Taking Care of Aging Family Members: A Practical Guide

Aging, Spring, 1996

1994. The Free Press/Simon and Schuster, 1230 Avenue of the Americas, 11th Floor, New York, NY 10020 Phone: 1-800-323-7445. 355 pp. Hardcover, $22.95, paperback, $14.95. ISBN 0-02-919518-7.

Helping caregivers to accept that caregiving can stir up angry and conflicted feelings as well as bring out the most loving and unselfish sides of their natures is one of the many gifts that the authors of this perceptive book have to offer.

Wendy Lustbader and Nancy Hooyman also help caregivers to understand that, given the hectic pace of modern life and more disconnected families and communities, caregivers' expectations of themselves may be the biggest block to effective caregiving.

Nancy R. Hooyman is Dean of the University of Washington School of Social Work and a recognized scholar on the subjects of aging, caregiving, and feminist social work practice. Wendy Lustbader is a medical social worker who specializes in outpatient mental health counseling at Pike Market Medical Clinic in Seattle and an affiliate assistant professor of social work at the University of Washington. Lustbader has also practiced in a home health agency, hospital geriatric unit, and a nursing home. She lectures nationally on chronic illness, aging, and the needs of family caregivers. This book is a revised and expanded version of a book by the same name published in 1986.

In their book, Lustbader and Hooyman confront problems th greatly distress caregivers but that they rarely discuss -- too much time together for a husband and wife when one partner is a full-time caregiver; the trauma of role reversal when a more dependent partner suddenly becomes the caretaker; excessive caretaking that leaves the ill person with nothing to do; the tendency of siblings to overburden the family leader with caregiving responsibilities but also for the leader to assume too much control; inheritance worries when the sibling who is the caregiver draws on the parent's life savings to pay for care; the suffering of the men in the family who feel they cannot weep; and the aloneness of an only child who becomes the sole caregiver to a parent.

The authors believe, however, that caregiving, despite its despairing moments, should be reinstated as a natural part of our lives and should be viewed, more than it is, as an opportunity for growth and deeper family relationships. They comment in their introduction: "Most people face a continued tug-of-war between their desire to take good care of aging relatives and other pressures impinging on their lives. Finding time for caregiving in the midst of other obligations is not easy. The societal emphasis on making money and enhancing individual goals has made caregiving an interference, rather than part of the natural rhythm of living and dying. The opportunities for personal discovery and satisfaction inherent in caregiving are not widely acknowledged, detached as they are from economic gain or social achievement."

In a section headed, "Why Take Care of Aging Relatives?," the authors comment that "long-standing patterns within families tend to limit what people do and say" and "can keep important topics off limits for years." "Caregiving," they believe, "can be an opportunity to change family patterns. In the midst of working together for the sake of aging relatives, family members often develop better relationships and discover new strengths in each other. There may be conflicts and tense moments along the way, but the whole enterprise of trying to ensure good care for someone loved in common can be a powerful force for unity and satisfaction for a family."

On the other hand, Lustbader and Hooyman are also aware that the illness and impending death of a parent can resurrect old family rivalries over a parent's love -- especially if one sibling is the preferred caregiver and executor of the will. In a chapter that lays out a sensible structure for a family meeting of siblings to discuss their caregiving roles, the authors are not afraid to acknowledge that, for some families, that kind of meeting could end in disaster -- so intense are the family conflicts. Having a caseworker contact members individually to find out their views on subjects, such as home care versus nursing home care, is the recommended course of action. Even for a meeting of a less fractious family, the authors recommend conversations by phone beforehand. They warn that just setting a date and getting together may be a "fruitless" activity.

The authors talk about the family conflicts that no one wants to admit, such as the wife of an only adult son who resents the time he spends with his mother, and suggest not necessarily happy solutions, but workable compromises that reduce resentments. While Lustbader and Hooyman follow modem therapeutic thinking in suggesting that acknowledging resentment, frustration or anger is half the battle, they offer solutions that are more than a matter of letting off verbal steam, ones that often require genuine effort and a willingness to be inconvenienced. Instead of trying to spend every minute with his mother, the only adult son could set up some routine she could look forward to, such as arranging a regular outing or asking neighbors to visit each Thursday to play a game of bridge. For the caregiver who is worn down by "relentlessly repetitive" chores, setting aside an extra half hour for a joint activity with the ill person, such as mounting photos in an album or tape recording family history, could bring a glimmer of hope to a seemingly hopeless situation.