Posted by Sheri Samotin on Tue, Apr 13, 2010
A just published book for adult children and their aging parents is "The Daughter Trap: Taking Care of Mom and Dad ... and You" by Laurel Kennedy. This is a valuable resource for all adult children, daughters and sons alike. Ms. Kennedy bases her work on hundreds of interviews with baby boomers in the thick of caring for their parents and the anecdotes help to illustrate her key points and make the work come alive.
The first half or so of the book frames the problem. While this section doesn't introduce much in the way of new insights, it does effectively capture the issues faced by so many who care for aging parents and summarizes many of the important studies and resources that have been published on this important topic over the past few years. At the end of each chapter, Kennedy has a section of "what we've learned" where she tries to guide the reader on actions they might take or things to think about. Some of this tidbits are more helpful than others. For example, at the end of Chapter 4, Kennedy writes, "When you need outside help -- ask for it." This sort of feels like motherhood and apple pie. On the other hand, in the wrap up of Chapter 6, Kennedy wisely opines, "Acknowledge your limitations and those of your family. Develop a plan B if caregiving becomes overwhelming to the detriment of your life..."
The second portion of The Daughter Trap focuses on solutions and here is where Kennedy forges new ground. For example, in Chapter 9 entitled "It Takes A Village", Kennedy does an excellent job of bringing her readers up to date on the various initiatives underway to explore alternatvie senior living models and later chapters focus on ways that corporate America can make a difference and technology solutions that are needed.
Kudos to Kennedy for this well researched work. For those who are well versed in the issues of baby boomers and their aging parents the second half of the book provides some "aha" moments. For those who are just getting involved with this critical demographic reality the first half provides a thoughtful overview.
Posted by Sheri Samotin on Fri, Dec 18, 2009
Visiting your aging parents over this holiday season provides a wonderful opportunity to create memories and to take a good look at how they are doing. Make sure you take advantage of this time to do both, especially if you live at a distance and don't get to see them often.
Perhaps the most important objective for your visit is to create memories. After all, who knows what next year will bring? One way to do this is to resurrect old traditions. Maybe your mom always baked Christmas cookies when you were young, but she hasn't done so in years. That's something you can do together, all the while chatting about the holiday in years past. Another approach is to establish new traditions together. Not only will these new traditions become part of your family lore, but they allow you to engage your parent in a new way. One way to make sure your visit is full of energy is to involve the younger generations in this memory creation marathon.
Of course, if you're like most of us, you have a list of tasks you hope to accomplish for mom or dad while you're visiting. Perhaps Dad needs help cleaning out the garage, or Mom can use some new clothes. Maybe it would be helpful for you to accompany your parent to a doctor's appointment or to take care of some banking. Whatever the task, taking care of some ordinary activities with your parent will give you a good idea of how he or she functions on a daily basis when you're not around.
During your visit, it is critical that you are a careful observer of both your parent and his or her surroundings. Observe both what Mom is doing and what she's not doing. Sometimes your best clue as to your parent's status is noticing the things they used to do with ease that they're not doing at all. For example, if Dad used to love to garden and the yard is a mess, that's worthy of your attention. Look for signs of deteriorating health, such as weight loss, recent ER visits, failing vision or hearing, or an empty refrigerator. Signs of safety or mobility concerns include recent falls, unexplained bruises, medication mishaps, or leaving the tea kettle on all night. Is Dad having trouble climbing the stairs to his bedroom? Does Mom wear her cane like a bracelet? Financial issues might be evidenced by piles of unopened mail, past due notices, or medical paperwork unopened or in piles. Perhaps the home looks different than it has in the past, with lots of clutter or maintenance and repairs ignored.
A holiday visit can be a wonderful time to engage in dialogue about these matters with your parents, siblings, or other family members if you choose the right time and approach. The right time is NOT at the dinner table on Christmas Eve or in the middle of the latke party on Hanukah! Rather, look for less formal and quieter times or even go so far as to create opportunities. A car ride or long walk can be a great time to talk, as can be a mother-daughter visit to the nail salon or spa. And remember, a dialogue means that everyone gets a chance to speak and that you're having a conversation, and that it isn't necessary or even desirable to reach any conclusions. There's time enough after your visit to work through details or logistics by telephone or email.
