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The New Caregiving Labor Market

I was recently asked to assume the reins of a home care company in North Carolina for a month while the owners took an extended summer vacation. As a former home care company owner, I expected to be stepping into a familiar environment.

While I certainly experienced some déjà vu while on this assignment, it frequently seemed more like I had entered a whole new world. This is the world of the “post-COVID” caregiving labor market.

For many years we have known about a potential shortage of caregivers in the workforce. We have also known that our aging population would produce an ever-increasing demand for supportive services for the elderly.

What we didn’t know—and certainly didn’t expect—was that a pandemic would turn the world upside down.

COVID-19 has accelerated some of the trends that were already emerging in the caregiving industry—such as the growth of telemedicine and the pursuit of innovative home-based solutions.

COVID-19 has also dramatically revealed a structural misalignment of the caregiving labor market. If there was ever any question about whether we have enough caregivers to meet the needs of our aging population, we now know the answer. Not only do we lack the sum total of caregivers required to provide for our elders, but we also do not sufficiently value the work of our existing caregivers.

The caregiving labor market has been historically driven by a demand for cheap and flexible labor. For this reason, direct care aides who are working on the front lines experience personal economic challenges that wouldn’t exist with better pay rates. Job turnover is high in the industry, and it negatively affects the quality of care provided to our elders.

In addition, COVID-19 has created new risks and demands for the direct care workforce. Caregivers on the front lines work under the weight of knowing that they could contract or transmit a deadly virus. COVID regulations—however well-intentioned—have introduced extensive, time-consuming safety protocols that add to the never-ending “to do list” inherent in caregiving. Many of our elders, especially those residing in senior living facilities, now live under restrictions that limit their ability to freely interact with friends and family members. With the increase in loneliness among such residents, it is usually left to the direct care staff to compensate for their residents’ lack of social interaction.

The COVID-19 environment has led to more staff call-offs and resignations, which ultimately heaps extra work onto the caregivers who choose to stay. These unprecedented stressors have made the tough job of caregiving even tougher.

Amid such circumstances, is it any wonder that recruiting new caregivers has become an even greater challenge than before?

Here is where the “post-COVID” labor market was so painfully evident to me: I had never experienced so many challenges in recruiting new caregivers as I did this summer when I was serving in North Carolina. I couldn’t believe how much effort it took for our team to successfully find and hire a single caregiver. It almost seemed like the company was losing more caregivers than it was hiring, even while new service requests were on the rise.

Unfortunately, my experience in North Carolina was not unusual. In local communities across America, there is a limited number of direct care aides. All care organizations in the community—assisted living facilities, nursing homes, home care and hospice agencies, direct service providers, hospitals—are competing with one another for access to the same limited pool of caregivers. In many localities today, there are more caregiving jobs than caregivers to fill them.

Changes will be required to promote the ongoing viability of the caregiving labor market. Here are three suggested changes that, in my opinion, will have a significant impact:

  1. Raise wages – front line caregivers must be paid in accordance with their worth. The days of cheap and flexible care-related labor are over. If we want to attract and retain caregivers who deliver quality care, we must offer commensurate compensation packages.
  2. Access to career advancement opportunity – direct care aides, certified nursing assistants, and home health aides can get pigeonholed as “unskilled” workers in the industry, which limits their earning potential and makes it more difficult for them to advance to higher-level positions in health and long-term care. Organizations and policy makers should create opportunities for such caregivers to more easily receive the education and training required for career advancement.
  3. Thoughtful technology solutions – there is a host of technological advancements that may be applied in caregiving situations. Artificial intelligence, robotics, and communication devices hold enormous potential to offer caregiving supports. At the same time, it will be imperative to use technology in a way that does not sacrifice the human element that’s so critical in caregiving.

Today’s circumstances clearly call for adjustments to how we manage the caregiving workforce. The assurance of quality care will involve increased labor costs and will be supplemented by emerging technology. Like it or not, it would be wise for us to recognize that the “post-COVID” caregiving labor market is here to stay.

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How Caregiving Changes Attitudes

experienced caregiver

As I meet caregivers across the country, they tell me, time and again, how their lives have changed. Many changes involve the tasks of care that have crept into their lives, but the most remarkable changes I hear about are found in how caregivers perceive their world. While every caregiver’s journey is unique and personal, I have learned that caregivers pass through a series of attitudinal adjustments that loosely align with stages of experience in the care-related role.

New caregivers often report feelings of disorientation and worry, aware that things are changing but afraid of what the future may hold. Resistance, reluctance, or confusion are common responses to the emergent circumstances of their lives.

Caregivers with some experience have adjusted to many of the changes imposed by caregiving, but they may continue to struggle with a life in abeyance. Such caregivers may feel like perennial fence-sitters, caught between what used to be and what is yet to come.

