Caring for Mom (and Dad, too)

The Hidden Sandwich Filling

2011-04-19T10:24:00.000-07:00

I’ve been calling myself a member of the sandwich generation for a long time, but I never really thought too much about it. My worst sandwich moment occurred when I was speeding my way through the industrial part of town, hurrying to visit my mother in the nursing home before it got too late.

Here I am, eating my Taco Bell burrito (they’re the easiest to eat while driving), when the phone rings. This was before it was illegal to talk and drive, but I’m pretty sure it wasn’t very smart, even then, to be talking on a cell phone while eating a burrito AND trying to drive.

On the phone is my youngest daughter.

“You’re on the way, right, mom?” she says.

I’m on the way, alright, but I have a feeling that’s not the “way” she’s referring to.

“MOM! You promised to bring my soccer shoes and clothes to the field. We’re playing in 10 minutes and I need to warm up! You’ll be here by then, won’t you?”

At that minute, I feel like the worst mom in the world. I think, “AH, this is what it means to be a sandwich gen mom!”

OK – you’re right. Those weren’t exactly the words that went through my head. But later, I thought how absolutely impossible it is to be in this position some days. The balancing act just requires way too much dexterity for many of us – and balls (and daughters’ soccer bags) get dropped.

Last week, however, I spoke to several women who made me feel like a mamby-pamby whiner. These are women who care for their aging parent (I can relate) AND one or more special-needs kids. They make numerous trips each month to the doctor, often traveling across their state for specialty medical care. They attend to complex physical needs and learn a whole new vocabulary of diseases, medications, treatments and specialists.

One such mom said to me, “It’s just different when you’re caring for your child. When it’s your parent, you know that aging and challenges will happen eventually. That’s the way of life. When it’s your child that demands all of your time and energy because of their care needs, you know it will never go away. You may even outlive your own child – and then who will care?”

These are the women that I now recognize are the true sandwich survivors. They attend with love and an amazing degree of grace and compassion to needs that I cannot even pretend to understand. They do this today, and they’ll do it tomorrow, the next day, and for as far into the future as they can see.

I am honored to have met several women who do this work. I’m even more honored to know that these women stand ready to support other sandwich moms and to offer encouragement, advice and an understanding ear to them.

You know the sandwich called the “Hero?” I believe that I’ve met their caregiver equivalent – heroes, each one of them.

Happy New Year!

2011-01-10T12:48:00.000-08:00

Did you have an enjoyable holiday season?

Millions of Americans find holidays stressful, sad or just plain exhausting. Family members may have a moment when they see mom or dad looking frail, needing help or acting forgetful – a very upsetting moment when we realize our parents really are aging.

Others of us spend time with our loved ones, but don’t experience the joy of the holidays because of illness, dementia or disabilities.

My dear aunt Judi sent me a note this Christmas. She had just returned home from visiting her husband. He’s been diagnosed with Alzheimer’s disease and has lived in a care facility for nearly two years. He no longer recognizes her or responds to her in any way. She wrote, “I used to have ‘friends’ who would come on Christmas to visit their loved ones. Today was the facility Christmas party and absolutely none of them came. I can only assume their loved ones have gone home or passed away.

“When the presents were handed out, I opened his for him (and of course, I had wrapped and brought it). He did not pay the slightest bit of attention to it. In a whole roomful of people, I have never felt so alone. I cried most of the way home.”

I know my own holiday experience had several bittersweet moments. I thought about my dad several times, missing him these last four years since his death. I held special ornaments in my hands that I had bought when my children were little, and reflected on the passage of time and the loss of tradition.

In many ways, a New Year is a great gift. We can look forward instead of back; we can feel cleansed of many of the holiday emotions and baggage.

Perhaps we can even get a few extra minutes of rest, relaxation and rejuvenation to get us through another year – with joy, peace and happiness. Happy New Year, friends.

It’s looking an awfully lot like Christmas

2010-12-14T11:36:00.000-08:00

It’s looking an awfully lot like Christmas – everywhere but my house!

The lights are on the courthouse; the tree in the public square is exquisite; my husband even got our own house lights up and operational – down to the little squizzly trees in the driveway.

