Focus on the Family

Becoming Your Loved One's Caregiver

by Focus on the Family

Most people begin to experience the consequences of aging gradually. Since you are aging too, you may observe yourself having certain difficulties even as you attempt to help a loved one who may be further along in years. For example, you may need bifocals, just as your elderly loved one may need cataract surgery. We are all on the same journey toward our final destination. We just have different roles at different times. If your loved one is ahead of you in years or is growing frail more quickly, one of your roles for a while will be that of a caregiver.

Difficulties by Degree

Your loved one's difficulties may have increased slowly, making you a caregiver by degrees. Perhaps you first started driving Mom to her home after dinner at your place; then you had to write down important events on a calendar for her; now she needs daily visits so you can be sure she has taken her heart pills. As people live longer, many develop chronic ailments that require more hands-on assistance over a longer period of time. You may have become a caregiver precipitously, after your husband's stroke. Elders often take an abrupt downturn in health after an illness or accident that requires medical intervention and hospitalization.

Either way, you are finding that you must become a caregiver. The role means far more than caring about others or feeling concerned for their welfare. Most likely, you have always felt appreciative of and devoted to your parents, grandparents, aunts, uncles, spouse, or older friends. But now they need more than your time and tender feelings. They need help with concrete tasks — paying bills, grocery shopping, deciding when it is time to see a medical specialist, or even changing soiled bed linen at 3 a.m. You may need to arrange for professional services and transport your loved one to appointments and social activities. As your elder's health deteriorates, you might be called upon to supervise financial affairs and medical treatments while working with professionals such as physicians, attorneys, CPAs, and insurance agents. When you assume such tasks and accept major responsibilities for the well-being of elderly adults, you become a caregiver.

The Spouse

When spouses are present as elderly people fall ill, they almost invariably become the principal caregivers. Elderly spouses are often enormously loyal to each other. But this arrangement can be tenuous. If you are a caregiving spouse — unless you happen to be a young one — you probably feel the effects of your own aging. What if you are asked to help your wife learn to walk again after her stroke, but you do not feel all that steady on your own feet? One devoted husband needed to help his wife to the bathroom several times during the night, even though he needed to take pills for his own difficulty sleeping at night. If you are such a caregiver, you might think privately, We could both use help. But since I haven't had a heart attack in 10 years, nobody seems to notice my needs.

Lifelines for Caregiving

When it comes to caregiving, you do not need to do it alone. Because of the needs of the aging population, a growing number of services and devices are available to help you, ranging from transportation services and adult day care to wheelchairs and home modifications. Yet one of the most frequent reasons caregivers give for not using a service is that they were not aware of it. Some caregivers report that they or their aging loved ones were "too proud" to use a service, such as adult day care (although somewere confused about what adult day care is). Fewer people cite cost as a barrier to obtaining needed services.1

When you seek out caregiving options for your elder, community services (especially those coordinated through your elder's local Area Agency on Aging), help from family, or a support group for yourself, it is not a sign of defeat or weakness. You will need a break from caregiving from time to time. High on your list of resources should be services for respite care that will provide opportunities for relief from the day in, day out responsibility.

Guidance From Others

You will also benefit from the practical guidance of other caregivers, whether they are friends from church or the members of a caregiver support group on the Internet. When a caregiver named George was trying to decide how best to care for his grandma, who could no longer live on her own due to Alzheimer's disease, he called his pastor for advice. Although his pastor had never been through the rigors of caring for an aging loved one, his father had. So George called his pastor's father. He ended up calling the man on a regular basis for advice and emotional support.

"You can read the printed word, look at research on the Internet, and learn about dementia or other diseases, activities that are all well and good for the purpose of educating you, but the best help often comes from someone who has walked a mile in your moccasins," says George. "Somebody who's been through it can tell you, 'Here's what I did right, and here are some mistakes I made.' They can speak from the heart."

On the bad days, look forward; give your complaints to God with an attitude of resting in His perfect will. Remember that God placed you in your particular family and is aware of your needs. He is "a very present help in trouble" (Psalm 46:1 NASB). You might feel that somehow you have to have all the answers, but you do not. Caring for elderly adults comes with some uncertainties and surprises. Accept your human frailty and ask God to provide the strength for each day.

