Child Care and Elder Care
The Differences Are Real
A college administrator in Maryland who has raised two children
and is now arranging care for his ailing, 72-year-old father describes
his experience with the two dependent care situations this way:
"The difference between the two is like night and day. For one thing,
when you’re involved with your parent’s care, you're not dealing
with a dependent. You don't have the authority, necessarily, to
intervene. You need to add to that sibling disputes over who should
help and how. You call state agencies and you get a recording. Or
someone's not helpful. Or it's the wrong number... This is probably
the hardest thing a family can go through. It defies the complexity
of what people go through with children."
As the 76 million Baby Boomers enter the second half of life (one
Boomer turns 50 every 8 seconds), HR and Work/Life professionals
face an increasing volume of work/life conflicts related to elder
care. The 14 million working caregivers in the U.S. today feel the
stress of the dependent care balancing act and, according to a 1997
study by MetLife, unaddressed elder care conflicts are costing businesses
over $11 billion annually in lost productivity.
Managers – even those at companies that have offered child care
supports for years - can find the demands of elder care puzzling,
tough to fathom. Looking at elder care work/life stresses in comparison
to child care provides a context for better understanding this growing
work place issue.
Caring for a child who is not disabled or chronically ill typically
follows predictable patterns or stages. For example, newborn care
means sleepless nights. The toddler stage includes the search for
quality, affordable day care and coping with common early childhood
illnesses. When a son or daughter enters grammar school, the entire
family makes new adjustments. This is also true with the transition
to adolescence, high school, and entering college. These important,
sometimes stressful life events require certain coping skills and
services.
Elder care situations follow no set pattern. Chronic illnesses
like diabetes, arthritis, or a heart condition don’t.
Adult-to-adult relationship
Most importantly, elder care involves one adult caring for another
adult. When little Johnny doesn't feel like going to school in the
morning, mom or dad can simply tell him that he will go to school,
escort him to the school house door, and drop him off there. In
some instances, the adult must exercise decision-making for the
child in the child's best interest. This is not the case in an elder
care situation.
No matter how debilitated, the elder is an adult, and, as such,
has the right to make choices bout how and where to live, to the
extent, of course, that the elder is responsibly able to make such
decisions. The elder's right to self-determination can often conflict
with the working caregiver's perception of what is proper, safe,
or appropriate care. Conflict may also ensue when the elder's decisions
inconvenience the adult child or vice versa. In a healthy caregiving
relationship, the adult son or daughter respects the autonomy and
decision-making capacity of the elder.
Coping with elder care is further complicated by the history of
relationships between parents and children and among siblings. Situations
where parents and adult children are estranged from one another,
or where there is a history of difficult and hurtful relationships,
add stress for all concerned.
In addition to the underlying reality of an adult-to-adult relationship,
elder care differs from child care in four important ways: 1) greater
variability and unpredictability, 2) the need to arrange assistance
from a variety of professionals and agencies, as well as relatives,
friends, and neighbors, 3) long term involvement is often required,
and 4) the possibility of long-distance caregiving.
Greater variability and unpredictability
Each individual ages at his or her own rate. While a ninety-year-old
may live a healthy, independent lifestyle, requiring little help
from others, a sixty-two-year-old parent with emphysema may need
daily health monitoring and a significant amount of day-to-day help
with such activities of daily living as cleaning the house, grocery
shopping, and meal preparation. Different diseases progress differently
and require varied kinds of self-care and professional oversight
and intervention. Other factors include the housing and financial
situation of the elder and the family and interpersonal dynamics
within the family.
Complex care arrangements
Arranging care that matches the elders needs and helps elders maintain
their highest feasible level of decision-making and independence
requires knowledge of the elder service system, the skills to negotiate
that system successfully, and the time to work with the elder to
put the pieces together. For most caregivers, this means either
devoting an enormous amount of time to learn the system or engaging
a care manager who acts as a surrogate family member to perform
these tasks for them on behalf of the ailing parent.
Long term care can mean long term involvement
The third way in which elder care differs from child care is that
it often involves long term care and long term involvement. The
average duration of an elder caregiving experience is four and one-half
years. As pointed out in Chapters 1 and 2, the need for elder care
is often rooted in the presence of one or more chronic illnesses.
