Phases of Family Caregiving

What they discovered is that caregiving changes a person’s view of themselves, within a relationship over time. I’m going to talk about family caregiving identity theory, which comes from Montgomery and Kosloski’s work. Family caregiving identity theory views family caregiving as a series of role based transitions, spawned from an initial set of family relations that change and evolve, over time due to the caregiving context.

There are five phases in this process, if you look at this pie chart up here. The pie chart represents the role within this family relationship and here we’re talking about a spouse who’s also a caregiver. Let’s say it’s a wife, for however many years, the wife in her relationship with that man has always been a wife.

In phase two, the caregiving activities start to become more involved in the relationship. The caregiving activities extend beyond the scope of the initial family role and the family member, the wife starts to actually see herself as a caregiver. She starts to say, “oh my gosh this guy who has always been my husband now he looks at me partly as a caregiver and I’m kind of looking at myself partly as a caregiver and less as a wife.”

Phase three is reached when the needs of the care recipient substantially extend beyond the boundaries of the initial family role. Which for many people involves assistance with personal hygiene and grooming and this phase causes varying degrees of discomfort among the family members. The wife is starting to say, “oh my gosh I am as much a caregiver as I am a wife to this man.”

In phase four, caregiving comes to dominate the role relationship, prompting more frequent thoughts about nursing home placement and other formal care arrangements. This is where the person starts to say, “you know what, I’m more of a caregiver now than I am a wife.”

In phase five if it’s reached, the care is turned over to formal care providers and it’s kind of a rebalancing and a reset. A return to phase two, where the wife gets to be a little bit more of a wife and less of a caregiver.