Christians are not meant to carry their burdens alone. As a caregiver, you will need not only professional help and social services from the community; you will also need support, encouragement, and inspiration from your church or religious community. Some churches have explored specific ways to help caregivers; others might be open to providing more assistance if they knew how. Your role may include asking for help that is already available, learning how to receive it graciously, or suggesting ways the church can be more helpful or available.

1National Alliance for Caregiving and the American Association of Retired Persons, Family Caregiving in the U.S.: Findings from a National Survey (June 1997).

Caregivers Need to Care for Themselves as Well

When caring for an aging loved one, do you ever ask, When is it okay to take care of myself? Or, How long can I go on like this?

by Focus on the Family

Caring for an aging loved one is a labor of love, but it is labor. As your elder becomes more frail and needs more of your time and energy, you may find yourself giving up outside activities and vacations, saying no to friends, feeling distracted at work, and getting stressed at home. If you try to do everything, you risk neglecting your own health.

To stay afloat, you will need the help of friends; family members; relatives; local, community-based organizations; and hands-on resources. You will need wisdom, inspiration, and discernment, because your many responsibilities leave little time and energy for self-care.

Most of all, you will need God's grace to help you stay faithful to fulfill your role as a caregiver effectively and compassionately.

Preserving Your Health and Well-Being

As a caregiver, it is critical for you to take good care of yourself — even while you are taking care of your aging loved one. Finding that balance can be a challenge, but now is the time to establish some healthy goals and habits. If you already are nearing the point of burnout, it is time to identify the reasons and make some changes.

Do you find yourself becoming chronically irritable? Too fatigued to eat right and exercise? Often depressed or hopeless? Feeling angry and guilty at the same time? These negative feelings are a signal that you need to take better care of yourself. Otherwise, your emotions will threaten your well-being, lower your resistance to disease, and make life miserable for you and your loved ones.

The physical demands of caregiving can also affect your health, aggravating osteoporosis or causing bursitis or damaged discs. Bathing or lifting an elderly person, for example, can be physically difficult for a caregiver to perform; carelessness can lead to injury, especially if you are pressed for time. You need to admit that there are limits to what one person can do and then seek some outside help.

The challenges of caregiving may seem formidable, and the consequences — emotional, physical, economic, relational, and spiritual — overwhelming. However, not everything associated with caregiving is difficult or stressful. Many caregivers gain a sense of fulfillment and satisfaction from their role. Support and encouragement from others is also helpful. In fact, the caregiving pathway is lined with hidden blessings if you know how to look for them. Where you least expect it, hope appears. The Lord's grace is tucked into hard places.

Caregiver Burnout

It is important for caregivers to have a support network in place for assistance and relief.

Those who do not have emotional support may suffer burnout. Consider these statistics from the National Family Caregivers Association:

The happier and healthier you are, the better your loved one will be served. Try these 11 ways to keep the threat of burnout at bay:

  1. Determine services available in your area, and ask for the help you need.
  2. Make healing habits of prayer, Bible and inspirational reading, music, and fellowship.
  3. Model an attitude of respect for both children and the elderly in your family.
  4. Plan your schedule around predictable mealtimes.
  5. Look ahead and include fun family activities in your schedule.
  6. Anticipate health concerns; keep nourishing snacks on hand, exercise consistently.
  7. Don't major on the minors with family members. (Save your steam for big problems.)
  8. Delegate household chores, but keep them simple.
  9. Listen well and learn to read between the lines with children or elders.
  10. Give yourself permission to enjoy hobbies. Take yourself out for a personal date.
  11. Don't entertain "what-ifs" and "if-onlys." Say, "I am doing the best I can."

Most caregivers have not planned for the role, and although many accept it with grace, others are forced to assume it. Most do not feel prepared to address the many issues ahead of them. You might be grieving the fact that the person you once looked to for advice and direction is now increasingly dependent on you.

