Caring for Others, Caring for Self

9

October 23, 2019 by Jean

senior friendshipsLately, I’ve been struggling to find the right balance between caring for a good friend with a serious degenerative illness and caring for myself. This friend and I have a long history of supporting one another through health crises. She traveled hundreds of miles to be with me when I had surgery to remove an ovarian tumor in the late 1990s, staying for a week until I was released from the hospital and had a support system in place at home; and it was she who took on the difficult task of calling my family and friends after the surgery to tell them I had cancer.

Like me, my friend is aging alone, without spouse or children or any family nearby, and I am her primary medical support person. For several years, as her health has deteriorated, I have been taking her to all her medical appointments. Her medical providers all know me and treat me as part of her care team. She stopped driving about four years ago and has become increasingly housebound and socially isolated, and I’ve recently committed myself to a scheduled date every two weeks for getting her out to do something outside the house. (I live an hour away from my friend, so I am not a daily presence in her life.)

I don’t feel overburdened by this level of support for my friend; the problem comes from her increasing needs for help and our very different personalities and responses to difficult situations. I am an upbeat, glass-three-quarters-full type who can find a silver lining in almost any dark cloud. My friend tends to emphasize the negative, and there is plenty of negative to focus on in her illness. I’m a problem-solver by inclination, and my best strategy for coping with stress is to find a workable solution and take action. My friend looks for the one perfect solution to any problem; she quickly finds the flaws in any action plan and rejects the plan because of these imperfections. Over the past several years, I have scouted out resources for things like transportation, social activities inside and outside the home, and help with home tasks she can no longer manage, only to have her reject them all.

Recently, she seems to have fallen into a downward spiral. The last few times I’ve visited her, she did not answer the door (although she knew I was coming); and when I let myself in, I found her still in bed and in her pajamas. It appears that she is no longer getting up and getting dressed on most days. I am increasingly concerned about her ability to take adequate care of her elderly pet cat or to keep her house and herself reasonably clean. Her brother, who lives hundreds of miles away and is himself in poor health, calls me several times each week to express his own concerns and to strategize; but we both feel powerless to take action. She is not legally incompetent, and no one can force her to accept help. But feeling both responsible and powerless to act is the classic description of a stressful situation, and both her brother and I are feeling rising levels of stress.

A few weeks ago, I convinced my friend to let me schedule a consultation with a geriatric care manager from a local agency that provides a much broader range of services and more flexible terms than most home health agencies do. I had high hopes for this visit; if we could get my friend set up with services to clean up one major mess in her house and provide weekly help with personal care, pet care, and housecleaning, it would make her life better and relieve some of the stress on her brother and me. The consultation seemed to go well. My friend was open in discussing the kinds of help she needed, and she liked the care manager. When it came time to sign on as a client, though, she balked, saying that she needed time to look over the service agreement and think about it. This wasn’t an unreasonable position to take, but I worried that it would lead to her finding reasons why this service wouldn’t work for her. And, indeed, her brother told me a couple of days ago that she has decided she shouldn’t sign on with this agency until she has interviewed two or three other agencies for comparison (which is something she will never get around to doing.)

My friend’s decision wasn’t entirely surprising, but it was still a disappointment. I am now left trying to figure out how to take care of myself while still providing her with support. I have decided that I will no longer spend time and energy in researching support services for her, since she always refuses to use them. Letting go of the feeling of responsibility to make her life better or even the hope that I could do so is the hard part of this decision; it will take time for me to get there. I am worried that the price of letting go of those feelings of responsibility will be distancing myself emotionally from my friend, leaving only a shell of our friendship. Another possibility is that I simply take over and hire the agency, using her funds to do so. I realized today that I am not powerless; I have her durable power of attorney, which gives me the right to take financial action on her behalf – although I think that this course, too, would do serious damage to the friendship. My final thought is to try to guilt her into hiring help by pointing out how much stress her lack of help is putting on those around her. (I honestly don’t think she has considered this, and feelings of responsibility toward her brother might goad her into action.) I am thinking I will start with the third option when I see her this week. If that doesn’t work, I will ask her whether she prefers that I take option one or option two to reduce my own stress levels. I think it’s time for some tough love.

9 thoughts on “Caring for Others, Caring for Self

  1. Mary-Beth Taylor says:

    She sounds depressed. Difficult to make decisions when depressed. What is best for her? Getting help…. if you have durable power of attorney can you get the help? She may resent you at first, maybe forever, but will it be better for her. She may not even let them in.
    Or Is she giving up? And that is her choice?
    What will make you be able to feel you have done what is right for her? And this is what is right for you.
    You are a wonderful friend. If it was reversed, what would you want her to do?

