Activities for People With Alzheimer’s Disease

It is universally recognized that elderly people with dementia lose their short term memory first and their long term memory last. For example, they often remember people and events from their earlier years, but have difficulty remembering what they ate for breakfast the day before. A short summary of some activities include the following:

1. Reminisce! Everything you do together lends itself to reminiscing. If the person can still speak fairly well, say, “Tell me about…” If his vocabulary is more limited, you may have to facilitate the story. “Do you remember when…” As you bake cookies together you can talk about residents’ favorite cookies, meals, etc.
2. Read aloud and use visual aids such as memory poems, family pictures, or stories about “the days gone by” stimulate reminiscences. Ideas include Chicken Soup for the Soul series and Yesterdays by NaDezan, and other short stories
3. Make music. Sing, hum, whistle, dance. Singing brings oxygen to the brain to help you think more clearly. Dancing exercises other parts of the body. Both increase your own sense of well-being as well as the well-being of the residents! Have music activities and entertainers visit. Choose the residents’ favorite cassettes.

4.  Sensory stimulation activities could include the following:

• Making lap quilts.
• Painting.
• Talking books.
• Scrap books.
• Walking!
• Flower arranging.
• Tutoring, or visiting with children.
• Baking.
• Happy hour with non-alcoholic drinks.
• Ice cream party.
• Brushing & fixing a resident’s hair.
• Manicures.
• Ladies luncheons.
• Building with wood (include sanding).

Although these activities are written for residents of a retirement community or a nursing home, they certainly could be utilized for private use as well. Keeping the mind and body active are important for everyone, but especially your loved one with dementia. Do something that is enjoyable for both of you, and it makes it that much easier. Raleigh Geriatric Care Management assists adult children of aging parents. caregiver.com

Is it time for Assisted Living?

by Paula Spencer Scott

The decision to help an aging adult move out of a current home is a complex one — both emotionally and practically. Above all, you want the person to be safe and well. How can you all feel more confident about whether circumstances suggest that your loved one should no longer be living alone?

1. Big-picture signs it might be time for assisted living

Keep the big red flags in mind. Certain situations make it more obvious that it’s wise to start thinking about alternate living arrangements.

Look for:

• Recent accidents or close calls. Did your loved one take a fall, have a medical scare, or get in a fender bender (or worse)? Who responded and how long did it take? Accidents do happen, but as people get older, the odds rise of them happening again.
• A slow recovery. How did the person you’re caring for weather the most recent illness (for example, a flu or bad cold)? Was he or she able and willing to seek medical care when needed, or did last winter’s cold develop into untreated bronchitis?
• A chronic health condition that’s worsening. Progressive problems such as COPD, dementia, and congestive heart failure can decline gradually or precipitously, but either way, their presence means your loved one will increasingly need help.
• Increasing difficulty managing the activities of daily living (ADLs) and instrumental activities of daily living (IADLs). ADLs and IADLs are the skills needed to live independently — dressing, shopping, cooking, doing laundry, managing medications, and so on. Doctors, social workers, and other geriatric experts evaluate them as part of a functional assessment, which is one way to get an expert’s view of the situation. Difficulties with ADLs and IADLs can sometimes be remedied by bringing in more in-home help.

2. Up-close signs it might be time for assisted living

Give your loved one a big hug. Clues aren’t always visible from a distance; especially when you don’t see the person every day, you might learn more through touch.

Look for:

• Noticeable weight loss. Does the person feel thinner? Are clothes loose, or has he added notches to his belt? Many conditions, from depression to cancer, can cause weight loss. A person who is having trouble getting out to shop or remembering how to cook (or to eat) can lose weight; check the fridge and watch meal-prep skills.
• Seeming more frail. Do you feel anything “different” about the person’s strength and stature when you hug? Can your loved one rise easily from a chair? Does she or he seem unsteady or unable to balance? Compare these observations to the last time you were together.
• Noticeable weight gain. Common causes include an injury slowing the person down,diabetes, and dementia (when someone doesn’t remember eating, he or she may indulge in meals and snacks all day long). Someone with money troubles may choose fewer fresh foods and more packaged goods or dried pasta and bread.
• Strange body odor. Unfortunately, a close hug can also reveal changes in personal hygiene habits. Causes range from memory trouble to depression to other physical ailments.
• Changes in appearance. Does the person’s hair and makeup look all right? Are clothes clean? Someone known for crisply ironed shirts who’s now in a stained sweatshirt may lack the dexterity for buttons or may have lost the strength for managing an ironing board and iron. A formerly clean-shaven man with an unkempt beard may be forgetting to shave (or forgetting how to shave).

3. Social signs it might be time for assisted living

Think realistically about the person’s social connections. Social circles tend to shrink with age, which can have health and safety implications.

Look for:

• Signs of active friendships. Does your loved one still get together for lunches or outings with friends or visits with neighbors, or participate in religious activities or other group events? Does he or she talk about others or keep a calendar of appointments? Lack of companionship is associated with depression and heart problems in older adults. If friends have died or moved away, moving to a place where other people are around could be lifesaving.
• Signs that your loved one has cut back on activities and interests. Is a hobby area abandoned? Has a club membership been given up? A library card gone unused? There are many reasons people cut back, but dropping out of everything and showing interest in almost nothing is a red flag for depression.
• Days spent without leaving the house. This sometimes happens because the person can no longer drive or is afraid to take public transportation alone and lacks a companion to come along. While many older adults fear being “locked away” in a retirement home, many such facilities offer regular outings that may keep them more mobile and active, not less.
• Someone who checks in on a regular basis. If not you or another family member, who does this? Is your loved one willing to consider a home-safety alarm system, a personal alarm system, or a daily calling service?
• A plan for a worst-case scenario. If there’s a fire, earthquake, flood, or other disaster, is someone on standby to assist? Does your loved one understand the plan?

4. Money signs it might be time for assisted living

Riffle through the mail. Your loved one’s mail can offer an often-overlooked clue to how he or she is managing money, a common early warning sign of cognitive trouble.

Look for:

• Snowdrifts of mail in various places. Finding lots of mail scattered around raises concern about how bills, insurance, and other matters are being managed. (Piles of mail are also a potential tripping hazard.)
• Unopened personal mail. Everybody skips junk mail, but few of us can ignore a good old-fashioned, hand-addressed letter.
• Unopened bills. This can indicate that your loved one is having difficulty managing finances — one of the most common first signs of dementia.
• Letters from banks, creditors, or insurers. Routine business letters aren’t worrisome. But it’s alarming if they’re referring to overdue payments, overdrawn balances, recent accidents, or other concerning events.
• Thank-you messages from charities. Older adults are often vulnerable to scammers. Even those who have always been fiscally prudent are vulnerable if they’re having trouble with thinking skills (a common sign of Alzheimer’s disease). Some charities hit up givers over and over, and your loved one may not remember having donating the first time.
• Lots of crisp, unread magazines. The person may unknowingly have repeat-renewal subscriptions he or she doesn’t need.

5. Driving signs it might be time for assisted living

Take a drive — with your loved one behind the wheel, if he or she is still driving. Living independently in our culture often depends on the ability to drive (or the arrangement of alternate transportation options).

Look for:

• Nicks or dents on the car. Notice the car body as you get in and out. Damage marks can be signs of careless driving.
• Whether the person promptly fastens his or her seatbelt. Even people with mild dementia usually follow the rote basics of driving. It’s worrisome if he or she is forgetting this step.
• • Tension, preoccupation, or being easily distracted. The person may turn off the radio, for example, or be unwilling to engage in conversation while driving. He or she may avoid certain routes, highway driving, or driving at night and in rain — a safe kind of self-policing but also signals of changing ability.
• Signs of dangerous driving. People whose driving ability is impaired are more likely to tailgate, drift from their lane, go below the speed limit, react slowly to lights or other cars, and mix up gas and brake pedals. See 8 ways to assess someone’s driving.
• Warning lights. Check out the dashboard as you ride along. Does the car have sufficient oil, gas, antifreeze, windshield-wiper fluid?

6. Kitchen signs it might be signs for assisted living

Go through the kitchen, from fridge to cupboards to oven. Because people spend so much time in this room, you can learn a lot.