Finally, remember to use some of your visit to help you plan for the future. Take home a copy of the latest yellow pages. This can be very helpful if you need to marshal resources for your parent from a distance. Get to know a few of your parent's neighbors if you don't already know them and make sure to take their phone numbers home with you. Make a list of important phone numbers, such as your parent's doctors or providers of household repair services. Anything you can do to be prepared for the day to day "crises" will help keep your stress down later on.
Above all, remember to enjoy the time with your family.
©2009 LifeBridge Solutions, LLC. All rights reserved.
Posted by Sheri Samotin on Tue, Oct 20, 2009
I am often asked to describe the benefits derived by adult children of aging parents when they elect to work with a family transition coach. Perhaps the best way to answer this question is through an example. I've changed some of the personal details to preserve the privacy of those involved, but the situation itself is based on a real situation from my practice.
Jennifer found me by reading an article I had written and published about family transition coaching in a local senior resource publication. I was in a meeting when she initially called, so she left a voice mail message that began, "I really need help, and I need it fast!" When I called Jennifer back, she told me that she is one of four siblings and the long distance caregiver for her mother Nancy. Nancy lives in southwest Florida and Jennifer lives in Michigan. Jennifer's siblings are scattered across several states, but none live near their mother.
Nancy is 84 and suffers from memory loss and some confusion. She is otherwise in good health and remains fairly active. Ever since Dad died six years ago, Nancy has been managing herself. She continues to live in the condo that she and Dad moved to in 1995 when they first relocated to Florida and until recently has maintained an active social life with her friends from church. Jennifer usually visits Nancy a few times each year; her siblings visit less frequently. Several months ago, when Jennifer came to visit, she noticed that Nancy seemed confused and somewhat withdrawn. Jennifer accompanied Nancy to her doctor's appointment and learned that Nancy's condition is considered to be "age related memory impairment." It was explained that this is a "normal part of aging" and that "there is nothing to worry about." Nancy assured Jennifer that she was fine and still able to manage on her own.
Several weeks after returning home from that visit, Jennifer called Nancy for her regular check-in and found her agitated and confused. She became extremely concerned, and called Nancy's neighbor and asked her to check on Nancy. When the neighbor called back, she told Jennifer that Nancy seemed okay. The next morning, Nancy didn't answer the phone when Jennifer called, and didn't respond to a knock on the door by the same neighbor whom Jennifer had called again. Fearing the worst, Jennifer called 911 who responded and took Nancy to the hospital. It turns out that Nancy suffered a stroke. Jennifer jumped on a plane to come to be with Nancy. She has taken on the role of primary long distance caregiver by default. The family has never discussed Nancy's situation as a group.
That's when Jennifer called me. She knew that she had to return home to her job and her family within a few days and was in a panic about what would happen to Nancy. At the same time, she was getting frustrated trying to convey information to her siblings, each of whom offered lots of input but none of whom offered to come and take over so that she could get home. Jennifer was under extreme stress.
The first thing I helped Jennifer to do was to get organized and get her siblings involved. We started by making a list of all of the things that had to be done, the documents that had to be found, the bills that had to be paid, and the decisions that had to be made. We then scheduled a conference call among the siblings which I facilitated. The stated objective of the conference call was to identify Nancy's needs and the resources that could be provided by the family working as a team. These resources included knowledge, time, and money. Once we had an exhaustive list of what needed to be accomplished, we matched the available resources. By the end of that first call, each of the siblings had their assignments and was committed to working as a team. Within a few hours of Jennifer's initial call to me, she was feeling as though she was back in control of the situation and didn't need to carry the burden on her own shoulders.
Over the next several days, I worked with each of the siblings on their piece of the puzzle, making sure that everyone stayed on track. The family had one very important decision to make, and that was where Nancy was going to go upon her discharge from the hospital. We worked with a geriatric care manager to identify the options and concluded that she could return to her condo safely as long as she had appropriate in-home care. Nancy's family now needs to address whether this is a sustainable solution given the financial realities, and the siblings have arranged to all come to visit Nancy at the same time within the next month. During that visit, they plan to go and look at several assisted living facilities and determine if that might be a better solution for Nancy. In preparation for their visit, Jennifer has asked me to help her identify several alternative facilities and to gather all of the necessary information so that she can share that with her siblings in advance of their visit so that they can make the most of their time together.
