Grandfamilies: the Health Challenges of Raising Grandchildren

Michael O. Schroeder
U.S.News & World Report

With an opioid abuse epidemic raging, many children of parents addicted to prescription painkillers or heroin, or whose parents have died from overdosing on the powerful drugs, are now being cared for by their grandparents. That's contributed significantly to a rise in so-called grandfamilies: As of last year, 2.9 million children in the U.S. were living with grandparents who were responsible for their care, according to a report from the Pew Charitable Trusts' news service Stateline. That's up from 2.5 million in 2005.

There are many other reasons a grandparent may end up needing to be a full-time caretaker for a grandchild, too. They include parental death from any cause, incarceration, mental illness, physical illness, divorce, homelessness, military deployment or having teenage parents, says Jaia Peterson Lent, deputy executive director at District of Columbia-based Generations United, a national nonprofit that seeks to improve the lives of children and older people, with an emphasis on connecting the generations. "There are also cases where parents need to move elsewhere for employment but do not have resources to bring the children with them," she says.

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The Loss of a Parent

While some children experience the permanent loss of a parent though death, many others suffer trauma and loss in another way: They've lost access to their parents in their day-to-day lives for reasons ranging from imprisonment to addiction, says Susan Neely-Barnes, a professor and interim chair of the department of social work at the University of Memphis. Often, children dealing with the difficult transition face mental health challenges, such as depression, anxiety and substance abuse. "The grandparents are taking on more responsibility than what we as biological parents have to deal with often," says Neely-Barnes, who has studied the health-related quality of life impact of grandparents taking on a custodial, or parenting, role.

Grandparents are also often grieving the loss of their own adult child -- or the life they'd envisioned for their son or daughter -- Lent says, and struggling with having to forgo the traditional grandparent role. "Whenever you envision a grandparent, you get to spoil a child, you get to provide the cookies and the candy, not be the disciplinarian," she says.

The demands of parenting can take a toll on grandparents' well-being, according to research on custodial grandparents. Custodial grandparents experience increased stress and depression, compared with non-custodial grandparents, and physical health problems as well, Neely-Barnes says. "For most relative caregivers, kinship care is usually unplanned, it's in a crisis and it's by default," says Joseph Crumbley, a family therapist in private practice specializing in kinship care who is based in Philadelphia, since the birth parents aren't around or able to take care of their children. That can lead many relative caregivers to feel overwhelmed, Crumbley says. While grandparent caregivers are usually under age 65, they're still older than typical biological parents, so the physical and mental rigors of parenting can be harder to handle, he adds.

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A Healthy Family

The range of stressors ranges from financial difficulty to housing concerns -- is there enough space for a child? -- and challenging relationship dynamics with parents can add to the strain, Crumbley says. To lessen the burden, experts advise grandparents take the following steps to preserve their health, while improving their ability to care for a child:

Be open in discussing challenges. Some grandparents may be embarrassed to acknowledge that they're taking care of their children's children, says Carolyn Graff, chief of nursing at the Boling Center for Developmental Disabilities at the University of Tennessee Health Science Center in Memphis -- such as in circumstances where a grown child is incarcerated or facing other potentially sensitive issues. But by acknowledging it, she says, grandparents can more clearly communicate their needs.

Find support and get answers. You may find family or someone you're just getting to know who's also raising a grandchild provides a sympathetic ear and helpful counsel. "There's a wonderful network of support groups across the country of other grandparents and other relatives that have stepped into this role," Lent says. Connect online, or for local options to access grandfamily support groups, call Generations United: 202-289-3979. In some states, you can also access kinship navigator programs through which caregivers can connect with advocates, such as a social worker or trained case manager, who provide relatives caring for children with information, resources and referrals to other experts. This can help in navigating an array of areas, from making health care- and education-related decisions to understanding the implications of having legal custody, or not having custody, of a child. Generations United provides a list of kinship navigator programs.

Access financial resources. Grandparents and other family can serve a critical role in caring for kids when parents aren't able to. But caregivers often neglect their own needs to take care of the child, Lent says. When children come into the care of relatives, along with chronic stress and depression, some relative caregivers experience physical illness that goes unchecked, like high blood pressure, she says. Particularly when money and time are tight, grandparent caregivers are more likely to forgo filling prescriptions or seeing the doctor, says Graff, who's done research on custodial caregivers. Experts say that makes it all the more important that they access available support and financial resources, as needed.

In some instances, where a child has been removed from a parent's custody by the state, a relative may consider applying to become a licensed foster parent for the child -- though that's not an option in all states. "It's an extensive process," Lent says. But those who are licensed foster parents receive a foster care payment to help with the cost of caring for a child, as well as getting connected with support services, while agreeing to state involvement, like home inspections. In the majority of instances, grandparents caring for grandkids do so outside the formal foster care system. Those in financial need may consider applying for community support or Temporary Assistance for Needy Families; though significantly less than foster care payments, this governmental funding is available in all states. "Some states take the relative's income into consideration," Lent says, regarding TANF funding. "Most states, however, provide the 'child-only' grant, which does not consider the relative's income."

Talk to your doctor. Whether you've put your health on the back burner or are concerned you can't afford your own pricey medication given the high cost of caring for a child, Graff recommends telling your health provider about your role as a caregiver. That way you can discuss your constraints and concerns to find workable solutions -- from taking a generic medication, where a safe effective alternative to an expensive brand-name drug is available, to making sensible lifestyle changes that fit within a busy schedule to accommodate time-intensive caretaking responsibilities.

Crumbley emphasizes that relative caregivers prioritize their mental and physical health not only for themselves, but to properly care for children. "One of the things that we have to constantly remind relative caregivers is that they've got be OK for the children to be OK," he says. "We're starting to see some research that's suggesting that the more depressed relative caregivers are, the more difficult it is for them to access services and to meet the needs of the children. So we're definitely seeing a correlation between mental health of the relative caregivers with the quality in care and access of services for the children that are in their care."

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Take a beat for yourself. Whether you contact a professional or organization that provides respite care, or get a hand from a family member or friend, find someone you trust who can care for the child occasionally, so that you can take a break. Just as downtime is good for a child, experts say it's equally crucial for caregivers. "It can be just a couple of hours," Lent says. "But that needs to be something that you prioritize and plan for as a caregiver to make sure that you're preserving your own health."

Michael Schroeder is a health editor at U.S. News. He covers a wide array of topics ranging from cancer to depression and prevention to overtreatment. He's been reporting on health since 2005. You can follow him on Twitter or email him at mschroeder@usnews.com.

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