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April 11, 2020
During the coronavirus pandemic, we are bombarded by frightening news and conflicting guidance. Our schedules have been upended, and in order to keep everyone physically healthy, we have sacrificed many activities that kept us emotionally well.
The unprecedented circumstances are challenging for everyone, but they may be especially difficult for caregivers. Whether they are supporting older adults, children, or ill family members, caregivers can find their experience rewarding and joyful. They may also find it demanding and exhausting. The coronavirus pandemic adds another layer of stress to their lives.
Ipsit Vahia, MD, medical director of McLean’s Geriatric Psychiatry Outpatient Services, said it’s important to recognize that caregiving is an active process that requires a person’s full engagement—often physically and certainly mentally.
Vahia said, “Many people are now having to balance both caregiving and other professional commitments at the same time their usual support system is unavailable to them.”
Many of Vahia’s patients are in their late eighties or nineties and have children in their sixties who are their caregivers.
“These caregivers may struggle to balance,” Vahia said. “There’s the anxiety of caregiving for their loved one. But there’s also their own anxiety around falling into the high-risk category for catching COVID-19 themselves.” Vahia believes this group may be at the highest risk for caregiver burnout because they must deal with their own health anxiety as well as stress from their caregiver role.
Friends and families of individuals with a substance use disorder are also supporting their loved ones. The challenges of addiction recovery during the pandemic are many.
Hilary S. Connery, MD, PhD, clinical director of McLean’s Center of Excellence in Alcohol, Drugs, and Addiction, said many of her patients with substance use disorders are struggling with disruptions to care during the public health crisis. Human contact, an essential part of recovery, is reduced as support groups have moved online. Many residential settings have had to shut down to prevent the spread of the virus. Those that have been able to remain open, such as McLean’s programs, have had to make intensive changes to sleeping arrangements, dining, and treatment.
Connery said families of loved ones struggling with addiction to drugs or alcohol may now be in close quarters with somebody, and this may result in a strained relationship because of a substance use disorder that isn’t in full recovery. “That poses challenges because what are you going to do? You can’t tell them, ‘You really need to get to treatment.’ Treatment isn’t as available,” she said. “Where treatment is available, it’s harder to get into at this point in an in-person way. That has a major impact.”
Compassion fatigue and burnout, two risks for caregivers, are overlapping but different issues, according to Joan M. Gillis, MSW, LICSW, senior clinical team manager in McLean’s Geriatric Psychiatry Inpatient Services.
Compassion fatigue occurs when a caregiver is continually stressed from caring for someone in need. “You emotionally disengage, which reduces your ability to provide care,” Gillis said. “You lose the ability to be empathic.”
Signs of compassion fatigue include:
Burnout shares many of the same traits as compassion fatigue, but includes more layers. Compassion fatigue can be sudden, but burnout usually emerges over time. “People who experience burnout have a feeling of not getting the job done,” Gillis said. “They can withdraw from family and friends and lose interest in activities they previously enjoyed.” People who experience burnout get sick more often and can neglect self-care.
Gillis recommends caregivers notice and track changes in their levels of compassion fatigue or burnout so they can act and make changes. They can also give themselves permission for self-care.
“Self-care is not selfish,” she said. “It keeps you mentally alert, physically healthy, and emotionally strong. You need stamina in the caregiving role. Poor health will impact your loved one. You need to take time out to recharge or focus on yourself. It is not a luxury. It is a basic and essential need.”
Gillis emphasizes it is okay for a caregiver to have complicated feelings. “You cannot be perfect, so suspend self-judgment and guilt,” she said. She recommends that caregivers remember a situation is not about their feelings, but how they act on and work through those feelings. “Occasional feelings of anger, resentment, irritation, and frustration are normal emotions, but they can cause shame and guilt.”
“Self-care is not selfish. It keeps you mentally alert, physically healthy, and emotionally strong.”– Joan M. Gillis, MSW, LICSW
When caregivers are stressed, Gillis said, they can pause and breathe. In tense moments, a solution can be as simple as counting to 10 to defuse a situation or walking away and taking a micro-break.
Connery stresses that caregivers should re-establish schedules that have been completely disrupted by the public health crisis. They can also look after their loved ones’ routines by “making suggestions—not demands.” She also recommends that family members of those who struggle with addiction try online support groups, such as Al Anon, Nar Anon, or the family support arm of SMART Recovery.
All the standard practices of self-care serve as preparation for stressful moments. During the coronavirus pandemic, and always, caregivers can exercise, journal, practice gratitude, meditate, and reach out to friends.
What can we do if we notice a caregiver is struggling? Vahia suggests gestures that lighten the load, like providing a meal or having a conversation on the phone—or even in the open-air with proper physical distancing. He adds that recognizing a caregiver’s situation can go a long way. “Most caregivers don’t pause to acknowledge the stress of caregiving,” he said. “Having a friend or neighbor validate that stress in and of itself can be therapeutic.”