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CAREFUL CARING

Nearly 40 million adults in the United States are providing unpaid care to an adult, and with half of that number joining the caregiving ranks every year, it's likely to be added to your list of responsibilities if it hasn't already. Knowing how to protect your own well-being is an essential part of providing care to others. Here are some tips for avoiding caregiver burnout.

What Is Caregiver Burnout?
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WHAT IS CAREGIVER BURNOUT?

Caregiver burnout is a term used to describe a state of compromised physical health and severe psychological depletion produced by the chronic stress of prolonged caregiving.

What Happens When Burnout Strikes
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WHAT HAPPENS WHEN BURNOUT STRIKES

Physical effects include lowered immune response, increased risk of hypertension, obesity and high cholesterol, and back and shoulder injuries from lifting others. Psychological effects include depression, anxiety, social isolation, irritability, and increased risk for substance abuse.

Why Burnout Happens
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WHY BURNOUT HAPPENS

Caregivers who are burned out are constantly exhausted, impatient, preoccupied, and overwhelmed. In spite of their symptoms of severe stress, they have trouble relaxing or stepping back from their caregiving role and might even reject attempts by others to help. The absence of self-care and the loss of perspective are hallmarks of burn out.

Other Contributing Factors to Burnout Risk
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OTHER CONTRIBUTING FACTORS TO BURNOUT RISK

There are also a number of additional factors that increase the likelihood of burnout. Situational factors can include sharing a residence with the care recipient that is not suitably adapted for mobility, long commuting distances, living in an area with few resources and medical providers, and juggling heavy work and family responsibilities with caregiving. Other obstacles can include limited financial resources, and limited familiarity with navigating complex medical, insurance, legal and financial issues.
Interpersonal and familial factors include inadequate support from friends or other family members, isolation from social networks due to caregiving responsibilities, and unresolved family rifts or conflicts resulting in factions, estrangements, or hostility that interfere with caregiving. There can also be an uneven distribution of caregiving responsibilities within a family, or family members who abuse medications or financial resources intended for the patient.
Additionally, nearly half of caregivers feel that they have no choice about their caregiving role and responsibility. Added psychological pressure can come from the hope that caregiving will create the opportunity for healing or closeness of a formerly unsatisfying relationship with the care recipient. Alternatively, there can be a reactivation of traumatic memories and emotions resulting from caring for someone who has been abusive or neglectful in the past (and who may still continue to be). And some caregivers find themselves seeking validation, approval and fulfillment through self-sacrifice and service to others.

Preventing Caregiver Burnout
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PREVENTING CAREGIVER BURNOUT

While there are numerous challenges that confront caregivers, there are also many strategies to prevent burnout.

Sleep Well
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GET RESTFUL SLEEP

Maintain healthy sleep patterns to ensure 7 to 8 hours of sleep per night. A good sleep routine includes a regular pattern of bedtime and waking, minimizing blue light exposure (from computers, televisions and iPads) an hour before bedtime, avoiding caffeine after noon, and restricting time spent in bed to sleep and sex. If you are having trouble obtaining restorative sleep, talk with your physician about options, including consulting with a sleep specialist. Be cautious in using sleep medications; adjusting exercise and behavioral routines result in better long-term outcomes for sleep disturbance.

Develop Healthy Eating Habits
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DEVELOP HEALTHY EATING HABITS

Maintain a regular eating schedule that includes a variety of foods and especially lean proteins and vegetables. Identify stressful moments when you might engage in emotional overeating, and have a plan for those times. Have healthy food readily available (for example, make salads ahead of time, prepare larger portions of healthy meals to consume later). Avoid purchasing sweet or unhealthy snack foods to minimize temptation.

Myth: Stretch Before Running
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PERFORM RELAXING AND RELEASING EXERCISE

Create and maintain a regular pattern of movement that includes both releasing activities (walking, swimming, biking or running, for example) and relaxing activities (stretching, yoga, Tai Chi, and others). Releasing exercises enable you to reduce stress by lowering levels of cortisol and adrenaline that build up in your body. Aim for 30 minutes a day, which can be broken up into smaller portions of time as needed. Schedule exercise with a friend to provide space for social and exercise opportunities, and explore free guided exercise options on television, through apps, and DVDs rented from libraries. Check Medicare health plans to see if they offer free gym memberships at local facilities, too.

Meditating With Apps
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PRACTICE MINDFULNESS AND MEDITATION

Mindfulness is a particular type of meditation practice that focuses on your breathing. There are a variety of other forms of meditation that also enhance awareness of breathing and promote relaxation. Explore the options online, in your library, and through classes and workshops. Classes are often offered for free from hospitals, clinics and gyms.

Stay On Top of Your Own Health
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STAY ON TOP OF YOUR OWN HEALTH

Make sure that you keep all scheduled appointments with your own health care and dental providers. If you have new or worsening symptoms, don't postpone addressing them. Let all of your healthcare providers know about your current stressors and describe the specific impact on your own health. When scheduling your appointments, ask the staff how to minimize wait times and call before scheduled meetings to ensure the practitioner is running on time.

I'm Mentally Healthy
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SEEK OUT PSYCHOLOGICAL SELF-CARE STRATEGIES

While caregivers often complain of physical exhaustion, there is also an emotional aspect to their depletion. By extending your energies, creativity, compassion and time, sometimes for years, you are drawing on your psychological resources and resilience. Think of this as wearing down your emotional battery. It must be regularly recharged for you to keep functioning.

