Most Americans will be informal caregivers at some point during their lives. A 2012 survey found that 36% of Americans provided unpaid care to another adult with an illness or disability in the past year. That percentage is expected to go up as the proportion of people in the United States who are elderly increases. Also, changes in health care mean family caregivers now provide more home-based medical care. Nearly half of family caregivers in the survey said they give injections or manage medicines daily.

Also, most caregivers are women. And nearly three in five family caregivers have paid jobs in addition to their caregiving.

As a caregiver, taking care of yourself and getting the help you need are important. Taking care includes maintaining healthy behaviors, managing stress, and seeking extra support, especially during COVID-19.

Maintain Healthy Behaviors

• Take steps to protect yourself and others against COVID-19.
• Take deep breaths, stretch, or meditate.
• Eat foods that are safe and healthy.
• Drink lots of water to stay hydrated.
• Exercise regularly.
• Get plenty of sleep.
• Avoid excessive alcohol and substance use.

Manage Stress

• Take breaks from watching, listening or reading news stories or social media postings about COVID-19.
• Make time to unwind. Take a walk or do an activity you enjoy.
• Connect with others. Talk with people you trust about your concerns and how you are feeling.
• Find other ways to cope with stress during the COVID-19 pandemic.

Seek Extra Support

• You are not alone. Support groups provide a safe place for people in similar situations to find comfort. Ask a doctor or your state or local health department to recommend a caregiver’s support group that offers virtual meetings. You can also find caregiver support resources by searching online and typing in “caregiver support group” and the name of your community. Childcare networks or eldercare support agencies for your state or county can also be contacted.
• Recognize when you may need more help. If stress or negative thoughts get in the way of your daily activities for several days in a row, talk to a psychologist or therapist, social worker, or professional counselor.
• Ask your doctor or local health clinic to refer you to counselors who may offer services for free or on a sliding fee scale. Some health insurance policies may cover counseling services.
• Recognize and act when you may be the victim of abuse or may become abusive. Abusive behavior by or against caregivers can happen more often during stressful periods like COVID-19. Get help with prevention or protective resources in your state for domestic violence, child abuse, or elder abuse as needed.
• If you are feeling overwhelmed with sadness or anxiety, feel threatened, or want to harm yourself or others:
  • Call 9-1-1
  • Visit the Disaster Distress Helpline, call or text 1-800-985-5990.
  • Visit the National Suicide Prevention Lifeline or call 1-800-273-TALK (1-800-273-8255)
  • Visit the National Domestic Violence Hotline or call 1-800-799-7233 or TTY 1-800-787-3224.
  • Visit the Childhelp National Child Abuse Hotline or call 1-800-4-A-CHILD (1-800-422-4453)

Many of us are facing challenges that can be stressful, overwhelming, and cause strong emotions in adults and children. Public health actions, such as social distancing, can make us feel isolated and lonely and can increase stress and anxiety.

After a traumatic event, people may have strong and lingering reactions. Learning healthy ways to cope and getting the right care and support can help reduce stressful feelings and symptoms.

The symptoms may be physical or emotional. Common reactions to a stressful event can include:

• Disbelief
• Feelings of fear, shock, anger, sadness, worry, numbness, or frustration
• Changes in appetite, energy, desires, and interests
• Difficulty sleeping or nightmares, concentrating, and making decisions
• Physical reactions, such as headaches, body pains, stomach problems, and skin rashes
• Worsening of chronic health problems
• Worsening of mental health conditions
• Increased use of tobacco, alcohol, and other substances

It is natural to feel stress, anxiety, grief, and worry during traumatic events such as mass shootings, natural disasters, or pandemics. Below are ways that you can help yourself, others, and your community manage stress.

