Parents usually dream of the day they can sit back and enjoy their grandchildren, not take the lead in raising them. Yet more often for reasons ranging from parents work hours to their substance abuse issues baby boomers find themselves as primary caregivers for their childrens offspring. The responsibility can increase stress for these older adults at a time when other health problems may exist. But pediatric nurses say the right resources can help grandparents meet their grandchildrens healthcare needs without neglecting their own.
Parenting the sequel
Six out of 10 grandparents served as caregivers to their grandchildren over a 10-year period (1998-2008), and of that group, 70% offered care for two years or more, according to a 2012 study from the University of Chicago. The study echoed the 2010 U.S. Census, which found that 2.7 million grandparents are primary caregivers that meet most of a childs needs, compared with 2.4 million in 2006. African-American and Hispanic grandparents are more likely than Caucasians to head a household in which the childs parents are not present, according to the study.
According to the National Committee of Grandparents for Childrens Rights, the top five states with the largest number of grandparents reporting that their grandchildren live with them are: California, 295,000; Texas, 257,000; Florida, 147,000; Illinois, 103,000; and Georgia, 93,000. The socioeconomic changes affecting society today are a major reason some grandparents are stepping into the parenting role, according to Susan Neville, RN, PhD, associate professor and chairwoman of the nursing program at the New York Institute of Technology School of Health Professions. In many families with young and school-age children, both parents need to work to meet family needs and, as such, require child care arrangements, she said. Infant and child care is costly, budgets are stressed to the max and many families simply cannot afford to pay for child care.
Parents rely on relatives, especially grandparents, for child care, often when the parents work schedules are hectic or they have safety concerns and prefer to leave their children in the care of family, Neville said. Grandparents also may get custody of grandchildren if their parents passed away or became disabled, are struggling with substance abuse, were abusive or neglectful, or are incarcerated.
Compounding the stress of these older caregivers, 60% still hold jobs, according to the University of Chicago study.
Special needs equals more care
When a child is sick, grandparents serving as primary caretakers have a worry burden that is doubly high, said Laurie R. Rome, RN, BSN, BA, NCIII, a pediatric oncology nurse at Johns Hopkins Childrens Center. They worry for their kids and their grandchildren.
Anna Walbert, RN, CPHON, also a pediatric oncology nurse at Hopkins said that when she knows grandparents will be very involved in a childs care, she works with a social worker to get all the legal documents in place, so they can sign consent for treatment when necessary. Even if they are not the primary caretakers and they are just in the room, I like to make sure they know whats going on because it takes the pressure off the parents, Walbert said.
Debbie Baber, RN, MSN, PNP, director of clinical operations for Central Virginia Health Services and a pediatric nurse practitioner, suggested grandparents get written permission from the parents so that, in the event of an emergency or when taking the child for routine care, grandparents have the authority to give permission for appropriate healthcare services. Grandparents should be aware of the childs medical history and family history on both sides.
But in many cases, the grandparent may not know much about the child beyond their own family history, she said. Healthcare providers can work within the constraints of whatever information they are given, Baber said. We provide the best care we can with the information at hand. If an emergency does occur and the grandparent does not have legal guardianship, the practice site may allow the grandparent to act as the locum parentis, or parent in place, to give permission for treatment.
RNs in home care frequently come across grandparent-run households. We do see a good [many]grandparents that are becoming primary caregivers as a result of [Department of Social Services] referrals, or if their child has special needs and they need to help a young mom, single mom or working mom with the family, said Dawn Baker, RN, co-owner and director of healthcare services for Interim HealthCare in Charleston, S.C., which provides home and hospice care. The moms must work, so the grandparents are typically in a better place to care for the child, or they may all live together.
Special-needs children require extra resources, which traditional insurance may not pay for. If your child has a feeding tube, what do you do? Baker said. You cant get a teenager to watch your child. You need someone you trust implicitly.
Baker said her companys pediatric nurses will refer grandparents to the Medicare waiver program, which is for medically complex children, and provides funding for skilled nursing services in the home.
For children who need to be kept on a well-care schedule, RNs can help by supplying grandparents with information pertinent to that visit and to the next age and developmental stage, as well, said Baber. You can get overloaded with too much information so we encourage phone calls for questions or concerns.
Pediatric nurses must be patient and choose their battles with grandparents who learn that practices for maintaining a childs health have changed since they raised their own children, Baber said. You have to establish a relationship with the caregiver to build up trust, she said. Change will not come about unless the person is willing to change. You can encourage, give good clinical information at a level they can understand, avoid medicalese, and be willing to compromise as long as it doesnt hurt the baby.
While children may miss their parents, grandparents who provide a stable, nurturing environment filled with love and trust will help the children cope with what comes their way, Baber said.
Taking on the parenting role can have health consequences for grandparents, as they often spend less time taking care of themselves, studies have found. At this stage of their lives, many have been managing their own health, appropriately following a set routine of self-care and healthcare practices, Neville said. A change in their routines, such as being responsible for full- or part-time care of their grandchildren, often places additional stress on their own personal time and healthcare management.
Grandparents may find they no longer have the time to exercise, socialize and make it to their own healthcare appointments. Those who care for children five days a week or when parents work shifts face even more stress, as it requires more energy and sometimes altering sleep patterns. Their needs and self-care practices are neglected as their primary focus becomes the care of their grandchildren, Neville said.
Kristen L. Straka, RN, DNP, CPN, vice president of the Society of Pediatric Nurses, said grandparents can tap into community-based services to gain the help they need to care for themselves. Resources to support grandparents are available, Straka said. Most pediatric hospitals include grandparents in the classes offered to caregivers, she said. Support groups, nurse-call triage and advice hotlines are among the resources provided by the nursing division and family support services, she said.
In the inpatient setting, grandparents are brought in and taught how to care for the pediatric patient at home, which may include a review of medications and medical equipment the child will need, Straka said. Validation of the competency of the grandparent is demonstrated through hands-on techniques…as well as verbalization, she said.
To help grandparents, classes in the community are expanding to provide greater resources such as well-child classes, CPR classes and first-aid classes, she said. Whether a child is born healthy or with health challenges, or develops health issues later on and their grandparents often seem like the likely source for help. We see a lot of grandparents stepping in and doing the right thing and helping to take care of the grandchildren, Baker said. Thats the wonderful part about family.