But inside the house, it’s still Thanksgiving. Beautiful fall colors; the harvest horn on the entry table – it’s all there, frozen in time.

Like so many of the sandwich generation, my life is busy beyond belief. Yes, I have the same number of hours in my day, but somehow my energy has serious limits.

And when I do get a few minutes of time, I find myself reaching out to those I love – my husband, my daughters and my friends. We share a quick catch-up conversation, and a sense of being part of a connected, significant family unit.

And isn’t that exactly what this season is about? Not the décor – I will, at some point, get the fall stuff down and the wreaths and tree up – but the people in our lives, and the blessings that we exchange as we do our very best to slow down and reach out.

My Christmas wish for you is that you take the time this season – leaving the dishes and the housework alone – to reach out, connect, and share the joy with those you love.

It’s “Hug Your Sister” Month

2010-11-03T13:09:00.000-07:00

It’s not really “Hug your Sister” month – it’s actually National Family Caregiver Month.

But if you’re a caregiver, you probably can relate to the groans I hear whenever a family caregiver starts talking about their siblings.

“He’s a great help – as long as he can phone it in.”

“I’m doing all the work, and she shows up once a year to visit. The way our parents treat her, you’d think she was the one doing all the work – not the one popping in to tell me how it should be done.”

“My sister disagrees with everything I want to do. She insists mom isn’t as bad as I say she is – she has no idea.”

It seems like every family has a breakdown among siblings, especially when mom and dad need help. One child – usually a daughter – becomes the primary caregiver or decision-maker. The other children typically take a seat as far removed from the action as possible.

Stop for just a minute this month to look at your own family situation from your siblings’ perspective. Maybe they’re not doing the work, but look at the time they’re missing out on, too.

Francine Russo tells the story in her book, They’re YOUR Parents, Too of being the “bad sister” – the one who rarely visited and left the heavy lifting to her sister.

At her mother’s funeral, Francine realized how much she had missed by not being actively involved in her mother’s care. While feeling relieved that she didn’t have to do the work, in reality she was robbing herself of an opportunity – forever gone – to get close to her parents and to have the kind of relationship that her sister had.

She learned, as many, many caregivers learn, that the greater the challenges of caregiving, the greater the rewards and sense of joy and accomplishment the caregiver often feels at the end.

So this month, if you’re tempted to think, “Why doesn’t she step up and take some of the load?” try rephrasing the question.

Try thinking, “She’s missing so much. I’m sorry for what she’s missing.”

And go hug your sister.

Calling all Caregivers

2010-10-13T09:19:00.000-07:00

In our caregiver support group we often talk about our caregiving experience as a journey.

Some days, you’re slogging through some pretty deep muck. You feel like you’re battling to get anything done. You feel like you’re doing nothing but battling with - or for – your loved one.

Some days, you’re hiking up a steep hill in shale. It takes every bit of effort you have to move a few steps forward – and then you slide almost all the way back to your starting point. The saying, “Three steps forward and two back” feels like positive thinking.

Then there are those rare days when the sun breaks through the clouds and you feel blessed and so very privileged to be able to care for someone you love.

In our group, we listen to other people’s stories. We reassure them (“No, you’re not crazy!”) and we reassure ourselves (“At least I don’t have to deal with THAT!”).

If we’re lucky, we find a lot to laugh about, from one caregiver’s story about her mom, (“So then she said…”) to another’s joke (“You know you’re crazy when…”).

By the end of the evening, we’re all glad we came. We’re relieved that we could share our challenges, and listen to others. We feel a little glow inside as we realize that we’re not alone on this treacherous journey through uncharted land.

I hear from families who can’t get to the support groups. Often, they’re the ones that could use the support and encouragement the most. They have no one to give them a little break; to stay with the person in their care so they can get out and get refreshed.

For the past year, I’ve been working on a national family caregiver’s support team, developing a website that will be fresh, interesting and unique. It is out intent that this site provide some relaxation and fun for family caregivers, as well as a place they can meet others who are traveling similar journeys, and help share the load.

We’re looking for individuals to help us – to join in building a community of people who support each other in caregiving.

