One of the most frequent concerns I hear from caregivers is how to deal with a care recipient who never wants his or her caregiver out of sight. This can be a real challenge for caregivers who need to work, take care of other family members, or just have a little time to him or herself. It is also often hard for caregivers to tell the difference between helping and enabling a loved one.
Most family caregivers have two main questions: What is the root cause of an elder's clingy behavior? and, What's a caregiver to do about it?
First, it is important to sort out which of the following 5 situations best describes the dynamic you face:
- Puppy: This individual is perfectly safe and has no behavioral disorder which causes him or her to become overly anxious when left alone (or with another friend, family member or paid caregiver), but prefers that you be around all the time. If you're dealing with a puppy, the best technique is training—also known as behavior modification. Try to have a reasonable conversation with your loved one and explain why you can't be with them every minute. You can negotiate and offer rewards for desired behavior. It sounds simple, but as with a puppy, it is helpful to give choices and let your loved one pick from among different alternatives that you're okay with. Sometimes, you will just need to go and do your thing. Try to stop feeling guilty about leaving them alone. If they protest, just know that they'll get over it eventually.
- Nervous: This person is safe but tends to panic when they are left alone (or with another caregiver). Sometimes this is due to behavioral issues which may or may not be related to their main conditions. If your loved one is nervous, the situation is more complicated, especially if they suffer from an anxiety disorder. In this case, it may be best to seek help from a mental health professional. These providers can offer techniques, such as cognitive behavioral therapy, to help alleviate an elder's anxiety. Your care recipient's need to have you close is very real to them and no amount of reasoning will change their experience of the fear of not having you close. In this case, it is important to find ways to help your loved one feel safe when you can't be around, but don't expect them to just deal with the situation on their own. Unlike the puppy who will bark, the nervous care recipient may have a full blown panic attack and hurt someone.
- Learned: This individual has had a real life bad experience in the past when you weren't around. They are clingy because they are afraid it will happen again. For a loved one who has learned that when you're not around bad things can happen, you have to acknowledge the reality of their fear that it could happen again. If you can help them to understand that they are clinging to you because of past experience, it may be possible to create safety nets that allow them to relax and let you go. For example, an emergency alert system might do the trick, or phone calls at agreed upon intervals.
- Oblivious: This person is unaware that they are clingy and thus can't change their behavior or expectations. Perhaps the saddest situation is a loved one who is oblivious to the fact that they are constantly clinging and demanding your presence. This is often the result of dementia or other neurological or psychiatric disorders, but can occur with any type of serious illness. This loved one has either lost the cognitive ability to recognize that their behavior and expectations are unreasonable, or they are so wrapped up in their own pain and suffering that the result is the same. In this situation, your best bet is to grit your teeth and do what you need to do, without taking anything your loved one says or does too personally.
- Manipulative: This individual is well aware that they are not at risk, but they simulate a panic reaction or some related tactic to keep you close at hand. The manipulative family member is the toughest customer of all. In this case, your loved one knows exactly how to push your buttons and does so for his or her own gain. A caution: try not to be too quick to conclude that this is the explanation for your situation – make sure that you consider all of the other reasons first. Certain dementia behaviors can seem like manipulation, but there is often a simple way to handle a clingy loved one situation, either by working with them, or wrapping your own mind around the circumstances and changing your understanding of what's going on. So many caregivers become frustrated and assume that their loved one is being manipulative when in fact it is really one of the other scenarios. If you are convinced that you are being manipulated, then it is up to you to decide that you're not going to fall into the trap anymore. You're unlikely to be able to change the manipulator's behavior, so your only option is to change how you allow yourself to react.