Psychology of caregivers

Lecture Notes by Farheen Meraj

MODULE II
CLASSIFICATION

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 Psychology of caregivers
Lecture Notes by Farheen Meraj

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 Psychology of caregivers
Lecture Notes by Farheen Meraj

Types of Caregivers
Dilworth-Anderson, Williams and Cooper (1999) identified different types of caregivers by their
level of responsibility and caregiving tasks.
1. Primary caregivers were identified by care recipients or their proxies and were verified
by the caregivers. They had the highest level of responsibility regarding care and
performed the largest number of caregiving tasks. Primary caregivers provided care
alone or in conjunction with other helpers.
2. Secondary caregivers were identified by the primary caregiver as persons who
performed tasks at a level similar to that of the primary caregiver, but without the same
level of responsibility. Therefore, secondary caregivers were not in charge of making
decisions about the care recipient's support and care and only provided care in
conjunction with primary caregivers.
3. Tertiary caregivers were usually identified by the primary caregiver and provided care
with the primary caregiver. These caregivers had little or no responsibility for making
decisions regarding the care recipient; they performed specialized tasks such as grocery
shopping, yard work, or paying bills. Some tertiary caregivers, however, provided care in
the absence of other caregivers, typically to high-functioning older people. Similar to
primary caregivers, these tertiary caregivers were identified by the care recipients or
their proxies.

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 Psychology of caregivers
Lecture Notes by Farheen Meraj

Primary Caregiver
A primary caregiver is the main person coordinating, planning and/or providing care for the
care-recipient. In other words, the primary caregiver is the person in charge, the organizer, who
also often does the bulk of the caregiving tasks. Primary caregiving can involve living with the
person you’re taking care of but living with someone does not necessarily mean you are a
primary caregiver. A primary caregiver may be the key person handling things from some
distance.
A child's primary caregiver is the adult who assumes the most responsibility in caring for the
health and well-being of the child. While one or both parents are the most common primary
caregivers, this term is often associated with other adults who take on this role. Primary
caregivers may include grandparents, other relatives or a legal guardian.
Being a primary caregiver carries some legal implications, as a person taking on this role with
a child may seek legal or practical rights to offer care and support. When a child is admitted to a
medical facility, for instance, the primary caregiver may have to complete a declaration or
application to acquire rights typically reserved for parents
In custody cases, most states' family courts allow a preference for the parent who can
demonstrate that he or she was a child's primary caretaker during the course of marriage, or
assumed that role in general if the parents are unmarried. The "primary caretaker" factor
became important as psychologists began to stress the importance of the bond between a child
and his or her primary caretaker. This emotional bond is said to be important to the child's
successful passage through his or her developmental stages, and psychologists strongly
encourage the continuation of the "primary caretaker"-child relationship, as being vital to the
child's psychological stability.

When determining which parent has been the primary caretaker of a child for purposes of a
custody decision, family courts focus on how parents have divided the key responsibilities for
taking care of their child, including such tasks as:

● Bathing, grooming, and dressing;

● Meal planning and preparation;
● Purchasing clothes and laundry responsibilities;
● Health care arrangements;
● Fostering participation in extracurricular activities;
● Teaching of reading, writing, and math skills; helping with homework;
● Conferencing with teachers; attending open houses; and
● Planning and participating with leisure activities with the child.

Depending on the state where the custody determination is being made, other factors may be
considered as important when determining primary caretaker status. Even such things as
exposure to secondhand smoke and volunteerism in the child's school have been considered in
a primary caretaker analysis.

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Lecture Notes by Farheen Meraj

If the question "who is the primary caretaker" is not easily answered, as when both parents have
equally shared parenting responsibilities, courts will generally look to the "child's best interest"
standard used for determining custody. Some of the factors a court will consider when making a
decision in the child's best interest are:

● The child's wishes (if he or she is old enough);

● The parents' physical and mental health;
● The parents' and child's religious preference;
● Need for continuation of stable home environment;
● Support and opportunity for interaction with members of extended family of either parent;
● Interaction and interrelationship with other members of household;
● Adjustment to school and community;
● Age and sex of child;
● Parental use of excessive discipline or emotional abuse; and
● Evidence of parental drug, alcohol, or sex abuse.

