Tips for Managing Caregiver Stress

September 19, 2011 By 3 Comments

Chances are that, to some degree, you been a family caregiver for your loved one for some time now. To one degree or another, you’ve been tending to their needs: taking frequent phone calls, grocery shopping with (or without) them, and performing chores around their home.

Whether you are the child, sibling, or the spouse of your loved one, you’ll be feeling the emotional and physical strain of the role you’re playing. There’s an uncomfortable shift in the dynamics between you.

If you’re the child, you’ve become a parent of sorts. If you’re the spouse, you’re forced into a new and often unwelcome level of intimacy. And, if you’re a sibling, it’s imperative that your decisions not be clouded by childhood memories or resentments.

Being aware of these shifts in roles and responsibilities is the first step in self- care for the caregiver (that’s you, remember). The second step could be to seek support and assistance. One great resources is National Caregiver Support Groups. These groups can put you in touch with their local chapters. In addition, you can get information regarding support groups in your area from local nursing homes or eldercare agencies.

The Effects of Caregiver Stress

Dealing with the health problems of someone you love naturally produces stress in your life. It can wear you down, both emotionally, and physically.

I mentioned in my opening story that at one point in my mother’s illness, I was driving hundreds of miles each week to visit her in the hospital or skilled nursing facility. My mother’s condition was the result of a sudden event – which is different from the lingering decline described as part of the assessment process. With such a dramatic event comes shock, guilt and acute sorrow.

The time spent on the road gave me hours to think about how things could have been different; the traveling to and from her bedside took time away from my work, and my relationships. The stress of my mother’s illness was dominating my life and had manifested itself in many ways.

Stress manifests itself in three ways: physically, cognitively and emotionally. Below is a list of stress symptoms. Looking back at that period in my life, I realize stress has manifested itself in many of those symptoms.

Physical Symptoms

  • Headaches
  • Sore back / stiff neck
  • Teethgrinding
  • Sexual dysfunction
  • Heart palpitations
  • Restlessness
  • Shortness of breath
  • Heartburn
  • Diarrhea/constipation
  • Jumpiness
  • Chronicinsomnia

Cognitive Issues

  • Difficulty in making decisions
  • Decreased problem-solving ability
  • Obsessive thinking
  • Short-term memory loss
  • Decreased concentration
  • Drop in organization skills
  • Limited attention span

Emotional Signs

  • Loss of interest in hobbies or recreational activities
  • Frequent crying or tearfulness
  • Persistent sadness or depression
  • Irritability
  • Chronic anxiety

Are you currently suffering from one or more of these symptoms of caregiver stress? I’m not surprised! Even in the early stages in dealing with the chronic health issues of a loved one – whether parent, sibling or spouse – you’ll find that you’ve become (more or less) tolerant of many of these manifestations of stress.

What I’ve learned is simple: taking care of yourself is essential to the well-being of your loved one. Here’s a short list of some of the things you can do to support yourself during the coming weeks:

Seek support from others. Turn to your loved one’s neighbors and friends; or other family members. They may be able to spend a few hours caregiving while you run errands, or even just take a short nap. Don’t feel you have to do it all alone!

Find a way to release your emotions. If you’ve got a pastor, spiritual advisor, close friend, or a therapist – someone you can trust 100% – be sure to reach out to them. They will be able to listen to you lovingly, and keep what you tell them to themselves.

Take time for yourself. If you like to walk on the beach, go shopping, take your dog to the park, or simply go see a movie – do it! Do not procrastinate on this: taking time for simple pleasures every day is critical to your well-being.

Simplify your life. Ask yourself this question: What can I let go of right now? Maybe you shouldn’t tackle new projects at work; maybe you should let go of hunting for that new house – whatever you can put ‘on the back burner,’ now is the time to do just that.

