Elderly Taking Care of Elderly – The Caring Generation®

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The Caring Generation® – Episode 65 December 2, 2020. On this caregiver radio program, join Pamela D Wilson, Caregiving Expert for Elderly Taking Care of the Elderly. What happens when adult children or friends considered elderly care for elderly parents or friends? Guest Dr. Kathryn McDonald, a patient-safety expert from Johns Hopkins shares information about making healthcare safer.

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Elderly Taking Care of Elderly


0:00:04.9 Announcer: Caregiving can sometimes feel like an impossible struggle. Caregivers may be torn between taking care of loved ones and trying to maintain balance in life. The good news is that it doesn’t have to be that way. The Caring Generation with host Pamela D. Wilson is here to focus on the conversation of caring. You’re not alone, in fact, you’re in exactly the right place to share stories and learn tips and resources to help you and your loved ones. So now, please welcome the host of The Caring Generation, Pamela D. Wilson.

0:00:39.1 Pamela D. Wilson: This is Pamela D. Wilson, Caregiving Expert, consultant, and speaker. I’m your host on The Caring Generation radio program, coming to you live from the BBM Global Network Channel 100 and TuneIn Radio. The Caring Generation focuses on conversations about health, well-being, caring for ourselves and aging parents, all tied together with a little bit of humor and laughter essential to being a caregiver. The topic for this caregiving radio program is elderly taking care of elderly. Are you an older adult taking care of elderly parents? Are you an exhausted spouse caregiver in your 70s, 80s, or 90s, struggling to keep up because you have your own health problems? Are you an older adult living alone caring for a friend, or maybe you have an elderly friend caring for you? Elderly, taking care of elderly is a trend that will continue to grow as all of us, and the population continues to age. I’ll share research from the Center for Retirement Research at Boston College to give you an idea of who is providing care. For all of us, whether we like it or not, aging is inevitable. If you don’t know who will be your caregiver or have a plan for caregiving, now is the time to discuss this before you need care or before anything happens with your health. During this program, we’ll talk about five situations that caregivers brought to me that impact caregiving relationships.

Caregiving: Elderly Children Helping Elderly Parents

0:02:18.4 Pamela D. Wilson: The guest for the health and wellness segment of the show is patient safety expert Dr. Kathryn McDonald. Dr. McDonald holds primary appointments in the Johns Hopkins School of Nursing and Medicine and joint appointments in the Carey Business School and Bloomberg School of Public Health. Dr. McDonald is also affiliated with the Armstrong Institute for Patient Safety and Quality and co-directs The Center for Diagnostic Excellence. Before joining Johns Hopkins, Dr. McDonald was the founding Executive Director of the Center for Primary Care and Outcomes Research at Stanford University’s School of Medicine and the Executive Director of Stanford’s Center for Health Policy.

0:03:04.6 Pamela D. Wilson: Let’s return to the idea of elderly taking care of elderly. For those of you who may not yet be at this stage in life, but for whom this may be your future. The goal of this caregiving program is to help you avoid surprises about aging and caregiving that few people talk about. Let’s start with who provides the most hours of care. If you’re a caregiver, this one should be no surprise. Spousal caregivers and daughters, according to an article called How Much Long-Term Care Do Adult Children Provide? by Wettstein and Zulkarnain, —62% of all care hours are provided by spouses and adult daughters. Sons represent about 16% of care hours provided. Other relatives, mostly grandchildren, this number is growing 18% of care hours provided and 4% by non-relatives, which would be friends.

0:04:00.9 Pamela D. Wilson: Let’s talk about these statistics. Spousal caregivers provide 31% of the total hours of care. This one makes sense because couples live together. So the spouse being the primary caregiver is obvious. If you are a couple, have you talked about a plan for when one of you becomes sick and needs care? If there’s an age gap, health being equal between the partners, it’s probable that the older spouse will need care first. What plans are you making for elderly taking care of elderly, knowing that the healthy spouse caregiver will eventually need care? I know it’s not something we want to think about or talk about.