Look for:

• Stale or expired foods. We all buy more than we need. Look for signs that food is not only old but that this is unnoticed — mold, sour milk that’s still used, or expiration dates well past due, for example.
• Multiples of the same item. Ten bottles of ketchup? More cereal than can be eaten in a year? Multiples often reveal that the shopper can’t remember from one store trip to the next what’s in stock at home.
• A freezer full of TV dinners. Your loved one may buy them for convenience sake, but frozen dinners tend not to make healthy diet. If there’s not much fresh food in the house (because it’s too hard to for the person to procure or cook), your loved one might be ready to have help with meal prep or delivery services.
• Broken appliances. Check them all: microwave, coffeemaker, toaster, washer, and dryer — any device you know your loved one uses (or used to use) routinely.
• Signs of fire. Are stove knobs charred? Pot bottoms singed badly (or thrown out)? Do any potholders have burned edges? Also look for a discharged fire extinguisher, smoke detectors that have been disassembled, or boxes of baking soda near the stove. Accidents happen; ask for the story behind what you see. Accidental fires are a common home danger for older adults.
• Increased use of takeout or simpler cooking. A change in physical or mental abilities might explain a downshift to simpler recipes or food choices.

7. Around-the-house signs it might be time for assisted living

Look around the living areas. Sometimes the most obvious sign is hard to see because we become so used to it.

Look for:

• Lots of clutter. An inability to throw anything away may be a sign of a neurological or physical issue. Obviously it’s more worrisome in a neatnik than in a chronic slob. Papers or pet toys all over the floor represent a tripping hazard.
• Signs of lax housekeeping. Spills that haven’t been cleaned up are a common sign of dementia — the person lacks the follow-through to tidy. Keep an eye out for cobwebs, bathroom mold, thick dust, or other signs of slackness. Physical limitations can mean your loved one needs housekeeping help or a living situation where this is taken care of for him or her.
• Bathroom grime and clutter. A common scenario: Your loved one makes an effort to tidy up living areas but overlooks the bathroom. Or the guest bath is clean, but not the one the person uses all the time (the one off a bedroom, for example). Here you may see a truer picture of how your loved one is keeping up.

8. Pet-care and plant-care signs it might be time for assisted living

Be sure to check out how the other living things are faring. An ability to take care of pets and plants goes along with self-care.

Look for:

• Plants that are dying, dead, or just gone. Most of us have seen plants go brown sometimes. Keep an eye out for chronic neglect, especially in a former plant-lover’s home.
• Animals that don’t seem well tended. Common problems: dogs with long nails, cat litter boxes that haven’t been changed lately, or dead fish in the fish tank. Poor grooming, overfeeding, and underfeeding are other red flags.

9. Home-maintenance signs it might be time for assisted living

Walk around the yard. Yard maintenance — or lack of it — can yield clues that your loved one isn’t faring as well at home alone anymore.

Look for:

• Signs of neglect. Look for discolored siding or ceilings that might indicate a leak, gutters choked with leaves, broken windows or fences, dirty windows.
• Newspapers in the bushes. Are papers being delivered but ignored? Sometimes people pick up those they can see on a driveway but not those that go off into the yard.
• Mail piled up in the mailbox. Go out and check — it’s an indication that your loved one doesn’t even retrieve it regularly.

10. Get help looking for signs it might be time for assisted living

Get the input of others who know your loved one in order to collect a fuller picture of reality. Gently probing about what others think isn’t nosy; you’re being loving, concerned, and proactive.

Look for:

• Input from those in your loved one’s circle. Talk to old friends and close relatives to get their sense of how the person is faring. Listen for stories that hint that the person doesn’t get out much (“She doesn’t come over anymore.” “She quit book club.”). Pay attention to comments that indicate ongoing concerns (“Has he had that heart test yet?” “We were worried the day the ambulance came.”).
• Medical insight. With appropriate permission, your loved one’s primary doctor may share your concerns about his or her patient’s safety at home — or may be able to alleviate those concerns or suggest where to get a home assessment.
• A second opinion. A social worker or professional geriatric care manager visits older adults’ homes and does informal evaluations. While your loved one may initially resist the notion of a “total stranger” checking on them, try pitching it as a professional (and neutral) second opinion, or ask the doctor to “prescribe” it. Some people wind up sharing doubts or vulnerabilities with a sympathetic, experienced stranger that they’re loathe to admit to their own children or family.

11. Caregivers’ signs it might be time for assisted living

Finally, realize that some of the information you collect is intangible — it has to do with feelings and emotions, and the stress levels of everyone involved.