Be Anxious for Nothing

Faith in our trustworthy God helps to dissolve our fear and personal insecurities. If, as the old hymn states, you are "cumbered with a load of care," tell the Lord about your worries. Follow this biblical advice:

"Be anxious for nothing, but in everything by prayer and supplication with thanksgiving let your requests be made known to God. And the peace of God, which surpasses all comprehension, shall guard your hearts and your minds in Christ Jesus" (Philippians 4:6-7 NASB).

Remember that God is able to handle your concerns. Peace is promised as you lean on Him and learn to turn every worry and need over to Him. As you do this, your doubts and fears will begin to subside, even when you do not understand everything.

Encourage Your Elder's Faith and Spiritual Life

Though your elder loved one may be ravaged by old age and mental difficulties, their need to actively practice their Christian faith is important.

by Focus on the Family

One area that provides room for continuing growth in the senior years is the spiritual domain. The body may break down, but the spirit is still capable of growth, renewal, or even new birth in old age. Those who are "spiritually dead" can find spiritual life through a new or renewed faith commitment in Christ. The new believer can grow toward spiritual maturity. The spiritually mature person can keep growing in wisdom, love, joy, and other spiritual gifts. In fact, many of this world's greatest prayer warriors are senior citizens. In spite of changes, losses, and chronic health conditions, elderly people can continue to cultivate their relationship with God.

Too often, however, elderly people encounter obstacles to spiritual support systems. Some are too feeble to get to church or to participate in religious activities with other believers. As their friends die or move away, they may lose their connections to the community of faith. Others feel alienated in churches that focus most of their energy on attracting a younger crowd. Failing eyesight can make it hard to read the Bible, and hardness of hearing can make it difficult to hear sermons. Seniors may be affected by negative stereotypes and myths that project old people as unteachable, useless, unproductive or dependent on others. Like all Christians, seniors need the fellowship and encouragement of other believers. Faith that is not nourished stagnates.

Aging in Body but Not in Soul

What can be done to foster an elder's faith? As a caregiver, you have a special opportunity to demonstrate the love of God to your elder. Your sensitivity to your aging loved one's spiritual needs can give comfort and stability in a time of change and uncertainty. Looking up to your elder spiritually is very affirming to him. A minister or chaplain can keep in contact with your elder too. Despite the obstacles, spiritual growth is both possible and desirable for the continued well-being of elderly people.

Gallup polls have shown that three-fourths of Americans past age 65 consider religion to be very important. A 1997 study found that people tend to pray more as they age; nearly 75 percent of the study's oldest respondents prayed at least once a day.1 And although Bible reading has declined since the 1980s, half of all Americans over the age of 65 read the Bible at least weekly, compared to 27 percent of people between the ages of 18 and 29. 2

But do we become more religious as we grow older? It seems logical to think that people who have more free time and who are nearing the end of life would become more religious in their later years. Yet research indicates that this is not true for most older people. Religious behavioris related to previous religious activity, the period or time in which a person was raised and lived most of his life, and whether he has chronic health problems.3

Wake-Up Call for the Church

America's changing demographics should send an urgent wake-up call to the church. The population of the United States is growing older. The elderly population is expected to continue to grow tremendously, with the oldest-old (85 and older) as the fastest-growing sector.4 For the last quarter century, the birth rate has fallen while the senior population is exploding. Yet most American churches continue to focus on youth programs and reaching out to the next generation while neglecting the fastest-growing sector of society. We certainly need youth ministries, but we also need equally passionate plans to integrate older people into the life of the church and to reach out to those who are too frail to attend.

There are benefits to remaining active in a religious community. Church attenders are not only more likely to avoid unhealthy actions, such as drunkenness or smoking, but they also have a stronger social network to call on for advice or help—important for both caregivers and elders. Frequent church attenders develop close ties with friends, neighbors, and relatives, and these have a positive impact on their health.

While many elderly people do attend services, for others church attendance is a negative experience. One reason is that many churches and denominations have undergone dramatic changes in recent years, such as reexamining their doctrinal stances regarding the role of women in the pulpit, contemporary music styles, homosexuality, and other issues. The result is a church very different from the church of years gone by.

