Peer Perspectives

The Balancing Act — Being a Social Worker and Caregiver

By Shannon Cousineau, DSW, LICSW

“The girls will do it!”—a phrase I have heard quite a bit since I was an adolescent. Any time I was with my female cousins or my best friend and something needed to be done, this was the response from my mother or other female adults in the situation. I had never realized how much this sentence would also be a kind of subtle mantra stuck in my head and heart. It was never said in a malicious way, but more of an expectation that if there was a task to be completed (read: that others couldn’t or didn’t want to do) I or we would be the go-to person or people. For example, I have fond memories of a trip to Italy with my mother, my dear friend, and some of my mother’s friends. Need something from the pharmacy? “The girls will do it.” Loading the luggage (for seven people) onto the train, making sure it was all on there and the humans were as well before the train left? “The girls will do it.” We were staying in an apartment in Rome—need groceries? “The girls will do it.” I did not speak or read Italian.

Looking back, it really was not an expectation, but because I could be trusted to complete the task thoroughly, correctly, and quickly. There was never a question that a task would be completed even if I had never performed it in the past. This became especially true when a new responsibility was tossed into my already busy world: caregiver for a close relative. At the time it did not seem that there would be much of a change in the lives of myself and my spouse. The person had mental health challenges and a few medical diagnoses, but all were fairly stable. While she needed some assistance with activities of daily living, there were many things she was able to manage on her own.

Over time my relative’s health and mental health destabilized, and she required more care. I found myself providing transportation to at least two appointments per week and managing medications, state benefits, care coordination, childlike behaviors, and more. We had several community supports in place with case managers, nurses, and day programs, but as the needs increased, supports decreased. Instead of hearing “the girls will do it,” I heard from family members and providers, “You’re a social worker, you know what do to.” Yes, I am, and I did know what to do, but that did not discount the need for help so that I could manage my own self-care and mental health.

Social Workers as Caregivers — How to Help
Edwards et al. (2020) reported more than 17 million adults are caregivers for family members or friends with a disability or who are medically compromised. According to the Bureau of Labor Statistics, in 2016 there were more than 675,000 social workers in the United States and those numbers were rising (Torpey, 2018). What does that mean for us who are both social workers and caregivers? Well, first and foremost is eliminating the notion that because we are social workers we are natural caregivers for our own family. While there are certainly some characteristic similarities between those who take on the responsibility of caregiving and that of social workers, the two are very different roles.

Being a social worker has its advantages in caregiving. We often understand the systems with which we are dealing and know how to maneuver through them in the most effective ways. Additionally, when we are unfamiliar with a particular area of practice, we often have colleagues or friends who do know and to whom we can go for guidance. This can reduce some of the stress related to bureaucratic policies that create barriers for service.

First, there are some ways to support those in the dual role of social worker and caregiver. The situation is unique and requires an understanding that there may be an overlap of service provision between the social worker in their professional role and the other providers with whom they interface as a caregiver. In one such circumstance, there was confusion as to why I was calling a provider regarding a different client because the service provider anticipated I was calling in my caregiver role. After clarification regarding the reason for my call, we were able to resolve the misunderstanding. This may be a common circumstance, especially in a smaller geographic area, such as my location. There is often a need for the social worker to have dual professional relationships with service providers.

Second, working with providers to recognize the strengths and weaknesses of the caregiver, especially if the person is a social worker, could help stabilize the person being cared for. Given my practice experience, mostly in crisis work, very little distresses me. This could be a strength or a weakness depending on the circumstance. For example, my mother-in-law often would have severe asthma attacks, especially in the springtime. While others may get alarmed by her coughing and need for asthma treatments multiple times per day, along with her rescue inhaler, I would monitor her, making sure she was taking the steps the doctor had provided previously and not panicking. The weakness of my calm demeanor was evident on occasions when we should have gotten to the doctor sooner than we did and instead there was a multiple day stay in the hospital. In this circumstance, given the number of nurses and case managers in the house on a regular basis, along with all the weekly doctors’ appointments and the people at adult day health, it would have been beneficial for someone with the medical background to intervene.

Third, identify what those needs and supports may be for each role. For some, respite from caregiving can bring a sense of rejuvenation. It certainly did in my circumstance. Often times the challenges came during “business hours” when I was working, but then also doing case management activities for my mother-in-law. Having someone ask what I needed would have gone a long way. The expectation that we, as social workers, can manage all the time feels lonely and isolating, even with providers and others actively participating in care. Having the other professionals ask would have shown that we were working together in the best interest of my relative. Identifying the needs and supports for each role would have provided some relief and organization to a chaotic, sometimes antagonistic situation. It also would have shown that the providers were trying to meet me where I was. I recognize that they all had their own challenges they were facing—staff shortage, personal challenges, and more—but we could have joined together to be successful, as social workers helping other social workers.

Self-Care
The obligation is not only on those working with the caregiver but also on those of us in the dual role. We need to be sure to understand that we do not have to be both the social worker and caregiver all the time. We are not invincible and sometimes one role takes precedence over the other. Sometimes when you are a caregiver, you must also think about what is best for yourself and your family, instead of the greater good, or only the person for whom you are caring.

Defining who we are as a person, outside of both of those roles, and doing things we enjoy is where the real strength comes from to be able to manage all that we do in our lives. When a person is going to have the dual role, it is important to have conversations with providers upfront regarding what tasks you are able to manage and the boundaries between the two roles. It is also acceptable to make changes to the defined tasks as time passes. Things and people change, requiring adjustments. There can also come a time when we have to let go of one obligation and allow others to assume responsibility. It is essential to be prepared for the feelings of relief and grief that come with that transition.

The undertaking of social worker and caretaker is challenging but very rewarding. The years I spent provided wonderful memories as well as self-awareness. I am now mentally, physically, and spiritually prepared when someone comes along and says, “The social worker will do it.”

— Shannon Cousineau, DSW, LICSW, is an assistant professor in the Masters of Social Work Program at Anna Maria College. She teaches courses in social work practice and research. With more than 20 years of practice experience, she has concentrated on crisis work in the areas of intimate partner violence, foster care, psychiatric emergency services, and medical social work.

References
Edwards, V. J., Bouldin, E. D., Taylor, C. A., Olivari, B. S., & McGuire, L. C. (2020). Characteristics and health status of informal unpaid caregivers — 44 states, District of Columbia, and Puerto Rico, 2015–2017. Morbidity Mortality Weekly Report, 69(7), 183-188. http://dx.doi.org/10.15585/mmwr.mm6907a2.

Torpey, E. (2018). Careers in social work: Outlook, pay, and more. U.S. Bureau of Labor Statistics. https://www.bls.gov/careeroutlook/2018/article/social-workers.htm