Look for:

• How you’re doing. While this decision to remain in one’s home is not primarily about you — the son, daughter, grandchild, caregiver — your own exhaustion can be a good gauge of a decline in older adults’ ability to care for themselves. Keeping someone at home can require lots of hands-on support or care coordination, and this is time-consuming. If your loved one’s need for care is just plain wearing you out, or if a spouse or children are feeling the collective strain of your caregiving activities, these are major signs that it’s time to start looking at other options.
• Your loved one’s emotional state. Safety is crucial, of course, but so is emotional well-being. If someone living alone is riddled with anxieties or increasingly lonely, then that may tip the scales toward a move not solely based on health and safety reasons.

If your loved one has a full life, a close neighborhood and community connections, and seems to be thriving, it’s worth exploring as many in-home care options as possible before raising stress levels by pressing a move from a beloved home.

If, on the other hand, your loved one is showing signs that living alone is a strain, it may be time for a talk. Broach the subject of where to live in a neutral way and you may find that your loved one harbors the same fears for current and future safety and security that you do. Find out what your loved one fears most about moving and about staying before launching into your own worries and what you think ought to be done.

Dealing With Verbal Abuse

Abuse of any kind is difficult to deal with, even if the abuser has Alzheimer’s disease and you know he can’t control it.

First of all, you have to work at not taking it personally. If this is an extension of his previous personality, you know it’s just the way he is. If this is a personality change, it will be a shock. You will have to mourn the fact that he has changed dramatically, and get to the point of acceptance.

Give the primary caregiver a break – whether that’s you or someone else. Maybe it means hiring someone to come in, taking your loved one to an adult day center, or having family members take turns, the primary caregiver needs a break. Chances are he will act differently with non-family members. If he does verbally abuse staff you have brought in or at the adult day center, it becomes a bigger problem. At that point, you may want to get your loved one’s doctor involved. Let the doctor know what is going on and see if he has any suggestions. He may want to try something for anxiety or depression. Many times individuals with Alzheimer’s are acting out because of an underlying problem such as anxiety, depression, or even physical pain.

Another way to deal with this situation is with humor. You can’t control how he is acting, so you have to control how you respond. At one adult day care center, when patients would say harsh things or become verbally abusive, the staff refers to it as “terms of endearment.”

Validating your loved one’s feelings may help decrease his frustration. Many times individuals with Alzheimer’s are so frustrated that they act out through this type of behavior. He has lost much of his independence and now he has both of you telling him what to do. Be sure when you are trying to get him to do something or avoid something, that you ask in a non-threatening way. If he resists, stop and go back later. Give him time to calm down, and then try again. Also try not to talk down to him. He is still an adult with a life history of success and independence. He will sense it if he is being treated differently.

Finally, join a support group. Many times others in the group will have experienced the same behavior with their loved ones. Group members may be able to counsel you on how they coped or dealt with it. Journal your feelings and frustrations about his behavior. Dealing with your feelings will help you deal with his behavior more effectively.
 

Thank you to Jackie Bedard, Carolina Estate Planning in Raleigh, NC for this article.

Keep or Lose a Friendship When Caregiving

~Paula Spencer Scott

Caregiving can be tough on friendships. Many of your old friends may not be able to relate to your new role and — unsure what to say or do — they avoid getting in touch. Others get tired of hearing about the demands of caregiving or your lack of availability.

Yet caregivers need, more than ever, the support of friends outside of their caring responsibilities. What helps?

1. Make the effort yourself.
   In the middle of a care crisis, you won’t be able to make calls or visits the way you once did. But over the long haul, you may need to force yourself to do these things, because friendships are built on give-and-take. Even if you can’t be as available as you once were, your friends still want to hear your voice or see your face — or even just hear from you in an occasional e-mail or text message.
2. Rely on some easy rituals to help you stay connected.
   Sometimes regular commitments are easier to build into your schedule than spur-of-the-moment ones, because you can make plans for respite care. The rituals can be as simple as a standing Friday afternoon walk or a monthly book club date. If it’s really hard to get away, invite your friend over — he or she won’t be expecting to be entertained; your company is what counts. Or try to involve your loved one, if possible — to go and get ice cream together, for example.
3. Self-impose limits on your venting.
   It’s wonderful to have nonjudgmental pals with whom you can gripe a little. The caveat: Don’t make griping — or caregiving, period — the sole focus of your talks. Agree in advance that you’ll talk for 15 minutes about your current caregiving woes, then stop — and set a timer. Or ask a friend to give you the equivalent of a weekly “get out of jail free” card: one phone call a month where you can just unload, no questions asked. This may help limit your negative interactions while giving you a chance to de-stress every so often.
4. Keep the ebb and flow nature of friendships in perspective.
   You may have a hard time being a good friend at the moment, but think back to when you were starting a job or had young kids. Sometimes we need more from close friends, and sometimes they need more from us. Caregiving is a phase in which you build a friendship debt with your best pals — and you can give it back, later.
5. Know, too, that not all friendships survive caregiving.
   Let’s face it: Many friendships are superficial or circumstantial — they may thrive in bright times, but when the situation is a little darker, you may discover that you have less in common than you thought, or that you know one another less well. Some people are freaked out by the demands of eldercare; some demand high levels of maintenance themselves. Chalk it up to life, and don’t take these lost causes personally.

