Category Archives: Adult day care

Moving in With Family: Issues to Consider

_77183535_77183027~Helen Hunter

Too often, the decision to move into a family member’s home is made when a crisis develops or as a last resort. Sudden illness or injury strikes and the family is left without a plan for long-term care for their loved one. Experts suggest that all families discuss the possibility of the need for long-term care, and the possibility of family members living together as a solution to the daily care situation. The following are some items to discuss with all members of the family before making such a move.

Accessibility

Is the home “elder friendly”? It is necessary to review the setup of the home, in terms of stairs, additional bedrooms, bathrooms and general safety issues. If home modifications are needed, they should be completed prior to the move.

Care

How much care will the relative require? Daytime supervision, medication management, meal preparation and entertainment are just a few examples of important issues to consider. Assess the level of assistance needed now and in the foreseeable future. If the relative is in poor health, who will be in charge of providing the care? Will other family members share in the caregiving duties? Establish basic rules and a care routine to help prevent conflicts and caregiver burnout.

Emotions

How do family members get along with each other? How are conflicts dealt with? All families have their share of problems and each family handles them differently. The loss of independence is difficult for anyone and reactions or behavior change is to be expected. It is important to be able to talk about how everyone is feeling and encourage the relative to continue with a life of their own. Communication skills, including active listening, are necessary in handling and resolving conflicts successfully.

Finances

How will the change in household expenses be handled? An increase in family size usually means an increase in family expenses. Will the relative contribute? Are there other family members who can help with financial support?

Responsibilities

What is expected of the relative? What responsibilities will they have for care of the home? If there is a separate apartment, will everyone dine together? What about family outings – will the relative always be included?

Avoid the feeling that the situation is permanent.

Start with a limited “trial period,” then review the situation.

Once the move has been made to live together, it is very important for all family members to have continual open and honest communication with each other on all matters. Don’t hold in your feelings – both positive and negative feelings need to be shared.

If the health condition of the relative changes, and additional care is needed, it is crucial for the family to review the daily plan. If the situation requires help outside the family, there are a number of alternatives that the family and the relative can explore together. Make sure that the relative is included in decision making, if they are able. Some other options for care include: daily home health aide or homemaker care, which would also provide respite relief for family caregivers, home based community care programs, friends and neighbors, church outreach programs and dividing the care responsibilities among the family by rotating care, with the relative going to others’ homes, or by allowing other relatives to come into the home to provide the daily care.

Families who maintain open and honest communication and are willing to share in the financial and caregiver responsibilities for a needy relative can successfully reside together in the same home. Support can and should be a two-way street. Where better to get the daily support that we all need than from our family!

Contact a Geriatric Care Manager/Aging Life Care Professional™ www.rgcmgmt.com for a free 15 minutes telephonic consultation.

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Considerations for Caregivers

By Arthur N. Gottlieb

Caregiving is not for everyone. Remember, it’s not about you. If the relationship is too emotionally charged or patience is not your best virtue, find someone else to take over the primary role of caregiver.

It is important to reflect upon your motivations for being a caregiver and to make an honest assessment of your limitations.

As a caregiver you may at times feel powerless and sad. But an experience laden with difficulty may also provide opportunities to strengthen relationships with loved ones, and for the development of one’s own personal and spiritual growth.

About Visits
Focus on the quality of interactions with a loved one, not on the quantity.

Consistency and predictability of visitations are important, especially for the homebound.

Communication Skills
Learn the healer’s art of “bearing witness.” This means listening empathically and suppressing the urge to intervene with solutions.

When speaking to someone in bed or in a wheelchair, sit down or otherwise lower yourself so that you are at the same eye level as they are. This will distinguish you from others who remain standing, essentially looking and speaking down to them with the unspoken but inherent power differential this implies.

Choose your battles wisely. Attempting to address an irrational situation with rationality is generally futile, and will increase conflict with no resolution

The hearing impaired are often too prideful to admit that they haven’t heard most of what you just said, and are hopeful that they can eventually figure it out.

Those with mild cognitive impairment are still quite capable of comprehension, but the thought process may have slowed down a little. Be patient and speak slowly.

Restoring Dignity
Asking for a senior’s opinion about a non-provocative issue may offer them an opportunity to feel respected and still relevant.

At the dinner table when others are present, if a person needs to have their food cut for them, discreetly take the plate back into the kitchen and cut it there. This will add an unspoken but important element of dignity for those being cared for.

Residential and Financial Concerns
The attitudes and behaviors of many seniors are oftentimes driven by an unspoken fear of abandonment.

When parents do not feel that their children have made wise decisions for themselves, they are naturally hesitant to turn over financial control to them.