Veteran caregivers, those who have answered the daily call to care over the course of several years, have usually reconfigured their lives to be available to a loved one in need. By now, former fears have yielded to an ambivalent acceptance of reality as well as a persistent focus on the present.

If you’re like most people, as you pass through stages of caregiving and develop resilience, you will probably discover that some of your perspectives and attitudes change. These changes may be manifested in a variety of ways, such as:

  • Your confidence to care for your loved one increases or decreases
  • Medical treatment options for your loved one are viewed differently
  • Time with your loved one grows more (or less) important to you
  • Your interest in world events waxes and wanes
  • Attitudes about your work/career (if applicable) are affected
  • Feelings about family members change
  • You worry less about what other people think
  • Personal values are refined by caregiving
  • Empathy for other people grows
  • You appreciate things that you didn’t see before

These succinct examples suggest how caregiving can change a person’s paradigm view of so many things. As I review the examples, I am struck by the fact that my personal caregiving experience produced lasting attitudinal changes for me in every single one of the areas listed above.

How has your own caregiving experience shaped your attitudes? In order to truly reflect on this question, I would encourage you to “lean in” to the caregiving experience, for it is only in acceptance of the caregiver role that the burden of care is mitigated and the beauty of care can be revealed.

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How Can Professionals Use the Model of Caregiver Resilience?

caregiver resilience graphic

When I first introduced the model of caregiver resilience, I explained that this is a learning model. In today’s installment of the series of blog posts on the model of caregiver resilience, I want to explain how care professionals can use this model to engage in learning through self-reflection or to facilitate the learning of others who are in caregiver roles.

Professionals Using the Model for Learning through Self-Reflection

Some time ago, as I was finalizing the model of caregiver resilience, I shared it with two friends, a married couple we had invited to our home for dinner. The wife is a social worker, and her husband is an engineer. Because of the wife’s professional background working with aging populations, I was keenly interested in her feedback about the model I had developed. She immediately saw the model’s value and offered some great insights to me.

While the social worker’s response was reaffirming, I was absolutely delighted to receive the following message the next day from her husband, the engineer:

“Aaron, I wanted to let you know that when I woke up this morning my mind was flowing with ideas of how your model of the 5 R’s of resiliency in caregiving is a framework to use for pondering on a new role I have at work.”

I was struck by the fact that a model developed for caregivers was of value to a professional engineer. My friend’s comments reveal the relevance of the model of caregiver resilience to a wide variety of professional situations.

He also highlighted how the model can be instrumental in the learning process of a professional. We can observe that he engaged in a process of framing, contextualizing, and thinking, as follows:

  • Framing: he viewed the model as a framework for pondering.
  • Contextualizing: he applied the model to his role at work.
  • Thinking: he let his mind flow with ideas.

If an engineer can learn from this model, then surely professionals in care organizations can do so as well. Whether you’re a physician, a nurse, a social worker, a certified nursing assistant, a therapist, an allied health professional, or a healthcare administrator, you can use the model to learn how to improve your resilience at work.

The model of caregiver resilience is a sort of lens that permits you to look at your work situation differently. As you examine how each part of the model applies to you, let the model “talk back” to you. If you use the model’s framework, apply it to your particular work context, and think expansively about the implications, many of the problems and challenges you’re experiencing within your caring role will crystallize, and potential solutions will emerge.

Professionals Using the Model to Facilitate Learning for Family Caregivers

There is a wide range of professionals who routinely engage with families in care-related situations. Social workers, counselors, and care managers have assumed responsibility to professionally support individuals and families through challenges associated with aging, illness, and disability. Skilled medical professionals treat their patients and interact with the families of the patients. Moreover, there are other professionals—such as attorneys, financial planners, clergy, realtors, and funeral directors—who find themselves in discussions with families struggling to care for loved ones.

The model of caregiver resilience is a practical resource that professionals can use to support the family caregivers they encounter. This can be done by using the model to facilitate a discussion with the family caregiver about their situation in order to identify problematic areas and develop strategies for improvement.

When facilitating this discussion, the professional adds one step—prompting—to the above process of framing, contextualizing, and thinking. “Prompting” represents the input of the professional in facilitating a learning opportunity for the family caregiver. The modified steps may be summarized as follows:

  • Framing: the professional presents the model of caregiver resilience.
  • Contextualizing: the professional references the model in the context of the family caregiver’s individual situation.
  • Prompting: the professional asks questions and makes comments to help the family caregiver engage in thoughtful reflection.
  • Thinking: the family caregiver and the professional “let their minds flow” about how the model can be applied in the family caregiver’s situation.

