Category Archives: humor

Creating Fun for Caregivers and Frail Seniors

By Lynn Howe

_1571741_origYour confined-to-home (or assisted living or nursing home) parent, just wants to have fun! You are focused on their safety, finances, medical treatment, medications, privacy, nutrition and therapy. You busy yourself with monitoring their progress (or decline) and doing everything in your power to keep them comfortable. You worry about their reduced energy level, increasing fatigue, physical weakness and variable mental status. But do you know how important it is for them to just have fun? To laugh deeply, live in the moment, to briefly not be just old and frail, to forget pain?

OK, so what can you do? I know that you are thinking, well, they can’t do that much, but you might be surprised at all the options. Too often thoughtful families accommodate so much to their senior’s weakening state that they overlook how much they can do and enjoy! While it’s good to try to bring the world to them with visits, letters, phone calls and email, it’s also important and possible to keep bringing them out in the world. Of course, it may involve more work for you — transporting walker or wheelchair, assisting in/out of cars and doors, walking slowly, negotiating steps carefully, finding bathrooms, keeping him/her dry, warm (or cool) — so be prepared for a different pace and smaller goals. And some cajoling might be needed to just get going.

Mini-field trips

Seniors look forward to having a day out, but as they age, they don’t have the stamina or mobility for trips to fascinating museums, over-stimulating casinos, monster malls, giant sports stadiums, wooded parks, loud modern restaurants, etc. But they may be able to go out for an hour or two. My mom adored a simple trip to the supermarket — colorful flowers, fanciful balloons, acres of fresh, bright produce, bakery smells, energetic families with huge carts. She pushed her walker along, senses on overload, straying down enticing aisles. We didn’t buy a thing. But it was an hour that she talked about for days – a new topic of discussion with her nursing home buddies.
Another day we drove one short mile to a local antique shop. “I had those gold Fostoria glasses,” she pointed out. “Your dad and I would stop at the Fostoria factory store on trips to see my brother in Washington, DC.” Talk about the glassware led to reminiscing about her deceased brother, until she0interrupted herself; “Look at the quilts – just like Grandmother’s.” And so on, pushing her walker forward toward the next memory. After about an hour, she had had enough and home we went.

The first trip to a small local department store just before Christmas involved a little arm twisting. But once there, lights, perfume, soft velvety fashions and just ahead a decorated Christmas tree, worked their magic. She wheeled ahead, touching, smelling, exclaiming. Onward through silky lingerie, cute children’s clothes and glittering jewelry. At about the hour mark, like Cinderella, she was done. She relived it all week.

Recently she and I went to a small jewelry store 10 minutes from her home – she had favorite rings that needed resizing. Instead of just taking them for her, I invited her to come along. For the first time in a long time she became the customer, the center of attention. Soon she asked for a chair, her shopping done. But for her it was a big accomplishment, an errand, like in the old days she so misses.

My father-in-law loved an afternoon drive looking at properties we were considering purchasing. He was curious about these houses we described, their yards, their roofs, the neighborhoods. Since we didn’t even bring his wheelchair or get out of the car, it was like a guided tour. “I’ve been in that house” he’d say. “This was always a good neighborhood” he’d remember. “Let’s see what they are building on that hill.” Other mini trips for him were to the cemetery where his wife was buried, their first house in that area and a volunteer organization they founded. He remembered being a neighbor, a businessman, a father and a contributer to the community.
Other ideas might be a quilt shop for a former quilter, a hardware store for the ardent handyman, the library, bakery, family style restaurant, plant store or flower shop.

Fun at home

You don’t have to go out to have fun of course. Opportunities are right there in their home (or facility) to have fun and fight boredom.

  • Stage a sing-along to his/her favorite music. Play the music loud and clear.

  • Get all dressed up and take some photo portraits – use them for family gifts.

  • Rent/borrow movies for slow afternoons – old ones, funny ones, scary ones.

  • Have a deck of cards on hand and play the old familiar games – gin rummy, hearts, war.

  • Scrabble is great fun with grandkids.

  • Keep a puzzle going if you have a spare tabletop – people coming in always get engaged and stay to talk

  • Get out of the room – visit other residents, attend sing-alongs, presentations, craft sessions, chair exercises lunch groups.

  • Pull out a family album – get them to identify the older ones you may have forgotten and take notes or audiotape the stories you hear. Family photos trigger floods of memories.