A primary caregiver becomes the main contact for:

➔ The child who will instinctively go to the primary caregiver in times of distress or simply
to be ‘filled up’ with cuddles and love.
➔ Parents who can inform the primary caregiver of any issues (e.g. a poor sleep last night)
or convey concerns as well as hear from the primary caregiver about planned events
and information on their child’s development.
➔ Other teachers who can consult the primary caregiver as they plan activities and for
teachers to give information to the primary caregiver to pass on to parents such as
observations, planned events or concerns.

The benefits of primary caregiving are usually associated with infants and toddlers where the
neuroscience says the need is greater. However, there are also benefits for older pre-school
children (3-5yrs) though perhaps more in terms of effective lines of communication. As one
centre manager said, “it prevents parents having to hear the same thing from all the teachers” or
not hearing at all what they need to know.

The previously mentioned benefits of primary caregiving still apply to 3-5 year olds such as
having a dependable best friend from day one. However, in time the preschool aged child might
get along well with another adult/ teacher who will become their ‘special teacher’.

Primary caregiving approaches for older children can go by other names such as whanau group.
Such approaches align with the purpose of primary caregiving thus giving the 3-5 year old
children a sense of belonging and a clear ‘go to’ person if needed.

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 Psychology of caregivers
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When their special teacher resigns from the centre a child may tend to be more involved in their
farewell ritual though also talk excitedly in anticipation of their new ‘special teacher’.

The aim of primary caregiving is to ensure that each child has a positive child care experience.
This is known as ‘secure base behaviour’ where a child will explore the environment and take
risks knowing an adult (with whom they have a secure, trusting relationship) is close by if
necessary.
Secure attachments are based on healthy relationships between children and caregivers.
Children who are securely attached will be happy to say goodbye to parents and caregiver, play
easily by themselves and with others and only cry if hungry, tired or hurt. Furthermore with the
consistency of educators research shows that young children are more likely to develop a
secure attachment (bonding) relationship at child care which enables them to trust, explore feel
good and begin to organize their behaviour and learn.
Early childhood research has also demonstrated that nurturing and responsive relationships
build healthy brain development in children, by providing a strong foundation for children’s
learning, behaviour and health. It is therefore essential that child care settings promote
consistent, nurturing relationships between child care professionals and children in which each
child’s needs are recognized and responded to sensitively.

Primary caregiver should consider herself the general manager of the loved one. That’s why she
needs secondary and tertiary caregivers to back her up.

Secondary Caregiver
A secondary caregiver is a person invested in the receiver’s care but who is not able to or willing
to be on the front lines as often or as closely. If we consider the primary caregiver the captain of
the ship, the secondary caregiver is the first mate. Secondary caregivers may perform some of
the direct caregiving duties to help the receiver, but additionally, they may do things to support
the primary caregiver.
Families must recognize that good secondary caregivers are invaluable. Ideally multiple
secondary caregivers will support the primary caregiver. Having a team of support by the way of
secondary caregivers should be the goal of the primary caregiver. A secondary caregiver would
enhance the receiver’s quality of life and also gives the primary caregiver a much-needed break.
While good secondary caregivers are invaluable, it’s important for them to resist stepping out of
their supporting roles. Secondary caregivers have to be very careful about stepping on the toes
of the primary caregiver. They should be respectful and defer to the primary unless there is true
imminent danger to either the care-receiver or the primary caregiver.

For example, if a secondary caregiver sees that the care-receiver is not getting her medications,
it may be appropriate to step in. But if the secondary caregiver merely notices that the
care-receiver is not getting dinner at exactly 6 pm every evening, it is probably wise to stay put.
(FitzPatrick, 2016)

Tertiary Caregiver
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Tertiary Caregivers provide support to and take stress off the primary caregiver. A tertiary
caregiver is similar to the dockhand at the marina. Any captain will tell you that docking can be
stressful, even under decent weather conditions. And even with the help of your first make,
docking can go awry because of unpredictable winds, mechanical malfunctions, or the angle at
which the vessel next to your ship is tied up. When there is a dockhand at the marina, it is much
easier to dock the boat.
Typically the tertiary caregiver does not have much direct contact or impact on the care-receiver.
But they can have a significant impact on the primary and/or secondary caregivers.

