Taking Care of Elderly Loved Ones: The Difficulties We Do Not Talk About

When people talk about being caregivers, most often they are talking about taking care of their young children.  However, there is a large segment of the population who are taking care of their aging parents or other family members either instead of or in addition to their own children.  Although the needs and concerns of this group often resemble the needs of the young parents, in a lot of ways, their job is even harder.

When an adult child finds themselves taking care of an elderly parent, they learn about a world of concerns that they were often unfamiliar with. Unlikely in the case of a child, where the needed care is often relatively standard based on age, the needs of a parent vary greatly, in both the physical and emotional realm.  As the adult child struggles to meet these demands, what they are often left with is guilt.  They walk around with the self-deprecating thought that they are not doing enough.  However, rarely do they stop to think about what “enough” would look like.  If they did, they would likely realize that the source of the guilt is that they do not measure up to their ideal caregiver – the magical person who does it all and never complains.  They do not generally acknowledge that this person does not exist.   Thus, if people are trying to deal with the guilt they are experiencing, a good place to start would be to say to themselves, “My parent is well cared for, and their needs are met.  Are there ways I can be more perfect – certainly – but if I am not perfect does not mean that I am doing a bad job.”  Changing how one thinks does not actually change anything in the real world and does not alter the extensive assistance that the caregiver needs to provide for their parent, but it does help to lessen the guilt, and that alone makes the job easier.

Perhaps if caregivers reached out to others in similar situations, they would realize that the guilt they are experiencing is common and others may be able to normalize the experience.  However, another problem that caregivers face is that when they try to talk to others about their hardships in order to get support, they are told that “They are lucky that their parent is alive, so they should not complain.”  However, being grateful that your parent is alive does not make the day-to-day job of caring for them any easier.  Also, just because you are struggling with managing their care, does not mean that you love your parent any less.  Again, the only thing that you can change is to be honest with yourself and acknowledge that although part of loving your parent right now involves doing these tasks, it does not mean that you have to love the tasks themselves.  Give yourself a chance to seek the support you need.  If you find that you are getting responses similar to the one above, then find the support elsewhere because it does exist.   On the other hand, some people do not ask for help because their care-giving role makes them seem like “saints,” and they do not want to jeopardize that image.  In these situations the person needs to acknowledge what is more important to them: preserving the image or getting the help.

Speaking of help, caregivers often feel like this burden is only theirs to bear, and they do not use their resources.  Frequently people say that they do not have any help because they “can’t afford it.”  However, a large part of getting help is identifying what resources you do have and pairing them with the needs that you have.  For instance, you may not be able to leave and go grocery shopping, but your friend is already at the store, have the friend pick up the milk since the milk doesn’t care who buys it. Also, places such as senior centers and religious institutions may offer help, so seek them out and ask.  They may be able to offer help, but they do not know that you need it until you ask for it.  Similarly, if there are distant relatives who voice the concern that they are unable to help out, perhaps they can send money since that allows for a greater amount of resources and allows them to contribute to the care remotely.

Another thing that often gets overlooked and glossed over for the sake of fitting into this role is that if the caregiver and the parent never had a positive or close relationship, it is unfair to assume that now because the parent needs help the nature of the relationship is changed.  The adult child may step into that role out of a sense of responsibility or duty regardless, but the conflicts in this kind of situation may be even more frequent.  In such a situation, it is important to say to yourself that it is likely that the conflict is only marginally related to the fact that the parent is now elderly.  This conflict has been going on for years, and nothing has changed just because the parent is ill or needs assistance.  People do not become perfect angels just because they become ill.  In fact, the opposite is true.  People who are ill and require extensive help may be more irritable and demanding than in the past making being their caregiving that much harder.  Regardless of what the situation is, the caregiver needs to accept that caring for an elderly loved one is difficult, and they need to do what they can to get the support and assistance that they need.


Parenting Angry Children

Anger is adaptive and serves a purpose.  It signals to the person that something is wrong and motivates them to take action to fix the situation in which their goal is blocked.  This is all good in theory, but what do you do when the person having this adaptive anger is your child, and the goal they are trying to reach is one you are actively blocking.  Parenting a child who has trouble controlling their anger is difficult for many reasons.  Some of these reasons have to do with the impact that the child’s anger has on the child himself.  For instance, the parent may realize that if the child continues to act like this, there will be serious consequences in the future since too much anger makes goals hard to accomplish because you start engaging in behaviors that are not helpful in reaching the goal.   The parent may also worry how their child is perceived by others.  Some of the other reasons relate more to the parent.  For example, the parents may be beating themselves up with thoughts such as “What are we doing wrong?” and feeling ashamed about what others think of them as parents.   This critical task is made even harder by the fact that anger may be the most frequent, if not the only, emotion that the child expresses to the parent.  And yet, parents have to find a way to persevere, so I hope that the following can help.

