No One Showed You How

Not Sedentary

Most advice aimed at caregivers assumes the person reading it has stopped moving. Sit less, get outside, find twenty minutes for yourself.

For a lot of people doing this work, that reads as nonsense. They are on their feet most of the day. Helping someone out of a chair, steadying them down a hallway, getting them in and out of a car, lifting a wheelchair into a boot, standing through an appointment, doing it again at bedtime. The problem is not that nothing is being lifted.

Many of the people doing it would not use the word caregiver about themselves. They would say they are helping out, or that it is just what you do for your brother. VA’s definition is narrower than the feeling and wider than most people assume: someone providing personal care services to a Veteran enrolled in VA health care, with no requirement to be a relative or to live in the house.

The Same Movement, Trained

Put those same movements in a hospital and they become trained work. Staff are taught how to transfer someone, told what not to do alone, and given equipment when the load is beyond one person.

At home, the same transfer happens several times a day with no instruction and no equipment, usually by someone who never decided to take the job. It arrived.

That is the gap this article is about. Not effort, which is already there in quantity. Technique, and recovery, and the fact that nobody walked anyone through either.

What Rest Does Not Fix

The standard advice is to rest more and take time for yourself. Rest is reasonable, and it does not address load. A back that is being asked to lift without preparation is not short of sitting down.

There is not a large body of research on this. The clearest trial is small and specific: 62 women in Spain, most of them daughters or wives of the person they cared for, average age in the mid-sixties. Everyone in it received a four-session caregiver programme. Half also did twelve weeks of supervised exercise, three times a week.

At the start, about seven in ten of them rated their pain as moderate, before anything was done. That was the normal condition of the group rather than the exception.

The exercise group’s neck and shoulder pain dropped by about a third on a standard scale, and their neck disability scores improved. In the group that did not exercise, pain drifted up slightly over the same period.

It is one trial, in one country, in women only, measured over weeks rather than years. It is not proof that exercise fixes caregiving. It is evidence that the direction of the usual advice may be wrong, and the direction is what matters here.

Training Already Exists

The part most people do not know is that VA runs caregiver skills training, and it costs nothing.

Building Better Caregivers is a six-week online workshop covering stress, difficult behaviours and the caregiver’s own health. Caregivers FIRST is four virtual group classes. REACH VA offers individual coaching, four calls over two to three months, or group sessions. There is peer mentoring that pairs caregivers with each other, and respite care that covers short breaks.

Access runs through the Caregiver Support Coordinator at a local VA, reached through the Caregiver Support Line.

Two Programs, Two Doors

There are two programs and the difference matters, because people turned down for one assume they have been turned down for both.

The Program of Comprehensive Assistance for Family Caregivers is the one with the monthly stipend, CHAMPVA health coverage and travel benefits. It is narrow. The Veteran needs a VA disability rating of 70 percent or higher, a qualifying discharge, at least six months of personal care needs, and enrolment in VA health care.

The Program of General Caregiver Support Services is the broad one. It carries the training, the coaching and the peer support rather than a stipend. There is no formal application, and VA states that General Caregivers do not need to be a relative or live with the Veteran. The Veteran needs to be enrolled in VA health care and receiving care from that person.

One Call

The reason to make the call is not the stipend, which most people will not qualify for. It is the training, which most people have never been offered and which is sitting there.

A person who has been doing transfers unaided for two years has built habits around a job nobody taught them. Those are worth examining before something gives.

The call takes a few minutes. The training it opens takes longer, and it is the part that was always missing.