While daily living certainly can be stressful, nothing compares to the level of stress faced on a daily basis by caregivers. How can caregivers continue to give their best performance at work with caregiving chores hanging over their heads before, during and after work? How can caregivers concentrate on their jobs under all that pressure?

We know that stress adversely affects employee performance. What we may not know is how things at home affect the ability of employees to concentrate on their work. A family healthcare crisis can create enormous stress for employees, whether it concerns a sick child, an elderly parent or an ill spouse, especially if long-term or permanent care is required. How does the average employee (or manager, for that matter) handle these healthcare situations? Do they come to their supervisor, spell out the details of their domestic obligations and ask for help? Not likely. Most working Americans play their home lives pretty close to their chests. Family matters are considered private. In fact, one of the big frustrations of self-help organizations is that caregivers tend not to self-identify; that is, they don't even define themselves as "caregivers" and thus are not motivated to attend support groups. Outreach is a continuous challenge for such organizations which, in good faith, have the desire and capability to be of help.

Why is caregiving so stressful? Those who volunteer to care for a beloved family member who has become chronically ill or disabled are indeed heroes. They deserve the respect and gratitude of extended family and the community at large. However, the very admirable qualities that make them dedicated and self-sacrificing are the reasons they are vulnerable to stress symptoms and, in extreme cases, burnout. They are compassionate to a fault. They are inclined to give their all at their own expense.

This kind of chronic caregiving is stressful for a variety of reasons:

• Caregiving for someone chronically sick or disabled is often expensive, putting a strain on the family budget.
• Caregiving takes an emotional toll. The personal lives of caregivers are dominated by the elephant in the room; that is, there is no end to what needs to be done for the care recipient, so there is constant pressure.
• The caregiver's needs are not being met; there is no time for play, for rest, for happiness.
• In the case of the ill spouse, the caregiver's pal is not available so companionship and intimacy needs are not being met.
• Caregivers tend to get minimal support from extended family. Family and friends are happy they don't have to make these sacrifices, so they often just stay away.
• Sleep deprivation is very common among caregivers. The needs of the care recipient don't go away at bedtime.

Caregiver Stress Symptoms at Work

Caregivers are under siege all the time. Those who know them well can readily see that something is wrong. Caregiver stress can take the following forms on the job:

• Wandering attention during meetings or conferences;
• Missing deadlines on more than one occasion;
• Periodic tardiness arriving at work;
• Time spent doing computer research on company time;
• Sad or depressed demeanor, diminished sense of humor;
• Slower than normal speech pattern;
• Unusual eagerness to leave work at the end of the day.

Caring for a loved one is admirable, but caregivers typically put their own needs and comfort on hold in deference to the needs of the care recipient. Before it is too late and burnout takes its toll, caregivers need to take inventory of the sacrifices they have made and the stress that is created because important needs (such as free time, reading, travel, companionship, etc.) are not being met. Then they need to make a commitment to make the necessary changes in their routines and find more balance and time for themselves; here are some guidelines:

• Caregivers need frequent breaks from caregiving duties. Find a way to get relief, whether by prevailing on family members to fill in, day-care programs with nursing homes, volunteer organizations, sitting services, or whatever can be arranged. No excuses. Do it today.
• Find someone to confide in, such as a professional counselor. You may tell yourself you don't need to talk to someone, but that is baloney. Caregivers need the kind of perspective that comes from opening up to someone.
• Get more sleep.

What Should the Organizations Do?

All organizations, large and small, private and public, are impacted by the caregiver stress problem. It is estimated that there are in excess of 50 million caregivers--about half of these are caring for a spouse--in this country, so the odds are in favor that some significant percentage of your employees are caregivers. Here are some steps to minimize the adverse impact of home caregiving responsibilities on employee productivity:

• Top management should communicate to all employees that the organization understands that providing care to relatives, children and spouses is part of being a responsible family member. The company plans to provide whatever support is possible to help employees stay focused at work and live a balanced lifestyle.
• Managers and supervisors should receive special training to spot symptoms of caregiver stress. They should be taught how to initiate communication with these employees in a way that will encourage them to open up and talk.
• Human resources managers should be given special instructions and training on how to create workable strategies for helping caregiver employees work out a program that will bring relief at home and restore productivity at work.
• Those at work may be the first to recognize the employee is suffering debilitating stress symptoms as a byproduct of caregiving. If the organization has an Employee Assistance Program, care should be taken to ensure that program makes provision for supporting caregivers in distress. A strategic alliance can be formed with existing self-help organizations, such as the Alzheimer's Association or the M.S. Society. They would welcome the opportunity to cooperate with your organization.

Trained employees are an organization's most important asset and should be treated accordingly. Caregivers are characterized as charitable, goal-directed, hard-working, and productive. The qualities that make them good caregivers also make them wonderful employees. It is in your organization's long-term economic interests to recognize caregiver stress and respond constructively to that knowledge.

David A. Travland, PhD is a clinical psychologist, a former caregiver and the author, along with his partner Rhonda Travland, of "The Tough & Tender Caregiver, a Manual for the Well Spouse." He is recognized as an eminent and ground-breaking organizational development consultant to small, medium-sized and Fortune 500 organizations. Rhonda is a gerontologist, a former nursing home administrator and was a caregiver for over 10 years. They are co-founders of The Caregiver Survival Institute, offering a variety of services to caregivers. For more information: www.caregiversurvival.org, Travland@sickpartner.com.