Helping Dependents become Independent

My second born at 12 months.

When my children were younger, I had to remind myself often that my role was to help them enjoy their childhood while I trained them to be independent at their level. I also reminded myself that, in those early days, I had the support of capable domestic helps who washed, cleaned, fed the kids, and knew exactly when to take them to play groups and bring them back, and when the school buses arrived. I am sure I would have been guilty of abandoning my children somewhere without their help with my children's social and school calendars!

However, I did a better job planning their daily routine of meals, naps, TV and bath times, getting them age-appropriate play materials, reading to them, swimming with them, and overseeing their psychosocial development.  In the process, each of my helpers learnt what not to fuss over. For example, mealtime is when a child sits at a table, not when the carer runs after the little one with a bowl. Dropping food all over the high chair and the floor as a two-year-old happily eats with her fingers is an expression of autonomy. Under the age of 7, bath time is splash time with toys and making shapes with shampoo in your hair! Lingering and laughing are definitely encouraged! From 7 years onwards, it's karoake time! Haven't you heard your neighbors sing in the shower?

As care givers, it is important to keep our eye on improving the quality of life and independence for those in our care.

You might ask: What about caring for aged?  A friend of mine prepared up to five different types of puréed food in small portions so that her frail and elderly relative would choose one dish she preferred to eat.  Another friend treats her edentate mum to teatime at home with her favourite chocolate cake mashed, and serves her tea in a tiny beaker for easy drinking.  While these treatments may seem like luxury to single-handed carers with no help, offering simple choices help to dignify dependents and foster a greater sense of self-efficacy that builds self-esteem, even with existing limitations.  Involving a non-ambulant elderly to choose where she prefers to sit at meal-times, which shampoo or bath soap she wants to use, what colour she wants to wear to the doctor’s appointment may not mean much to the able-bodied.  But to those who are made dependent on others by their conditions, it reminds them that they are still humans.

Recently, I turned care giver when my husband recuperated from stroke-induced amnesia.  For a while, I was making up for his cognitive deficiency and living two lives!  I told him what was best for him, and attempted to act in his best interest, even when he showed no interest to live with limitations.  When he took the car out barely a week after hospitalization, I called the police an hour later.  But he came back unscathed and perked up, having spent an afternoon at my friend’s place drinking Chinese soup!  More of such anti-climaxes happened before I realized that I needed to pull back and give him the autonomy that he needed – whatever the outcomes.  I relinquished fear over his safety and immediately regained peace of mind for myself, trusting that his rehabilitation would come through the necessary process of regaining independence. So far, so good.

As carers, we can easily overlook the importance of allowing our dependents to develop autonomy. We run the risk of objectifying them as problems and dehumanizing them when we take over every decision and whatever little choice they have because of their age or mental capacity.  Care giving should begin with the end-goal of liberating the dependents we care for in appropriate context - no matter what their physical or cognitive limitations.  We, too, can become so dependent on our care giving roles that we forget to give ourselves time off.  

Humanizing the care giving experience reminds us that we are humans.  When carers open the door to regular friendly home visits for their elderly charges, they are giving themselves the much needed time-out.  But more importantly, social interactions are precious reminders to dependents that they are not just old, just ill, or just wheel-chair bound, but they are also humans who can smile and be nice even if it is increasingly rare.  And any attempt to bring back positive emotions is noble.  Good company is healing both for carers and dependents.

Autonomy or empowerment is a mutually liberating goal for both carers and dependents.  Sometimes, it’s not in expecting big changes but looking for the proverbial cloud the size of a hand that is a sign of positive progress.