Everyone has a breaking point: Laura Patyk's came while caring for three live-in elderly parents (including her father-in-law with dementia and her mom with congestive heart failure) and six kids under age 14. She developed terrible insomnia. She couldn't eat. Some days, despite her many daily chores, she couldn't get out of bed. One night, symptoms landed her in the ER. Diagnosis: physically healthy but emotionally and mentally exhausted.

“I was trying to do it all, be everything to everybody,” says Patyk, 45, who lives in Charlotte, North Carolina. “I was taking care of everybody but myself.”

10%

Percentage of adults who describe their health as "fair" or "poor"

17%

Percentage of caregivers who describe their health as "fair" or "poor"

22%

Percentage of caregivers who report worsened health due to caregiving

38%

Percentage of caregivers who report a “highly stressful” caregiving situation

Source: AARP’s Caregiving in the U.S. 2015 Report

Family Caregivers Today Are Highly Stressed

Most people don't enter caregiving thinking that they're putting their own health in harm's way. But those who provide care to a frail or needy loved one tend to live with high chronic stress and skimp on self care -- factors that raise the risk for numerous illnesses. And this, in turn, undermines the ability to continue providing good-quality care.

“Caregivers tend to be a special personality type: big-hearted, sensitive, responsible, well-intentioned -- people who are motivated by and take a deep satisfaction in doing right by their loved one,” says geriatric psychiatrist Ken Robbins of the University of Wisconsin-Madison. “But that's often to the exclusion of taking care of themselves.” Adding to health risks: Most caregivers are at midlife or beyond themselves, ages when their own chronic illnesses and weaknesses tend to surface.

If you're used to putting others first, how can you shift to not putting your own self last?

Not surprisingly, caregivers report higher levels of psychological stress compared to non-caregivers, according to a 2011 report by the UCLA Center for Health Policy Research. Caregivers also report stress at higher levels than other Americans, according to Stress in America, an annual report of the American Psychological Association, which names caregivers as one of the three most-stressed groups (along with the obese and the depressed -- and many caregivers “win” that triple crown).

Caregivers are more likely than the general public to have a chronic illness (82 percent versus 61 percent) and to rate their own health as “fair” or “poor” (34 percent versus 20 percent). Other research has shown that the longer a caregiver is in the role, the more likely he or she is to report a decline in health.

“The mind and body are connected. When you experience stress, there are a whole range of physiological changes -- every organ in the body is affected,” says Vicki Rackner, a clinical faculty member of the University of Washington School of Medicine and the author of Caregiving Without Regrets. “Sustained stress isn't good for the body, which explains why caregivers frequently die before their care recipient dies.”

Caregivers in poor health can't provide optimal care for someone else -- and they can't even provide decent care for very long. Both caregiver stress levels and caregiver health play a major role in the decision to shift care to a nursing home or other long-term care facility, research shows.

“Making the connection between your well-being and your ability to continue providing care is often the 'ah-ha' realization for caregivers whose own health is suffering,” Robbins says. “Only then do many make their own healthcare a priority.”

What is Caregiver Burnout?

Caregiver burnout is mental, emotional and physical exhaustion that may develop through the responsibilities of supporting and caring for another individual. “Caregivers often focus so intently on the needs of the individual receiving care that they may neglect their own health and wellness,” says Darren Sush, Psy.D., a licensed clinical psychologist and in Los Angeles.

As this lack of self-care persists, along with the ongoing obligations of providing care for a loved one, caregivers’ exhaustion often intensifies, impacting different aspects of their lives, as well as their effectiveness and compassion as a caregiver.

Sush says that burnout may be easily misunderstood as simply feeling overly tired, or even occasionally exhausted. “Unfortunately, while being tired can often be resolved by taking a break, getting a little more sleep, or actively trying to relax, burnout is more often less easily relieved. Individuals who experience caregiver burnout, tend to face an all-encompassing fatigue that impacts multiple areas of their lives,” he says.

