Recognizing and Addressing Family Caregiver Stress

EAP Ask the Expert : Owen Wyatt, LMHC, CEAP, Consultant, & Eldercare Support Group Facilitator, MGB EAP

Do You Have Senior Family Caregiver Stress Overload?

If you are a family caregiver for an elderly relative, do any of the following resonate with you?

• You feel like you are always taking steps backwards, versus having a balance of up and down days?
• You are not meeting your own basic needs for health and well-being. Are you?
  – Feeling like you are selfish or a sub-par caregiver for taking care of your own needs
  – Skipping your own medical or dental appointments
  – Not engaging in your hobbies and interests
  – Not eating well
  – Not exercising
  – Using substances to cope
  – Missing out on social engagements
  – Not paying your own bills
  – Not present or efficient at work
• Are you often experiencing any of the following?
  – Guilt
  – Denial
  – Anger
  – Exhaustion
  – Sleep or appetite challenges
  – Depression
  – Anxiety
  – Physical issues such as headaches or stomach problems

If you answered yes to several of the items above, this might be a good time take a step back and evaluate the impacts of your current situation and the quality of your life. Consider whether what you are doing is actually helpful to the family member you are trying to assist.

Archangels (an organization dedicated to caregiver support) offers a tool to rate your caregiving intensity.

If you are responsible for the care of an elderly relative, you are not alone. According to the National Alliance for Caregiving (NAC), almost 42 million Americans provided unpaid care to an adult over 50 in 2020. This represents a significant increase from past years. Some of the many areas of assistance include:

• Healthcare
• Finances
• Daily personal care
• Tasks involving technology
• Managing schedules
• Home maintenance

Caring for older loved ones is different than being a caregiver at work. It is usually unpaid, can be more complicated, and can have undefined boundaries. Some are comfortable acknowledging stress from a job but not necessarily from being a family caregiver. Many of us feel it is just something we are supposed to do, without recognizing or addressing the challenges associated with this “work”.

Helping the cherished seniors in our lives is a privilege and can be very rewarding, but it can also take a toll. A 2022 survey conducted by The University of Michigan showed that family caregivers reported:

• Highly stressful caregiving situations (36%)
• Emotional or physical fatigue (34%)
• Difficulty balancing work or other responsibilities (31%)
• Lack of time for self-care (22%)
• Trouble finding time for family/friends (21%)

To better understand and navigate stress associated with being a family caregiver of elderly relatives, we turned to EAP Consultant, Owen Wyatt LMHC, CEAP. He shares insights from his experience in facilitating the EAP Eldercare and Caregiver Support Group. Our goal is to highlight that improving the health of seniors is closely tied to ensuring the well-being of caregivers.

Why can Family Caregiving be stressful?

While every situation is somewhat unique, there are common themes that impact many caregivers. Owen explains that very often there are a combination of factors that are cumulative and create challenges to the well-being and healthy functioning of caregivers. Some issues include:

• Navigating care systems
  – Finding the right resources
  – Re-evaluating and addressing care needs over time
• Balancing caregiving and schedules with the other things in your life
  – Relationships
  – Work
  – Self-care
• Dealing with family dynamics, due to:
  – Complicated relationships with elders or other relatives
  – Differing opinions about the nature of/severity of the problem and the best path for care
  – Lack of clarity about roles and responsibilities
  – Varied contributions, often with one person bearing most of the responsibility
• The emotional toll of seeing those we love age, change and struggle
• Having unrealistic expectations of ourselves or others
• Coping with feelings of guilt about not being successful as a caregiver or having frustration, resentment, or exhaustion
• Feeling isolated, either because you are the sole provider or because caregiving by nature may separate you from your supports, connections, and routines
• Those with social determinants of health barriers may have added caregiver challenges
• Financial Considerations
  – Care is expensive
  – Time off from work, sometimes unpaid

Managing the stress of Caregiving

Even if you don’t meet the criteria for “burn-out”, it’s important to address stress to maintain the well-being of all stakeholders. Each person experiences stress differently and will find and tweak their own path to preventing or minimizing the impacts. Below are some key components and strategies to consider.

Educate yourself on available resources

As they say, “knowledge is power”. A significant amount of stress associated with eldercare is related to knowing about and accessing resources.

An understanding of avenues for assistance will make navigating care easier and may allow you to reduce the tasks for which you are responsible. This might even result in more quality time with senior family members, because you are not solely focused on caregiving. The EAP website has a large Eldercare section.

Here are a few relevant resources:

• Supports for Family Caregivers
• Senior Living
• Estate & Healthcare Planning
• Geriatric Care Managers
• Information on Common Medical Conditions
• Finances

Focus on your own health and well-being

Whether you are a caregiver at work, outside of work, or both, the best way to ensure you will be able to help others is to take care of yourself. Take time to consider your own requirements for well-being. How can you meet your own basic needs and replenish your reserves? It’s similar to training for a marathon – you need to plan, establish a routine, and practice. A recent EAP feature discusses how to build healthy habits.

