Caregiver Anger and Guilt

~Paula Spencer Scott

No, it’s not all sweetness and light taking care of an aging loved one. They can make us mad. Very mad. Very, very, very mad.

Take, for example, some things I’ve heard caregivers say (or, uh, said myself. . . though I won’t say which ones!):

• “I try to do something nice for her and she ignores it, or complains!”
• “She makes me so mad because she doesn’t trust me!”
• “I could throttle him when he launches into that same story again. . . .”
• “How can I help but lose my temper with my mom when she ticks off the aides I’ve so carefully hired?”
• “Why why WHY does he keep doing that? He should know better!”
• Fill in your own blank!

What follows when our loved ones make us angry is often worse than pure anger: It’s anger mingled with guilt. We feel guilty because often the person can’t help being the way he or she is (dementia, depression, difficult illness). We feel guilty when we keep the upset feelings bottled up and simmering inside. We feel guilty when we snap and say something rude or sharp to the person. We can’t win.

So here’s one guilt-soothing thing to remember about caregiver anger: It reveals something very important about you.

No, not that you’re short-tempered or foul-natured. Not that you lack self control. Not that you’re uncaring or mean. Not that you’re even doing anything terribly wrong, really.

Getting mad at your loved one when you’re a caregiver reveals this about you: You’re human.

You’re only human.

So stop beating yourself up for what are, let’s face it, often perfectly natural responses to extreme stress. Do work on reducing the causes of that stress. But don’t add to your misery with a needless layer of guilt.

If you neverevereverever get mad, hats off; you’re human, too, though with a much longer fuse than the rest of us. But if you’re like the rest of us, you’ve gotten mad before, and you’ll be mad again.

And it’s okay. Because it’s normal.

What are the benefits of hiring a geriatric care manager?

• Help meet goals of older adult and all involved.
• A care manager’s knowledge, education, training, and experience can objectively help set realistic expectations while addressing obstacles that might be present.
• Often families are overwhelmed with the many options presented. A care manager can efficiently streamline decision making.
• As a neutral third party with knowledge of issues of older adults, a care manager can often help resolve conflicts that a more emotionally involved party can’t.
• A care manager can often be a cost-effective alternative to families doing it themselves. Knowledge of entitlement programs, the elimination of often hours of research, reduction of time off from work and crisis-based travel can prove to not only provide positive outcomes but save time and valuable financial resources.
• Avoid problems. The proactive nature of care management can help avoid many of the unfortunate problems that face older adults. Supervising caregivers, home safety precautions, and safe financial management can be vital parts of a care manager’s role.
• Avoid family conflicts. Having a facilitator to assist with difficult decisions can maintain family stability. Difficult decisions including end of life, driving, and relocation can be addressed in a positive manner.

~~excerpt from caring.com, Brad Prescott

In Raleigh, NC, Contact: Raleigh Geriatric Care Management, http://www.rgcmgmt.com, lwatral@rgcmgmt.com

Tips and Techniques for Dealing with Stress

by Dr. Rita Gugel   Change is an expected part of our daily lives today. Dealing with it so that YOU control IT rather than vice versa is an important and positive force in controlling your life. Try a few of these tips. 1. Accept what you cannot change. Take a tip from AA. Change what you can, if it bothers you. But, if you cannot change it, learn to live with it. 2. Face up to your problems. Sort them out, and see which ones are real and which are simply imagined. Deal with them as they are, and not what you think they are. 3. Deal with one problem at a time. Sort out your priorities, and deal with them in the order of their importance to you. 4. Be flexible. Give in once and a while. If you do, others will too. 5. Don’t hold all of your worries inside yourself—talk it out. Frequently we swallow our unhappiness (along with candy, cake, ice cream, etc.) because we can’t let the problems out. Talk to someone. A burden shared is much less of a burden. 6. Work off Stress. Physical outlets for stress help your body to fight off many of the negative results of stress. 7. Get enough rest/relaxation/sleep. Give your body a chance to recover from day to day. Lack of sleep and rest will only make matters worse for you. 8. Avoid “self medication.” A “spoonful of sugar” may make the “medicine go down,” but it does your body no good. Sugar, alcohol, nicotine, and ice cream may all feel good going down, but they make matters worse—from the inside. They add to your body’s physical stresses, thus making dealing with external stresses much harder. 9. “Take time to smell the roses.” Have some fun. Relax. 10. Think about and do something for others. A little altruism never hurt. It even makes people feel better about themselves. 11. Be the “captain of your ship.” If you are not happy with your life, think about what’s wrong or missing, and then plan the necessary actions to change it to coincide with your needs and desires for your life. 12. Work on your relationships with those who share your life. Don’t hold back your feelings. Share them with your family and friends and co-workers. It can help to decrease tensions.

