Shadows of ceiling fans spin in the subdued light of Bonda Ehlers' home.

Muffled sounds of rustling pets and the bubbles from a fish tank are the only interruptions of the night's hushed silence.

At 1 o'clock, Bonda, 52, passes quietly down the hallway.

On this night, she is up early. Normally, her alarm wakes her at 2 and 6 a.m. so she can get up and turn her mother. On doctors orders, she will reset it for 5, giving her four hours of uninterrupted sleep.

"I turn her at least every two hours during the day," said Bonda, who has cared for her mother, Martha "Mildred" Haeffner, for the past three years. "I was doing it every two hours at night. He said to go to every four hours so I could get some rest." After turning her mother in bed, Bonda caresses her head, kisses her on the cheek and wanders through the darkened hallway back to her bedroom. Martha, 78, is diabetic and has had quadruple heart bypass surgery, several strokes and seizures.

"I think of myself lying in one position for an hour and not being able to turn myself. That would be terrible," Bonda said. "I love to walk and I love to go for walks, and I think it's because both my mom and dad have lost their ability to walk so early in life." Caring for a loved one is not new to this family, and they are not alone.

Nationwide, there are more than 25 million family caregivers, according to the National Family Caregivers Association. In Nebraska 158,000 people are taking care of disabled or chronically ill family members and friends, a 1999 study released by the Alzheimer's Association showed.

The care they provide saves the health-care system in America $196 billion a year, more than double the amount spent on nursing home care, the Hospice Foundation of America reports, citing information compiled by the National Health Council.

In the case of Martha Haeffner's family, caregiving is a long tradition.

Bonda's daughter, Marcie Sheets, 29, said her three children remember their great-grandmother taking care of their great-grandfather, and now they watch Bonda care for Martha.

"Through all the years that I've known my grandma, she's taken care of somebody," she said.

Marcie said her kids help their grandmother care for their great-grandmother.

"They like taking care of her. They like giving her water. That's just part of their job when they go over there. It's everybody's responsibility. It's just what we do." First, Martha took care of her own mother for about two years. Then, she took care of Bonda's dad, William Haeffner, for about eight years until she broke her leg and could no longer lift him. He was still living in a nursing home when Bonda and her husband, Chuck, moved in with Martha.

Bonda took on the role of around-the-clock caregiver gradually. She started dropping by during mealtimes to make sure her mom was eating properly, and grandson Kevin Palmer lived in Martha's basement and looked after her at night. When Martha lost control of her blood sugar and blood pressure, Bonda began monitoring medications and meals. She would eventually quit her job as a secretary at Nebraska Wesleyan University, and she and Chuck rented out their home and moved in with Martha.

Kevin, 25, comes over most days after he gets off work as an activities assistant in the Alzheimer's activities unit at Lancastor Manor and helps his mom turn and bathe Martha.

At first, Martha could still play cards and feed herself, but her medical problems took away one thing after another.

If her mother is uncomfortable, Bonda gives her drops of pain medication from a medicine dropper. She mixes her other crushed pills in a slurry of yogurt or applesauce and feeds it to her mother spoonful by spoonful, just as she feeds her breakfast, lunch and dinner.

"You just kind of watch the facial expression for signs of pain," Bonda said. "She eats, most of the time, with her eyes closed, just kind of like a little baby bird." Bonda said attending to her mother's personal needs -- giving her sponge baths, emptying her urinary bag and cleaning her up after a bowel movement -- is not as difficult as she expected.

"I thought I would be real uncomfortable with it. But, after doing it once, it's not a problem, as long as I have my rubber gloves. That's just what you do when you take care of somebody." Sometimes, though, when the alarm clock rings at 2 a.m., it is 2:30 before she can force herself to get out of bed. There are days -- she calls them "weepy days" -- when her mother takes a turn for the worse, and mortality seems a little closer.

"My mom's basically had to give up her life in every sense of the word," said Bonda's daughter Trisha Conroy, 31. "My grandma needs care 24 hours, around the clock.

"It's kind of like a long-term grieving process," she said. "I've seen her become a little depressed here and there. You can see sometimes the effect the strain has on her. But she just doesn't give in to it." A survey of 817 members of the National Family Caregivers Association found that three out of every eight caregivers were depressed, six times the national average for clinical depression. Those who reported depression were more likely to be helping with such personal care as bathing, dressing, helping with personal hygiene and eating.

Bonda Ehlers is not the only member of Martha's family who sometimes struggles with emotions.

"There's lots of guilt that goes along with having your sister take care of your parent," said her brother Bill Haeffner, 44, who lives in Lodi, Calif.

He comes when he can, but short-notice plane tickets are expensive.

"We've pretty much used up most of our vacation for emergency trips," he said.

As a way to participate in his mother's care and offer support to his sister, Bill installed an 800 number so Bonda can call when she needs to talk.

Still, he worries about his sister and the frustrations she faces.

He saw firsthand one of the aggravating facts of a caregiver's life -- transportation. When William Haeffner died April 1, the family ended up taking Martha to her husband's funeral in a borrowed van because they could not find public transportation for any trip not deemed medically necessary.

In frustration, they talked to a neighbor who happened to use a wheelchair. He loaded Martha into his own accessible van and drove her to the funeral himself.

"Thank God for good neighbors," Bill Haeffner said.

But caregiving certainly has its rewards.

Bonda's daughter Trisha Conroy said her family has received much more in return than it has contributed to Martha's care.

"She still tells me that she loves me. That's priceless. Nothing's worth more than the smile that you see on the person's face. That is the basic reward right there. They've given so much of their life, the least you can do is give back a little.

"I would do the same thing for my own mother, I mean I plan to do it for her when she needs it," Trisha Conroy said.

Bonda knows her kids will be there for her.

"Marcie's in charge of hairdo and wardrobe," she said. "Kevin's in charge of back rubs and feet rubs, and Trisha's in charge of mashed potatoes and watermelon." The duties involved in caring for her mother are endless, but Bonda is well aware how important it is to take care of herself as well.

"It wouldn't do her any good if I got so worn out that I couldn't take care of her any more," she said.

Still, she doesn't get away often, and taking care of her mom doesn't leave much time for her marriage.

She and Chuck attended a marriage retreat in September, the first time since February they had been away from home overnight. Bonda had to find three people to take care of Martha for the 34 hours she was gone and leave three pages of notes so everyone would know their responsibilities.

They had plans to get away for their fifth anniversary as well but had to change them.

"Our wedding anniversary was Labor Day weekend, so we had to cancel our anniversary plans because Mom wasn't doing too good," Chuck Ehlers said.

Martha Haeffner is now a hospice patient, not expected to live longer than six months.

"When she does pass away, it's going to leave a very big hole in my life because she's been so much a part of my life," Bonda said. "I wonder what I am going to do when she's gone. I'll miss her an awful lot. I'll have to start looking for a job again and start restructuring my life.

"I'd like to have her live forever, but I hate to have her in this state, too," she said. "I'm just glad that I do have faith in God and that when I do have to say goodbye to my mom that it'll only be until I can see her again some day.

"They were very good dancers," she said of her parents. "I learned how to dance on my dad's toes. I stood on his toes, and away we'd go. I like to think of my mom and dad dancing in heaven. I like to just close my eyes and see mom and dad dancing, dancing in heaven." National Stroke Association: (800) 787-653; www.stroke.org American Heart Association: (800) 242-8721; www.amhrt.org Amercan Diabetes Association: (800) 232-3472; www.diabetes.org/default.htm

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