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Submitted by PatientsEngage on 25 April 2016

Many caregivers feel guilty and think it is wrong to get tough with their loved ones, even if the intention is to help in the long run. Maya Ramachandran delves into the dilemma with a personal account.

As caregivers, we are concerned about the health of our loved one. We assist with the care of/take care of our loved one, in the midst of many other responsibilities that we are required to fulfil. Sometimes, the patient is uncooperative or simply stubborn to a point of no return. What do we do then? Do we throw in the towel, rave and rant, dissolve into tears, or, resolve the situation in a healthy manner?

I have sometimes been placed in this position while caring for my father who suffered from dementia. In one particular instance, he hadn’t taken a bath for 5 consecutive days in summer. His body was sticky and I could see he needed a bath at all costs. All approaches to get him into the bathroom failed. He claimed that he had had a bath that morning and that I wasn’t willing to trust his words. The girl who was hired to take care of him while I attended to my full-time job denied this completely. I then decided to get tough. I looked him directly in the eye and told him that I was going out for a walk (to release some ‘steam’) and would be back in a half hour; that I expected him to have had a bath. In the event that he hadn’t, I would take charge and give him a bath. Stating this with all the firmness I could muster and with much love in my heart, I set out, hoping that he would cooperate. When I returned after the promised half hour, my father was looking as fresh as a flower and smelling of the loveliest soap. I thanked all the Gods I was familiar with as everything had ended on an amicable note!

My father needed physiotherapy on a daily basis to work his muscles that were stubborn and seemed to have a mind quite their own. We had a dedicated physiotherapist come home and help him with his exercises. On certain days, he would be so adamant as to not even have a bath and get ready to meet him. On other occasions, he would threaten me and my mother that if we as much as allowed the therapist to come into his room, he would not cooperate. On certain days, my mother and/or I would apologise to the therapist on my  father’s behalf, requesting him to come back the following day; however, on other days, I would request him to work with my dad with a brief warning that he wasn’t ‘in the best of moods’. His therapist knew him very well and had all the handles to manage him very efficiently. As caregivers, we cannot always please our loved one, especially if it is to their detriment. Going against what they want, knowing full well that it is for their well-being is part of practicing ‘tough love’.

Similarly, mashing food with his hands was recommended for my father in order to  strengthen his muscles. Being South Indians, this was our customary way of eating. My mother would, on many days, both out of pity and/or fear of facing his wrath, mash the food and serve it to him. I would plead with her sometimes and argue with her at other times to desist from doing something that was not going to be helpful to him. My father would ‘make hay while the sun shone’, meaning that he would cooperate when I served him and demand that my mother mash his food when she was around (and I wasn’t).

Relevant examples of tough love in other situations would include the following:

  • refusing to permit children to watch their favourite TV programme until they have completed their studies as agreed upon
  • genuinely concerned parents refusing to support their drug-addicted child financially until he or she enters drug rehabilitation 
  • not cooperating with your spouse when he/she speaks untruthfully as it goes against your ethical values

Tough love, to me, is about holding my ground when I do/say something in the interest of the patient with genuine love in my heart, even if the patient doesn’t necessarily agree with this. The intention is of utmost importance here, as it always needs to be for the patient’s well-being. It needs to be practised consistently for expected outcomes to materialise. It might mean being the lone voice in the room with everyone else standing on the other side! I never promised this was going to be easy! However, this will help the patient in the long run, even though caregivers would need to work through resistance, anger, and perhaps, resentment in the short-term. In most cases, the patient would end up doing what he/she needs to do; however, it is our fear of “what if he/she doesn’t do it” that prevents us caregivers, from allowing them to be responsible. 

Many caregivers feel guilty and think it is wrong to get tough with their loved ones. If this feeling prevails, it is well worth asking oneself the question, “What within me is bringing up this guilt?” and pay attention to the answers that emerge (inner voice). We need to realise that in the end, we cannot control them or encourage dependency; rather, we need to help the patient do whatever he/she can do on his/her own to help himself/herself. We are facilitators and cannot take over all the responsibilities of the patient, as it will be damaging and limiting for the patient  as well as burdensome and unhealthy for the caregiver.

To quote Bobby W. Miller, “Tough love is real love. Why? Because it’s never easy. It hurts the giver far more than the receiver”

Other Caregiving articles 

I never wanted my mother to go into a dementia care home

Care for the Caregiver 

Dementia Caregiving Challenges and Solutions

 

 

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