Caregiver burnout can happen to anyone who is providing care for another person, whether it’s hands-on care, is only occasional, from a distance, or even at the “managerial” level, says Zina Paris, MSW, associate director of Clinical Services at Alzheimer’s Greater Los Angeles, a local non-profit that helps families affected by Alzheimer’s and other dementias. “It happens when you feel that the experience of caregiving is overwhelming and that you do not have the support – physically, mentally, emotionally, financially – that you need in order to successfully care for the person and to take care of yourself adequately at the same time,” says Paris.

Very often, caregivers can find themselves accustomed to the routine stress, worry, and discomfort that comes with providing care for a loved one. And as a result, Sush says you may not acknowledge warning signs of your own needs for gaining support.

Caregivers are among the three most-stressed groups in the country, according to the 2012 Stress in America Report by the American Psychological Association. Some researchers call the unique stress experienced by family caregivers a form of posttraumatic stress syndrome. As many as 70 percent of family caregivers show signs of depression, surveys show -- far higher rates than for peers who aren't in a caregiver role.

Recognize the Symptoms of Caregiver Burnout


1. A Short Fuse

Losing your temper easily or feeling angry toward friends, family members or even the person you’re caring for is one obvious sign of caregiver stress. Frustration may particularly increase when obstacles or challenges come up, whether major or minor.

2. Emotional Outbursts

If you find yourself crying or feeling despair unexpectedly or more often, that could be another warning sign. Of course, if you’re caring for a loved one with a declining condition, it’s natural to grieve, and caregiving can stir up a range of complicated emotions. But if you're increasingly emotional or feeling emotionally fragile, there may be something more going on. Depression is a real risk for caregivers. Even if you're not clinically depressed, emotional outbursts can be an unconscious outlet for feelings of being overwhelmed.

3. Sleep Problems

If you’re having trouble falling asleep, staying asleep, or waking up tired, that could be another warning sign. Caregiving -- especially full-time caregiving -- requires tremendous physical effort, but the emotions involved can lead to sleepless nights. Sometimes the issues your care recipient may be suffering from, like wandering or waking up in the middle of the night in pain, can cost you opportunities to rest on top of the tiring work you do all day. It can be a vicious cycle too, as trouble getting to sleep or staying asleep can also be caused by stress, anxiety, and depression.

4. Significant Weight Change

Suddenly gaining or losing weight can be another warning sign. For some people, stress can result in weight loss when they can't seem to find time to eat adequately or nutritiously. Anxiety often lowers the appetite as well. For others, feeling stressed or guilty leads to weight gain from mindless or emotionally triggered eating, frequent snacking, or quick but unhealthy food choices.

Changes in eating and sleeping habits can also indicate depression. If your weight has changed by more than five or ten pounds since you began caregiving, your body may be sending you a signal that you need help.

5. Physical Ailments

If you find yourself getting headaches more often or feeling like you just catch one cold after another, that could be another warning sign. Or if you’re getting chronic back or neck aches or developed high blood pressure. Mental and emotional stress can cause physical disorders. For example, stress can lead to headaches that are more frequent, more persistent, or stronger than you're used to. You'll also lack the time or inclination to properly take care of yourself, setting the stage for more stress. Stress lowers immunity, which is part of the reason caregivers have nearly double the risk of chronic illnesses compared to non-caregivers.

6. Social Isolation

If you find yourself going entire days while seeing no one but your care recipient or are dropping out of your usual activities to care for someone, that can lead to burnout as well. Getting out can simply be hard if you're responsible for providing care. You may feel you lack the time for your former pursuits. Your care recipient’s changes in behavior may also make you feel embarrassed or make going out in public too onerous to attempt. Whether intentionally or not, you may become withdrawn. Unfortunately, social isolation itself contributes to stress, whereas being with others and taking time for yourself are both replenishing.

