Caregiving Decisions: When No Choice is Ideal

By Pamela D Wilson CSA, CG, MS, BS/BA

Unexpected, uninformed, overwhelmed, stressed, anxious, depressed, angry, fearful, between a rock and a hard place, poor choices, lack of planning, what were our parents thinking, what were we thinking.  All terms caregivers utter when a decision has to be made about the care of a loved one and because of a lack of planning or because of advancing health conditions, the available choices are less than idea.  Difficult decisions result in caregivers who experience emotional distress, guilt, regret and a few sleepless nights.

Details of situations that result in difficult decisions are as varied as the family situations that exist.  However the decisions revolve around the four general areas:  the financial ability to pay for care, the complexity of the health diagnosis, caregiving and family relationships and reality orientation to the current situation and planning for care needs.  Caregiving situations arise because a need for support has been identified.

In many cases there is denial on the part of the older adult that care or support is needed.  This results in challenges with reality orientation and delays planning.  In other cases, family caregivers, friends and others are in denial or disagree about the extent of the care needed because of their own personal or emotional reasons.

Finances present front and center when there is no money to pay for care and families must consider public assistance through Medicaid including nursing home placement; a decision children promised mom and dad they would never consider.  Other times caregivers are more interested in a financial inheritance rather than the care of a loved one or parent.  Sometimes financial abuse has already occurred by a child appointed power of attorney the parent thought they could trust.

Health conditions, like memory loss or advancing chronic disease, will result in difficult choices to move a parent to a care community, to decline surgery when there is no clear benefit, to say no to the decision to resuscitate and to refuse aggressive measures to preserve life.  The relationship with end of life decisions and losing a loved one is different for all caregivers.  There’s no way to know how we will react when we lose a loved one.

When difficult decisions are presented the ease or difficulty of the situation relates to the quality of our relationship with other family members, parents and the person needing care or support. Society today is mobile.  Families are separated by distance and drawn back together because of a caregiving crisis. Distance and unfamiliarity complicate caregiving decisions.  Many family members believe they are alone in dysfunctional situations.  This is rarely the truth.

If you are in a challenging caregiving situation and decisions are present or in the near future, becoming educated about your options is important.  Decisions made in haste without adequate information are often regretted and can be costly.

© 2012, 2014 Pamela D. Wilson, All Rights Reserved.

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