To better understand what you may be dealing with, let’s start at the beginning; let’s talk about temperament.  Anger is one of the earliest developed emotions and can be seen by approximately two months of age.  During normal development, infants display low levels of anger early in infancy, then anger increases through late infancy and early toddlerhood and then decreases as toddlers get older[i].  Also, as the expression of anger changes as the child grows, so do the coping skills that the child has at his disposal.  Initially, the child is comforted and calmed by outside forces, such as the parent, who provides physical comfort and labels the emotions that the child experiences.  However, as the child grows, they develop the ability to regulate their emotions by themselves using cognitive strategies, such as thinking about things in a different way or distracting themselves.  Thus, it is important to point out that although temperament does impact the child’s likelihood to get angry, coping skills are learned and therefore can be taught by parents.  This notion is also supported by the finding that if a parent dismisses a child’s emotions, the child is more likely to have trouble regulating them[ii].  This may suggest that by dismissing the emotion, the parent passes the opportunity to teach their child how to manage it.  Based on this information, it would seem that the role of the parent is clearly defined.  The parent will teach their angry offspring how to manage their emotions, and the child will learn these skills and grow into an emotionally-savvy adult.  This is known as the development of “emotional regulation.”

However, as every parent of a child who expresses regular and intense anger knows, neither the teaching nor the learning needed for this to happen comes easily.  Nevertheless, when the parents actually do have a chance to teach their children about managing their anger, it may be helpful to know which strategies have been found to be effective.   One study found that when children are angry, helping them learn to focus their attention on something else was helpful.  Another technique that was found to be helpful was getting the child to think of different ways to look at the situation.  However, this strategy only worked if the mother and child engaged in it together.   On the other hand, comforting was not found to be an effective strategy for decreasing anger.   The study also documented that as the study progressed, the children expressed less anger and used coping strategies more[iii].  This can be taken to suggest that as the children get better at using these strategies, they become more and more effective.  This should be an encouraging finding for parents to whom it may seem that their efforts to help their child regulate their emotions are having no impact.

Now let’s get back to the real story.  It is difficult to stay positive and warm towards your child if they are constantly angry.  It has been documented that children who have trouble controlling their anger are significantly less likely to receive “positive parenting” from their mothers than children who do not have problems with anger.  “Positive Parenting” was defined as being responsive to the child and showing the child positive emotions.   This relationship does not hold up the other way, so it is not the lack of positive parenting that is leading to the children’s anger[iv].  Moreover, parents’ personality traits in general were not found to be related to how likely a child was to become angry.

However, the personality of the parent does play a role in how the parent is able to respond to a child who has trouble controlling his anger.  For instance, it has been found that a parent who is high on the trait of conscientiousness responds to this stress with empathy and sensitivity.  The study also found different results for each parent.  Thus, mothers who showed a lot of optimism responded more positively to their angry children.  Interestingly, if the children were not particularly angry, then optimism had no affect on their mother’s response[v].   The authors suggested that the mother’s optimism may help her view the child’s angry behavior as a more positive trait, such as spunk, which helps her approach this behavior with less stress.   On the other hand, openness was found to be the trait that helped fathers deal with difficult children.  Here the authors proposed that the ability to come up with innovative solutions and new ways of looking at the situation helps the fathers cope, rather than trying to get the children to comply with the established norm. [vi]   Thus, the take-away message is that not getting hung up on the idea that “I have an angry kid” but instead thinking about the behavior in more adaptive terms or trying to approach the behavior in a new way helps parents cope.

This does not mean that parents have to accept everything their child does, but approaching the problem with a new perspective may be more effective and lead to less stress for the parent.  For example, since anger is associated with motivation to change the situation, the same infants who were found to be the most angry when a reward was removed were the ones who expressed the most interest and engaged best after the prize was returned [vii].  Thus, parents can try to think about ways that the child’s anger can be turned into motivation.  However, to do this, the parents would have to help the child identify an acceptable goal.  For instance, if a child is angry because he wants to spend more time on his Ipad, it may be helpful to show him that being motivated to do his homework faster (appropriate goal) is an effective way to get more time rather than being angry at the amount of screen time that is left after the homework is done in the usual slow way.  Thus, here the goal is “done homework faster” rather than “spend more time on Ipad,” and although they are clearly related, they send a different message.

Moreover, the parent’s ability to regulate their own emotions can play a role in the situation.  When a parent is able to regulate their emotions, they are able to use a wider repertoire of parenting skills, which may help the child to cope better[viii].   Moreover, when parents express negative emotions when a child acts out, the child’s behavior tends to worsen[ix].  However, surprisingly, according to one study, a mother’s reaction to her child was better predicted by the child’s expressed emotion rather than their actual misbehavior[x].  Conversely, when the children sought out comfort from the mother, this appeared to positively affect her emotional reaction regardless of what the actual level of anger was.  Similar effects were found when the child tried to regulate their own emotion.  It also appears to matter if this level of anger is a constant struggle for the mother or an anomaly for this child.  The study found that the mothers of children who are generally more angry, react with more negative emotions as compared to mothers who deal with anger infrequently.  Again, this is independent of the actual level of anger.  Interestingly, the authors reported that mother’s level of positive emotions was more related to how her child’s anger compared to other children rather than whether her child has gotten angrier over time.[xi]

So, now what? How does knowing any of this help a parent who is facing yet another angry outburst in a situation that does not appear to the parent to warrant any anger at all?  Here are a few suggestions:

