Elderly caregivers also get bored

The study of the causes and consequences of boredom in the work environment has been the focus of researchers since the beginning of the 20th century. Many have demonstrated their association with efficiency and maintenance of attention, with the level of satisfaction in the workplace, with motivation and active and creative participation in the organization, with the increase in risk rates and accidents at work, or with other pathologies such as stress, anxiety, exhaustion and depression. Numerous scales for measuring this phenomenon and strategies and models for preventing boredom at work have also been developed to date. 

The analysis of boredom in the workplace is relevant in productive terms, but also from the point of view of the health and well-being of the workers and those on whom their work depends, especially when it comes to jobs in which community service is provided, such as those in education, military service or clinical practice, to name a few. In this last professional field, boredom in workers has been taken into account as a risk factor in a superficial way. Moreover, in one of its branches, the care of the elderly, the causes of the boredom suffered by the caregivers and the consequences it has for them and for the elderly who depend on them have hardly been studied, and how we can address this problem. In this post I will briefly review the few jobs that posit boredom as a risk factor in the performance of elderly care and caregiver welfare in formal and informal settings.

When it comes to approaching the experience of boredom in the elderly, the focus is usually on the latter, as I explained in my previous posts. There has been talk of boredom in the elderly, but not in their caregivers, and how this boredom in and with the workplace reverses or feeds back into the caregiver's own boredom and challenges the goal of achieving dignified aging. What if those responsible for promoting a stimulating environment for the elderly become bored as well? How does caregivers' own boredom affect minimizing the boredom of the elderly? 

Not only can caregiver boredom lead to neglect of caregiving tasks and experience of the discomfort associated with boredom itself, but it also prevents the elderly from avoiding the plague of boredom. Therefore, it is necessary to return to the study of boredom experienced by caregivers, to know its causes and consequences and to propose prevention strategies to ensure the physical and mental well-being of both parties involved. 

When we talk about the work of the caregiver, we can refer to the figure of the informal caregiver, who usually represents a close relative of the elderly person or an untrained person who is hired to take care of him or her, or the caregiver trained in gerontology and geriatrics who provides his or her services at home or in private and public institutions. In both cases, the provision of care services can have a negative impact on the caregiver's health, known as caregiver syndrome or caregiver overload, whose symptoms have medical, social and economic repercussions. The experience of boredom is present in both situations, but with very different nuances that result in states of dissatisfaction, apathy and hostility, among other mental and physical disorders that, in the long run, affect not only the well-being of the caregiver but also that of the caregiver.

The work of the informal caregiver has always been seen as a discredited job. Perhaps that is why so few studies focus on their experience of boredom. Among the few existing ones, it is shown that this work is mostly done by women (wives, daughters and daughters-in-law), 82% of whom report suffering from stress, loneliness and boredom. It is a job in which one rarely has contact with people other than the oldest person in charge and in which, no matter how hard one tries to accomplish the task, the achievements are barely visible. In addition, when dealing with seniors with special medical needs, caregivers face problems of concentration, low productivity, forgetfulness of responsibilities and boredom that lead them to act impulsively and avoid making decisions due to lack of knowledge about care and confidence in the work assigned. The family caregivers carry out a job that sometimes forces them to leave their private lives, their socialization routines, their hobbies, dedicating 24 hours to care. 

All this awakens the experience of boredom, accompanied by states of depression, demotivation and even resentment: 

I was often bored during my caregiving years. Because we spent so many hours in each other’s company, my mother and I usually ran out of things to say to each other, except for what was immediately necessary […] The fact that family caregivers are more prone to boredom than most people is not due to a lack of interest in the well-being of the people we’re caring for. To the contrary, we put up with long stretches of boredom because we want to make a positive difference. But many of the activities that caregiving requires are less than enthralling.

This is the testimony of clinical psychologist and family therapist Barry Jacobs. For many, informal elder care represents something like being "a prisoner in your own home". No wonder, then, that writer Ivy Bronwyn has described eldercare as "moments of sheer panic when you’re rushed off your feet interspersed with periods of mind-numbing boredom”. 

Some try to keep a positive attitude and motivate themselves by thinking that if they didn't do the caring, no one would; but this only reverses the negative emotions like boredom for a moment. The caregiver's workload, coupled with the monotony of the tasks, soon makes the lack of motivation and boredom reoccur: "It is easy to become bored when you are stuck at home taking care of someone else and not doing things that fulfill your own wants and needs. And by the end of the day, you are often too tired to pursue something of interest to you”, explains social worker and aging specialist Donna Schempp. Someone under the pseudonym NeedHelpWithMom seeks comfort in the experience of others by explaining their ordeal on the AgingCare website: 

Sometimes I get incredibly bored being a full time caregiver. I’ve kind of lost interest in hobbies I used to love. Sick of television. Don’t even listen to my favorite music much anymore. Of course, I do necessary stuff like cook, clean and take care of mom. I’m talking about fun things like jewelry making that I love or other crafts. Anyone else dealing with boredom? Or is it that I struggle with loneliness or even depression?

Caringfor1 answers, "I know how you feel and pray for all of us on this journey. I often wonder if I’m bored, depressed or angry”. NewGirl empathizes with the situation by confessing: "I Became extremely bored at my moms house. And wondered how much longer will she live because I’m getting tired, my mind is mush and I too feel depressed”. 

