Recognizing Double-Duty Caregivers ...

Is this a picture of a helping professional or of a family caregiver? Both, you say? Then you're absolutely right. This is the picture of a double-duty caregiver (DDC), a helping professional who also cares for a family member or friend who is frail, mentally or physically ill, addicted or disabled.

Double-duty caregivers (DDC's), as you can imagine, are at increased risk for compassion fatigue. Most significantly, their primary and secondary trauma exposure is high, leaving them vulnerable to the posttraumatic stress, diminished empathy and emotional disengagement that comprise compassion fatigue. Additionally, they may work in depleting professional environments with inadequate staffing and resources and/or with insufficient human resource support for caregivers.

At home, these same helpers can experience the stress of being "on call" 24/7, of watching loved ones suffer and knowing better than most the meaning of that suffering, of being pulled in different directions by conflicting personal and professional roles, of being expected to take over the bulk of at-home caregiving because they are "the professionals", and of having to make urgent caregiving decisions in situations where they may not have clinical expertise or appropriate resources.

As DDC's, many of us cope with our double-duty workloads by pushing ourselves to work harder. When we ignore the impact of double-duty caregiving in this way, we put our personal health and that of our personal and professional care recipients at risk.

Last weekend, I was invited to attend a national meeting of clinicians, educators, administrators and policy-makers interested in creating policy recommendations to support the needs of a discreet group of double-duty caregivers - healthcare professionals who also care for elderly family members.  It was wonderful to meet with such a diverse group of colleagues, colleagues with the power to effect change who obviously cared about the welfare of caregivers in general and DDC's in particular.

Although not the primary focus of our discussion, the workshop content reinforced my belief that compassion fatigue must be addressed at three major levels - individual, organizational and societal.

• First, we must remember that CF is, at its core, a trauma response incorporating primary and secondary trauma exposure. Individual trauma work is thus the core intervention for healing CF. 

• Secondly, organizations can do much to create DDC-friendly environments (with resultant reduction in sick time, long term disability claims and attrition, to say nothing of improved patient/client care). Educating all levels of the organization regarding compassion fatigue and double-duty caregiving and providing flexible scheduling, access to unpaid leaves, and access to adequate, caregiving-aware EFAP programs can go a long way toward easing the dis-stress of DDC's. Then, we need to create adequate staffing ratios and pools that will allow DDC's to take advantage of such supports. 

• And, thirdly, at a societal level, we need to recognize and value the significant contributions and sacrifices of all family caregivers, to advocate for their needs, and to provide adequate and flexible funding and services appropriate to individual needs. (eg Flexible respite care delivered by professional caregivers who have sufficient training to make assessments and deliver appropriate care while the DDC is away at work.)

When we work to make changes at all three levels, we positively affect the health and wellness of DDC's, both in the workplace and at home.