A Brief History of Caregiving

Excerpted from The Complete Caregiver Support Guide, by Ester R.A. Leutenberg & Carroll Morris with Kathy Khalsa

In past generations, it was customary for people to have large families. Members of an extended family often lived within a few miles of each other. Few women had jobs outside the home, so the elderly and infirm were cared for within the family. Both the primary caregiver and care-receiver had the support of nearby relatives, friends, and community.

Circumstances are different today. Families are typically smaller and are often scattered across the country and around the globe. A much larger percentage of women work outside the home. People live longer, often with chronic illnesses. These factors make caregiving much more complicated than it was in the past. 

The early stage of caregiving is often handled by family members or by friends who live near the person needing help. They begin by doing what they can, and often, as time passes, assume the caregiver role without realizing it – caregiving isn’t a job that many people choose to sign up for.

The tasks caregivers perform can vary widely, from transporting a child with disabilities to school each day, to doing someone else’s laundry, to helping with medications, to dealing with insurance companies. Caregiving can be temporary, as when someone is recovering from an accident, or long-term, as when caring for a person in need of significant ongoing support.

In an attempt to define family caregiving, the National Family Caregivers Association (NFCA) developed a list called “Caregiving Is.”  The following is inspired by their list.

• Caregiving is as diverse as the individuals needing it. 
• Caregiving means being a person’s healthcare advocate.
• Caregiving is stressful work. 
• Caregiving challenges people to go beyond their comfort zone. 
• Caregiving forces individuals to deal with change.
• Caregiving is an endless search for balance. 
• Caregiving is a strain on relationships. 
• Caregiving can be a lonely world.

Caregiving requires a great deal of emotional, physical, mental and spiritual energy. Given all that it entails, it is not a surprise that caregivers suffer from stress. The cost of that stress – whether short-term or chronic – on the caregiver’s health can be considerable.

Stress (or the stress response) is what you feel when your body prepares to meet a challenge. It goes into a fight-or-flight mode, releasing a flood of adrenaline and cortisol. The breath quickens, the heart beats faster, and the senses sharpen. The body readies for action both when the danger is immediate and real and when it is a matter of perception. 

When short term, the stress response is beneficial. It helps us react quickly to avoid accidents. It keeps us sharp. It provides the endurance to keep going beyond our normal strength. When the threat – perceived or real – passes, the stress level lessens and the body returns to normal. Long-term stress is another story.

When a real or perceived threat to well-being or the need for action is ongoing, the stress response remains activated, releasing hormones over an extended period of time. The body acclimates to being in a defense mode. It turns on the stress response more quickly and leaves it on longer. 

Many people in today’s fast-paced, complicated world live with chronic stress. They may come to depend on the accompanying adrenalin lift and feel down in its absence. But chronic stress has health consequences. Studies indicate that the majority of doctor’s visits are for stress-related complaints.

The list is long. Stress exacerbates health conditions such as asthma and arthritis. It weakens the immune system, making us vulnerable to illness. It can cause headaches, high blood pressure, chronic fatigue, digestive tract problems, higher incidences of diabetes, and sleep disorders. It can negatively impact memory and judgment, cause depression and anxiety, and lead to substance abuse.

If you’re a caregiver, your situation can be a perfect storm of chronic stress.

Making Life Easier

Survival Strategies for the Stressed

It may sound simplistic, but it’s true: Taking time to plan your day and organize your environment can go a long way toward reducing stress and helping you feel you have some control over your situation. With your lists in hand, you will not have to wonder what it is that you need to do, whom you plan to call, where you want to go, or what you intend to buy.

If you do not accomplish everything you hoped to in a given day, move undone items to the next day, putting those of highest priority first. If you repeatedly move the same thing forward, ask yourself: Why do I resist doing it? Is it essential or necessary? Can someone else do it for me? 

Strategies for minimizing daily stress and irritations:

1. Organize your environment (cupboards, closets, a place for your keys, etc.) 

2. Go through mail daily (sort, toss or keep.) 

3. Make lists in a portable notebook/calendar you can keep with you (to do, phone calls, groceries.) 

4. Schedule a realistic day (important things first, doesn’t have to be perfect.) 

5. Create a “What If?” plan. (What if my care-receiver wanders off when we’re shopping?) 

6. Prepare the night before (prepare meds, set the table, review to-do lists.) 

7. Rise before your care-receiver wakes (read, shower, meditate, or enjoy a cup of tea or coffee.) 

8. Do one thing at a time (multi-tasking isn’t always effective when you’re stressed.) 

9. Know your limits and learn to say No! (Protect your time, energy, health.) 

10. Be prepared (food and postage in the house, full gas tank, extra house and car keys.)

11. Keep up with maintenance (fix, replace, maintain – yourself or ask someone.)

12. Take care of your health. (Have a physical exam, eat healthy, sleep well, exercise.)

13. Maintain good relationships (apologize if needed, forgive others, and yourself.)

What will I do to make life less stressful?

After reviewing the list above, write down the stress-relievers you think will work for you. Use the space below or your journal. If you can, chat with other caregivers to see what they are doing to cut down on their stress levels. It could be anything from yelling encouragement at your kid’s hockey game, to reading a good book, to meditating for an hour. Choose what will work for you. Then choose two to implement in the next month. Each month thereafter, add a couple of new stress-reducers to your repertoire.

Remember, it doesn’t have to work for anyone else, just for you.