Perhaps you’re in a business that serves caregivers – you’re invited to share your expertise and wisdom.

Perhaps you’re great at sharing your own stories about caregiving, or at simply listening.

Whatever your gift, please join us in building this community. Email me (Sharon@aquiretraining.com). I’ll send you details and welcome your help.

When it comes to caregiving, like so many of life’s most challenging tasks, it does, indeed, take a village.

Want to stay in your home? Check out new technology!

2010-09-07T10:00:00.000-07:00

Several years ago the Center for Aging Services Technologies, in conjunction with Intel, created a video imagining what digital health and wellness monitoring for senior adults might someday look like. People got excited about this – and kept asking where they could get it.

“It’s all available technology,” says CAST representative and Intel aging technology expert Eric Dishman. “But none of it is readily available today exactly as it is shown in this video.”

That was then.

Today, technology to aide seniors and their caregivers is a fast growing industry. It’s diverse and, if baby boomers are true to form, it will soon be as pervasive as the internet.

Earlier this week a feature story on National Public Radio, “Wired Homes Keep Tabs on Aging Parents” showcased a video monitoring system offered by ResCare, a national in-home care company that provides “telecaregivers” for clients. While it might feel a little invasive at first, the peace of mind provided by having someone visually checking in with a loved one is worth it, at least for the family in the NPR story. Noteworthy as well is the unexpected benefit of this service: social contact and companionship for the elder.

More and more Americans are living longer, healthier lives. Most want to stay in their own homes as long as possible. While this may be our preference, it is often not the optimal situation in light of brain science.

“Our brain is designed for us to be connected to other people – our ‘tribe,’ if you will,” says brain development education consultant Joseph Christensen, founder of Brain Development Etc., and part of the aQuire Training Solutions’ development team. “When we don’t have our tribe around us we are very stressed and don’t know why. Chronic stress, of course, can lead to a host of other problems such as depression, anxiety and social withdrawal.”

Nutrition and exercise are also keys to long, healthy lives – and brains. Social isolation tends to negatively impact these areas as well.

With the ResCare program, even elders living alone at home can gain companionship and human contact. This alone might be the factor that allows them to continue to live in the place of their choice – their home. Certainly combining this program with other home technology programs (like fall detection monitors, medication reminder systems and more), we begin to approach the world where technology, in all its forms, helps us continue to live healthy, productive lives to the end.

Caregiver Reality: Sometimes it stinks

2010-08-17T12:41:00.000-07:00

I rarely endorse specific products, although sometimes a caregiver will share with me a product that they feel saved their life. This is one of those times. Dorothy Mayer, a senior care professional who is also an instructor for online courses at our site for nursing home and assisted living administrators (www.EasyCEU.com) asked me if she could share her story – and her pitch for a product that made her own caregiving journey just a little more pleasant.

Here it is – you can check out her website (www.mayer.sentsy.us) for details:

I have been a caregiver for most of my life as my parents were 36 and 57 when I was born.

When my Mama died on December 15, 2008 I became the full-time, only caregiver for my father. He is now 90 and, although he has three other living children, I am his caregiver.

Proudly.

Unabashedly.

Sometimes badly.

More often than I care to admit, reluctantly.

But we are definitely a “we” as opposed to some caregivers who have a real life. I don’t really. This is it. This is what I promised to do and I will – even when the doctors suggested that he needs to go to a nursing home. I said “no” and surprisingly got some of them quite angry.

He is my responsibility.

In the summer of 2009 he got quite ill. To be polite I will call it intestinal distress. We went to the hospital three times and he was never admitted – in fact his problem was rather dismissed. On the third visit I went to the CEO’s office and demanded that he be admitted (luckily I went to high school with the CEO) and he was admitted immediately.

It turns out that he was fine (although in my mind I had diagnosed him with colon cancer). He had just listened to one of his other children and been told that as you age you lose the ability to produce hydrochloric acid and so he was supplementing his diet with hydrochloric acid (I am not a physician but I do not recommend this).

Between the hospital stays this house smelled horrible to put it mildly. Between his “intestinal distress” and his habit of taking off a depends in the middle of the night and throwing it on the bathroom floor I was literally unable to go into his bathroom to pick up the depends.

