June 2015

"Look after yourself, daughter!"

More and more people care for relatives in need of help and care. What starts out of love can at some stage turn into a great burden. Professor of Psychology Pasqualina Perrig-Chiello has researched care within the family. In this interview she explains why the subject is so highly charged.

Interview mit Frau Perrig-Chiello

Pasqualina Perrig-Chiello is Professor of Psychology at the University of Bern Institute of Psychology. She heads various research projects on different stages of life.

Ms Perrig-Chiello, in collaboration with your colleague, the sociologist François Höpflinger, you have conducted a large-scale study about care within the family. Why this particular topic?

Perrig-Chiello: When I researched life satisfaction in middle adulthood, I observed that it was at a low point then. On the one hand because of problems at work, with the children, in the relationship - but on the other very much due to the sudden need to look after elderly parents. For women in particular, this can become a great burden. This is what I wanted to explore further.

And what about sons?

In German-speaking Switzerland, only a third of family carers are men, half of them sons. In Romandy, this figure is only 20%, in Ticino 10%. Sons tend to provide care out of duty, daughters out of love. But both also do it for financial reasons – for example, so that the parents' house does not need to be sold.

And what role do care-providing partners play?

The older the parents get, the more likely that the children step in. At that stage, partners are often in need of support themselves.

Approx. 220,000 people in Switzerland provide care for relatives – not including those that merely help with shopping, cooking or cleaning. This is an astounding number.

Solidarity within the family is indeed still a highly regarded value; people help each other. Two-thirds of people in need of care who live at home are cared for by family members. However, family members can only provide good care because of support provided by home care services such as Spitex, Pro Senectute or the Red Cross. Switzerland boasts one of the best home care services in Europe, thanks also to our wealth.

Despite this support, though, family members reach their limits at some point.

Absolutely. Particularly women who have a job. About a third of them reduce their working hours and 16% quit their job altogether. This has a massive impact, not just on their personal lives, but also on our economy.

However, giving up work is an option only if you have a partner who earns an income.

Voilà. Many are divorced these days – and the divorce rate is rising. These women need their jobs.

How do daughters and sons get into the situation of providing long-term care for their parents?

Most just drift into that role. At first you provide some help: booking a taxi, going shopping, filling in the tax return ....Then gradually more caring tasks get added. By the way, many do not see themselves as carers. They say: "But I just help my mother."

But that is a very nice thing to do.

Yes, on the one hand that is a strength, but on the other it is an infinite drain on the women. To start with, they do it out of love, stating "that goes without saying", and suddenly they realise: this does not go away. Even though the care provided by a daughter is less intensive than that provided by a partner, their health suffers more.

What are the symptoms?

More frequent visits to the doctor, for example, and their consumption of medication, which is significantly higher in this group than in the average population. This shows that care-providing daughters tend to be hidden patients.

What can they do to avoid this trap?

Make better use of external help. Family members have to set limits. Some are better at that than others. Our study has shown that the level of care required by the person in need is irrelevant to how burdened the care-providing family member feels; it is a matter of organisation and mental state. Also, they should talk about their situation to others in order to realise that they are not alone.

What can the elderly in need of help or even care expect of their family members?

They should expect nothing – they can only hope. And as far as they possibly can they should take action themselves.

What should they do?

For example, they should discuss with their children the best way that the latter can help, such as in organising professional support. Most sons and daughter are happy to do that and do it well. Or the parents should be open to new technologies – e.g. wearing a wristwatch with an emergency button. The advances in robotics are also enormous.

You appeal to parents to take responsibility themselves.

Correct. Taking personal responsibility - this is confirmed by all studies on ageing - is the prerequisite for a long life with a good quality of life.

How can the elderly who are still hale and hearty improve their quality of life?

The right diet is the be-all and end-all. Also, they should go out regularly - maybe to a rhythmics class. As far as conditions permit, they should organise their own lives. Many barriers exist only in our heads.

What if parents refuse outside help? What is the best way to react?

You have to be persistent, but not pushy. You have to tell them that there is no need to be ashamed if meals are brought in or a cleaner comes. This shame is typical for German-speaking Switzerland - the western Swiss have far fewer problems with that.

But it is only natural that parents prefer being cared for by their children.

However, it can no longer be expected these days for children to be around their parents at all times. Children should help their parents, but they also have to retain their own autonomy.

Isn't that a bit egoistic?

Care-providing family members often suffer a breakdown when their mother or father have to move to a home or die. Once the burden has disappeared, they frequently become ill themselves. The hidden patient becomes a real one. Carers have to be told in advance: look after yourself!

That is easy to say.

This is a challenge not only for family members, but also for companies and politicians. In Switzerland, care within the family is seen as a private matter, and society expects that help to be provided. However, the economic impact of this help is enormous.

What support can companies provide?

They should deal flexibly with employees who provide long-term care for a family member; for example, with extra holidays or an adjustment of their working hours.

Very soon now, the baby boomers will reach retirement age - and then the problem of care in the home will become acute.

Our generation - and I am one of the baby boomers, too - really has no more excuses. We know that we are all getting ever older and we have ever fewer children who could care for us. The rate of dementia sufferers is on the increase. We have to redefine family. Friendships are becoming ever more important, help within the neighbourhood, senior citizen self-help groups. We also need to find new ways of living in old age. Rethinking on several levels is required.

Are you optimistic for the future?

Yes. Our study made some real waves. For example, it is used in political planning. Last December, the Federal Government issued a statement, a commitment to support family carers. Finally and at last! Previously, when the burden on these family members was mentioned, the standard reaction was: "Well, it's a private matter!" Now we can point the finger exactly to where the problem lies.

Interview: Daniela Diener