One of the most frequent concerns I hear from caregivers is how to deal with a care recipient who never wants his or her caregiver out of sight. This can be a real challenge for caregivers who need to work, take care of other family members, or just have a little time to him- or herself. What is at the root of this very common situation, and what’s a caregiver to do?
To best identify what’s really going on and then develop a strategy to address the problem, it is important to first sort out which of the following situations best describes the dynamic you face:
Puppy - This care recipient is perfectly safe and has no behavioral disorder which causes him or her to become overly anxious when left alone (or with another friend, family member or paid caregiver) but prefers that you be around all the time or wants to be near you
Nervous - This care recipient is safe, but tends to panic when left alone (or with another caregiver), possibly due to behavioral issues which may be separate from or related to their main conditions
Learned – This care recipient has had a real life bad experience in the past when you weren’t around and they are afraid it will happen again
Oblivious – This care recipient is unaware that s/he is clingy and can’t change his or her behavior or expectations
Manipulative – This care recipient is well aware that they are not at risk, but they simulate a panic reaction or other tactic to keep you close at hand
If you are dealing with a Puppy, the best technique is training (also known as behavior modification)! In this instance, you should be able to have a reasonable conversation with your loved one and explain why you can’t be with them every minute. You can negotiate and offer “treats” for desired behavior. It sound simple, but as with a puppy, it is helpful to give choices and let your loved one pick from among alternatives that you’re okay with. Sometimes, you will just need to go and do your thing, and if they “bark”, you know that they’ll get over it eventually. Try not to carry the guilt with you.
If your loved one is Nervous, the situation is more complicated, especially if s/he suffers from an anxiety disorder. In this case, seek help from a behavioral health professional who might be able to offer techniques such as cognitive behavioral therapy. Your care recipient’s need to have you close is very real to him or her, and no amount of reasoning will change their experience of the fear of not having you close. In this case, it is important to find ways to help your loved one feel safe when you can’t be around, but don’t expect them to just deal with the situation on their own. Unlike the Puppy who will bark, the Nervous care recipient may have a full blown panic attack and hurt himself or others.
For a care recipient who has Learned that when you’re not around bad things can happen, you have to acknowledge the reality of their fear that it could happen again. If you can help them to understand that they are clinging to you because of past experience, you can often create safety nets that allow them to relax and let you go. For example, an emergency alert system might do the trick, or phone calls at agreed upon intervals.
Perhaps the saddest situation is the care recipient who is Oblivious to the fact that they are constantly clinging and demanding your presence. This is often the result of dementia or other neurological or psychiatric disorders, but can occur with any type of serious illness or pain syndrome. This loved one has either lost the cognitive ability to recognize that their behavior or expectations are unreasonable, or are so wrapped up in their own pain and suffering that the result is the same. In this situation, your best bet it to grit your teeth and do what you need to do without taking anything your loved one says or does too personally.
The Manipulative care recipient is the toughest customer of all. In this case, your loved one knows exactly how to push your buttons and does so for his or her gain. Just don’t be too quick to conclude that this explains your situation – make sure that you consider all of the other reasons first because there is a way to handle them, either by working with your loved one or wrapping your own mind around the situation and changing your understanding of what’s going on. So many caregivers become frustrated and assume that their loved one is being manipulative when in fact it is really one of the other scenarios. If you are convinced that you are being manipulated, then it is up to you to decide that you’re not going to fall into the trap anymore. You’re unlikely to be able to change the manipulator’s behavior, so your only option is to change how you allow yourself to react.