  2. cacjjc says:

    This must be so hard to watch! It certainly sounds like she is depressed. Anger, anxiety and uncertainty can all be components of depression as well. I wonder if her family doctor has screened her for depression. Talk therapy and medication combined have the most success in treating depression. With winter coming, decrease in hours of daylight, her symptoms may only be exacerbated.

    Tough love; I think it is a very reasonable choice at this point. She really needs help; she may be so depressed that it may be difficult for her to accept the kind of help she needs.

  3. Linda says:

    Hi Jean,
    I totally understand your predicament with your friend. I had a cousin who I was her only support. She was starting to fail and found fault in many of my suggestions that would help her. One day I told her, no one cares about you but me. I can’t help you if you don’t want to help yourself. If you push me away, you will be alone. That’s your choice not mine, so I won’t feel guilty or hurt. I love you but I’m not capable of all the care you need right now.
    When they don’t have control over their life they get combative and agitated very easy. Jean she is not herself, she’s hiding under a rock like a wounded animal. You either just do what needs to be done or walk away, which I know you can’t. Call elderly services and have her evaluated. They are very good and deal with this very delicately. They also can advise you and listen. You’re a wonderful caring friend, listen to your inner voice and the answers will come.
    Thinking of you cousin and praying this situation gets resolved.
    Sending hugs,
    Linda

  4. Jean R. says:

    This puts you in a no-win situation because no matter what you do, it comes with guilt and maybe strain your friendship big time. But there is one thing you really must look into… The fact that you have her legal power of attorney could leave you with some risk of being in legal trouble for neglect if you DON’T act to bring in a geriatric care manager or other hands-on care of some kind. It only takes one call to Social Services to trigger an investigation. All states laws are different so call your lawyer and get some solid guides on what you can and can’t do with the type of power of attorney you have and what is at risk if you don’t do anything. (Is it for health care and/or finances? I had both documents for my husband even before we were married. It’s the health care power of attorney that covers what you need to do, I think.) Then call the brother and both get on the same page. How sad it is for all three of you! And I agree with the the above about this situation being at the point where tough love is needed. Geriatric care managers are godsend.

  5. Laurel says:

    Your friend sounds very depressed, as others have mentioned. It might be helpful for her to talk with someone and I’m sure the geriatric case management service you contacted could recommend someone. Sometimes you just have to tell the person “this is what’s going to happen”. I know it sounds rough, but sometimes it works! Your friend is so lucky to have you. Being a caregiver can be tough. I hope your friend will accept help. It would be awful if she were to lose your friendship and help. Good luck and I hope you’ll let us know what happens.

  6. Charlie Emmons says:

    This is an important social support lesson, and I admire your clarity in figuring out what to do.

  7. Jean says:

    Thanks to everyone for your helpful comments and advice. I had a good visit with my friend last Friday. She was up and dressed when I got there (the first time in six weeks), and she made me some tea so that we could sit and visit. She acknowledged that depression has been a recurring problem in her adult life, but she doesn’t see the point in seeing someone about it because she hasn’t had good experiences with anti-depressants in the past. I left her with information about a geriatric psychiatrist whose special interest is the relationship between physical illnesses of aging and mental health issues. We also discussed the need for her to have some aides coming in to help, and I gave her a one-week deadline for making a decision. She called me today to report on her progress, and I think she’s very close to re-hiring the agency she used (and liked) a couple of years ago. Her problem with them in the past was that their four-hour minimum shifts seemed to her like more help than she needed, but she now thinks the four-hour minimum would not be a problem. And hiring the agency she chose in the past rather than the one I chose recently gives her a greater sense of control. I feel like we have made progress, and having a frank conversation restored a greater sense of equality and closeness in our relationship.

    • Laurel says:

      Your friend is so lucky to have you! I’m glad your talk with her helped her to open up about her depression. It’s too bad she isn’t willing to talk with a therapist (not a psychiatrist), but maybe she’ll change her mind. Deciding to hire the caregiver is a huge move forward. I hope she will continue to feel better. Thanks for letting us know how things are going.

    • Jean R. says:

      That’s really a great outcome from your visit and concern. Sounds like you found just the right balance of compassion and tough love.

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I am Jean Potuchek, a professional sociologist who has just stepped into the next phase of my life, retirement, after more than thirty years of college teaching. This blog is about my experience of that new phase of life.

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