A friend called me and invited me to one of those home party that sell things. At first I said, “No way,” but decided to check it out. The product they were selling was “Scentsy” – and I was impressed.

Scentsy Wickless Candles are just that – wickless. The wax melts by a light bulb so there is no open flame. Most of the scents are quite nice and relatively strong.

I bought one that day and it has lived in my dad’s bathroom ever since. I do have to change out the scents as they run out of, well, scent but I became a convert that day and we now have three in this house. Because they do not have wicks and are therefore flameless they are allowed in nursing homes and assisted living facilities – as well as other work places where traditional candles are not.

I am such a believer in this product that I tell every other caregiver about it. Go look at my website: www.mayer.scentsy.us to get an idea of this great product.

Thank you caregivers for all that you do – it is a thankless job sometimes but necessary.

Dorothy Mayer

Reduce the Risk of Falling

2010-08-05T11:20:00.000-07:00

If you’re like most families, falls are one of the top things you worry about with your aging loved ones. Falls are, in fact, the “second leading cause of injury-related deaths for people ages 65 and older, and are the most common cause of injuries and hospital admissions among the elderly” according to the Centers for Disease Control. (Source: CDC, NCHS. Mortality Data Tapes. Hyattsville, MD: the Center, 1998.) For many elders, falling and breaking a hip is one of their greatest concerns – too often, it spells the end of independence and mobility.

There are several simple things you can take to help prevent falls, including steps around the house (extra bright lighting, removing throw rugs, clearing pathways). Exercising regularly to maintain strength and mobility is also crucial to fall reduction. The CDC brochure has many more useful tips (also available in Spanish).

Even if you do all of these things, fall risk is still a concern. Consider one of the many fall alerts now available (like this one from Wellcore), that can identify a fall even the person cannot push the button. This is particularly useful if a fall is caused by, or causes, an unconscious episode. In that case, a fall detector that automatically summons help can save a life – a life that’s important to you.

Gail Sheehy Addresses Caregiver Stress

2010-06-24T11:31:00.000-07:00

The Orange County Register's news article about author Gail Sheehy's new book, "Passages in Caregiving: Turning Chaos into Confidence," is right on point regarding caregiver stress. The article quotes Sheehy as saying,

Once the solitary caregiver gets so stressed out emotionally that her own health declines, she can no longer provide the care. The only option left is to place the family member in a nursing home - the last choice of everybody, the most expensive for taxpayers and guaranteed to leave the caregiver burdened with guilt.

While I'd like to note that there are other options than nursing home (assisted living and in-home care, to name a few top choices), Sheehy is right overall. When the caregiver is too stressed to continue care, she is often too stressed to work through creative solutions to care or to make the necessary arrangements, all of which are, additionally, stressful and exhausting.

Sheehy stresses the need to caregivers to take good care of themselves and to form a support circle of family or friends. On these very essential points, I couldn't agree more!

Just one more nudge, too, to family caregivers to get information from whatever source you can to help you provide care is the most effective, efficient and pleasant way possible. Caregiver training, in whatever form it takes, DOES work!

Three simple steps to optimal caregiving

2010-06-22T15:57:00.000-07:00

With all the news about the increasing prevalence of families involved in caregiving activities you know one thing: You’re not alone.

That may not be much help to you at 3am, though!

One of the joys I’ve recently discovered is working with a local hospital’s Alzheimer’s family support group. I was a little concerned that it might feel like a long day at work, but I’ve discovered that it feels more like an evening shared with friends. We brought home-baked goodies, fresh fruit and simply talked about what was on our minds.

I had prepared a program on how to reduce the stress caregivers experience – stress that causes family caregivers to have significantly more illness and shorter life expectancy than their non-caregiving peers.

But the group had other questions, namely “How can I help my loved one best?”

Caregiving is difficult work. Knowing how to do it is even more difficult, especially when you’re feeling isolated, sleep-deprived, exhausted. While tons of caregiver training and support classes are available (including my own at www.caringformom.com) sometimes families just want to talk. They just want it simple, too – nothing too difficult to remember; no need to memorize stages, steps or techniques.

