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 Several months ago, when Jennifer came to visit, she noticed that Nancy seemed confused and somewhat withdrawn.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 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 Fri, Jun 26, 2009
This is the title for a very interesting blog post on the New York Times' "New Old Age Blog". Take a look at the posting. While the post itself is interesting, and covers the concept of care contracts for family caregivers, I find the discussion prompted by this post to be incredibly interesting. The points-of-view expressed make clear what an emotional and difficult issue we face as individuals and as a society. As with so many things, there is no "one right answer" for every family and every situation.
It is true that we place value as a society on the commandment to "honor your parents", but there are many ways to fufill this goal. Are we honoring our parents if we quit our jobs to care for them and by doing so, make it impossible to properly care for ourselves and our own children? You'll likely answer this question differently than I will, since we come from various faith traditions and family circumstances.
So, instead of pretending that there is "one way", why don't we acknowledge that therer are many ways, all equally valid, and work to support the way chosen by an individual family? If we can agree to that, we can focus our attention on putting the resources in place to support every one of the "ways".
As a family transition coach who works with baby boomers and their aging parents, I can assure you that some situations absolutely call for care contracts for family caregivers, while other situations do not. Let's not create a stigma or guilt for the caregiver who feels they need to implement such a contract. Instead, let's applaud him or her for rising to the challenge, and do everything in our power to make that journey meaningflul and as stress-free as practical.
Posted by Sheri Samotin on Sun, Jun 14, 2009
I'm often asked, "What's the difference between a geriatric care manager and a family transition coach?" In a nutshell, the geriatric care manager deals with a situation once it is happening, and tends to focus on the physical and clinical care for the care recipient. On the other hand, a family transition coach is involved with advance planning as well as with ongoing situations, and will focus on the big picture, including "the business of life", for the whole family.
A family transition coach will often have the opportunity to refer to a geriatric care manager, who will then be responsible for coordinating the physical care that is required, and will often accompany the care recipient to doctor's appointments and arrange for additional care such as home health services. At the same time, the family transition coach may arrange for other services such as managing the mail, paying the bills, or fighting with insurance companies. So, the two professionals are complementary and work together. This is only one example of how they might work together.
The role of the family transition coach is to help the family understand their caregiving (or future caregiving) reality, and then to identify potential situations and make plans to address them. The coach may work directly with the care recipient, or with his or her adult children or other family members. The coach serves as a resource, but also often plays the role of objective third party, and can challenge your thinking and facilitate decision-making. Whereas the geriatric care manager spends most of his or her time and focus on the care recipient, the coach will often spend as much or more focus on the caregivers.
If you are interested in learning more about family transition coaching, please click here.
Posted by Sheri Samotin on Mon, Jun 08, 2009
Are you a baby boomer? If you answered "yes" then you are probably staring a life transition in the face. Is that face scary or serene? To some degree, that's up to you.
Life transitions, such as getting married, having a child, changing jobs, dealing with health issues, getting divorced, taking care of aging parents, becoming widowed or becoming an empty-nester are part of all of our lives. Of course, the stakes get really high when we are dealing with two or more of these life changers at once. The real key to successfully navigating life's transitions is being ready for them, and then understanding what is happening while it's happening.
So, right now, today, make a commitment to yourself. Commit to preparing your own Transition Plan. And then commit to pulling it out, dusting it off, and making the necessary changes on an annual basis.
Where to begin? Start by making a list of every possible transition you can think of, even if you think it will never be relevant to you. Once you have that long list, it will be time to eliminate those that are not relevant to your life at this time (e.g., if you are not married or in a committed relationship, you're not likely to get divorced or become a widow). For each remaining transition, you will need to ask and answer many questions. Here are a few to get you started:
- What scares me about this possible transition? Why?
- What's the worst thing I can imagine if this happens to me?
- What if the opposite were true?
- How would my 80-year old self advise me?
Make notes, and plan to come back and look at them in a few days or a few weeks. Building a Transition Plan is not something you can accomplish in one sitting. Once you have fully explored your thoughts and feelings about each of the possible life transitions, you are ready to formulate your plan.
Your Transition Plan should contain the following elements:
- Definition of possible transitions
- Assessment of fears about the transition
- Specific steps that you can take to plan ahead or prepare for the possible transition, and an assessment of the positive that will come from doing so
- A timeline for getting these steps accomplished
- A commitment and method for keeping your plan up to date
This process probably seems overwhelming. We all know that when we have a mountain to climb, it's pretty easy to talk ourselves into quitting before we even start. After all, we're great at telling ourselves that the distance is too far, or the altitude is too high, or we're not in shape, or we don't have the right supplies. So don't make a mountain out of a mole hill! Break the task into manageable pieces. Don't try to lose fifty pounds. Try to lose ten pounds five times! When you lose that first ten, it's easy to believe that if you keep going, you can get rid of the next ten. Soon enough, the finish line is in sight. Tackling your Transition Plan works the same way. Start with one transition. Work through it. Make a plan. Then, take some time to reflect before you start on the next one. You'll probably have lots of ideas about how you can make it a more efficient experience.
Often, it is helpful to seek the help of a transition coach to work with you through this effort. Like any other type of coach, a transition coach is there to guide you to your best performance. Your coach will help you to hold yourself accountable, and will be able to ask those powerful questions that help you get unstuck. Your coach may also be able to point out areas where you need more "practice", or where you need to build your "skills" and can help you figure out how to do that. If you are interested in considering coaching, why not sign up for a complimentary coaching session? All you need is a telephone and an open mind!
We're all dying of a terminal disease called LIFE! Preparing a Transition Plan is an important way we can ease the journey for ourselves and for those whom we care for and who care about us.
Posted by Sheri Samotin on Thu, May 28, 2009
Caregiving is all about control. As the caregiver, you want to control everything so that "nothing bad" happens. The person being cared for wants to remain in control so that they continue to feel like a complete person. If you can remember that control is at the core of every action and every reaction, it will help you keep things in perspective. When you become frustrated, ask yourself why you are trying to control the situation, what will happen if you stop, and why YOU feel out of control.
One of the most important caregiving lessons is to ask for help. And then, ask again. There are so many wonderful people and resources available to help you. Don't feel like you are less of a caregiver when you accept help. Be specific about what you need. It's much easier for someone to respond to your request to bring Dad dinner one night a week then to respond to the vague request to "keep an eye on Dad."
And speaking of asking for help, remember that you are no good to anyone if you get sick, so take the time to take care of yourself. Eat well, exercise, and get plenty of rest. Ask for help for your own needs if that will help you be the best caregiver that you can be.
While it might seem expensive, engaging a professional to help you may be a wise investment. A family transition coach can assist you in putting all of the pieces in place early, ideally even before your loved one's health has deteriorated. This professional can help you select your caregiving team so that you know exactly who to call when the time comes. As a neutral third party, your coach can help navigate the family dynamics that often are heightened during times of transition.