You’ll note in this scenario, the professional is instrumental in not only introducing the model but also joining with the family caregiver in applying the model. The model enables the professional to: 1) use shared language to analyze the situation with the family caregiver, 2) listen to the family caregiver’s thoughts, and 3) bring professional guidance to the discussion.

Both participants thus engage in a learning-oriented exchange that will produce insights as to how the family caregiver could approach caregiving more effectively. In turn, actions can be taken that will ultimately make caregiving better for both the caregiver as well as the care receiver. The model can be revisited again and again to evaluate progress and identify new ways to develop resilience as care-related circumstances change and evolve over time.


Over the last several months, we have released a series of blog posts on Dr. Blight’s Model of Caregiver Resilience. By examining a care situation in light of the five “R” words (Roles, Relationships, Realities, Rewards, and Readiness) in the model, you can identify areas that are causing friction, figure out how to address challenges, and learn to make the most of your circumstances.

If you’d like to invite Dr. Blight to speak to your group, please contact us.

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Keys to Caregiver Readiness: How to Learn to Help Your Loved One

caregiver and elder

If you’re like most family caregivers, you didn’t aspire to be in this situation. You didn’t plan to be a family caregiver. You probably didn’t receive training or certification or education that qualifies you to be a great family caregiver. If you received some kind of formal health-related education, it helps, but it does not prepare you for everything you will encounter as you care for your family member. It’s easy to feel overwhelmed and underprepared.

As if that wasn’t enough, you soon discover that not only do your loved one’s needs evolve and change over time, but your caregiving approach must also evolve and change in accordance with those needs. This means that no matter what you’re actually doing today, how you provide for your loved one is likely to change in the future. Caregiving thus becomes a process of continual adaptation to your loved one’s health conditions.

Amid such changing circumstances, how can you develop skills to deliver the tasks that are required to help your loved one over the long trajectory of caregiving? Consciously or unconsciously, all family caregivers ask this question—often repeatedly and at various intervals of time.

You may not know exactly how to be a family caregiver, but please have faith in yourself and in the reason why you’re in the caregiving role. Choose to believe that you can develop the ability to do what your loved one needs you to do.  This choice will lead you to adopt a learning orientation to caregiving.

As part of your learning process, seek information about your loved one’s specific condition, including the diagnosis, prognosis, and potential treatment options. This will allow you to understand what is happening to your loved one and discover what to expect over time.

In addition to the “book knowledge” you acquire about your loved one’s condition, you will need to learn new ways to handle unfamiliar challenges arising in connection with the tasks of caregiving. This can be anything—such as helping your loved one get in and out of a car, providing hands-on personal hygiene assistance, assisting with medications, or responding to dementia-induced behaviors. Often family caregivers feel most unprepared when they’ve never performed a care-related task before.

How do you learn to deliver the different tasks of caregiving? Adult learning theory suggests that over time, you can develop practical judgment through your ongoing work and interactions with your loved one. Practical judgment is like on-the-job training, a situation in which a person’s effectiveness grows over time through the acquisition of experience.

An example of practical judgment shaped by experience is found in a research study of staff members working in a care facility for people with dementia.[1] The employees who worked at the facility were unskilled, direct care aides who had not received specialized formal schooling in managing dementia-related behaviors. However, focus group discussions revealed that, despite their lack of formal education, the aides had learned ways of effectively managing these challenging behaviors through their own process of “showing, guessing, and trying.” They developed ways to establish order in the environment after observing and adapting to the behavioral patterns of the residents with dementia. Learned practical judgment made it possible for the aides to do their work more effectively.

Your loved one’s condition is introducing you to new situations that you’ve never experienced before, and you need to develop practical judgment to deal with them. If you are unsure of how to help your loved one, I encourage you to remember the steps of “showing, guessing, and trying” that the aides in the care facility used:

  • Showing involves a demonstration of what must be done;
  • Guessing suggests a choice that is made amid the uncertainty of alternative approaches;
  • Trying is the experimentation, a “trial and error” process which allows you to evaluate your attempted approach and gather new information about what may or may not work.

Your efforts at showing, guessing, and trying different approaches to the tasks of caregiving (always keeping safety as your foremost concern) will gradually enable you to learn how to handle your own challenging care situations more effectively.

I suppose that it all comes down to the proverbial saying, “practice makes perfect.” In skill-building, there’s really no substitute for practice.

As caregivers practice performing requisite care-related tasks, they grow in their capacity to meet the needs of their loved ones. An increased capacity to meet the care receiver’s needs will enable you to overcome setbacks, strengthen resilience, and fulfil the caregiver role for a longer period of time. After sufficient practice—marked by your experiences of showing, guessing, and trying—you will find yourself ready to more confidently serve your loved one, whenever and however your assistance is required.


