’s important that a caregiver remember the bigger picture of who they are: a spouse, parent, wage earner, person with hobbies and passions beyond the caregiving role.
Identity work and connection strategies can help reframe the caregiver’s view. This can take various forms: practicing self-care, engaging in enjoyable personal activities and relationships, establishing firm boundaries or finding a support network with others who are experiencing similar challenges. Journaling and other self-reflection activities can enhance one’s mindfulness, sense of purpose and ability to create balance. It’s not a process of minimizing the caregiving role but rather of seeing how it fits in with other, equally important aspects of the caregiver’s life.
Setting boundaries should be part of this process. This might include redefining the way we communicate, both with others and with ourselves. For example, at Brookdale, we prefer the term “care partner” over “caregiver.” A partnership, as opposed to one-way giving, suggests a shared journey. We are in this together.
One boundary concerns decision-making. Keep in mind that people living with dementia are still capable of making choices. Allowing the person in your care to make choices, even if it’s a small choice like what color of socks to wear, can:
Another important boundary involves establishing clear expectations of what you will and won’t do, what behavior will and will not be tolerated and other limitations and consequences. Again, we can’t overemphasize the importance of setting boundaries to help ensure that your own needs are met, even if that means getting help.
One of the tools at a caregiver’s disposal is the ability to transform experiences. This can benefit both the person living with dementia and the caregiver. For example, an individual living with dementia might be experiencing confusion at mealtime, thus hindering the caregiver’s efforts to facilitate good nutrition. Tools such as environmental modifications, timing, food presentation and distraction reduction can help ease the individual’s confusion and make them more likely to enjoy their meal.
On a personal level, acceptance and commitment therapy (ACT) can help caregivers develop a better understanding of their own thoughts and feelings and commit to a meaningful life that aligns with their values. ACT techniques include simple mindfulness and values-based exercises.
Caregivers can also leverage everyday actions suggested by the U.S. Study to Protect Brain Health Through Lifestyle Intervention to Reduce Risk (U.S. POINTER). This two-year clinical trial demonstrated that structured lifestyle interventions could significantly improve cognitive function in senior adults at risk for cognitive decline and dementia. Changes such as increasing physical activity, adhering to a healthy diet, engaging in cognitive and community activities and monitoring one’s health could yield positive results.
Validation, a human need, remains important in the later stages of one’s life. If the individual is no longer capable of verbal communications, the caregiver can show attentiveness, empathy and understanding in various ways:
Other elements of behavioral support that can help enhance the caregiver’s efforts include employing a positive and proactive approach, working to understand the reasons for the individual’s actions, teaching new skills for dealing with various situations and offering positive reinforcement. Such an approach can help reduce stress for both the caregiver and the person receiving care. It’s all about meeting them where they are in their care journey.
Caregivers should stay alert to potential warning signs and indicators of burnout. These can include:
Caregivers who are struggling with these issues may benefit from specialized counseling or other mental health therapy. Counseling can provide emotional support, practical guidance and strategies for coping with the stress of their work. This can help them avoid burnout and improve their well-being as well as that of the person in their care.
Support groups are also a great way to converse with others dealing with similar issues, share experiences and identify resources. Online resources such as the Family Caregiver Alliance and government programs including the National Family Caregiver Support Program and your local Area Agency on Aging and Disability can help connect caregivers with resources. Disease-specific assistance is available through organizations like the Alzheimer’s Association® and the Lewy Body Dementia Association.
AARP®, the National Institute on Aging and the Centers for Disease Control and Prevention, among others, offer a variety of resources and support on topics from providing personal care and medical management to financial guidance and creating a healthy work-life balance.