When Your Valentine Needs Care
When a couple says their wedding vows, the words traditionally include “in sickness and in health.” But if the time comes when illness and disability touches one of the spouses, changed roles can have a profound impact on the marriage. Researchers have been looking at the issues of couples in which one is providing care support for the other.
The stereotype of a grumpy old couple sniping at each other after years of marriage is a staple of comedy—think of the Lockhorns in the daily comics, and Fred and Ethel Mertz from “I Love Lucy.” However, studies show that these fractious unions are the minority. “Older people in stable marriages are relatively happy and experience low rates of depression and anxiety,” said University of California Berkeley psychology professor Robert Levenson. “Marriage has been good for their mental health.”
But with age comes an increased risk of illness and disability, and a greater likelihood that one spouse will need to provide care for the other. Statistics show that a larger percentage of family caregivers today are spouses, rather than adult children. A study published in Health Affairs showed that more than half of all spouse caregivers do it all alone, with little support. (It’s important to note that most of these studies also apply to committed partners in a long-term relationship, regardless of marital status.)
A person living with a chronic health condition is at an advantage when they have a spouse to support them. Caregiving spouses help their partner keep track of appointments and follow the doctor’s recommendations, and provide hands-on care and emotional support. But this can be hard work, no matter how willingly it is provided. If you or someone you know is caring for a spouse or partner, here are four important things to do:
Take care of the marriage. A good marriage promotes good health, but the opposite also can be true. Marital strife is stressful and can have a negative effect on health. It can be hard to maintain a loving, romantic relationship in the midst of medication management, wound care, helping one’s spouse use the toilet, or dealing with the changes brought by Alzheimer’s disease. Psychologists report that the caregiver spouse can experience resentment—and the spouse who is dealing with health challenges might make their caregiver spouse the target of anger. “The hurt feelings on both sides quickly lead to bitter squabbling,” psychologists Barry Jacobs and Julia Mayer told AARP. “In our professional experience, we’ve found that by far the most challenging caregiving situation is when one spouse looks after the other.”
Take care of the caregiver. Receiving care benefits the ill spouse, but sometimes has the opposite effect on the well spouse. Caregiving can be hard work, both physically and emotionally. Caregivers often fail to get enough sleep, to eat well, and to keep their own doctor appointments. They suffer emotional distress as their loved one and their life changes. And in many cases, the term “well spouse” is an overstatement, as spouse caregivers often have health problems of their own. University of Michigan professor of psychiatry Courtney A. Polenik says it can be very stressful when spouses’ health needs differ.
Ask for help. Compared with adult child caregivers, spouse caregivers are much less likely to seek assistance from family and friends. The couple may feel protective of their independence, and fear intrusion into their intimate situation. “As a former spousal caregiver, I certainly understand the desire to take care of all of a spouse’s needs,” said Carol Levine, former director of the United Hospital Fund’s Families and Health Project. “But the care that is needed and the responsibilities thrust upon family caregivers by our healthcare system—typically, without adequate support—are more than any family caregiver, particularly an older spouse, can handle alone.” Other family members are urged to help, and to address the couple’s concerns about privacy and autonomy.
Call in professionals. The help of family and friends may not be enough. Fortunately, there are many resources caregivers can access. Your local senior services agency can recommend care support services, as well as caregiver support. An aging life care professional (geriatric care manager) can locate services and help the couple navigate the changes in their lives. An adult day center, respite care or home care can give the caregiver spouse a break. Couples also can benefit from marriage counseling to help them nurture their relationship even as it has changed.
Consider where to live. If one or both of the couple is living with challenging health conditions, moving to a supportive living environment can benefit the well-being of both. Assisted living or a long-term care community can provide health care support, assistance with medications, meals, housekeeping and activities that are appropriate for the person’s physical and cognitive condition. Even if supported living is only appropriate for one of the couple, the other can continue to be fully engaged in their spouse’s life, and with the support of senior living staff, continue to focus on their relationship rather than care tasks.