Category Archives: nursing homes and assisted living

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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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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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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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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