Advanced Parenting, page 16
Perpetuating this default—that women handle the caregiving work and managing their family’s interactions with health-care professionals—doesn’t do anyone any good. We know that discrepancies in the sharing of household labor can increase resentment and marital conflict—variables that impact parent wellness and, inevitably, child outcomes. Additionally, when children have chronic health and educational needs, data (not surprisingly) suggest that when fathers are more involved, the child benefits—better child adherence to treatment, better child psychological adjustment, and improved health status.7
If you are struggling with allocating labor equitably in your home, some of the skills I’ll discuss later in this chapter like communication and time management will help. But as a first step, I recommend improving awareness of who does what within your household. When you are open about what you are doing—especially if you are frustrated, overwhelmed, or sensing an imbalance—explicit, clear communication is the first step toward making a change. Sometimes more transparency inspires change directly—if your partner doesn’t know how much is on your plate, they may not know when you need more help. Even if it doesn’t motivate change, it can lead to acknowledgment and awareness as more work emerges to be done.8
While we can’t immediately change the broader society or health and educational systems with which we interact, we can change the way our family works. Often time spent in this pursuit—allocating tasks more equitably or more thoughtfully—can have a large positive impact on family functioning. Before we dive into how to optimize your individual performance, consider:
• Do you communicate openly with your caregiving partners about all that you do?
• Do you feel resentment about the balance of tasks within your household?
• If you’d like to change the balance of caregiving responsibilities, what barriers have kept you from this in the past?
Skills to Help Optimize Your Performance
While it may feel odd to think of your parenting and caregiving “performance,” objectively assessing how well you handle the work on your plate may help you to make meaningful improvements. As we discussed earlier, understanding your unique skills, strengths, and weaknesses can help you respond to your challenge in the best way. If you can have the cognitive flexibility to think of yourself objectively, as an employer might think about an employee, how would you review yourself? Some things are going well, and you have some areas for growth. Once you identify these areas, you can change and adapt for the better.
When you think of a job review, the domains offered for evaluation might include some of the following:
• Goal-setting and continuous improvement
• Time-management skills
• Communication skills
• Teamwork
• Organization
• Creativity
• Problem-solving
As you read this list, you probably picked out a few skills you know you already excel at. When you think about improving your performance, you can look at the area where you struggle and seek easy ways for meaningful improvement. If I give myself a low score in time management, making a small improvement might result in substantial found time. You might find different ways to improve your skills, perhaps by reading a book, setting some goals, or asking for help. It could also be helpful to really lean in to what you are best at—using your strengths to support your weaker areas. If you enjoy organization, can you take this skill and apply it to other areas, like communication or teamwork, to improve your performance?
There are a few reasons some parents may hesitate to set goals for their caregiving and home life. One of the most common barriers I encounter is pessimism or learned helplessness. Parents stop believing that things can be better. Hope and optimism are essential ingredients for setting goals. Goals can motivate creative problem-solving and enhanced performance. When someone makes a small positive change, they may see a small positive impact, which provides additional motivation and positive feedback to continue the process of change. But this starts with the bravery and self-confidence to consider that you can improve your family’s experience of whatever you are facing.9
I believe you can make small meaningful changes and I hope you do too. However, as we proceed, let’s keep in mind that your performance is often not the problem, though it may be part of the solution. The health-care and educational systems you navigate are difficult. Our society doesn’t prioritize and protect caregivers. But you have control over your behavior and choices. So, even if this doesn’t fix the underlying problem, it may help.
Skill Building—An Incentive
Gloria immigrated from Mexico and only spoke Spanish. When I first started treating her children, I experienced some difficulty in our communication. I knew some Spanish, but her regional accent was thick, and her specific dialect used a lot of local colloquialisms that made it hard for me to comprehend. We used a telephone-based translation system, through which we connected with four translators from her region who could help, but when they weren’t available, communication was difficult.
Even with adequate translation in place, Gloria was not familiar with the American health-care system. She wasn’t sure how or when to access emergency services, and she had never worked with a pharmacy before, and her children’s health suffered as a result. These barriers were not reflections on her intelligence, but gaps in her skill set and experience.
She knew she had to remedy the situation. She signed up for English language classes and frequently reached out to social workers for help accessing health care. Over time, she mastered English and gained medical fluency, and once her children were plugged in to care, Gloria used these skills to find paid work as a medical assistant.
Nothing about this was easy. Gloria hardly had the time, money, or childcare she needed to make this commitment. But she found a way, because she knew it was important to her family. The resilience caregiving parents exhibit is inspiring. While we think of our children as works in progress, sometimes we forget that adults can also change their habits, tendencies, and abilities.
