Nancy Gahles, DC, CCH, RSHom(NA) discusses family caregiving and how integrative healthcare can aid those giving care to their loved ones.

by Nancy Gahles, DC, CCH, RSHom(NA)

The caregiver in the family is the person who has the majority of the responsibility for either administering care or providing direct care to someone in their immediate family who is otherwise unable to care for themselves either wholly or in part.

In today’s society, we have a spectrum of need for care within families. We have the parent(s) of children with high needs, we have the spouse with functional/cognitive/physical impairment, we have the aging parents of the middle aged baby boomers with chronic diseases and their sequelae that need full time management.

The family caregiver that provides care in the home setting faces many issues that may not be brought to the primary care doctor’s attention for their face value. Likely, that person will present to their medical doctor for treatment of physical symptoms that are a result of the stressful situation that they find themselves in. Stress or stressed-out will be the etiology they will tell and will name as the cause of their pain. Pain will be the reason for the visit. In my practice as a Doctor of Chiropractic, low back pain, joint pain and head pain are the most frequent complaints. In my practice as a Certified Classical Homeopath, anxiety and depression are the most frequent complaints.

It is incumbent upon the practitioner who is first consulted to ask the questions that will reveal the maintaining cause of the symptoms. It is necessary to explore the person’s understanding of the word “stress” and the feeling of “stressed-out”. What does that mean for them? What situation/circumstances provoke those feelings and those physical/mental/emotional symptoms? What is the total expression of your stress?

Delving into the causation will reveal the person’s role as a caregiver in the family and the extent to which that situation impacts their life. It is at this point that the practitioner begins to make the assessment as to how this person can be managed in total from their professional expertise and in an integrated model, referring to practitioners of specialties perhaps outside the box of conventional therapies.

Who are the caregivers and what are their issues? We have now the largest number of Americans ever over the age of 50.  This is one group to discuss, the caregivers for the aging. According to a recent survey of 1,130 long distance family care providers by MetLife Mature Market Institute and the National Alliance for Caregiving, family caregiving from a distance has become a fact of life for millions of Americans. Approximately 34 million Americans are providing care to older family members. Fifteen percent of these caregivers live an hour or more away from their relative. Nearly a fourth of these long distance caregivers are the only or primary care provider and 80 percent work full or part time.

Expenditure of time in caregiving becomes a major issue in this case. Half of the survey respondents reported spending 13.6 hours a month arranging care services and half said they spend another 16 hours per month checking on their care recipient or monitoring the care being received.  Nearly three quarters of these long distance caregivers provide help with instrumental activities of daily living (IADL) such as transportation, shopping, cooking, cleaning, managing finances and medications for an average of 22 hours per month. And 40 percent are involved in basic activities of daily living (ADL) such as bathing, dressing, feeding and toileting, for an average of 12 hours per month.
In both my practices, similar themes emerged for these family caregivers:
“I lost my life…the loss of flexibility, to be spontaneous and independent.”

“I feel like my whole life revolves around that. It’s always in the back of my mind. Anything I do, I have to think about that first.”

“It’s stressful.  It’s hard.  You can’t completely live your life. You have this other thing you have to take care of”.

“It feels like a lot of pressure.  Emotionally and physically draining. No matter how tired I am when I get home from work, I have to go there to take care of her”.

“I feel drained beyond belief. My life became second place to hers. I felt out of control because my personal life was falling apart. My relationship went down the drain because my mate wasn’t supportive. I felt I would have a nervous breakdown.”

On a mind/body level, I treated these patients with chiropractic care for the manifestation of these feelings in the presentation of low back and neck pain, primarily.

On a mental/emotional/spiritual level, I treated these patients with homeopathy for the totality of symptoms presented, mind/body/emotional/spiritual.

The question arises, for those whom this protocol doesn’t help to achieve a level of symptomatic, psychological and emotional relief, who else do you include in your treatment plan? What practices might offer relief in concert with your therapy?

The results of a 2007 study by the National Institute of Health (NIH) recently became public. The study revealed that adults in the United States spent $33.9 billion out of pocket on visit to Complementary and Alternative (CAM) practitioners and purchases of CAM products, classes and materials.

Who are these CAM practitioners? According to this study, they were chiropractors, naturopaths, acupuncturists, homeopaths, massage therapy and hypnotherapists.

The fact that Americans are actively seeking out the services of CAM practitioners speaks volumes about the need for primary portal of entry practitioners to educate themselves about these other practices and their efficacy. In my opinion, it is in the best interest of both the patient and the healthcare provider to be working together in an integrated fashion to develop, administer and maintain a coordinated effort toward achieving the best total outcome.

The questions that arise here might be:

Am I aware of those practices that are a fit for me and my philosophy of practice?

Do I know anyone in my community who practices that specialty?

Am I willing to refer my patient?

Am I willing to collaborate in an ongoing dialogue with the other practitioners?

Am I open and flexible to work in a simultaneous fashion rather than a linear one? That is, can I work in an integrated team where I see the patient one day for my treatment, another practitioner sees the patient on another day, and we share our findings and outcomes on a regular basis? The standard method has been to finish our treatment protocol and when experiencing less than positive results refer to someone else who does the same and then pass the patient off to another, and on and on. 

For the caregiver, for whom time is of the essence in many ways, can we develop a strategy of effective integrative networks that serves everyone’s best interest?

I conclude by welcoming discussion from all disciplines on this very important issue of caring for the family caregiver. Your successes and your challenges will be most informative. I look forward to hearing about your “teachable moments”, the ones where you learned the most.

As this issue is discussed and evolves over the next few months, there will be more articles for discussion based upon your valuable input.  The culmination will be a panel of experts presenting on this topic at the annual Integrative Healthcare Symposium in New York City on Feb. 25-27th, 2010.

I will see you there and thank you personally for your input and care for this community.

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