Most family caregivers want what is best for their loved ones, and they’ll do whatever it takes to make that happen while caregiving. Unfortunately, discerning what’s best for a senior is often easier said than done. In many cases, a loved one’s own desires (or demands) may actually jeopardize their health, erode their independence and diminish their quality of life. Caregivers are left to walk this thin line between helping care recipients just enough and enabling bad behaviors that may come back to bite both parties.
Care decisions are hard enough as it is, but how do you know when you’re enabling an elderly loved one to slide by the easy way as opposed to helping them out with something they truly need? The truth is, it’s rarely an easy call, and the answer may differ on any given day.
I watched my mom struggle with painful arthritis in every joint. She had undergone two hip replacements already and with every step she took, her knees rubbed bone against bone. Sometimes, watching her struggle with her walker tore at my heart so much that I couldn’t help but insist that she let me get her into her wheelchair.
Yet, we both knew that if she didn’t move, her joint pain would only worsen. Arthritis can freeze the joints so that movement gradually becomes almost impossible. This is one of many examples of “use it or lose it” that comes with getting older. Knowing this, I tried to rein in my tendency to be overly helpful. I attempted to encourage Mom to do what she could while still being available to help when she needed me to.
Other family caregivers are likely to find themselves in situations like mine and even some more conflicting circumstances. I’ve cared for several elders over the years and encountered my share of challenges. Below, I address two relatively common dilemmas that cause family caregivers a great deal of grief. Keep in mind that every family and caregiving situation is unique, and toeing the line between assisting and enabling a love one can involve many different things.
Handling an Elder Who Wants Everything Done for Them
Some seniors adamantly refuse to accept help from anyone even when they really need it. This poses a whole other set of challenges. Other older adults, however, take the opposite approach. They aim to retire from life and let their relatives handle all of their affairs. Some even expect their caregivers to be available at all times to satisfy their every need.
How do you handle elders like this? Well, it depends on the reasons behind this behavior. In some cases, caregivers step in to lend a hand after an elder has a health scare or an accident. Even if they aren’t in terrible shape, we caregivers tend to nurture and sometimes coddle our loved ones in situations like these. What starts as a bit of pampering here and there to show an elder they are loved can get out of hand very quickly.
Some seniors grow accustomed to being waited on hand and foot, regardless of their health and abilities. If a loved one is frail and in delicate condition, yes, healing and recovery can take a great deal of time. But, part of aiding in a senior’s recuperation is allowing them to do for themselves and reestablish their old routines as much as possible.
Making yourself too available and helping too much crosses the line into enabling. In fact, this can actually hinder a senior’s progress—in some cases permanently. We hate to see our elders struggle or endure pain or embarrassment, but sometimes these hard times are necessary for them to pick themselves up, focus on getting better and adapt to new circumstances.
In other cases, even if caregivers haven’t set the pampering precedent, some seniors wind up relying heavily on their family members because they crave attention. A little voluntary doting usually conveys affection, therefore an isolated or self-involved elder may force such a scenario by asking for (or demanding) help with every single little thing whether it’s needed or not. This can get annoying for caregivers very quickly, but again, it can have some of the same unintended consequences for elders as described above.
In either of these scenarios, the best thing to do is set some boundaries. This can be difficult but sticking to them is best for both of you. Try tapping into the “ignore bad behavior and reward good behavior” philosophy. Press your loved one to do what they can for themselves (as long as it’s safe) and reassure them that you are available only for specific tasks and emergencies. If attention-seeking is the problem, make a point of visiting with them regularly just to socialize and see how they are doing. This may serve to reinforce the idea that they needn’t demand your attention and affection to get it.
How to Handle a Senior’s Addictive Behavior
On a more serious note, millions of caregivers struggle to cope with an elder’s addictive behavior. This may involve anything from cigarettes or alcohol to prescription drugs or unhealthy foods. When a family member steps up to care for an elder with addiction issues, it can bring a lot of grief for both parties.
The biggest question these caregivers face is what role do they play in their loved ones’ addictions? Should they refuse to take part? Should they selectively enable their elders? Should they take it upon themselves to help put an end to the self-destructive behavior?
Some may say there is only one right answer: you take away the harmful substance, or at least don’t help them obtain more of it. However, I can’t say that I’d always agree with this take. A common example is cigarettes. Many caregivers are torn between their elder’s need for cigarettes and the knowledge that smoking is incredibly unhealthy.