Time Management
As a cancer survivor, despite being in good health, I have half a dozen health maintenance appointments a year. Keeping track of this requires a substantial amount of energy, particularly when circumstances in my life change—a new job schedule, a new health insurance carrier, or moving to a new address. Some of these specialists are in different hospital systems and don’t communicate with each other. Some of the tests require prior authorization from insurance, and even when this is obtained there are at least a few bills per encounter. While I’d like to rely on my own primary care doctor to organize and execute this maintenance plan, in my early thirties I finally realized that ultimately, I cannot evade responsibility.
Accepting the scope of the responsibility was an important “aha” moment for me. I did the mental math with a certain number of appointments a year, each requiring a specific amount of time scheduling, traveling, and following up, and the final number was not one I was happy about. Only then, when I realized the total impact on my life and my family, how this work eroded time for the other things I wanted to do personally and professionally, did I commit to minimizing the unnecessary time.
This first step to creating a solid time-management plan is to understand what you are already doing and what you need to be doing. To accomplish this goal, you can start by tracking every task you complete during the day or how you spend every minute of your day. Many caregivers decrease their paid work to accommodate their caregiving responsibilities, but doing so does not mean their time becomes less valuable. Your time has value, so considering how you spend this valuable commodity is important.
Being selective and intentional about your time is an important part of improving your family life. At times you may need to compartmentalize some of your caregiving. Perhaps your other child needs your attention in a particular week, or you need to focus on your career, and you aren’t able to devote the usual amount of time to caregiving. This may go against our instincts as parents, who often want everything for our children right away, but more often than not, you can put off some concerns and, in doing so, lighten your load.
As you look critically at how you spend your time, consider the following:
• What is the most important thing you do all week?
• Is there one thing you can just stop doing?
• If you had more time, what would you do with it?
• What are three ways you spend your time that bring you joy and you want to spend more time doing?
• What are the three things you do that you hate doing and wish you could eliminate?
• What are the factors (financial, practical, relational) that keep you from changing the way you spend your time? Are there any that could change?
Barriers to Intentionally Spending Your Time
When you take a critical look at how you are spending your time, you need to investigate what your priorities are. Why do you want to make these changes? What areas need more attention: your child’s caregiving, the siblings or other family members, or your own well-being? When you break down how you are spending your time, you’ll identify some items that you enjoy and value in your week, things that spark connections with loved ones or inspire your creativity. Before eliminating those tasks, ask yourself what it is you enjoy about them. Some self-awareness may help you identify more ways to increase joy.
You’ll also find that you’re using your time on things you didn’t expect, such as spending more time than you realized on social media or watching TV. Some of this may be purpose-driven, or for relaxation or connection, but some of it may be filler. Some of us may find that we spend a lot of time doing things that we do not enjoy and that we are not particularly well suited for.
In her book 168 Hours, Laura Vanderkam discusses options for clearing your calendar and recommends ignoring and minimizing these undesired tasks. Sometimes we find ourselves doing things, even time-consuming things, but when we think critically it doesn’t have to be that way. Just letting a task go completely can be best. Early in the COVID-19 pandemic, my nurses were photographing and uploading each COVID-19 test from patients for record-keeping purposes. As we got busier and I took a closer look at our workflow, I realized we could stop documenting photos and simply write the result in the chart, saving time without sacrificing quality.
To minimize the time you spend, sometimes you can constrain time spent doing something into an allocated block—for example, set a limit for time spent scrolling social media or watching TV. Batching tasks can help reduce the time spent too. Rather than responding to each medical bill or insurance correspondence that comes in the mail immediately, allowing them to accumulate (within reason) and sitting down to handle several at once may be more efficient.
Other items that can’t be minimized or omitted may be able to be delegated or outsourced to use less time. While many parents think of outsourcing as a luxury out of reach, remember that sometimes you can outsource or delegate within your family without an additional financial cost if you have a co-parent, a sibling, a grandparent, or a neighbor who may be willing. Some children with disabilities or dependence on medical technologies can qualify for home health aids, personal-care aids, or skilled nursing at home through their insurance or through Medicaid waiver programs. If you think your child might qualify for this type of assistance, ask your child’s physician or a social worker for help.