For older persons there is a sense of security in the traditional ways and a feeling of loss when these ways are abandoned. The switch from traditional hymns to contemporary songs, the incorporation of drums, and the use of drama and dance in some churches makes many older people uncomfortable. While some adapt to the changes or tolerate them because they do not want to leave their church, others slack off in attendance. Those who stop attending church might feel guilty for "forsaking the assembling" of believers together (Hebrews 10:25 NKJV), but they may not feel up to looking for a new church that is more traditional. In that case, consider checking around for a church with a worship style that suits your elder, then offer to attend with her. If poor eyesight keeps your elder from driving to church (a common problem for evening or midweek services, when it is dark), offer to arrange transportation.

An Overwhelming Church

Decreasing mental capacities also can make church an overwhelming or negative experience for a senior. Research shows that people with dementia (such as Alzheimer's disease) experience too much stimulation from attending religious services. Many people in this situation find it less stressful to watch religious television or listen to radio programs.5

As you take care of your aging loved one, don't neglect your own times of prayer and personal Bible study. When you allow the Holy Spirit to enlighten the eyes of your own heart to know the hope to which He has called you, you become better equipped to encourage your elder's faith and spiritual growth. No matter what happens, take the apostle Paul's advice, who, while a prisoner, said, "Rejoice in the Lord always. I will say it again: Rejoice!" (Philippians 4:4 NIV). Then commend your aging loved one to the Lord's sovereign plan and tender mercies, trusting God to be faithful.

1 J.S. Levin and R.J. Taylor, "Age Differences in Patterns and Correlates of the Frequency of Prayer," The Gerontologist 37 February 1997), 75-88.
2The Gallup Organization, "Six in Ten Americans Read Bible at Least Occasionally," Gallup News Service (October 20, 2000).
3Barbara Payne, "Spiritual Maturity and Meaning-Filled Relationships: A Sociological Perspective," in James J. Seeber's (ed.) Spiritual Maturity in the Later Years; (New York: Haworth Press, 1990).
4U.S. Bureau of Census, Federal Interagency Forum on Aging-Related Statistics, Older Americans 2000: Key Indicators of Well-Being
5 A. Albertson Owens et al., "The Relationship Between Cognitive Status and Religiosity in Older Adults," 1993. Paper presented at the annual meeting of the Society for the Scientific Study of Religion, Raleigh, NC.

When a Nursing Home Must Be Considered

If you have been trying to go it alone in caring for an elderly loved one, remember that burnout is a very real possibility. It is important to acknowledge the impact caregiving is having on you and to get support and good counsel about available services and resources.

by Focus on the Family

The decision to move an aging loved one into a nursing home may be one of the most difficult you will ever make. In fact, it is common for adult children to promise themselves they will never subject a parent to "that kind of place." They may be sincere, but that kind of promise is based on unpredictable circumstances. Life, especially with the elderly, is fluid and changing. Promises that include the word never or always are unrealistic. Not one of us knows what the future will bring. So give yourself grace in making the decision for a nursing home. Heartsearching goes with the territory, but don't torment yourself with guilt.

Start the decision-making process by asking these questions:

  1. Are you finding it difficult to continue hands-on care for your loved one?
  2. Do you feel emotionally drained or chronically tired?
  3. Does your elder need rehabilitation or specialized supervision?

Caring for an aging parent or spouse is tough work. As an elderly person requires more and more care, the tired caregiver often scolds himself for not loving more, for not working harder, and for not having more energy. Yet it is difficult to give the type of constant loving care that many elders need. At times, an aging person can make your job even harder by being irritable, demanding, or angry. If you do not get enough rest and help, you yourself might feel angry, depressed, anxious, and resentful.

It is helpful to discuss your situation with a friend or in a support group for caregivers. Besides having the comfort of a listening ear, you might come up with some practical answers to your elder's specific situation. You also might find new ways to cope with your weaknesses and limitations.

Acknowledge your limitations.