It was not uncommon for senior women to have deferred to their husbands’ judgment when choices were being made about financial and property issues. If now widowed, they may feel more comfortable acting in accordance with someone else’s say-so for important decision-making.

It may be illuminating to discover what memories a senior has of his or her own parent’s convalescence. What would they, as caregivers, have done differently? Had they promised themselves they would never go to a “nursing home”?

When a senior is facing the prospect of moving to a continuing care or assisted living community, speak to them about what they think this will be like. Many will have a stark vision of facilities from many years ago when options were relatively limited.

About Moodiness
Seniors will experience good days and bad days due to effects of pain, adjustment to medications and or emotional issues.

Seniors who seem short-tempered may be responding to the frustrating lack of control of not being able to think as quickly, and remember as well, as they once had.

Psychology of Seniors
Understand and be prepared to recognize the issues that trigger depression and anxiety for seniors.

Be sensitive to anniversary depressions. Birthdays, anniversaries, and major holidays evoke memories of those who have passed, and independence lost.

For most, losing control of physical functioning is difficult. Experiencing the steady loss of friends and relatives leads to sadness and isolation. For those with dementia, witnessing the gradual loss of one’s own self can be the ultimate loneliness.

If a senior is grieving the loss of a loved one they think died yesterday, even if that person actually died years ago, their grief will be as deep and painful as though it just happened.  This is legitimate suffering and must be handled with empathy.

Oftentimes, a parent will have a set of expectations of how they deserve to be treated by their children based on the sacrifices they made on behalf of their own parents. When children do not meet these expectations, resentment, depression and various forms of acting out behavior are the result.

Some seniors harbor lifelong prejudices that were carefully concealed. It can be quite distressing for a caregiver to discover that their parent has “all of a sudden” developed a shocking taste for racial bias. The gradual loss of mental functioning allows one to become “dis-inhibited”; thoughts, formerly suppressed due to social constraints, are now out in the open. This applies for latent sexual desires as well, especially for men.

Denial
If the person you are caring for continually puts off medical diagnosis, they are using the defense of denial in the service of their fear. If they are never diagnosed, then they never have to face the reality of being sick.

For Senior Men
More often than not, senior men went along with the social arrangements made by their wives. If a man becomes a widower, he may feel out of place socializing with others on his own. Additionally, since women outnumber men of this age group, a man may feel he is betraying the memory of his wife when engaging in social situations involving mostly women.

Religion and Spirituality
It is important to understand what a person’s religious or spiritual beliefs are. Does he or she believe in an afterlife? Are they concerned over what is in store for them when their mortal life ends? Are they disillusioned  or angry with God?

Restore and Maintain Balance
It is essential for you, as a caregiver, to leave time for your own introspection and emotional balance. Engage in activities that serve to cleanse toxins and stress from the body and spirit.

Engage the help of others when necessary to de-stress and achieve perspective.

Rest and relaxation are critical in order to prevent “caregiver burnout.”

Raleigh Geriatric Care Management Aging Life Care Professional  www.rgcmgmt.com

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Geriatric Care Manager—>Aging Life Care Professional

WHAT IS AN AGING LIFE CARE PROFESSIONAL?

An Aging Life Care Professional, also known as a geriatric care manager, is a health and human services specialist who acts as a guide and advocate for families who are caring for older relatives or disabled adults. The Aging Life Care Professional is educated and experienced in any of several fields related to aging life care / care management, including, but not limited to nursing, gerontology, social work, or psychology, with a specialized focus on issues related to aging and elder care.

The Aging Life Care Professional assists clients in attaining their maximum functional potential. The individual’s independence is encouraged, while safety and security concerns are also addressed. Aging Life Care Professionals are able to address a broad range of issues related to the well-being of their client. They also have extensive knowledge about the costs, quality, and availability of resources in their communities.

Aging Life Care Professionals become the “coach” and families or clients the “team captain,” giving families the time to focus on relationships rather than the stress. In Raleigh, Durham, and surrounding area, contact Raleigh Geriatric Care Management, an Aging Life Care member.


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Are You the Middle of a Triple Decker Sandwich?

Kathy Birkett, Senior Care Corner

Many baby boomers have grown to think of themselves as part of what has been termed the “sandwich generation”, caring for their aging parents or grandparents and their children at the same time. Calling that simply a sandwich overlooks a very important part of the equation, unfortunately the same part many boomers overlook — yourself.

Sharing information about the Triple Decker Sandwich Generation is an attempt to get boomer caregivers to realize the portion of the sandwich in the middle needs care as well. So often we find family caregivers putting their own needs on hold to address the sometime overwhelming needs of their children and senior loved ones.