Family transition coaching can be helpful during a crisis, as in the case study presented above. While it is always better to plan ahead, the reality is that most people avoid thinking about the inevitable issues that will arise as their parents age. If you find yourself in the midst of a caregiving crisis, don't hesitate to reach out to a family transition coach.
Posted by Sheri Samotin on Mon, Oct 19, 2009
One of the most difficult aspects of parenting your parents is the very delicate balance between preserving their independence and taking charge. While most of us will perceive it as "easier" to take on an activity ourselves, it is usually better to find a way to get the job done in a manner that allows our aging parents to remain in control.
For example, if your Mom is having difficulty managing her mail and her bills and keeping her checkbook balanced, you might decide to have her mail come directly to you and to set up automatic payments for most of her bills. However, by doing so, you rip control from your Mom, likely making her feel angry toward you. An alternative might be to ask your Mom to put all of the mail in a special place each day, and then for you to come once a week and sit with her while she sorts through the mail and prepares her checks. Sure, this will take you more time, but you will allow Mom to feel as though she is still responsible for herself.
Sometimes, we will have no choice and we will have to take charge in order to keep our parent safe. If Dad has cracked up the car and you've determined that it is no longer safe for him to drive, you must make sure that he no longer is behind the wheel. How can you preserve Dad's independence in this situation? One idea might be to arrange for transportation services that he can access when he needs them that don't require him to ask you for a ride. In some areas, local taxi companies will allow you to set up an account. This way, if Dad wants to meet a friend to play cards, he can do so without the extra stress of arranging to get there and back.
Whenever you are concerned about your parent's ability to manage activities of daily living, you have an opportunity to help them preserve independence. There are always choices for how to solve the problems you will encounter. If you make a real effort to consider your parent's dignity, and balance that need with your need to get the task done efficiently, you are likely to enjoy a better relationship with your parents as they age.
Posted by Sheri Samotin on Thu, Sep 24, 2009
When it comes to our parents, it's only a matter of time before we adult children need to become more involved in their day-to-day lives. Unless we are incredibly lucky, our parents won't live to be 100 and die in their sleep with no deterioration in their physical or mental abilities. For the rest of us, we need to be prepared for the inevitable time when our help is needed. It makes sense to sit down with our parents and our siblings to think about how we'll handle things before the need to do so is a crisis. After all, these are not easy issues to think about, much less discuss, and being able to consider them over a period of time is preferable to making decisions during a time of extreme stress.
If you don't think this topic concerns you, consider that, according to the National Clearinghouse for Long Term Care Information:
- Long-term care is a variety of services and supports to meet health or personal care needs over an extended period of time. Most long-term care is non-skilled personal care assistance, such as help performing everyday "Activities of Daily Living" such as bathing, dressing, and eating
- At least 70 percent of people over age 65 will require some long-term care services at some point in their lives
- This year, about 9 million Americans over the age of 65 will need long-term care services; by 2020, that number will increase to 12 million
- On average, someone age 65 today will need some long-term care services for three years
- One year of care in a nursing home, based on the 2008 national average, costs over $68,000 for a semi-private room
- One year of care at home, assuming you need periodic personal care help from a home health aide (the average is about three times a week), would cost almost $18,000 a year
- A caregiver is a family member, partner, friend, or neighbor who helps care for an elderly individual or person with a disability who lives at home; in 2004, there were more than 44 million caregivers age 18 or older in the United States - about 21% of the adult population
- Approximately 60% of caregivers are women
- Thirteen percent of caregivers caring for older adults are themselves aged 65 or over
- The typical caregiver is a 46-year-old woman who is married and employed, and is caring for her widowed mother who does not live with her
- A 2006 study of caregivers found that on average caregivers spend 21 hours a week giving care
Taking the time to plan ahead will reduce the inevitable stress when the time comes. You will have an idea of the resources that are available to help you and your parent, and you will have prepared for how to pay for it. If you have siblings, it helps if you are all on the same page regarding how each of you will contribute to your parents' care, whether it is financially or by doing. If you're interested in learning more, check out the National Clearinghouse for Long Term Care Information at www.longtermcare.gov and download their very informative planning guide.