0:04:41.6 Pamela D. Wilson: The state of your health today directly impacts the amount of care you will need when you age. What steps are you taking today to be healthy and minimize the possibility of being diagnosed with a chronic disease like high blood pressure? If you already have a diagnosis of high blood pressure, are you taking medications? What other steps are you taking to minimize the likelihood of being diagnosed with yet another chronic disease? If your doctor didn’t tell you, one health issue can lead to another if you’re not proactive. These are the issues that the healthcare system should be talking to you about, preventing. Unfortunately, because the system is so rushed, there’s little time for these discussions when you visit the doctor. That means it’s up to you to take charge of your health. If you don’t, no one else will, and as you know, nagging a spouse or a family member does no good. It’s up to each of us to motivate ourselves, to change health habits based on how we want to live our lives, being healthy or being old and sick.

0:05:45.1 Pamela D. Wilson: The next statistic—31% of caregiving hours are also provided by adult daughters. Why is this? It’s because of a societal view that women are the caregivers. In part because women have children and choose to take time out of the workforce to have and raise children. This opting out of work, places women in a permanent role of that family caregiver, leading to elderly taking care of elderly. The assumption exists that women will always be that caregiver. This can mean placing a career on hold to deal with family issues, including caring for aging parents and a sick spouse. As you might imagine, the research confirms that the percentage of caregivers providing care increases with age. Even though there are a high number of millennials providing care these days for middle-aged parents, more elderly taking care of elderly exists with adult children over age 60 who provide care for elderly parents. The equalizer to age and taking care of elderly is the time devoted to care. These numbers might shock you. For adult children of all ages, from age 30 up to age 70, the hours spent on a monthly basis taking care of elderly averages 77 hours per month or about two weeks a month of a full-time paying job.

0:07:10.3 Pamela D. Wilson: If you’re a caregiver, you probably know this. More interesting at the point that an adult child reaches the age of 70, those hours skyrocket up to 95 hours of care each month. The challenges for 70-year-old children caregivers is that by this time in life, these caregivers are dealing with their own health issues. Caregiving spouses also experience similar challenges. Many spouses go it alone without help from adult children. Caregiving spouses, the elderly taking care of elderly, experience more health issues, physical and mental. Many are in and out of the hospital. More information about spousal caregivers is on The Caring Generation podcast, it’s called How to Get Elderly Parents to Accept Help, and that includes elderly spouses.

0:08:01.5 Pamela D. Wilson: Up next, we’re going to be talking to Dr. Kathryn McDonald from Johns Hopkins University. She joins us to talk about patient safety, including patient education strategies that you should be aware of to make sure that elderly parents and you get the care that you need and want from the healthcare system when you are dealing with hospitals and health care providers. She’s going to be talking about some common health conditions and things that you really should know. More helpful information for caregivers and aging adults is on my website, that’s www.PamelaDWilson.com. It is in my Caring for Aging Parents Caregiving Blog.

0:08:41.9 Pamela D. Wilson: You can also follow me on Facebook at PamelaDWilsonCaregivingExpert, where you can join my online caregiver support group. It is called The Caregiving Trap, which is also the name of my book. The caregivers in that group are worldwide. They are from all over the world—they are very helpful. It is a very positive group, caregivers helping other caregivers through a lot of situations, and there is no what I call caregiver shaming. Many caregivers are hesitant to join groups because they feel like they’re going to be judged—there is none of that in this group. So check out my Facebook page, PamelaDWilsonCaregiving Expert. This is Pamela D. Wilson on The Caring Generation radio show, live on the BBM Global Network Channel 100 and TuneIn Radio. Stay with us. We’ll be right back.


0:11:58.7 Pamela D. Wilson: This is Pamela D. Wilson, Caregiving Expert. I’m your host on The Caring Generation radio show for caregivers, live from the BBM Global Network Channel 100 and TuneIn Radio. Dr. McDonald, welcome. Thank you for joining us.

0:12:12.0 Dr. Kathryn McDonald: Thank you, delighted to be here.

0:12:14.5 Pamela D. Wilson: So you’re an expert on patient safety, what is the goal of patient safety practices?

0:12:22.3 Dr. Kathryn McDonald: They are very important actually for patients and for their family members. They relate to being able to know that when you go to the hospital, or you have a healthcare situation—you’re in the nursing home, or even at a doctor’s office, there’s a chance that something can happen in the course of your care that you didn’t expect to happen just because you were exposed to the care and things like getting an infection from having a line placed in your body. And so, patient safety practices are oriented to trying to figure out how to prevent those patient safety events. Those adverse events that can happen to people when they’re in a healthcare environment. And they run the gamut from processes that clinicians perform to make things safer to changing the structure of care. How it’s organized, to things that patients can do and their family members can do. So there’s a whole range of practices that can be implemented to keep care safer for patients.

