by Betty Brock

• Caring for a terminally ill family member or elderly family member is often a complex and overwhelming journey for a caregiver. Some have said that caring for the elderly is like caring for children, especially when the elderly person has lost much of his physical and mental capacities and seems to be in a second childhood. But, the two are not at all the same. Probably the greatest difference and that which changes the entire scenario is that the elderly is moving from independence to greater dependence and ultimately to physical death. And generally the care gets tougher the longer it continues. With children, parents go from one exciting milestone to another; with the elderly the milestones are declining milestones and are leading to death, grief, and loss. The conversation that a mother shares with a father at the end of a day is about all the new things a child has done; the conversation of the caregiver of the elderly very often centers on declining health, loss of mobility, and deteriorating mental responses. Diapers and potty chairs bring to mind a very different picture.
• Because caregiving situations are so varied, ask a variety of questions so that you can have a complete picture of what the caregiver is dealing with. She may be providing transportation to the grocery store or the doctor or may be providing 24/7 care in one’s home. The time extent may be from one hour a week to every waking hour (with very few sleeping hours left over). The longer the caregiving extends, the harder and more extensive the responsibilities usually become. You will want to find out the following information from the caregiver:

1. Personality or emotional makeup of both the aging loved one and the caregiver; spiritual gifts of caregiver
2. Health of aging loved one; health of caregiver; extent of caregiving
3. Living situations (size of home, children in home, privacy)
4. Resources—use and knowledge of; belief concerning receiving help from government or support groups
5. Relationships (husband, children, siblings, aging loved one)

• In the course of one day, a caregiver may be giving care out of many motives—duty, love, expectation, pity, reputation, or just dire necessity. God’s desire is that we would serve others out of love all day. Helping the counselee to come to the place of desiring what God desires should always be a goal and prayer in our counseling.
• One of the greatest problems that caregivers face is the desire or misconception that they need to do this on their own. The loved one may desire (and often demand) that only the counselee take care of them. Siblings may hesitate at the thought of another person other than the family being involved, but may be unwilling to actively get involved. The counselee may believe that the care is her responsibility and she should be able to do it alone. On the other side of the spectrum is the counselee who believes she should not be responsible for any of the care and is frustrated and angry at the aging loved one, as well as the siblings or her spouse. This attitude could stem from how she has been treated by this person in the past, to what her present plans and responsibilities are and what she may be giving up, to the concern that she is unskilled and feels inadequate for this undertaking.
• Most caregivers did not plan their life as it is happening. Many had always planned to take care of their parents in some way but had quietly hoped that it would not ever be such intensive caregiving. Studies show that people between the ages of 45 and 65 worry more about caring for aging parents than about the death of parents, losing a home, separation from children, or marriage breakup. Only the death of a spouse created more worry. Counselors may need to help the caregiver learn to trust God and His love, knowing that He does all things well in just the right time.
• Information may be one of the greatest needs of the caregiver. They need to know what resources are available to help them financially, practically, legally, and medically. If you can teach them how to access these services (Knowing where to call, logging of calls and contacts, letter writing, asking questions, etc.) rather than doing the work yourself, they will be better helped. Sometimes they just need someone to walk them through a frustrating situation; sometimes they may need someone to take over when it has become too overwhelming. The paperwork of insurance, Social Security, Medicare, and medical establishments are sometimes more than a tired person can bear.
• Everyone has limitations and a caregiver may need help in understanding and accepting their limitations. You may need to help them to know when they have reached the limits of their caregiving abilities, especially if the aging loved one has a progressively serious health condition.
• Developing caregiving skills can save time and energy and protect their own health. Help them to make arrangements for an occupational therapist to visit their home and teach them some of those skills.
• A caregiver needs encouragement—lots of encouragement. “You poor thing” is not what she needs, but she does need someone to ask about how she is doing sometimes—not just how her aging loved one is doing.
• A caregiver needs to laugh as does an aging parent. Proverbs 17:22 tells us that “a merry heart doeth good like a medicine: but a broken spirit drieth the bones.” Proverbs 15:13 again speaks of the merry heart: “A merry heart maketh a cheerful countenance: but by sorrow of the heart the spirit is broken.” A wise caregiver will make a special effort to have a merry heart; a wise counselor will encourage her in this endeavor. When a caregiver decides to keep a happy heart while dealing with the elderly, the spirit of the elderly is affected.
• If a caregiver is giving 24/7 care, they must have time away from that responsibility. Most elderly who go into nursing homes do not go in because of the deterioration of their own health, but rather the deterioration of their caregiver’s health. Help the caregiver go to a ladies’ retreat where she will be rejuvenated physically and spiritually. In order to visit other family, she may need help in making a plan for such a visit, because making the arrangements may be harder than not going at all. Those who will “Grandma sit” are often harder to find than those who will babysit. Help the caregiver develop a list of those who will help, either through volunteering or through pay. Before planning a time away, pray with her over the list asking for the Lord’s help in the arrangements.
• Galatians 6:2 tells believers to bear one another’s burden. Enlist the help of other ladies in encouragement, sharing the burden, and praying.
• Communication with family about the care of a loved one can become messy. Hard times, such as when parents are aging and deteriorating will often bring out the worst in families. Secrets that have been covered for years are often uncovered as folks see death is near. They desire to clear their conscience. This is a time when the lack of good communication in the average family shows its ugly head and makes a hard situation almost unbearable. As family secrets are uncovered, the counselee may need help in forgiving or seeking forgiveness.
• Dealing with parents who are suffering from dementia or Alzheimer’s disease is difficult for the caregiver and sometimes unsafe for the loved one and those living with them. Again, helping them to find the right information in dealing with the increasing decline of health may be needful.
• Dealing with a parent whose mental capacity is fine, but their spirit and attitudes are not, adds a tension to caregiving that is hard to bear. The caregiver will need to understand that honoring a parent is not synonymous with that parent’s running roughshod over them or their family. A sweet reprimand is not out of place, but the reprimand is best given at a neutral time and not just as something unkind has been said. Encourage her in the virtue of graciousness, yet help her to be discerning concerning limitations and unsafe situations for her children or the aging loved one. Caregivers sometimes need to be reminded of the losses (cherished roles in life, careers or jobs, perceived usefulness, being needed or enjoyed, siblings and lifelong friends, independence, involvement with children, possibly their spouse, home, hometown, friends, etc.) that their aging loved ones are going through in order to lovingly show mercy.
• Honoring a parent is often best done simply. Books are available as well as websites that give simple and practical ideas on how to honor parents and to teach children how to honor their grandparents or the elderly. Simplicity is the key word here. Caregivers should not get caught up in trying to make up for prior negligence, get involved competitively with siblings as to who can do the most, or even be manipulated by the aging loved one into an elaborate scheme that causes hardship on those involved. One of the best ways to honor a person is by listening to them and discussing their life—past, present, and future.
• Caregivers with children in the home must be careful not to neglect the care of their children or the special times with them alone so that the children will not resent the fact that Grandma lives with them. Making children a part of helping in ways children enjoy and commending them for their patience and love for the family members helps them grow sweet rather than bitter through the experience. Often children give up the most in caregiving situations, including their room, their ability to have friends over, and their time with their parents. Remembering these sacrifices and letting them know that God sees as well encourages them.
• Caregivers need interests and ministry outside their caregiving. You can help them find a ministry where they can serve, even if they cannot be away from the home very often.
• Bible studies and homework that center on God’s love and care will be an encouragement on those discouraging days. Learning to give each day to the Lord and to take each day a step at a time is a challenge for the caregiver, but it is the only way to learn contentment in caregiving. Plans are unusually fragile when one is caring for someone whose life seems fragile; therefore the challenge is to continue making plans while living day by day. A friend wrote to me recently about her days of taking care of her mother for many years, “It wasn’t until she lay in her dying days that I FINALLY realized the Lord only wanted me to walk the NEXT STEP . . . He would care for it all STEP by STEP.”