Five Myths About Medicaid’s Long-Term Care Coverage

While Medicare gets most of the news coverage, Medicaid still remains a bit of mystery to many people. The fact is that Medicaid is the largest source for funding nursing home care, but there are many myths about exactly who qualifies for it and what coverage it provides.  Here are five myths followed by the real story.

1. Medicare will cover my nursing home expenses. Medicare’s coverage of nursing home care is quite limited. Medicare covers only up to 100 days of “skilled nursing care” per illness. To qualify, you must enter a Medicare-approved “skilled nursing facility” or nursing home within 30 days of a hospital stay that lasted at least three days. The care in the nursing home must be for the same condition as the hospital stay.
   
2. You need to be broke to qualify for Medicaid. Medicaid helps needy individuals pay for long-term care, but you do not need to be completely destitute to qualify. While in general a Medicaid applicant can have no more than $2,000 in assets to in order to qualify, this figure is higher in some states and there are many assets that don’t count toward this limit. For example, the applicant’s home will not be considered a countable asset for eligibility purposes to the extent the equity in the home is less than $536,000, with the states having the option of raising this limit to $802,000 (in 2013). In all states, the house may be kept with no equity limit if the Medicaid applicant’s spouse or another dependent relative lives there. In addition the spouse of a nursing home resident may keep one half of the couple’s joint assets up to $115,920 (in 2013).
3. To qualify for Medicaid, you should transfer your money to your children. Medicaid law imposes a penalty on people who transfer assets without receiving fair value in return. This penalty is a period of time during which the person transferring the assets will be ineligible for Medicaid, and the length of the penalty period is determined, in part, by the amount of money transferred. The state will look at all transfers made within five years before the application for Medicaid. That doesn’t mean that you can’t transfer assets at all — there are exceptions (for example, applicants can transfer money to their spouses without incurring a penalty). However, before transferring any assets, you should talk to an elder law attorney. 
   
4. A prenuptial agreement will protect my assets from being counted if my spouse needs Medicaid. A prenuptial agreement only works to keep property separate in the event of death or divorce. It does not keep your property separate for purposes of Medicaid eligibility.
5. I can give away up to $14,000 a year under Medicaid rules. You can give away up to $14,000 a year without incurring a gift tax. Under Medicaid law, a gift of $14,000 or any other significant amount could trigger a penalty period if it was made within the five-year look-back period.

Elderlaw News, Mary Markovich

Family Money Fights

 

by Carolyn Rosenblatt

Let’s imagine that you have an aging loved one who has cognitive impairment. You are aware that your loved one is “slipping.” You tell yourself it’s OK. You do nothing more than try to pay closer attention. You may ignore the fact that if your loved one has dementia, it’s not going to get better. You ignore the reality that if a person develops dementia, he or she is not going to be able to manage money for very long and that alternatives must be in place. Then something happens that brings you to a crisis.

It may be loss of money to a scammer. It could be huge mistakes in careless spending. It could be that bills aren’t paid and the utilities are cut off. Whatever the event, it brings you and your family to the boiling point. Some are angry. Others may still be in denial. A family fight breaks out. Siblings accuse each other of wrongdoing. The elder accuses you of plotting against him. It’s a nightmare.

If there is one recurring theme we see in working with families who have aging parent issues, it’s conflict about finances.

Whether siblings are arguing with each other over how to pay for a parent’s care, or it’s about Dad mishandling the checkbook after being diagnosed with dementia, it’s a source of enormous distress. Part of the problem is that when an aging parent’s mental capacity begins to decline, it is subtle, uneven, and can be hidden for a time. Most families are in denial about cognitive impairment. It’s just too painful for so many to accept and take in.

Adding to the stress of a parent’s cognitive impairment is the consequence of denial: Money issues arise and no one is prepared to deal with them.

Here are some suggestions for avoiding those nightmare fights over money that can be prevented by planning ahead.

