Caregiving: Stress, Yes, But Also ‘Joy And Enrichment’

There are two sides to the coin of becoming a caregiver for an aging parent, something more and more people are discovering.
On the one hand, almost everyone would expect this to be enormously stressful, both physically and emotionally.
But on the other hand, as pointed out in a recent article on the website of the University of Missouri-Kansas City, there are some very real rewards, as well.
“The time of caring for an older parent or relative can be one of joy and enrichment,” according to the article. “It can be a period of increased sharing, a renewal of that special closeness that has perhaps slipped away over the years; a time of rediscovering the family history. It can be a time for the healing of those old wounds left festering from childhood or adolescence. It can be a time for renewing old friendships or gaining wisdom from an elder.
“The majority of caregivers actually report that providing care makes them feel useful. Many anecdotal reports attest to caregivers’ satisfaction knowing that their older relative is receiving help while remaining in the community. For many caregivers the giving of assistance is not a one-way street. Rather, it is part of a mutual aid pact, as approximately one fourth of caregivers report that the older person for whom they care helps financially or with household chores.”
To be sure, the role-reversal of the children taking care of parents is not all sharing and renewal, as the UMKC researchers point out in citing numerous academic studies
“A pervasive theme found in the research centers on the burden and the stress of caregiving,” the article continues. “The caregiving process can be a time of increased anxiety and difficulty, particularly when the responsibilities of working, marriage, child rearing and parental caregiving collide. When the demands of work, spouses and children are juxtaposed against those of an aging parent with many needs, severe emotional drain can occur. Some research even reports that although most caregivers feel ‘close’ to their care receivers, an inverse correlation exists between the closeness of kin relationship and the ability to get along without rancor.
“If there are prior family problems lurking in the background, such as abuse, neglect or denial of emotional or financial support, there can be a potentially dangerous situation because the caregiver who was abused now is in the position of power.”

Advice On Making Right Choice For Help With Elderly Care

The cost of hiring someone to help care for an elderly relative has remained fairly steady in recent years, according to a recent item in The New York Times.
It’s still about $19 an hour for a hired homemaker, someone takes care of things like cooking and cleaning. A home health aide, who can assist with personal care such as dressing or bathing, costs only $1 more an hour, according to the article by Ann Carrns.
Those figures represent an increase of only about 1 percent over five years ago, according to the story.
Something else that hasn’t changed, the writer points out, is that it takes some digging to make certain the homemaker or health aide is the right person to be given the job.
Carrns offers these suggestions, with a little help from experts:

  • How do I know what kind of caregiver my family member needs?
    You can assess needs, like his or her ability to handle activities of daily living such as dressing, eating and bathing, using a checklist, like one provided by the National Caregivers Library. Or, you can have a professional conduct the evaluation, which is advisable, said Amy Goyer, a specialist in home and aging with AARP. To find someone qualified to do the assessment, you can contact your local office of the National Association of Area Agencies on Aging for a referral. You can find the one nearest you on the federal government’s Eldercare Locator site.
  • How do I go about finding a home caregiver?
    One option is to use a home care agency, which will screen and train caregivers to make sure they can provide the level of care needed. Since the agency employs the caregiver, it also handles payroll tasks. An agency can also schedule alternative caregivers if your primary caregiver is ill or unable to work. Because the agency offers these services, its hourly rates may be higher.
  • What if I prefer to hire someone myself?
    You may be able to obtain a lower rate by hiring someone directly. But if you hire a caregiver yourself, you’ll have to handle payroll and possibly taxes, said Leah Eskenazi, director of operations for the Family Caregiver Alliance, a nonprofit that helps people caring for relatives. Ms. Eskenazi advises that word of mouth is often a good way to start your search; friends or family members who can vouch for a caregiver’s skill and reliability can be good first references. The AARP website offers a tool to search for an agency by ZIP code.

In addition, Carrns advise that websites like also help find independent candidates in a given geographic area.

Having A ‘Care Conversation’ May Be Easier Than Many Assume

Many adult children avoid have “The Conversation” with their elderly parents regarding their long-term care because they don’t want to hurt their feelings.