Caregiver burnout is one of the main reasons a family eventually places an elderly loved one in a 24-hour-aday nursing facility. While the average caregiver provides care for 18 hours per week, one in five provides "constant care," or at least 40 hours per week caring for an elderly loved one.1 More than seven in ten caregivers are women, although 27 percent of caregivers are men. Because many caregivers also work outside the home — an estimated 14.4 million full- and part-time workers balance caregiving and job responsibilities2 — perpetual weariness is a common problem. Many are discovering they cannot do it all. Some have to reduce their hours at work or quit a job, which also reduces their income during key wage-earning years. Caregivers grow weary of being on call all the time. Unless they can find someone to help them, they tend to neglect their own lives, their health, their marriages, and their children in order to care for the ailing elder.

Caregivers often feel isolated and overextended. A 1997 survey by the National Alliance for Caregiving found that one in three caregivers who provide care for at least 40 hours a week says that no one else helps. As caregivers struggle to survive a difficult situation, they may not recognize their own changing needs. Those without a support system are more prone to emotional strain and physical and mental problems (such as depression, sleeplessness, back pain, and other health conditions) and are less apt to wade through the complex health-care and social-service systems for help.

If you have been trying to go it alone in caring for an elderly loved one, remember that burnout is a very real possibility. It is important to acknowledge the impact caregiving is having on you and to get support and good counsel about available services and resources. You need the help of friends, relatives, siblings, your church, and local communitybased organizations to assist you. If your aging loved one needs roundthe-clock specialized care and is not satisfied with home and community-based services, it may be time to discuss the possibility of nursing-home placement.

When it is time for your aging loved one to move into a nursing home, there are some things you can do to make the transition easier. For example, have your elder take her most cherished possessions with her. (Be careful of theft.) This will help her remain connected with her past. If she is associated with a church, ask the pastor or a close friend to greet her at the nursing home when she arrives. Once she is settled in, encourage your elder to get involved in the various activities planned at the facility. A well-run facility will have a variety of activities to meet the many needs of the elderly. Perhaps you can attend with her at the beginning. Let her know how important it is for her to remain active and alert if she is to live out her life with dignity and vigor.

Try to stay aware of how your loved one is eating, feeling, and doing once the move takes place. Are appropriate therapies and medications being provided? Discuss the facility's rules for taking your loved one out to dinner, church, or other activities. As you get to know the staff, build a positive relationship so that when problems come up, a solid foundation is laid for the best care possible under the circumstances. Bring treats and flowers for them. Send notes of thanks when they go out of their way to help. Participate in family-care conferences. If you must investigate mishaps, try to understand all sides.

It will be important to establish realistic expectations about visits with your aging loved one. Plan for times with other family members and friends as well as personal times when you can visit alone. When are the best times to come by, based on your elder's schedule and yours? Are drop-in visits welcomed? What amount of time is about right for you to stay? It may take a little time to work out how frequently you should visit and what works best.

Your Changed Role as a Caregiver

You may feel overwhelmed by the task ahead of you. There are so many decisions to be made, so many people to consult. But remember that there is wisdom in many counselors. Seek wise counsel and pray to receive wisdom. God gives wisdom generously to those who ask for it. If you must do something you had hoped would never be necessary, such as placing your loved one in a long-term-care facility, it does not mean you are abandoning him. It means your role has changed and the challenges will be different. Pray about each step and ask, How might I make my loved one more comfortable from this new perspective? Look for the life-giving elements in each step forward, even when it seems like a backward step. God's grace shows up as you ask for it.

1National Alliance for Caregiving and the American Association of Retired Persons, Family Caregiving in the U.S.; Findings from a National Survey (1997),21.
2 Metropolitan Life Insurance Compnay, The Met Life Study of Employer Costs for Working Caregivers (Wesport, CT: MetLife Mature Market Group, June 1997).