Avoid excessive alcohol or drugs. Ah, the temptations of self-medication. Don’t give into them. It’s not the wise path; ultimately, the care you are trying to provide suffers, and you’re less able to take care of the other things in life. Your job, marriage or parenting duties will suffer. That’s why I highly recommend the next tip:

Continue or begin an exercise program. It’s been clearly proven: aerobic exercise causes the brain to produce endorphins, which are your body’s natural way to enhance your mood and relieve your stress. Find a way to build regular exercise into your week: walk, run, practice T’ai chi; go bowling or play a round of golf with friends. Note: Always check with your doctor before beginning a new exercise program!

Do yoga. Yoga can be a fantastic stress reliever which providing a great deal of exercise and better flexibility. I cannot recommend Yoga enough, as it alone helps me reduce my stress level and irritability. A note for the men reading this book: Yoga can be hard work, very challenging and a great way to relax and build muscle. Don’t think Yoga is effeminate or too easy!

In the wonderful book, When Someone You Love Needs Nursing Home Care, the authors, Robert Bornstein and Mary Languirand help their readers to build a long-term plan, based on six principles:

  • Plan ahead. It may be a difficult subject to broach with your loved one, but planning ahead provides them with the opportunity to fully participate in the decision-making process.
  • Get advice. Don’t discount the value of speaking with those people who have been down this same road. Join a support group (online or offline), and speak with doctors, nurses and health care professionals. When it’s financial or legal advice you need, turn to attorneys and accountants.
  • Get others involved. Share the workload with family members, co- workers, and friends. Remember they care about you, and would love to help when they can – so don’t hesitate to ask!
  • Keep colleagues informed. Those people in your workplace need to be taken into your confidence; they’ll want to know why you’re frequently absent from your desk, or unable to take on additional work.
  • Take care of yourself. We’ve already touched upon ‘self-care’ as being critical not only to your well-being but to the well-being of your loved one as well.
  • Put things in perspective – and keep them there! Short-term thinking (“Things are falling apart and will never get better”) is a trap. As I’ve learned so clearly, people grow through adversity, and you’ll never be able to know just how this growth will manifest itself. Remember that change is inevitable…“this too shall pass.”

Photo Credit: lululemon athletica.

Filed Under: Caregiving, Family Life, Health Tagged With: , , ,

Is it Time for A Geriatric Screening?

September 12, 2011 By Leave a Comment

With elder care, there are rarely black and white answers to your concerns. Do you believe that your loved one is exhibiting behaviors that indicate their inability to perform basic or complex tasks? If you find yourself answering “yes,” then you should consider a geriatric screening for your loved one. You can arrange for a geriatric screening through your local hospital or social service agency.

To have a productive conversation with the healthcare worker or elder care provider, be sure to gather enough information about your loved one’s medical condition, legal status and personal preferences.

What is Geriatric Screening?

A geriatric screening is a comprehensive assessment designed to optimize an older person’s ability to enjoy good health, improve their overall quality of life, reduce the need for hospitalization and/or institutionalization, and enable them to live independently for as long as possible. An assessment consists of the following steps:

1. An examination of the older person’s current status in terms of:

  • Their physical, mental, and psycho-social health
  • Their ability to function well and to independently perform the basic activities of daily living such as dressing, bathing meal preparation, medication management, etc.
  • Their living arrangements, their social network, and their access to support services.

2. An identification of current problems or anticipated future problems in any of these areas.

3. The development of a comprehensive “Care Plan” which addresses all problems identified, suggests specific interventions or actions required, and makes specific recommendations regarding resources needed to provide the necessary support services.

4. The management of a successful linkage between these resources, the older person and that person’s family so that provision of the necessary services is assured.

5. An ongoing monitoring of the extent to which this linkage has or has not addressed the problems identified, and modification of the Care Plan as needed.

Who Performs a Geriatric Screening?

A geriatric screening can be done in many different settings such as:

  • a hospital
  • a nursing home
  • an outpatient clinic
  • a physician’s office
  • the patient’s home

Because a geriatric screening is so comprehensive in scope, it can only be successfully conducted by a multi-disciplinary team of experts. This team might include:

  • physicians
  • ancillary personnel
  • social workers
  • physical and/or occupational therapists
  • dieticians
  • psychologists
  • pharmacists
  • geriatric nurse practitioners

You can request a referral for a geriatric screening from a primary care physician. Also, check with any large hospital or university to see whether they have a geriatric assessment unit.