So we broke it down to three key things:

1) Accept. Accept that your loved one is doing the best that he or she can. Today. Right now. Even if he could do it better yesterday. With very few exceptions, people with memory loss ARE doing the best they can.

2) Reassure. Imagine feeling like a strange person in a very strange land. Nothing makes sense anymore – words don’t make sense, nothing is where it seems like it should be, even buttons refuse to cooperate. How would you feel? Angry? Frustrated? Depressed? Lonely? Frightened? A family’s job sometimes is simply to provide the tour-guide reassurance. “It’s OK to be afraid; this is tough stuff. We’ll figure it out together though. I’ll be right here to help if something doesn’t make sense. I’ll try to remember when you forget. I’m here for you.”

3) Maintain best function possible. You can’t turn back the clock. You can’t defeat an irreversible disease process – or conquer aging, for that matter. You can work to keep your loved one at his optimal level of functioning by making sure some basics are met:

Nutritional needs. Live alone and start forgetting – nutritional impairment is right behind. Assuring that your loved one gets good, nutritionally balanced meals is key to optimal functioning.
Medication. Most of us, even with good healthy memories, forget if we took that last pill. For elders, medication mis-management can result in frequent hospitalizations, with a little more slipping every time. Electronic reminders are available if the people-reminders aren’t!
Exercise. Moving the blood through the body moves the blood through the brain, too. Walking or even chair movement can keep the person as alert and functional as possible. Sedentary days, evenings and nights can cause a rapid decline in all functioning.
Social interaction. We’ve probably always know this, but lately we seem to have lost our connections. We humans are social creatures. We were made to live in close tribes – then neighborhoods – then families. We supported each other, but we also spent hours discussing the world events and arguing about Joe down the street. Today, we disconnect and sit in front of the TV and wonder why our minds fade, and we start to lose our will to live. We know now that staying socially engaged keeps us mentally engaged – and that keeps us vital and alive to the end.

These basic tips might be challenging to implement, but they’re essential to the well-being of the elder – and the caregiver.

They’re not impossible, but while you’re thinking how to best implement these with your loved one, you might just want to take a walk. It’s one of the best stress-relievers you’ll find, and it’s free!

Caregiver Stress

2010-06-08T09:28:00.000-07:00

You recognize the feelings of fatigue and not having enough time for yourself. You might even realize that you’re a little more short-tempered than usual, and you don’t have the usual bounce-back ability when things go wrong.

But do you really know how the stress of being a family caregiver is affecting your body and your life?

Researchers recently reported on a newly discovered physical impact of the stress of caring for a spouse with Alzheimer’s disease in the June 8, 2010 issue of the Journal of the American College of Cardiology.

What the researchers found was a direct relationship between how impaired the person dementia rated and the level of flow-mediated dilation (FMD). While this sounds mysteriously complicated, in simple terms, the more impaired your FMD is, the higher your risk for cardiovascular events like a heart attack or stroke.

It’s not surprising to me that individuals who are caring for higher demand loved ones suffer physical problems at a higher rate.

We’ve known for a long time, in fact, that these special caregivers suffer more sickness and a higher rate of death than their peers who are not caregivers.

But for the average caregiver, they’re just doing what they have to do, without realization of the stress it may be causing their bodies.

How do you know if you’re too stressed? Ask yourself these questions:

Do you feel like you’ve lost your energy or enthusiasm for life?

Do you feel tired or exhausted much of the time?

Do you feel out of control and sometimes show emotions that aren’t normal for you?

Do you feel nervous, anxious or tense much of the time?

Do you feel like you’re becoming isolated from your friends and family members?

Do you have sleep problems – getting to sleep, staying asleep, waking up too early? Do you feel like you need to sleep all the time?

Do you have problems concentrating or remembering things?

Are you experiencing more illnesses than usual for you? Colds, upset stomach, headaches? Is your blood pressure higher than it should be?

Even one or two YES answers indicate that your work as a caregiver is causing you stress.

What can you do?

Start by taking stock of the things that most challenge you in your caregiving work. Then start looking for resources to help you with those challenges.

