Monday, August 10, 2009

Non-spousal caregivers need to keep "personal sovereignty"

Following on to yesterday’s post, I wanted to expand into the area of family caregivers who are not spouses, such as adult children, siblings or other relatives.

It’s important that caregivers (especially adult children who move in with parents) keep some sense of “personal sovereignty”. That means some separation of some life goals, including other consensual adult relationships (especially important for LGBT people), personal expression, social networking and the like. For some caregivers who never raised children, it can mean some boundaries on the degree of intimacy or personal cuing expected. That means that he or she needs (as the caregiver said yesterday about even spouses) to outsource or purchase some services.

That’s easier when the widowed parent was left provided for by a spouse; but if not, in many states, according to filial responsibility laws, the adult child can be held responsible for the parent’s expenses, and an otherwise childless person might be expected to share more of the expense. Filial responsibility laws (that generally kick in when someone tries to use Medicaid to pay for custodial care) have not been enforced very often so far, but they are likely to be enforced in the future as states scrap with recession-damaged budgets. (California could become one of the first states to look at this.)

Given demographics and the evolution of geriatric care, it’s surprising to me that this whole area has not been debated more in public, and doesn’t get more attention as part of the health care funding debate in Congress and with the White House.

As this blog noted before, long term care insurance enters into this debate. Eventually, there could be calls to make that insurance mandatory.

Families, particularly with unmarried or childless adults without intimate family experiences created on their own, should sit down and anticipate and plan how they will deal with these issues in the future. In some cases, an adult child could consider purchasing a home to move the parent into, or consider encouraging the parent to downsize into a community with support services before a problem becomes critical. If an adult child moves back, the expectations should be clear; but they often won’t be clear because of cultural changes that develop between generations. Younger adults expect to live in “alternate spaces”.

Non-spousal caregiver "autonomy" becomes a sensitive topic for some people, because of the "existential" meaning that can be given when some wants to "quarantine" some of his (family-of-origin) life away from his interaction with "his own world." The literature on adult abuse talks about "withdrawal of affection" or "lack of attachment" as if to suggest that emotions normally appropriate in marriage should apply in all caregiving situations.

It’s interesting that British novelist Clive Barker anticipated some of these problems with his 1991 novel “Imajica” and uses the term “reconciliation” to describe what happens when separate cultures must come back together in one space and learn to communicate again.

That song “Let me be myself” plays on the TV now (as part of a blood pressure ad).

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