How to Address Difficult Moments in Caregiving


By Dr. Vicki L. Smith

There are many reasons why these interactions can be very difficult. From the caregivers perspective, providing assistance with basic personal care is very time consuming, can be physically demanding, and very uncomfortable. Not many people are comfortable with providing personal care for their spouse, adult child, or parent.

The care receiver has the same issues and many more. A person with cognitive and/or physical problems can become confused and frustrated very easily because of their loss of physical skills, cognitive skills, communication skills, and sometimes alterations in their senses such as hearing, vision, touch, or balance. Over time, every relationship goes through changes. This is another change in your lives. Remember how you adapted to change before.

Many caregivers and care receivers go through phases of adjusting, including:

  • Denial phase. This is a time when neither the caregiver nor the care receiver is emotionally ready to accept the situation. This creates a lot of tension in the relationship.
  • Mourning phase. This can lead to aggression, anger, or depression about the situation or toward people.
  • Adjustment phase. This is when both the caregiver and the care receiver have accepted the situation and are able to develop coping skills. The energy of the relationship is focused on helping each other rather than denying or being angry.

Here are some ideas on how you can progress your relationship to the adjustment phase.

  • Pay attention to little things for yourself and the care receiver (hair, clothes, something the caregiver enjoys, and don't forget something the care receiver enjoys).
  • Admit the differences. Times have changed and that's OK.
  • Watch out and correct misconceptions about the situation. For example, a care receiver may say he is dumb because he can no longer dress himself. Dressing has no relation to intelligence.

Here are some things to try to make this time more comfortable for both you and the person for whom you are caring:

  • Make sure both you and the person are ready for completing the task.
  • Realize that personal care is invasive. Give the person as many options and choices as you can to give them control. For example, let him or her pick out his or her own clothes, decide what to eat first during a meal, and have a choice on when to bath or eat.
  • People who have difficulty moving can become fearful very easily. Make sure you have the right bathing equipment (tub transfer bench, hand-rails in the bathroom) to keep you and the person safe.
  • Everything moves slower for individuals with physical or cognitive problems. Break down the tasks into small components. For example, instead of trying to do a full shower, wash the face and neck before breakfast.

These are only a few recommendations for helping eliminate the uncomfortable aspects of providing personal care. Caregiving is a two-way process between the caregiver and the care receiver. The goal should be: do with the person not for the person.

For more information, consult your physician and ask for an occupational therapy referral.

Vicki L. Smith, Ed.D., M.B.A., OTR/L is professor and chair of occupational therapy at Keuka College, one of the fully accredited schools for occupational therapy in upstate New York. Dr. Smith has authored two books on making the transition from the classroom to the occupational therapy clinic. This topic is reflected in the unique opportunities Keuka Colleges provides though its clinical education fieldwork. When she's not busy teaching students how to become an occupational therapist, she enjoys spending time with her family and playing with her Droid.

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