A Caregiver Check-In

Editor's note: Information on the COVID-19 crisis is constantly changing. For the latest numbers and updates, keep checking the CDC's website. For the most up-to-date information from Michigan Medicine, visit the hospital's Coronavirus (COVID-19) webpage.

The need for caregiving is intensifying once again. As we enter another season of the pandemic with cases soaring and the nation gripped by ongoing tensions and concerns, we are faced with an unprecedented depth of fatigue and trauma.

Caregivers are maxed out and their access to support is limited. With families having been separated during the holidays when closeness and support is needed most, there may be intense pain felt. Many are missing that natural time where they could restore connections, express concerns and get offered assistance leading into the New Year.

Most women near and over age 50, an age and gender seemingly common for many care partners, are conditioned to be selfless. Caregivers may feel like they are disappearing as independent people. It's important for all of us to help them remember that doing something just for yourself is not self-indulgent, it's self-preservation.

Keeping the caregiver well is not only best for all, it's imperative. 

The aim here is modest: how not to make things worse, and wherever possible, in the smallest and yet meaningful ways, make these caregivers' lives a little easier, especially during the pandemic.

But, before approaching and offering help to the caregiver in your life, remember to first:  

Examine your own tone and hidden assumptions

While demands are not the intention, the subtext of encouraging caregivers to "please, remember to take care of yourself, too" can be misinterpreted as: We feel terrible for you and this makes us feel bad and helpless, making it harder for us to care for you, too!

To the thoroughly defeated caregiver, a self-care reminder is appreciated, though without meaningful action it can feel as if they're not doing enough, or worse, that they're doing it wrong.

So, how can we provide encouragement without the unintentional judgment or badgering?

It begins with understanding ourselves first. Thankfully, we don't even need to know the ins and outs of their complex situation. When we proceed with awareness, no matter the actual circumstances, we will approach our caregivers from a kinder and stronger place from within ourselves.

Assume they are doing the best they can with what they have

Caregivers would love to take a minute, an hour, a day or more to regroup, reconnect, rejuvenate or rest and it feels like additional stress to train or trust ourselves or someone else to care for a partner or parent. They are constantly mitigating this stress and orchestrating micro-care exchanges and communication, which are difficult to interpret and respond to day in and day out. They don't have consistent back up, or feel they have reliable support to step away on a regular basis, or they may fear allowing it for the first time. 

Taking care of ourselves is one of the hardest things we do in our lives. For a caregiver, this often feels even harder due to these barriers.

The need to ground and balance your communication for clarity

A friendly check-in can easily go off the rails into a vent fest. While this can feel good in the moment, it can feel heavy afterward for you both.

Instead, make an intention to ask permission and see if just a bit of curious direction can help the sharing (and learning) in both directions. Keep it simple; starting with one to three topics to discuss is a great place to begin and offers plenty of material to talk through during a 30-minute conversation. Examples include:

• Three things that are working for you and three things that are a struggle.

• Three things you have found comfort in today and three things that felt hard.

• Three things you look forward to and three things you look forward to letting go/be.

The answers will give you more insight into each other's lives and experience, and is less likely to be mired more deeply in problems, which are only part of the story. Most of the time, there isn't a crisis going on, which makes you quick to move on and miss the opportunity to support what is functioning well.

When and if your caregiving friend is in a crisis, after approaching your weekly or daily conversations this way, you both will have a clearer sense of where your heads and hearts are by understanding these smaller details first. Just listening to the answers without jumping into problem solving is a tremendous gift you can give to them.  

Now that you've adjusted your attitude and approach to offering support, here are four concrete ways to get started:

1. Offer to arrange help or be there so caregivers can seek their own medical care.

COVID-19 impact data indicates people are delaying critical routine visits and follow-up care. While the data hasn't been compiled yet to specially cite family caregivers, we can assume the delay is far more staggering, and devastating, than realized.

Visit or help arrange a visit to provide support so caregivers can do something healthy just for themselves, regularly. Also keep in mind that current appointments are taking an average of three to six months to reschedule.

2. Ask how you can help prioritize their top three concerns.

The concerns that keep a caregiver up at night are a good place to begin. Imagined or real threats are equally valid. This is complicated. People are complicated, and caregiving raises the stakes. This usually involves multiple steps and sometimes, dead ends, which can be extremely frustrating and sadly, can also delay critical care. Just the thought of beginning the process (again) is often too much for a caregiver to initiate on time, so offering to help with one or more connections can lighten the burden. Not knowing where there may be a solid lead and the discovery of resources is enough to shut someone down.

From a bird's eye perspective, we can see how this delay is counterproductive, yet we all do this. Most of us, even recently, have delayed beginning a process by minimizing our needs with all kinds of defenses and even well-meaning resistance. When we acknowledge this, we can be humble and compassionate when we enter a caregiver's world. It's normal, so let's normalize this!  

Your approach could begin with: I know this is hard and it's perfectly understandable to feel resigned or even hopeless. May I help by taking the first step with you?

3. Help in other areas of their life.

While you can offer to be there, I would encourage even more autonomy. Help by supporting another area of their life which will free up time in another, such as organizing a one to three times per week meal train for a simple meal they won't have to prepare.

In addition, here are two simple to use free online platforms for coordinating friend and family support for caregivers in unobtrusive, timely ways: Lotsa Helping Hands and Meal Train.

4. Provide additional resources that may help.

Here are three places to get you started in securing additional support to offer them:

• Wellness Initiative - University of Michigan Alzheimer's Disease Center offers a variety of free weekly and monthly programs, as well as courses and annual retreats for caregivers.

• The Silver Clubs - U-M Turner Senior Wellness Programs offers day programs for people living with memory loss so that their caregivers have the opportunity to recharge.

• Area Agency on Aging 1-B offers caregiver coaching, classes for caregivers, resources, and more, specifically in southeast Michigan and metro Detroit.

You are wise and kind to look into these or other resources on behalf of a caregiver, and you don't have to do this alone. Calling your local Area Agency on Aging or the Alzheimer's Association is always helpful. 

If you have a friend or family member in long term care during the COVID-19 pandemic or know someone who does, please consider attending one of the weekly, one hour, Michigan Ombudsman meetings for updates about policies and advocacy for older adults.

They do all the work to synthesize the information coming from the governor's office so you don't have to. This has been highly recommended by caregivers who have attended during the pandemic. Listening to one of the meetings may provide information they need and do not have time to gather or bandwidth to attend.