For more information on geriatric screenings, I recommend you review The Geriatric Patient: A Systematic Approach to Maintaining Health. This article by the American Association of Family Physicians provides a detailed review of the standardized assessment tools typically used in an outpatient setting.

Photo Credit: simaje.

Filed Under: Assisted Living, Caregiving, Health Tagged With: , , ,

3 More Signs of Functional Decline

September 5, 2011 By 3 Comments

elder careIn the last blog, I discussed some of the warning signs that your loved one could be experiencing functional decline, including difficulty communicating and the disturbance of everyday functions and tasks. These kinds of hardships may be symptoms of a more serious functional decline, in which your loved one is losing the skills needed to maintain basic independence.

In the previous blog, I gave a detailed account of physical, perceptual and cognitive changes that can indicate a functional decline. Now here are three more areas to monitor if you believe your loved one may be experiencing functional decline.

1. Hearing and Vision Loss

Hearing loss is hard to hide; it’s often one of the first indications your loved one is in need of assistance. Here’s a list of things to note:

  • Saying “What?” over and over again during conversations, or repeating what you just said, as if to confirm what they heard.
  • Turning the volume up on the television repeatedly, until the neighbors may be able to hear it – while your loved one still complains it’s ‘too low.’
  • An inability to distinguish certain sounds, such as f, t, and z, resulting in misunderstandings and miscommunication.
  • Nodding frequently during conversations, as if to confirm that they are participating fully in the dialogue.

And then there is eyesight – often the first of the senses to be noticeably affected by age. Focusing on small details becomes difficult; self-grooming becomes challenging – and who can write out the checks to pay bills when you can’t see the numbers?
As with hearing loss, compromised vision is also a safety issue. What are some of the signs of decreased visual acumen? Just ask yourself these questions:

  • Has your loved one lost interest in reading, playing cards, or other hobbies where clear vision is required (embroidery or television viewing, for example)?
  • Are their clothes, shoes or socks frequently mismatched?
  • If they still drive a car, are they getting lost more often (because they can’t see the street signs)?
  • Has your loved one started to fall, trip or bump into things more frequently?

Once again, a primary concern here is one of safety. How safe can your loved one be, if they can’t clearly hear or see the world around them? And if they’re driving, it can be catastrophic.

3. Frequent Falling

Certainly, frequent falling may not be related simply to poor eyesight; it could be the result of medical conditions related to poor physical health. Or repeated falling in the home environment could be the result of poor safety habits: loose throw rugs, a cluttered living space, exposed wiring, no handrails or poor lighting. There are also those elderly who refuse to use their assistive devices such as canes, walkers and wheelchairs – even refusing to wear their eyeglasses!

Whatever the causes, the consequences are serious – and should be addressed by your family or geriatric physician. Here are some things to watch out for:

  • Unexplained cuts and bruises, or explanations for these injuries that seem far-fetched or implausible.
  • Hesitancy when walking or climbing stairs.
  • Reticence to leave the familiarity and relative safety of their home.

4.  Psychological Changes

May Lamberton Becker – the journalist and literary critic once said, “We grow neither better nor worse as we get old, but more like ourselves.” What she’s describing is the process called disinhibition, where those personality traits that may have once been charming or quirky slowly become exaggerated as we age. Aunt Rosemary used to be rather bossy, but now she’s dictatorial; your father, who used to simply be self-reliant, is now completely resistive and argumentative.

It seems that the natural process of disinhibition is magnified when aging is coupled with fear and unhappiness. If it is complicated even further by depression or anxiety, your loved one will completely cling to those coping strategies that served them so well in their younger days – to the point they completely interfere with an independent life.