  • Pick a theme for the week or month. Decorate his/her room and door. It will bring people in to check it out and or conversation.

  • Rearrange furniture and pictures – just for stimulation.

  • Order in or pick up some favorite foods that aren’t on the regular menu – hot dogs for my mom, milkshakes for my husband’s dad.

  • Manicures and pedicures are a special treat too. Have candy for drop-in guests and gifts for visitors – order online; think about birthday and holiday gifts and ‘shop’ on line.

  • Make up a Christmas, holiday or birthday wish list from the web – send it to family members. So think about what your loved one has always enjoyed, listen to what they talk about, look around your neighborhood and give it a try!

Call Raleigh Geriatric Care Management at 919-803-8025 for a FREE 15 minutes phone consultation. lwatral@rgcmgmt.com       www.rgcmgmt.com

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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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Laughter is the Best Medicine

By  Helen Hunter, ACSW, LSW

When was the last time you had a really good laugh?

The scientific definition of laughing is a “successive, rhythmic, spasmodic expiration with open glottis and vibration of the vocal cords, often accompanied by baring of the teeth and facial expression”. That doesn’t begin to tell the story of what laughing does for us, however. The bottom line is that laughing is medically beneficial.

Laughter establishes or restores a positive emotional climate and a sense of connection between two people. In fact, some researchers believe that the major function of laughter is to bring people together – the more social a person is and the more social support a person receives, the more likely that laughter will result from that social connection. Mutual laughter and play are an essential component of strong, healthy relationships. By making a conscious effort to incorporate more humor and play into your daily interactions, you can improve the quality of your relationships.

What are the Physical Effects of Laughing?

Laughing makes people feel good for a reason. Studies have shown that laughter boosts the immune system and triggers the release of pleasure-inducing neurochemicals in the brain. The immune system, which contains special cells that are responsible for defending the body against infection, have been shown to increase during the act of laughing. In the central nervous system, the brain releases powerful endorphins as a result of laughing. Endorphins are natural, morphine-like compounds that raise the pain threshold, produce sedation and induce euphoria (commonly called a “natural high”). In other words, we feel better when we laugh because endorphins reduce physical and mental pain. While this may be a wonderful feeling, laughing has other benefits as well:

During a laugh, respiration, heart rate and blood pressure temporarily rise. This causes oxygen to surge through the bloodstream that then results in lower blood pressure.

Laughter improves the function of blood vessels and increases blood flow, which can help protect against a heart attack and other cardiovascular problems.

Laughter reduces pain and allows toleration of discomfort.

Laughter reduces blood sugar levels, increasing glucose tolerance in diabetics and non-diabetics alike.

Laughter relaxes the whole body, relieving tension and stress. It has been shown that following a good, hearty laugh, muscles in the body are relaxed for up to 45 minutes afterward.

Laughing burns calories – laughter is sometimes referred to as “inner jogging”. A hearty laugh gives the muscles of the face, chest, shoulders, stomach and diaphragm a good workout.

Laughter also helps to create a positive mood. It allows the expression of happiness and the release of anxiety. Humor eases tension and is a great antidote to a stressful situation. Laughter is often seen as a temporary vacation from everyday problems, bringing us to a paradise in which worries do not exist. Humor and laughter are natural safety valves that shut off certain hormones that are released during stressful situations. In fact, your sense of humor is one of the most powerful tools you have to make certain that your daily mood and emotional state support good health.

Here are some ways to bring more humor and laughter into your life:

Smile: Smiling is the beginning of laughter. Like laughter, it’s contagious. When you look at someone or see something even mildly pleasing, practice smiling!

Count your blessings: Literally make a list. The simple act of considering the good things in your life will distance you from negative thoughts that are a barrier to humor and laughter!

When you hear laughter, move toward it: People are very happy to share something funny because it gives them an opportunity to laugh again and feel the humor in it. When individuals hear laughter, they seek it out and ask “What’s funny?”

Spend time with fun, playful people: These are people who laugh easily, both at themselves and at life’s absurdities and who routinely find humor in everyday events. Their playful point of view and laughter are contagious!!

Bring humor into conversations: Ask people: What’s the funniest thing that happened to you today? This week? In your life?

Laugh at yourself: Share your embarrassing moments.

Attempt to laugh at situations rather than bemoan them: Look for the humor in a bad situation, the irony and absurdity of life. This will help improve your mood and the mood of those around you.