Only in cases where work is paid do the potential negative consequences of caregiving such as loneliness and boredom seem to diminish. But this is not necessarily always the case, as evidenced by complaints about boredom from trained caregivers working in nursing homes.   

No study has focused on addressing the boredom of nursing home care professionals and how this affects their well-being as well as that of the residents themselves who already experience much more boredom than those who spend their final years at home.

Hossain and Ahmed are two of the first researchers to focus on this issue, albeit superficially. For them, there is no doubt that professional caregivers also get bored of caring for the elderly, “which also compromises the care and assistance needed for the vulnerable elderly”. Before them, Scharlach had already warned that residential care workers were suffering from loneliness and boredom, and Cohen-Mansfield also pointed to the burnout syndrome and chronic fatigue suffered by care workers. Hsu and her team were quick to point out the boredom inherent in performing repetitive tasks in nursing home care. And recently, Rausch warned that this problem would increase as certified caregivers became younger, because accustomed to the fast pace of life and multitasking of the millennials, they would experience much more boredom in a medical field where repetition is a fact of life. 

Boredom is not the only evil for certified and informal caregivers in residences and homes; they are also plagued by emotional exhaustion, dysphoric symptoms, emotional distancing as a form of self-protection, anxiety, feelings of guilt, impatience and irritability, low tolerance for frustration, feelings of loneliness, feelings of alienation, feelings of helplessness, disorientation, experiences of low self-realization and depressive feelings, as indicated by Maria Marleni del Valle Vega. And all this undoubtedly has an impact on the quality of care offered to the elderly. 

It is clear that we all experience moments of boredom in our work, and that in each case the consequences can be more or less harmful to oneself and to others involved, if any. But when it comes to the boredom of caregivers we are facing a serious issue because their performance and welfare also depends on reducing one of the risk factors that most attacks a vulnerable and often dependent population as is the elderly. It is not understandable, therefore, that we continue not to dedicate our efforts to reach a better understanding of this reality and to postulate solutions to the problem it represents.

Some have pointed out that moments of respite for caregivers are essential in managing boredom and stress: "“Without regular periods of respite, caregivers will end up run down, unmotivated, and may even start building feelings of resentment”. But it's not that simple. Breaks from the caregiving routine involve another type of stress related to the fear of forgetting important elements of the caregiving routine such as medication administration. In addition, the moments of respite do not take into account the boredom of the elderly. 

Perhaps Hossain and Ahmed's technology could be the alternative. These computer engineers have developed a care support system based on a virtual caregiver to free human caregivers from work overload and boredom. However, such a system presents two problems: the cost of implementation and the increased levels of boredom and loneliness of the elders themselves who become less aware of their responsibilities. 

Perhaps the bet on Hossain and Ahmed's technology could be the alternative. These computer engineers have developed a care support system based on a virtual caregiver to free human caregivers from work overload and boredom. However, such a system presents two problems: the cost of implementation and the increased levels of boredom and loneliness of the elders themselves who become less in touch with the caregivers. At most, it seems a difficult system to implement in domestic and informal care settings. 

Interventions need to take both sides into account to be successful. According to Thomas, du Toit and Van Heerden, the study of caregivers' perspectives is essential for a process of understanding and joint effort to achieve progress in eldercare practice. They are committed to person-centered care in a broad sense that includes both the elderly and the caregivers themselves and that allows for the creation of a mutually supportive and creative environment. Does this sound familiar?

The good news is that, as I pointed out in my previous posts, there are other initiatives that are less costly and capable of avoiding boredom and other risk factors in both caregivers and seniors, such as The Eden Alternative, The Pioneer Network and The Green House Project. In addition to the benefits that these models bring to the elderly, studies show that they are also capable of reducing absenteeism by 48% and reducing overtime by 50%, which translates into a lower workload and relief from boredom. Testimonials from workers in several nursing homes operating under The Pioneer Network model state that they feel like family, rowing with their elders in one direction and that this makes them want to work there until retirement. There is no room for boredom. Caregivers spend every few months taking surveys like the one below to assess whether they are really getting their work done.

1. Do the directors care about me and my development as a person?

2. Are the directors making it easy for us to go in the right direction?

3. Do I know and understand the mission of this organization? 

4. Are the principals listening to me and taking my opinions seriously?

5. Is my work recognized by my team as valuable?

6. Do I have the resources I need to do my job effectively?

7. Is there a happy atmosphere in the workplace?

The bad news is that these types of initiatives are not widespread globally, so an effort is needed to evaluate their potential implementation in formal and informal eldercare settings and their effectiveness and long-term sustainability as an alternative that can reduce boredom and its consequences for both parties. 

Much work remains to be done. Cultural change is not widespread and these holistic projects need to be publicized on a larger scale. Moreover, although the principles governing these initiatives have been shown to be effective in residential centers, there is little data on how they are applied in informal domestic settings and what their outcomes are. In this regard, we must also lead efforts to better understand the phenomenon of boredom in the informal care setting and conduct studies to explore the application of these holistic models and the evaluation of their results. 

Carrying out this work is now more urgent than ever due to the current global pandemic situation. In a context of self-isolation affecting both caregivers and elders, in formal and informal settings, the experience of boredom is increasing. In homes, the elderly are deprived of the possibility of receiving visits and performing certain activities that involve contact with the outside world and with other people, and caregivers are more limited than ever and subject to strict care protocols; in the domestic setting, many informal caregivers spend more time at home and must combine their care tasks with teleworking. All this is governed by the fear of COVID19.