Fostering a realistic view of caregiving

Time, energy, and emotions often underestimated

Caregivers often underestimate the responsibilities of caring for an elderly relative. Frequently they have conflicting feelings about what they have undertaken, and it is hard for them to work through this and set limits on what they can accomplish, says Marilyn Rantz, PhD, RN, director of the Center of Excellence in Aging and a professor at the School of Nursing at the University of Missouri in Columbia. "Sometimes people make promises to loved ones, and when they get into the reality of the situation they can’t handle it," she says.

If an elderly relative needs help for a few weeks or months due to an injury or illness, families often can put other obligations on hold and provide assistance. However, it is difficult when the care is needed for years. People need to be realistic about getting help and accepting help, says Rantz.

Most people know about agencies that deliver a hot meal to homebound seniors. However, there are many other services available. When Rantz lost her father, the family needed to find a transportation service for her mother to get around. Her mother learned of a van service while getting her hair done at the beauty shop. This enabled her to go to the drugstore for medications, shop, and go for walks at the mall on her own. It helped her remain in her home an additional three years after the loss of her husband, Rantz recalls.

She also had the opportunity to use a home care service when her mother was recovering from a fall. This service is frequently covered by insurance and provides home care workers to care for seniors while the family is at work and school. These workers can give baths, prepare meals, help with exercise, and keep seniors company.

People who take on the role of caregiver also need to accept help for themselves, such as finding a support group and a good source for information, says Michael Doran, CSW, coordinator of Caregiver Services at Health Outreach at New York Presbyterian Hospital in New York City.

"Given the emotional challenge and the time and energy of maintaining one’s own life, work, and family responsibilities, caregiving can be overwhelming — especially if someone is doing it all by themselves," says Doran.

What is tricky about the situation is that often the caregiver is the son or daughter, and it is difficult to relate to one another in a different way. No matter the age of those involved, the daughter still is the daughter and the mother still is the mother, he adds.

The elderly adult may refuse to agree to something such as hiring a home care service to help attend to his or her needs. When this happens, it is important to get an outside party involved, preferably someone the elderly adult trusts such as their minister or health care provider, says Rantz. This scenario also can be avoided if families make plans in advance with seniors fully involved in the decision making, she says.

It often is difficult for adult children to see their elderly parent’s health deteriorate and to see them losing the ability to do things for themselves such as grooming. It can be an emotional time for families, says Doran. That is why a support system is important.

Information that can help families make the best decisions can be helpful as well, says Rantz. That is why her organization created a guide on how to select a quality nursing home. "If people have to use a nursing home or assisted living facility, I encourage them to make the decision based on quality of care — not just on price or location. It is quality of care that will make the difference," she says.

At the University of Missouri School of Nursing, research is being conducted on how to help the elderly age in place, says Rantz. The model of aging in place means that seniors are able to remain in their preferred place of living as they age by contracting with services as needed so they do not have to move to a more restrictive environment.


For more information about providing education for caregivers of older adults, contact:

Jennifer S. Browning, MS, RN, CS, Gerontology Clinical Nurse Specialist, Inpatient Nursing, University Hospitals, The Ohio State University Medical Center, 841 Center Doan Hall, 410 W. 10th Ave., Columbus, OH 43210-1288. Telephone: (614) 293-3516. E-mail:

Michael Doran, CSW, Coordinator Caregiver Service, Health Outreach, 420 E. 76th St., New York, NY 10021. Telephone: (212) 746-4365.

Marilyn Rantz, PhD, RN, Director of the Center of Excellence in Aging and Professor at the School of Nursing, University of Missouri, Columbia, MS. E-mail:

Collette Schelmety, RN, Assistant Nurse Manager, ACE Unit, New York Presbyterian-Cornell Hospital, 525 E. 68th St., New York, NY 10021. Telephone: (212) 746-0316. E-mail: