If you give a mouse a cookie, reads the popular children's book of the same title by Laura Joffe Numeroff, he's going to ask for a glass of milk. When you give him the milk, he'll probably ask for a straw, and so on and so on. This somewhat-predictable, lighthearted take on the relationship between a mouse and a boy delights. Yet when a spouse becomes a caregiver, the results are not always so easy to predict and may not be lighthearted. If a spouse becomes a caregiver, as opposed to an adult child or other relative becoming one, a unique relationship is created that can be incredibly loving and productive, or hurtful and destructive, and sometimes both.
A spouse who becomes a caregiver is often uniquely positioned to help the one in need of care. He or she has often known this person for many years, is already acquainted with the person's habits and healthcare needs, and can usually provide the time necessary for care if the couple no longer has children living at home, and especially if they are retired. The couple usually spends long hours together and are already acclimated to one another's schedule and routines. There is also an intimacy shared between spouses that can make caregiving less uncomfortable than between parents and children or other relatives. Spouses, after all, have seen each other bathe and disrobe, often have shared a bedroom and bathroom for many years, and are more used to being near one another during private and vulnerable moments.
There are some natural advantages to the spouse-as-caregiver scenario. Yet the key to a healthy spouse-caregiver relationship is in communication and planning, both within the relationship and without it.
Every effort should be made to communicate feelings and needs between spouses. A caregiving spouse must ask questions and listen to the answers closely, especially in regard to caregiving or healthcare. Since spouses who have been together into old age are usually quite close, they can often discern hidden feelings or messages; bring those to the forefront and encourage honesty and openness with each other. Only with clear, healthy communication can anyone (but especially a spouse) provide exemplary care. Remember that the feelings of both parties are equally important and valid, so allowing both the person in need of care and the person giving care to express feelings is better than expecting both to have the same (or even similar) feelings about the caregiving situation.
Gender may complicate matters. Wives are very often the primary caregivers for their husbands, notes a New York Times article, and this sometimes becomes overwhelming, given the high expectations already placed on women by society--caring for children, being generally nurturing regardless of their own temperaments, doing much of the housework, and also working for an income. Some women describe caregiving as a roller coaster ride, replete with verbal abuse, depression, and feelings of anger. Men receiving care feel the hit to their ego, again because of social expectations, when they can no longer provide or function as "the man of the house" and so question their self-worth. This can lead to depression and feelings of hopelessness, which often worsen health and can result in a man lashing out at his spouse. Such problems arise when spouses do not communicate their feelings and needs.
Making a Plan
Creating a written and clearly articulated plan for caregiving is a great idea for any relationship, but it can also help create and support boundaries between spouses in caregiving scenarios. This plan should include a broad array of topics, such as eventualities ("If this occurs, we will do this"), boundaries ("This will not be allowed"), and routines ("We will go out for lunch every Sunday after church in order to have time for ourselves"). The more articulated and specific these written plans are, the more smoothly they will function. Pointing to specific discussions and plans can help spouses communicate and negotiate around unforeseen problems that may arise. Some more specific examples of articulated rules and boundaries are, for example: "I will help Robert bathe every day before breakfast"; "Twice a week, we will go together to purchase groceries"; "I will help Amanda with our finances once a month, and we will always make sure we both understand where we are financially." Spouses do well to use these kinds of statements as a template once a spouse-caregiver relationship has been established, and to share it with close relatives if appropriate. This can help relatives determine when it may be time to step in.
Asking for Help
Spouses often feel as if they should keep the entire burden of care on their shoulders, but this is not true. Both the spouse giving care and the spouse receiving care should accept help when it is offered, and ask for more help when they need it, especially if it comes from outside their relationship. A working spouse may need an adult child's help with purchasing groceries or driving to a specific doctor's appointment, and many children, even if they are not the primary caregiver, are happy to help to their aging parents if possible.
A therapist may be needed, who will help both parties navigate the complex relationship of spousal caregiving. Visiting a therapist before problems start may be thought of like taking vitamins rather than visiting a doctor--the couple is not looking for antibiotics to fight infection; they are looking to strengthen their relationship's immune system to make sure infections don't happen.
Brody, Jane E. (April 9, 2012). Caregiving as a "Roller-Coaster Ride From Hell." The New York Times. Available at http://well.blogs.nytimes.com/2012/04/09/caregiving-as-a-roller-coaster-ride-from-hell/?_r=0. Retrieved May 30, 2016.
Jacobs, Barry J. (July 10, 2014). In Sickness, Health and (Sometimes) Anguish. AARP.com Available at http://www.aarp.org/home-family/caregiving/info-2014/caregiving-spouses-marriage-stress-jacobs.html. Retrieved May 30, 2016.
Military OneSource. When You Become Your Spouse's Caregiver. Available at http://www.militaryonesource.mil/search?content_id=268719. Retrieved May 30, 2016.