  • First, accept that parenting an angry child is difficult, and therefore it is normal that you feel drained or saddened by this. It is likely that once you accept that these feelings are normal, you may feel less ashamed and be more likely to ask for help.  If you find yourself getting depressed or anxious, seek help for yourself.  At that point, that is the best thing you can do to help your child.  By giving yourself the emotional support and resources that you need to be healthy, you will increase the chances that you have the patience and stress-tolerance to deal with the anger.
  • Avoid listening to people who tell you “It’s not that bad.” They do not know what it is like specifically for you to parent this specific child.  If you think, “it is that bad,” get help.
  • Be kind to yourself. Instead of saying to yourself, “Here we go again. Nothing I do help,” try saying “I have dealt with his anger before, I will get through this incident too.”  Remember that the calmer you stay the better, you will be able to consider different ways of responding.
  • Try to assess whether at present you can “teach” a coping skill or is the child too angry for that right now. If you decide that you can, try it.  If you decide that you can’t, try to discuss the incident later when the child has calmed down and try to teach the skill then.  Try to focus on what your long-term goal is, which is to help your child deal with this situation better next time, so even if you cannot impact this particular tantrum, you may be able to impact the next one.  Also, try to remember that emotional regulation is something children learn and are not born with but some children learn this skill with more difficulty than others.  They are also unlikely to become experts on their first try, so recognize each small improvement for what it is – progress.
  • It is also possible that you are not the best person to teach your child these particular skills since they approach everything you say with a battle. In this case, identify who may be the best person for this job.  It may be another family member, a teacher or a counselor. Alternatively, you may benefit from having a therapist intervene.  If any one of them succeeds where you did not, this does not make you a failure.  They are not dealing with the same dynamic as you likely are; just be glad that they were able to succeed.
  • If you have a new idea for how to intervene, try it. You do not know when a creative solution will turn out to be just what you need.
  • Sometimes it is helpful to be “the rock in the storm.” Depending on the child’s age, you may be able to teach them this visual.  Their anger is the storm that is flying around and trying to destroy everything in its path.  You are there with them as the rock but are not impacted by the storm.  You can tell them that you will not engage with the “storm,” but you are not afraid of their anger and will be right here when they are ready to engage with you again.
  • Also, as with everything, consistency is key. If your child knows that displays of anger, no matter how intense, do not get them to their goal, they may be willing to eventually consider other strategies.  Again, as a way of teaching, after the incident where the child was not allowed to do something because of an angry outburst, you can help them think about what they were trying to accomplish.  Demonstrate how they could have gotten what they had wanted and instead they lost that opportunity.

Your parenting job may be harder than someone else’s, and that may seem unfair, but at the end of the day, that is your reality.  Try to focus your limited energy on being the most effective parent that you can be to your child, instead of wasting that precious energy beating yourself up for not doing enough or feeling cheated.

[i] Brooker, R., Lemery-Chalfant, K., Buss, K. & Aksan, N. (2014). Developmental Psychology, 50 (10), 2343-2352.

[ii] Sheffield Morris, A., Morris, M. D. S., Silk, J. S. & Steinberg, L. (2011). The Influence of Mother-Child Emotion Regulation Strategies on children’s Expression of Anger and Sadness. Developmental Psychology, 47(1), 213-225.

[iii] Sheffield Morris, A., Morris, M. D. S., Silk, J. S. & Steinberg, L. (2011). The Influence of Mother-Child Emotion Regulation Strategies on children’s Expression of Anger and Sadness. Developmental Psychology, 47(1), 213-225.

[iv] Lee-Baggley, D., Preece, M. & DeLongis, A. (2005). Coping with Interpersonal Stress: Role of Big Five Traits, Journal of Personality, 73, 1141-1180.

[v]  Lee-Baggley, D., Preece, M. & DeLongis, A. (2005). Coping with Interpersonal Stress: Role of Big Five Traits, Journal of Personality, 73, 1141-1180.

[vi]Koenig, J. L., Barry, R. A. & Kochanska, G. (2010). Rearing difficult children: Parent’s personality and children’s proneness to anger as predictors of future parenting. Parenting: Science and Practice, 10, 258-273.

[vii] Lewis, M., Alessandri, S. M. & Sullivan, M. W. (1990). Violation of Expectancy, Loss of Control and Anger Expression in Young Infants. Developmental Psychology, 26, 745-751.

[viii] Connell, A. M., Dawson, G. C., Danzo, S. & McKillop, H. N. (2017). The Psychophysiology of Parenting: Individual Differences in Autonomic Reactivity to Positive and Negative Mood Inductions and Observed Parental Affect During Dyadic Interactions with Children. Journal of Family Psychology, 31 (1), 30-40.

[ix] Cole P. M. Teti, L. O., & Zhan-Waxler, C. (2003). Mutual emotion regulation and the stability of conduct problems between preschoolers and early school age.  Development and Psychopathology, 15, 1-18.

[x] Lorber, M. F. & Slep, A. M. S. (2005).  Mothers’ emotion dynamics and their relations with harsh and lax discipline: Microsocial time series analyses. Journal of Clinical Child and Adolescent Psychology, 34, 559-568.

