If some of your clients in their 40s, 50s or 60s seem irritable, angry and unreasonable to deal with, there may be a very understandable reason. They may be looking after an elderly relative — or two or three, taking aunts, uncles and in-laws into account. In addition to their roles as parents, spouses and employees, they may also be caregivers.

These relatives may be frail, even senile, and whether they are living with your clients or in nursing homes or in palliative care, they are foremost in your clients’ minds. This puts clients under a tremendous amount of stress. Caregiving can be physically exhausting and emotionally draining.

You can ease the client/advisor relationship by understanding and acknowledging the role your clients have taken on. Here’s a look at some of the types of caregivers and the problems they face.

> Full-time caregivers. Caring for an elderly person at home on a 24/7 basis is especially stressful. Full-time caregivers need ongoing support and as much as 20 hours of free time a week, says Mark Nagler, a Hamilton, Ont., sociologist who runs Nagler Disability
Associates, a consultancy for people working with the elderly and disabled. “Without some respite, burnout and breakdown can result,” he says. “Pushed to their limits, some caregivers have resorted to elder abuse and neglect.”

> Distance and long-distance caregiving. Just because a relative has entered a seniors’ residence or is in long-term care doesn’t mean family members stop being caregivers.
They need to schedule regular visits, even shop for clothes, books and gifts for the elderly relative. There are meetings with residence staff — usually during business hours. And the elderly person often has to be taken to medical specialists.

“Distance caregiving can be extremely stressful,” says Karen Henderson, founder of Toronto-based Caregiver Network Inc. and the How to Care national caregiver resource centres. “There’s a lot of guilt; in spousal relationships, the partner on the outside feels he or she is breaking a vow. Distance caregivers worry that they may not be keeping on top of things because they’re not on-site all the time. So they try to be there as much as possible, neglecting their own interests and health.”

Caring for a person living in another city can be particularly difficult, says Clarissa
Green, professor emeritus of nursing at the University of British Columbia and a
Vancouver family therapist. The key to long-distance caregiving is frequent visits and knowing the neighbours and community in which the elderly person lives. When the person can’t do his or her own housekeeping, the caregiver can find help.

“Long-distance caregiving is also expensive,” she says. “My mother was living on the East Coast and I was [in Vancouver] during the last years of her life. I spent $10,000 a year on travel.”

> Reluctant caregivers. Not everyone is cut out to be a caregiver, but there may be no one else to take on the role. Even in large families, caregiving usually falls to one adult child.
“It’s a myth that all the siblings will pitch in,” says Heidi Cowie, a social worker and psychotherapist in Burlington, Ont. “Usually one adult child does it all, has all the responsibility and gets the calls in the middle of the night that Mom has had a bad turn.
This causes frustration, anger and guilt at feeling frustrated and angry.”

Sometimes the caregiver may need to set boundaries. “A woman who was sexually abused by her father drew the line at any physical care [by her for him],” Green says.
“She arranged for his care and she visited him, but she wouldn’t touch him.”

The caregiver role may fall to an in-law, especially among new Canadians who believe elders should be cared for at home.

> Anticipatory grief. This is the process of grieving prior to a death. Green says it exists in all caregiving situations involving elderly people: “The end is in sight. The caregiver sees the losses along the way: bodies slowing down, thinking slowing down. It’s a prolonged process of saying goodbye.”

Henderson cared for her late father, who suffered from dementia. “He lost the ability to walk, to talk and, finally, to recognize me,” she says. “You’re filled with sorrow but there’s no grave to weep over.”

@page_break@> After death. After an elderly relative dies, a caregiver may initially be relieved. But former caregivers are often surprised to find that grief soon sets in.

Like it or not, Green says, caregiving is an inevitable journey we all go on as relatives and as we, in turn, become elderly.

“Remember,” she says, “your children are watching the example you set as a caregiver.” IE