No one in the multiple layers of the sandwich benefit when a caregiver ignores her or his own needs to focus totally on the needs of others. For some reason, though, we have been taught to feel like we’re being selfish when we think of ourselves. Just the opposite is true however.  When we take time to take care of ourselves, we put ourselves in a better position to give our best to others.

What happens when you shove your needs aside for too long? There are many reports of stress related disease and depression among boomer caregivers. Certainly being the middle “deck” of the sandwich can contribute to that. Focusing on the health care needs of others but ignoring your own can have serious consequences, especially for those entering a time in their lives where medical visits should be growing more – rather than less – frequent.

Being a Caregiver to Yourself

Taking care of that middle deck of the sandwich doesn’t mean simply looking after yourself, but those aspects of your life that are also necessary to your well being.

  • caring for a relationship with a spouse, partner or friends who help complete your life
  • putting appropriate focus on the job that provides the income needed to support the other aspects of your life (and hopefully some fulfillment)
  • hobbies, sports or other activities that let you get away from the rest of your life for a while
  • anything other aspect of your life that is important to you and allows you to decompress

The first step in caring for the middle deck of your family sandwich is to recognize that you and your needs are important and need to be met. Take some time for yourself and think about those needs putting plans in place to address them, just as you do to meet the needs of your children and senior loved ones for whom you care.

How do you care for yourself and your needs when it already feels like there are too few hours in each day? Can you substitute technology for some of the effort you put in already? There are a growing numbers of devices and programs that bright people have developed to meet the needs of people like you. There might just be an app for that!

In order to fully care for yourself to care for your family, you have to give yourself permission to put yourself in the sandwich instead of on the side of the plate. Some days will be harder than others to find time for your needs, but don’t give up. You will feel stronger when you have met your needs and be more able to be a loving and competent caregiver to the rest of the sandwich layers in your life.

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Caregiver Burnout

By Dr. M. Ross Seligson

Being able to cope with the strains and stresses of being a Caregiver is part of the art of Caregiving In order to remain healthy so that we can continue to be Caregivers, we must be able to see our own limitations and learn to care for ourselves as well as others.

It is important for all of us to make the effort to recognize the signs of burnout, In order to do this we must be honest and willing to hear feedback from those around us. This is especially important for those caring for family or friends. Too often Caregivers who are not closely associated with the healthcare profession get overlooked and lost in the commotion of medical emergencies and procedures. Otherwise close friends begin to grow distant, and eventually the Caregiver is alone without a support structure. We must allow those who do care for us, who are interested enough to say something, to tell us about our behavior, a noticed decrease in energy or mood changes.

Burnout isn’t like a cold. You don’t always notice it when you are in its clutches. Very much like Post Traumatic Stress Syndrome, the symptoms of burnout can begin surfacing months after a traumatic episode. The following are symptoms we might notice in ourselves, or others might say they see in us. Think about what is being said, and consider the possibility of burnout.

  • Feelings of depression.
  • A sense of ongoing and constant fatigue.
  • Decreasing interest in work.
  • Decrease in work production.
  • Withdrawal from social contacts.
  • Increase in use of stimulants and alcohol.
  • Increasing fear of death.
  • Change in eating patterns.
  • Feelings of helplessness.

Strategies to ward off or cope with burnout are important. To counteract burnout, the following specific strategies are recommended

  • Participate in a support network.
  • Consult with professionals to explore burnout issues.
  • Attend a support group to receive feedback and coping strategies.
  • Vary the focus of caregiving responsibilities if possible (rotate responsibilities with family members).
  • Exercise daily and maintain a healthy diet.
  • Establish “quiet time” for meditation.
  • Get a weekly massage
  • Stay involved in hobbies.

By acknowledging the reality that being a Caregiver is filled with stress and anxiety, and understanding the potential for burnout, Caregivers can be forewarned and guard against this debilitating condition. As much as it is said, it can still not be said too often, the best way to be an effective Caregiver is to take care of yourself.

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What to Do When Parents Must Live Separately: 6 Tips to Help Them Cope

By Dave Singleton, Caring.com author

After decades of living together, one parent needs more care than the other can provide. It’s not only hard on the parents; it’s a devastating situation for children and loved ones, too. You want to help, but you feel helpless in the face of what amounts to a forced separation.

What can you do to ease the trauma and provide support for parents facing this circumstance? Recently, I spoke with two eldercare experts who’ve counseled dozens of families and offer these six practical tips:

  1. Determine in advance how the relationship will continue.

    “Before anyone makes a move, encourage your parents to map out how the marital bond will carry on,” says Mary Koffend, president of Accountable Aging Care Management. Of course, if a parent has dementia or Alzheimer’s, it could be impossible for them to make such a plan. But assuming they can, “if Dad now lives in assisted living, then maybe Mom comes over every day for dinner.” Or perhaps she joins in on a regular activity that they can both enjoy on-site, such as discussions, book clubs, craft sessions, games, gardening, playing cards, or watching television.