0:13:35.5 Pamela D. Wilson: I found you through your research called Making Healthcare Safer, and it talked about three areas where patient safety interventions can have the most significant effect. What are those?

0:13:47.5 Dr. Kathryn McDonald: The setting of care can impose more risks. So hospitalization— being in a hospital is a place where there’s more activity. More things are happening to patients and with greater risk. So any time a patient’s in a hospital, that’s a time where there’s—obviously lots of important good things are happening while a patient’s in a hospital—but there’s also the exposure to the possibility of harms. Things like falls in the hospital because it’s maybe being disoriented and not really being familiar with the room. So that’s one area. The hospital, certainly critical care within the hospital, is another area where the risk can be higher, and therefore the need for patient safety practices and attention to that risk is also higher. And surgery is another risk area. There’s a lot that the body is going through with surgery, and there’s a lot of processes all occurring together that put a patient at more risk.

0:14:56.4 Pamela D. Wilson: And that report mentioned—I was amazed, 79 patient safety practices with 11 being more likely to decrease risks, and one of the areas mentioned was patient interaction and the informed consent process. Can you talk about why that’s important?

0:15:13.7 Dr. Kathryn McDonald: Sure, I think this is really important for people to understand. I’ve been in patient safety for a number of years, and that report was actually written about a few years ago and continues to be updated. It was the first report to try to articulate what types of patient safety events could happen and what types of practices could reduce the risk of those events. So we, in that report and then in subsequent work, have focused on how and what the patient or the family members do can help add protection. And so I think this would be really important to your listeners is that when you are a family member, and you’re in the hospital with a patient in times that are different than now, there’s an ability to maybe set the room up in a way that’s safer and more comfortable for the patient. There’s communication in terms of knowing who’s coming in the room and what their role is. Asking about that. There’s lots of interventions that have happened in terms of giving the patients and the family members more education when they come into the hospital about how they can activate greater levels of attention if they’re concerned about something going on. And so that’s real important is the ability for patients and their family members to feel comfortable asking questions and seeking input into how they can help keep their care or their family member’s care safer.

0:16:51.8 Dr. Kathryn McDonald: In terms of the other thing you mentioned with the informed consent process, this is risks-related to any intervention that’s done on a patient. Having the patient and their family members understand what the actual risks are and include those in their decision-making. Not all interventions are equal in terms of the benefits they provide. And so the balance of risk that a patient may have versus the benefit they may get, and their preference for that benefit or their concerns about that risk need to be well understood before making a decision. And that’s what informed consent is all about. It’s having a process that makes sure that the patients and family members really understand what will be happening to them and what the risks are.

0:17:42.4 Pamela D. Wilson: And another question on that—so is that mostly done with the doctor or when they’re signing paperwork? And I know we’re going to have to go out to a break, but maybe you can start the answer, and we can finish it after the break. Who does that informed consent?

0:17:57.6 Dr. Kathryn McDonald: It really varies from place to place. If you need a colonoscopy versus if they’re going in the hospital for surgery. So that’s one of those things that you have to be alert to. You can even ask when you’re starting down a care journey, when will I be able to understand what my risks are and what the benefits are, when will I be involved in an informed consent process?

0:18:22.0 Pamela D. Wilson: And then I know that you are involved in research on diagnostic safety. What types of problems relate to that?

0:18:30.2 Dr. Kathryn McDonald: Yes, diagnosis is really an understudied area of healthcare, and yet pivotal for patients. That’s what starts their journey is getting the right diagnosis in a timely way. And there are many diagnosis that go really well, and you get the right diagnosis, and you’re off to the right care. But there are certainly instances where there are delays that are consequential. A longer time to say, get a cancer diagnosis can be really, have quite a bit of consequence in some cases, and just having the wrong diagnosis for any number of, any common diagnosis can be misdiagnosed. So it’s an area that patients are usually having. It’s harder to know what could go wrong in a diagnosis. Once you have a particular diagnosis. Then you can look up information about that. But before you get diagnosed, you’re coming in with a need to explain what’s going on with your symptoms, and it’s not always just one doctor who’s involved. There’s referrals, and there can be the real challenge is actually with the elderly. There could be important challenges related to side effects from medications that don’t get diagnosed, and that’s a real common one in the elderly.

