It is easy to assume that conflicting roles as worker, wife, mother, for
example, always increase stress. However, a study by Stoller and
Pugliesi (1989) suggests otherwise. After reviewing the data of a variety
of studies they suggest that these various roles can sometimes serve as
an emotional resource for the caregiver, sometimes linking them to other
social networks. Results of their study found that occupying multiple
roles is associated with better health, lower psychological stress, higher
self-esteem and greater well-being. There is a threshold, however, beyond
which multiple roles become detrimental.
Not Always Easy: The bulk of present research, however, presents
a less positive picture of caregiving. For example, a study conducted by
the Benjamin Rose Institute, (Deimling, Bass, & Jensen, 1987) found
that four out of five caregivers indicated that some aspect of helping
was difficult, tiring, or emotionally upsetting. Six out of ten
said they had no clear idea about
what was best to do in the caregiving situation, while more than half said
the person they cared for made too many demands on them.
A pervasive theme is found in the research centers on the burden and the
stress of caregiving.
The caregiving process
can be a time of increased anxiety and difficulty, particularly when the
responsibilities of working, marriage,
child rearing and parental caregiving collide. When the demands of work,
spouses and children are juxtaposed against those of an aging parent
with many needs, severe emotional drain can occur. Some research even reports
that although most caregivers feel "close" to their care receivers, an
inverse correlation exists between the closeness of kin relationship and
the ability to get along without rancor (Cantor, 1983). If there are prior
family problems lurking
in the background, such as abuse, neglect or denial of emotional or financial
support, there can be a potentially dangerous situation because the caregiver
who was abused now is in the position of power.
Both Stoller and Pugliesi (1989) and Brody (1985) point out that many of
the stress reported issues relate to aspects of either feeling totally
responsible for caregiving or feeling guilty that not enough is being done
for the care receiver.
These aspects are as much related to personality issues as they are to
family dynamics. From the literature on helpers, both formal and informal,
it appears that some caregivers run a very high risk of stress due to certain
personality issues. For example, there may be aspects of control, and need
to be identified (by self and others) as the caretaker that are part of
the individual's personality. Persons with these traits do not easily allow
themselves to be helped. Instead, they may put themselves in the role of
super person, not letting others know of needs or allowing others to share
in the responsibility. It is important that informal caregivers be or become
able to recognize and accept their own limitations and seek assistance
when needed.
Dependency of the older person on an adult child is often difficult for
both and may reactivate family relationship problems, including reverse
dependency issues. Brody
(1985) associates this dependency problem to unresolved issues on the adult
child's part, regarding his or her own dependency needs, thus relating
this situation of caregiving to that of a parent caring for a child. It
is Brody's (1985) contention that either case will lead to increasing frustration
and guilt for the caregiver. Is it not surprising that interpersonal
problems are frequently reported by caregivers?
Family issues surface in a number of ways in considering the caregiving
context. For
example, the burden experienced by caregivers appears to be highly related
to the number of informal social supports available from other family members.
The family can thus be either a potential source of support or a cause
for additional stress. Although family members may not share equally in
the care of elderly persons, they are part of the decision making network.
Family members who are excused from caregiving responsibilities are still
considered, by both elderly persons and adult children, to be part of the
decision making process regarding care arrangements (Cooper & Sheehan,
1987).
It has been found that family support systems generally operate under the
principle of substitution, in which family members are available in "serial
order," rather than acting as a "shared functioning unit."
Thus the caregiving experience burns out the first one, then another of
the family unit unless they are wise enough to parcel out the tasks and
provide one another with relief from the various duties. This assumes,
of course, that there are others with whom to share the caregiving function
in the first place.
Caregiving demands often conflict with family members' individual perceptions
and expectations of life and their respective roles such as future plans,
privacy, vacations, money and social life.
Relationships among spouses, adult siblings, and across generations
are strained as members compete for attention and time, and which occasionally
leads to the reactivating of old intra-family rivalries. Even stable family
relationships and positive perceptions can become distorted as the demands
of caregiving increase.
The financial stress of caregiving may compound the problems of already
burdened caregivers.
The personal resources of both recipient and provider in a family caregiving
situation may be seriously drained or devastated by prolonged need for
care. Financial compensation for family caregivers may come from insurance
or benefits of organizations the elder has belonged to, such as the
Aid and Attendance Allowance from the Veterans Administration. Federal
Child and Dependent Care Credit provides limited tax credit and some state
programs reimburse family members for care, again in a very limited fashion.
Decreases in services toward private pay clients, making these services
even less available to those with low income.