By David A. Travland, Ph.D. and Rhonda Travland

While daily living can certainly be stressful, nothing compares to the level of stress faced on a daily basis by caregivers.  How can caregivers continue to give their best performance at work with caregiving chores are hanging over their heads before, during and after work?  How can caregivers concentrate on their jobs under all that pressure?

We know that stress adversely affects employee performance.  What we may not know is how things at home affect the ability of employees to concentrate on their work.  A family healthcare crisis can create enormous stress for employees, whether it be a sick child, an elderly parent or an ill spouse, especially if long-term or permanent care is required.  How does the average employee (or manager, for that matter) handle these health care situations?  Do they come to their supervisor, spell out the details of their domestic obligations and ask for help?  Not likely.  Most working Americans play their home lives pretty close to their chests.  Family matters are considered private.  In fact, one of the big frustrations of self-help organizations is that caregivers tend not to self-identify; that is, they don’t even define themselves as “caregivers” and thus are not motivated to attend support groups.  Outreach is a continuous challenge for such organizations which, in good faith, have the desire and capability to be of help.

Why is caregiving so stressful?  Those who volunteer to care for a beloved family member who has become chronically ill or disabled are indeed heroes. They deserve the respect and gratitude of extended family and the community at large. However, the very admirable qualities that make them dedicated and self-sacrificing are the reasons they are vulnerable to stress symptoms, and in extreme cases, burnout. They are compassionate to a fault. They are inclined to give their all at their own expense.

This kind of chronic caregiving is stressful for a variety of reasons:

• Caregiving for someone chronically sick or disabled is often expensive, putting a strain on the family budget.
• Caregiving takes an emotional toll.  The personal lives of caregivers are dominated by the elephant in the room; that is, there is no end to what needs to be done for the care recipient, so there is constant pressure.
• The caregiver’s needs are not being met; there is no time for play, for rest, for happiness.
• In the case of the ill spouse, the caregiver’s pal is not available so companionship and intimacy needs are not being met.
• Caregivers tend to get minimal support from extended family.  Family and friends are happy they don’t have to make these sacrifices, so they often just stay away.
• Sleep deprivation is very common among caregivers.  The needs of the care recipient don’t go away at bedtime.

Caregiver Stress Symptoms at Work

Caregivers are under siege all the time.  Those who know them well can readily see that something is wrong.  Caregiver stress can take the following forms on the job:

• Wandering attention during meetings or conferences
• Missing deadlines on more than one occasion
• Periodic tardiness arriving at work
• Time spent doing computer research on company time
• Sad or depressed demeanor, diminished sense of humor
• Slower than normal speech pattern
• Unusual eagerness to leave work at the end of the day

If you are an employee and a caregiver, here are resources to look into: Caring for a loved one is admirable but typically caregivers put their own needs and comfort on hold in deference to the needs of the care recipient.  Before it is too late and burnout takes its toll, caregivers need to take inventory of the sacrifices they have made and the stress that is created because important needs (such as free time, reading, travel, companionship, etc.) are not being met.  Then they need to make a commitment to make the necessary changes in their routines and find more balance and time for themselves.

• Caregivers need frequent breaks from caregiving duties.  Find a way to get relief, whether by prevailing on family members to fill in, day care programs with nursing homes, volunteer organizations, sitting services, or whatever can be arranged.  No excuses.  Do it today.
• Find someone to confide in, such as a professional counselor.  You may tell yourself you don’t need to talk to someone, but that is baloney.  Caregivers need the kind of perspective that comes from opening up to someone.
• Get more sleep.

What Should the Organization Do?

All organizations, large and small, private and public, are impacted by the caregiver stress problem.  It is estimated that there are in excess of 50 million caregivers – about half of these are caring for a spouse – in this country, so the odds are in favor of some significant percentage of your employees are caregivers.  Here are some steps to minimize the adverse impact of home caregiving responsibilities on employee productivity:

• Top management should communicate to all employees that the organization understands that providing care to relatives, children, and spouses is part of being a responsible family member.  The company plans to provide whatever support is possible to help employees stay focused at work and live a balanced lifestyle.
• Managers and supervisors should receive special training to spot symptoms of caregiver stress.  They should be taught how to initiate communication with these employees in a way that will encourage them to open up and talk.
• Human resources managers should be given special instructions and training on how to create workable strategies for helping caregiver employees work out a program that will bring relief at home, and restore productivity at work.
• Those at work may be the first to recognize the employee is suffering debilitating stress symptoms as a byproduct of caregiving.  If the organization has an Employee Assistance Program, care should be taken to ensure that program makes provision for supporting caregivers in distress.  A strategic alliance can be formed with existing self-help organizations, such as the Alzheimer’s Association or the M.S. Society.  They would welcome the opportunity to cooperate with your organization.