These resources may be family members – tell them what you need. Don’t wait for them to volunteer their help.

It’s also time to call in the paid helpers. Perhaps some in-home care will relieve you enough to regain your health and your sanity.

Perhaps it’s time to look at an assisted living community or other level of facility care.

Ask around in your community for other programs and services that might work in your unique situation.

Here’s the bottom line: as a caregiver, if you don’t take care of yourself FIRST you won’t be around to care for your loved one. It’s a simple fact.

Did you know that one sure way to reduce caregiver stress is to learn tips and techniques to make your caregiving work easier? Check out a caregiver training course in your community today or go online to learn more from www.caringformom.com.

Picnics in the park

2010-05-25T14:00:00.000-07:00

I kept a photo on the refrigerator door for a long, long time. The picture was of my eldest daughter and I at a picnic, taken at a moment neither of us was posing or prepared. We both had on sunglasses and were laughing together at something.

Here’s what I loved about that picture: you had to do a serious double take to tell which was me and which was my daughter. We looked so very much alike. Of course, I loved that!

I didn’t feel the same joy when I looked at my mom and wondered if people could still tell us apart.

It is a tough thing to watch our parents age and realize that this will one day be us. If we provide care to our parents, we are likely even more aware of the toll aging has taken on their bodies. We watch them experience cognitive decline and wonder, “Will I start to lose my mind any day now, too?”

Sometimes, watching the changes in our parents is enough to cause us to take a step back. It’s easier not to be faced with our inevitable aging than it is to look it right in the eye. We hold back our time; we hold back our energy. We feel a deep level of pain, fear and anxiety that keeps us from laughing, hugging, joking together.

And so, we are not present, when our simple presence could make all the difference.

I recall those moments when I so proudly would look at the picture on my fridge and think, “We look just alike.”

My daughter may have looked at the same picture, have the same thought, and feel horror and dismay.

It’s time to look past our obsession with youthfulness, and focus instead on relationships. It’s time to add more love – not less – to our lives.

Maybe we can close our eyes to the ravages of age. Maybe we can learn to open our eyes to the inner beauty of our elders – to the 25 year old young man with his new car; the young mother with her new baby.

Their hopes and dreams were fresh and alive then. Inside, some of those hopes and dreams still burn on, just waiting for us to say, “Hey mom, do you want to go for a drive to the park and have a picnic with me?”

Respite for family caregivers

2010-05-04T08:00:00.000-07:00

“It’s so incredibly isolating,” my friend Melanie said recently about the time she was caring for her mother. “Even though we had great hospice nurses, there was often time when I couldn’t talk to anyone about my experience.”

Melanie helped her dad care for her mother, dying of cancer, through the end of her life in her own home. I remember talking to her one day about her drive time from her home to her parents, and how she had spent the entire drive home that week (over an hour each way) composing her mother’s obituary. Difficult, but so very important to Melanie to write the final chapter – the summary, really – of her mother’s life.

Like so many family caregivers, Melanie balanced her children – one at college and one still living at home – her family tasks and helping her parents. She talks of feeling too tired to even carry on a conversation after spending a day or two immersed in her mother’s care.

Melanie is a bright, well-educated woman who comes from a family with good financial and emotional support. For her, caregiving was isolating, exhausting, emotionally draining. What must the person with family, financial or emotional stresses in addition to the caregiving experience?

Another friend, Mary Ann, runs a local agency that offers family caregivers relief through a program called “Respite.”

The program, run by our local county and funded through state dollars, doesn’t ask how much money you make. It is available to family caregivers at any economic level. It provides someone to stay with your loved one while you take a break. It even pays for a massage, if that is what relieves your stress best.

“We all have a breaking point,” says Mary Ann. “Anything we can do to help someone avoid that breaking point is extremely valuable to the caregiver and to the person receiving care.”

Mary Ann knows. She cared for her grandmother with dementia; now she cares for her mother who has advanced memory loss. Even though her mother lives in a small care home, Mary Ann is involved in the day-to-day care. Ask her about her mother on any day of the week, and she’ll choke up as she shares – just a little – the pain of watching “mama” slip away.

