People do not need care just because they are getting old, or very old.  People need care when they become too ill to take care of themselves, and that is the focus of this commentary.

Whenever one person can dominate another in a relationship, there can be trouble.  Individuals who are ill and need care may feel that they are in a position to be dominated.  Let us label this type of relationship as “vulnerable.”  The caregiver can be vulnerable to the person needing care as well. Sometimes the person expected to receive the care strikes out preemptively so as to dominate the caregiver.  Other individuals needing care are embarrassed to accept it, and this embarrassment can turn into resentment, which is an emotion that invites the care giver to feel guilty, incapable or manipulated.  Let’s face it, even if the person providing care listens and tries to do everything with the consent of the other, illness is a fact of life which changes the balance in a relationship.

A person giving care may become disillusioned or impatient over a period of time, just managing the tug-and-push of this new relationship with their loved one—much less providing all of the physical support, bookkeeping, medicine management, transportation services and home maintenance required for a person who is no longer capable to provide fully for him or herself.  We call this Caregiver burnout.

One way to adjust to a more healthy approach is to reconsider what we call the relationship altogether.  A different approach to the care-giver/care-receiver relationship is to change the idea of care-giver/care-receiver to CARE PARTNERS.  In 1997, Virginia Bell and David Troxel wrote a book to help people care for loved ones with Alzheimer’s, entitled, “The Best Friends Approach to Alzheimer’s Care.” (Health Professions Press: Baltimore, 1997.  www.healthpress.com )  As I read this, it struck me that the ideas presented might work well for a family member providing care to an aging parent who is ill—one who does not have dementia or Alzheimer’s. 

The upshot of the CARE PARTNERS approach is this:  find the strength in the relationship you have with your loved one and build on that.  Actively build a friendship with your loved one by not assuming the friendship is in place by virtue of genes or history.   Virginia Bell and David Troxel describe the elements of friendship (pp. 46-47): consider following these guidelines in the context of the help you are trying to give to your needy loved one:

Friends Know Each Other’s History
and Personality

• Share stories, re-tell important stories in both your history
• Talk about traditions and values
• Appreciate the other person’s moods and problem-solving style

Friends Do Things Together

• Involve the person in daily activities and chores
• Initiate activities
• Tie activities into the person’s past skills and interest
• Encourage the person to enjoy the simpler things in life
• Remember to celebrate special occasions

Friends Do Things Together

• Listen skillfully
• Speak skillfully
• Ask questions skillfully
• Speak using body language
• Gently encourages participation in conversations

Friends Build Self-Esteem

• Give compliments often
• Carefully ask for advice or opinions
• Always offer encouragement
• Offer congratulations and appreciation

Friends Laugh Often

• Tell jokes and funny stories
• Take advantage of spontaneous fun
• Use self-deprecating humor often

Friends Are Equals

• Do not talk down to the person
• Always work to protect the dignity of the person to “save face.”
• Do not assume a supervisory role
• Recognize that learning is a two-way street

Friends Work at the Relationship

• Are not overly sensitive
• Do more than 50% of the work
• Build a trusting relationship
• Show affection often

As you reflect on these statements, think about the quality of the relationship of the one who you are assisting—can it be helped by taking a new approach?  The following resources are available to assist you.