Surround yourself with reminders to lighten up: Keep a toy on your desk or in your car. Put up a funny poster in your office. Choose a computer screensaver that makes you laugh. Frame photos of you and your family having fun.

Keep things in perspective: Many things are beyond our control, so make the best of a situation and find the positive in the situation.

Deal with stress: Stress is major impediment to humor and laughter.

Pay attention to children and emulate them: They are the experts on playing, taking life lightly and laughing!!

Here is a simple prescription for a healthy life:

Thirty minutes of exercise at least 3 times a week, and 15 minutes of laughter on a daily basis!!

The bottom line – laughter may just be the best medicine on the market today!

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Should You Tell a “Fiblet” to a Parent With Dementia?

From our earliest days we are taught never to lie, especially to our mother or father. However, a recent survey of aging experts reveals that telling a “fiblet” can actually be therapeutic when adult children are faced with telling painful truths to aging parents who have a cognitive impairment such as Alzheimer’s disease.

The National Association of Professional Geriatric Care Managers (NAPGCM) recently surveyed 285 professional geriatric care managers about the most common and difficult situations faced by families who are helping aging parents. Geriatric care managers help these families deal with some of the most sensitive and challenging issues.

More than 90 percent of the professional geriatric care managers surveyed said they have used or recommended the “fiblet” strategy to relieve stress and anxiety and protect the self-esteem of an elderly person. The situation cited most by experts in the survey as an appropriate and helpful use of a “fiblet” is when a senior is refusing clearly needed care or assistance at their home. For example, telling an aging parent with Alzheimer’s that a paid caregiver is coming to their home for their spouse’s benefit or for another concrete role can help the elder maintain pride and reduce anxiety.

The following were identified by care managers as situations when it can actually be therapeutic to tell a “fiblet” to an aging parent:

  • When they are refusing needed care and assistance at home. Telling them the caregiver is there for their spouse’s benefit or for another concrete role can help them maintain pride and reduce anxiety (identified by 83 percent of those surveyed).
  • When they can no longer safely drive, yet insist on doing so. Telling them their car is in the shop getting repaired can reduce confrontations (68 percent).
  • When knowing the cost of in-home care prevents them from accepting the needed service (68 percent).
  • When it would only cause worry and stress to tell them about family problems they can’t solve, e.g., unemployment, financial upheaval, divorce, drug abuse, incarceration (64 percent).

According to the National Institutes of Health, as many as 5 million of the 43 million Americans age 65 and older may have Alzheimer’s disease, and another 1.8 million people have some other form of dementia. Americans feel increasingly challenged by the need to communicate difficult information to aging family members with dementia.

“A therapeutic ‘fiblet’ is just that—it is therapeutic because it calms and reassures, reduces anxiety and protects self-esteem,” said NAPGCM President Emily Saltz. She added, “You would use a ‘fiblet’ only with parents who have a cognitive impairment such as Alzheimer’s disease.”

Geriatric Care Managers Share Their Experiences

As part of the survey, geriatric care managers were asked to provide comments about their own experiences in recommending the use of a “fiblet.” A universal theme of the comments was that family members should navigate this clearly delicate area with help from a support group or from an experienced professional care manager. Care managers also stressed that one should only use a “fiblet” to protect and support a family member rather than for personal benefit or gain.

The following are from among more than 200 stories collected through the survey about geriatric care managers’ experiences of using a “fiblet” in the course of their practices:

  • “I’ve used therapeutic ‘fiblets’ in many instances, but probably (most often) when the death of a loved one is beyond a person’s capacity to understand. For example, if a person is looking for a deceased loved one, I tell them that I haven’t seen that person today but when I do, I’ll tell them that the person is looking for them. This serves to validate their experience and provide reassurance that someone cares.”
  • “When an adult son was diagnosed with cancer, the decision was made to not inform his frail, memory-impaired nursing home-bound father of the diagnosis. At the same time, the son increased his visits to his father during treatment, as he had more free time available for visits. The son and father enjoyed more time together without stressing the father with a scary diagnosis.”
  • “A client wanted to see their mother who had passed away many years ago. Instead of telling her that her mother had died and causing her to grieve again, we told her she was out and would return later. She accepted that and went on with her day.”