Posted by Sheri Samotin on Tue, Sep 15, 2009
If we're honest with ourselves, we can remember back to a time when we and our siblings were all living at home and we settled into certain patterns within our families. For example, in a family of three brothers, there was the elder who had his act together, the middle one who was the clown, and the youngest who was Mom's favorite. Does it surprise you when forty years later, these three brothers are dealing with their aging mother and the same patterns play out? The oldest brother, the "responsible" one, takes charge of the nuts and bolts, and at some point he probably feels put upon because his siblings aren't helping enough. The middle brother is always there for the fun and happy times, but he seems to disappear when the going gets tough. He might feel that he's not in the loop. And the baby, Mom's favorite, announces that he is coming to visit and Mom talks about nothing else for weeks before and after. It's likely that he's oblivious that both of his brothers are annoyed with him. This is an example of siblings who, despite the adults they have become, revert to their childhood roles when confronting the aging of their parent.
In addition to historical family patterns, gender roles often come to the forefront in family caregiving situations. Why is it that women so often take on the caregiver role? Is it because they expect it of themselves, or because their families expect it of them? Is there truth to the old saying that, "a daughter is a daughter for life, but a son's a son until he takes a wife?" Is it because caregiving is often still considered to be "women's work"? While there are certainly many families where men play leading and significant roles in the care of their parents, many surveys show that sons most often write checks while daughters (and daughters-in-law) provide more of the hands on caregiving. Whatever might be the situation in your family, it helps to be aware of gender roles, and think about whether you are falling into default positions or really are sharing the load.
Proximity and distance also become factors in the family caregiving dynamic. In many families, one sibling lives near their parents, while others don't. The one who is close by will tend to see the parents more often and may not notice subtle changes in a parent's ability or behavior. Then, one of the out-of-towners comes for a visit and begins pointing these things out. If not handled with care, the in-town sibling might take this personally, thinking that the sibling is saying that he or she isn't doing a good enough job of looking after Mom and Dad. At the same time, the distant siblings might take it for granted that their in-town brother or sister is both expecting and willing to take on the caregiver role, leaving that caregiver by default to feel taken advantage of.
Complicating the family dynamic, each of us has different needs. We all know someone who needs to be needed. This person will often have great difficulty when their caregiver role naturally comes to an end. What about the person who needs to fight fires, and who might even set a few in order to be able to save the day? Without even realizing it, this person might make the caregiving more complicated than it needs to be. Do you know someone who needs to be seen as the big spender? This person is likely to feel that money is the answer to every caregiving challenge, and will look for opportunities to show how generous she is. When that generosity isn't acknowledged, she's likely to get angry. Finally, do you know anyone who has a need to be the "good" son? This person will take actions based on how they appear to others, and will look down on his siblings who aren't as "good" as he is.
Money, competing responsibilities, and disparate skills rear their heads as well. It is all too easy for families to fall into roles when they don't take the time to discuss these things out loud. The best family caregiving situations arise when everyone is working together. There can be a role for everyone, even those who live far away. All it takes is some good ongoing communication and a plan. If you're not sure how to get started, you might consider hiring a family transition coach to help. As an objective third party, your coach can help provide focus and will have experience with others who have going through similar transitions so that you don't have to start from scratch. In addition, a family transition coach will be knowledgeable about the many resources that are available to you and can facilitate necessary but difficult conversations and decisions. If you can anticipate the challenges you may face with your siblings in these circumstances it is likely that you can avoid some of the pitfalls.
Posted by Sheri Samotin on Mon, Jul 27, 2009
Whether you are teaching your young daughter how to knit, or helping your aging mother balance her checkbook, how do you take charge without taking over? How many times have you found yourself "showing" someone how to do something by doing it for them? It's human nature. But while it might make sense to show by doing when you are "teaching" someone younger or less familiar with a particular topic than you are, it usually leads to anger when you do this when you are "assisting" someone with a task that he previously has been perfectly capable of handling himself.
It was probably hard enough for your mom to agree to let you help her pay her bills and balance her checkbook. And even once she agreed, it wouldn't be surprising if she told you that she didn't know why you were insisting on helping her since she is perfectly capable of doing it herself. The truth is that acknowledging that you need help with the business of life is really, really hard for most seniors. If they come to the point where they need your help, they are confronted with their own limitations. And those limitations won't "get better" in most cases. Deep down, your mom knows that this is the beginning of the end of her independence as she has come to know it.
So, how do you take charge without taking over?
