The most press­ing bur­den all care­givers car­ry is to meet peo­ples’ needs, not just by per­se­ver­ing through its de­mands, but by do­ing so day in, day out. Whether it’s car­ing for the el­der­ly, car­ing for some­one with spe­cial needs, or car­ing for some­one who’s ex­pe­ri­enced ma­jor trau­ma or ill­ness, the phys­i­cal, emo­tion­al and re­la­tion­al de­mands of care­giv­ing take their toll over time. While there are sev­er­al strate­gies to light­en your bur­den, some are quick­er to ap­ply than oth­ers.—(Amer­i­can Natur­opath, Nathan Mcveigh)

The old adage that sug­gests in the cy­cle of life a man is "once a man and twice a child", may seem ap­pro­pri­ate if one con­sid­ers on­ly the gen­tle­ness with which both a ba­by and an el­der­ly must be han­dled. But care­givers and spe­cial­ist de­bate this, as they say, it is quite dif­fer­ent sim­ply be­cause ba­bies are de­vel­op­ing and pro­gress­ing while the el­der­ly at most are de­gen­er­at­ing.

Rober­ta Rose-Collins, founder of Yes She Can, a health-fo­cused women’s em­pow­er­ment NGO, learned this all too well when she took on the role of care­giv­er to her bedrid­den aunt-in-law—man­ag­ing from the help, to her meals, to ther­a­py among oth­er dai­ly com­mit­ments, all while work­ing full time.

Though on­ly the most su­perb care was ad­min­is­tered to her aunt-in-law, Rose-Collins told the Sun­day Guardian it was not easy es­pe­cial­ly be­cause her aunt-in-law was an­gry about be­ing con­fined to a bed and of­ten times she would get de­pressed and de­spon­dent, even re­fus­ing ther­a­py in some in­stances, oth­er times just un­will­ing to co­op­er­ate.

"There were times that peo­ple (hired care­givers) would just stop work­ing be­cause they could not deal with her ag­gres­sion and I had to take time from work to care for her.

"On days that the ther­a­pist was com­ing to the house, I had to take time from work be­cause she would not lis­ten to the staff," Rose-Collins ex­plains.

"She was the strong one in the fam­i­ly. Every­one came to her so ly­ing there was not pleas­ant to her, to say the least. It was re­al­ly dif­fi­cult try­ing to help some­one who had giv­en up on liv­ing."

When she suf­fered a few strokes and could not ex­press her­self well, this posed an­oth­er chal­lenge and a dif­fer­ent lev­el of ex­haus­tion for Rose-Collins as her aunt-in-law be­came very con­tentious.

"There were days that I was dressed to go out and had to sit and try to de­ci­pher what she was try­ing to say as she would get ag­gres­sive if she was not be­ing un­der­stood," Rose-Collins re­calls.

Apart from tak­ing nu­mer­ous days off from work over the years, when­ev­er her aunt-in-law would 'act up' or had to be tak­en for den­tal vis­its, Rose-Collins al­so found her­self tak­ing loans at times to pay for her aunt-in-law's ex­pens­es.

Rose-Collins said while these chal­lenges were re­al, and it be­came over­whelm­ing and ex­haust­ing jug­gling her mar­riage, care for her son and her aunt-in-law, she could not help but be­come ex­treme­ly emo­tion­al at times, hav­ing to watch life slip away from her aunt-in-law who was once so full of life.

"We gave her the best life we could but her qual­i­ty of life was poor. Ly­ing there...hav­ing per­sons take care of her every need."

Rose-Collins re­called the day her aunt-in-law died at the hos­pi­tal, where she spent her fi­nal days, she pre­vi­ous­ly had a 'gut feel­ing' that day would be the last day she would be alive.

"I just had this feel­ing that I should not leave as I usu­al­ly would go, see the doc­tors then go to the of­fice which was in Siparia.

"I stayed at her side and told her that it was ok to go. I held her hands and spoke to her. She was un­able to speak but I know that she un­der­stood me. I re­mem­ber feel­ing the life leav­ing her body and her tak­ing her last breath. It is an ex­pe­ri­ence that evoked mixed emo­tions in me be­cause on one hand I was sad she had died but al­so hap­py she was no longer suf­fer­ing," Rose-Collins says.

Asked if she felt there was the need for train­ing even for fam­i­ly mem­ber on how to care for the el­der­ly in their fam­i­ly who now re­quire un­di­vid­ed at­ten­tion, Rose-Collins said in her opin­ion love alone does not give any­one the abil­i­ty to give prop­er care. And it was al­so im­por­tant for care­givers to get a break.

"I be­lieve that’s a ma­jor rea­son for the el­der­ly be­ing abused. It’s emo­tion­al­ly drain­ing es­pe­cial­ly if it’s some­one close to you," she says.

Shar­ing the view of Mcveigh, Rose-Collins dis­tin­guish­es be­tween car­ing for a ba­by op­pose car­ing for the el­der­ly. "Ba­bies de­vel­op and grow so the changes are pro­gres­sive. They learn to talk and to ex­press them­selves. With the el­der­ly they are go­ing down one day they can talk and the next day they can’t. One day they re­mem­ber that they ate and the next day they are telling peo­ple that you are starv­ing them."