0:19:52.4 Pamela D. Wilson: And Dr. McDonald… If you can hold on to that thought, we are going to take a break. Listeners, we will continue this conversation with Dr. Kathryn McDonald after this break. I’m Pamela D. Wilson on The Caring Generation, live on the BBM Global Network Channel 100 and TuneIn Radio. Stay with us. We’ll be right back.


0:22:38.5 Pamela D. Wilson: This is Pamela D. Wilson, Caregiving Expert. I’m your host on The Caring Generation on the BBM Global Network Channel 100, and TuneIn radio. We’re back to continue our conversation with Dr. Kathryn McDonald. So Dr. McDonald, maybe finish up the thought that you were talking about before we went out to the break about diagnosis and the importance of patients being proactive.

0:23:00.3 Dr. Kathryn McDonald: Oh, sure. It’s surprising actually how easy it is for patients to feel dismissed and not have a strong enough voice. Especially in a setting where they’re in the middle of going through some symptoms that are debilitating or difficult. So that’s where family members and the patients being able to know that it’s okay to keep pursuing a diagnosis if the explanation that they’ve gotten isn’t seeming to work out. I think it’s really important to trust one’s gut, and the research really bears that out.

0:23:40.7 Pamela D. Wilson: Thank you for that. So another item mentioned in the report was adverse drug events. Can you explain what that is and how caregivers and patients can help prevent that?

0:23:51.7 Dr. Kathryn McDonald: Yes, this is another area in patient safety that’s really vital. Just like what we were talking about with diagnosis. Elderly especially are taking quite a few medications often, and each medication has a potential for side effects or interactions with other drugs, and adverse drug events are any negative reactions that could harm a patient. So to prevent those, there’s been a lot of work on how to prevent them. And I think what I would really highlight for folks who are older and those who care for them is those patients who are on multiple drugs, being able to work with a geriatrician or a clinical pharmacist. Seeking out care from a specialist who can review the multiple drugs and make sure that they’re all necessary. And sometimes there’s not a discontinuation of drugs that are not so important anymore, and they can then be interacting with drugs that are on board. So there’s been more and more attention recently to—and it’s called polypharmacy. Where there’s enough different drugs that a patient is on that adverse drug events are related to being on more drugs. And it’s getting to those specialists who are good at understanding the added risk of having multiple drugs and reviewing that and discontinuing medications that aren’t offering enough benefits, given the whole constellation of needs that a person may have, so patience from family members can again help with that.

0:25:44.1 Pamela D. Wilson: And another drug that was listed in the complication list was warfarin, I call it Coumadin. I have a lot of clients who have been on that, and there wasn’t a lot of education. Where can consumers learn more about the importance of managing that and all the other associated things they should do, like the INRs and things like that?

0:26:02.9 Dr. Kathryn McDonald: Yes. This is a very complicated area for patients. You’re talking about a drug that’s pretty risky, but it’s important in terms of benefit. You’re reducing the chances of clotting-related effects, things like strokes and deep vein thrombosis, and so it’s an important drug.  But managing it in a way that faces, because it can increase the risk of bleeding is vital. And what we’ve seen is that, as you’ve pointed out, patient education is really important, and so the question is, in what form? Is it talking to patients about stories? Giving them examples of other patients and how those patients have—what they’ve needed to do? Make sure to go in and get your lab tests. Make sure to talk about any big changes to your diet that would mean you’re not consistently taking the same foods and might have a difference in your vitamin K levels. Things like that. So being able to engage the patient and give the patient enough information that is accessible. It can be challenging because it’s complicated, and so there’s some evidence that explaining with stories from other patients is helpful.

0:27:22.8 Dr. Kathryn McDonald: Another great resource that I want to mention too is the Agency for Healthcare Research and Quality, that is very focused on quality and safety. And they have on their website, you can go to something—maybe look at blood thinners and using blood thinners safely, or put in Coumadin or warfarin safety and the Agency for Healthcare Research and Quality—there’s a video and there’s other patient education material that’s been well tested and could be helpful.