[xi]  Cole, P. M., LeDonne, N. & Tan, P. Z.  (2013). A Longitudinal Examination of Maternal Emotions in Relation to Young Children’s Developing Self-Regulation. Parenting: Science and Practice, 13, 113-132.

The Housework Never Ends: Strategies for Reducing the Sense of Burden

Today’s post is likely to stir up some controversy because it touches upon the sensitive topic of housework, who in the house is doing it and how well.  It would be great if I could use the generic terms of “one spouse” does this and “one spouse” does that and avoid this controversy.  However, the research demonstrates that, as most of us know, men and women approach and complete housework differently, so the comments have to be gender specific.  Despite that, I invite you to approach this post not as another treatise on the uneven divide of housework, but as a useful guide for addressing the problems that arise in couples as they navigate this unpleasant chore.  There are tips for both men and women, and they apply whether one spouse does all the work or the spouses split the work completely equally.  This posts hopes to show that “housework” is not as static as it may seem, and it is impacted by many elements of life. Therefore, if you can better understand what affects how housework is approached and thought about, it may feel like less of a burden.

Historically housework was viewed as the “woman’s domain,” and a woman, especially a wife, used to spend a large portion of her time taking care of the house.  However, as women began to enter the workforce, they had to begin splitting their time between their careers and housework.  As this occurred, women obviously started to do less housework because they simply did not have as much time.  So what happened to all that work that went undone?  At first, you may think that the husbands took on the tasks, and that is in part true, as men’s contribution to housework has risen.  However, research shows that, even with the increased input from men, the total hours spent on housework per family have declined from 17.5 per week in 1965 to 13.7 in 1995.  This appears to be related to people reevaluating standards and deciding that housework is just not that important.  Instead of doing housework people are allocating their time to other things[i].

So, our the culture as a whole can come to the conclusion that not all housework that used to be considered essential actually is, then maybe each individual family can begin to assess what housework tasks “must be” done and which are just preferred.  For example, the family can decide that to alleviate doing the dishwasher once a week, the family will eat off paper plates or decide that the Cheerio- covered floor will only be swept every other day since it is again covered in Cheerios a few hours after sweeping anyway.  Reassessing the absolute necessity of the tasks and eliminating those that are not important to this particular family may help family members feel less burdened.  It is important that the family does an honest assessment rather than just assume that everything is critical because society says that “your house should be kept up.” If it works for your family, and it is not impacting anyone’s health or wellbeing, then it may be enough.

In addition to deciding which tasks will and will not be done, the family needs to decide to what standard the housework will be performed.  Research has documented that women have a higher standard for housework quality than men.  This likely stems from the fact that historically a woman’s evaluation as a wife was in part based on her ability to keep the house in order, while the state of the house did not say anything about the husband[ii].  Here again honesty is critical.  If a wife expects her husband to pitch in and do things around the house, but then ends up redoing everything because it is not “up to her standard,” this is likely to result in a lot of marital conflict.  Although the husband may have to try to be more diligent, this does not mean that the husband has to blindly conform to the wife’s standards.  It just means that a conversation is in order.  For instance, it may be helpful for the wife to acknowledge that her standards are based on a need to conform to an external image of “a good wife” and not on her true belief that for the house to function the cereals must be alphabetized. Therefore, this negotiation may involve a compromise between the partners.

Not only is housework impacted by internal qualities of the partners, but it is also heavily subject to external influences.  For example, when stressed by work or other things outside of the home, men do less housework.  In response to this, women will often pick up the slack.  Interestingly, men are generally unaware of the fact that their wife had taken on the tasks in the home that they had not completed.  However, when the situation is reversed, and the woman is stressed by events outside of the home, men have not been found to compensate.  That being said, men were found to do the most housework when they perceived some stress internal to the house for themselves or for their wife[iii]. Interestingly enough, under these circumstances (high stress resulting from something in the home), the wife is least likely to notice the husband’s additional efforts.  On the other hand, when the wife’s stress in the home is low, she is most likely to notice how much housework her husband is doing, but unfortunately, it is under these circumstances when he is likely doing the least amount.  Therefore, it appears that when one partner “covers” for the other partner, this effort generally goes unnoticed. Over time, it is likely that the desire to pick up the slack declines and the resentment due to the feeling of “being taken advantage of” increases. This can obviously lead to marital conflict.  Thus, personal stress, especially stress outside of the home for men and stress from inside the home for women, should serve as a cue for one partner to look at what the other is doing, chances are, they are doing more than usual.  Pointing out that the effort is noticed and appreciated may go a long way to sustaining this effort and reducing marital conflict.

Interestingly, stress does not only appear to impact how much housework gets done and by whom, but also how the quality of that work is perceived.  For instance, as the stress from the outside increases, the connection between how much time is spent on housework and the results perceived becomes weaker[iv].  This means that when you are stressed, you keep doing things but not feeling like you are getting anything done.   Furthermore, when the stress originates in the home, women work longer to reach their level of satisfaction with the work.  On the other hand, when the stress comes from outside the home, women work fewer hours for the same level of satisfaction[v].  This clearly speaks to the fact that “satisfaction” with one’s work is not dependent on how closely it approximates some outside standard and instead has to do with how one is feeling.  Becoming aware of this tendency, may save many hours and thereby reduce the sense of burden that many feel.