Healthy Ways to Cope with Stress

Feeling emotional and nervous or having trouble sleeping and eating can all be normal reactions to stress. Here are some healthy ways you can deal with stress:

• Take breaks from watching, reading, or listening to news stories, including those on social media. It’s good to be informed but hearing about the traumatic event constantly can be upsetting. Consider limiting news to just a couple of times a day and disconnecting from phone, tv, and computer screens for a while.
• Take care of yourself. Eat healthy, exercise, get plenty of sleep, and give yourself a break if you feel stressed out.
• Take care of your body.
  • Take deep breaths, stretch, or meditate.
  • Try to eat healthy, well-balanced meals.
  • Exercise regularly.
  • Get plenty of sleep.
  • Avoid excessive alcohol, tobacco, and substance use.
  • Continue with routine preventive measures (such as vaccinations, cancer screenings, etc.) as recommended by your healthcare provider.
  • Get vaccinated against COVID-19 as soon as possible; get a booster shot if you are age 18 or older.
• Make time to unwind. Try to do some other activities you enjoy.
• Talk to others. Talk with people you trust about your concerns and how you are feeling. Share your problems and how you are feeling and coping with a parent, friend, counselor, doctor, or pastor.
• Connect with your community- or faith-based organizations.
• Avoid drugs and alcohol. These may seem to help, but they can create additional problems and increase the stress you are already feeling.
• Recognize when you need more help. If problems continue or you are thinking about suicide, talk to a psychologist, social worker, or professional counselor.

Helping Others Cope

Taking care of yourself can better equip you to take care of others. During times of social distancing, it is especially important to stay connected with your friends and family. Helping others cope with stress through phone calls or video chats can help you and your loved ones feel less lonely or isolated.

Helping Children and Youth Cope with Stress

Children and youth often struggle with how to cope with stress. Youth can be particularly overwhelmed when their stress is connected to a traumatic event—like a natural disaster, family loss, school shootings, or community violence. Parents, caregivers, and educators can take steps to provide stability and support that help young people feel better.

Tips

Tips for Parents and Caregivers
It is natural for children to worry when scary or stressful events happen in their lives. Talking to your children about these events can help put frightening information into a more balanced setting. Monitor what children see and hear about stressful events happening in their lives. Here are some suggestions to help children cope:

• Maintain a normal routine. Helping children wake up, go to sleep, and eat meals at regular times provide them a sense of stability.
• Talk, listen, and encourage expression. Listen to your child’s thoughts and feelings and share some of yours. After a traumatic event, it is important for children to feel they can share their feelings and that you understand their fears and worries.
• Watch and listen. Be alert for any change in behavior. Any changes in behavior may be signs that your child is having trouble and may need support.
• Stressful events can challenge a child’s sense of safety and security. Reassure your child about his or her safety and well-being. Discuss ways that you, the school, and the community are taking steps to keep them safe.
• Connect with others. Talk to other parents and your child’s teachers about ways to help your child cope. It is often helpful for parents, schools, and health professionals to work together for the well-being of all children in stressful times.

Tips for Kids and Teens
After a traumatic event, it is normal to feel anxious about your safety and security. Even if you were not directly involved, you may worry about whether this type of event may someday affect you. Check out the tips below for some ideas to help deal with these fears.

• Talk to and stay connected to others. Talking with someone you trust can help you make sense out of your experience. If you are not sure where to turn, call your local crisis intervention center or a national hotline.
• Take care of yourself. Try to get plenty of sleep, eat right, exercise, and keep a normal routine.
• Take information breaks. Pictures and stories about a disaster can increase worry and other stressful feelings. Taking breaks from the news, Internet, and conversations about the disaster can help calm you down.

Tips for School Personnel
School personnel can help their students restore their sense of safety by talking with the children about their fears. Other tips for school personnel include:

• Reach out and talk. Create opportunities to have students talk, but do not force them. You can be a model by sharing some of your own thoughts as well as correct misinformation.
• Watch and listen. Be alert for any change in behavior. Are students withdrawing from friends? Acting out? These changes may be early signs that a student is struggling and needs extra support from the school and family.
• Maintain normal routines. A regular classroom and school schedule can provide a sense of stability and safety. Encourage students to keep up with their schoolwork and extracurricular activities but do not push them if they seem overwhelmed.
• Take care of yourself. You are better able to support your students if you are healthy, coping and taking care of yourself first. Eat healthy, exercise, get plenty of sleep, and give yourself a break if you feel stressed out.

