Summer 2024 Issue

When Care Providers Are Caregivers
By Sue Coyle, MSW
Social Work Today
Vol. 24 No. 3 P. 10

Social workers face an uphill battle toward self-care.

When Kayleigh Summers, LCSW, PMH-C, owner and founder of Hope Perinatal in Downingtown, Pennsylvania, gave birth to her now 4-year-old son, she and her husband were working and living at a boarding school. “The way that a boarding school works is it’s the triple threat model. You have to teach, coach, and do something at night twice a week. When you are on at a boarding school, you are on 24/7,” she explains. Summers was not a teacher, rather a counselor, but did adhere to the same expectations.

The school did and does have a maternity leave policy that allowed Summers to take the time she needed to recover after giving birth. However, “We were living in a dorm.” She was literally surrounded by her work, and when she returned from maternity leave, she was back to the boarding school schedule, as her husband had been the whole time. “We were there until [our son] was 3. It was exhausting.”

Summers’ experience may be unique in setting, but the reality (and the exhaustion) of trying to manage the requirements of a direct service job with caregiving at home is not unlike that of many social workers throughout the country.

Social workers everywhere are providing care services to clients as therapists, school counselors, case managers, and more before going home to care for their children, parents, partner, siblings, or other loved ones. For them, finding the right balance between work and home is tricky. Add in self-care, and it’s nearly impossible.

Social Work Today spoke with four social workers who are people-facing at work and caregiving at home about the challenges they face, the choices they’ve made, and how they keep track of themselves through it all.

Challenges
It’s no secret that social work is a taxing career. Rates of burnout and turnover are consistently high throughout the profession. For example, a 2015 study of frontline social workers, most of whom had been in the field for more than six years, “found high levels of emotional exhaustion in the majority of respondents (73%) with one in four (26%) reporting high levels of depersonalization, which describes the process of becoming emotionally hardened toward service users.”1

Similarly, caregivers of all kinds experience high rates of stress and overwhelm at least in part because of their caregiving. The Family Caregiving Alliance cites that “More than one-fifth (22%) of caregivers are exhausted when they go to bed at night, and many feel they cannot handle all their caregiving responsibilities,”2 while a survey by the Everyday Health Group in 2022 found that 68% of moms report experiencing anxiety.3

Social workers who do both—work on the front line and care for someone at home—are then faced with trying to find a balance between two things that can be both rewarding and draining. As Joelle Pitts, MSW, LCSW, an emotional support counselor at a Bucks County, Pennsylvania, high school puts it, they’re often left with “zero time for self-care” but plenty of time for guilt and worry about not doing and being enough in either setting.

Pitts, for example, works on a strict school schedule and, as a result, is unable to be physically present for all of the activities that her three children have at daycare and in elementary school. “When there’s a Halloween parade or the other events that happen during the school day, it’s really challenging to get there,” she says, adding that she feels pressure not only from the school and her peers but from her children, as well, to show up even when she can’t.

Boundaries
A pivotal part of managing this balancing act is setting boundaries at work and at home—boundaries that may not have seemed necessary before caregiving began.

“When I started practicing direct care, I wasn’t married. I didn’t have children. I worked late evenings. I worked on Saturdays to supplement the work I was doing in the nonprofit space,” says Elizabeth Burke, LCSW, founder of Empowered Therapy in Chicago. “Then, when I got married and got pregnant with my daughter, even through that pregnancy, I had to set up boundaries with my schedule. After she was born, my schedule was totally changed.”

Of course, not all social workers are able to adjust their schedules to align with their caregiving needs. Many organizations, such as schools, have set requirements and expectations for their employees in regard to hours, even those with flexible schedules. However, setting boundaries on overextending one’s time, as Burke did, can be helpful in avoiding burnout, as can finding ways to truly delineate between work and home. Whether a schedule is ideal or not, it’s vital that social workers find opportunities to decompress as they shift from professional to personal and vice versa.

For Megan Tavares, LICSW, PMH-C, owner of Peace & Pearl Wellness and Counseling, the transition from work to home—even when they’re in the same physical space—is vital. “When I worked outside of our home, I’d at least have some opportunity to transition while on the way home, or if I had some time before I needed to pick up my boys, I’d get a Dunkin’ iced coffee and park in a random parking lot just to catch my breath from the day,” she says. “On the days where I didn’t have the opportunity to transition, I noticed I had very little patience for my own boys and often had strong, sometimes outsized reactions to things they’d do because I was tired, overstimulated, and knew I still had dinner, bath, and bedtime to get through.”

Now that Tavares is working from home, she’s made sure to assess her schedule and approach it in a way that allows her to have some downtime before and after her children are home and/or in the evenings.

Similarly, Summers is very conscious of creating the space to be present for her work obligations, as well as her son, and even has what she calls partner meetings with her husband to determine when she needs to be focused on work and when she can be 100% on at home. “For us, it’s about sitting down and planning and being very purposeful instead of just letting life happen to you. It’s about sitting down and saying this is when I am turning off my professional hat, and there are no ifs, ands, or buts about it. There are times when I am burnt out, I am overworking, I work into the night, and I feel guilty. I’m not perfect,” she says, but it’s being aware of the boundaries she wants to set and planning them out that helps her get through those times and find more balance.