So, whatever you do, don’t delay in taking action. Start actively assessing all six areas of your loved one’s strengths and abilities as soon as possible. If there are signs of a serious functional decline, then you may want to consider a transition to assisted living.

Photo Credit: Flickr user One From RM.

Filed Under: Assisted Living Tagged With: , , ,

3 Common Signs of Functional Decline

August 29, 2011 By 4 Comments

Everyone changes physically and mentally with age, but there are some changes that can really put a loved one’s safety at risk.  If you think that a loved one may require a transition to assisted living or elderly care, then you must first assess whether they are undergoing a true functional decline.

Functional decline is sometimes difficult to diagnose as individual symptoms often go unnoticed. Below is a list of symptoms of functional decline to be familiar with.

  • Misusing medication (over or under use and deviating from a schedule)
  • Reports of inexplicable behavior from friends, neighbors or family members
  • Poor personal hygiene
  • Unpaid bills
  • Changes in spending patterns
  • inappropriate clothing
  • Stains on clothing or upholstery from urine or feces
  • Forgetting how to use simple tools
  • Poorly cared-for pets
  • Repetitive questioning
  • Difficulty in communicating
  • Confusion
  • Unfinished tasks and chores
  • Spoiled or poorly-prepared food

Studies have documented that functional decline, i.e., the loss of either complex or basic ADL functions is due to changes in one or more of six areas: physical, perceptual, cognitive, visual and hearing, falling and psychological.  Below I will describe the first three areas in more detail and I will discuss the latter three areas in the next blog post.

1. Physical Changes

It’s obvious to anyone: as the human body ages it loses physical strength, stamina, muscle coordination, and balance. Those of us who had aging grandparents or aunts and uncles saw firsthand how the natural aging process affected their abilities to perform commonplace tasks.

2. Perceptual Changes

Here we’re considering all the senses: vision, hearing, sensitivity to touch, taste – even smell. After all, each is important to overall well-being. If you can’t smell smoke, you may lose your life to a house fire; if your sense of touch is diminished by poor circulation, you may be burned by scalding water.

Many medications are responsible for changes in taste perception. When this happens, it’s easier to eat spoiled food, or even choose not to eat at all, as food no longer tastes like it used to. I have noticed that after older people are less able to use the telephone with ease. Warning alarms and buzzers may go unnoticed.

3.  Cognitive Changes

While our thinking may remain clear, the speed at which a human can process information slows considerably as we age. It’s not just the speed at which we perform tasks. It’s also our ability to multitask. Our ability to divide our attention fades as we age.

Those changes are within the range of normal and expected changes; but what of the complications of dementia and Alzheimer’s disease? With dementia and Alzheimer’s loss of memory, language processing skills and inability to solve problems greatly affects your loved one’s level of independence.

Look for these warning signs:

  • Disorientation, fright or confusion when faced with a change of location, such as a doctor’s visit, visiting friends or family, or eating out at a local restaurant.
  • Giving incorrect or evasive answers when asked simple questions. For example, “What day is it?” gets the response, “What, don’t you know?”
  • Aggressive behavior or noticeable personality changes.
  • An inability to concentrate on television programs, tasks or conversations.
  • A gradual (or sudden) loss of memory.
  • Disinterest in routine tasks, such as cooking or housekeeping.
  • A decline in social skills, such as successfully engaging in conversation, or eating a meal with the correct utensil.
  • A decline in judgment skills, or inability to recognize consequences. This could manifest itself in leaving the water running, not shutting off the stove, or leaving the front door unlocked.

There are three more areas to monitor in order to determine whether a loved one is experiencing a real functional decline: hearing and vision loss, frequent falling and negative psychological changes. In the next blog post we’ll discuss symptoms within these three areas and how these problems can lead to a functional decline and loss of independence in aging individuals.

Photo Credit: Flickr user e-MagineArt.com.