Other Types
o There are four types of caregivers:
1) Professionals
2) Natural supports
3) "Sandwich" caregivers
4) Grandparent caregivers

Professionals receive compensation for their services, and are not related by blood or marriage
to the person for whom they are providing care. Professionals typically have at least a two- or
four-year degree in business management, nursing, medicine, education or social services.
Professionals receive training in abuse/neglect recognition and prevention, first aid, CPR and
automated external defibrillator use, historical foundations of in and out of home care, human
rights, disease prevention, community health, human sexuality and expression and other topics
as they apply to providing services to special populations. Professionals are usually licensed or
regulated by the state in which they provide services, and are subject to mandatory
abuse/neglect reporting requirements.

Natural supports are people in the community, who may or may not be related to the individual
receiving care, who provide services and support without compensation. This includes friends,
neighbors, church members, grocers, bus drivers and postal workers. Anyone who makes the
community accessible to the individual is a natural support.

Sandwich caregivers are those who are still raising children while caring for adult family
members in the home. They may or may not be related by blood or marriage to the person
receiving care. The difference between these caregivers and a professional is the location
where care is being provided rather than whether or not they are being paid to provide these
services. Sandwich caregivers are at particular risk of burnout due to the demands on their time
and emotional resilience. The bulk of elderly caregiver support is targeted toward this group.

The fastest growing category of caregivers are grandparents. Economic pressures, drug and
alcohol addiction, housing foreclosures, unemployment, divorce and many other social factors
often result in absent parents being replaced by grandparents. This group has the greatest need

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 Psychology of caregivers
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for respite services, transportation assistance and income, with the fewest opportunities for
employment.

Misconceptions
o One of the biggest misconceptions about caregiver support is the idea that caregivers
can and should devote all their energies and resources to their family members in need. Self
sacrifice is a wonderful thing, but if you are on an airplane and the oxygen masks drop down,
you must first put your own mask on before you can help anyone else. Taking care of your own
needs lasts results in burnout and is a factor in most cases of abuse, neglect or abandonment.
Another misconception is that caregivers are overpaid. This is as far from true as it is possible to
be. With the exception of R.N.s, most caregivers receive wages that are not capable of
supporting the average family without working a second job. A third misconception is the idea
that the elderly are simply being cared for, rather than the truth: Many elders are caring for
adults with disabilities or children despite having care needs themselves.

Function
o Caregiver support groups provide necessary social contact, recreation, stress relief and
information about available services to meet basic family needs. By caring for themselves first,
caregivers are able to recharge and return to the home ready to face the next round of
challenges. These support groups make information available about accessing respite services,
such as daycare and after-school care for children, as well as work programs and day activity
programs for adults with disabilities and fragile elders.
Locating caregiver support services is simple. Find your local Area Agency on Aging and
request an assessment of need for the person for whom you are providing care, if they are
elderly, or ask for an assessment of your own care needs if you are over age 60 yourself. If you
are providing care for a child, check with your local family services center. Those who are caring
for adults with disabilities should contact their local board of mental retardation and
developmental disabilities. For children with disabilities, contact your child's school counselor.
Benefits
o Elderly caregiver support groups provide a needed outlet for the constant challenges and
frustrations of providing for family members in need. Everyone has a need for social contact, but
caregivers in particular have a tendency to ignore their own needs. Caregiving can become very
socially isolating. The difficulty of getting a fragile family member ready to go out results in far
fewer outings than if that family member were able to get himself ready without assistance. If
transporting someone with limited mobility who uses a device such as a walker or wheelchair,
there is the added burden of transferring the individual from wheelchair to car and back again,
twice each way. Mobility equipment is rarely light and easy to maneuver in and out of a vehicle's
trunk or cargo area. Caregiver support groups often know how to access paratransit services,
provide references for competent aides and help navigate the system to obtain needed services.

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