Source: The National Association of Professional Geriatric Care Managers (NAPGCM). NAPGCM was formed in 1985 to advance dignified care for older adults and their families. Geriatric care managers are professionals who have extensive training and experience working with older people, people with disabilities and families who need assistance with caregiving issues. For more information, visit http://www.caremanager.org. –

Raleigh Geriatric Care Management in Raleigh, NC  www.rgcmgmt.com

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Long Distance Caregiving

Carol O’dell

If you’re a long-distance caregiver, then you know the drill. You call all the time. You coordinate care from 400 miles away. You spend long weekends or vacation time visiting your loved one and hoping before you open that door that they’re OK. Worry comes with long-distance caregiving, and so does guilt, but you try really hard to make it work — and you dread the day that won’t be enough.

You are not alone. According to a recent Caring.com poll, nearly one-third of all caregivers do not live with or, in many cases, even near their loved ones. Here’s a look at a few challenges long-distance caregivers face, and tips to help manage care from afar.

Feeling emotionally connected to your family members.

Sometimes phone calls or visits filled with doctor appointments and home chores don’t allow for heart-to-heart talks. As much as there is to cover, make the time to just sit for a few minutes and allow a natural conversation to emerge.

Set up a weekly phone-chat date for the times that you’re apart. Have it at a time when you both can look forward to it and nothing competes. After you discuss some of your “to-do” list items, begin to share something personal about your own life. Ask their advice on something — anything — from the color shoes you should wear to your cousin’s wedding to whether you should get a bigger car. Let them feel as if they’re a part of your life as well.

Getting shut out.

Many long-distance caregivers, particularly those helping someone with moderate to severe dementia, find that their visits actually aggravate their loved ones — who are confused and want to “go home” or don’t understand why you keep calling them “Dad.”

Remind yourself that you’re not just there to visit. You’re there to make sure Mom or Dad are being cared for properly. (Having a loved one with moderate to severe dementia increases the likelihood that he or she is living in a care facility.) Stay out of sight if you have to, but visit the staff, have lunch in the cafeteria, and walk the grounds. Talk to the people your loved one interacts with to find out how he or she is doing. It’s painful not to be able to connect, but remember that you’re still needed.

Knowing your loved one is safe and appropriately cared for.

Audrey Adelson, author of “Long-Distance Caregiving,” writes, “Often, long-distance caregivers obtain important information from their elder or secondhand from family members who have spoken with a member of their loved one’s treatment team. This makes it difficult to get a clear understanding of what is really going on.” How do you stay in the loop when you’re not in the area?

How to manage? By having lots of eyes. Whether you coordinate care for your loved one in his or her home or an assisted living facility, start to connect with those who interact with your loved one. Call after an appointment and ask how it went. Let them know you plan to be involved, and be sure to send a thank-you card or friendly e-mail.

Managing insurance and financial needs or making sure you can trust those who do.

Trust is a big issue for long-distance caregivers. When you don’t have people who genuinely care for your loved one and communicate with you about what’s going on, then you begin to worry, and worry, and worry.

Take the time to find professionals who can assist you and your loved one. It’s worth the time and effort. Hire an elder law attorney to make sure their financial assets are protected, or check into local resources designed for seniors and their family’s needs.

Make a plan for whatever comes next.

Long-distance caregivers dread getting “the call.” Whether it’s from a concerned neighbor or from the ER at 4 a.m., it’s difficult to know what to plan for when anything could happen. Try to laugh (or scream, or sob) when all of your planning and hard work takes a dive and you have to come up with a new plan. Change is inevitable, and when we fight that it that causes us pain.

Play “what if.” Come up with the three possible scenarios — a fall, a worsening of a condition or ailment, or a refusal to move even when that’s needed. How will you handle it? Can you go ahead and do some online searches? Can you connect with other caregivers and ask how they handled a big change and ask how it’s going now? It’s easier to face the “what ifs” when you know that somehow, some way, you will get through.

Being a long-distance caregiver comes with challenges you never thought you’d have to face. Sometimes you have to let go, just a little, of all that you can’t control. Caregiving isn’t easy, and there aren’t always solutions, so grab your rearview mirror the next time you’re in your car and look at yourself and say, “You’re doing the best you can.”

For a loved one living in Raleigh, NC, contact Raleigh Geriatric Care Management to assist with your family member. www.rgcmgmt.comRaleigh ,NC

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Remember the Studebaker? Reminiscing as Therapy for Your Parents

By  Paula Tchirkow, MSW, LSW, ACSW

Not again? You’ve heard that story about Sunday trips in the big black Studebaker at least 100 times. But you sit politely as your elderly mother recalls her grandfather’s rumble seat, running boards, chrome grill and overflowing picnic basket.