When reading and thinking about these difficulties, an easy solution probably comes to mind – hire help or at least get some appliance that makes the job easier!  However, research has found that this solution is not as widely implemented and, in some ways, is not as effective as it may at first seem.  For example, it is assumed that a washing machine substantially reduces the amount of time that people spend doing laundry.  However, research has found that people end up doing laundry much more frequently, and as a result, they do not experience all of the benefits of saved time that they could.

In terms of hired help, the impact on the overall tasks that are expected of a spouse differ by gender.  Men tend to hire help that replaces a task they have to do, such as mowing the lawn.  However, women tend to hire help that supplements the tasks they have to do, hence “cleaning for the cleaning lady.”  The authors suggest that this may relate to the fact that it is culturally acceptable for men to not do housework and thus hiring help does not affect their identity while women feel the need to work along with the hired help[vi].  Here again, the acceptance that the woman’s actions are being driven by her compliance with a stereotype may allow her to accept the help that she is paying for and use her own time for something else.

Obviously, the financial situation of the family effects how much outside help is possible. Interestingly, the source of the money determines the kind of help that is sought.  A higher income for the man is associated with all sorts of services, while the woman’s higher income is related to the hiring of cleaners and an increase in meals outside the home.  This likely represents the fact that when the man earns more, there is more discretionary income for all kinds of help, but when it is the wife, she uses the money for those things that make her load lighter or those things she is not realistically getting to because of her job.   Surprisingly, the amount of hired help does not relate to the person’s subjective assessment of being pressured for time. Furthermore, the number of hours spent in paid work was strongly related to the feeling of time pressure, but the number of hours spent in housework was not.  Therefore, it makes sense that reducing the number of hours that people spend in housework by hiring help does not impact this subjective feeling[vii].  However, since this feeling of time pressure is primarily driven  by perception rather than actual number of hours occupied, it may be helpful for people to project what getting outside help will do for them and then note if this is actually happening.

Few things in a marriage are as laden with stereotypes and historic assumptions as housework.    Therefore, it is not surprising that given the central role it plays in the lives of most families, there is often a lot of conflict surrounding this topic.  However, it does not have to be this way.  If couples spend the time to tease out what is important to them and what are blind conformations to either stereotypes or old societal norms, they can narrow down the amount of housework that needs to be done and how well it must be completed.  Moreover, if the couple becomes aware of those external elements that influence housework, and learn both how they themselves and their partner reacts to them, they can proactively avoid conflicts.  At the end of the day, housework is not going anywhere and all we can do is reduce the amount of burden we feel from it and the amount of conflict we have about it.

[i] Bianchi, S. M., Milkie, M. A., Sayer, L. C. & Robinson, J. P. (2000). Is Anyone Doing the Housework? Trends in the Gender Division of Household Labor. Social Forces, 79(1): 191-228.

[ii] Bianchi, S. M., Milkie, M. A., Sayer, L. C. & Robinson, J. P. (2000). Is Anyone Doing the Housework? Trends in the Gender Division of Household Labor. Social Forces, 79(1): 191-228.

[iii]  Pittman, J. E. & Kerpelman, J. L. (2001). Stress and Performance Standards: A Dynamic Approach to Time Spent in Housework.  Journal or Marriage and Family, 63, 1111-1121.

[iv] Pittman, J. E. & Kerpelman, J. L. (2001). Stress and Performance Standards: A Dynamic Approach to Time Spent in Housework.  Journal or Marriage and Family, 63, 1111-1121.

[v] Pittman, J. E. & Kerpelman, J. L. (2001). Stress and Performance Standards: A Dynamic Approach to Time Spent in Housework.  Journal or Marriage and Family, 63, 1111-1121.

[vi]  Craig, L. & Baxter, J. (2016). Domestic  Outsourcing, Housework Shares and Subjective Time Pressure: Gender Differences in the Correlates of Hiring Help. Social Indices Research, 125, 271-288.

[vii] Craig, L. & Baxter, J. (2016). Domestic  Outsourcing, Housework Shares and Subjective Time Pressure: Gender Differences in the Correlates of Hiring Help. Social Indices Research, 125, 271-288.

An Elderly Adult is Not a Child: Important Differences for Caregivers

People often say that taking care of an aging parent is like taking care of an infant.  What they mean by this is that often the aging parent can no longer meet their own needs, cannot make sound decisions and cannot plan for their own care.  However, there are in fact many ways that caring for an elderly parent is not like caring for an infant, and these differences is what makes the latter job significantly harder.