1. If possible, do the tasks alongside your mom rather than doing it for her. While this approach might take longer than doing it yourself, you allow mom to retain some self esteem by letting her take the lead.
2. Let your dad tell you what aspects of a particular activity he needs your help with, and if possible, try to limit your assistance to just those things, at least for now. Of course, if your dad doesn't have a realistic picture of what he can do for himself, you will need to gently find a way to help him see your perspective.
3. Be respectful, and ask permission before you just jump in. For example, when you take your parents to a doctor's appointment, don't just assume that they want you to come into the examining room with them. Instead, ask them if they'd like you to be there the whole time, or if perhaps you can just be called in toward the end of the visit to make sure that YOUR questions are answered.
4. Set up invisible safety nets. For example, if you come every Sunday and set up your mom's medications in a weekly medication management system, you can have some expectation that she will take the correct medications at the right time. But it wouldn't hurt to also have a way of checking that once or twice during the week. This might take the form of a medication management visit by a home care company or trusted friend or relative or perhaps daily medication reminder phone calls from you.
5. Make a distinction between safety and everything else. When your dad's safety is on the line, you might just have to take charge by taking over. On the other hand, if you'd just prefer that something be done a certain way or at a certain time, there might be an opportunity to loosen the grip a bit.
Your job as your parent's caregiver is to keep them safe, comfortable, and happy. As long as you keep that in perspective you should have no trouble taking charge without taking over.
Posted by Sheri Samotin on Tue, Jul 21, 2009
If you are like most baby boomers, you're busy, busy, busy! Whether you do it with a PDA, a scratch pad and pencil, or all in your head, you're a list-making creature. With so many balls in the air, you don't want one to crash back down. You feel immense pleasure when you accomplish something and can cross it off that list. Your orientation is to "fix it", isn't it? Unfortunately, if you're the caregiver for an aging parent, you can't "fix it". Your parent's death is inevitable, and no checklist, no matter how well you accomplish all the tasks on it, will prevent that day from coming. Indeed, your aging parent is going through a natural process, and you can't make everything okay. All you can do is smooth that natural process through paying attention to your parent's needs. You don't have to have all the answers, and you'll probably never feel like you have all of the information you'd like, but you can still make good decisions.
The day you stop looking at your caregiver role as Ms. (or Mr.) Fixit is the first day of the rest of YOUR life. The next time you have a caregiving challenge, stop for a moment and think about the situation. What does your parent need? Are you sure this is what she needs, or are you making an assumption or projecting your own needs onto the situation? If you're sure about the need, then what are the possible ways to fill it? Is there really only the one way, the way that seems impossible right now and has you (and your Dad) so frustrated?
Let's take the situation of Lisa and her Dad, John. Lisa is in her mid-50s, is married, and has one teenager still at home and two in college. Lisa works full time outside the home. John lives about an hour away from Lisa and her family in a condo he owns. John is in his mid-80s and was widowed two years ago. Lisa's younger brother lives across the country. John's in pretty good health, but he's become increasingly frail over the past six months and seems to have lost a lot of weight. Lisa is worried about her Dad, but with her other responsibilities, it's hard for her to get to John's home more than once per week.
Over the past week or two, Lisa has concluded that John is not eating well and that's the cause of his weight loss. Every time she visits, she brings a load of groceries and meals she's cooked at home. Ms. Fixit to the rescue! Yet, on subsequent visits, the food is pretty much right where Lisa left it. She's frustrated because, "no matter what I do, Dad won't eat." When she begs him to eat, John gets angry and tells Lisa that he's just not hungry. The situation escalates, and ends with Lisa storming out of John's home in tears.
What if Lisa had stopped for a moment before her Ms. Fixit instincts kicked in? Instead of jumping right in to fix what she saw as a "problem", Lisa might have talked with John about how he was doing. Had she done so, she would have learned that John was very worried about his finances. He was afraid that he was going to outlive his money, and as a result, John had decided that he could get by on less. The last thing that John wanted was to be a burden on Lisa and her brother. So when Lisa starting bringing food to John, he felt guilty because exactly what he feared seemed to be coming true. He felt that if he didn't eat much of the food that Lisa brought, maybe she'd stop brining it, and he would find his way out of this cycle.
