The reluctant caregiver - a challenge for society

 

Anna Holmes

There is a paradox about caring – caring is supposed to arise out of compassion or a universal love of others but often is done out of a sense of duty. Paula Span writes well in “The Reluctant Caregiver” about care done out of duty not affection. Reluctant caregivers may be family, friends or neighbours as well as professional carers. Thanking a reluctant caregiver can make them feel ashamed because care is done from a sense of duty rather than compassion. I wonder if reluctant caregivers are compassionate and do not recognise it. Caring as a moral obligation can still be compassionate.

In New Zealand the numbers of those aged over 65 years will double to more than a quarter of the population over the next 50 years and the demand for caring will also increase. Technology will help with practical issues. There are already mobile apps that send messages to remind people to take their medications, or remind them to eat, or attend appointments. There are even small robots that can follow patients around and call for help when required.  However, these cannot meet the human need for connection and community.

There are various cultural and social dynamics at work that are making the provision of compassionate care more difficult. When visiting a rest home recently I asked some of the residents what had changed in New Zealand society since their youth. They replied: “There’s been a loss of community.”  “People are less caring now.” “It’s all the divorces and people living together so relationships don’t last.” “Families don’t live in the same place anymore.” “Our children are so busy with work and their families they haven’t time to see us.”

To these I would add the necessary increase in numbers of women working, the increased cost of education and training, smaller families and increased economic constraints around the help available to the frail. Regional health authorities reduce available funding for care in the community because funding complex technological medical care is seen as more important as it can be measured against ‘health targets’.

Over the past century, respect for the elderly has diminished in European societies. Various factors fuel a growing sense of ageism in these societies, particularly a shift towards individualism and materialism. Along with this is a lack of ethical reflection in policy. This results in older people being seen as consumers of goods without being contributors. It is as if the work, taxes, love and caring that they have contributed to society in the past has no value. It is not surprising that more elderly people consider themselves a burden.

As the number of elderly people increases, more New Zealanders who can afford it choose to live in retirement villages, which offer care at a price. They cannot provide the hope and connection of a multi-aged community and life often feels meaningless. They all too easily become ghettoes distanced from the rest of society. There is an urgent need to rediscover the place of elders as useful, contributing members of society.  A number of recent studies have shown that volunteering and being connected are important factors in health and longevity. [1] The problem is how to connect a fragmented society into an organic whole.

It is ironical that ‘undeveloped’ societies are better at this. A Tanzanian woman, speaking to medical students said Tanzanian children have a duty to care for their parents, including sharing any money with them. The old are treated with great respect and honour for they are the living history of the people. They help where they can and are not seen as, and nor do they feel themselves to be, a burden. They carry the wisdom and tell the story of the community. This is also the traditional way kaumatua are regarded and treated in Maori communities.

In 48 years of medical practice I have seen far more compassionate caregivers than reluctant ones. There is a clear duty to ensure that any ‘reluctance’ caregivers experience is not exacerbated by a lack of physical, emotional, spiritual or economic support. As a start, how about a care giving allowance that is adequate to maintain family income? 

As a society we have a responsibility to ensure the weakest and most needy have good care and support. If we fail to do this it will not be surprising that the elderly and frail feel they are an unwanted burden and might be tempted or coerced to seek death rather than life.

Dr Anna Holmes has recently completed a PhD on Embracing the paradox : Spirituality in General Practice . She is a Clinical Senior Lecturer, Department of General Practice, University of Otago. Over the past 48 years she has practised medicine in student health, rural practice, as a medical manager in the regional health authority, and in palliative care. Her experience includes work in a number of different cultures.

 


[1]Altruism, Helping and Volunteering: Pathways to Wellbeing in Late Life Kahana, Bhatta et al Journal of Aging and Health
25(1) 159–187