However, even if you can outsource, you still must dedicate time to planning, coordination, and supervision. In addition to the financial barriers to outsourcing, sometimes relatively benign, well-intentioned thought processes interfere with making good decisions about which tasks we own versus which we delegate. If you can identify these cognitive errors, you can redirect your thoughts. For example:
• “It’s on me as the parent.” Some parents feel shame or stigma in asking for help, as if needing help indicates you are less capable or dedicated. To the contrary, I often feel impressed when I see a parent identify a possible need for their child and fill it.
• “I do it better.” Often caregiving parents feel when their child is ill or suffering that there is no acceptable substitute for their presence. Sometimes this may be true, but often there are other loving adults willing to support your child. The largest barrier to delegating to these individuals is not their competence but your trust. Sometimes parents truly are better, but for some less-essential tasks, it’s also possible that someone else doing it imperfectly would be better than you doing it perfectly and suffering.
• “It’s easier for me to do it.” Especially when we are used to things being done a certain way, this is often true in the short-term. But for tasks that will require a long-term commitment, you do stand to accrue a long-term benefit by investing the time required to train someone else and delegate. Imagine cleaning up after dinner or packing a bag for school; it may take months or years to teach your children to do these tasks reliably, but once they do, they have gained a skill and you have gained daily assistance.
As you consider the structure of your workday as a caregiver, one of the most obvious ways in which a parent differs from a paid employee is break time and leave. Few parents protect their need for a break—a meal, a shower, or chat with a friend. You can’t ever truly be off duty as a parent in the same way as with paid work. But we know that vacation, rest, and leisure make employees more effective, and you deserve these benefits too.
Later in Chapter 7, we’ll talk more about how we balance care between co-parents and delegate some of these tasks to your co-caregiver or other people in your life. While there are many barriers to successfully assigning these tasks to others, frequently it becomes a necessity.
Communication: Teach-Back
As we’ve discussed, most children have a team of people involved in their care—teachers during and after school, therapists, babysitters, and family who aren’t always involved day to day. Even when children aren’t facing challenges, keeping everyone informed can be a time-consuming task—what does your child want to eat, what’s the routine for sleep, what do they wear are all essential pieces of information constantly changing. When a child is facing a challenge, the quantity of information and the essential nature of the information multiplies—medications, therapies, appointments, doctors’ phone numbers, emergency plans, and supplies. If there were a time when you could fully train everyone and just be done with it, that would be one thing, but a child is always changing and so is their plan.
Informing family of a plan to give medication or to pick a child up from a certain address a certain day can be seem straightforward, but many challenges involve care plans that can bring up individual opinions, values, and beliefs. Diet, discipline, use of medication, making a big deal out of something, or maintaining vigilance about a safety plan are the type of issues I see frequently cause drama between parents and other members of the care team. Fear of judgment and stigma can become barriers to communication. Communication about other conditions such as mental health, disabilities, or genetic conditions can similarly be more complicated to discuss openly, especially with many stakeholders.
As a caregiving parent, you’ll find that you know more about your child than anyone else does, sometimes even more than your medical or educational team does. But there will be times when others are caring for, teaching, coaching, or supervising your children. To effectively quarterback your child’s care, you have to share your knowledge with others productively and keep them updated over time. An essential part of this is to build in time and opportunity for communication. When you leave a meeting with a teacher at the school or a physician in a clinic, it’s a good practice to consider not just what you need to do, but who you need to inform about the conversation. You can also consider regular meeting times to solicit feedback from other caregivers on how things are going. When you listen to these other important people in your child’s life, you can learn important information to improve your child’s care plan. You can also share important updates and priorities for their time with your child.
It’s essential for parents to be thoughtful about minimizing errors and maximizing understanding. The Agency for Healthcare Research and Quality (AHRQ) has developed a “Health Literacy Universal Precautions Toolkit,” which is designed to help medical providers communicate more effectively with patients. Their data show that only 12 percent of individuals receiving instructions from their provider understand them. The education level of the individual is only one of many barriers here; often, health professionals use jargon and convey complex topics quickly—particularly when emotions are high, or an individual is not feeling well or focused. Similarly, when you communicate between a caregiving parent and another family member or paid caregiver, there may be a misunderstanding.
To tackle this problem, one of the tools the AHRQ promotes is called “teach-back.” Teach-back was designed for health-care providers to use with their patients, but this tool can be used by caregiving parents when they are communicating their child’s care plan with others. You are now the expert in your child and you are instructing others, so using similar techniques makes sense. Teach-back involves asking the receiver of information to explain what they’ve just been told. The goal isn’t to test their verbatim recall; if they repeat your words back to you, that doesn’t mean what you said was understood. The goal is to see how they have interpreted what you’ve said.
