Resisting A Rest: Combating Caregiver Burnout With Self Care

Jane Smith, Associate Editor

January 1 2021

Photo by Kat Jayne from Pexels

In October of 2018, I hit a wall. I had spent a decade of my professional life caring for others in a medical and non-medical capacity, volunteering for an organization that supported others through trauma and toward healing, and holding down the fort at home as essentially a single parent of two tinies.

The year that preceded my crash and burn in October, 2018 had been one of the most exciting years of my career.

After leaving a hospice management position, I stepped into an autonomous role managing a non-medical home care agency with two territories and multiple locations. I was having fun recruiting and training skilled and compassionate talent and creating protocols that earned us a reputation as an industry leader in service, caregiver and client safety, and accountability in our area. I was meeting families in their homes and at their loved one’s bedsides and facilitating quality of life discussions and supporting them in making end-of-life decisions. I was the recipient of endless gratitude on our agency’s behalf, held people while they cried and held people while they died. I understood vocation and I felt the reach of my impact on my team and on the families for whom we provided care.

I was also working sixty hours a week and was almost always on call. Our work phones forwarded to my cell phone. My pause button was busted, and as such I brought my kids to my office for their holiday and spring breaks; they came with me to work when they took turns with the flu, and I left them with their dad on weekends while I tended to our clients’ and caregivers’ emergent needs. As an empath, I was living osmotically with no emotional boundaries between myself and my work. My social life suffered, as I permitted work to gobble up the time I’d otherwise spend nurturing intimate friendships. My marriage further unraveled, ultimately ending in divorce. I gained weight and struggled with tension headaches and migraines, insomnia, depression and anxiety.

Every fiber of my being was craving rest, but as I gave more at work, the demands increased. If you know or follow me, you know my instinct is to hustle — do more, better, faster. My need to be reminded otherwise is so crucial to my sense of well-being, it’s inked on my shoulder — “More love, less hustle” — but I didn’t slow down.

Instead, I crashed. Hard.

I emptied my vessel pouring out for other people, and I didn’t have any self-care habits in place to fill myself back up. I felt drained and depleted. Burned out. Apathetic. I recruited my replacement, spent three weeks training her and introducing her to all of our families, and resigned.

Full stop.

That was my experience working in health care management and as a care provider, and it is epidemic among nurses, caregivers, and social workers, to name a few. Even more alarming was how pervasive it was among the families we served.

The adult children of my patients and clients were often established in their careers or retired. Instead of enjoying the full benefits of an empty nest, the financial, emotional and physical demands of being a caregiver were fingers that reached thoroughly and often unexpectedly into every area of their lives.

According to Jeff Vespa, “In less than two decades, the graying of America will be inescapable: Older adults are projected to outnumber kids for the first time in U.S. history.

Already, the middle-aged outnumber children, but the country will reach a new milestone in 2035. That year, the U.S. Census Bureau projects [PDF] that older adults will edge out children in population size: People age 65 and over are expected to number 78.0 million, while children under age 18 will number 76.7 million.” reports the following statistics:

  • Approximately 43.5 million caregivers have provided unpaid care to an adult or child in the last 12 months.
  • About 34.2 million Americans have provided unpaid care to an adult age 50 or older in the last 12 months.
  • The majority of caregivers (82%) care for one other adult, while 15% care for 2 adults, and 3% for 3 or more adults.

Being almost 40, I’m more representative of The Sandwich Generation. We often have children at home and aging parents, both of which require care to varying degrees. The Sandwich Generation is still working and developing careers. We are still growing our expertise in our fields and establishing professional reputations. We are still parenting and coaching and carpooling and volunteering at school, at church, and in our communities. But, we’re taking a more vested interest in our parents’ legal and medical decisions — Do they have a living will or advance directive? Have they chosen a Power of Attorney? Do they have Long Term Care insurance? What’s happening at their doctors appointments?

We’re caring up and down the generational spectrum, and here’s what we don’t say in polite company: It. Is. Exhausting.

Self care feels kind of trendy right now, but it’s not a new idea. Psychology Today defines it here as “…a holistic process that we all need in order to foster presence, engagement, wellness and self-love.” You can find any number of lists on Pinterest that detail things you can do for yourself, including a pedicure or a massage or a bubble bath.

But, what happens when your self-care deficit is so great that those little indulgences don’t scratch the surface? What if the exhaustion is mental and emotional as well as physical and it feels like, more than a nap, a nice, restorative coma is just the ticket? What happens when you’re touched out, tapped out, worn out and completely bushed on a cellular level?

That’s a big question with a complex answer, but the piece I want to focus on is the root of this tree and the area where we have the most agency.

You. Me. The caregiver.

For us, it involves trauma cessation/healing/integration and rewiring our sympathetic nervous systems. It involves reteaching our bodies that while adrenaline and cortisol are excellent tools for fighting bears and flipping cars and responding to life’s more typical emergencies, they are damaging in excess. We need to learn (or re-learn, as is often the case) to care for ourselves in a way that permits our bodies to use those chemicals as needed, not as a way of life.

Devoting some time to learning and cultivating new self-care habits will restore our relationships with ourselves for both our own benefit and for the recipients of our love and care. In so doing, we will slowly retrain our bodies to body to relax and create stasis where we are both equipped and capable of growth, renewal, creativity, compassion and care.

I don’t feel like I need to talk with you about child abuse. You know. The American Society for the Positive Care Of Children has some sobering statistics. Simplified, “Hurt people hurt people.” But, here’s the thing: elder abuse is on the rise. As our population ages, and as more people are thrust, ready or not, into a caregiving role, the potential for abuse rises.

According to the National Council On Aging, roughly 1 in 10 Americans aged 60+ have experienced some form of elder abuse, be it physical, sexual, emotional, confinement, passive neglect, willful deprivation or financial exploitation. In almost 60% of elder abuse and neglect incidents, the perpetrator is a family member. Two thirds of perpetrators are adult children or spouses. It’s not shocking — tragic, but not shocking.

Being poorly equipped with self-care habits and tools to manage the stressors of providing consistent care is the foundation for compassion fatigue, caregiver burnout, and in the worst case, abuse.

Image courtesy of Chris Laverty, The Care Company, August 2019

Person A, who is over-committed, with poor eating/sleeping/exercise habits, whose social life is suffering due to lack of time, and is chronically stressed about work without coping strategies is more likely to be abusive towards their children or an elderly care recipient than Person B who is managing a reasonable schedule, has a healthy support network, is eating for balanced nutrition, is getting enough exercise and who has strategies for managing work stress. Regardless of your patient, client, or loved one’s need based on age, diagnosis, living situation, mental or emotional or financial state, you provide better care when you take care of yourself.

We don’t drive our cars for 200k miles without getting regular oil changes, fluid flushes, new tires, brake checks, and an occasional detail. Why do we do it to ourselves? Consider self-care routine, preventative maintenance.

While you can cull any number of ideas off lists of self-care practices on Pinterest lists, sometimes you need more than a bubble bath or a walk in the woods to feel centered again. In my next essay, Combating Caregiver Burnout with Self Care: The Toolkit, we’ll take a deeper look at the meaning of rest, and explore some more specific self care strategies in the mind/body/spirit-purpose arenas.

Until then, remember that you can’t care for other people in your life, if you are chronically railroading your own physical, mental, emotional and spiritual needs. It cannot be done. Awareness of this and practicing self-care will be what ensures your cup is full, you’re at capacity, and your loved ones do not become statistics.

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