When It's Time to Let Go

When the soul is about to return to God, it is a moment of great awe. If you have the opportunity to be there when your elderly loved one takes that final breath, be there.

by Focus on the Family

There comes a point when, despite numerous prayers for healing and the efforts of doctors and modern medicine, it becomes clear that a loved one will not recover. The idea that he or she will not be around much longer is hard to swallow. How can this person, who has been part of your life for so long, really go away? It is common for caregivers to have guilt and conflicting emotions — wanting the suffering to be over (and being exhausted from caregiving), yet not wanting the loved one to die. You might spend all your energy taking care of your elder and postpone talking about death, avoiding words like terminal or dying. Your elder might also avoid the subject.

But the reality is that it is important to broach the subject of death, including your loved one's preferences for end-of-life care and funeral arrangements, while your elder is still living. This may be your only chance to talk about your fears, make any apologies, express your love and appreciation, and recall special shared memories. It also may be your last opportunity to help your elder prepare to meet the Lord. The words of Scripture often take on special meaning to one who is dying. Even if your elder is too sick or mentally impaired to respond, you can still talk, touch, and show affection, reassuring your loved one of your ongoing love and care.

Don't Wait Until It's Too Late

If your loved one is approaching death, don't wait until it is too late! Take the time now to say good-bye. Sometimes a dying person lingers because she is worried about her spouse or children and how they will cope without her. This is the time to express sentiments of love and thankfulness to your elder and to give her permission to let go. One couple took the opportunity to say good-bye to a terminally ill loved one in a special place and time, then said, "Whatever happens, we've said our formal good-byes." The end did not come for another six weeks, but they were glad they had been able to choose when to say good-bye.

Just as Jesus made provision for His mother by entrusting her care to the disciple John, let your loved one know that the surviving family members will be taken care of. Don't be embarrassed if you cry. Tears are a natural part of saying good-bye and can help you to let go, too.

Hope in the Word

When the soul is about to return to God, it is a moment of great awe. If you have the opportunity to be there when your elderly loved one takes that final breath, be there. But let your words be few and meaningful. If any sounds can reach the ear now, if any words can touch the heart,

God's words can. Speak to your loved one slowly and distinctly, not in a whisper or in a loud voice but clearly and gently. Singing your elder's favorite hymn or praying the Lord's Prayer (Matthew 6:9-13) and speaking the comforting promises of God in short sentences should take priority. Psalm 23 is especially comforting to Christians. Also consider the following Bible verses:

We can expect to grieve the loss of a loved one. Your reaction may be immediate or delayed, and you are likely to feel both relief that the suffering is ended and guilt for feeling that way. You will likely grieve that your loved one is gone and wonder who you are now that you are not a caregiver. You will need to give yourself time to refuel and time to reflect.

Nevertheless, grief is different for the Christian. We grieve, but not as those who have no hope of the resurrection of the dead (1 Thessalonians 4:13). "For if we believe that Jesus died and rose again, even so God will bring with Him those who have fallen asleep in Jesus" (1 Thessalonians 4:14 NASB). Christians await Resurrection Day, when the souls and bodies of the saints who have died shall be reunited and gathered to Christ, that He may present them to the Father: "Behold, I and the children whom God has given me" (Hebrews 2:13 NASB). A loved one whose body was ravaged by cancer will be raised with a glorious body like Christ's (Philippians 3:21). The Christian who suffered from Alzheimer's in this life will be able to look on his Lord with full cognition and joy in heaven.

Even the Comatose Might Hear

Grief is different when you know a person is absent from the body but present with the Lord in heaven. Your tears are not for that person but for yourself (which is a totally appropriate response). If you do not know whether your dying loved one has accepted the Lord, consider praying that God will give you wisdom and a door of opportunity to share the mystery of Jesus Christ while your elder is still alive (Colossians 4:3; 1 Corinthians 15:1-4). Even a person in a coma may be able to hear words of Scripture. Pray that your loved one will be receptive to the message. Then leave the matter in God's hands. Your elder may trust in Christ on her deathbed with or without your knowledge. Either way, the decision for or against Christ is a matter of personal responsibility. God will judge fairly, for those who come to Him He will by no means cast out (John 6:37). Genesis 18:25 (KJV) says, "Shall not the Judge of all the earth do right?"