0:27:57.6 Pamela D. Wilson: Thank you for mentioning that website. I’ll be sure to put a link in the transcript. So we’ve got about time for one more question. So the report also mentioned safety practices for the elderly. What type of injuries should they watch out for if they are in the hospital?

0:28:12.7 Dr. Kathryn McDonald: One of the most important areas is delirium. So about a third of hospitalized patients over 65 have some level of delirium—disorientation. And it can be related to having a serious illness. Maybe being on new medications. Having sleep disturbances while in the hospital. And it’s often, it’s family members who are the first to notice that their family member is seeming a little bit more disoriented and unable to have the level of cognitive function that they came in with. And so that’s helpful because if a family member can say they’re concerned, then the medical team can start to look at what the cause is. If it’s a new medication, maybe that medication would be changed, and there’s plenty of other things that can happen for that. So it’s one real important area. Falls are another area. Another target that I think I mentioned that earlier in terms of really making the patient’s room a little bit more like home—so that there’s not as much risk of being out of your routine and then slipping. There’s a lot of things that hospitals do too, to try to reduce fall risk. And the last one I’d mentioned is the bedsore prevention. If a patient in a hospital has a hard time turning over, it’s important to move enough to not have skin breakdowns. So those are three that matter.

0:29:49.4 Pamela D. Wilson: Dr. McDonald, thank you. Thank you so much.

0:29:52.1 Dr. Kathryn McDonald: Sure.

0:29:53.4 Pamela D. Wilson: I so appreciate your time. Thank you for joining us and really for all of the work that you do. Listeners, invite your family and friends to join us every Wednesday night. This is Pamela D. Wilson, your host on The Caring Generation, live on the BBM Global Network, Channel 100, and TuneIn Radio. Stay with me. We’ll be right.


0:32:33.9 Pamela D. Wilson: This is Pamela D. Wilson, Caregiving Expert, consultant, and speaker on The Caring Generation radio program for caregivers and aging adults. In the first part of the show, I shared research on the number of elderly taking care of elderly and the challenges of caregiving for your elderly parents or an elderly spouse. I want to share experiences that caregivers shared with me about five situations that impact caregiving relationships. Elderly taking care of elderly involves navigating family relationships and relationships with healthcare providers. In both sets of relationships, the caregiver needs help and support. The million-dollar question for elderly taking care of elderly is how do you accomplish getting what you need and deserve? I say deserve in part because of the relationship that you have with the healthcare system—like we talked about with Dr. McDonald. Healthcare providers have a duty to provide care. As elderly taking care of elderly, caregivers run into a lot of roadblocks with the healthcare system. I was talking to a caregiver recently who has been trying to have a family member placed on hospice. One of the issues was, is that there were just too many people involved.Too many providers offered to follow through, and they didn’t do anything.

0:33:44.9 Pamela D. Wilson: There was no single point of coordination, and the caregiver didn’t understand his or her role in being that person. Elderly taking care of elderly involves several health care providers when health is complex, and the more people that you add, the more you as the caregiver have to do to coordinate care and organize the details. You can’t leave that responsibility up to someone else because it doesn’t always work out. It’s up to you to figure out why gaps or delays in treatment or care is happening. If you don’t understand the way the system works, ask, and keep asking. This example was about hospice care.

0:34:23.3 Pamela D. Wilson: Hospice is end-of-life care for persons whose health is declining and for whom it’s expected to continue to decline. By the time a person is accepted into hospice, that means that they have decided and agreed that they don’t want any life-sustaining treatments. In the case of this situation, the family member said that. But the first snag was a home health care company visiting suggesting physical therapy. The goal of physical therapy is to improve physical function. Expected improvement is the opposite of not treating a decline, so it was in conflict with a request for hospice. And so confusion arose in the family because you’ve got a home health care company saying, “Well, let’s do physical therapy,” and the person saying, “No, I don’t want any more treatment.”