1. If you have a loved one with cognitive impairment, whether officially diagnosed as dementia or not, be sure you have the critical legal documents you need properly prepared and signed. You need a durable power of attorney for finances and an advance healthcare directive. Do not wait. Eventually, your loved one may be unable to sign any legal document. Lack of signed legal documents can force you into court for a guardianship (conservatorship in California) and cost time and money you don’t need to spend.
2. Educate yourself. You need to know what assets your aging parent has, what debts exist, and whether any arrangements, such as long-term care insurance, are available to help with the cost of care. You need to know what income your parent receives and how that income is being spent. If you or your family members are able to contribute to the cost of caring for an aging loved one, including providing some care yourselves, be sure you write down the agreements as to who will do what. Strive for equity. Most of us can do something to help, even from a distance.
3. Seek advice from a qualified financial advisor to use any assets you have in the best way possible to care for your loved one. He or she may seem fine now, and able to manage independently. With cognitive impairment, this independence will not last. It is typically, with any form of dementia, a progressive and deteriorating condition. Not everyone is ready to handle the behavior changes, the need for constant supervision, and the need for helping with activities of daily living that dementia causes. It costs a lot to hire help and give family relief from the often burdensome responsibilities of long-term dementia care.
4. Have a family meeting to discuss the need for care and the sharing of responsibilities. Someone needs to take leadership and develop an agenda for topics that should be discussed. Identify them and be sure everyone has the same information well before the meeting. Everyone should be allowed the chance to speak and give his or her views. If there is no one in your family who is good at leading a discussion, get outside help from an experienced mediator,  geriatric care manager, or social worker. The cost of help is well worth it in guiding your family to good decision making.
5. Include your aging loved one, even with cognitive impairment, in the planning process as much as possible. This does not mean that you allow an impaired person whose judgment is not intact to make all the decisions. Ask your loved one for his or her preferences. Respect your parent’s values as much as possible. And use your own good judgment to keep your elder safe. He may not be able to see or understand his own cognitive problems and may think he is fine to manage money, drive, live alone, etc. If he can’t see the problem, step in and assume the necessary role of parenting your parent.

No one needs to experience the heartache of family fights over aging parent finances. With smart planning, you and your family can weather the storm of a parent’s cognitive decline with dignity. And you can know that you’ve done everything possible to make this part of your aging parent’s life the best it can be.

Making Nursing Home Visits Meaningful

By Sarah Wood, Caregiver.com

Oftentimes, as nursing home residents decline, they lose the ability to communicate. Sadly, this is a time when families stop visiting as often because they don’t know what to say or how to make the visits meaningful for the family, as well as their loved one. Sometimes, just being present can be satisfying.

Here are some tips for the families.

