Self Caring

5 Caregiving Rules You Can Break

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We all carry ideas in our heads about the way taking care of a loved one is "supposed to be." These images can begin anywhere from old Waltons episodes to the ways we saw our elders care for their elders.

Are some of these cultural "rules" making you crazy, unnecessarily? Here are five such ideas that are showing their age:

Old rule: Nobody can provide care as well as family.

New rule: Caregiving takes a village.

Certainly nobody knows the person in need as well as a family member. But plenty of others can do a pretty competent job. From those with specialty training to those with way more experience than you in dealing with older adults, to the kid down the street who reads to your loved one after school, "outsiders" bring expertise and insights that enrich care. And by spreading the burden, these helping hands allow the primary caregiver to care better, longer.

Thankfully, local resources of many different forms are increasingly available to meet rising demand. And they don't have to cost a fortune. Why play the Lone Ranger when there's a whole cavalry ready to watch your back?

Old rule: Adults deserve to drive until it's an obvious problem.

New rule: Don't wait until it's too late.

Any of these sound familiar? "But she's not going far." "He's driven that road every day of his life." "She goes so slowly." "He'll shrivel up without the independence of his car!" We Americans love our wheels, and we're loathe to crimp anybody else's style, even to the point of making excuses for creeping evidence of crummy driving caused by low vision, arthritis, dementia, or other conditions.

Yet it's this creeping evidence "“ those little signs of bad driving that should be the real red flags "“ not the can't-turn-back-the-clock tragedies, like a driver with dementia who got lost two states away or an older driver who injures "“ or, yes, kills. If you're worried, it may already be too late.

Old rule: Don't talk about someone else's finances; it's private.

New rule: Money is a family matter.

We're trained from childhood that an elder's finances are his or her own business. But fraud against older adults is on the rise. It's especially risky with people who have undiagnosed dementia; problems with writing checks, paying bills, giving to charity, and other money-related issues are a hallmark early sign of Alzheimer's.

The truth: Staying alert for signs of financial trouble in loved ones is loving and protective, not nosy.

Old rule: Love means promising to never put your loved one in a care facility.

New rule: Every decision has implications for others; you need to consider them all.

"Good daughters" don't, right? Loving mates don't, right? (See the poll: "Have you promised your parent you'd never put him or her in a nursing home?".) The problem with making a blanket decision to never have a sick older adult live outside your home is that other people are living in that home, too "“ your spouse, children, you!

And all of these affected parties need to be considered, too. Stories abound of marriages torpedoed, children neglected, and caregivers self-imploded by a caregiving situation spiraling out of control.

Fortunately the quality of and variety in alternative care situations continues to rise, which means there are nearly always options, often good ones. Sometimes the challenge is a matter of getting past the stereotypes in your head. You owe it to everyone involved (self included) to explore all options, with both heart and eyes wide open.

Old rule: Pursue every treatment possible.

New rule: Relieve pain and preserve quality of life.

Aggressive medical care for a loved one helps us feel like we're doing something, even when there's little left to be done. (Even doctors sometimes feel this way.) For most older adults with a chronic disease, unfortunately, there comes a point where the physical and emotional cost of continued treatments outweighs the benefits. Invasive tests may weaken the person or cause added discomfort, while creating uncertain or irrelevant results. Or treatments with a low likelihood of success may relegate to a hospital someone who'd prefer to spend the last days or months at home, without extending lifespan.

"Quality of life" is a great guiding principle for someone in late life, geriatricians often say. It's the idea behind palliative care, a growing option that remains open to curative measures while elevating the importance of preserving comfort and presence. Managing pain well, in particular, is one of the more overlooked aspects of late-life quality of life. Sometimes, a simple pain pill and your clear love can do more for your loved one than yet another complicated "cure" regimen.