Unlike a broken leg or a bad cold that might lay up a younger person
for a few days or weeks, long term illnesses can constrict the activities
of older people for months or years. Some chronic conditions, like
arthritis, can take a slow, steady toll, gradually reducing the
ability of the elder to cook, clean, and dress him or herself. Others,
like diabetes, may be successfully kept in check through conscientious
self-management of the condition. However, if needed precautions
are not taken, such situations can result in acute medical problems,
falls, and other injuries which lead to hospitalizations and nursing
home placements. Working with elders to adapt to changing capabilities
while maintaining autonomy and maximum independent functioning can
sometimes require long term involvement.
The four key elements involved in successfully managing a long
term care situation may be visualized as the legs of a four-legged
stool. In order for elders to navigate the many changes and challenges
of chronic illness, they need access to 1) adequate financial resources,
2) appropriate housing, 3) quality medical and social services,
and 4) timely and accurate information about all of the above.
Very often, the working caregiver whose parent is suffering from
the effects of a chronic illness finds that the parent has done
little or no planning in relation to any of the four legs of the
long term care stool. As a result, the working caregiver, the aging
relative, and the entire family experience the situation as a crisis.
Perhaps the mother has suddenly been hospitalized and cannot return
home safely without on-going assistance with many tasks that she
had always performed on her own. Suddenly, the adult child is faced
with questions like
- Does mother have adequate health insurance coverage to pay for
on-going home care help? She most probably does not, since only
about 1% of elders have policies that cover long-term care.
- Is mother's home safe and accessible in her impaired condition?
For example, can she still navigate a flight of stairs? Are the
kitchen and bathroom free of barriers and hazards, which could
result in injury-producing falls?
- Does one physician have the overview of mother's health, or
has she been dealing with a series of specialists, each focusing
on one facet of her medical condition? How many different medications
is she taking? Is she conscientious about taking the proper dosages
at the proper intervals? Does she have a significant impairment
in memory or mental acuity?
- Where can mother turn if she needs help with shopping assistance
or transportation to medical appointments? Is she eating properly?
A host of issues require attention - issues never before faced
by most families. The caregiver needs to work with the parent and
other family members to both cope with the immediate situation and
to anticipate the parent's future needs by developing a plan that
addresses the financial, housing, service, and information dimensions
of the situation.
Long distance caregiving
Parents and their children generally live in the same household.
This is not the case with elders and their adult children. In 80%
of elder care relationships, the caregiver and the care recipient
maintain separate residences. In most instances where the elder
and the caregiver do live together, they began doing so because
of the care recipient's need for care. The section entitled Caregiver
Characteristics which appears earlier in this chapter provides additional
information about the phenomenon of long distance caregiving.
EFFECTIVE CAREGIVING
Good intentions not withstanding, many people are not cut out to
be an effective caregiver. In their book on caring for aging parents,
Cohen and Eisdorfer liken the skills needed to effectively care
for an elder to those needed in managing a family business: "Tasks
like managing the financial aspects of care, coordinating the people
directly and indirectly involved, mobilizing technical and professional
support, and finding housing and transportation are also tasks done
by managers and executives in business. What does the business world
tell us about a successful manager? What qualities make an effective
person? If you are an effective person:
- You know yourself...
- You are aware of the impact you have on other people...
- You can accept weaknesses...
- You can identify strengths in others...
- You can accept others who are different from you or who think
differently from how you do...
- You have a flexible style...
- You create a trusting environment for people to think, work,
and live in...
- You can manage conflict."
Cohen and Eisdorfer advise that caregivers assess their capabilities
in relation to this list. They recommend that caregivers who
do not see these characteristics in themselves should reach
out to other members of the family to play a leadership role
in managing care. Sometimes, there is no other appropriate family
member who is willing or able to do this. In such cases, the
family needs to engage help from a professional, for example,
a private geriatric care manager.
i) NAC, 12
iii) Donna Cohen, PhD, and Carl Eisdorfer, PhD, MD, Caring for
Your Aging Parents (New York: Putnam's Sons, 1993) 105.
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