The main and most obvious difference, although one that is frequently overlooked, is the fact that an aging parent had been an independent adult for many years prior to their current condition while an infant has not been.  Thus, a parent often remembers a time when they were able to do all of these things by themselves, and are frustrated by their inability to do so now.  For example, after 80 years of walking, it is very difficult to accept the fact that you cannot do this simple thing anymore.  This realization creates a host of negative emotions ranging from frustration to anger to resentment to self-loathing.  When the caregiver comes to help, all of these emotions are triggered and often directed at the care giver.  On the other hand, an infant who has not yet learned to walk does not see his lack of ability as a personal failure, he sees it as something cool that older kids do and that he may want to put some effort in figuring out how to accomplish and reacts accordingly.  When a caregiver understands and acknowledges what the loss of independence means for the parent, it can help to both build compassion and provide the caregiver the opportunity to help their parent grieve, in the true sense of that word, the loss of whatever function they are no longer able to do.

In some ways, the caregiver’s job becomes even harder if the parent refuses to acknowledge that there are tasks that they are no longer able to do.  This may be something as major as driving or cooking or something mundane as getting to the bathroom on their own.  However, regardless of the magnitude, the parent’s continued effort to do this task can result in serious injury to at the least themselves and frequently others.  The parent who attempts to cook but cannot remember to turn off the stove is putting the entire residence at risk while the parent who insists on getting up to go to the bathroom by themselves is constantly at risk for falls.  In such a situation, not only does the caregiver have to take on the task, but they also need to have this conversation and get the parent to agree.  Unfortunately, initiating this conversation is likely to make the caregiver the target of the parents’ anger.  Despite their parent’s potential wrath, the adult child still must put a stop to the dangerous behavior.  In this way, the caregiver’s job is similar to a parent’s, where they get to enforce decisions that won’t make them particularly popular.  To help the caregiver take this necessary step, they can say to themselves “Although this conversation is going to be hard and my mother will be angry with me, that is nothing compared to how angry I will be with myself if I do not do something about this and she falls.”

It is important to understand that in addition to changes in self-image, which loss of functioning creates, there is also a sense of loss of control.  Thus, whatever the caregiver can do to help the parent feel in control will help to ease this transition.  It may also help to address the sense of “demandingness.”  For example, if the parent is asking to be taken to the bathroom every 10 minutes, and this is preventing the caregiver from getting anything else done, they can develop a schedule where the caregiver takes the parent to the bathroom during the first ten minutes of every hour or however long is determined to be an appropriate interval.  It is helpful to develop a time table where the caregiver can check off the times, and this can serve as a visual are reminder.  Such a plan will help the caregiver get other things done without being constantly pulled away, but even more importantly, it will help the parent since they will no longer have to ask and wait.  They will know when it will happen and this returns some sense of control to them.  This intervention can be used for many different frequent requests.

Another major difference between a parent taking care of a child and a child taking care of a parent is the conflicting feelings about the future.  Parents of young children may have to provide a lot of grueling care, but they do so with the knowledge that with each passing day, their child will require less and less care.  They know that the child will soon be an adult and no longer require their care.  Also, they know that the stage they are in now is temporary, and afterwards, they will maintain the relationship with their child, but it will no longer be so demanding on them.  This is the opposite of the knowledge that adult-children enter their caretaker role with.  They know that they may be taking care of their elderly parent for an extended period of time, that the care is only going to get more extensive and that the only way they will be able to stop taking care of their parent is when they die, which is not something that most people can “look forward to” as a way out of their situation. This is a very difficult situation to be in.  People would benefit from being honest with themselves and develop a plan of care that is sustainable.  For instance, if the parent requires 24-hour supervision, the adult child may be able to provide that for a week, but not for the next ten years.  An honest stock of the real care needs will likely result in the child having to have many more difficult conversations, such as the need for outside help.  Moreover, when looking into the future, it may be helpful for the caregiver to understand that being exhausted by the work of the care is not the same thing as wanting their parent to die.  The caregiver needs to give themselves permission to acknowledge how exhausted they are and how burdened because only then will they seek appropriate support and resources.

Moreover, the work itself tends to be harder and less “cute.”  Babies even at 2am can snuggle up and give the mother that sense of peace and tranquility.  Let’s be honest, there is very little that an elderly person can do at 2am that will be seen by their caregiver as endearing.  Furthermore the work itself is physically more difficult and demanding.  The elderly are heavier and are often in pain making handling them not as easy as lifting an infant.  Also, while children are resilient and a cut or a bump heals easily, for an elderly person a small cut can potentially cause serious illness, thus raising the stakes for the caregiver to provide “flawless care.”  Such high risks and demands contribute to the burn out found among caregivers.  It is not only the emotional burden of the constant demands and the guilt from not “doing enough” as discussed in my previous post, but it is also the physical demands of the care.

If the physical aspects of the care are wearing the caregiver out, they need to take an honest look at what is happening. For instance, if their parent does need to go to the bathroom every hour, but they are heavy and in pain and each one of these trips takes half an hour and results in a hurting back for the caregiver and in a hurting everything for the parent, maybe diapers or a bed pan need to be considered.    It is likely that the parent will be upset by this discussion, but as discussed above, that does not mean that this conversation should not take place.  The parent may “refuse to think of themselves as someone in diapers,” but the caregiver must protect themselves.  What good will they be to their parent if they hurt their back? After the caregiver has assessed exactly where the problem areas are, they can research the available resources and medical supplies.  Since they are likely not the only one who is having this problem, it is likely that someone has thought of a solution.