7. Complaints from Family

If you’re getting complaints from family, or getting in more arguments with them, that could be a sign of burnout. It's a common caregiver temptation -- and mistake -- to take on the entire burden of care. It's also easy to make ourselves think that we have everything under control or that things aren't so bad. Denial is a powerful emotion. When you're in the thick of things, it can be hard to see other ways of doing it. Listening to an outsider can be healthy, even if you don't agree. What may sound like a criticism or complaint may have a nugget of truth that relates to your emotional well-being.

Which Caregivers are at Highest Risk of Burnout?

While caregiving is stressful for anyone, some groups tend to be at greater risk of deteriorating health and burnout than others, so it’s important to consider what challenges are unique to you. The following are among the most common family caregiver relationships.

Family Members

Anyone caring for a family member should be particularly careful to protect against burnout. According to a 2015 report by the AARP, caregivers who are caring for a close relative like a spouse or parent are at much greater risk of declining health as a result of caregiving, and people caring for relatives are at greater risk than those caring for non-relatives.

A survey of caregivers found that 37 percent of people caring for a spouse reported their caregiver role negatively affected their health, 25 percent of people caring for a parent reported a negative effect, and 17 percent of people caring for another relative. Of people caring for a non-relative, only 5 percent said it made their health worse.

What’s more, studies have shown that spousal caregivers of Alzheimer's patients in high-stress situations are less likely to get flu shots or take their medications when ill and are more likely to skip doctor’s appointments and to not refill prescriptions.

Parents

The sandwich generation -- squeezed between slices of elders and youngsters -- is taxed by a double burden of responsibility. “Adult children are generally more likely to be overwhelmed at first, because it's the first time they're experiencing role reversal with their parents and they haven't yet accumulated a lot of caregiving experience,” says I-Fen Lin, a sociologist at Bowling Green State University.

Although there hasn't been a lot of research done yet on the stress of a learning curve for caring, she adds, it stands to reason that unfamiliarity makes things more difficult. And that's doubly difficult when it comes at the same time you're on a parenting learning curve as your children go through new stages.

Live-in Caregivers

A key risk factor for caregivers is how many hours you put in and how consuming the work is. The average caregiver spends 20 hours a week in the role, according to National Alliance for Caregiving (NAC), a nonprofit coalition advocating for family caregivers across the U.S. But live-in caregivers put in almost double that amount (39.3 hours).

The AARP found that the number of hours spent caregiving is another risk factor for declining health, and that 30 percent of co-resident caregivers reported caregiving had a negative impact on their health.

Caregivers with live-in parents also tend to be part of the sandwich generation, still actively responsible for minor kids.

The economy isn't helping. Since the economic downturn, more older adults have moved in with families, and more families have moved into “the big house” to look after elders. The benefits of being in close quarters can also bring added strains.

Caregivers with Complex Duties

If your caregiving duties require nursing tasks, such as giving injections or dressing wounds, or if your care recipient suffers from an emotional or mental health issue, that can also increase your risk of caregiver burnout. The AARP found that of the 25 percent of primary caregivers reported declining health, 27 percent of those perform medical or nursing tasks, and 34 percent care for someone with a mental or emotional health issue like Alzheimer’s disease.

Alzheimer's caregivers have a uniquely high stress load. They tend to experience high levels of burden and stress due to the regressive nature of dementia (their loved one’s condition just keeps getting worse) and because there are few effective medical treatments. Compounding that stress, these caregivers often keep at it for years. The longer caregivers provide care, the more they report a decline in their own health.

In fact, 25 percent of the 1,222 Alzheimer’s family caregivers tracked for the National Institute of Health’s Alzheimer's REACH-1 (Resources for Enhancing Alzheimer's Caregivers' Health) project in 2008 increased their personal use of health services over 18 months. Emergency room visits by the caregivers doubled, as did their use of hospital-based services. Plus, self-rated health scores declined steadily and significantly over the 18-month study.

Medical problems add to uncertainty and stress, too. Patients are being discharged from hospitals and rehabilitation facilities earlier and sicker than ever, placing a burden on families unfamiliar with such technical aspects of care as IVs, oxygen, and more, says NAC President Gail Hunt.