0:35:08.0 Pamela D. Wilson: So the doctor’s offices were confused. The providers were confused, and because of all that, hospice wasn’t begun and the caregiver was waiting and waiting and waiting for all of the providers to work out the situation between themselves, and that really didn’t happen. It actually took months before I was contacted, and I said, “This is the problem here. This is what you want to do,” and so it did get resolved. But those types of confusing situations result from a lack of understanding by the caregiver—elderly taking care of elderly—that it’s your responsibility to gain clarity and move situations forward when they become stuck. If you wait on the healthcare system to do their job, sometimes they’re not going to follow through, and you’ll experience a lot of problems and delays.

0:35:56.5 Pamela D. Wilson: So let’s talk about a similar concern by caregivers related to navigating family relationships. The same advice applies. If you wait and expect that family members will understand how you feel, understand the pressures that you are experiencing, or know what being a day-to-day caregiver is like, you know that you’re wasting time hoping that someone is going to offer to help. No one can read anybody’s mind and really understand how an exhausted caregiver feels.

0:36:23.6 Pamela D. Wilson: In both situations, the relationships with the healthcare system and relationships with people, you want to ask yourself, are your actions and behaviors contributing to those gaps, the misunderstandings, or the frustrations? For all of us, the more clear that we can be in communicating needs, asking questions, and trying to learn about health concerns, the better that taking care of elderly becomes. We know it’s not easy. We know it is so complicated, challenging, and frustrating, especially when we feel that others aren’t helping. On the other hand, elderly taking care of elderly can be one of the best parts of your day and the best parts of your life when you see that what you are doing is actually making a difference in the life of a spouse or a parent.

0:37:11.7 Pamela D. Wilson: In the 20 years that I spent in direct care, taking care of elderly and disabled clients, I became a master at problem-solving. If you haven’t learned this yet, what you think to be that obvious problem isn’t always the problem. Getting to the source of a health issue or a gap in care can take a lot of investigation and asking questions until you thoroughly understand what that issue is and how all those situations go off track. I always say that caregiving is like a do-it-yourself project. Each situation is different, and the same solution won’t work for you as it might work for another person. But it’s good to ask other people their experiences so that you can learn from them.

0:37:52.8 Pamela D. Wilson: Family situations, health situations, working with insurance providers, hospitals, all of that is different for everybody. And it can pose a variety of hoops for you to jump through, but you can succeed. The manual on how to be a caregiver, plan and coordinate care, it’s in my online caregiver course. It’s called Stay at Home: Taking Care of Elderly Parents, and Beyond.  Information about that is on my website under the How I Help tab on the drop-down. More help for caregivers is also in my book, The Caregiving Trap: Solutions for Life’s Unexpected Changes. That book takes you through the early stages of being a caregiver. It talks a lot about planning for the future and trying to avoid all of these unexpected situations that we know that happen that can cause issues with care. It talks about caregivers taking care of themselves and how important that is to be proactive so that you can continue to take care of your loved ones and not experience health issues all yourself.

0:38:58.0 Pamela D. Wilson: So information about that online caregiver course and the caregiver book is on my website at www.PamelaDWilson.com. Remember to follow me on Facebook at PamelaDWilsonCaregiving Expert. You can also join my caregiver support group. It is called The Caregiving Trap. This is Pamela D. Wilson, Caregiving Expert, advocate, and speaker. You are listening to me on The Caring Generation. Invite your family and friends to join us every Wednesday night. Stay with me. We’ll be right back after this break.


0:41:51.6 Pamela D. Wilson: This is Pamela D. Wilson, Caregiving Expert, consultant and speaker on The Caring Generation, live from the BBM Global Network Channel 100 and TuneIn Radio. Let’s talk about the second situation that elderly taking care of elderly tell me affects caregiving relationships. This one is what I call promises and commitments. Think back, how many times have you offered to do something for someone else and you never follow through? How many times do others offer to help and never follow through? If we’re honest, we’ve all failed to keep a promise at one time or another. What we don’t realize is that the person to whom we made the promise or commitment is expecting us to follow through. What happens when we don’t? For elderly taking care of elderly, the feelings are disappointment, anger, frustration, sometimes fear, a lot of worry. If the promise was insignificant, it might not be a big deal. But if the commitment you made was important—it can be a huge deal. Not following through could be a major issue for an elderly parent, a spouse, a caregiver, another person who is depending on you to do that one thing. If you are in this situation, no matter what side you’re on, it’s time to follow through on your promises and commitments.