Had Lisa just asked the right questions and really listened to John's answers, she might have come up with another way to solve the problem. In any event, by allowing John to participate in the solution, she would have allowed him to preserve some of his independence and feel more in control of his situation. And Lisa herself likely would have felt less stressed and less frustrated. Of course, it's possible that John wouldn't have shared his fear with Lisa directly, but Lisa might have included John in identifying the problem and trying to solve it. Even if that approach failed, maybe Lisa could have arranged for some of John's friends to invite him over for dinner so that he would have the social interaction and not feel like a burden.
As the caregiver for your aging parent, you have many choices and decisions to make, and the sheer volume of what needs to be done can be overwhelming. To the extent that you can remember that it is not your job to fix everything, you and your care recipient will both be better off. Your job is to make the natural progression of aging easier for your parent, but as hard as you try, you won't be able to stop it. Once you can acknowledge and accept this reality, it will be easier to keep things in perspective. Your job is to do your best, and to do it with positive intentions.
Posted by Sheri Samotin on Mon, Jul 13, 2009
The aging parent who asserts that they will never be "sent" to a retirement home is the parent who fears being abandoned in his or her old age. He usually has expectations that one of his children will take him in. She might expect that she will be able to manage in her own home forever. This parent has rarely purchased long term care insurance and often hasn't thought much about what will happen when he can no longer take care of himself. Most adult children will agree that worrying about this is hugely stressful for them once they start to think about it.
But is it possible that the parent who is determined never to consider an alternative living situation has actually cheated himself out of some meaningful experiences with his kids? Might this mother and grandmother one day regret that while she is living under the same roof with one of her kids that they are never really engaged with her on an emotional level because they spend so much time attending to her physical needs? Is there a positive benefit that comes from adult children caring for their parents from a bit of a distance? While your parent has not been physically abandoned, might their fear of being pushed aside have created a situation where they are emotionally invisible?
Like so much else in life, it's all about balance. Perhaps the ideal situation is when your parents have put the pieces in place so that even if they live in your home, you can afford some caregiving help. Or maybe if they understood that moving to a retirement community doesn't mean that they will be abandoned will make it easier for them to consider that option. When their health or memory begin to fail, the time you spend with your Mom or Dad can be about keeping them company, making them comfortable, and allowing them to participate to the extent that they can in your life and your children's lives. Think about it. Don't let your parents do such a good job of making you feel guilty if you consider an alternative living situation that you forget that they need you on an emotional level.
Posted by Sheri Samotin on Fri, Jul 10, 2009
There seem to be two kinds of aging parents - those who are determined never to be a burden on their families, and those who are in denial about the reality that their changing condition and ability places upon those who love them. This isn't a value judgment; it just seems to be the way it is. And it doesn't mean that one type of parent is easier for their adult children to deal with either. Sometimes economic realities limit options, but the parent who plans ahead usually has more options than one who doesn't. Let's explore the parent who "won't be a burden". Does this stance actually prevent what they are hoping to avoid?
The parent who fears being a burden is the parent who plans ahead for his or her old age. He usually has taken care of having his affairs in order and has written a will, power of attorney, health care proxy, and so on. She might even have one place where all of her important papers are kept, including lists of her medications, her doctors, and other important phone numbers. This parent has often entered into an arrangement for a prepaid funeral, and might have purchased long term care insurance years ago, or moved to a continuing care retirement community (life care community). Yes, this parent has typically taken much of the financial and decision-making burden off of her children, and most adult children will agree that this is appreciated.
But is it possible that the parent who is determined never to become a burden has actually cheated himself out of some meaningful experiences with his kids? Might this mother and grandmother one day regret that she has done such a good job putting all the plans in place that her kids don't have "reasons" to come around, and so they don't come very often? Is there a positive benefit that comes from adult children participating in their parent's later years?
Like so much else in life, it's all about balance. Perhaps the ideal situation is when your parents have put the pieces in place so that they won't be a financial burden, but they have shared with you the details about the kind of life they hope to lead under different circumstances and allowed you to help them think through some of these often difficult situations in advance. Later, when their health or memory begin to fail, the time you spend with your Mom or Dad can be about keeping them company, making them comfortable, and allowing them to participate to the extent that they can in your life and your children's lives. Think about it. Don't let your parents do such a good job of not being a burden that you forget that they need you on an emotional level. Don't thank them for all of their planning and preparation by being a stranger. Thank them for making your caregiving job so much easier through your presence and emotional support.