“Many older adults are being sent home from hospitals with devices intended for nurses or someone with training, like respirators, suction devices, and catheters,” Hunt says. “In one study, a caregiver reported that a nurse said, ‘Now I'll show you how to do it -- and if you don't do it right, he could die.’” Talk about pressure.

Women

Women make up the majority of family caregivers and tend to work more hours at it than men. According to the AARP, six in 10 caregivers are female, and 62 percent of higher-hour caregivers, who provide more than 21 hours of care per week, are female as well. Of this group, married women may be at greater risk of burnout, as 27 percent say that providing care has adversely affected their own health, compared to 16 percent of unmarried women or 20 percent of men.

“Male caregivers usually have more positive feelings about the caregiving experience than women,” says sociologist Lin. “Not because they enjoy it more -- but because in the U.S., we assume women will take care of the elderly. So if they do, they're taken for granted. We don't have high expectations of male caregivers, on the other hand, so friends and relatives give them more praise and positive feedback for what they do.”

This means: The applause men get compensates for a lot of the stress they're experiencing, Lin says, which reduces their overall perception of stress.

Men

Women still outnumber men when it comes to family caregivers. But the number of men caring for an older adult has doubled in the past 15 years, from 19 percent of caregivers in 1996 to 40 percent by 2009, according to data from the Alzheimer's Association and the National Alliance for Caregiving (NAC). More men than women provided long-distance care in that period, too.

Men also tend more to be working simultaneously with providing care, according to the AARP. For male caregivers, 66 percent were employed compared to 55 percent of females. Men also may face steeper emotional challenges than women, struggling with the most intimate aspects of caregiving and facing a stigma that might stop them from seeking help.

Jean Accius, an AARP policy expert in caregiving, authored a report published in 2017 to draw attention to male caregivers and to dispute stereotypes about them. One of the biggest misconceptions about male family caregivers is that they’re only taking on tasks like financial assistance, household chores and shopping, according to Accius.

But he says that they are often taking on the most personal tasks of caregiving, helping patients with eating, bathing and dressing, and even handling nursing tasks like giving injections, tube feedings or wound care.

It’s these deeply personal tasks that men tend to struggle more with than women, Accius says. Many men the AARP surveyed said they felt unprepared or uncomfortable doing those types of tasks.

Complicating matters, men are also less likely to seek help and talk about the emotional challenges they face with caregiving. Accius says he’s heard from men from throughout the U.S. that they tend to “suck it up” rather than seek help. But by not expressing their experiences, these men are at greater risk of anxiety, isolation and depression.

“Most of the male family caregivers agree that caregiving is stressful, but very few reached out for help,” Accius notes.


Coping Strategies for Caregiver Stress


1. Seek professional guidance and support groups

Enlisting the help of a therapist is one option. “That provides a safe, sympathetic, and constructive environment where caregivers can express their wants and needs,” says Darren Sush, Psy.D., a licensed clinical psychologist in Los Angeles. Support groups for caregivers, even highly tailored ones such as for Alzheimer’s caregivers or particularly for men, may also be available in your area, though most caregivers find it difficult to get out of the house for support groups in their limited free time. Ask at local hospitals, senior centers, places of worship, or the Alzheimer's Association.

2. Ask family and friends for help

Find others who can step in and give you a break. Not only will it give you some time to relax, but those filling in will better understand both your needs and your care recipient’s needs. Make sure to express your gratitude: It's sometimes a good idea to either pay a small amount or to compensate family or friends informally with gift cards, restaurant meals, or other goods or services. Ask your loved one who they would most like to pitch in, and when approaching potential helpers, be specific about what's required and get a solid commitment about the days and times they're available.

3. Bring your employer into the loop

Caregivers are often reluctant to bring up caregiving distractions at work, but you may be eligible for caregiving-related programs, including leave time, flex time, free needs-assessments by geriatric care managers, and more. Not all companies offer such programs, says Gail Hunt, president of the National Caregiving Alliance in Bethesda, Maryland. But of the 18 percent of the workforce that's eligible for such programs, only 2 percent are using them, she says.