Consider your READINESS to serve as a caregiver for your loved one:

  • Based on your care receiver’s current conditions, what are the skills you can improve to deliver care today?
  • Based on your care receiver’s prognosis, what capabilities will be needed to offer care in the future?
  • As you reflect upon the above questions, how will you develop the readiness that is required to help your care receiver, now and into the future?


“Practicing Readiness” is a component of Dr. Blight’s Model of Caregiver Resilience. By examining a care situation in light of the five “R” words (Roles, Relationships, Realities, Rewards, and Readiness) in the model, you can identify areas that are causing friction, figure out how to address challenges, and learn to make the most of your circumstances. Over the last several months, we have released a series of blog posts on the five domains of caregiver resilience. Next month’s blog will focus on how professionals can use the Model of Caregiver Resilience to support families in care-related situations.

If you’d like to invite Dr. Blight to speak to your group, please contact us .

[1] David Beckett and Paul Hager, Life, Work, and Learning: Practice in Postmodernity (New York: Routledge, 2002).

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How to Recognize the Rewards of Caregiving

caregiver pushing elder

Caregiving offers rewards that you don’t necessarily expect amid the struggle of providing daily service to your loved one. The rewards may pop up in a single moment, or they may become perceptible only after the long, arduous slog of care is over and your loved one is no longer with you. Often the hardest things to do are also the most rewarding things to do, and caregiving reflects this reality.

Unfortunately, so much of our research has focused on the hard realities of caregiving, like burden and stress, that social science has yet to develop a comprehensive and robust view of positive outcomes associated with being a family caregiver. This is why I was so gratified to receive the following comment from Clare Stacey, a sociologist at Kent State University, in her endorsement of When Caregiving Calls. “[The book] considers aspects often overlooked,” she wrote, “such as the rewards that come from caring.” Stacey proceeded to describe When Caregiving Calls as “essential reading for those providing care, as well as for policy makers and social scientists.”

How can policy makers and social scientists learn about the rewards of caregiving? It’s easy: just ask the caregivers. Here is what three family caregivers told me about the positive dimensions of their service to loved ones:

  • “Being a caregiver for my dad was the toughest job I have ever had, and yet what a privilege to be there for my parent during the last year of his life as he was for me during my first.”
  • “Being a good caregiver has many answers, I’m sure. However, in my case, it was the fact that my mom had total confidence in me and there are no words to describe that feeling.”
  •  “It was tough but caregiving did a lot for my soul. I was able to make sure he knew I loved him, not just in deed but in words. I was able to help him deal with his pain, and what an amazing feeling to know you have comforted someone you love. The greatest reward is being able to give back to him. He was my big brother and he did a lot for me and there is no price I can attach to how great I feel even now—that I had the opportunity to give back AND let him know I loved him so.”

These heartwarming and profound thoughts are merely a sample of the responses I have received when asking family caregivers about the rewards they find in their caregiving experiences. Their insights never cease to touch me.

You will undoubtedly discover your own collection of caregiving treasures. You can find them by pausing and consciously asking yourself how caregiving has rewarded you.

As a first step, I’d invite you to set aside at least fifteen minutes to brainstorm and write down all of the rewards that you have found in caregiving for your loved one. After your brainstorming exercise, review your list to identify the caregiving rewards that are most significant to you. What makes these rewards particularly meaningful?

As a second step, consider keeping a gratitude journal. On a daily or weekly basis, write in your journal about the best parts of your caregiving experience. By looking for the good, you will find the good. What you discover may surprise you.

Caregiving is not wholly about illness, aging, disability, burden, and stress. Please let caregiving reveal its beauty to you. When you’ve committed yourself to be there for your loved one, there are moments you’ll remember forever, lessons you’ll apply to the rest of your life, and attitudes that will be permanently adjusted as a result of your caregiving experiences. These are but a few of the significant rewards that caregiving offers.


Consider the good—the REWARDS—you’ve found in your caregiving experience:

  •       What is rewarding about being a caregiver?
  •       How has caregiving improved your understanding of life, other people, yourself?
  •       How can you continue to cultivate the positive aspects of caregiving?


“Cultivating Rewards” is a component of Dr. Blight’s Model of Caregiver Resilience . By examining a care situation in light of the five “R” words (Roles, Relationships, Realities, Rewards, and Readiness) in the model, you can identify areas that are causing friction, figure out how to address challenges, and learn to make the most of your circumstances. We have been discussing each of the five domains of caregiver resilience, one at a time, over the course of five months. Next month’s blog will focus on “Readiness.”

If you’d like to invite Dr. Blight to speak to your group, please contact us.

