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When I worked as a nurse, I often counseled families about the challenges of caring for their parents when they could no longer take care of themselves. Even as more and more people benefit from long-term care, the challenge of accessing good care can still be overwhelming. Cohen and Eisdorfer, in their book, Caring for Your Aging Parent, offer excellent information on how to meet the challenges of caring for the elderly. Cleric Desmond Tutu once said, “There is only one way to eat an elephant: one bite at a time. The nature of caring for an elderly parent requires you to tackle it one task at a time. According to Cohen and Eisdorfer, there are seven steps to effective caregiving, and they are as follows.

• Recognize and prioritize problems. It is essential to assess all the problems rather than solving the problems without having the big picture. Ask yourself, “What is going on right now that needs your attention?” If your relative has to change their place of residence, it is an urgent problem. To avoid repeatedly fixing this problem, create a plan for what you will do now and in the future. When choosing a senior care facility, choose one that can accommodate patients at different levels of care, making it easy to change your loved one’s level of care if necessary. A plan is essential regardless of a person’s mental state, but it is especially important when cognitive decline makes it difficult to adapt to change. The three things to remember when assessing problems are safety, function, and plan. My advice to families is to go at your own pace. Things will not be perfect. Your mom or dad will have times when they are not happy, but by recognizing the issues and prioritizing them, you can take comfort in knowing that you are addressing the issues that matter most.

• Overcome denial. When a parent is in need of care, denial can make you think you are capable of handling more than you can, and even more than is humanly possible. Even if you are a professional caregiver, caring for your parent is different and providing 24/7 care for an extended period of time is exhausting and dangerous to your mental and physical health. Whether you want to deal with it or not, it is necessary to recognize that you cannot do everything and to accept help. You need a healthcare professional who can monitor them (and you) from time to time and assess their condition and needs. There will be things they need that you can’t do. Self-care for a parent can be very difficult. Even if they changed your diaper, you may not be able to change theirs. With age, problematic habits like heavy drinking and unhealthy eating are likely to get worse, not better. Although there are conditions that cause reversible dementia, mental decline is usually progressive. Your elderly parent will have good days and bad, aging is gradual. It is important to make decisions and take action to deal with mental and physical decline.

• Manage emotions, yours and theirs. It can be difficult to see your relative walking away while they are still alive. The first time a person sees their parent staring blankly at them without recognizing them is heartbreaking. Acceptance is difficult and managing your emotions is essential. You may have heard the following story:

At 8:30 a.m. one morning, an elderly man arrived at his doctor to have the stitches removed from a cut in his thumb. He had an appointment at 9:00 am and asked if we could see him earlier. I jokingly asked him if he had a date. He told me he was going to the retirement home to have breakfast with his wife. When asked how she was, he told me she had Alzheimer’s disease. I asked her if she would be mad if he was late. He told me she hadn’t recognized him for about five years. I was surprised. I asked her, “Are you still going to see her every morning, even if she doesn’t know who you are?” He looked at me and said, “She doesn’t know me, but I still know who she is.

For this man, visiting his wife every day was a way to keep some normalcy in his life. Some of the emotions that caregivers may experience in themselves, their older parents, and family members are anger, guilt, blame, anxiety, and depression. Everyone handles grief differently, and the less family drama, the easier it is for everyone. Having good boundaries is very important. Protecting vulnerable parents is essential and sometimes protecting yourself is just as important. When emotions are overwhelming, breaking away with love can be your best course of action.

• Build collaborative partnerships. By carefully evaluating resources, roles, and relationships, you can ensure your aging parent is receiving the care they need. It is important to establish an excellent medical care team. Gerontologists are not available in all communities, but a compassionate doctor or nurse practitioner who understands the needs of the elderly patient is worth their weight in gold. A mental health professional can also be a necessary member of the healthcare team. You may also need personal care assistants and people to help with shopping, housekeeping, or the company. It is good to identify other people who can share these tasks. It helps when caregivers are familiar and cohesive, but depending on one person for every need can leave you embarrassed if they leave or become unable to provide care.

• Balance needs and resources. Sometimes obligations can compete with responsibilities. Anyone who wishes to be involved in the care of the elderly should be considered. It is however advantageous for families to choose someone to be the “tip” person who communicates with the doctor or nurses, everyone will have an opinion on what to do and how to do them. Establishing and maintaining open discussions and honest communication can be essential in ensuring that your elderly parent receives good care. When everyone involved in care is clear about what is expected, you can work as a team. If the family dynamic is contentious, it can make effective patient management more difficult for you and the staff. You may find that the professionals on the healthcare team can help set boundaries with difficult family members if they know you will support them. As experts in care, their advice on what is best for the patient will carry more weight. Care for the elderly is often a marathon rather than a sprint. Sudden death of a parent is difficult, but it can be emotionally and financially draining when a parent deteriorates and loses the ability to think or function but continues to live in this condition for years. While it is noble to want to provide loving care to your parents in their later years, it does not make sense for you as a caregiver to sacrifice your life, health, career, or relationship with your children, grandchildren or siblings. Manage the expectations you have for yourself and for others, and you will save everyone involved a lot of hardship. Taking care of yourself is as important as taking care of your parents. If family conflict is high, giving decisions to a trusted third party can ensure that decisions are based on what is best for the parent and that their recommendations are more likely to be accepted by everyone.

• Let go and move forward. No one is ready to become their parent’s caregiver. It goes against the natural order of things. Your parents’ needs may become more than you can provide without you even realizing the time is right. It is wise to delegate someone you trust to tell them when they got lost in caregiving. Years ago, I took care of my dying stepfather. I had been the primary caregiver for about a month, 24 hours a day, seven days a week. Even though he usually slept through the night, I often didn’t. One day a family member who was a nurse visited me and suggested that I take a break. I got in the car and went to the grocery store. As I walked around the store, I realized I had lost my way. I couldn’t remember what I liked to eat or what I liked to do before the role of caregiver took over my life. The family enjoyed what I was doing, but I needed to change my level of entanglement. I did and I was more successful in taking care of him during the last three months of his life by taking better care of myself. Accepting help, allowing myself to detach a bit, and preparing for the end were all crucial steps in letting go and moving forward. I then realized that if he had needed six years of care instead of six months, I should have done it very differently. I was lucky my stepfather was a pleasant and cooperative patient and always grateful for my help. I know the challenges I faced were minimal compared to what a lot of people face when looking after their parents.

I hope you find these seven steps helpful as you take care of someone you love. For more information, I highly recommend Cohen and Eisdorfer’s book Caring for Your Aging Parent. Our community has many valuable resources for families who need help. If you have a specific question, please feel free to email me at the address below. If there is an answer, I can help you find it.

Cami Miller is a business coach and partners with leaders at all levels to develop strategies for success. Contact her at [email protected]

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