It’s likely that your mother has not forgotten that she told you the story before. And she’s not just shooting the breeze or living in the past. Your elderly parent is bolstering her self esteem by reminiscing. Like many older adults, she is engaging in an important psychological process called “life cycle review,” and it’s healthy.

Encouraging an older adult to reminisce is one of the easiest and most effective techniques you can use to boost their confidence and brighten their mood. In fact, it’s virtually foolproof as a method of combating mild depression or loneliness.

Go ahead, give it a try. Next time the Studebaker story comes up, engage your mother. Ask her how many people fit in the car? Did it have a rag top? How fast did it go? What were the roads like back then? And what exactly was in that picnic basket?

The vivid connection to a time when your mother or father felt more alive, happier, successful, and useful reassures them that they weren’t always in their current physical and mental state. Reminiscing helps older adults review past accomplishments and activities, thereby giving them a renewed sense of fulfillment about their life.

Although most people tend to focus on good memories, life cycle review can also help older family members become comfortable with the past. That is, the technique gives older adults an opportunity to admit and accept the parts of their lives that didn’t go as well as expected.

Both the reckoning process, and the acknowledgement of happier times, clears up minor depression, reverses feelings of isolation, and helps parents get back into a rhythm of positive reinforcement that boosts physical and mental well being. To be sure, the benefits of storytelling and review are greatly underestimated.

To discover how valuable life cycle review can be for older adults, here are 10 tips to help you get the process started:

  • On your next visit, quickly survey the home for an object to spark a conversation. For example, a cookbook may start the person talking about a favorite recipe or holiday. A piece of antique furniture, nick-knacks, old records, needlepoint projects, a piece of clothing, even a dish towel has worked as a catalyst for conversation.
  • Visit the attic. If you’re not having luck with the items that are in plain view, don’t be shy about taking a trip to the attic or basement to dig out old photos, cards and letters, maybe a wedding dress. Personal props such as these can trigger a flood of memories and conversations.
  • Use scents. Without fail, certain smells bring back memories almost instantaneously. That may be because the sense of smell is the most primitive of our senses, and the last to fail. Even older adults suffering from advance stages of dementia usually respond to smells, albeit not verbally. For instance, their eyes may brighten or a smile may appear when they get a whiff of cinnamon, wildflowers, fresh baked goods, peppermint, or coffee.
  • Create reminiscing cards. Browse magazines, newspapers, or the Internet to find images of items that you know will prompt a conversation, such as scenes from the Depression Era, amusement parks from a parent’s childhood, places they visited on vacation. Paste the pictures onto pieces of cardboard and build a catalog of visual aids. The cards can be use by family members or healthcare workers who look after your parent.
  • Don’t shrink from the unhappy memories. Recounting less-than-perfect events can be cathartic. Reflection doesn’t always have to be rosy, and often unlocking long-forgotten disappointments is uplifting. It’s a way for older adults to get worn-out burdens off their chest. For instance, you may hear from an older widow, that if she had to do it all over again, she would not have married her husband. They key is to let people freely express doubts and fears about the past, and validate—don’t judge—those feelings. Interestingly, and sort of magically, we all become less inhibited about expressing feelings as we get older. So don’t shut out the more sobering events for fear that it might depress your parent – the exercise will likely raise their spirits.
  • Do it on the phone, in person, or on the Internet if your parent is computer savvy. These reminiscing sessions can take the form of a 15 minute phone conversation; an hour-long respite over tea, maybe a look through a photo album after Christmas dinner. There is no set length of time or frequency that is ideal. The amount of time you spend recollecting is case specific, and usually depends on the attention span of the older person.
  • Encourage in-home health aids or the staff at healthcare facilities to use the technique too. It’s a great alternative to stale topics, like the weather. For parents that live in care facilities, create a personal history poster to hang over their bed. In that way, healthcare workers can refer to the poster when they visit the room. Include things like your parent’s nickname, former profession, how they met their spouse, the names of their children, grandchildren and pets, hobbies, favorite movies, songs, or books, towns and cities where they lived, or any other piece of personal trivia that will guide the staff into a rewarding conversation. Aside from prompting conversation, the fun facts help the staff envision your parent as someone other than a frail or stubborn resident.
  • Assemble a scrapbook. For parents that can physically handle this task, it’s a great way to organize memories and start a new hobby – one that can be shared by the whole family. Include photos, ticket stubs, fabrics from, say, a wedding dress, newspaper clippings, recipes, and other homespun memorabilia. For parents that are unable to create a scrapbook, adult children can put it together, and keep it handy as a conversation starter. If you’re making a scrapbook for parents with advanced Alzheimer’s disease or dementia, keep the book short and simple.
  • Allow your parents to reap the physical benefits. Recollecting good memories, and dropping old burdens, has a positive physiological effect on older adults. Research shows that sparking these memories causes blood pressure and heart rates to drop, essentially producing a calming effect. (Pet therapy produces the same effect.)
  • Document the past for the future. There’s something in life cycle review for everyone involved, especially future generations. Photos and scrapbooks are often considered family treasures, but new generations of archivist are using audio and video tapes as well. Use new technology it to capture a little bit of your family’s past, just make sure you hang on to the right playback equipment or your memories could be lost – remember the fate of eight-track players?