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Five Hard Realities of Caregiving

Family caregivers often report that caring for a loved one is among the hardest things they’ve ever done. Until you’ve assumed the responsibilities of caregiving, you’re probably unaware of the multi-faceted commitment that must be made to meet the ongoing needs of a loved one who depends on you. Nevertheless, when caregiving calls, you eventually discover how the physical, emotional, relational, and spiritual dimensions of caregiving can cause deep distress and dissonance in your life.

Caregiving has a way of rudely introducing you to things you never wanted to think about. You may choose to ignore some of these things, preferring to avert your eyes from the stark view in front of you. Avoidance can become a default position because it may be more comforting to choose not to think. Denial is a related but slightly different strategy: you know what may occur but refuse to accept that it applies in your situation. Another approach is busyness, where you can be so focused on your “to do” list that you don’t have time to manage the tough stuff.

As difficult as it may be, the best way to handle the hard realities of caregiving is to confront them. When caregivers honestly confront the most troubling aspects of their experiences, they place themselves in positions to find support and solutions that will help.

Every caregiver will face a personalized set of hard realities. While the list of challenges that could arise in caregiving is extensive, here are five hard realities that can deeply affect caregivers as well as care receivers.

Hard Reality #1: Bodies fail.

It’s amazing how easily we take our bodies for granted. We don’t even think about how much we need a particular body part until it’s no longer working for us. You know what I mean if you’ve ever broken a bone, had an organ failure, or thrown out your back. Hopefully you were able to recover and restore proper functioning. But if you’ve ever experienced such incapacitation, then you have caught a glimpse of what care receivers experience. Many care receivers—especially those who are older—traverse through a sequence of bodily failures, one after another.

As if the physical implications of a failing body aren’t bad enough, some bodily failures can also be socially stigmatizing because they make care receivers feel inferior, even less than human.

Care receivers should never feel ashamed of a bodily failure because this is actually the natural order of life. As a caregiver, you have the ability to reduce the potential embarrassment of your loved one and help them retain human dignity by choosing to take their bodily failures in stride.

Hard Reality #2: Sometimes the treatment is worse than the disease.

We are fortunate to live in a time when the miracles of modern medicine enable people to be treated for many serious illnesses and chronic conditions. But some things cannot be fixed, no matter how many medical procedures a person receives. And some things don’t warrant fixing, especially if the patient has lived a full life and finds going through treatment less attractive than living with a medical condition.

In his groundbreaking book, Being Mortal, Dr. Atul Gawande raised compelling questions about the moral implications of relentlessly pursuing medical treatments regardless of the impact such treatments may have on a patient’s overall quality of life. He writes, “The problem with medicine and the institutions it has spawned for the care of the sick and the old is not that they have had an incorrect view of what makes life significant. The problem is that they have had almost no view at all. Medicine’s focus is narrow. Medical professionals concentrate on repair of health, not sustenance of the soul. Yet—and this is the painful paradox—we have decided that they should be the ones who largely define how we live in our waning days.”[1]

Dr. Gawande suggests that patients, especially those approaching end of life, often have priorities that are outside of the hospital. If the patient finds treatment to be worse than the disease, then it may be time to forego treatment—and that is the patient’s choice to make.

Hard Reality #3: Caregiving causes stress.

Caregiving introduces an entirely new level of stress in your life. At any moment, day or night, you may have to abruptly stop what you’re doing to address your loved one’s immediate need. Sometimes these interruptions are momentary inconveniences, while other times they can completely derail your day or your week.

The frequency and severity of these interruptions are driven by your loved one’s health conditions. Your loved one’s exigencies can make it difficult for you to plan for things like out-of-town trips, daylong excursions, or even a night out for dinner. It can become hard to plan for anything in the future, because your loved one needs you here and now.

The stress induced by caregiving includes a nagging sense of never doing enough despite doing all you can do. It’s accompanied by the knowledge that your loved one is always vulnerable. Studies have repeatedly demonstrated that family caregivers are more prone to stress-related illnesses than people without caring responsibilities. If caregiving is causing you stress, you will benefit from stress reduction techniques like those mentioned in Chapter 6 of When Caregiving Calls.

Hard Reality #4: Caregiving can be an emotional roller coaster.

Caregiving produces a wide range of emotions, from extreme highs to extreme lows and everything in between. While caregiving delivers unexpected moments of joy and solace, it will also challenge your emotions in ways that you haven’t experienced before. Many caregivers carry a worrisome anxiety that causes them to feel emotionally spent, tired, and depressed. Research has shown that rates of clinical depression are markedly higher for caregivers than for the general population. Moreover, guilt and grief—the two “G” words of caregiving—usually make their presence known at various times throughout the caregiving journey.