My feeling is that, unless there is a way to humanely help an addicted person quit smoking, there isn’t much of a choice other than accepting that the elder will continue to smoke with or without the caregiver’s help. One potentially helpful device that is available these days is the electronic cigarette (e-cigarette). This device is an electronic inhaler that vaporizes a liquid solution of nicotine into an aerosol mist. The inhaler resembles a cigarette and the physical act of inhaling simulates the act of tobacco smoking.
While this device may not be “healthy” or help smokers to kick the habit as advertised, it may provide a safer way for a shaky, forgetful elder to “smoke” without the need for an open flame or the risk of fire. Some readers have said that the e-cigarette has given them a middle ground when it came to convincing their elders to give up conventional cigarettes.
Alcohol is another issue altogether. Alcoholism and alcohol abuse are serious problems among the senior population. Alcohol can interact with medications, contribute to falls, disrupt normal self-care and household routines, cause interpersonal issues, interfere with sleep, suppress immune function, and increase the risk of health problems like cancer, nutritional deficiencies, heart disease, and various types of cognitive impairment.
Obtaining help through medical detoxification and/or Alcoholics Anonymous would be ideal for an alcohol-addicted elder who is even slightly willing to undergo treatment. You can also try an intervention with the help of a professional addiction therapist, but the close supervision of medical professionals is highly recommended to properly manage any withdrawal symptoms.
However, the reality is that many elders are too far along in life to give up their addictive behavior. Thus, the humane approach may be to allow them to keep their long-held sources of comfort. Watering down their alcohol—if you can gain access to it—may help them drink less and minimize some of the negative effects.
If a loved one can’t or won’t quit smoking, drinking, eating junk food or abusing their prescription medication, keeping them as safe as possible may be your only realistic choice. You—and they—know that they are damaging their body and risking their health and independence. But for most, short of locking them up, there is no other way.
Much depends on a loved one’s age and physical and mental condition. Forcing a ninety-year-old woman who is nearing the end of life to stop smoking isn’t likely to have a significant impact on her longevity at this point. If she continues to enjoy her cigarettes and is supervised while smoking, this is one instance where enabling is okay in my book. On the other end of the spectrum, when it comes to illegal amounts of pain killers and other drugs, you cannot help them continue that kind of addiction. Seek medical help right away for withdrawal and try not to judge. Never risk your own future in an effort to obtain illegal substances for an elder.
One of the most difficult things a caregiver in this kind of situation must accept is that a competent elder is entitled to make their own decisions—even bad ones. Only you can make the decision whether to cooperate with, ignore or flat out refuse to be a part of your loved one’s addiction. The sad reality is that there will be consequences no matter what you choose to do.
When in Doubt, Encourage Independence
When it comes to walking the line between helping and enabling, easy solutions rarely present themselves. Nearly every caregiver will regularly face the dilemma of determining whether they are helping or hurting their vulnerable loved ones by providing a particular service or access to some substance.
However, even the most vulnerable elders may have areas where they can help themselves.
The first elder I cared for was my neighbor, Joe. He liked to walk the ten blocks or so to our local downtown area whenever the weather permitted. His destination was a bar that had been a big part of his life when he’d been a working man. He’d then take a cab home when he was good and ready.
When I offered to give Joe a lift into town, he’d decline, saying the walk was good for him. I knew it was, both physically and psychologically. However, a deaf old man hobbling down sometimes slippery sidewalks is scary business. Many times, I’d practically hold my breath until I saw the cab drop him off at his home next-door.
Yet this was Joe’s choice. He was happy for me to get his groceries. He was happy for me to take him to run errands. But his bar run was his own. Frankly, this was good for me, too, because I didn’t have to feel guilty if he was even more wobbly when he arrived home. We both agreed that I would mind my own business when he chose to take those journeys.
If there is some way your loved one can exercise a little independence, then that should be encouraged. Good days may require less help from a caregiver, whereas bad days may require significantly more. Helping versus enabling is just one more moving target that makes caregivers second-guess themselves, so pick your battles.
Be sure not to let guilt dominate your care decisions. Whether you intervene and prevent an elder from participating in something they truly enjoy despite the risks that come with it, or you cave and give them free rein, you are bound to feel some undeserved guilt either way.
Above all, try not to doubt yourself. Accept that all your decisions won’t be perfect ones. Instead, rely on making decisions based on the best information you have at the time and move forward.
–Carol Bradley Bursack | agingcare.com