Filed Under: Alzheimer's, Assisted Living Tagged With: , , , ,

Finally, a Vision for Care Referrals That Will Improve Outcomes

October 4, 2010 By Leave a Comment

Picture this: you’re one of millions of Americans who needs care at home either because of aging, dementia, recovery from surgery or other disabilities.  You’ve got a family—and often an unpaid caregiver who helps with your care.  They’re part of an elaborate team of caregivers, physicians, therapists and non-medical assistance.  I’ve lived this first-hand as I’ve cared for my mother, and I’ve spoken to literally hundreds of families in the same situation.

Insurance companies and other employee benefit programs often deliver these care recommendations.  They do the best they can considering maintaining these programs—and the underlying data—is not their primary business.  Unfortunately, they struggle to extend these programs across the whole company so that each member-facing group can leverage the same data to provide the best care referrals to their members. I’ve just assumed it was one of those “not-yet-solvable” situations, as healthcare technology is always a bit slower than other industries.  So we did the best we could and used what was not an ideal support system.

The Future of Care Referral Programs

I think I finally found a vision for the future.

I ran into a white paper from SNAPforSeniors that really caught my eye.  If SNAP can deliver on this vision—and if insurance companies, call centers and other providers have the vision and foresight to adopt it—it will dramatically change the outcomes of care coordination as part of the age in place movement.  More important, it will give families like mine the peace of mind that we are getting referred to the best matched providers for our care.

I know this vision may not concern some of you, but I highly recommend you check it out.  These types of ideas are the ones that are going to make the biggest impact. If you think your family would benefit from your insurer adopting programs like this, you should let them know.

Here’s the link to the paper – http://bit.ly/aPPsWU.

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How Meditation and Prayer Promotes Impacts Aging

September 23, 2010 By 1 Comment

Note: This post is not intended to promote or discourage any type of religious believe.  We found the research interesting and felt readers would find it interesting regardless of the religions, or lack of, religious beliefs.

Previous research has shown religion to have a positive effect on older peoples’ lives.

Older people who practice religion tend to be more physically healthier than those who did not. The reason why is because older people who practice solitary spiritual pursuits are engaged in purposeful activities that give them inner satisfaction.

The idea that a personal relationship with a higher being through prayer promotes successful aging is an example of selective optimization with compensation. This theory says that successful aging is dependent on a person selecting a specific task important to them, and then completing that task by optimizing the skills they still have while compensating for the skills they no longer have.

The classic textbook example illustrates an older man who wants to keep his driver’s license but knows he can no longer see at night. What does he do? He only drives during the day and finds someone to drive him around at night. Now back to the prayer example; by SELECTING prayer as a means to maintain religious identity, older adults are OPTIMIZING their current abilities while COMPENSATING that they are no longer able to be as physically involved with their church as they use to be.

Studies have found that a prerequisite to these benefits is an existing belief in a higher being. Sometimes people dealing with the end stages of life seek out religion as a way to come to terms with death. This has been shows to have little impact, as individuals were not show to receive the emotional and physical benefits of prayer unless they has an existing belief in the who/what they are praying to.

The role of meditation

It should also be noted that meditation has many of the same benefits that prayer has. People who practice meditation are physically healthier than those who do not. It is probably because meditation helps people deal with a stress in a more healthy manner.

Both practices–prayer and meditation–help people deal with stress and anxiety. Prayer teaches people to give their worries to a higher being, meditation teaches people to let their worries just go. What’s the secret to successful aging? To age successfully you need engage in meaningful activities that bring your inner satisfaction that also reduce your stress.

Photo credit: Kris_B

About the Author: Ryan Malone is the founder of InsideElder Care and author of the ByFamilies, For Families Guide to Assisted Living. He regularly speaks and advises families about how to improve their aging loved one’s quality of life. Ryan is also the president of SmartBug Media, a content marketing agency that helps companies increase leads, customers and influence. You can read more from Ryan on the SmartBug Media blog or follow him on Twitter.

