Your employer was just diagnosed with cancer. Or their partner is dealing with chronic illness that’s significantly worsening. Or someone in the household has condition that means medical crisis is ongoing reality rather than temporary situation. Suddenly your nanny position that was stable and predictable has become something completely different, and you’re trying to figure out what your role should be when the family you work for is facing something this difficult.
The kids need care more than ever because their parent can’t provide usual level of attention. The household is chaotic with medical appointments, treatment schedules, and everyone’s emotional stress. The parent who’s well is overwhelmed trying to manage work, their partner’s illness, the kids, and everything else. You’re watching people you care about suffer and you want to help, but you’re also uncertain about boundaries between being supportive employee and being pulled into family crisis beyond your role.
After twenty years working with nannies across Seattle and nationwide, we’ve heard many stories about navigating employment during family illness. Some placements where nannies provided extraordinary support during terrible times and felt good about that contribution. Other situations where nannies got swallowed by family crisis, couldn’t maintain boundaries, and ended up leaving traumatized positions that damaged them emotionally without actually helping the families much.
What Kids Need When Parent Is Seriously Ill
Your primary job during family medical crisis is still providing excellent childcare, but what excellent childcare looks like shifts when kids are dealing with parent’s illness.
Kids need consistent routines and normalcy during periods when everything else feels unstable. If they’ve always had specific bedtime routines or regular activities, maintaining those provides grounding when their world is being upended by parent’s illness. You’re the person who can preserve some predictability when everything else is changing.
They also need honest age-appropriate information about what’s happening, but that information comes from parents rather than you. Your job is supporting whatever parents have chosen to tell kids and helping them process it, not making decisions about how much kids should know. If kids ask you questions about parent’s illness, redirect to parents: “That’s something your mom/dad can talk with you about. They know what’s happening and they can explain it better than I can.”
Kids experiencing parent illness often have big complicated feelings they don’t know how to express. They might be scared, angry, confused, or acting out in ways they didn’t before. Your role is providing safe space for those feelings while maintaining appropriate boundaries. You can validate their emotions – “I know this is really scary for you” – without trying to fix feelings or convince them they should feel differently.
Watch for signs kids need more support than you can provide. If they’re regressing significantly, showing signs of anxiety or depression, or behaving in ways that seem concerning rather than just difficult, parents need to know so they can get kids appropriate professional help. Your job isn’t being their therapist but you can notice when they’re struggling beyond normal adjustment.
Maintaining Normalcy While Acknowledging Reality
One of the hardest balances during family illness is maintaining as much normalcy as possible for kids while also acknowledging the real changes happening in their family.
Don’t pretend everything’s fine when it clearly isn’t. Kids know when something’s wrong, and pretending creates confusion and anxiety rather than protection. You can acknowledge reality – “Your family is going through a difficult time right now” – while still maintaining routines and expectations that provide structure.
Continue with regular activities and outings as much as possible. Kids still need to go to park, see friends, attend their regular classes and activities. Their lives can’t stop entirely because parent is ill, and you’re the person who can maintain some continuity of their normal childhood even when family life is disrupted.
At the same time, be flexible about behavioral expectations. Kids dealing with parent illness are under stress that affects their behavior. They might be less cooperative, more emotional, or more challenging than usual. Maintain basic safety and respect boundaries but give more grace than you normally would for typical kid behaviors that are being amplified by stress.
Be honest with parents about what you’re observing. If kids seem to be handling things reasonably well, that’s good information. If they’re really struggling, parents need to know even though they’re already overwhelmed. You’re not adding to their burden by telling them truth about how kids are doing – you’re giving them information they need to support their children appropriately.
Your Boundaries Around Medical and Emotional Support
When families are dealing with serious illness, the line between childcare and other types of support can get blurry, and you need to maintain clear boundaries about your role.