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Stress and the Holidays: Coping Strategies to Keep you Sane

By Helen Hunter,

Every year, the media bombards us with advertisements showing the “happy family” gathering for the holidays. People from different generations are together, having a wonderful time, sharing traditions of old and creating new ones as well.

It is not that way, though, for a great number of individuals. For those who don’t have families of their own, or for those who live alone and have relatives living far away, holidays often bring heartbreak and depression. Those who have been used to family celebrations in the past and no longer have that to look forward to cannot accept the “change” in the tradition, especially if they keep hearing about others who are getting together with their own families.

There are two things to remember that can help get you through the holidays. The first thing to realize is that it is okay to cry. This can be a tough time for many. It is natural to feel depressed when your friends are having the ideal family gathering. Allow yourself to express your inner feelings.

The second thing to remember is to control the holidays, do not let them control you. This requires planning. If you know that you will be alone on the holiday, start planning ahead for what you will do. Here are some suggestions for things you can do to sidestep the holiday blues:

  1.  If you cannot be with family, try to spend time with friends or neighbors instead.
  2. Get away from the source of the depression. If your home reminds you of past holidays spent with a loved one, go on a cruise, or take a vacation to another part of the country, or go abroad.
  3. Get involved with an activity. Volunteer at a local senior center, church or community center that serves meals on the holiday, or give your services to a hospital. If you know that someone will be alone and cannot get out for the holiday, visit. If the person lives far away and you cannot physically visit, make a phone call. In helping those who are less fortunate than yourself, you can forget some of your own troubles.
  4. Invite others who are also alone to your home to share the holiday. You can prepare a meal for them, or you can go out to a restaurant. Company always helps ease depression.

Be gentle to yourself, especially if you have recently lost a loved one. If you do not feel like celebrating, don’t! If you do wish to celebrate, keep it simple. Remember the TRUE reason that we celebrate the holidays!

The important point to remember here is that if the old traditions cause heartbreak and depression, change the tradition – start a new one!

Also, be sure to review your expectations and be realistic. Not everyone is jolly, generous and loving all through the holiday season. As Wayne A. Van Kampen from the Bethesda PsycHealth Reporter wrote, “ Somehow (during the holidays) persons feel pushed into hiding, covering over, or denying the reality of sadness, fear and tension. Perhaps what is needed most is simply a more honest embracing of ourselves, others, and the realities of life.” Not everyone will have a happy family gathering just because it is the holiday season. Old resentments are likely to resurface, no matter how hard we try, when people are thrown together for an extended period.

In addition, there are a number of strategies that can be used in planning the holiday celebration.

These strategies include the following:

  • Delegate responsibilities and activities so that one person is not taking on more than can be accomplished without help.
  • Do not assume responsibility for the entire household’s holiday happiness.
  • Work minute by minute on your attitude. Postpone becoming angry and show understanding and calmness. This technique should be used not only during the holiday period, but every day!
  • Any task that you have chosen to do, whether it be the cooking, cleaning, gift wrapping, card addressing, organizing, decorating or shopping, is to be viewed as a choice that you made. Try to have fun in tackling these tasks, which will make the holiday easier and keep your spirits positive.
  • Start traditions that make the most sense to you in your life now. It doesn’t always have to be done the same way every year.
  • Do things together as a family that you all truly enjoy.

