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VOL. 40 | NO. 7 | Friday, February 12, 2016

Caregivers also must take care of themselves

By Linda Bryant

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Brian Hooper works with adult children of aging parents as a part of his counseling practice, helping them process the often-overwhelming stresses and emotions connected to caregiving.

Hooper, who is a state-licensed clinical pastoral counselor and ordained Lutheran minister, knows about the issue firsthand. In 2010, he moved from his home in California to Tennessee to help care for his parents, who were rapidly deteriorating.

“It had become clear to me that my father was developing Alzheimer’s. Then, unfortunately, my parents were swindled in a scam that I did not know about,” Hooper says.

“I knew then that I was really going to have to step in. I sold my place in California and moved in with them to help them get their place ready to sell. By this time my mom had gone from a walker to a wheelchair. My interest in this type of counseling comes out of having to navigate this difficult terrain myself.”

The Ledger spoke with the Nashville resident about how caregivers can watch over their loved ones and take care of themselves at the same time.

What are some of the hardest issues for caregivers?

“Caregivers search for a delicate balance because we want to affirm as much independence for our loved ones as possible, but also try to spare them from the ravages of financial predators, the physical ravages of old age and, in many cases, physical and mental disabilities.

“We don’t want them to end up getting hurt or hurting themselves. I know for myself – and for many people that I’ve worked with and spoken to – it makes a big difference just to have a person to talk about what they are experiencing.

“One of the first things that we have to do as caregivers is to be sure that we are doing things to take care of ourselves. There is an old saying, and we hear it every time we get on an airplane: Make sure you put your own oxygen mask on first before you help the person next to you.

“We have to be really careful about not compromising on sleep. Careful to make sure we’re getting recreation, not drinking too much alcohol to escape at the end of the day. Let’s face it, when you begin to get involved as an active caregiver, you have another job. Even when a loved one is in assisted living you have an additional part-time job.

“Give up on the idea that you’re going to change your parents because you’re not. And don’t be afraid to put up some boundaries and say what you can and cannot do. This can very hard.

“A client has a take on the AA Serenity Prayer: ‘God grant me the courage to change the people I can, the serenity to accept the people I cannot change, and the wisdom to recognize I am the only one I can change.’”

“Let’s say there are wonderful activities available for your loved one, but they don’t want to do any of them because they feel they are somehow different. You’re frustrated. Instead of arguing, it’s better to simply join the conversation and say, “It’s really hard isn’t it? It’s true, not everybody is like you are they? I understand.”

“Just accept what is and let people choose the options that they want to choose. You can’t engineer their lives for them.’’

I imagine caregivers have all sorts of emotions – anger, sadness, despair, etc.

“Certainly, and they are normal feelings. The issue of anger and resentment is ubiquitous. Then there’s guilt over feeling angry at the very people who brought us into the world. I counsel clients to accept the anger and also accept where the loved one is. The anger often comes out of an expectation that the person ought to behave differently or think differently than they are.

“The trick is to accept them where they are and recognize you can only offer what you can offer. If they don’t want that, that’s OK. And you don’t try to persuade them to be grateful for something that they don’t want.’’

What kinds of actions can people take ahead of time to avoid a caregiving crisis?

“No. 1 is get an advanced directive in place. The last thing you want to have happen is that mom or dad have a stroke, and suddenly, you’re stuck with making decisions about the details.

“You need to have really frank, practical conversations about your parents’ wishes. A trust needs to be established if the parent can go on record designating one of the children as the lead person in taking direction in their care.

“I’m an only child, and I have had people say to me, ‘Oh my gosh, you are carrying all the burden for your parents.’ On the other hand, I don’t have a sibling who I’m at cross purposes with.

“One client came to me wanting to do the very best for a parent. The client wanted to use the parent’s funds only for their ongoing care. Their sibling was trying to get the money for their own personal reasons. My client had to take the sibling to court.

“If the parent or parents can be clear about who they want to take the lead in decision making as they age, it can make a world of difference.’’

Besides the caregiver do you ever counsel the person receiving the care?

“I will meet in a consultation kind of arrangement but really the challenge is not getting triangulated. Sometimes I take the family on as a unit. But if I have somebody come to me to process how they’re dealing with mom or dad, I can’t really be seeing mom and dad because then I’d be triangulated. A conflict of interest could potentially come up.’’

Can you give a couple of examples of the kinds of changes you see in clients once they have come in and gotten some support from you?

“This type of counseling can help a caregiver reframe how they see their parents’ situation and bring relief from their own sense of guilt, anxiety and inadequacy. Moving to a place of acceptance doesn’t mean you have to like what’s going on. But you have to simply acknowledge what is.

“You can move to a place of holding your situation with a gentle heart that has given up expectations.

“One technique people find very helpful is called mindfulness meditation and breathing. So often we are attached to our thoughts about fear and unmet expectations, and those thoughts begin to run our lives.

“Learning how to breathe can help us detach and unhinge from those anxieties and expectations and get back into our own self, our unique experience and our own bodies. Deep breathing facilitates calm, peaceful elder care.

“As caregivers we often want to fix everything, and we have to start by accepting what is and by having an attitude of curiosity, wonder, and questioning.

“We need to find ways to disengage from confrontation and challenging and unrealistic expectations.

“Many people engaging with an elder parent are practicing “regret management” because they don’t want to have regrets when their loved one is gone.

“Admitting that is a big thing. It brings us to say, “You know what? I’m freely choosing to engage in this care because I value it, and it’s important to me.

“Now, how do I do this in a way that doesn’t turn me into a physical and emotional wreck?”

“We learn how to separate what’s urgent from the things we can do tomorrow. We don’t have to jump at everything, yet some things have to happen today.

“I have a client who always lets phone calls from her father go to voicemail so he can hear what the need is, figure out how he can work it into his schedule and respond calmly.

“I think that’s a very loving thing to do. It’s not only loving towards the father, it’s loving towards himself. You have got to honor yourself if you honor your parents.’’

How do you charge for your sessions? Do you think that the demand is increasing for this particular niche?

“I see folks on a sliding scale based on their household income.

“And yes, the need is increasing. At the same time a lot of people don’t realize that they can turn to a therapist to talk about these issues.

“When I first started out, I remember sitting in a senior Resource Center in San Diego with tears running down my face because the first thing was that I just wanted somebody to understand what I was going through.

“The second thing I wanted was some very practical directions. Who do I talk to about legal things?

“How do I handle social services? How do I work with Social Security, and what are the implications if I become the designated payee?

“There needs to be a whole book on all that.’’

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