And so Mary Ann encourages all family caregivers to get relief any way they can. She actively looks for ways to encourage, support, train and relieve the most exhausted caregivers, before they simply say, “No more.”

It is isolating, exhausting and draining, as Melanie points out.

But there is help. There is hope.

In the end, there is joy.

Caregiver tip of the day – slippery jammies

2010-04-20T14:00:00.000-07:00

Vickie Young shared her favorite caregiving tip today: silky pajamas.

We were talking about the value for family caregivers to taking a caregiving class – something really challenging for the typical too-busy-already family caregiver.

But as Vickie shared how much simpler care for her bed-bound father-in-law was with that one simple adjustment from comfy (but sticky) flannels to slippery satins, it made so much sense: who knows the tricks better than someone who’s been there before you?

Find a class and learn tricks of your own. Today, we have online classes for caregivers that make learning fit your schedule. In fact, with online learning you can take classes whenever it works for you, even at 4 in the morning.

In your own pair of slippery pajamas.

Waiting to Exhale – The final stage of caregiving

2010-04-13T08:00:00.000-07:00

My friend graciously allowed me to interview her on camera the other day about her caregiving experience. She shared how she began her caregiving journey as a long-distance caregiver, trying to arrange for care for her mother who lived all the way on the other side of the country.

Frustration and increased needs led her to move her mother to her home town. Ultimately she has placed her in a care setting, and visits her several times each week, remaining incredibly involved in her mothers care.

She talks about experiencing the loss of her relationship with her mother, and finding herself struggling to get her mother to bathe – her mother, who always prided herself on cleanliness (next to Godliness, you know).

She talks about how difficult it is to share what sets most heavily on her heart: her readiness to say goodbye to her mother, and to finally breathe a sigh of relief that her mother no longer struggles but is at peace.

She’s talking about welcoming her mother’s death.

No wonder she hesitates to share her feelings about caregiving.

No wonder she believes that only those who have been there will truly be able to relate.

I remember my aunt who cared for my grandfather to the end of his life, sharing a story that made us laugh and cry along with her. My grandfather had been barely responsive for days when he finally seemed to slip away. My aunt tiptoed out of the room, thinking, “At last; peace for both of us,” and called 911.

The ambulance crew loaded Grandpa onto their gurney for transport to the hospital where he could be pronounced dead. On the front steps, one of the crew tripped and bounced my grandfather – who promptly took a deep breath, and began to breathe again. My aunt simply cried.

For her, this event delayed the inevitable moment when her round-the-clock work would be finished and my grandfather would be at peace.

To someone not in the end stages of caregiving this might seem callous and horrifying.

To the caregiver who lives in that place of end-stage care, it’s entirely understandable. They can relate to the pain of watching a loved one slip away, one tiny bit at a time, wondering when – at last – it can all be over for both of them.

That’s one reason why I encourage family caregivers to connect with other caregivers, any way they can. Join a support group – join an online chat group – take a caregiver class. Connect with others who share your journey.

You won’t have to suffer in silence like my friend who believes that no one will understand how deeply she’s longing for the opportunity to finally exhale and say goodbye to her beloved mother.

Caregiver Training worth the investment

2010-03-15T08:00:00.000-07:00

I noticed an announcement about a caregiver training course being offered – free – in a community in the mid-west. That’s not really breaking news, but the part of this story that startled me was that hardly any one had signed up for the class. The news story was that lots of space was still available.

When I talk to family caregivers I get a clue why the class was still empty. Families realize that training would be helpful, but how on earth can they fit it into their already over-booked schedules? It can feel like one more thing to do – one more task requiring attention.

I encourage those caregivers to consider whatever training they can get as a tool that can make a real difference in their caregiving life. I tell them about online learning options, and about resources available to pay for training for those with long term care insurance policies or coverage.

I say it over and over, because of these reasons:

Caregivers who have been through training experience significantly less depression and stress – ailments all too common for family caregivers.

Caregivers who have been through training classes are often able to keep their loved ones in a home setting – avoiding nursing home placement – for up to 2 years longer than those without training.

I tell them, “It’s worth the investment of time and money.”

