Resource Guide for Family Caregivers
Caregiving after placement from a psychologist’s perspective

As a companion piece to the previous article, the following was written by Dr. Holly Tuokko (Centre on Aging, University of Victoria) who has worked as a psychologist for the Elderly Outreach services in Victoria.

The possibility that placement in a care facility will become necessary, especially if the care recipient has a degenerative condition (e.g., Alzheimer’s disease), is an obstacle which may seem insurmountable to many family caregivers. The decision to place an individual into the care of a facility or institution poses what may be considered the ultimate negative choice for caregivers. This decision may provoke stress and is surrounded by conflicting values. A caregiver may need to accept that he/she can no longer meet the needs of the care recipient or that the situation is beyond his/her control. This may prompt feelings of guilt (e.g., for abandoning the care recipient or feelings of failure at caregiving) or anger at oneself, one's family or the care recipient for “causing” the situation in the first place. Although the actual deciding factor may differ from family to family (e.g., lack of recognition of family members, incontinence), ultimately the balance of needs between the care recipient (e.g., nursing care, safety issues) and the caregiver (e.g., health, well-being) is tipped and placement becomes yet another necessary transition in the ongoing caring relationship.

As with many transitions, adjustments must be made and challenges overcome. After placement, a caregiver does not give up her/his role but remains involved in new and different ways. The pressure of being “on call” all of the time and the physically draining efforts of providing care are likely to be relieved by placement. The new challenges faced by the caregiver centre around finding ways to become an active member of the health care team and participate in planning care. Family caregivers bring a unique, historical, intimate understanding of the person that can greatly assist staff in understanding how to meet the individual’s needs.

Placement often provides increased opportunities for social and recreational activities for both the patient and the caregiver. Although placement may allow for the physical and social care needs to be better met, family and friends continue to be the ones most able to reach the emotional needs of the afflicted individual. Through interactions with staff, involvement in facility programs and monitoring of care provided, the caregiver’s role is extended into new frontiers. This shift in responsibilities from fulltime provider of care to visitor, advocate and facilitator also allows the caregiver an opportunity to return to some previous activities, spend relaxed time with close friends or start new projects.

There is no denying that the decision to place the care of a loved one in the hands of another is difficult and pivotal. The consequences of placement pose new challenges to be overcome in terms of shifting roles and adjusting to losses (e.g., separation, companionship). Think about the issue of placement before a not be faced alone.