Past views of stressed caregivers have focused almost entirely on respite care to give them a break -- programs such as adult day care or an in-home visitor to allow them a brief escape from their often 24-hour commitment. For the lucky few, there may be a local caregiver support group. But those programs often fail.
Too Fatigued to Seek Help
For Bill Hartke, the stress of constant physical decay and 24/7 care was so all-consuming that when he went outside to relax with a cigarette, he could still hear his mother-in-lawâ€™s voice echo inside his own head.
â€œEven when she wasnâ€™t calling my name for help, I would hear her calling me,â€ sighed Hartke. â€œThatâ€™s how crazy it got.â€ Paralyzed by the overwhelming responsibility of caring for an older adult, caregivers typically donâ€™t reach out for services â€“ for reasons of all-out fatigue, personal pride or the belief that theyâ€™re not the ones who need help.
Today, the focus is on something far different: the emotional state of the caregiver, especially their attitudes about this new and exhausting role.
Montgomeryâ€™s brainchild is TCARE â€“ Tailored Caregiver Assessment and Referral â€“ a national model developed at the University of Wisconsin-Milwaukeeâ€™s Helen Bader School of Social Welfare.
The cornerstone of the program is a sophisticated assessment of the caregiver â€“ not the elderly adult. Its mantra: All caregivers are not created equal.
Some caregivers plan for this responsibility and accept it graciously as their familial duty; others scream their way through the caregiving process in a cycle of avoidance, anger, regret and shame.
â€œCaregiving Is Not a Diagnosisâ€
For Montgomery, caregiver solutions need to be customized to include all of those factors.
â€œCaregiving is not a diagnosis,â€ said Montgomery. â€œItâ€™s a group of people who need to be seen for what their needs are.â€ She added, â€œIâ€™ve met caregivers who are 15, and there are some who are 102. And they certainly have different needs.â€
There are two essential elements to the TCARE program, which Montgomery developed with gerontology professor Karl Kosloski of the University of Nebraska-Omaha.
The first: Help the caregiver understand how their identity has shifted â€“ to explore this new caregiving role while integrating the best parts of their previous life.
Many caregivers, for example, no longer see themselves as a child or spouse. Others sacrifice their personal lives and jettison their favorite hobbies.
â€œA lot of times theyâ€™ve been so isolated, they donâ€™t know what to do when they get a break,â€ said Michelle Nevins, executive director of the Del Oro Caregiver Resource Center, which serves 13 counties in Northern California.
The second step for caregivers is to fully accept their new role and get the help they need â€“ for their loved one, and themselves.
Ironically, this process sends the successful caregiver down a narrow path: They must embrace their role as a caregiver, yet stop seeing caregiving as their only role in life.
â€œTheyâ€™re so entrenched, they really need to back off,â€ says Leigh Wellcome, program manager for the Family Caregiver Support Program for the state of Washington, which introduced TCARE in 2009.
Montgomery said the physical tasks of a typical caregiver â€œhas almost zero correlationâ€ to their stress level.
Some caregivers work diligently with virtually no stress. Others fall apart performing even the simplest tasks.
A San Francisco Bay Area wife and mother uses her husband as an example: â€œIâ€™ll ask him to do something and heâ€™ll flip out because heâ€™s got a million things on his list to do,â€ she said. â€œIt could be the littlest thing like changing a light bulb.â€
According to Montgomery, caregiver stress is caused by the chasm between the caregiverâ€™s perspective of their role--and the role itself.
Montgomery compares this to a rubber band measuring these two extremes: the life they once had, and their new life as a caregiver.
â€œThe further that stretches, the tighter that rubber band is,â€ Montgomery noted.
Accepting Caregiverâ€™s Role
Accepting the new caregiving role goes a long way to relieving caregiver stress. â€œWe have simple solutions once we understand where your stress is from,â€ said Mary Brintnall-Peterson, a long-time caregiving expert and former colleague of Montgomery who now heads MBP Consulting. â€œYou have to change your identify to â€˜Iâ€™m not just a daughter, but a caregiver.â€™â€
TCARE offers a broad spectrum of 99 total caregiver services ranging from additional medical and dental care to coping skills, housework, errand assistance and transportation.
Since caregivers often neglect themselves, behavioral and physical health are high on the list. Counseling for depression is often the first recommendation.
Although TCARE is virtually unknown in California, the progressive Los Angeles Department of Aging has scheduled a summer pilot program for TCARE. City officials hope to convince surrounding officials in the most densely populated senior county in the state to introduce the assessment tool. There are more than 1 million older adults 65 and older in Los Angeles County.
Bonnie Shoemaker is one of the few in the state so far to implement TCARE. Working for the Partners in Care Foundation, headquartered in San Fernando, sheâ€™s helped more than a dozen caregivers manage their stress.
She cites former teacher and administrator Wilbur Williams â€“ who has taken care of his wife for four years â€“ as the ideal example.
â€œWe were able to work through his identity,â€ said Shoemaker, now the owner of Tailored Caregiver Solutions. â€œIt totally changed how he looked at things . . . Even though the situation didnâ€™t change for him, he was able to live through it and have far less stress.â€
Before Washington introduced TCARE in all 13 of the stateâ€™s local area agencies on aging, Wellcome said pairing the right services to caregivers was a frequent guessing game.
â€œMost of the time we were not right,â€ she admitted. Wellcome recalled an elderly caregiver who supposedly needed only respite care. In truth, the help he needed was inside his head.
â€œHe didnâ€™t feel like a husband anymore,â€ explained Wellcome. Besides mental health counseling, the man needed to understand and accept his new relationship with his own wife.
These types of lessons from Washington are critical as TCARE expands in other states.
For example, Montgomery said, â€œOur work in California builds on information we have gained through our work with organizations in Washington.â€
Nationally, there are other programs designed for caregivers that have achieved some success. The most successful program to date is called Powerful Tools for Caregivers, a six-week education program featuring such topics as â€œTaking Care of Youâ€ and â€œCommunicating in Challenging Situations.â€
The Savvy Caregiver program targets older adults with Alzheimerâ€™s and other forms of dementia.
The United Hospital Fund of New Yorkâ€™s Next Step in Care campaign claims to be the only program in the country targeting caregivers helping a family member transition from hospital to home.
The only federal program that offers caregiver assistance is the National Family Caregiver Support Program â€“ spawned by the Older Americans Act of 1965 and created in 2000.
Into this swirling mix of programs, TCARE has become an important new addition to the growing number of caregiver solutions â€“ physical, emotional and financial. â€œTCARE saves money because it gets the right resources to the caregiver,â€ said Brintnall-Peterson.
Matt Perry wrote this series as part of the MetLife Foundation Journalists in Aging Fellows program, a collaboration of New America Media and the Gerontological Society of America. Photo courtesy of Right at Home, Inc., a leading international provider of in-home care to seniors and the disabled. Visit their website at www.rightathome.net.