0:43:12.2 Pamela D. Wilson: If you’re on the receiving end and others are not following through, call out the behavior. For example, “Mary, it’s Wednesday, and you promised to do X. When can you do this?” It’s true that we all get busy and distracted, but maybe Mary forgot. But if you don’t bring that promise to Mary’s attention, she’ll not think that it’s important to you. It’s important to agree on time frames for promises and commitments so that there’s no misunderstanding about expectations on either side. Also, if you want people to keep their promises or commitments, become that person who keeps yours. And for caregivers—extremely, extremely important—don’t over-commit. There are 24 hours in a day. Elderly taking care of elderly can only do so much.

0:44:05.1 Pamela D. Wilson: Caregiver situation number three for relationship concerns is not learning from our mistakes. Look at your life. Are there situations or promises that repeat time after time, just like the movie Groundhog Day with Bill Murray? If your answer is yes, it means that you’re not learning from your actions and from these situations. A simple way to learn from our mistakes is to be honest with ourselves and take responsibility. Ask yourself what went wrong? What didn’t happen according to plan? And how what you did contributed to that?

0:44:36.5 Pamela D. Wilson: This leads us to the number four relationship concern for elderly taking care of elderly—it’s blame. Over the years, think of things that were important to you. What situations did you put up with because you didn’t want to confront the behavior or the action, or maybe you blamed it on something else. Elderly taking care of elderly involves routines and things that we become used to. In any of your relationships did you point or blame to outside circumstances or problems? What conversations do you have with yourself when things go wrong? Do you take responsibility or do you blame others? A lot of caregivers have a tendency to wait until disaster strikes to do anything, and that happens because honestly, you’re so burned out. So you start putting up with things and then all of a sudden that straw breaks the camel’s back. You’re mentally and physically done taking care of elderly parents or a spouse. You’ve lost all your patience. The challenge for caregivers who get stuck is to take action before it gets that bad.

0:45:38.1 Pamela D. Wilson: That situation makes me smile because when I used to meet with caregivers at my office, I would always say, “Well, what brought you here?” And they would say, “Oh, I’ve had your business card in my wallet for a year, I visited your website. A friend told me about you. I saw you speaking in an event, and I read your book.” And I would say, “Well, what took you so long to get here?” And the caregiver would say, “Oh, it wasn’t that bad until recently.” As elderly taking care of elderly, ask yourself, how bad does it have to get? How much are you willing to put up with before you’ll ask for help? Before you’ll start asking questions? Before you will become educated about a care situation?

0:46:20.2 Pamela D. Wilson: When you learn and take action about how to manage all of this stress, situations will become easier. Then you can stop pointing to outside circumstances. You can take an honest look at the situation and decide to act differently. While hope is a wonderful belief, hope or expecting others to change, or hoping a situation that you don’t control will change, will have you in the same place six months from now. Change doesn’t happen overnight. Changing a caregiving situation of elderly taking care of elderly can take weeks or even months to get better. And if you refuse to look at your situation differently, you probably will be in the same place six months or 12 months from now, wishing that you would have done something differently. With COVID and everything else that’s going on these days, everything is so uncertain. But don’t wait to act, do something different today.

0:47:19.8 Pamela D. Wilson: Make a list of the caregiving issues that you are experiencing. What’s working, what’s not working. Look at promises and commitments that others are making to you and that you make to others. Ask yourself if you’re being realistic Learn from things that don’t go right in your life, learn from those things that repeat. Identifying that true issue at hand. Not only the obvious issues but the ones that you uncover later. It takes a lot of observation—it takes a lot of questioning.

0:47:54.6 Pamela D. Wilson: It also takes us to the fifth situation that caregivers share about relationship snags. It’s the idea of deciding what’s important and what you are willing to do. And so what that really means is, what’s important to you? Is the relationship with a spouse or an elderly parent important to you? Is your health important to you? What is important, and what can have the greatest impact on your day-to-day relationships and the day-to-day care that you are providing for loved ones? Once you can identify what’s important, then you want to start making a list of what you can do to improve or change that situation, and what you can do. Is it learning? Is it being more proactive? And also, share with the person you’re caring for what they can do. Because caregiving should be a 50/50 relationship, it should be a two-way street where the caregiver isn’t doing everything for a loved one. Now that can get difficult when chronic disease is an issue or when dementia is an issue because sometimes elderly parents can’t initiate activities—they need a lot more hands-on care. But if you talk about all these situations early, then you can have a plan for when caregiving does get a lot more difficult.