To help people think about the emotions they feel as they fulfill the caregiving roles, I have created a downloadable list of 148 emotions. If you’re a caregiver, I’d encourage you to download this list and spend a few moments in thoughtful reflection, identifying the emotions you have experienced as you’ve been helping your loved one.

If you perform this self-assessment and find yourself gravitating toward several negative emotions, it’s a strong indication of the impact that caregiving is having on your mental health. It’s important for you to know that negative or anxious feelings are very normal for caregivers. At the same time, please don’t let yourself ignore such feelings. Although caregiving for your loved one is never going to be easy, things will be better when you obtain the support you personally need to address your emotional struggle.

Hard Reality #5: Death happens.

Even after a prolonged period of caregiving, “death” can be the unspeakable word that is never uttered. Our culture tells us that death is to be prevented, battled, resisted. Yet we paradoxically know that death is the inevitable course of our lives.

Caregivers escort their care receivers on a final journey toward the last breath of life. Knowledge of the ultimate destination doesn’t necessarily make either traveler eager to get there. On this trip, you’ll rarely hear a caregiver or care receiver ask, “Are we there yet?” because there are taboos which prohibit such a question. In fact, this might be the only journey where the more frequent question is: “How can we delay our arrival?”

Until you’ve encountered hospice care, you may have never considered the idea of a “good death.” What is a good death? It’s a question that hospice professionals ask all the time. Perhaps that’s why “hospice” is another word that people don’t like to say. However, many families find that hospice offers a refreshingly honest view of death, not to mention life. Honesty about death opens the mind to a greater appreciation of the entire life course, up to and including its final stages. As the fear of death dissipates, the ability to explore and embrace the final moments of life increases.

 Confronting Your Caregiving Realities

If you’re a caregiver, there are things you may not want to think about. Hard things. Things that make you uncomfortable. Starting with the questions below, please take an inventory of your toughest realities and decide to confront them. In so doing, you’ll be opening the door to the possibility of better circumstances for your loved one as well as yourself.


Consider the REALITIES of your caregiving experience:

  •  What is hard about being a caregiver?
  •  What are the physical, emotional, financial, and spiritual realities you must confront as you care for your loved one?
  • How can you respond more effectively to your specific caregiving challenges?

“Confronting Realities” is a component of Dr. Blight’s Model of Caregiver Resilience. By examining a care situation in light of the five “R” words (Roles, Relationships, Realities, Rewards, and Readiness) in the model, you can identify areas that are causing friction, figure out how to address challenges, and learn to make the most of your circumstances. We are discussing each of the five domains of caregiver resilience, one at a time, over the next few months. Next month’s blog will focus on “Rewards.”

If you’d like to invite Dr. Blight to speak to your group, please contact us.

[1] Gawande, A., 2017. Being Mortal: Medicine and What Matters in the End. London: Picador



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How to Honor Relationships While Caregiving

Caregiver and grandmother standing by window

Caregiving changes relationships. While this can be disorienting and unwelcome, it’s among the most important things for caregivers to realize as they seek to meet the ongoing needs of a loved one who is aging, sick, or disabled. By recognizing that relationships are changing, caregivers are also uniquely positioned to honor their relationships with care receivers.

If you’ve become a family caregiver, you and your loved one have a shared relationship history. Perhaps you’re caring for your spouse, your parent, your uncle, or a friend. Whatever that relationship is, your interactions with your loved one were historically based upon the roles (e.g., parent-child) that each of you filled in the relationship. The role that you have played in the relationship has personal significance and meaning. The history between the two of you continues to affect the way you perceive and interact with your loved one today.

Caregiving requires a different type of role-based relationship between two people. Remember from last month’s post that the caregiving roles only emerge because of an unanticipated health condition. Nevertheless, if you do it long enough, caregiving will alter the nature of your relationship with your loved one.

You can see how your relationship has changed by comparing the terms of your historic relationship with your loved one to the new terms of your caregiving relationship with your loved one.

For example, think about your relationship with your mother. She bore the special responsibility of raising you when you were a child. Now that you’re an adult, your historic relationship with your mother is embedded in your subconscious mind; it affects how you perceive your mother and how you act around her, even today. Your mom has played a singular role in your life, and it’s hard to imagine her in any other way.

When the mother who cared for you becomes dependent upon care by you, the change can be unexpectedly difficult to comprehend and accept. You might begin the early stages of caregiving by reminding your mother about things she forgets, but eventually, you may find yourself changing your mother’s adult diapers. Family caregivers are not only dismayed to observe a loved one in such need, but they also often struggle to navigate the degree of their own involvement in the caregiving tasks that are required.