Make the holiday season a time for you and your loved ones to have fun and to share special memories. When the entire season is over, sit down, relax and count your blessings. Remind yourself as to how lucky you are. When you make an effort to have a joyous, stress-free holiday, you can avoid the stress. The key is to plan ahead, and to ask for and accept help from others.

Raleigh Geriatric Care Management www.rgcmgmt.com

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Holiday Family Gatherings: A Time for Enjoyment & Meaningful Discussions

Once again we’re preparing for families to come together over the holiday season. We long to see how our seniors are doing, especially those who are far away from us and living independently.

Are they ok? Have they been eating well? Is the house in good repair? Are they paying all the bills on time? Have they been keeping things from us?

Hopefully, during our visit with them to celebrate a time of family sharing we will be able to observe them for any signs that they need a little bit more help. There are many things we should be on the lookout for in their home, their own health and appearance, the car, the home and the yard.

Another important thing we should do while we are visiting our senior loved ones is talk.

“Talk about what specifically,” you ask?

Serious Discussions with Parents & Other Senior Loved Ones

We might find some discussions hard to begin and others may be taboo in your family or culture. Unfortunately, once your parents reach a certain age (and you as well) it is recommended that these uncomfortable discussions happen and the answers clearly brought out into the open.

Whether you want to or not, some things are just better to know.

  1. Do they have any advance directives? Is there a living will created about which you should know? What are their wishes for end of life care? Do they have a DNR or a healthcare proxy to speak for them if they can’t? It is important to hear directly from them what they anticipate their end of life to be. What if they get into an accident or have a medical emergency? If you don’t talk openly about this eventuality it will be more difficult, especially if you are at a long distance, to make decisions in an emergency without prior knowledge. Do they have burial plans already?
  2. If they have executed these documents, where are they kept? Can you get a copy? Does the doctor know about them and do they have a copy on file? Do they need to be updated?
  3. If they don’t have them created, can you do this during your visit so all their wishes are documented in case of an emergency? Now is a good time to get important documents executed while you are there to get the necessary information. These decisions must be made before your senior is no longer competent to make his wishes known legally.
  4. Do they have a will? Who is the executor? Where is the will kept – who is the attorney? Where are the contact numbers for lawyers, doctors, and other people if you need them?
  5. Are they still competent to drive safely? Has the car been damaged since your last visit? Take a ride as a passenger to test them, even if it is without them knowing your purpose for going for an ice cream cone together.
  6. Are they declining in functional status? Does it look like they are having difficulty keeping themselves neat and tidy? Are their clothes clean and in good repair? Are they shaving? Do they have unexplained bruises? Are they appearing thin or weak? Are they having trouble balancing themselves when they walk or get up from sitting? Do they need more help?
  7. Is their home still adequate to age in place? Is it where they want to be or would they rather come closer to you, go to a senior living area or move to a smaller home that is easier to care for alone? Some seniors enjoy living in an assisted living facility where they have less responsibility and more opportunity for social engagement. Is their current home accessible to transportation services if they can no longer drive? Is their home in good repair with adequate safety modifications to prevent accidents? Can you work on some modifications while you visit and schedule other more involved upgrades for when you are not there?
  8. Are they depressed or isolated? Some seniors choose to stay home and reduce their visits to places, people and events that they once frequented for a variety of reasons. Perhaps they are afraid to drive, don’t want to go alone, can’t leave the house for too long for fear of needing a restroom quickly, or have side effects of medications that keep them from being active. Seniors need to be social, mentally stimulated and engaged to prevent boredom and loneliness. It might be a good time to get them reconnected, take them to the senior center and arrange transportation if necessary. Find things for them to be active and involved from home. Set up some technology and teach them to use it so they can use social media, Skype or Facetime to engage with distant family and friends.
  9. What about their finances? Do they have enough money to meet their needs? Are they paying their bills? Do they have a supplemental insurance policy or long term care policy which you should be aware? Are they struggling to make ends meet? Are they getting the benefit of all — well — benefits to which they are entitled?

~by Kathy Birkett

Assistance is offered with Raleigh Geriatric Care Management in North Carolina www.rgcmgmt.com to help you and your aging loved ones navigate the myriad of senior resources and services.  lwatral@rgcmgmt.com for more information. 