You should also address barriers to self-care by:

• Setting boundaries and taking breaks
  – Owen gives the example of determining what is and isn’t an emergency and worthy of an immediate response
• Evaluating and challenging false or unrealistic beliefs
• Setting small and achievable goals
• Managing resentment, guilt, and negative self-reflection
• Searching for the positive in a tough situation, via:
  – Gratitude
  – The opportunity to repair, improve or shift relationship dynamics
• Maintaining connections
• Asking for help when you need it

Focus on healthy lifestyle activities:

• Healthy Eating
• Sleep
• Mindfulness 
• Limiting Alcohol Use

Resist the urge to achieve or expect perfection

Eldercare is never going to be completely mastered. It exists on a continuum with changing requirements. It’s always going to be a work in progress. Coping well is highly dependent on being realistic and honest about the capabilities of all involved.

Managing expectations of yourself

First and foremost, try to limit the pressure you place on yourself. Being organized and working to get a handle on things is a good strategy, but only within reasonable limits. Consider acknowledging that you are dealing with an unpredictable situation with many moving parts and a lot of new learning. Be kind to yourself and allow for acceptance of the “good enough”.

This has the potential to:

• Limit frustration and guilt, which are both barriers to being a good caregiver
• Honestly evaluate what you can tackle or improve and what you can’t
• Take some things off your plate
• Give yourself permission to ask for and receive help

In support of the above, Owen suggests the following:

• Control what you can control
• Attempting to manage things that are beyond your control means that those things end up controlling you
• Make a list
  – What is causing you stress?
  – What can you/must you continue to tolerate and what can you let go of or change?

Managing expectations of others

Part of the process of being realistic and feeling successful involves understanding what others can accomplish or contribute. Try to remind yourself that the only person you can control is you.

Chances are good that your older relative does not want to burden you and would actually prefer to manage their own life and retain the independence and capabilities they once enjoyed.  Like you, they are doing the best they can. It may not be easy, but consider adjusting unrealistic expectations. This means accepting that your relative may not be the exact person they were before. Compassion, respect, and gratitude (for still having our seniors in our lives), may lead to greater patience and hopefully less stress. This is not meant to imply that you won’t ever get frustrated, tired or need to take a break, but it can help you to manage resentment and minimize the guilt related to having resentment.

You should also consider how best to navigate relationships with other concerned (or not concerned) relatives. Dealing with family conflict on top of being a caregiver will just be an added stress. Don’t expect family dynamics to improve or change under challenging circumstances.  You may have to cope with the fact that others don’t pull their weight, or that they are “seniorsplainers”, with strong opinions about care, regardless of their willingness to help. While it’s perfectly acceptable to ask for assistance, try to accept that not everyone can or will contribute in the same way or to an equal degree. If there is a disagreement about care, it’s OK to make a decision without consensus, especially if you are the primary caregiver, health proxy, power of attorney and/or meeting the wishes of your older relative.

Supporting a Caregiver

As discussed above, a big contributor to the stress of being a caregiver are feelings of isolation and loneliness. Although tangible assistance is definitely useful, of even greater value may be to let the caregiver know they are not alone in this process. Owen recommends the following:

• Be a good listener and ask open-ended questions
• Convey validation/understanding and reinforce that that these are complex and challenging issues
• Resist the temptation to swoop in and problem-solve or put a simple overlay on a difficult issue
  – Consider how it might be interpreted if you imply that a long-term problem can be fixed with a 30-minute conversation
• Ask about what support they need and only commit to help for which you plan to follow through on

Seeking Help

Many of us identify with being a caregiver, inside and outside of work. While this is typically a positive attribute, it can be problematic when we are the ones who need help. It may be hard to admit that we don’t always have all the answers, endless energy, grace, or patience. It’s common for caregivers to believe that they must always be perfect. Part of this mindset is the belief that we should be able to handle everything on our own. In reality, by accepting help, you can take care of yourself, and will be in a much better position to assist your loved ones.

• Take advantage of community resources for caregivers
• Reach out to a friend, colleague or relative and ask for support or help
  – Be direct about what you need. Don’t expect people to figure it out on their own
• Learn about HR options for support such as Family Medical Leave
• Contact the EAP for individual assistance or a referral
• Participate in the EAP Eldercare support group

Help from the EAP

The EAP offers free and confidential services for employees and immediate household family members. EAP records are separate from medical and HR records. Contact the EAP at 866-724-4327 or request an appointment via our online form for confidential assistance. In-person appointments are available at the following locations.  Phone or Video (Zoom) appointments are available from all locations