4. Adopt a problem-solving approach

Try to break down the tasks of caregiving into specific puzzles to be solved: If bathing is stressful, try to figure out exactly why and what might be done about it. Do you fully understand why people with memory problems say and do the things they do? Are you intimidated by a piece of medical equipment? Defining concrete problems and identifying possible solutions puts you closer to getting help with them and helps you avoid feeling overwhelmed by the big picture.

5. Listen when your body talks

“Pain in your body is like a warning light in your car,” says Vicki Rackner of the University of Washington School of Medicine. “You ignore the ‘E’ on the gas gauge at your own peril. Your body is no different.” Chances are that ignoring a new symptom isn't going to help it go away; it will only start shouting at you by getting worse.

6. Connect with your loved one's doctor

“Everyone is better served -- including the caregiver -- if the caregiver is included as part of the team,” Rackner says. Research shows that when doctors find ways to address the unique needs of individual caregivers, the stress load is reduced -- admittedly a tall order when physicians are short on time and have a primary relationship with the care receiver.

7. Schedule yourself in

Caregivers spend an inordinate amount of time with a loved ones’ doctors but seldom see their own. Make your own appointments for regular exams, flu shots, dental visits, and the like at the same time you arrange a loved one's. Some practitioners allow simultaneous visits for pairs who share providers.

8. Find healthy emotional outlets

Caregivers need at least one safe place to vent. Maybe this is a friend who agrees to listen without judging, or a diary that's scribbled in and then burned. Peer support from others in similar situations is ideal. Online caregiver forums provide safe places to vent 24/7.

9. Find ways to exercise

Although many caregivers are daunted by the idea of finding time or opportunity, and still others loathe the idea of spending precious free time working up a sweat, doctors increasingly agree that if you do just one good thing for your overall health, it's moving your muscles and working your heart a bit every day.

Lifestyle Changes to Alleviate Caregiver Stress


1. Have a social life

Make sure you take time for your friends so they don’t disappear. You may be feeling isolated or annoyed that your old circle no longer seems to check up on you and how you're faring. But is it possible that you've turned them down so often because of your caregiving duties, or that caregiving concerns so dominate your life and conversation, that they got the message you're just not interested in them? So when you do see them, don’t just talk about caregiving. If every conversation concerns one subject, it's a warning sign that topic is monopolizing your life.

2. Take a vacation

Vacations are really hard when you have a disabled or impaired person to consider, but not being able to even remember the last break you had is a sure sign you're due for one. It doesn't have to be three weeks in France. Start small if you must: a simple overnight at a friend's house or a local B&B. Just do something. To stop caregiving stress, stop caregiving sometimes.

3. Get a hobby

Your hobby doesn't have to be a conventional one like stamp-collecting or bird-watching, it just needs to be an outlet away from caregiving. Reading trashy novels uninterrupted, taking up knitting, joining a book club, taking adult ed courses, being a matinee-movie addict, or enjoying your children and grandchildren all count, too. Anything that takes you away from caregiving for bursts of time. Bonus points if it takes you out of the house, too.

4. Address sleep deprivation

If you can't sleep because someone with dementia or other health issues is disrupting caregiver sleep, first make sure your care recipient’s “sleep hygiene” is in order. That means making sure they’re not having stimulating beverages or activity late in the day, have a quiet, dark room and proper clothing for sleep, are turning in to a proper bed and not nodding off in a chair, and aren’t using TV or electronics in the bedroom at night. Also make sure your own sleep habits are similarly healthy.

Also discuss sleep issues with your care recipient’s doctor and make sure no medications are interfering with sleep. While dementia can lead to sleep disruptions, that can often be remedied with a consistent routine and steps to reduce anxiety.

