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Why Family Caregivers Should Say “No”

Occasionally declining help can assist the care recipient in the long run

spinner image woman holding two circles one says no and the other says yes and she is looking at the one that says no
Getty Images/AARP

“I can’t say no to my mother,” said 53-year-old Kim, emphasizing the word “can’t.” “She has been so good to me. She needs my help now.”

I had asked her during this psychotherapy session whether she could imagine saying yes to helping her mother with certain tasks but not others. Could she agree to manage her finances, for instance, but not do her taxes or clean her house? Drive her to medical appointments and the supermarket, but not to an upcoming family reunion two hours away? I pose these questions to clients who have made heartfelt commitments to caring for relatives to point out that they still have choices about which care tasks to provide and how. Understanding and exercising those choices, I suggest, can help them avoid feeling trapped, powerless and, ultimately, depressed as caregiving demands increase over time.

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The idea of choosing, though, seemed to horrify Kim. Saying no to her mother, she was sure, would make her a neglectful and ungrateful daughter. She felt she should always say yes to everything her mother needed for as long as she needed care.

Kim was in good company. One of the two things I have heard most often during 30 years of psychological practice is caregivers saying, “I have no choice.” (The other is people with chronic illnesses and disabilities saying, “I don’t want to be a burden to my family.”) They were afraid they would feel guilty as if, by asserting themselves and saying no, they would be admitting they did not love their family member with their whole heart, or were a fair-weather caregiver who was only sometimes devoted to them. To show the full measure of their affection and commitment, they felt they must never turn down a caregiving task.

The challenge for Kim and all caregivers, of course, is that none of us is superhuman with boundless time and energy. We get pulled in many directions by the multiple roles in our lives and feel enormous strain. Saying no during the long caregiving years may become a necessary survival strategy at times. How can family caregivers feel guilt-free and comfortable with that?

Here are some ideas:

What’s good for caregivers…

Most family caregivers have heard too many times that they need to take care of themselves through scheduling and protecting time for self-care activities, such as respite, physical exercise, enjoying nature, seeing friends, and eating and sleeping well. They already know without repeatedly being told that self-care offers replenishment to make them more resilient and effective. But few caregivers will practice self-care if they think this is a zero-sum game in which care they give themselves subtracts from the total amount of care available for their care receivers. They must be convinced those family members will benefit, too.

…may be good for care receivers

Few care receivers like being dependent upon their caregivers because it makes them feel diminished and childlike. They also worry and feel guilty about how their caregivers are being affected by caring for them. While in many instances they can no longer handle certain tasks and must rely on others, there are occasions when, with more time and effort, they can do something for themselves, but their caregivers have completed the job already. When caregivers say no, they may in fact be providing care receivers with the chance to act with greater independence. For example, perhaps Kim can tell her mother she does not have the time to take her to the supermarket, and then coach her with ordering groceries online to be delivered to her house. Or she could ask her mother to get a ride to the doctor’s office from one of her church’s volunteers, thereby meeting two objectives — making her appointment and socializing with a fellow congregant.

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Separate the means from the ends

Caregivers can say no to a specific task and remain fully committed to caregiving and a family member’s well-being. The difference is that they have made a commitment to caring for that family member, not to a specific way of caring for them, such as managing all tasks on their own. Kim, for instance, could decide to organize family members to pay for a cleaning service to tidy up her mother’s house, regardless of whether her mother would prefer that Kim do it. There is no neglect nor love lost there.

Wrap “no” in practicalities

Most of the time, caregivers do not need to be so direct or harsh as to tell a care receiver, “I refuse to do that for you.” Instead, saying no should be undertaken in a spirit of partnership by saying, “What is the best way for us to get this task done?” What is generally “best” is what works logistically and emotionally for both the care receiver and caregiver. That often means letting caregivers delegate tasks to others with a minimum of guilt, knowing they are still fulfilling their responsibilities.

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