Raleigh Geriatric Care Management :  www.rgcmgmt.com

Helping the Aging Parent Who Refuses Help

by, Dale Carter

We see our parents struggling with their living situation, and we have tried every way possible to talk with them about it, but they refuse to accept help in their home.  What can we do? On a high level, the mention of services brought into the home can make your parent think, “This is the first step to losing my independence. If this happens, what’s next?” Whether they consciously or unconsciously have this thought, they will want to fiercely grab on to the life they know and resist any change.

• Your parent may treasure their privacy, so even the mention of bringing a home aide or visiting nurse into their home, may be unsettling.
• Your parent may be financially conservative, wanting to be frugal and responsible. They’ve lived through the Great Depression. They see their health care costs rising, and the instability of world economy.

So, with those thoughts in mind, how can we approach the conversation in a more empathetic way?

• Begin by listening to your parent. Have a relaxed conversation away from your homes, perhaps in a park or some other peaceful setting. You’ll be amazed at how this can break the cycle of a “stuck” conversation. Ask a big question like, “Mom, what has been the most difficult part of aging for you?” She’ll have to dig deep to answer that, and you’ll learn about her values, wishes and goals. And, you will then be able to find common ground and build trust as you work together in the future, in finding the right option for your parent.
• Observe.  Become like a quiet shadow beside your parent. Envision yourself as a caring friend. Watch how your parent moves, what they struggle with, what makes them happy, how they interact with their friends and the outside world. Don’t let yourself be overwhelmed or disturbed by what you see. By all means, do NOT jump into solution-mode. I love this quote by James Thurber, “Let us not look back in anger or forward in fear, but around in awareness.” This is what we need to do as we seek to understand our aging parents.
• Reach out to your Area Agency on Aging. Now that you have listened and observed, you will need to reach out and learn about options and resources. Every part of the country is covered by one of these agencies, funded by the federal government. They offer a hotline staffed by trained elder advisors. They maintain a comprehensive listing of community resources, and most now have a geriatric care manager on staff. No matter where you or your parent are in the country, you can go to their website and plug in a zip code to get the contact information for your Area Agency on Aging. Simply explain your parent’s need(s) and ask for assistance.
• Reach out to a geriatric care manager. So, you’ve tried the listening and the observing. And, you reached out to your Area Agency on Aging and gathered resources and options. But, your parent will still not consider accepting help. Then it is time to have a professional step in and assist. Your Area Agency on Aging can recommend a geriatric care manager. This professional usually has a background as a social worker or nurse. Such individuals have the experience and sensitivity to meet with your parent in their home and do a holistic assessment (of your parent, their living environment, their support structure) and then make recommendations. They are trained to know that each elderly person and each family are unique in their needs and wishes. They will be able to frame their recommendations in a way that will help your aging parent understand it is in their best interest.

7 Communication Techniques for Talking to Elderly Parents

By Marlo Sollitto

Caregiving results in major changes in a family: physical, emotional, social and financial issues can arise. It changes the roles, responsibilities and feelings within the family, which can lead to tension and fighting.

Don’t Give Advice Unless It’s Asked For

Parents have advised their children their whole lives, so hearing advice from a child – albeit an adult child – might not go over so well. That parent-child role reversal is hard on the parent. Therefore, giving advice is best avoided unless you are sure it has been asked for. It is generally better to let an outside person be the advisor. You can encourage and provide support, without doling out advise.

Listen to What Your Elderly Parent is Saying

Really listen. Listen to what the person is saying. Don’t interrupt or try to fill in the silence. A period of silence could mean your family member is contemplating a response, thinking through the conversation and how to reply. Listening goes both ways, so try to determine that the person is hearing what you say.

