In stable and supportive families, caregiving can produce unexpected rewards, often strengthening ties between those who give care and those who receive it.
But what happens in troubled families, where relationships are strained and normal bonds of affection are frayed? Is caregiving possible when an adult child who was abused or neglected by parents long ago now needs to care for those parents in their later years?
That's the question Ellen Eichelbaum of Northport, N.Y., has faced in the past 18 months. All through her childhood and young adulthood, she says, her parents subjected her to what she describes as "a tremendous amount" of physical abuse, coupled with emotional abuse and neglect. Explaining that she was not a submissive child, she adds, "I always had something to say. My parents couldn't deal with that."
Now her widowed mother, an octogenarian, needs assistance. The daughter is putting aside, as best she can, deep hurts as she makes daily decisions about how to respond as a caregiver. In the process, she is learning lessons in compassion, forgiveness, and maybe even love.
Nearly 34 million Americans provide unpaid care for someone over the age of 50, according to a 2004 survey by the National Alliance for Caregiving. No one knows how many of these caregivers come from family situations similar to Eichelbaum's. But as a gerontologist, Eichelbaum knows there are many more.
"It's more common than people think it is," she says.
Although married and the mother of two daughters in their 30s, Eichelbaum performs her caregiving duties without support from her family.
"My kids say, 'How can you do this, after what Grandma did to you?' " she says. "I tell them, 'I do this for Grandma because she's my mother.' " She adds, "I do what I do in spite of what was done to me. I am a bigger person because of it. I do what I feel God needs me to do."
Cases of neglectful elders come in many shades of gray - most of them not as dark as the one Eichelbaum describes. For one caregiver in suburban Boston, who asks not to be identified, family dynamics were shaped not by parental abuse but by her mother's absence during her early years.
When the woman was a preschooler, her father died. Her mother, forced to go to work, put her young daughter in an orphanage for several years, unwittingly subjecting the little girl to harsh treatment there. Although her mother visited on weekends, no real bond developed between the two.
Now, nearly six decades later, her mother needs care, and the daughter is willingly providing it. "We've never been close," the daughter says simply. But she takes the approach that the past is over, and the present offers a fresh start.
Caregiving, however noble and essential, is an act done largely in private, invisible to the world. Perhaps for that reason, it's a subject often confined to private conversations.
Employees hesitate to discuss it with their employers. Friends may be sympathetic, but no one wants or needs too many details. Even other family members may not be aware of the day-to-day realities. Among adults who are taking care of parents who didn't take care of them, an even greater reticence prevails.
To help break that silence, Eichelbaum is working on a book about caring for abusive, neglectful, or absent parents.
"It's a whole forgiveness thing," Eichelbaum says, emphasizing that she is not condemning her mother. "Despite what happened to me, I will not abandon my own mother. There's a piece of me that feels very sorry for her. She never experienced joy. She looks back on her life with a million regrets."
Each family situation is unlike every other. Some people who grew up in difficult and unloving circumstances may make, as adults, different decisions about caregiving than Eichelbaum did. No outsiders can fairly judge them.
As longevity increases, and with it the number of people involved in caregiving, other grown sons and daughters may find themselves echoing the comments of Eichelbaum, who says somewhat wistfully, "I wish I were taking care of someone who took care of me."
Still, she wastes no time in self-pity. She encourages those in situations like hers to let go of resentment. "There has to be an open mind and an open heart when you're caring for someone," she says.
And what about love? Is it a word an abused caregiver can use? Eichelbaum, for one, is trying. At the end of each phone conversation with her mother, she tells her she loves her. Although that is not always easy, she concedes, doing so helps her to "keep those positive thoughts going."
For any formerly abused adult facing caregiving challenges, Eichelbaum offers one more suggestion.
"Start to go for forgiveness," she says. "It isn't easy. It takes time. But it can happen."