0:49:18.3 Pamela D. Wilson: We’ll talk more about this after the break. Please do share The Caring Generation podcast with your elderly parents, family members, friends, co-workers, and social groups. The podcast is available on my website, www.PamelaDWilson.com, about a week after the show. You can add that app to the cell phone of a family member, a friend. It’s on Apple and Google podcasts. This is Pamela D. Wilson Caregiving Expert, consultant, and speaker on The Caring Generation. Stay with me. We’ll be right back.


0:52:07.9 Pamela D. Wilson: This Pamela D. Wilson, Caregiving Expert, consultant, and speaker. I’m your host on The Caring Generation. Let’s continue to work our way through the idea of deciding what’s important and what you’re willing to do as elderly caring for elderly who are taking care of elderly parents and a spouse. Resentment, anger, and feelings of guilt can creep into relationships. Especially if situations have existed where you realize that you put up with things that perhaps you should have paid more attention to. As a doctor or a family member who is working with an elderly parent, maybe your parent didn’t want to take any action, and then there are consequences. So perhaps your elderly parent is less able to take care of him or herself day-to-day. Ask your parent how will you be able to care for them when they become sicker? Why should you as a caregiver commit more time if your elderly parent isn’t willing to make an equal commitment? Remember that commitment of marriage in better or worse, until death do us part? Sometimes it’s a similar commitment with caregivers, but for older people, ask your parents at what point did they just give up caring? Elderly, taking care of elderly doesn’t mean that a healthy caregiver has to give up his or her life for another person or a spouse. This is where each person taking care of elderly parents or a spouse gets to decide.

0:53:38.2 Pamela D. Wilson: As elderly taking care of elderly, maybe you do decide to stick it out because you’d feel guilty abandoning a loved one, or maybe you decide to balance the care situation and hire some outside help or move a loved one to a care community. There’s nothing wrong with that. Getting outside help is important if your health is breaking down caring for an elderly parent or a spouse. The numbers of elderly taking care of elderly and friends taking care of friends is going to continue to grow as the population continues to age. So ask yourself what plans you’re making today for that potential future of elderly taking care of elderly. People who plan ahead in looking at care needs and looking at care costs, those who look at long-term care insurance policies or saving money to pay for care when older—it’s so important so that you don’t find yourself in a situation where you feel out of control.

0:54:38.2 Pamela D. Wilson: I want to thank all the caregivers who continue to go to my website, www.PamelaDWilson.com, and complete that caregiver stress assessment. There is a caregiver survey on my website, you go to the Contact Me button, and you can scroll down to find the survey. Caregivers who share their stories there—it’s all confidential—help me create articles and these shows for you every single week. I also will respond in videos. I do videos on my Facebook page every day. So please check that out, www.PamelaDWilson.com, the Contact Me button, and then the Caregiver Survey.

0:55:13.2 Pamela D. Wilson: Please do invite your elderly parents, spouses, family and friends, and co-workers to check out the helpful information on my website at www.PamelaDWilson.com. You can follow me on social media—on Facebook, you can watch my videos. My page is PamelaDWilsoncaregiver expert. On Twitter, I’m CaregivingSpeak. On Instagram, I’m WilsonPamelaD. All of you caregivers, I thank you so much for everything that you do. This is Pamela D. Wilson, Caregiving Expert, consultant, and speaker. God bless all of you, sleep well tonight, have a fabulous day tomorrow, and a great week until we are here together again.


0:55:52.4 Announcer: Tune in each week for The Caring Generation with host Pamela D. Wilson. Come join the conversation and see how Pamela can provide solutions and peace of mind for everyone here on Pamela D. Wilson’s The Caring Generation.



Interested in Caregiver Education? Check Out Pamela’s Online Caregiver Education Course Stay at Home: Taking Care of Elderly Parents and Beyond.

About Pamela Wilson

PAMELA D. WILSON, MS, BS/BA, NCG, CSA helps caregivers and aging adults solve caregiving problems and manage caregiving needs through online programs, live support groups, and an extensive caregiving library that includes articles, podcasts, videos, and webinars.

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