Trained employees are an organization’s most important asset, and should be treated accordingly.  Caregivers are characterized as charitable, goal-directed, hard-working and productive.  The qualities that make them good caregivers also make them wonderful employees.  It is in your organization’s long term economic interests to recognize caregiver stress, and respond constructively to that knowledge.

Feeling Owed Syndrome: A Cautionary Tale for Caregivers

How could a man just take a gun into a crowded store and start shooting people? How could a mother drown her two children in a car? How could a drunk driver mow down a crowd during a street festival? Why would a successful executive commit suicide by jumping out of his office building window? How in the world can we explain this behavior in terms of normal motives and common, well-understood forces that are common to all of us?

And what does any of this have to do with caregiving?

The people who commit these horrific crimes are angry. Where does all this anger come from? These people are feeling put upon. In their minds, they have done for others and in return have gotten the shaft. They have succumbed to Feeling Owed Syndrome (FOS). Caregivers tend not to be potential criminals, but this kind of inequity is built into caregiving relationships, and with time and additional stress, it can turn into an explosively violent situation.

Caregiving relationships often suffer from inequity, where one person contributes more to the relationship than the other. Caregivers give, and give, and give, and then receive very little in return from the person receiving care. You might be tempted to observe, “Of course. The sick person can’t give much back. They are too sick.” And you would be correct. But understanding it does not make it go away.

Our society teaches us that this inequity shouldn’t make us angry, but it does. The fly in the ointment is the brain has a mind of its own. We all carry around an internal ledger that keeps track of what we are investing in any given relationship, and what we are getting back in return. For example, let’s say you are exiting a department store and someone with their arms full of packages is following you. As a courtesy you hold the door for them. We have all done this hundreds of times.

Now suppose that the person with the packages walks through the door, nose in the air, and does not even bother to acknowledge your presence. How does this make you feel? If you are normal, you are going to be at least a little annoyed. You won’t be hostile or depressed, but you are likely to be miffed. Why? Because you performed a service for that person, holding the door, and they did not bother to give you anything back, such as a “thanks” or a smile or a nod. You have just experienced an unbalanced relationship and you feel owed. That has resulted in a tiny amount of stress.

Multiply that situation by a thousand, as would be the case in the caregiver situation, and you are likely to be facing an accumulation of stress a thousand times more obvious. Behavioral scientists know stress is cumulative, one stressor just piles on top of the next one, and it gets worse and worse. As the relationship imbalance gets more and more pronounced, we gradually begin to identify we are feeling owed, that we are not getting nearly enough back from the person we are caring for to counterbalance what we are putting into the relationship. FOS is brought about by chronic imbalance in a relationship, any relationship. It is not only experienced by caregivers, but by anyone who feels they have been short-changed or denied an adequate return on their investment in others. The more they feel they are owed, the more extreme their reaction, whether it be stress translated into illness, or acting-out behavior taking revenge on an ungrateful world.

What can caregivers do about this? How can FOS be avoided?

• Caregivers must admit they keep track like everyone else. They need to admit caregiving is extremely demanding, that it is often a thankless job, and that they are carrying around some resentments.
  The next step is caregivers must commit to finding a way to reduce the amount of inequity. They must find a way to limit what they invest because it is unlikely they can successfully demand more back from the patient.
• Caregivers need to pay close attention to their own needs. Sacrificing too much for another person is a dangerous game, resulting in physical and emotional damage.
• Caregivers should treat their own symptoms – anxiety, depression, escape fantasies, loneliness, anger – seriously and create an action plan to correct the imbalance in the caregiving relationship.
• Caregivers need a confidant, someone to talk with who can understand caregiving frustrations. Normally another caregiver is the best choice; a mental health professional is another option. Those who don’t have any caregiving experience will often have a hard time relating or empathizing.
• Caregivers need periodic breaks from the caregiving routine. Finding a substitute caregiver is crucial, whether a relative, friend, neighbor, or someone hired to sit with the patient.
• Caregivers must distinguish between what the patient wants and what the patient needs. Compassionate caregivers have a tendency to treat wants and needs alike, and the patient’s wants can run caregivers ragged. The needs must be met, but not the wants, especially those that interfere with the caregiver’s needs.
• Caregivers need to make every effort to arrange for a full night’s sleep every night. Sleep deprivation amplifies FOS and  may result in depression, anxiety and anger.

Caregivers must take care of their own needs or they will not be effective as caregivers. FOS causes caregivers to become indifferent to the needs of the patient, and if there is no relief in sight, the symptoms of depression, anxiety and anger can get out of hand. Caregivers make headlines occasionally by exhibiting violent behavior toward their loved ones and themselves. In these cases, FOS was not recognized early enough to head off disaster.