Ad­di­tion­al­ly, there is joy when a ba­by learns to walk Rose-Collins point­ed out, but there is sad­ness when your loved one is no longer able to care for them­selves be­cause it means that things are get­ting worse.

Re­it­er­at­ing the toll car­ing for her aunt-in-law took on her, Rose-Collins says, "The truth is that I nev­er re­alised how much tak­ing of her af­fect­ed me un­til af­ter she died. It’s like I was hold­ing my breath for years and not re­al­is­ing it."

She said the emo­tion­al ex­haus­tion far ex­ceeds the phys­i­cal and she could not imag­ine how dif­fi­cult it is for the fam­i­ly mem­ber who is not trained to deal with these spe­cif­ic chal­lenges, has no one else to turn to and has to sole­ly re­ly on the Gov­ern­ment for care.

"Can you imag­ine hav­ing to clean some­one with a catheter or give med­i­cine via in­jec­tions? And not be­ing trained for this," Rose-Collins asks.

Geri­atric hos­pi­tals, schools need­ed

Last week­end, the Sun­day Guardian high­light­ed the abuse of the el­der­ly and spoke with for­mer di­rec­tor of the Di­vi­sion of Age­ing in the Min­istry of the Peo­ple and So­cial De­vel­op­ment, Dr Jen­nifer Rouse, who of­fered her ex­per­tise ad­vice in re­duc­ing or elim­i­nat­ing the abuse of the el­der­ly. She rec­om­mend­ed that like the Chil­dren’s Au­thor­i­ty es­tab­lished for the pro­tec­tion of chil­dren, T&T should con­sid­er the de­vel­op­ment of an old­er per­sons au­thor­i­ty for the pro­tec­tion of the el­der­ly.

To­day she ad­dress­es the chal­lenges faced by care­givers of the el­der­ly. Rouse said there was need for a na­tion­al pub­lic ed­u­ca­tion cam­paign on the age­ing process and is­sues, and re­tire­ment plan­ning.

She be­lieves mul­ti­me­dia pro­grammes must al­so be ramped up to cater for the in­firm and those who are house­bound, to have ac­cess to ex­er­cise pro­grammes and so­cial en­gage­ment.

Speak­ing on the chal­lenges fam­i­ly mem­bers face car­ing for the el­der­ly, Rouse ex­plained that it was re­al­ly a 'two-fold' is­sue. She said first­ly since fam­i­ly size has shrunk from the con­ven­tion­al ex­tend­ed to nu­clear to the sin­gle par­ent, there are few­er mem­bers in the house­hold to share the re­spon­si­bil­i­ty of car­ing for el­der­ly par­ents or rel­a­tives. As a re­sult, the work­ing adult chil­dren (of­ten re­ferred to as the "sand­wich gen­er­a­tion") and the re­tirees who still have their aged par­ents alive (due to ex­tend­ed longevi­ty) have to jug­gle their work­load, in­come, and chores be­tween their de­pen­dents on the one hand and the de­mands of their work­places.

Sec­ond­ly, the re­tirees are al­so ex­pe­ri­enc­ing phys­i­cal de­cline them­selves and liv­ing on fixed in­comes. As a re­sult, the sit­u­a­tion be­comes ten­u­ous for both groups to es­tab­lish a work-life bal­ance with fi­nan­cial bur­den and emo­tion­al burn-out of­ten the by-prod­ucts.

She not­ed that with the age­ing pop­u­la­tion grow­ing at an ac­cel­er­at­ed rate and re­quir­ing spe­cialised care and cus­tomer ser­vice, there needs to be the es­tab­lish­ment of two geri­atric hos­pi­tals erect­ed in north and south Trinidad. Al­so, uni­ver­si­ty de­gree pro­grammes in geron­tol­ogy and geri­atric ser­vices should be es­tab­lished in the Caribbean re­gion since, she re­vealed, this re­gion is grow­ing old at a faster rate than the de­vel­oped coun­tries in the north.

Ad­di­tion­al­ly, she felt that schol­ar­ships in these fields should be award­ed to suit­able can­di­dates, in re­sponse to the ex­ist­ing sup­ply-de­mand dy­nam­ic in T&T's age­ing pop­u­la­tion.

Asked about the ex­ist­ing el­der­ly care ser­vices in T&T, Rouse said home care ser­vices, which are pro­vid­ed by the Gov­ern­ment's Geri­atric Ado­les­cent Part­ner­ship Pro­gramme (GAPP), are of­ten over-sub­scribed.

"GAPP, which is means-test­ed, trains care­givers aged 17-35-years-old to pro­vide care for se­niors. As a re­sult of the in­creas­ing de­mand for the ser­vice, there is a pro­lif­er­a­tion of pri­vate agen­cies mush­room­ing...un­li­censed...pro­fess­ing to de­liv­er home care ser­vices for the el­der­ly at ex­or­bi­tant cost."

How­ev­er, with no om­nibus leg­is­la­tion, which pro­vides over­sight and mon­i­tor­ing of such un­reg­u­lat­ed agen­cies, and which grants au­tho­ri­sa­tion for li­censed of­fi­cers/in­spec­tors to en­ter pri­vate res­i­dences where care is met­ed out to the el­der­ly oc­cu­pants, Rouse said it should re­al­ly be con­sid­ered a dis­ser­vice to the el­der­ly.