1. Visit with your loved one in the facility sensory room.
2. Prepare for the visit ahead of time. Bring items of interest with you. For example; if your loved one had a love of pets, you could bring your family pet to visit. If he or she had a love of a certain kind of music, bring a CD to play while in the room.
3. Talk with your loved one about events going on in the community or family. Don’t assume they can’t understand. Just hearing your voice will bring comfort and keep them connected with the outside world.
4. Bring their favorite foods and spices for the visit, but make sure to adhere to the diet recommended by the dietitian and physician.
5. Reminisce about past life experiences. Bring in old family photographs. They may enjoy just listening to your memories. If they are able to respond, this may spark a memory.
6. On their calendar, take a highlighter and mark the date of your next visit. This will remind them that you will be returning soon.
7. Personalize their room. Now is the time they need the most stimulation. Look how you can make their room pretty while at the same time reflecting their personality. You could put up sports banners, add family photos, put pictures on the walls, a CD player at bedside with favorite CDs, plants, decorator pillows and pretty afghans, knickknacks that are meaningful to them, lotions and perfumes or colognes, fake fish tanks (real ones if someone can take care of it), wind chimes over the bed.
8. Bring a book of their favorite author and read to him or her during your visit.
9. Bring flowers from your garden.
10. Try aroma therapy. You can purchase candle warmers and electric aroma therapy machines. Use smells that they would like, but be aware that medications can make them nauseous. Light scents such as lavender may be preferred.
11. Provide hand massages and back rubs. Oftentimes, the only touch they receive is by the facility staff. Having a massage can be really uplifting, especially when being touched by a loved one.
12. Include children in the visit. Bring things for the children to do. It could be a children’s book that the child can read to the resident. If there are animals or bird cages in the facility, plan your visits there.
13. Don’t be afraid to laugh and share humorous stories. Bring funny cartoons and funny stories to share. It’s ok to laugh.
14. Bring cassette tapes or CDs of the religious services from their local church. Share the church bulletin with them.
15. Bring the local community paper and read what is happening in their local community. It will help them still feel connected.
16. Share events happening in your family.
17. Read poetry.
18. Share a meal with them. Many facilities allow families to purchase a meal and eat with the loved one in the dining room.
19. You could do a makeup session or fix their hair. You can bring pretty nail polish and do a manicure.
20. Share a scrapbook or photo album.
21. Go for a stroll together. Nothing is like a visit outside. Many facilities have lovely patios.
22. If your loved one is able to take a drive in the car, go on short outings. Suggestions would be: a ride around the community, zoo, restaurant, park, church, local store or a pet shop. Call ahead to make sure the destination is wheelchair accessible.
23. Bring to family gatherings, such as weddings, holiday dinners and religious events.
24. Bring games they enjoy, cards, checkers, chess, word puzzles.
25. Bring crafts they enjoy, such as yarn or cross stitch.
26. Bring a video of family events such as weddings, graduations, baseball games, dance recitals, or share a video with them of a movie you enjoyed.
27. If they like to read, but now are unable, purchase books on tape.
28. Begin a project that you can work on each time you come. For example, if they loved to garden, you could begin a flower press book and dry the flowers. Once they are dried, you could make a collage together and hang the picture on the wall.
29. Assist your love one with writing a letter to a friend or relative.
30. Help fulfill their final wishes. It may be contacting a long lost friend, or giving away a valuable. Listen to “what they want” and don’t make judgments. There are organizations that grant last wishes of the elderly. It may be a hot air balloon ride or a dinner with all of their loved ones.
31. Exercise with them. There are several video tapes for elderly in wheelchairs. It could be simple arm lifts, walking or hand exercises.
32. Place calendars in their room with large clocks. Don’t assume they can’t tell time.
33. Hug a lot.
34. Create a tactile blanket with different textures and items of interest to touch
35. Bring items related to the season, such as pumpkins, poinsettias, spring flowers.
36. Decorate their room for the seasons, with decorations and scents specific to the holiday or season. Take down old decorations.
37. Bring fresh fruits and vegetables.
38. If the facility has a community kitchen, cook a meal together. Some facilities have activity rooms where you could have a large family gathering.
39. Follow the nursing home’s schedule for visits. Generally, it is better to visit in the afternoon. In the morning, many facilities are busy providing care and getting residents dressed. Phone ahead to let staff know you are coming. Follow through.  If you say you’re coming, please show up when you said you would. Always knock before entering the room. Always state who you are. With dementia, they may forget your face. Feelings are the last to go, they may feel terrible if you say, “Mom, this is Sally”. But instead, you could say, “Hi Ruth, my name is Sally and I came to visit with you.”
40. Get to know the staff. Find out what’s new about your loved one.
41. Let your loved one express their feelings and accept them. They just need someone to listen. You don’t have to have all the answers. Your presence is present enough. Enjoy the time you do have and the tender moments together. Try to leave negativity at home. Make your visits joyful and pleasurable. Don’t rush in, act bored, put down the resident, make them feel guilty about their health, or act like you would rather be somewhere else. They know!

If you plan what you will be doing before your visit, you will have a successful and rewarding experience.

3 Creative Ways to Get a Loved One to Accept Help

 

~Paula Spencer Scott

Is your loved one resistant to having any kind of help from “outsiders” (often, anyone who isn’t you)? Sometimes the person you’re trying to help can be your biggest impediment to help!

Here are three strategies to get around that block:

1. Consider what kind of help the person traditionally made an exception for. So, for example, someone who never hired help but always followed the advice of clergy or a doctor might be open to hearing the need for certain kinds of assistance from one of these professionals. Or someone who grew up with cleaning help or a cook may be open to that kind of household help, which would at least free you up for caregiving chores.

2. Make the presence of help sound commonplace. Some people are more accepting if they know it’s what their peers do: “Jane’s parents have a maid, Mom” (even if that person is really a personal aide).

3. Appeal to prestige interests. Some people are swayed by exclusivity or impressive credentials: “This is the best neurologist/geriatric care manager/moving consultant in town, Dad.” Or, “It usually takes six months to get an appointment with this doctor, but she has an unexpected opening and can see you next week.”

 

How to Grieve/5 Myths That Hurt

by Paula Spencer Scott

Grief is a natural response to loss, and it can unfold in many ways. Unfortunately, well-intentioned onlookers — dubbed “grief police” by grief expert Robert Neimeyer, professor of psychology at the University of Memphis — often say things that mistakenly imply to the bereaved that there’s a “right” way to grieve.

Consider these all-too-common grief myths:

Myth #1: It’s possible to cry too much.