  2. Ensure that the facility supports the couple.

    “The key is to promote the couple’s identity as a couple as much as possible, or desirable, for both partners,” says Cheryl Woodson, author of To Survive Caregiving: A Daughter’s Experience, A Doctor’s Advice. “Make sure the facility is convenient for the healthy partner in terms of transportation, access, and schedule.” If transportation to and from the new living facility is an issue, arrange in advance for a loved one or paid caregiver to drive, so that your parents get time together. “Even if it’s brief, at least they talk a bit, kiss good-bye, and off one of them goes,” says Koffend.

  3. Help your parent with feelings of guilt and inadequacy.

    Chances are the parent remaining at home feels tremendous guilt as well as sadness over the separation. “A parent might feel like he’s no longer honoring his wedding vows, or that he isn’t doing enough,” says Koffend. You can be supportive by being the voice that reminds Dad that he’s doing all he can. Give him a dose of what Koffend calls “reality therapy” — in other words, talk him out of wishing for what can no longer be. “Help parents understand the choices they are faced with, and reaffirm that they made the right choices, emotionally and logically,” says Koffend.

  4. Get your parents outside help if needed.

    Sometimes your best efforts might not be enough, and you need to engage outside support. “No matter how cooperative the facility is, no one can understand how bereft these couples may feel,” says Woodson. “Families should encourage the healthy partner to talk to clergy, behavioral health professionals, and/or to participate in support groups with other spouses in similar circumstances.”

  5. Help foster private time, if desired.

    Contrary to popular opinion, the need for intimacy doesn’t end when a separation like this occurs. It might be a little awkward for family members to address (understatement!), but help the couple work through whatever issues might be present in order to get deserved privacy. “For example, if a spouse can’t leave the facility for whatever reason, kids can step in and have a very straightforward conversation with the facility’s administrators about arranging alone-time for the couple,” says Koffend. It’s important to understand the concerns of the facility, which might be liable for falls or health issues that occur under their watch. Koffend cites one example of a wife who brought Viagra to her husband in an assisted living facility, which resulted in him having a strong adverse medical reaction. Address concerns and see if you can set fair boundaries.

  6. Expect the unexpected.

    Finally, “Don’t assume that this transition ends once the initial decision and move are over,” says Koffend. “Be prepared for whatever your parents’ needs are afterward, when there’s sadness or frustration on either side.” For some who’ve spent years caring for a spouse, the transition to living alone can be jarring and rudderless. When primary caretaking is replaced by a facility, you might need to help the parent remaining at home to feel needed and purposeful, whether by encouraging her to see friends or volunteer or simply by facilitating more involvement with her spouse’s new life at the facility. “Help your parent realize they have a practical role in the care and upkeep of their spouse who’s now living in a new place,” says Koffend. “It gives purpose to the visits, even if it’s as simple as bringing a few products and a hairbrush to help maintain physical appearance.”

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Who’s Most Likely to Feel Caregiver Stress?

~Paula Spencer Scott

Does caregiving actually cause stress? Some surprising new research says no, the real source of the stress lies within the person, not the situation.

After looking at more than 1,200 female caregiving twins, Peter Vitaliano, professor of psychiatry and psychology at the University of Washington, concluded that how stressful caregiving is for you psychologically is more a matter of your genes and your upbringing. Caregiving itself does not cause stress, he says. This new study appears in the Annals of Behavioral Medicine.

Who’s most at risk, according to this research? People who:

  • Have a history of depression. “Like putting salt in a wound,” says Vitaliano.
  • Grew up with parents who showed a lot of avoidance and fear in response to big stressors (like losing a job).
  • Lack resources to help them cope, like social support and finances.

The study also found that caregiving can cause anxiety, which is in turn linked to depression.

This all may sound like splitting hairs. Though this research confirms Vitaliano’s earlier work debunking a causal connection between caregiving and stress, it flies a bit in the face of many, many other studies that link them. There’s even a name for it: caregiver stress syndrome.

This study didn’t specifically look at Alzheimer’s caregiving, whose duration and unique challenges can wear down even the best-adjusted family member. I wonder, would the results look different?

Bottom line: It doesn’t strike me as terribly helpful to be told your stress is the fault of your genes or your family history. If you’re feeling it, you’re feeling it. It’s nobody’s fault — the real question is what to do about it.

File this info in the nice-to-know category. Then go hide in the bathroom for a little deep breathing, a few bites of dark chocolate, and a wish for some respite time to come your way this week.

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