5. Plan and prepare

Constantly refill what's depleted so you’re not stressing about running out of anything. Learn as much as you can about your loved one's condition(s) and how it/they typically progress. Caregivers are sometimes reluctant to “read too far ahead” for fear they can't relate to later disease stages. They're also prey to fear of ‘jinxing’ -- worrying that if they think about something, it might come true.

Diseases are realities, not wishes. Ask your loved one's doctor to be candid about the prognosis and course of the disease, read info online, ask others who've been there. If your loved one has dementia, understand the various stages, where your loved one likely is, and what to do next.

It could also help to focus on some “if this, then this” scenarios. This type of thinking helps you at least begin the process of considering where you might find more help, what kind of home modifications would help and how you'd get them done or alternative living situations.

6. Find some privacy

Having physical privacy means having boundaries that let everyone in the house get away from 24/7 interactions, but it's especially challenging in small living spaces or when you have live-in care recipient with dementia. The disinhibition that can be part of a dementia like Alzheimer's can lead a loved one to barge into bedrooms and bathrooms, for example.

Make necessary home improvements to allow the live-in care recipient to have his or her own space, not just for sleeping but also for living: a TV set and comfortable chair, a desk, opportunities to get out of the house. Establish household rules everyone agrees on for the use of the TV, the kitchen, and other possible points of conflict. Keep in mind, though, that in the case of dementia, rules become less realistic as the disease progresses. Use locks and a low-key response to help manage disinhibition; explain it to kids so they're not frightened.

If boundary-intruding becomes overwhelming, talk to the doctor about making sure medications (like antianxiety drugs) or alcohol use aren't contributing to the problem. If aggression is the problem and it can't be managed with behavior modification or medication, realize this can be a deal-breaker for home care. Everyone in the house -- including you -- must be safe.

7. Find new ways to manage overwhelming care tasks

Make sure you're not trying to solve the problem alone. Brainstorm possible solutions with other family members, a social worker or geriatric care manager, doctors, and friends -- including virtual ones -- who may have experienced similar issues.

Be sure there's been a through physical exam to see if a problem, such as incontinence, is fixable. Adult diapers and toileting schedules, or a change in medications, may make incontinence more manageable, for example. Frequent falls and problems getting up are other physiological problems that may be treatable. For behavioral issues such as wandering, learn the basic ways to address the problem (for example: floor alarms, locks, reducing anxiety) and see if they make a difference.

Explore whether bringing in more help, such as personal care assistants or nurse aides, can buy time and get you through difficult challenges. If you've explored every option and things still aren't working, ask yourself if you're resisting out-of-home placement because of guilt.

8 Common Respite Care Options for Family Caregivers

Regardless of a caregiver’s stress levels, there will inevitably come a time when alternative care options for their aging loved one. Today, there are a wide range of respite care options for times when family caregivers have to tend to personal obligations, take a vacation, or simply need some time off from the often overwhelming responsibilities of caring for their aging family member. What follows are some of the most common respite care options for elderly adults.

1. Companion Care

An elder companion can prepare meals, do light housekeeping, help with laundry, shop for groceries, run errands -- and, most important, offer companionship to the elderly person you care for when you can't be there. Its cost can range from free services provided by local volunteers to $10 or more per hour for help arranged through an in-home care agency, depending on the type of care needed and the time of day. Medicaid or a similar state program may help pay some of the costs of respite care from a licensed provider for those who have low incomes and few assets.

From local sources to national groups and organizations, there are many sources for companion care. If you know of a neighbor, friend, or family member who's been able to find a good match for companionship needs, ask how -- and whether he or she might be able to recommend others for the position.

Start your search by using Caring.com's In-Home Care Directory to find an agency near your elderly loved one -- and to see ratings and reviews.

2. Personal Care Assistants

in addition to providing light housekeeping and homemaking tasks, personal care assistants can help clients with bathing, dressing, toileting, and grooming. They can't provide medical services, such as diabetes care, but they can help administer prescribed medications and -- if they have the proper training -- help move those who have mobility limitations. Costs range from $15 to $40 per hour for intermittent help; $120 to $200 per day or more for live-in care.