Accept Differences of Opinions

No matter how close a family is, and despite the dynamics involved, everyone is not going to agree all of the time. There is sure to be differences of opinions. Respect the opinions of others; don’t disregard them. Listen to all sides, and make a decision together when possible.

Speak Distinctly

Some older adults do not like to admit that they cannot hear or understand the conversation around them.  The higher pitch of women’s voices may be a problem for older adults; consciously think to lower the voice pitch. Remain calm and talk in a gentle, matter-of-fact way, keep sentences short and simple, focusing on one idea at a time.

Don’t Condescend

Make sure your attempt to “turn up the volume” and slow down your speaking patterns doesn’t come across as condescending. Even if your parent suffers from dementia or extreme hearing loss, don’t speak to them as you speak to a child. Patronizing is a sure way to start an argument.

Choose the Right Environment

Avoid competing noise or activities such as TV or radio. Face the person as you talk to them. When talking in a group, make sure that the elder is not on the end of the row.  It is better to place the senior in the middle so that the conversation is around them. Or perhaps a quiet walk works best for your elderly parent.

Consider What It Is Like To Be Old

Most seniors experience a series of losses during their later years and are trying desperately to stay in control of themselves and their environment. Letting others help feels to them like giving away control of things.

Pick Your Battles

Most elderly face multiple challenges as a result of growing older. The most common include mobility limitations, decreased stamina, living alone and memory problems. You will need to prioritize the issues you want to address and hope for small victories.

Laugh When you Can

Laughter really is the best medicine. Even in a difficult and stressful caregiving situation, there are some humorous moments. A shared laugh can ease tension while building closeness. However, be sure to laugh with your family, not at their expense.

Raleigh Geriatric Care Management at www.rgcmgmt.com can assist adult children with their aging parents in North Carolina.  More information about caring and caregiving is available on the website.

The Art of Multitasking and Still Remaining Focused

by Maggie Almeida

Caregiving itself is an art. Many today are part of the Sandwich Generation who find themselves caring for both young children and teenagers as well as aging parents. Caregivers need to be professional multi-taskers to address everyone’s needs and not neglect their own. So what should a good caregiver focus on? As many know, it’s a balancing act, but there’s an order to follow starting with the caregiver himself.

Step number one is to look out for number one; me, myself, I, the big cheese, the head beagle (just ask Snoopy). This may sound selfish, but it’s really the most unselfish place to start. After all, if number one is not well, you cannot take care of your other charges. If you have a good attitude, you can even overcome your own health issues with greater ease. Those you care for also notice because they naturally behave as they see you behaving. This is called mirroring. One wise caregiver told me that her husband with Alzheimer’s was manageable because she knew that when her demeanor was calm, so was his. If she raised her voice, so did he. You can see where this leads. The caregiver had total control of her life as long as she managed her own emotions.

Step number two would be to give your attention to the next most vulnerable person you’re caring for. If it’s a child, have the older generation help since they may be acting childlike now. They may be able to play simple games with a child that you don’t have time for. Age and ability specific jigsaw puzzles, puppets, lying down with a child to get them to take a nap, or any other play related activity.

If your children are older, and you need to focus on Mom or Dad or Aunt Sally, have the older children help you in caring for your aged loved one. Keep it small and simple, but their involvement can mean the world to the older relative. It esteems them and they feel useful, as if the child needs their guidance. Some children feel esteemed when they’re asked to help and it also builds their character to practice acts of kindness toward the elderly. If they want an example of the positive impact of a grandmother on a pop star they all know, look at Will Smith. Even while accepting an American Music Award he gave the credit to his grandmother. She must have been inspirational, but he also allowed himself to be inspired by spending time with her. Parents can make this happen and enhance the whole family dynamic as well as build its heritage.

In conclusion, look at multi-tasking as building blocks. Today many families are fragmented because a caregiver in the sandwich generation gets burnt out on both ends. As they focus on caregiving, there are levels of trust and affection that we build. When the stress gets too much, sometimes the “tower of family solidarity” gets knocked down. Someone yells or cries. This doesn’t mean that the tower is erased from memory. Go back and do something nice for yourself because you are the cornerstone of your tower. The other blocks will be added again and again. Focus on the big picture because your part in caregiving is a temporary role in a continuum. As soon as your duties end, you may be the one needing care.