Promises in Caregiving

Most people don’t make promises with the plan to ever break them. But with good intentions, many caregivers often make promises to their older loved ones that are difficult, if not impossible, to keep. Such promises include statements like:

I will never…put you in a nursing home.

I will never…let strangers take care of you.

I will never…move you out of your home.

Caregivers take such promises seriously. But caregivers must make peace with the fact that they may not be able to keep these promises indefinitely. When promises like these are made, the caregiver typically doesn’t know what he or she is truly agreeing to. The caregiver had every intention to keep this promise, but circumstances changed.  This was especially true when there were ever-changing Covid-19 policies.

Maybe your older loved one’s dementia is so advanced that she is wandering out of the house each day, putting herself at risk. Since you can’t always have your eyes on her, 24/7 supervision at an assisted living facility may need to be considered. Maybe helping your older loved one bathe after his stroke is becoming too physically demanding for you. In this case, perhaps a home care agency can help. You may resist taking these options into account because of the earlier vow you made to your loved one.

So what do you do if keeping that earlier promise is becoming impossible?

If your loved one does not have memory loss, explain why you are changing course: what have the consequences been to your life by keeping this promise? For example, you may explain to your older loved one that because you are spending so much time helping out at his house, you have been late to work five times in the past month. Then you can discuss options such as hiring home care, a housekeeper or arranging to have meals delivered. Frequently older loved ones will not be happy with changes they did not initiate, but the caregiver must set such boundaries to avoid burnout. In addition, many older adults do not want to impose on their family members so they will try to understand.

If you have already made a promise and your loved one has cognitive impairment, you may not be able to have a conversation where you can reason with him or her and discuss how the circumstances have changed. But it’s still important to let yourself off the hook. Talk to a geriatric care manager, a psychotherapist, your spiritual advisor or a supportive friend to deal with your guilt. Permit yourself to reframe your earlier pledge.

Most people, especially older adults, want to remain at home without assistance for the rest of their lives. In an effort to make this dream come true, caregivers struggle with negative emotional, spiritual, and physical consequences of trying to honor their loved ones’ wishes at any cost. While it is admirable for caregivers to respect their loved one’s preferences, it is critical to understand that many promises cannot and should not be upheld in many care situations. To be healthy themselves and provide the best care for their loved ones, caregivers must make peace with the fact that keeping earlier promises is often unmanageable.

If you haven’t made such a specific promise to an older loved one you are caring for, resist. Don’t do it. Instead say, “I will make sure you have the best care I can afford.” Or, “I will keep you at home as long as it is safe for everyone involved.”

While it can be very upsetting to both the caregiver and older loved one, often revisiting caregiving promises is essential. Further, sometimes even breaking those promises is absolutely necessary to ensure the safety and well-being of both the caregiver and the older adult.