Sunday, February 22, 2009

Caregivers... Who Helps... and Are Women Better Than Men?

If you take a good long look at several family situations like this, you see two things:

  1. The majority of the care and decision making falls to one person.
  2. That person is usually (but not always) a female.

I have observed countless families in a caregiving scenario where more than one sibling or other family member who is perfectly able to provide assistance, yet much of the responsibility falls to one person. It's almost like there is a "natural order" where the majority decides, even subconsciously, that "the one" is better suited to handle such things. The reasons for this are varied, but it can be that the others view this person as more organized, more caring, or more able - meaning this person has more spare time, is better off financially, and/or is more knowledgeable. That doesn't mean these people are right, but it might explain some of the "how and why" this happens.

With regard to men vs. women, some of that is our fault as women. We have, by nature, looked after our men for generations and set ourselves up in the role of caregiver and nurturer. Couple that with the fact that men, on the whole, either would just rather not deal with such things - or they feel inadequate to do so - and it is easy to see why many men eagerly step into the shadows and let the women handle this. Another factor could be that men tend to deal with such issues - particularly unpleasant ones - with a matter-of-fact, let's-just-get-this-done, approach. My friend phoned her brother (who lives in another state) to discuss their mother's diagnosis of "vascular dementia" (which is a nicer way to describe something akin to Alzheimer's) and his immediate comment was, "Put her in a nursing home!" Their mother wasn't ready for a nursing home, but she did need extra care and attention. I don't think this man was cold and uncaring as much as he simply did not understand how to address this issue... and he felt inadequate as a caregiver and assumed his sister would be much better suited to this task.

I have also seen men who were excellent caregivers... attentive, astute, and truly wonderful. However, I must say that most often, this happens when there is no one else, and the man has no choice. If the person who is needing care has three sons, for instance, often a wife will step in and handle much of the work and burden for her husband and his brothers. And in the defense of the men, they may have no experience on which to draw and feel inept - and as I have mentioned, much of that is our fault as women for spoiling and coddling our men! But...I have seen cases where men have learned - even if by default - how to be excellent caregivers. We’re not talking rocket science here!

While my 96-year-old grandmother lives alone in her own home (thankfully), I am still her primary caregiver, meaning that major responsibilities and decisions about her care and well-being fall to me. I handle her bill paying, many of her errands and shopping duties, her medical appointments and medications, the mountain of paperwork involved in keeping her enrolled in Medicare Part D prescription drug coverage, Home Health assistance, and other programs that aid and assist her. Three times she has been placed in a nursing home for several weeks to a few months of rehabilitation after falls or illnesses, and I completed the massive paperwork to admit (and release) her, kept up with nursing reports and therapists, did her laundry, and kept an eye on her and the nursing home staff who cared for her.

My dad died nearly 10 years ago, and for a couple of years my mother was available to help with some of the needs for my grandmother (her mother-in-law). But 10 years ago, my grandmother could still manage a lot of things for herself, so there wasn't that much to do. My mother remarried in 2002, and she and her husband travel a lot. In 2003, my grandmother fell and had to go to the nursing home for rehab. Mom was leaving the next day for a summer-long trip, and she handed me my grandmother's checkbook and said, "You'll need this, and you will probably need Power of Attorney." I have a sister who lives in the same community, and she will help me when I ask, but pretty quickly (as is often the case) everyone seemed to fall to the wayside and give me a wide berth as the primary caregiver. Over the last six years, my grandmother has come to depend on me heavily. Yes, she does still live alone in a home my parents provided for her, but when the least little thing arises, she turns to me. If her telephone malfunctions, she calls me to fix it. If a light bulb burns out, she wants me or my husband to put in a new one. If she gets a notice in the mail about a medical appointment or an insurance report, she calls to let me know. And all of this is fine... I don't mind. But I just know she probably isn't calling anyone else!

I take my grandmother to get her hair done every week, and I shop for her and run any other errands she needs handled. I dispense her medication for the week into a set of those daily pill dispensers. I fix anything that is broken (if I can) - or arrange for someone else to do so... change any light bulbs, fill her bird feeders, and do anything else she feels needs attention. But for the most part, at this point I can handle these requests all in one day. I know... I am very fortunate at this moment! I also know that, as was the case last winter, a fall or illness could send her to the hospital and/or nursing home, and she would require my help and attention every day - almost around the clock - for several weeks and months.

But what is the solution to being “stuck” as the single caregiver? How do you keep your sanity? First of all, I have learned that it is okay to ask for help. My grandmother does have Home Health aides who visit several times a week and help her with her bath, change her bed and check her vital signs. She has a housekeeper once a week. She has a strong network of friends from church who visit with her often - some even daily.

I ask for help from agencies that provide it. The only thing I can’t seem to accomplish is Meals on Wheels – my grandmother won’t eat them. This would be a great help, as it would cut down on her cooking, which concerns me. It would also provide her with a nutritious meal each day, and I would feel like she was eating fairly well. But she has balked at this idea, and I can’t forcer her to get the meals. I don't hesitate to ask my mother or my sister - or even my 19-year-old niece - to help when I get in a bind. When I had the flu and couldn't get out of bed, much less be near my grandmother, I asked my niece to drive her to the beauty shop and buy her groceries. When I needed to travel with my husband to visit his family in another state, I asked my sister to step in and see after my grandmother for a week. My grandmother doesn't think women know how to "fix things" around the house, so she doesn't hesitate to ask my husband or my mother's husband to do these projects. They are both glad to help, when available, and I let them!

My pastor gave me some great advice a few years ago. I was phoning my grandmother EVERY DAY to check on her, and by the time we hung up, we were arguing. Often she hung up on me. I didn't understand her - I wasn't attentive enough. Even if I said it was a beautiful sunny day - she found a problem with it. I was at my rope's end. My pastor told me that I did not have to do this alone - that there were others who were phoning her and visiting her. I did NOT have to call every day. In fact, my "errand day" once a week was sufficient contact, unless something came up that necessitated we talk more frequently. He also told me that "'No!' is a complete sentence!" That was probably the best advice I ever received.

So while you don't have to tell your loved one "No!" about everything, there are probably little things you can refuse that won't make a hill of beans' difference to them, but will give you a little breathing room. You can tell when people are sincerely offering to help you - and when they are just being polite. If the offer is genuine and you need the help or a break, accept it. Call your siblings and give them a specific job to do... "I need you to come and sit with Mom for an evening." or "Dad has a doctor's appointment on _______ and I would like for you to take him."

Pick and choose the tasks with which you need help. If you are in charge of your loved one's medications, it's probably best if you handle prescription issues and medical visits. You know the questions to ask, and getting others involved in the mix can lead to confusion. There are some things that it will be better for one person to handle. However, there are plenty of ways that others can assist you... and sometimes they are just waiting on you to ask them.

Finally, remember that anyone can learn to be a caregiver, regardless of their gender and blood relation. Some will be better at it than others, and those who have no heart for it may always be fairly lousy and merely going through the motions. In caregiving, it truly does "take a village." As primary caregivers, it is up to us to make sure we keep an open mind, a thick skin, and our "radar" up for opportunities to ask for help.

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