Your job is providing childcare, not medical care or caregiving for ill parent. If family asks you to help with medical tasks for ill parent, be very clear about what’s appropriate and what’s not. Bringing ill parent water or a meal is reasonable household help. Managing medications, providing physical care, or taking on nursing responsibilities is beyond your role and potentially beyond your competence.
You’re also not the family’s emotional support person. Families dealing with illness need to vent, process feelings, and receive support, but that support should come from appropriate sources like therapists, friends, or family members. If parents try to lean on you heavily for emotional processing about their fear or grief, redirect kindly: “I can see you’re going through something incredibly difficult. Have you been able to talk with your therapist/friends/family about what you’re feeling?”
Don’t let scope of your job expand dramatically during illness without appropriate discussion and compensation. Families dealing with medical crisis need more help, and you might be willing to provide some additional support. But if your forty-hour childcare position is becoming sixty hours including household management, meal prep, and other responsibilities you weren’t hired for, address that formally rather than just absorbing infinite additional work.
Also be clear about boundaries around your off-time. Families in crisis mode might start calling you constantly during your off hours or asking you to be available at unpredictable times. Unless you’ve explicitly agreed to on-call availability with appropriate compensation, maintain your normal schedule boundaries as much as possible.
When Illness Changes Family Dynamics Permanently
Some illnesses are temporary – parent undergoes treatment and recovers, and eventually family returns to something resembling normal functioning. Other illnesses are chronic or terminal, meaning the family dynamics you knew won’t return and you’re working in permanently changed situation.
With chronic illness, you need to evaluate whether the new normal is situation you can sustain long-term. If parent’s illness means household is perpetually chaotic, if kids’ needs have intensified permanently, if the stress level is something you can’t manage indefinitely, those are signals you might not be able to continue in this position long-term even though you care about the family.
Terminal illness creates impossible situations where you’re watching someone die while trying to maintain normalcy for their children. This is emotionally devastating work that most nannies aren’t prepared for. If parent’s illness is terminal, you need to honestly assess whether you have emotional capacity to witness that while continuing to provide good care for kids.
Some nannies choose to stay through terminal illness because their presence provides stability for kids during worst possible time. Others recognize they can’t handle that level of pain and trauma while working, and they leave even though timing feels terrible. Neither choice is wrong – it depends on your emotional capacity and what you can realistically sustain.
If you’re staying through chronic or terminal illness, make sure you have your own support systems. Therapist, friends, family – you need people who can help you process what you’re witnessing and experiencing because this work will take emotional toll regardless of how compassionate and strong you are.
Managing the Increased Household Chaos
Serious illness creates household disruption that affects your work environment significantly. Medical appointments disrupt schedules. Treatments cause side effects that change family functioning. Financial stress from medical costs affects everything. The household that was organized and predictable becomes chaotic and unstable.
Your job becomes more about adaptation and flexibility than about maintaining ideal routines. You’re constantly adjusting to changing circumstances – parent can’t pick kids up from school because of treatment appointment, meal plans change because ill parent can’t eat normal foods, schedules shift based on medical needs.
Some of this flexibility is part of supporting families through crisis. But there’s difference between reasonable accommodation during difficult time and your job becoming unsustainable because nothing is ever predictable. If chaos becomes permanent baseline rather than temporary crisis response, evaluate whether position is still workable for you.
Also be aware that families under medical stress are often functioning at reduced capacity in all areas. Parents might be more disorganized, more forgetful, less communicative, and less appreciative than they were before illness. This isn’t about not valuing you – it’s about being overwhelmed by medical crisis. But it still affects your experience of working for them, and consistent lack of appreciation or organization creates difficult working conditions regardless of valid reasons behind it.
Deciding Whether to Stay or Go
One of the hardest decisions when families face serious illness is whether to stay and support them through crisis or whether to prioritize your own wellbeing by leaving even when timing is terrible.
Factors that support staying include: family has treated you well before illness, compensation is adequate for increased demands, you have emotional capacity to witness and support family through this difficulty, and there’s reasonable expectation that either illness will resolve or that you can sustain working in permanently changed environment.
