Aging Well Guru
Helpful tips for family caregivers

Empathy: Can you have too much?

Our brains are predisposed to feel the emotions of others. This capacity, called “empathy,” fuels our most altruistic acts as humans. And it fosters sweeter and deeper relationships.

But it is possible to be overly empathetic. If the doorway to your heart is always open to feeling another’s emotions—pain, sadness, anger, fear—you are on a sure path to burnout when caring for an ailing elder.

Signs of too much empathy

• Inability to identify your own needs or feelings. Can you answer these questions: “What am I feeling right now?” “What would I like to do?” “What do I need?” If this seems difficult—or impossible—you may be overly empathetic.
• Unexplained physical or psychological exhaustion. Taking on the emotions of others is deeply tiring.
• Generalized anxiety (overwhelm) and low-level depression. A lack of boundaries leaves you at the mercy of another person’s situation. Feeling powerless is a precursor to anxiety and depression.

What you can do

Retain your compassion: care deeply but hold enough self-awareness that you don’t lose your own identity.

• Pay attention to the signals of your body. Do you get tense when someone you care about is troubled? Learn to distinguish between your own feelings and the distress of another.
• Practice relaxation techniques. Release physical and emotional tension. Deep breathing, guided imagery, and progressive relaxation are simple and easy to implement.
• Get support from others. Talk with other family caregivers to gain and maintain perspective. They share your need to care and to set healthy personal boundaries.

Keep track of things you do for yourself. When you are overly tuned in to others, it’s easy to unconsciously ignore your own needs. The upshot is burnout, and then everyone loses. Strive for balance. Each day do at least one thing that is just for you.

When family is paid for care

In many families, care of an elder relative falls predominately to one person. This typically begins with assisting occasionally for a few hours, and it can be a very loving connection. But as the needs increase, so do the hours. While the care may be given willingly, it does eat into the care provider’s personal time and may force a cutback in his or her work hours.

Time is a scarce resource! It is fair and appropriate to compensate members of the family who provide reliable care.

The wisest course is to draw up an agreement. Putting everything in writing can go a long way toward preventing family discord or misunderstanding.

Elements to include

• Types of tasks to be performed. Cooking, cleaning, transportation? What about intimate care, such as bathing or toileting?
• A start date. Don’t arrange to pay someone for work done in the past. Decide on a start date and begin payments going forward.
• Documentation of hours worked. And expenses, mileage driven, etc.
• Rate of pay. How much and how often the family caregiver will be paid.
• Clarification about time off. Is there vacation pay? What about sick pay? Who will provide care when the caregiver isn’t there?
• A termination clause. How much notice will be given?

Taxes. The IRS says that a paid caregiver—even a relative—is an employee. See our March 2016 article about taxes when hiring a family member.

Consult with an elder law attorney. He or she can help clarify the issues and make sure that decisions made now do not jeopardize future government benefits.

Hiring a relative can be awkward. Be sure the risks to the family relationship are worth the benefits or convenience of hiring a relative. Remember the old adage, “Don’t hire someone you can’t fire.”

Is breathing difficult?

If the person you care for has a lung condition, there may be times when breathing is a challenge. Start by noticing patterns:

Is there a time of day, type of activity, or emotional state that triggers the difficulty?

Is the person sitting, lying, or standing?

Here are some strategies to consider:

Home environment

• Remove dust and replace furnace filters frequently.
• Eliminate or reduce strong odors. Bleach, paint, perfume. They all exude chemical particles that can irritate the lungs.
• Raise the head of the bed. Lying flat makes it harder for some people to breathe.
• Institute a No Smoking policy. No secondhand smoke in the house. And, of course, the patient should not smoke.

Quick tips

• Find a better position. Sometimes it helps to sit up straight or brace elbows on a solid surface, such as the arms of a chair or a table.
• Turn on a fan or open a window.
• Add moisture. Consider a humidifier.
• Pace yourself. Plan the day so there are few activities, and time to rest in between. Even a shower counts as an activity.

Stress reduction

• Guided imagery or deep-breathing exercises. These strategies can calm the anxiety that comes with not enough oxygen.
• Slow, focused breathing. Breathing slowly through pursed lips helps some. Counting to extend an exhale helps others.

Talk with the doctor

If these strategies don’t ease the difficulty, talk to the doctor. There are medications that can open the airways. There are also specific breathing exercises. Does your loved one like to sing? Believe it or not, joining a singing group might help. Or ask the doctor if there’s a “Second Wind” or “Better Breathers Club.” These support groups help people get appropriate exercise and provide opportunities to share tips about living with breathing limitations.