Chapter Three of When Caregiving Calls presents research from applied gerontology suggesting that family caregiving is marked by a series of role-based transitions, which start from an initial set of family relations and change over time due to changes in the caregiving context. As the care receiver’s needs become greater, the caregiver’s actions must change—and this changes the caregiver’s role identity within the relationship.

Thus, if you’re caring for your mother, the parent-child history of your lives together becomes intertwined with—or perhaps even subsumed by—the tasks of caregiving that you’re now performing for her. You may even reach the point that you start to ask yourself: who am I now in this relationship?

Although you’re observing changes in your relationship with your mother because of her care-related needs, the woman you’re caring for is still your mother. As a result, honoring your relationship with your mother is a critical component of continuing to care for her.

There are three steps to honoring relationships while caregiving:

  1. Remembering your historic relationship with your loved one;
  2. Acknowledging that things are changing due to your loved one’s health conditions;
  3. Adapting to the terms of an emerging care-based relationship with your loved one without forgetting the history you share together.

Adapting to the terms of a new care-based relationship with your loved one could involve uncomfortable topics of conversation concerning your loved one, the performance of caregiving tasks you never had to do before, or spending more (or less) time together. As the needs of care receivers continue to evolve over time, caregivers must make corresponding adjustments. Through it all, family caregivers remember in their minds and hearts that the person they’re caring for is special.

Honoring relationships allows caregivers to nurture and continue to be present for the important people in their lives. While the functions of caregiving may change the nature of interactions between participants, the historic relationship bond between caregivers and their loved ones motivate caregivers to summon the strength they need to continue to care.

Consider your RELATIONSHIP with your loved one, the care receiver:

  • How would you describe your historic relationship with your care receiver?
  • How would you describe your current relationship with your care receiver?
  • How has caregiving affected your relationship with your care receiver?
  • How do you feel about the changes that caregiving has brought into the relationship?

“Honoring Relationships” is a component of Dr. Blight’s Model of Caregiver Resilience. By examining a care situation in light of the five “R” words (Roles, Relationships, Realities, Rewards, and Readiness) in the model, you can identify areas that are causing friction and figure out how best to address those challenges. We are discussing each of the five domains of caregiver resilience, one at a time, over the next few months. Next month’s blog will focus on “Realities.”

If you’d like to invite Dr. Blight to speak to your group, please contact us.

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How to Understand Caregiving Roles

caregiver helping elder in wheelchari

Roles are positions we occupy in the social world. Roles are central to our human relationships as well as our place in society.

Consider these famous words from William Shakespeare:

  • All the world’s a stage,
  • And all the men and women merely players;
  • They have their exits and their entrances;
  • And one man in his time plays many parts…

Shakespeare proceeds to trace the roles a person plays in life, up to and including “the last scene of all,” which he describes as “second childishness…sans teeth, sans eyes, sans taste, sans everything.”¹

Although Shakespeare paints a grim picture of life’s final act, he’s also keen to observe how declining health conditions force role changes for people at the end of their lives.

“Care receiver” is among life’s least coveted roles.

And we know that caregivers don’t exist without care receivers.

In Chapter Two of When Caregiving Calls, I describe caregiving by using the metaphor of a stage play, borrowed from the work of sociologist Erving Goffman.² In a caregiving play:

  • the care receiver is the star of the show;
  • the script is written by the care receiver’s health conditions;
  • and the caregiver is a supporting actor.

With caregiving, nobody knows exactly when the curtain will fall and this play will end—not the audience, not the critics, not the supporting actor, not even the star of the show. We do know, however, that when the show is over, the star performer may not be there to take a bow.

While every caregiving storyline is unique, the care receiver and caregiver are always, respectively, the primary and secondary roles in an unfolding drama.

By understanding the roles implicated in caregiving, the caregiver is able to make adjustments to an emerging caregiving story. In making these adjustments, the caregiver learns how to fulfill a supporting role that is exclusively for the care receiver.

As new dimensions of a care-based relationship evolve over time, both caregiver and care receiver adapt their positions but continue to be present for one another.

A reciprocal understanding naturally emerges. Aware of one another’s obvious imperfections, caregiver and care receiver develop a mutual acceptance and, at times, admiration for each other. The roles of caregiving thereby produce a symbiotic relationship that has the potential to reward both of the principal actors.

Consider the significance of ROLES in your personal caregiving story:

  • How would you describe your caregiver role? How do you feel about it?
  • How would you describe the role of your care receiver? How do you think your care receiver feels about it?
  • Take some time to write your caregiving script. What is the storyline? What are some of the lines your role calls on you to speak?

“Understanding Roles” is a component of Dr. Blight’s Model of Caregiver Resilience. By examining a care situation in light of the five “R” words (Roles, Relationships, Realities, Rewards, and Readiness) in the model, you can identify areas that are causing friction and figure out how best to address those challenges. We are discussing each of the five domains of caregiver resilience, one at a time, over the next few months. Next month’s blog will focus on “Relationships.”