Another major difference is the stage of life when the “caregiving” takes place.  When a family is first starting out, it is “expected” that they will have children and that the early years will center on raising children.  While in the midst of caring for their young children, spouses often saying that they will be able to do those things that they like “when the kids are grown.”  Furthermore, most of the families around are at the same stage of life.  As a result, there is both social support and a social group for the family to fit into.  For example, it may be normal to meet friends for breakfast instead of dinner because that is a better time to go out with small children.  However, when an adult child finds themselves taking care of an elderly parent, this often occurs later in life, when the couple may have been past caring for children for some time and was beginning to enjoy their independence.  Now, similar constraints that were in place when they had young children are back.  For example, the couple may not be able to go out to dinner without securing someone who can care for the parent.  However, this may be even more difficult than getting a babysitter since the parent’s medical needs may necessitate someone trained to do the job.

This loss of independence can put strain on a couple.   The first strategy for addressing this issue, as with all the scenarios described above, is to be honest with yourself. Acknowledge that the couple has lost the accustomed freedom and that this may be troublesome for both partners, but especially for the partner who may now feel abandoned.  Talk to the spouse about the concerns you have regarding how this may impact the marriage.  Understand what is actually concerning.  Is it that you can never plan anything because there are constant emergencies? Is it that you never have time alone? Is it that you can no longer go on vacation? Depending on the specific problem, solutions may be available.  On the other hand, what is not helpful is for the spouses to begin to resent each other.  The spouse who is not the primary caregiver may feel abandoned, as mentioned above, while the spouse who is providing the care may feel unsupported and feel like their spouse does not understand that “they have no choice.”    Honest, albeit, difficult discussions may help both spouses serve as a resource for each other at this difficult time instead of being another source of stress.

Caregiving is never easy, but it is especially difficult when the work is physically demanding, there is little social support and the end of the work can only happen with the parents’ death.  In such situations even the small steps that the caregiver can take to relieve the burden can be beneficial.  Whether through the development of schedules or from enlisting the help and understanding of the spouse , the caregiver must acknowledge that they do not only have to take care of and protect themselves in order to continue to be a caregiver, but that they also deserve to take care of themselves.


Not All Free Time is Created Equal

When people think about their hectic lives, a frequent theme comes to mind, “I wish I had more free time.”  Although this wish is common, some segments of the population appear to be most affected by being “leisure poor,” as this concept is known in the literature.  Predictably, this group is mothers, and especially mothers who work full-time.  Working mothers as compared to other groups often shoulder the responsibility for the household and the childcare, as well as their job, leaving minimal time for other things.  This has been supported by research which found that after subtracting paid employment, childcare and household tasks, women in this group had an average of ten hours per day left.  Although that may seem like a lot at first glance, remember that these 10 hours need to include: sleeping, eating, showering and all other activities that are not explicitly paid work, childcare or household tasks [i].  To gain an even clearer understanding, one study looked at how much does each child “cost the mother” in free time, and it was found that for a married parent, the cost of one child is the loss of 1.4 hours of free time per day and 2.6 for two children.  If a child is under age 3, then there is an additional cost of 2.4 hours per day.  The length of any individual period of leisure time is also shortened when the child is young.  It was found that women get this time by taking it out of leisure activities and self-care[ii].  The minimal amount of free time is associated both with the sense of being rushed, as well as low satisfaction with the free time that does exist[iii].

Although there may be very little that mothers can do to increase the amount of free time they have, there are things that can be done about the level of satisfaction if the cause of the dissatisfaction is identified.  For some women it may be the kind of activities that are being considered as leisure.  It was found that women spend 30 minutes less per week eating, 3 hours less per week watching television, 1 hour less per week socializing and doing sports and 30 minutes less reading than men[iv].   Thus, it is possible that if a woman who is an avid reader has to sacrifice reading in order to sleep, eat and exercise, she may be unsatisfied with her “leisure time” since she derives potentially no pleasure from the tasks she engages in.  There are several ways to address this problem.  Ideally, there is enough flexibility in the schedule, where the desired task can be added into the schedule on an infrequent but regular basis at the expense of something that can be either delegated or skipped.  For example, one can say to herself, “I will create the time to read for one hour each week.  I will do this by ordering pizza for the family once a week for dinner.  Doing this will give me the hour that I need because I will not need to cook or clean up.”  If this works, and the needed time is created, the important thing then is to protect that time and use it for the activity for which it was intended.  So, if after ordering pizza, the woman spends the hour mindlessly reading through Facebook, this is unlikely to improve her satisfaction with her leisure time.

Nevertheless, very often such changes are not feasible since the schedule is already as leveraged as it could possibly be.  In these situations, the satisfaction needs to be derived by changing how one thinks about the free time.  Specifically, instead of saying to yourself, “I can’t believe I don’t have the time to spend on the things that I love to do,” try saying to yourself “This may not be ideal, but I am getting a break from work, and since this is what I am able to do, I may as well enjoy it.”   Another way to think about it is “If I did not have this time to do _____ (insert less preferred activity), I would be doing _____ (insert work/household/childcare…).  This is definitely better” or  “I am not enjoying this thing that I am doing because I keep wishing I was doing something else.  Continuing to do this will make me feel like I did not have this free time at all, and I refuse to waste the limited free time that I have.”  Changing how you think about the activity that you are engaging in may help to alter how you perceive your free time.