Parents (Photo credit: mohammadali)
Parents (Photo credit: mohammadali)
It’s just too sensitive a subject, or so the reasoning goes.
“These perceptions may not be reality,” according to a recent posting on the website “Loved ones may want to talk. The process may be easier than we think. We simply won’t know until we try, so it’s important to push past initial reservations and commit to taking action.
“Once you’ve made the decision to act, how do you go about initiating a delicate conversation? Even with the best intentions and strong determination, you may find yourself speechless.”
The website offered five tips for improving chances of a successful outcome for “The Conversation.” They are:

  • Address the Who, Where, and When – The right mix of people, place, and timing will help set the right tone for a pleasant, productive care conversation.
  • Be flexible – Unforeseen circumstances can alter even the best-laid plans. However eager we may be to “get it over with”, a care conversation should not be forced or rushed. Allow discussions to evolve naturally. Plan for a few hiccups.
  • Take the “right” approach – Everyone’s situation is different, so there is no one-size-fits-all “right” approach. Consider your loved one’s unique preferences and tailor your tactics accordingly.
  • Ask specific questions – Be specific in your questions to fully understand the situation and level of need. For example, if your loved one seems to struggle with a fear of dying, you might simply ask, “Are you afraid?” Honest questions can make difficult situations easier, and offer greater peace of mind.
  • Remember, it’s not about you – The goal at this point is to simply gather information, listen and observe. While we can certainly help our loved ones make choices, we should be careful not to take over the decision-making process.

End-Of-Life Websites Popping Up All Over

A recent article in The New York Times focused on a woman facing tragic irony: Just as she was developing a web-based business focusing on end-of-life planning, the East Hampton, N.Y., resident received word that her brother had been killed in a traffic accident.
“Suddenly, her fledgling business, Everplans, a website that helps people create detailed end-of-life plans, took on greater meaning,” according to the story.

Funeral For A Friend & Co-Worker
(Photo credit: Tobyotter)
“In the middle of building this site to help all of these hypothetical people that might die someday, my family experienced a tragedy,” Abby Schneiderman told the newspaper. “My brother was 51 and had all of the resources to have a plan in place. But my family was still left with a huge amount of logistics and complicated decisions that we had to make.”
“Just as she was building the tool to help people navigate through the mental fog that follows such a devastating loss, she and her family were experiencing it,’ the article noted.
“It turned what had been a project into a mission,” said Ms. Schneiderman, now 33. “And we wanted to make sure that nobody was left in the same situation my family was in, which was without a plan.”
The story went on to explain that the woman’s business startup is part of a growing trend.
“The number of end-of-life planning and document storage sites is on the rise, like and Principled Heart, and many of those, too, have sprung from personal loss or out of necessity. Other websites deal with a specific piece of planning, such as online memorials, sending emails from the grave … or what should happen to your Facebook account. And some estate planning lawyers are said to be working on storage sites of their own.
“Whatever method you use, what’s most important is that you put a plan in place and let your inner circle know where to find it.”

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Less Costly Options Exist To Afford In-Home Care

While in-home care for elderly parents or other relatives may be a kinder approach than placing them in a nursing facility, it can also be a very pricy proposition.

English: My parents.
(Photo credit: Wikipedia)
A recent article offers some creative approaches to affording this option.
“In general, pay rates in urban areas are higher than in rural communities, and still higher on the east and west coasts than in the central United States,” according to the article. “Costs also depend on whether you’re looking for homemaker services, defined as ‘hands-off’ care, such as cooking, cleaning, running errands, and general companionship, or home health aide services, which include personal care, such as bathing and dressing. A comprehensive 50-state survey of care costs by MetLife found that as of 2011, average hourly rates for home health aides ranged from $16 to $29 across the country, while rates for homemaker aides without medical training ranged from $13 to $24. These rates do not seem to be changing much over time. According to Genworth’s 2012 data analysis, the median rate for in-home care of $18 to $19 an hour nationwide is rising by only 1.15 percent every five years.”
Among the advice on making this sort of care more affordable are reversible mortgages, pensions for veterans that may have previously gone untapped and making alterations to life insurance policies no longer needed to care for others.
“The way this works is that your loved one sells the policy back to the issuing agency for 50 to 75 percent of its face value, an amount determined based on the amount of the policy, the monthly premiums, and the policy holder’s age and health,” the article stated. “There may be restrictions; some policies can only be cashed in if the policyholder is terminally ill. But many are quite flexible. And if yours isn’t, there are settlement companies that will buy the policy, also at 50 to 75 percent of face value, then pay the premiums until the policyholder’s death, when the company will collect the benefits.
“If the company that issued the policy won’t cash it in, don’t worry. Your loved one may be able to sell the policy for a ‘life settlement’ or ‘senior settlement.’ In this case the settlement company pays the premiums until the policyholder dies, then receives the benefits that would originally have gone to the policy’s original beneficiaries.”