Kris_B

Filed Under: Health Tagged With: , , , , , ,

10 Benefits of Culture Change on Skilled Nursing

April 8, 2010 By 5 Comments

Culture Change (also known as person-centered care or resident-directed care) transforms the traditional long-term care model from medical facility to a supportive home environment.  This movement is designed to change the overall mindset and environment of nursing homes into personal communities.  Culture change is designed to nurture the human spirit of aging residents as well as take care of their medical needs.  Its focus is on both quality of care and quality of life as guiding forces for improved life experience and life expectancy.

Within the culture change model, seniors have more privacy and choices, much like they would in their own homes.  They are given more control over their daily lives including meal and bed times and the caregivers are given more autonomy to care for residents in this flexible environment.  Residents’ needs and preferences come first, and care community operations procedures are shaped by this perspective.  Even the physical structures are changing from large hospital-like units to smaller communities resembling more of a group-home atmosphere in which they are cared for by a dedicated team of caregivers.

10 Benefits of Culture Change

  1. Respects the right of the resident to make their own decisions and honors their need for control over choices in their daily lives.
  2. Reduces boredom and helplessness in residents.
  3. Improves mental health (reduces loneliness, depression, behavioral issues).
  4. Encourages a personalized home atmosphere by allowing residents to create their own living style in their rooms.
  5. Increases enjoyment and life expectancy of the patients.
  6. Focuses on using person-centered language that respects and honors the patient by putting the person first and then the characteristic second.  For instance, instead of a wheelchair-bound resident, the description is modified to a person who uses a wheelchair for mobility and instead of a feeder the patient is referred to as someone who needs assistance with dining.
  7. Focuses caregivers on person-centered care, rather than completion of tasks.
  8. Individual care focusing on personalized needs and preferences of the staff and the residents creates a supportive environment that puts people first, over the facility.
  9. Promotes a dedicated team approach rather than rotating assignments for staff thereby creating personal connections and familiarity for the residents.
  10. Creates a team-building environment for the staff based on consistency of staff teams.
  11. Reduces employee turnover which in turn keeps a steady team of familiar faces rather than the need for temporary staffing agencies with training needs and learning curves.

The essence of culture change is about transforming philosophies and management style so that aging is no longer synonymous with decline and illness.  The principles of culture change are founded in a new way of caring and being cared for that is based on choice, creativity, and flexibility.  The future of culture change lies in the commitment to improve resident and staff quality of life through empowerment.

For more information on the culture change movement, visit the Pioneer Network.

Photo credit: K?vanç Ni?

Filed Under: Skilled Nursing Tagged With: , , , , , , , , , ,

Your Senior Health Care Bill: $260,000!

March 10, 2010 By 3 Comments

I have always been a big fan of Howard Gleckman, author of Caring for Our Parents.  In fact, he was the very first person I interviewed for my Leaders in Elder Care series.  If you aren’t familiar with Howard’s blog, you’re really missing out on a complete play-by-play of how the health care debate is impacting the cost of senior care.

This morning, he shared some startling statistics about paying for elder care that I have quoted below.  In this article, Howard has links to some fascinating studies about the out-of-pocket costs for seniors, and it is shocking.  It is mind-boggling to me how financing elder care will be solved as we move forward. He wrote:

A typical couple would have to save nearly $200,000 to pay for their out-of-pocket medical costs from the time they are 65 until they die, according to an important new study by the Center for Retirement Research at Boston College. Add in nursing home costs, and they are likely to need $260,000.

But that’s only part of the story. About 5 percent of 65-year-old couples will face catastrophic medical and long-term care costs exceeding $570,000, according to researchers Anthony Webb and Natalia Zhivan.They estimate those expenses would have exhausted the total financial assets of 85 percent of all retirees even at the peak of the stock market in 2007.

As someone who has first-hand experience with out-of-pocket expenses and my Mother’s care, I was still so stunned by these numbers, that I could not write a conclusion to this article.  What do you say?

Obviously, I encourage you to check out Howard’s writing.  In the meantime, what are your thoughts about these big numbers?

Photo: bubble dumpster

Filed Under: Legal & Financial Tagged With: , , , , , , , , , , , , , , , , , , ,