If you’d like to invite Dr. Blight to speak to your group, please contact us.

¹Bloom, H., 2004. William Shakespeare’s As you like it. Philadelphia: Chelsea House.
²Goffman, E., 1959. The presentation of self in everyday life. Garden City, New York: Doubleday.

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How Do Caregivers Develop Resilience?


Resilience is the ability to adapt to difficult situations. Resilient caregivers find the strength to continue to help others, even in the face of adversity. How do caregivers develop resilience?

Based on research and practice, I have created a model of caregiver resilience. In this model, caregiver resilience is developed across five domains represented by “R” words: Roles, Relationships, Realities, Rewards, and Readiness.

  • Understanding ROLES involves making adjustments to an emerging caregiving story. Resilient caregivers learn what it means to fulfill a caregiving role. They know that the care receiver didn’t choose to be in this position, and they socially adapt to the changing conditions of their loved one.
  • Honoring RELATIONSHIPS allows caregivers to nurture, and continue to be present, for the important people in their lives. While the functions of caregiving may change the nature of interactions between participants, the historic relational bond between caregivers and their loved ones motivate resilient caregivers to continue to be there.
  • Confronting REALITIES enables caregivers to deal with the hard parts of caregiving. Instead of denial or discouragement, resilient caregivers realistically assess and strive to overcome the challenges they experience while caregiving. Although some things cannot be changed, acknowledging and embracing what is hard enables caregivers to endure and occasionally triumph.
  • Cultivating REWARDS opens the mind and heart to the good parts of caregiving. Sometimes adversity reveals unexpected blessings, such as personal growth, moments of joy, paradigm shifts, or enhanced relationships. Resilient caregivers seek and recognize the good even as they struggle with the bad.
  • Practicing for READINESS is how caregivers prepare themselves to offer appropriate support to their loved ones. Resilient caregivers are not innately endowed with the ability to deliver the tasks of caregiving; it is only through practice (trial and error) that they develop the sustainable capacity to do what is physically required for a loved one in need.

This model of caregiver resilience allows caregivers and the professionals who support them to review a current care situation, impose a frame on it, and assess the implications. It’s a learning model. By examining a care situation in this manner, the reflective caregiver or practitioner can identify problematic areas, formulate strategies for improvement, and evaluate progress over time.

If you’d like to invite Dr. Blight to speak to your group about the caregiver resilience model, please contact us.

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What’s It Like to Hold a Virtual Workshop for Caregivers?

caregiver looking at laptop

Are you seeking fresh ideas for your caregiver support program during the pandemic? You may want to consider holding a virtual workshop for your caregivers. 

I recently created a new workshop outlining the framework for caregiver resilience—which is something all caregivers need, especially now more than ever. I was invited to present the workshop for a few different caregiver groups. In each case, this was originally planned as an in-person event, but COVID-19 turned it into a virtual one. 

Admittedly, I was concerned about how the workshop would play out in a virtual setting. In a face-to-face environment, you have the opportunity to engage with participants in a more personal and intimate way. When a participant makes a compelling comment, you can easily ask follow-up questions. In contrast, online participants are physically separated and further detached by the veil of technology that introduces a degree of anonymity to the whole experience. 

I found, however, that the virtual setting has advantages. Family caregivers who might otherwise be unable to attend a face-to-face meeting (often due to the needs of their loved one) can participate from their homes. In addition, caregivers participating in the online workshops seemed to be more willing to share their thoughts and feelings in response to questions. Perhaps the anonymity of the computer made them more forthright in sharing their struggles. 

The honesty of these comments from caregivers—often delivered via the “chat” feature of the technology platform—was strikingly relatable and illuminating for everyone present. As an example, in one workshop I asked participants what the title of their caregiving script would be. Here are a few of their answers: 

“The Juggler.” 

“The Amazing Daily Adventures of Grandma.”

“More than a Caregiver.”

“Welcome to Crazy Train.”

“Down the Rabbit Hole of Denial and Stubbornness.” 

“Up to the Challenge.”

“As the Chaos Turns.” 

By merely reading this list, can’t you just sense something about what’s underneath? I think every caregiver can probably read each one of those titles and relate in their own personal way. 

After a few experiences like these, I’ve become a proponent of virtual workshops for caregivers. While they are different from face-to-face groups, the virtual setting enables broader participation by caregivers and offers its own unique rewards in delivering an enlightening and uplifting experience. 

If you’d like to create a similar program for caregivers in your area, please let me know. I’d be delighted to work with you—from the comfort of home—to support your caregivers.