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HEART Insight:
doi: 10.1097/

When Grandpa Moves In

Patton, Carol

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Helping your family cope as caregivers for a sick relative

Not many adult children expect their parents or grandparents to move in with them. Usually, it's the other way around.

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But as the lifespan for Americans is projected to climb to 79.5 years in 2020, according to the U.S. Census Bureau, the number of extended families living under one roof could become more common. One of the reasons may include tight finances due to a struggling economy. Another is something not every family considers: illness.

When Grandpa is recovering from a heart attack or stroke, he may no longer be able to live independently. Or when Mom suddenly becomes sick, she may not be able to afford in-home nursing care. So adult children put out the welcome mat, assuming the role of caregiver. However, many are unprepared, unaware and uninformed of what to do and how their family's lifestyle will change.

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Before any sick relative moves into your home, analyze your family situation, says Jennifer Fitzpatrick, M.S.W., who owns Jenerations Health Education in Baltimore, a consulting firm that provides education and coaching in the field of geriatric healthcare and caregiving.

“It cannot be just about Mom or Grandma who's 90,” she says. “Families can avoid making a mistake if they give some thought as to what's right for the family unit before they jump in.”

Almost everyone underestimates the amount of time and energy that's involved in acclimating to another person living in the house, especially if that individual is sick, Fitzpatrick says. Everyone's role and routine changes. So does the family dynamic, but not always for the best. If not prepared, existing problems like a troubled marriage or children with behavioral issues may get worse.

Or new problems may surface. She points to teenagers who rebel because they must sacrifice their room for Grandma. Young children may also act out because they're uncomfortable around sick people or bothered by their grandmother's deteriorating appearance.

The key is effective communication and setting realistic expectations, says Fitzpatrick. Explain why Grandpa is sick, what he can and can no longer do. When possible, take frequent trips to the hospital to visit Grandpa before he moves in so family members get used to changes in his appearance, abilities or personality.

Still, it's difficult for people to anticipate the emotional impact on their family until it happens. In the meantime, she says the most important message you can communicate to your family is that caring for Grandpa requires a team effort.

“[Caregiving] is not a job for one person,” says Fitzpatrick. “In order to keep your family balanced and things happy and meet everybody's needs, don't do this alone.”

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Before your sick relative moves into your home, ask everyone in your family to develop a list of questions and concerns, including things that may possibly frighten or anger them about a grandparent or other family member moving in, says Diana Denholm, Ph.D., L.M.H.C., a psychotherapist in West Palm Beach, Fla., and author of The Caregiving Wife's Handbook (Hunter House, 2012).

Review everyone's list, and develop a master list of issues you need to address with your sick relative to formulate a plan. How does she want things handled? Who's going to make key decisions? Who's going to schedule doctor appointments, dispense medications, call the insurance company or set up the bathroom to accommodate physical disabilities?

“If your sick relative still has her wits about her, don't go behind her back and make these decisions,” Denholm says, adding that it's important to create the right environment for the conversation, such as when your children are in school so you can devote full attention to the discussion or when your spouse is home and can attend to their needs. “Then prepare yourself so you can have a conversation that has compassion for [your sick relative] and yourself or it's not going to go anywhere.”

Share the plan with your spouse, then with the rest of your family. Avoid dictating what tasks your spouse or children need to perform, Denholm says, explaining that it's always better to let people decide on their own how they can help Grandpa. Create an understanding of what's going to happen based on what they volunteer to do. Put it in writing, suggests Denholm, describing the responsibilities of each family member.

“There are going to be a lot of errors made,” she says, adding that your plan should be reviewed on an ongoing basis, especially around holidays, which can be stressful and even depressing for some people. “There's too much of a tendency for caregivers to take on tasks and duties that the ill person actually could be performing and that the ill person may want to still be doing. You may make a person invalid, turning him or her into an invalid, when you're too codependent.”

Overall, try to keep life as normal as possible, especially since people get “lulled into the normalcy of the illness and trauma,” Denholm says. Observe the same daily or weekly routines such as attending your son's soccer games or helping your daughter with her homework after dinner. Plan activities that your sick relative and entire family can enjoy to build close family ties.

Not every family shares the same problems or successes. Family caregiving is a highly individualized experience, adds Tamilyn Bakas, Ph.D., professor of nursing at Indiana University School of Nursing in Indianapolis. Those who are unprepared may find it hard and depressing. But for others, who take the time to prepare their home and family to care for a sick relative, “it's a very positive experience,” says Bakas. “[It] actually brings families closer together as they realign what's important to them.”

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Family harmony

* Make sure your children know they're important and loved. Set aside time for them and listen to their concerns.

* Be honest with children. If your parent or grandparent is moving toward the end of life, be honest about it. Also explain to children that their grandfather's anger or bothersome behavior is a result of his condition, not them or their actions.

* Pay attention. Children pick up on emotions and stress. Their disruptive behavior may reflect a tense situation at home.

* Let children help as long as they feel comfortable. Young children can draw pictures to boost their grandmother's spirits. Older children can read to her. When possible, encourage your sick relative to interact with your children. Your father, for example, can help them with their homework if he's able.

* Prevent problems from escalating. If things get too tough, don't be afraid to seek family therapy.

* Inform your employer about your changing circumstance. Ask about revising your work schedule.

* Develop realistic expectations. List what you would expect of yourself as a good caregiver, and then create the same list for someone else in your situation. Now be more realistic and fair to yourself.

Source: Tamilyn Bakas, Ph.D., professor of nursing, Indiana University School of Nursing, Fellow of the American Heart Association and American Academy of Nursing.

© 2012 American Heart Association, Inc.