An additional issue is that not only do women have less free time, but they are also responsible for “providing the setting” for free time[v].  For example, if the “leisure activity” is having friends over, then the woman is often the one who, in anticipation, is cleaning the house and cooking the meal, thereby creating additional housework  This means that the free time comes at a price.  The cost of the leisure activity may at times feel too high to engage in.  However, this then leaves the woman feeling like all she does is housework, work and child care, which in effect turns out to be true.  To address this issue, it may be necessary to readjust what kind of leisure activities happen and/or readjust expectations for prerequisite activities. For example, if a woman had always cooked a full sit-down meal for company, she would need to determine what part of that activity is important to her.  If the important element is being able to socialize with friends, then she may have to learn to be okay with store-bought appetizers instead.  Although this may at first feel disappointing and like she is not living up to her own standards, the woman has to remind herself that she needs to stay focused on the targeted element, in this case socializing, and the less important element, the food, is the obstacle.  It is also important to remember that the feeling of disappointment in herself is preventing her from enjoying the leisure activity she had created.

The above example sheds light on another critical finding, which is that free time is less restorative for women than it is for men[vi].  The authors proposed that this may be due to the fact that women continue to worry about everything that they have to do while engaging in leisure activities.  It is also possible that women often engage in free time activities for the sake of the family rather than because it is something that they want, and as a result they are less restored by it. Some women may also view themselves as less deserving of free time, and the guilt interferes with the restorative effect.  This is an excellent opportunity for other adults in the woman’s life to intervene and help the woman get as much out of her free time as possible. For example, a husband knowing that his wife plans to give up something that she wants to do, such as read a favorite book, in order to have family over for dinner, may suggest that he will find another time that they can see the family, so that she can spend the time on herself, or he can propose to make reservations for a favorite restaurant and make arrangements for everyone to meet at the restaurant instead of coming to their house.  However, it is important that he takes on these tasks because if she needs to take on the coordinating of the changed plans, it will use up all of the time that she was trying to create for reading.  Also, an offer of this type from her husband reaffirms that he believes that she “deserves” the time she is setting aside for herself.

The other issue that needs to be considered for leisure activities is the fact that for many people, and especially mothers, leisure time is “contaminated” by other activities, meaning that the person is engaging in several activities at ones in order to meet all of their time demands.  It was found that parents spend approximately 1.25 hours per day of their free time with their children with about half of that time spent alone with their children with no other adults present.  This is important because under such circumstances, free time can turn into childcare very quickly.  For example, the mother may be playing a board game with her children-free time, but the children begin to argue and she ends up having to separate them and address the arguing- child care.  In this example, it is unlikely that the woman walked away from that experience refreshed. Also, if the woman is alone with her children for a large part of her free time, it limits the kind of activities that she can engage in.  For instance, she may not be able to go play tennis because she has to be with the children.  Again, if the family recognizes the importance of making sure that the mother has adult free time, which is the type found to be most restorative[vii], a plan can be developed where her time alone to engage in the things she enjoys is protected from other activities and responsibilities.

This topic is critical because with every year people feel more rushed as lives get busier and busier, and this trend has been steady since 1965[viii].  However, it appears that having restorative free time is an effective coping technique for this pace.  Since life circumstances make it difficult for women to experience such restorative free time naturally, it is important that it is created using the strategies above.

[i] Ekert-Jaffe, O. (2011). Are the Real Time Cost of Child Equally Shared by Mothers and Fathers? Social Indicators Research, 101, 243-247.

[ii] Ekert-Jaffe, O. (2011). Are the Real Time Cost of Child Equally Shared by Mothers and Fathers? Social Indicators Research, 101, 243-247.

[iii] Gimenez-Nadal, J. I. & Sevilla-Sanz, A. (2011). The Time-Crush Paradox. Social Indicators Research, 102, 181-196.

[iv]  Gimenez-Nadal, J. I. & Sevilla-Sanz, A. (2011). The Time-Crush Paradox. Social Indicators Research, 102, 181-196.

[v] Mattingly, M. J. & Bianchi, S. M. (2003). Gender Differences in the Quantity and Quality of Free Time: The U.S. Experience.  Social Forces, 81(3), 999-1030.

[vi] Mattingly, M. J. & Bianchi, S. M. (2003). Gender Differences in the Quantity and Quality of Free Time: The U.S. Experience.  Social Forces, 81(3), 999-1030.

[vii]  Mattingly, M. J. & Bianchi, S. M. (2003). Gender Differences in the Quantity and Quality of Free Time: The U.S. Experience.  Social Forces, 81(3), 999-1030.

[viii] Mattingly, M. J. & Bianchi, S. M. (2003). Gender Differences in the Quantity and Quality of Free Time: The U.S. Experience.  Social Forces, 81(3), 999-1030.