With some worksites, schools, and childcare centers closed because of COVID-19, many caregivers must manage work while also teaching and caring for their children. Balancing more than one role can be hard when you are taking care of children. Seek support from family and friends when you feel anxious or need help with childcare or other household tasks in order to reduce your stress. If possible, consider asking your employer for flexible work schedules. Consult your state website for re-opening plans and refer to guidance for specific industries and workers to help inform your options and decisions about returning to work.

Children may find it hard to cope with hearing and seeing too much information about COVID-19. Caregivers can share COVID-19 information for children and limit how much news and social media they see. Children, like adults, should also practice social distancing. This means limiting their contact with other children and adults who live outside their home. Social distancing from friends and less time for play may also make them feel sad or angry. Search for new ways to keep children busy with their normal interests and routines as much as possible.

Here are a few tips for caring for children during the COVID-19 pandemic:

• If you need childcare while you are working from home, try to avoid choosing someone who is at a higher risk of severe illness, such as an older relative or someone with an underlying medical condition.
• Ensure appropriate resources and emergency planning for children with special needs.
• Help your child stay socially connected. Kids can stay connected by reaching out to their friends and family by phone, video chats, or through letters and cards.
• Help children continue learning when school is not in session. Many schools are offering lessons online (virtual learning). If your child is having a hard time doing assigned work, let the teachers know. Ask teachers for help if you’re not sure what your child is ready to learn or how your child learns best. It’s important to create a routine yet flexible schedule for learning at home.
• Check if your school will serve meals even when school is not in session. Many schools are providing free meals for kids in local communities.
• Encourage your child to play outdoors when possible. Being active is great for children’s physical and mental health. Use indoor activity breaks (like stretching or dance breaks) throughout the day to help your child stay healthy and focused.

Most caregivers of older adults are women over age 50. Female caregivers report having more physical and mental distress and poor health compared to male caregivers.Managing your own health while caring for an older adult can be hard. Check for respite services in your local area so that you can take a break, rest, and recharge, as needed.

Older adults are at higher risk for severe illness from COVID-19, so it’s important to create a plan to protect them. A care plan describes what you will do if you become unable to care for your older family member. A care plan includes a contact list of family, friends, neighbors and local service agencies that can provide caregiving support if you are ill or not available. For example, a backup caregiver should ideally not be someone at risk of severe illness from COVID-19.

Because of COVID-19, you may be unable to visit the older person you normally care for if they are admitted to a hospital or nursing home. Ask the facility staff if they can help you reach out to them by phone, video chat, text, or sending cards or letters.

Here are some other tips to help you when caring for older adults:

• Take extra steps to protect older adults and people with medical conditions from getting sick.
• Limit trips outside the home except for essential errands such as going to the grocery store, pharmacy, or seeking medical care. Keep canned, packaged, or frozen foods, cleaning supplies, and EPA-approved disinfecting products at home to limit trips to the grocery store.
• Try to keep extra supplies of medications and other necessities such as oxygen, incontinence supplies (pads or disposable underwear), thermometers, wound care (antiseptics, bandages, and gauze), or other medical supplies for older adults in your care.

A larger percentage of women than men work as nurses and other healthcare practitioners, nursing home and home healthcare support workers, social service workers, teachers, childcare workers, grocery store cashiers, and postal service workers. During COVID-19, women continue their work in these and other essential jobs serving the public, including emergency workers and first responder personnel.

If you are an essential worker, you may have a lot of stress due to longer work hours and tough working conditions. You may have less time and energy to be the caregiver you want to be. It is critical for essential workers to stay well in order to help those in need. In addition, essential workers may also have a greater risk of exposing their household members to COVID-19.

• Sleep is a biological need for life and health, similar to the need for food. Sleep affects your mental and physical performance as well as long-term health.
• Most adults need 7 to 8 hours of good-quality sleep every 24 hours to perform during emergency operations.
• When you lose sleep, you build up sleep debt that will seriously impair your performance. The only way to pay off this debt is to get enough sleep. Willpower alone will not keep you safe from the mounting effects of sleep debt.
• As someone who is deployed, you should view sleep as a critical logistical item, just like water, food, and the supplies needed to carry out operations.
• The longer you go without sleep, the more you are prone to slow thinking, confusion, and making mistakes. This could put you and others around you at risk for injuries and death.
• Fatigue has been identified as a causal factor of vehicle crashes and several well-known industrial disasters.

