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Levels of Adjustment
by Juli A. Koroly
When a family member faces a chronic
illness, the entire family structure is rocked to its
foundation. The inevitable life changes occur in stages,
and we can adjust to them more easily if we recognize
these stages when they happen. Having experienced the
trauma of my husband’s paralysis following surgery, I
have learned to identify three major levels of
adjustment. It is important to acknowledge these and
understand that we have choices at each of these levels.
The first level of adjustment is accepting the
responsibility for our family member through the initial
medical crisis, release from the hospital and beyond.
The momentary pleasure of having him or her home is soon
replaced with abject fear of the enormous job ahead. No
instruction manual is sent home, and even the simplest
tasks take on Herculean proportion. The types of choices
to be made include personal care needs, everyday
household management, a plan for disease management, and
the level of physical activity permitted. Fortunately,
help is available though home health agencies and
The second level is the reorganization of the home –
physically, financially, and in the roles family members
play. When our loved one arrives home, it may be
necessary to make alterations to accommodate a
wheelchair, lift, or walker.
If our loved one has been the main breadwinner, the
family’s financial support will suddenly fall to someone
else. Major role changes are called for. Both the care
recipient and caregiver will feel insecure at first with
the loss of the old roles and uncomfortable with their
new roles, until they become more familiar.
The third level is the most difficult level of
adjustment. Caregiver, care recipient, and other family
members must accept the changes this new situation
demands. In time, this regime becomes normal. But at
first, everyone is in shock with the realization that
their circumstances are permanent. Acceptance will come
with time, if the family works together.
The entire family must take a proactive role in seeking
out educational and support resources and accepting the
family’s reconfiguration. This journey will be easier
and more productive when everyone concentrates on where
you are going, rather than on where you have been.