Meet Your Own Needs
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MEET YOUR OWN NEEDS

Check in with yourself at least once a day by asking yourself three simple questions: What am I feeling? What do I need or want? What are ways to make things just a little easier or better right now? By pairing your check in with some regularly scheduled routines, such as brushing your teeth or shaving, you create a consistent and useful feedback loop. Protect time and energy for the relationships, activities, and interests that nurture and restore you. These are the essential rechargers that you require to maintain your resilience.

Do Something for Yourself
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DO SOMETHING FOR YOURSELF

Perform some task or activity for yourself on a daily basis. It underscores the fact that your separate goals and priorities deserve your attention. Keep a private journal of your thoughts and feelings. Consider individual psychotherapy as a way to focus exclusively on your emotional experience by addressing feelings of loneliness, fear, grief, or resentment, and to develop effective coping strategies.

Look for Growth
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HAVE REALISTIC EXPECTATIONS AND BELIEFS

Burnout frequently results from unrealistic beliefs and ideas about your role and responsibilities. If you think you are selfish or showing inadequacy when you ask for help, you are setting yourself up for burnout. Similarly, if you bow to pressure from your loved one to provide all the caregiving, even when others are available, you are agreeing to an untenable arrangement.

Affirm the Choice
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AFFIRM THE CHOICE

It is important to recognize the role of choice in caregiving. While you may not have had a choice about what has happened to your loved one, you do have a choice about how you participate, the attitude that you choose, and the way you care for yourself. Take a regular inventory of your range of choices and alternatives.

Create Islands of Serenity
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CREATE ISLANDS OF SERENITY

Cultivate the ability to appreciatively observe your surroundings and to find special moments in your connections with others. By listening to a beautiful bird-song or admiring the colors in a sunset, you create a moment of joy and peace. Being able to feel fully present as you spend time with others gives you needed respite from the anxieties and stressors of your day.

Activate Support Systems
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ACTIVATE SUPPORT SYSTEMS

It is important to create a large network of social supports and resources as soon as the need for caregiving arises. This minimizes the risk of burnout and avoids disruption if the primary caregiver is suddenly unable to continue care.

Define Roles and Commitments
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DEFINE ROLES AND COMMITMENTS

Make two lists: One is of the current and upcoming needs of the care recipient, and the second is of all potential care providers and their contact information. Some websites like Lotsa Helping Hands even provide an easy way to create an online calendar and a way for care providers to sign up for specific tasks. A number of websites offer tips, checklists, and online videos assisting caregivers.

Get Help
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GET HELP

Designate specific responsibilities of fellow helpers. A family member who lives far away can still participate in caregiving by managing finances, or by setting up online services such as rides to medical appointments with services such as TenderCare, RoundTrip, Circulation, or Kaizen.

Communicate Clearly
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COMMUNICATE CLEARLY

When asking for support from family members or other helpers, be specific. For example, "Mom's new bed is scheduled for delivery next Tuesday afternoon between 1:00 and 3:00. Someone needs to be there to let the delivery company in and for operating instructions. Delivery and set up instructions are projected to take 45 minutes. I have a required work meeting. Can you be there to oversee delivery and write down the instructions?"

Look For Ways to Help Maintain Group Morale with Fellow Caregivers
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LOOK FOR WAYS TO HELP MAINTAIN GROUP MORALE WITH FELLOW CAREGIVERS

  • Foster “team spirit" by asking for feedback on progress, extending and receiving thanks, sharing new strategies and updates, and providing advance information about your plans and availability.
  • Caregiving can be a multi-year commitment, so acknowledge that the members of a community will have variations in their availability. 
  • Moments of disappointment or frustration within a care group are expectable, but modeling healthy communication practices can reduce conflict.
Research
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EXPLORE COMMUNITY AND ONLINE RESOURCES

The American Association on Aging has a list of comprehensive resources for caregivers. Some focus on providing advocacy and information, while others provide tools and training for caregivers. Resources for groups such as veterans, non-English speakers, and LGBTQI members are also on the list.

Consider Online and Community Support Groups
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CONSIDER ONLINE AND COMMUNITY SUPPORT GROUPS

Finding a local support groups can be done through referrals from national organizations or searching libraries, medical centers, and newspapers. Online support groups are available at AARP.org and elsewhere.

Caregiver Safety Becomes A Concern
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KNOW WHEN TO SEEK PROFESSIONAL CARE

Hiring a professional caregiver may be necessary when the care recipient lives far away, has needs that go beyond your expertise, or when you are limited by your own time or health constraints. Identify specific needs and explore multiple resources before making financial commitments. Some families may also hire a caregiver to perform bathing and toileting care to preserve the care recipient's dignity.
Respite care is also a consideration for caregivers who need time away from their care recipient in order to relax, travel, or attend to their own health needs. Resources are accessible through ARCH National Respite Network.

Take the Opportunity to Learn About Your Own Health and Needs
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TAKE THE OPPORTUNITY TO LEARN ABOUT YOUR OWN HEALTH AND NEEDS

As a caregiver, you are entrusted with the health and well-being of another individual. In one study, 91 percent of respondents said that they were grateful to provide care to their recipient and felt fulfilled knowing they were doing something good for someone they loved.
Caregiving is also an opportunity to learn how to manage your own process of aging and changes in health. You may learn how to navigate health care systems, use community resources, communicate with healthcare providers, and address financial and estate planning needs.

Carol Povenmire, Ph.D., is a licensed psychologist with a practice in Pasadena, California.