Additional Self-Care
Boundaries and balance between working and home aren’t the only answers. Social workers still need to find time and ways to care for themselves. That can come in many forms, but one of the most important things is accepting that perfection is neither achievable nor the goal.

“This is actually something we’ve been talking to our 8-year-old about recently, as he’s a goalkeeper for his travel soccer team—the need to recognize perfect doesn’t exist and that we can actually make more mistakes when we’re striving for perfection. And it’s funny because I feel like this is a lesson I’ve learned through being his and his brother’s mom I wouldn’t want them to ever feel the need to be perfect, so it’s really my job to model being able to tolerate making mistakes or being okay with being myself without trying to fit into this cookie cutter version of what a mom should be,” Tavares says.

“The other interesting thing about this,” she adds, “is that there is a definite parallel between letting go of perfection in my parenting and letting go of perfection as a therapist. When I first started my practice, I was so nervous about getting it right; I think I lost who I was as a therapist for a bit.”

Once social workers allow themselves to be less than perfect, it can be easier to identify opportunities for self-care. Those opportunities may not be plentiful, and the self-care may not be at the level one might hope. But that’s okay. Don’t discount the little things, Pitts says. Bubble baths and a good book may be the clichés of today’s self-care conversations, but that doesn’t mean they aren’t helpful.

“Cut out the time for yourself, even if it’s a little tiny thing here and there, like last night. I had lost all patience, so I finished a podcast and took a 10-minute walk after bedtime. It can be as simple as being intentionally mindful in the moment. If you ordered your favorite food, don’t eat it and scroll on your phone. Just eat it. Take the moment,” Pitts says. She even works moments of self-care into her professional life, finding ways to take walks around campus with students when it’s nice out or taking her groups to the gym to work their energy out when possible.

Employer Considerations
If, even after attempts at setting boundaries and finding self-care, there’s still not enough bandwidth for a social worker/caregiver, choices may need to be made. Often, those choices revolve around employment—the type, the organization, and the level of commitment.

Some employers are keenly aware of the commitments their employees have outside work, whether or not those employees are caregivers, and work to help them feel and be supported. Burke, for example, says that she has shifted her perspective on how her practice can accommodate its staff. “At first, when I started Empower, I decided we weren’t going to have part-time staff. But as people’s lives changed, we decided we wanted to support them in the way that I would feel supported. Now, we have part-time staff who can really create their schedules around their childcare needs. We have people who come to us and say my life is changing, and I need A, B, or C. If we can make it work, we do.” After all, she stresses, “Healthy staff, healthy practice.”

But not all employers are like that, and even organizations that say they are or try to be family friendly don’t succeed all the time. It’s easy to lose sight of the person providing care when the bottom line is prioritized. In those instances, many social workers have had to decide if they can stay at a place of employment while also caregiving. Sometimes, the answer is no.

Pitts, for example, was working at an emergency shelter for youth when she had her first child. By the time she had her second, she’d decided to move on. “I was always available to [the shelter]. I was always anticipating a phone call. When I had my first, when I was waking up at night—when she would cry and wake me up—I would grab my phone. I did that forever. Every time she woke me up, I would check on the shelter. I made the decision to leave while on maternity leave [with my second] because I felt that I was barely surviving it with one kid.”

Now, at a school and with three kids, Pitts says there are still downsides. She’s able to go home and leave work at work at the end of the day. She has the summers off, but as aforementioned, she doesn’t have the flexibility of time she did at a nonprofit. She can’t leave for an hour for a doctor’s appointment, and her time off during the school year is limited, for instance.

Systemic Changes
It should be noted that everything that’s been described thus far may sound simple, but it’s not, and it’s not available to all social workers. Leaving a job, for example, can take months, if not years. In that time, persons caring for an ailing parent might reach the end of their caregiving. A child may reach a new level of independence. Quick fixes do not exist for social workers who are caregivers at home or social workers at all. A part of the reason for this is the way society views social workers as well as caregivers.

“I think there’s something to be said about female dominated workforces that are underpaid and undervalued and told that they should just be happy that they’re helping people. They don’t need good pay because they should be happy that they’re helping people,” Summers says.

Pitts adds, “If we don’t find ways to actually sustainably support social workers, the field itself is in trouble. It’s a field with lots of women who are likely caregivers in some way. If you want people for whom [social work] is really their passion, you have to find balance. And if those people aren’t well and don’t feel cared for, how are they going to care for other people?”

The responsibility for self-care cannot be all on the social workers who are trying to balance their careers with their family obligations. It also rests on a system and a profession that, thus far, has struggled with the challenge of supporting them.

— Sue Coyle, MSW, is a freelance writer and social worker in the Philadelphia suburbs.

References
1. Cooper J. Exhausted social workers on the edge of burnout but still achieving positive change. Community Care website. https://www.communitycare.co.uk/2015/07/14/social-workers-on-the-edge-of-burnout-but-still-achieving-positive-changes/. Published July 14, 2015.

2. Fordyce M. Caregiver health. Family Caregiver Alliance website. https://www.caregiver.org/resource/caregiver-health/. Published 2006.

3. Hoskin MN. Moms are feeling more anxious and burned out than ever, even as the pandemic recedes. What to Expect website. https://www.whattoexpect.com/news/first-year/survey-moms-feel-more-pressure-pandemic. Published October 12, 2022.