Factors that support leaving include: you’re being asked to take on responsibilities far beyond your role without appropriate compensation, the emotional toll is affecting your mental health significantly, household chaos has become unsafe or completely dysfunctional, or you don’t have the capacity to witness this family’s suffering without being damaged yourself.
Some nannies stay because they genuinely want to help families they care about through terrible times, and they’re able to provide that support without sacrificing their own wellbeing. These placements where nannies supported families through cancer treatment or serious illness can be incredibly meaningful experiences.
Other nannies stay because guilt prevents them from leaving even though the situation is destroying them. They’re sacrificing themselves trying to hold families together, and they’re burning out completely. Staying out of guilt rather than genuine capacity to help doesn’t actually serve anyone well.
If you’re considering leaving during family illness, know that it’s allowed. You’re not obligated to martyr yourself for families facing medical crisis. Your own wellbeing matters, and sometimes protecting yourself requires leaving situations that are too painful or demanding even when families genuinely need help.
When the Emotional Toll Is Too High
Working for families dealing with serious illness takes emotional toll that shouldn’t be underestimated. You’re witnessing suffering, supporting frightened children, and managing household stress that’s constantly elevated. This affects you even when you maintain good boundaries.
Watch for signs you’re being emotionally damaged by the situation. If you’re having intrusive thoughts about the family’s situation during your off time, if you’re losing sleep worrying about them, if your own mental health is declining, those are signals the work is costing you too much.
Some nannies develop vicarious trauma from witnessing families’ medical crises. You’re not experiencing illness directly but you’re close enough to it that you absorb some of the pain and fear. This is real trauma that can affect you long after you leave the position, and it’s something to take seriously.
If you recognize the emotional toll is too high, leaving is self-protection rather than abandonment. You can care about the family and still prioritize your own mental health. Explaining “I care about your family deeply but I don’t have the emotional capacity to continue working through this difficult time” is honest communication about your limits.
What Families Owe Nannies During Illness
Families dealing with serious illness are understandably overwhelmed and not at their best. But they still have responsibilities to employees, and understanding what you should reasonably expect helps you evaluate whether you’re being treated fairly.
Families should communicate as clearly as possible about what’s happening and how it affects your employment. You don’t need medical details but you do need to know “my wife has cancer and will be starting chemotherapy next month, which will affect our household functioning” so you can prepare for changes.
They should pay you on time and correctly even when they’re dealing with medical crisis. If they genuinely can’t afford to keep employing you because of medical costs, they need to tell you that honestly rather than letting pay become irregular or unreliable.
They should treat you with basic respect even when they’re stressed and overwhelmed. You’re not responsible for their illness but you’re also not their punching bag for the stress it creates. Parents taking out stress on you isn’t acceptable even when stress is completely understandable.
If they need significantly more from you than your original job description, they should acknowledge that formally with adjustment to compensation or clear discussion about temporary versus permanent changes. You stepping up during crisis is generous but it shouldn’t become permanent expanded role without recognition.
The Bottom Line
Supporting families through serious illness can be meaningful work where you provide genuine help during terrible times. It can also be emotionally devastating work that damages you without actually helping families much if you’re in over your head.
Before committing to staying through family medical crisis, honestly assess your capacity. Can you maintain boundaries while being supportive? Can you witness this family’s pain without taking on their trauma yourself? Do you have support systems that will help you process what you’re experiencing?
If you can stay with appropriate boundaries and support, these placements sometimes become the most meaningful work of your career. If you can’t sustain it without sacrificing your own wellbeing, leaving is legitimate choice even though timing is terrible.
After twenty years in this field, we know families remember nannies who supported them through medical crises with genuine gratitude. We also know nannies who stayed too long in situations that damaged them and who carry that trauma for years. Protect yourself while being as helpful as you can, and recognize that your limits are real and valid even when families desperately need support.