You can locate in-home care agencies in your area by searching Caring.com's Senior Living Directory.

3. Adult Day Care

Adult day services, also known as adult daycare, provide some health monitoring, mind and body exercise, social activities, meals, transportation (often door to door), and other support services. Most offer a safe, supervised environment for clients as well as respite for regular caregivers. Facilities include stand-alone centers, churches, hospitals, and nursing homes. The cost from a licensed provider ranges from $25 to $150 per day; many offer sliding-scale fees and accept Medicaid and some types of insurance coverage.

It's best to contact and tour possible adult day services providers to find the best fit for your loved one. Two good places to find leads: Use Caring.com's Senior Living Directory to search for adult day services by city or zip code -- and to see ratings and reviews. Or contact the staff at your local Area Agency on Aging and ask for a referral.

4. Assisted living respite care

Many assisted-living facilities, continuing care retirement communities, and nursing homes (also known as skilled nursing facilities) offer room and board for older adults who need help with everyday tasks. Time frames range from a partial day to several weeks. The stay allows residents and their families peace of mind, knowing that a caregiver is always close at hand. A possible added benefit: The arrangement allows a commitment-free way for a potential resident to check out whether the facility might be a good fit down the line. Many facilities offer hourly, half-day, full-day, overnight, or extended respite stays. Costs average $100 to $250 per day, depending on the amount of care needed; some places impose minimums and maximums on the number of days for a respite stay.

Some facilities offer respite stays only when not at full capacity, and some don't advertise their respite services openly, so you may need to do some investigating to find a local facility that offers the service. Some places to contact for help: Go to Caring.com's Senior Living Directory and search for assisted living facilities and nursing homes by city or zip code.

Contact the staff at your local Area Agency on Aging and ask for a referral.

5. Caregiver Co-op

Organized co-ops give members an affordable way to pitch in and take turns caring for one another's charges in exchange for some time off. The arrangement not only gives caregivers more time for themselves; it also fosters a sense of community among both those who give and receive the care. There's usually no charge; members qualify for respite services by volunteering time caring for other co-op members’ loved ones.

Talk with neighbors or friends who have similar needs; in such cases, it is usually a good idea to have a central person charged with keeping track of the availability and scheduling of the volunteer caregivers. Or check with local community centers or adult day services providers to see if one has already started a co-op.

6. Veterans’ Options

The Veterans Administration (VA) offers a number of programs and support for veterans and for some wartime veterans who are caring for their spouses -- all designed to give the primary caregivers some help and time off. Many local VAs operate adult day healthcare centers, open Monday through Friday, which offer caregiver respite and focus on rehabilitation for veterans.

The VA's home-based primary care program delivers care such as meal planning and preparation, medication management, nursing, and social services to some veterans whose medical issues make it difficult to leave home. A similar VA program, Skilled Home Care, offers this care from licensed non-VA medical professionals. The VA also provides qualified veterans with up to 30 days of respite care each year at home or through temporary placement of a veteran at a VA community living center, a VA-contracted community residential care facility, or an adult day healthcare center.

The services are generally free or offered for a minimal amount for qualifying veterans and their family members. Both a telephone hotline and website can help you in this search.

Staff at the VA's Caregiver Support Line, available Monday through Saturday at (855) 260-3274, can explain what assistance is available from the VA and help callers get access to other local services.

Also, most VA offices are staffed with licensed caregiver support coordinators who can help match callers with services for which they're eligible. Find the local coordinator by searching by zip code on the VA's Help Near Home page.

7. The ARCH National Respite Network and Resource Center

The ARCH National Respite Network and Resource Center helps caregivers and professionals find respite services in their local area to match their specific needs for emergency or planned respite care. Although it doesn't provide an exhaustive list of all possible providers, it can be a helpful source in helping to jump-start a search. The service is free; the cost of respite services varies greatly. About 30 states run Lifespan Respite Programs funded by the Administration on Aging that helps fund local respite services.