Concerns affecting approaches to tasks: Hector fears retirement, which will be accompanied by greatly reduced income. It is a constant worry that affects his decision-making. Because of increasing stress as he watches Juana’s condition deteriorate and her care needs escalate, combined with financial worries, Hector is sliding into depression and becoming less capable of making positive decisions both at home and at work.
Solutions available now: Hector can begin drawing Social Security now, but if he delays until age seventy, he will get the maximum allowed. Because both he and Juana are seniors, there may be services available through government programs in addition to what is covered under Medicare. Hector served in the Coast Guard and may qualify for VA benefits for himself and Juana, and perhaps he can use his legal plan (provided as a company benefit) to speak to an elder law attorney about how Juana can apply for and receive Medicaid to cover increasing expenses and the cost of a nursing home in case she needs one. If a Diversion Program is available under Medicaid, Medicaid may help with providing paid in-home care for a few hours a day. He needs to ask his priest at church this Sunday if they have volunteers who can help out, especially when he has to be away overnight.
Changes that may alter which solutions work: Juana’s condition will get worse, and she will need more care. Hector must retire in two years but may lose his job sooner. Hector’s health could deteriorate if he doesn’t make personal changes, and that, along with his age, will make it harder to find even menial work to supplement post-retirement expenses.
Creating more positive outcomes: Hector needs to find ways to reduce his stress. He knows what the problems are but is stuck on worrying about his job. He sees work as his only solution. Although family caregiving is not a “disease” or, typically, a mental health issue, he might seek the help of a psychologist to talk through his stress and look at alternative ways to make decisions. He may need the help of an elder care/disabled care specialist. He could join a support group for those caring for spouses with chronic illness. He could seek assistance from local, county, and state elder care agencies.
Eleanor
Since starting work just after her marriage, thirty-one-year-old Eleanor has been gradually moving ahead in her position as a financial manager. Her husband, Will, a sergeant in the Army, was killed two years ago while serving in Afghanistan, leaving her alone to take care of their now four-year-old son, Joseph, and two-year-old daughter, Anne, whom he never got to see in person. Will’s military life insurance money (which was only $10,000) is dribbling away toward things like home and care upkeep. Her salary is modest, and she gets a small amount of money from the VA to take care of the children. They had no savings when Will died, so things have been tight. Paying the mortgage and paying for childcare is not easy, especially when Joseph has a bout of asthma and his expensive medicines have to be refilled often. Her mother-in-law has offered to take care of the children—to pick them up from day care or stay at Eleanor’s house when a child is ill so that Eleanor can work—but Eleanor insists on doing it all herself. So far, she has been making ends meet and has been able to handle things at work and at home without using too many sick leave hours, at least not so many that anyone has seemed to notice.
However, recently she had to begin taking additional time off—her grandparents are having difficulty taking care of day-to-day needs, and she is spending more and more time taking care of things such as tracking and paying their bills. Eleanor was an only child and both of her parents died in a car crash when she was only thirteen. From then on she was raised by her grandparents, who are now in their late seventies and live a few miles from her. Her grandmother, Alice, is still mentally alert but is getting very frail. Eleanor worries about Alice, but it is her grandfather, Joseph Senior, who worries her the most. Lately he has been very forgetful. Eleanor just found out he has been experiencing memory problems for a while, but neither he nor Alice wanted to say anything to her; they do not want to worry her, and Alice is terrified of what may happen if Joseph Senior gets worse.
Observations
Here are a few observations about Eleanor’s caregiving concerns. Much more could be said. What other observations do you think are important?
Responsibilities: Child care, elder care, day-to-day demands of work, increasing financial resources for future care, self-care, and the need for her own social interaction.
Specific family circumstances: Eleanor sees herself as the only person who can provide child care. She wants to grow in her profession but is beginning to feel the pressures of both working and raising her children. Her concern for her grandparents, who are the only parents she’s really had, have added to her concerns, and she is faced with making even more decisions that will affect how she balances family and work life.
Caregiving issues: Balancing the demands of two distinct types of caregiving (child care versus family caregiving for elders), both of which are likely to increase as Eleanor’s children get older and more active socially. Determining the nature and potential severity of her grandfather’s memory loss, whether treatment is available, and, if not, what may happen over time.
Concerns affecting approaches to tasks: Growing frustration due to having to put her own plans on hold and unknowns about her children’s welfare. She is lonely and wants to add to her own life with some adult companionship. She is using caregiving and child rearing as an excuse not to get out, in spite of her mother-in-law offering to watch the children and help out in other ways.
Solutions available now: See what her church offers in local child care. See if there is a senior center where her grandparents might find social interaction. Does the VA have survivor’s benefits in addition to the child-care stipend that Eleanor and her children might be eligible for? Does her workplace have an Employee Assistance Program (EAP) that might help her work out plans for her children or grandparents?
Changes that may alter which solutions work: Further deterioration of either of her grandparent’s health, changes in her work circumstances (e.g., a promotion that requires her to spend more time working, slower salary growth due to a perception held by her manager that she is not working as hard as she should), or her son’s asthma getting worse and requiring more of her time and money to keep him healthy.
Creating more positive outcomes: Eleanor needs to learn more about her grandparents’ financial resources so she knows what she has to work with for their care. If her grandfather does have dementia, she may have to take over management of household expenses and other practical matters he has handled over the years. She also needs to recognize that she does not have to do everything herself. Her mother-in-law, for example, is ready to help with the children at any time. There may also be a local support group for military widows through which she may be able to find emotional and practical support. Also, if her grandfather has dementia, she could join a support group for adult children caring for parents (and grandparents). Eleanor also needs to consider how she is protecting her own children in the event something happens to her.
Ed and Harriet
Ed and Harriet had been very lucky. They ran a successful business together and had been planning for an early retirement (being the same age, both were planning to retire at fifty-five after selling the business), and had a wonderful family. Both of their kids were smart and had a great work ethic. Their daughter, twenty-one-year-old Coral, was working toward a veterinary degree. Their son, nineteen-year-old Ed Junior, was planning on being an engineer. Everything was working out perfectly. Then the accident happened.
Ed Junior had a passion for competitive diving and stayed in the water as much as he