SECTION H – DELEGATING

H1.  INTRODUCTION TO DELEGATING

If you take on too much, try to be too attentive, you will eventually reach a point where you will feel overwhelmed by the situation. You could become resentful because so many demands are being placed on your time and energy. This is why delegating is so important for all caregivers.

Why do so many caregivers seem to fall into the trap of becoming overwhelmed, over-extended, and burned-out?  There are several possible reasons:

          * Compassion - Recognizing that someone needs assistance.

          * Too few caregivers to share the load.

          * Unforeseen crisis - too few skilled people, too many needing help.

          * Personal inability to say 'No'.

          * Feeling needed - Rescuer/Victim roles; Need to feel indispensable.

For some of the above reasons, it appears that some situations are simply beyond the control of individuals, and can be classified as crisis situations.  This is usually the operational status at the start of an epidemic or a group of people start a caregiver program in an area previously neglected, where there are few people skilled and qualified to deal with the situation, resources are few, and large-scale planning and strategy has not been formulated in advance.  A typical example is in the area of HIV/AIDS, where the rate at which the epidemic is spreading, is faster than the rate at which structures can be put in place to counsel such infected people.

H2.  CAREGIVING vs CARETAKING

Caregiving in Africa is not the same as caregiving in the Western world. The availability of resources in Africa is restricted, in terms of medical technology and personnel, and access to communication facilities, information and training is likewise limited in Africa. Similarly, access to medical aid schemes, subsidized health care, and most of the resources which Western models take for granted, often do not exist in Africa, or are very expensive and out of reach of the average person.

The greatest caregiving resource in Africa - often, the only resource - are the caregivers themselves.  Therefore, caregivers should be treated as a highly valuable non-expendable resource, and cared for accordingly.  For example, to train someone - formally, or informally through hands-on experience - takes precious time and money. When caregivers leave the field of caregiving, they take their invaluable knowledge and experience with them.  Often, the cause for caregivers leaving the field of caregiving is due to burn-out, stress, and the inability to cope with the work-load.  These are usually the result of mismanagement - as an organisation, or personally. It is in this context that delegation - and the other sections of this manual - becomes of crucial importance in sustaining caregiving services over the long term.

Caregiving is about giving assistance to someone who is not presently in a position to do something themselves, typically due to some disease, such as cancer, AIDS, arthritis, altzheimers, etc. Fundamentally, it is a series of actions of giving. When such actions forget to take the larger perspective in mind - the continued provision of caregiving services, which means supporting and sustaining the caregiver as well - caregiving services falter, and eventually collapse.

At a basic level, you can not give what you do not have. You can not give care if you do not take care of yourself.  Delegating means that you ensure that you share resources and responsibilities so that you - and others - can continue to give care, without destroying yourself in the process, which would mean that the care you seek to give, will end at some point.

Therefore, when someone refuses to delegate responsibility, or who refuses to take time out to look after themselves and their own needs, they are not in the business of caregiving - they are performing actions of care with a motivation of taking ... taking approval from others for being so strong and wonderful, taking time away from their families and their own personal life, taking approval from the ill person, taking responsibility and competence away from colleagues, family, friends, and the sick person as well. This is dis-empowering others. This is psychologically based on the need-to-be-needed ... I need to prove things to you in order to feel good about myself, and to get approval from you, as I do not feel I have value in and of myself.  'See how indispensable I am ... You need me ... I am competent, you are incompetence ... I have the answers, you do not'. This is essentially care-taking, not care-giving.

When someone can recognize the value of their own time, they can recognize the value of another person's time. When someone can recognize their own dignity and rights, they can support and recognize another person's dignity and rights.

H3.  OBJECTIVES OF DELEGATION

• Ensuring that the sick person retains the right to choose, until their death, what they need and what they can and cannot do;
• Ensuring that everyone concerned - family and friends, or colleagues - participate in giving care, and learn and grow as a result - this ensure healthy closure occurs for all concerned if death of the person follows;
• That the caregiver does not become resentful of caregiving itself, or the sick person, or other people, which ensures that the caregiver truly gives care, which enhances the sick person, and does not demean them.

H4.  TIPS ON DELEGATING

1. List all current and future needs of the person you are caregiving to. Note the times and days of all appropriate needs.

2. Ask the person you are attending to what they need.

3. Seek practical support, such as a friend who can come by and sit with your loved one so you can get out of the house for a few hours and take care off yourself. Discuss this with the sick person - explain that you do not want them to be totally dependent upon you, as this would leave them in a very difficult situation if something should happen to you.

4. Get someone who can help you with day-to-day tasks such as shopping, laundry, house cleaning, etc.

5. Seek emotional support from friends, social workers, a therapist or your minister.

6. Take care of long term planning, such as legal and financial needs. Tidy up all business matters, including tax.  Ask the sick person what they want as far as medical support and their right to die - do they want life-support machines keeping them alive if they go into a coma ?  Are these choices written down and known to the family ? Inform them that, if they do not make these choices early, and later go into coma, they lose this choice to decide. Arrange the funeral. Plan the service. Do all this in consultation with the person you are taking care of.  Try to keep the family and close friends informed and involved in these issues. Often, these aspects are neglected, especially financial aspects, and getting a will drawn up.  If the person dies without a will, their estate becomes a subject of dispute, which can have serious consequences for family unity, and also financially, as their estate then goes through a long legal procedure before it is finalized. Grieving processes are also likely to be marked with conflict between surviving family members, which is not of benefit to anyone.

7. Brainstorm for all the possible resources in your area. Be creative. Include professional services, agencies, co-workers, club members, churches, friends and family members. Ask others about resources they know of.  Contact these resources and let them know your needs.

8. Be realistic about your commitments and this way you can avoid guilt and disappointment.

9. Assign tasks to your support network. Ensure that they understand that they need to understand that they cannot break an agreement to take care of the person, without sufficient notice so that someone else can be there.

10. Be sure to involve the person you are caring for as much as possible. This also means that they are kept informed of medical aspects and disease progression.

11. Be firm about you own limitations and acknowledges those of other people in the experience.

12. Have regular meetings with your support network to discuss potential problems or challenges that may arise. Keep the support network informed and updated.

13. Try to ensure that the family and friends of the sick person, as well as anyone else involved in the caregiving network, if kept informed about the illness itself, what happens when certain conditions surface, and that it is important to be honest with the sick person.

14. Encourage those people in the support network to be honest about how they feel towards the sick person, about death, and the disease. Do not be afraid to discuss your beliefs about what happens when a person dies - ask the sick person what their beliefs are in this regard. Encourage family and other support caregivers to be open to discuss this as well. If the person becomes delirious, do not automatically dismiss what they say as 'nonsense'. Often, people who are dying give advance notice of the impending transition, and sometimes ask permission, indirectly, to die. Ensure that your personal fears and insecurities do not interfere with the sick person's desire to leave this world. If they ask for permission, give them that permission - it is their right, and part of their dignity as a human being.

15. Share your concerns and encourage others to do the same.

16. Learn to go with the flow. You can't know all the answers. Learn to trust your instincts.

H5.  PERSONAL EVALUATION

1. How do you feel about delegating responsibility for certain aspects of your current caregiving activities?

2. How do you feel about discussing some of the issues, such as your need to have time to yourself, the funeral arrangements, or drawing up their will, with your loved one (or client) ? How would you go about doing this?

3. In your present role as a caregiver, which of the mentioned suggested ways of delegating responsibility do you feel would be most useful to you, at this present stage of your caregiving?