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The Sandwich Generation

~By Kathleen Bogolea, MS

Since the adoption of the National Family Caregiver Support Program in late 2000, there have been numerous news articles and points of interests written about the family caregiver and their many different roles within the family and the community. Roughly, it is estimated that American families provide 80 to 90 percent of all in-home long term care services for their aging family members, disabled adult children and other loved ones.  These services may include assistance with activities of daily living (ADL’s), medical services coordination, medical supervision, administration of medications and assistance with financial, legal, spiritual and emotional concerns.  These services are priceless and the family caregivers that provide them often go unrecognized and over utilized which can lead to great stress for the family caregiver.  In contrast, if these same services were to be provided by our national health care system, it would be estimated at approximately 250 billion dollars per year.

Recently, and of particular interest, there is a new buzz around a subset of caregivers known as the  “Sandwich Generation”.  These are caregivers who find themselves squeezed in between caring for younger loved ones such as children, and their elder parents or other elder family members.  While the Sandwich Generation is not a new form of family caregiving, these caregivers are receiving a long overdue peaking of interest within American society.

Currently, the typical American Sandwich Generation Caregiver is in her mid-forties, married, employed and cares for her family and an elderly parent, usually her mother. With this said, it is important to note that there are more and more men that find themselves in a caregiving role and even squeezed in between the generations.  It is also important to note that there is an ever-growing segment of family and sandwich generation caregivers that live in rural communities. Unlike caregivers living in urban and industrial areas, rural caregivers may find themselves removed from readily available and professionally organized supportive services and care networks.  They may also find themselves not only carrying the normal burdens that are associated with providing care for a loved one, but also they may be faced with challenges such as geographic barriers to resources and isolation from other caregivers, family members or informal supports.  This lack of service availability, care networks, and isolation from other caregivers and family members can add to caregiver stress, burnout, and depression. 

The demanding role of being a caregiver spreads across all racial, gender, age and ethnic boundaries.  Some of the common stressors that affect both urban and rural sandwich generation caregivers are:

  • How do I split my time between my children/family and my elder loved one?

  • How much of my time is too much time in each caregiving role?

  • How do you find the time for my marriage?

  • How do you find the time for myself?

  • How do I keep the generational peace between my kids and my elder loved one?

  • How do I find the resources that I need for my self and my loved one?

  • How do I combat my feelings of isolation?

  • Guilt, Guilt and more Guilt for not having enough time to accomplish all that “should” be doing. 

To counter act some of these stressors, here are some caregiver tips that may help sandwich generation caregivers along the way:

Hold A Family Meeting
At this meeting, discuss the many different caregiving tasks that need to be accomplished each day or week.  Set a task list for family members to complete each day/week.  Set mutual expectations of how the many tasks of caregiving will be accomplished.  Caregiving is often a one-person show but it does not need to be if you have family support.  The family meeting also allows for family members to participate and share in the valuable gift of caregiving and this can be very rewarding.

Communication
Encourage children and elders to communicate with one another.  During the family meeting, make sure that all family members have a chance to talk about their thoughts and feelings.

Ask For Assistance
Make a point of picking up the telephone and spending time calling resources such as your local Area Agency on Aging, a hospital social worker, a physician or church. The Internet can also be a wonder resource finding tool.  Never be afraid to ask for assistance when you need to, you may be surprised at who has been waiting to help you.

Take Time To Care For Yourself
Too often I meet caregivers who are run down and even sick because they have not taken time to care for themselves.  Sure, no one can take care of your loved ones as well as you do but you must care for yourself if you want to continue to care for your loved one.  This is not an act of selfishness, it is actually an act of great giving.

Take time every day to “check-in” with yourself, even if it is only 10 minutes.  This should be your protected time.  Enjoy this time by reading, listening to music, exercising or whatever you like to do.

  • Remember to laugh at the funny things in life.

  • Take time to be “in” your marriage.

  • Listen to your body. If your body is telling you to slow down, or that something is not right, seek medical advice.  Too often we do not listen to our bodies no matter how loudly they may be talking to us.

Every caregiver and caregiving situation is unique but there are always common factors which bridge these situations and caregivers together.  It is easy to become lost in the caregiving that you are providing but remember that support can come from many different sources and in many different ways.  For those of you who are squeezed in the sandwich generation please know that you are not alone and that assistance is often only a telephone call or internet site away. Your local Family Caregiver Support Program is here to help you.

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