Responding to disasters is both rewarding and challenging work. Sources of stress for emergency responders may include witnessing human suffering, risk of personal harm, intense workloads, life-and-death decisions, and separation from family. Stress prevention and management is critical for responders to stay well and to continue to help in the situation. There are important steps responders should take before, during, and after an event. To take care of others, responders must be feeling well and thinking clearly.

Here are some important steps responders can take to ensure they are able to do their job and cope with challenging situations:

Preparing for a Response:

• Try to learn as much as possible about what your role would be in a response.
• If you will be traveling or working long hours during a response, explain this to loved ones who may want to contact you. Come up with ways you may be able to communicate with them. Keep their expectations realistic, and take the pressure off yourself.
• Talk to your supervisor and establish a plan for who will fill any urgent ongoing work duties unrelated to the disaster while you are engaged in the response.
• Make plans for your household, childcare, and pet care needs if you will be away from home.

During a Response: Understand and Identify Burnout and Secondary Traumatic Stress

Limit your time working alone by trying to work in teams.

Responders experience stress during a crisis. When stress builds up it can cause:

• Burnout – feelings of extreme exhaustion and being overwhelmed.
• Secondary traumatic stress – stress reactions and symptoms resulting from exposure to another individual’s traumatic experiences, rather than from exposure directly to a traumatic event.

Coping techniques like taking breaks, eating healthy foods, exercising, and using the buddy system can help prevent and reduce burnout and secondary traumatic stress. Recognize the signs of both of these conditions in yourself and other responders to be sure those who need a break or need help can address these needs.

Signs Of Burnout:

• Sadness, depression, or apathy
• Easily frustrated
• Blaming of others, irritability
• Lacking feelings, indifferent
• Isolation or disconnection from others
• Poor self-care (hygiene)
• Tired, exhausted or overwhelmed
• Feeling like:
  • A failure
  • Nothing you can do will help
  • You are not doing your job well
  • You need alcohol/other drugs to cope

Signs of Secondary Traumatic Stress

• Excessively worry or fear about something bad happening
• Easily startled, or “on guard” all of the time
• Physical signs of stress (e.g. racing heart)
• Nightmares or recurrent thoughts about the traumatic situation
• The feeling that others’ trauma is yours

Limit your time working alone by trying to work in teams.

Get support from team members: Develop a Buddy System

In a buddy system, two responders partner together to support each other, and monitor each other’s stress, workload, and safety.

• Get to know each other. Talk about background, interests, hobbies, and family. Identify each other’s strengths and weaknesses.
• Keep an eye on each other. Try to work in the same location if you can.
• Set up times to check-in with each other. Listen carefully and share experiences and feelings. Acknowledge tough situations and recognize accomplishments, even small ones.
• Offer to help with basic needs such as sharing supplies and transportation.
• Monitor each other’s workloads. Encourage each other to take breaks. Share opportunities for stress relief (rest, routine sleep, exercise, and deep breathing).
• Communicate your buddy’s basic needs and limits to leadership – make your buddy feel “safe” to speak up.

Responder Self-Care Techniques

• Limit working hours to no longer than 12-hour shifts.
• Work in teams and limit amount of time working alone.
• Write in a journal.
• Talk to family, friends, supervisors, and teammates about your feelings and experiences.
• Practice breathing and relaxation techniques.
• Maintain a healthy diet and get adequate sleep and exercise.
• Know that it is okay to draw boundaries and say “no.”
• Avoid or limit caffeine and use of alcohol.

It is important to remind yourself:

• It is not selfish to take breaks.
• The needs of survivors are not more important than your own needs and well-being.
• Working all of the time does not mean you will make your best contribution.
• There are other people who can help in the response.

Responding to disasters can be both rewarding and stressful. Knowing that you have stress and coping with it as you respond will help you stay well, and this will allow you to keep helping those who are affected.

After the response: Family and Work-life

Family members can help make the transition easier after the response is over.