Everyone grieves differently. There’s no single correct way to express the pain, sorrow, yearning, and other aspects of the transition of adjusting to the death of a loved one. Intense responses are sometimes seen as “losing control,” when in fact they’re simply how that person is actively (and productively) processing the loss.

Myth #2: If you don’t cry now, it’ll be worse later.

Some people never cry. Tears or outward expressions of anguish simply aren’t everyone’s grieving style, says psychologist Neimeyer. This doesn’t mean they’re grieving less intensely than a visibly shaken individual, or that they loved the person who died any less. Nor does a lack of obvious emotion mean the griever has an emotional block or problem or will face a longer, more difficult adjustment to the loss.

Myth #3: Grief is something you “get over.”

Most people never stop grieving a death; they learn to live with it. Grief is a response, not a straight line with an endpoint. Many psychologists bristle at words such as “acceptance” or “resolution” or “healed” as a final stage of grief. The real stages of grief involve tasks of processing and adjustment that one returns to all through life.

Myth #4: Time heals slowly but steadily.

Time is the commodity through which a grieving person sorts through the effects and meaning of a loss. But that process isn’t a steady fade-out, like a photograph left in the sun. Grief is a chaotic roller coaster — a mix of ups, downs, steady straight lines, and the occasional slam. Periods of intense sadness and pain can flare and fade for years or decades.

Myth #5: Grieving should end after a set amount of time.

Ignore oft-quoted rules of thumb that purport to predict how long certain types of grief should last. A downside to six-week or eight-week bereavement groups, says Sherry E. Showalter, a psychotherapist specializing in grief and the author of Healing Heartaches: Stories of Loss and Life, is that at the end of the sessions, people mistakenly expect to be “better” (or their friends expect this). “Everyone tells me the same story: ‘I failed Grief 101,’ because they still feel pain,” Showalter says. “We grieve for a lifetime, because we’re forever working to incorporate the death into our own tapestry of life.”

Learning how to grieve is ultimately part instinct, part stumbling along, part slogging along — a bit like learning how to live.

3 Creative Ways to Get a Loved One To Accept Help

~Paula Spencer Scott

Is your loved one resistant to having any kind of help from “outsiders” (often, anyone who isn’t you)? Sometimes the person you’re trying to help can be your biggest impediment to help!

Here are three strategies to get around that block:

1. Consider what kind of help the person traditionally made an exception for. So, for example, someone who never hired help but always followed the advice of clergy or a doctor might be open to hearing the need for certain kinds of assistance from one of these professionals. Or someone who grew up with cleaning help or a cook may be open to that kind of household help, which would at least free you up for caregiving chores.

2. Make the presence of help sound commonplace. Some people are more accepting if they know it’s what their peers do: “Jane’s parents have a maid, Mom” (even if that person is really a personal aide).

3. Appeal to prestige interests. Some people are swayed by exclusivity or impressive credentials: “This is the best neurologist/geriatric care manager/moving consultant in town, Dad.” Or, “It usually takes six months to get an appointment with this doctor, but she has an unexpected opening and can see you next week.”

7 Smart Tips for Communicating With Someone Who Has Low Hearing

Does your loved one seem to ignore what you say half the time? Maybe you’re not being heard. Fully one-third of adults over age 65 and about half of those over age 85 have significant hearing loss.

To improve your odds of getting your message across:

1. Realize that you don’t have to SHOUT! It’s kind of condescending, when you think about it, which starts communication off on the wrong note. Shouting also actually makes enunciation harder to understand.

2. Deliver your message face-to-face, rather than from across the room or from the next room. We all use lip-reading to some extent to help us hear.

3. Turn off the TV or radio to eliminate background noise. Even the low hum of the dishwasher or a leaf blower outside can muffle your words.

4. Don’t rely on hearing aids working perfectly. If you find that someone with a hearing aid is having trouble hearing well or isn’t using it, ask questions to find out why. Is it uncomfortable? Is ambient sound interfering?

5. Especially with someone who has dementia, avoid talking while coming up from behind him or her. You may not be heard until you’re right upon the person, causing your loved one to be startled and flustered — and not comprehend a word you’ve said.

6. If the person has vision problems, ask the eye doctor just what his or her range of vision is. For some people, there’s little peripheral vision (on the sides), so you must be positioned squarely in front to be seen and understood.

7. Speak slowly and clearly. You don’t have to dumb down your speech to robot tones, but try not to rush through your sentences, either. You’ll be more easily heard by any listener, of any age or health condition.

~Paula Spencer Scott