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Selling off a late parent’s possession can be stressful

As if losing a parent wasn’t trying and troublesome enough, many adult children face the grim task of subsequently have to dispose of some of their late mother’s or father’s prized possessions.
Often the sad reality is that what these older people held dear doesn’t have much value to others.
“A few months after my mother died in 2011 at the age of 93, I put her Manhattan apartment on the market and was lucky enough to have a deal within days” Terry Pristin wrote in a recent item for The New York Times. “The buyers were paying cash and seemed certain to be approved by the co-op board.
“But then I faced the real challenge: disposing of six rooms’ worth of furniture and hundreds of decorative plates, crystal bowls and other knickknacks my parents had accumulated during a 61-year marriage. In the end, I spent a lot more time unloading the contents of the apartment than I did selling the apartment itself, although the financial payoff was, of course, in no way comparable. And there were moments when the job seemed overwhelming.”
“You’re lucky if the contents are worth one-tenth of the value of the apartment,” Nick Thorn, vice president of Litchfield County Auctions in Litchfield, Conn., was quoted as saying. “But people get so stressed about this stuff.”
“Anxiety, it seems, is an inevitable part of the process,” according to Pristin. “Even if there are no conflicts with siblings about what to do with family belongings, disposing of those things can feel like discarding your history, especially if you are still grieving. That table where you used to have family dinners can feel nearly impossible to part with. Those of us who have been through the process have learned, sometimes the hard way, that there are several ways to alleviate the stress.
“Consider asking your estate lawyer or real estate broker to recommend an intermediary to act as an adviser, someone who knows what sells, where the market is and which auction houses are reputable. This adviser, who may also be able to negotiate with auction houses for a break on commissions and fees, does not have to be an appraiser.”

Long military deployments can weigh heavily on children

People who have volunteered to serve their country are going on increasingly long deployments abroad, and that is having a profound impact back home.

English: BAHRAIN (Aug. 26, 2009) Lt. Miles Hic...
(Photo credit: Wikipedia)
In the homes of these men and women of the military.
“A leading pediatricians’ group is highlighting the plight of children in military families in a new report,” according to an article on the website of HealthyDay News. “Tours of duty can last up to 18 months, and studies have shown that one in four children of active-duty service members has symptoms of depression. One in three children experiences excessive worry, and half of children have trouble sleeping, according to the American Academy of Pediatrics report.
These problems can be even worse when there are other psychological issues in the family …”
The HealthyDay News item was based on an article that appeared in the June issue of the journal Pediatrics.
The American Academy of Child and Adolescent Psychiatry also highlighted the special mental health concerns of military families.
“A family that loses the active presence of a parent through separation faces significant challenges and stress,” a report on the academy’s website states. “During the parent’s deployment, family members may feel isolated, unsupported and anxious. They may also experience financial stress. Media coverage of events can also increase concern.
“While most families and children manage successfully, it is important for parents to be aware of signs of stress and possibly serious problems. The responses of children to stress of separation are determined by their individual makeup and developmental age.”
“By understanding the military family and the stressful experiences of parental wartime deployment, all pediatricians, both active duty and civilian, and other health care providers can be the front line in caring for U.S. military children and their families,” Dr. Benjamin Siegel, co-author of the journal report, said in an American Academy of Pediatrics news release.
“In the past 10 years, more than 2 million children in the U.S. have experienced the emotional and stressful event of being separated from a loved one deployed for active duty,” the other co-author, Dr. Beth Ellen Davis, said in the same press release. “Most children cope and adapt quite well, but all children experience a heightened sense of fear and worry during a parent’s deployment. It’s important for pediatricians caring for these families to be aware of their family’s situation so they can guide them appropriately.”

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