Role Reversal

What happens when a veteran and their caregiver must switch roles? Although it may sound like a simple thing, it can actually cause a lot of stress to all parties involved. In many, if not most, cases there are fairly clear reasons as to why a veteran needs an actual caregiver. These usually stem from some form of physical disability and sometimes from mental or psychological reasons as well. Whatever the case, caregivers usually fill gaps in veterans’ lives, either assisting with or fully doing certain things the veteran is no longer able to do on their own. These challenges are one part of what can make stepping into a caregiving role difficult for some veterans. In situations where the caregiver is either out of commission due to illness or has medical issues that require surgery or hospitalization, they may require their own assistance in doing daily activities such as; cooking, cleaning, getting dressed, bathing, or even walking. In normal situations this may cause a little stress or anxiety, but if you add in the fact that the person trying to fill this role has physical disabilities making doing these things for themselves difficult, now you can see how now having to help someone else do them would be even harder.

The other side of this role reversal can sometimes be just as hard, if not harder, for both the veteran and the caregiver. This is the mental and emotional side. This comes into play because many caregivers are “bad patients.” They are the ones who are used to giving help, not receiving it. They have developed and set their own systems and routines in place that works best for them. Many caregivers have a tough time relinquishing control of things enough to allow someone else to take control of them. This can cause them to want to micro-manage the way things are done while they are unable to do things themselves. Stress levels and anxieties on both sides get raised because of differing views on how and when certain things should get done, minor fights break out because the reversal of roles can feel awkward. The person who usually is the caregiver feels upset because they just want to do things their way, and/or for themselves, but can’t. The person who is now stepping into the caregiver role feels bad or gets upset because they either can’t do a certain task or feel they’re messing up somehow and failing the person who always takes care of them.

So what do we do in these situations? The first thing I would suggest is sitting down and talking about this type of scenario before it happens. Make a plan for all the things you can think of that might make the role reversal easier once you need to do it. If possible, discuss plans on having someone come in to help - at least for the first few days to make things easier. Whether it’s a family member, a friend, or an in-home nurse, having an extra set of hands around can definitely help. It would also help to discuss expectations beforehand so that everyone is on the same page. These few things could help save many headaches in the future.

Written by: Beth King, Veteran Caregiver

Aging with TBI and PTSD

On May 29th, 2004, my husband’s vehicle was returning from an operation in Ramadi, Iraq, when a car bomb was detonated as they passed. His left leg was torn open by shrapnel, taking out most of his knee in the process. After three weeks of wound care, many surgical washouts, and medication, he ended up losing his leg above the knee due to infection. He also sustained a traumatic brain injury (TBI) when blown out of the vehicle and suffers from PTSD.  

I met Jimmy six months after his injury while at Walter Reed, so I don’t have the before-and-after experience that many caregivers do. In the beginning, he showed little to no signs of PTSD, and the effects of his TBI were noticeable, but we had strategies that allowed us to cope and deal with it. Back then, I would’ve never categorized myself as a caregiver. Jimmy was very physically active for the first number of years we were together. He was deeply motivated in his recovery and physical therapy; he would do two marathons in one week on his handcycle and attend other sporting events like the D.A.V. Winter Sports Clinic to go skiing. His PTSD was more situational, along with dealing with nightmares. These were generally managed by simple things like choosing seating arrangements in public places that allowed him to easily monitor his surroundings, and although he had nightmares that made his sleep unrestful, he rarely remembered his dreams once he woke up.  

The social and emotional impacts of TBI and PTSD are usually one of the most difficult parts of daily life for veterans, and their families, when they suffer from these conditions. Jimmy’s mood can change in an instant, going from 0-100 mph (and sometimes right back to 0) because of his TBI and PTSD. Jimmy is a quiet, intelligent, and loving guy who will give 110% to any and all of those he loves and cares for. But, over the years, he has become more reserved, less active, and has become more isolated. He has his moments when he is angry, but mostly, he is very flat – it can be challenging for him to get excited about things. This wasn’t always the case; it was a gradual change over the course of several years.  

It wasn’t until life slowed down during COVID that I started really noticing how different he had become. We had made a multi-state move just before the pandemic, and Jimmy never returned to work with all of that going on. Not having a job and many things being closed to social gatherings only amplified these changes in him. We have now identified these changes, and are working on addressing them through therapy, making friends through the church to be more social with, and putting plans in place to start looking for things to do – either individually or as a family – such as exercising or going to the park with the kids. For both veterans and caregivers, it is important to be mindful of how the effects and symptoms of living with PTSD and TBIs can change over time and what steps are needed to maintain the best caregiving and self-care treatment plans to help ensure the best quality of life for both the veterans and their families.

Written by: Beth King, Veteran Caregiver