Women traditionally take on the caregiving role in families. For many women, the launching of children into adulthood is followed swiftly by the assumption of care for failing parents or relatives.

Not every caregiver or "helper" feels she* has a choice about taking in that parent or relative. By the same token, not every elder feels she* has a choice about where she will spend her last years. Although adults in midlife may need to bring an aging family member under their roof, these individuals do have choices about how each of them will handle this challenging situation. Taking care of an elder is really about the elder and helper taking care of each other through what can be a very difficult time. Those relationships that thrive are the ones in which people understand that there has to be a cordial give-and-take. When people are gentle with each other, opportunities for love and understanding emerge and enrich the years they share.

There are a number of issues that are common to all such helping relationships:

Communication: Communication is the key. Often elders don't communicate fully because they worry about being a burden or about asking for too much. Grateful to be cared for, they don't feel entitled to ask for what they feel they need. Other elders were never particularly good at communicating and find it even more difficult now that they are unable to take care of things by themselves. Often, helpers frustrate communication because they are in a hurry or they are overwhelmed. A successful caring relationship requires that both parties make an effort to listen carefully and to state things clearly. Assumptions about meaning only lead to trouble.

·        Advice for elders: Try to save important issues for when your helper isn't harried.

·        Advice for helpers: Find a time each day when your elder can be assured that you have the time and energy to really listen.

Identifying Needs: Many people in helping relationships find themselves in an odd dance around needs. The elder may feel so badly about imposing that she doesn't state needs or she may feel so bitter about needing help that she becomes bossy. More confusing still is the elder who expresses the full range of these feelings. Some helpers assume they know what the elder needs and are hurt when the elder isn't properly grateful. Others feel helpless in the face of so much neediness and don't have a clue about what to prioritize their responses.

·        Advice for elders: Figure out what you really need and ask politely.

·        Advice for helpers: Don't assume you know. Ask politely.

Privacy: When an elder is cared for by an adult for whom they provided care during childhood, roles are embarrassingly reversed. It doesn't feel "natural" to either party for a child to bath, change, and dress a parent or older relative. The elder may cope by withdrawing or she may be angry at the whole situation. The helper may be embarrassed and awkward or may be overly rough in wanting to move through situations that create discomfort.

·        Advice for elders: Be cooperative and helpful when your body needs care.

·        Advice for helpers: Take on a "professional" attitude when touching your older family member’s body. A detached, matter-of-fact, approach often feels less intrusive.

Activity: When an elder is housebound or bed-bound, life can get pretty dull. It's no fun to be the last to hear news or local gossip! For some elders, conversation is reduced to issues of health and the repetition of old news.

·        Advice for elders: Think about new things you can contribute to the conversation like memories and stories. Make an effort to engage with visitors.

·        Advice for helpers: Leave for a while when visitors come by so that the elder will have something to share later. If appropriate, encourage clergy and other visitors to come by. Provide books on tape, large print books or newspapers, etc. -- whatever will stimulate thinking and promote conversation.

Boundaries: In the intimacy of a caregiving relationship, it can be difficult to know where one person ends and the other person begins. There is a limit to what each of you can expect the other to know, do, and be. Helpers can't be on tap every minute of the day. Elders can't be expected to adapt immediately to a change in schedule just because it’s convenient for the helper. It's very important to negotiate clearly what each of you can and cannot do to make things go smoothly.

·        Advice for elders: Accept boundaries. Negotiate if they don't seem reasonable. Make every effort to be flexible when the helper introduces new activities or has to make a change in schedule.

·        Advice for helpers: Set boundaries around your time and availability. Give the elder time to transition to new activities or a change in schedule.

Dealing with Systems: Elder and helper will both have to deal with systems outside of the family, including the healthcare system, the social security system, systems of assistance, etc. Often, getting what is needed is challenging for the most educated and stouthearted. For those who are shy, overwhelmed, or simply confused by the complicated regulations and guidelines of these systems, getting help can be a daunting task.

·        Advice for elders: Provide as much information as you can to your helper so that she can help. This may mean giving access to papers and records that feel private. Find a way to talk about your need for some measure of control.

·        Advice for helpers: Be sensitive to the elder's feelings of confusion and upset over loss of control over very private matters. If you find it confusing to deal with outside systems, get help for both you and the elder so that you can make good decisions.

Ultimately, success in the caregiving relationship requires exquisite tact on the part of both people. When both parties go to great lengths to be polite and considerate, each feels acknowledged and appreciated. In that context, elder and helper may discover new depth and satisfaction in their relationship with each other.

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·        Helpers and elders are, of course, male as well as female. But for purposes of clarity, I am using the feminine pronoun, since most people in caregiving relationships are female.