In response, I hear family members who have completed training say, “I can’t believe that I was doing this all wrong! If I would have known these things, it would have been so much easier – on both of us.”

Or the family who says, “Learning this saved my life! I felt sure I couldn’t continue until I took these classes.”

So find a class, sign up and get going! If you can’t make it to a classroom-based program, try an online class. You may be amazed at how much this changes your caregiving journey from one of stress and chores to one of joy and deep satisfaction.

To learn more about the caregiver training programs offered by this author’s organization visit www.IPCed.com or www.aquiretraining.com.

Coping with the demands of caregiving

2010-03-01T14:03:00.000-08:00

If you’re busy caring for a parent or spouse you may not have heard the rumbling from all corners lately.

Family caregiving is finally getting a little respect.

Suddenly, we’ve become aware that it’s not just the hidden few in our community who are responsible for managing care – or providing it hands’-on – to a loved one.

It’s nearly one out of every five households in the U.S. today – nearly 50 million Americans, according to a recent AARP-MetLife survey.

While there’s some comfort knowing you’re not alone in your caregiving challenges, the real advantage comes from the actions that this is inspiring.

Just check out the internet these days. Type in “family caregiver” in any search engine, and watch the websites, news articles and information start pouring in. You can find tons of helpful articles and resources if you’ve got the time to wade through the results.

Of course, if you’re busy caregiving you probably don’t have a lot of time to sit at a computer searching for resources.

You may just want to read a good mystery at the end of the day, or watch a mindless sitcom on TV.

No one would blame you for wanting a real break, when you finally get to take a break.

But I’d like to encourage you to take a few minutes to seek out some resources that work for you, especially information, training, or resources that make your caregiving job easier.

Imagine if you could communicate more clearly to the person in your care, and avoid some of the frustrations you now encounter. Imagine learning how to ask your friends or siblings for help in a way that they respond to, without getting offended.

Imagine learning tricks to make the tasks go easier for both of you.

Caregivers who take the time to attend training classes say, “It saved my life.” Often, they don’t realize how hard their job is, and how many little things they can do to make it easier, until they take a step back to learn from an expert.

You don’t have to dedicate every waking minute to this.

Just start with one little step. There are a thousand experts out there, just waiting to support you and help you be able to continue to care.

If you’d like to learn more about online training for caregivers, check out the Personal Care Aide Certification course offered by the Institute for Professional Care Education at www.IPCed.com.

You are not the boss of me

2010-02-22T09:23:00.000-08:00

Don’t you just love it when you hear those words, “You’re not the boss of me!” While we usually think of them in relation to our toddlers or teens, I’ve heard them lately from two sources: a middle aged person (to his spouse) and an elder (to their child).

Happens to be true, you know. Think about our children, from birth, through the toddler years, to pre-teen and teen. When can we possibly think we’re the boss of them?

Not in those first few weeks after birth – those new little ones are clearly the boss of us, waking us from sound sleep, demanding to be fed, changed or just cuddled.

Certainly not during the toddler years when we find ourselves challenged by the simplest things (“wear your coat for Pete’s sake – it’s snowing” – “eat at least ONE pea!”). We negotiate, we beg, we yell a little, too, and usually end up resorting to bribery of some sort, despite our intentions never to stoop to that level in our parenting.

Anyone who has imagined they’re the boss of their teen children has been sorely tested, and likely battered and bruised in the process, too. Lock them down, and they’ll find a way to escape. Try to control who they talk to, and they’ll just hide their friends from you.

When our kids finally arrive at the “adult” years (I put that in quotes, because most of the people I know are still supporting in real, tangible ways our grown kids), we sort of sigh, and think, “I’ve done my best – my parenting is over.” But of course, it isn’t. Our kids call with adult challenges, crises and questions. We juggle and balance like high-wire circus performers, trying to answer their questions without being the over-bearing “mom who won’t let go.” Again, we hear, if only in the back of our own heads, “You’re not the boss of me!”

And then we arrive at that point we just didn’t see coming (or were in denial about): the time when our parents need us to re-engage in their lives. Only this time, instead of them giving us advice, we’re giving them advice. We’re helping them navigate complex health care issues, deciding what housing options make sense for them (and for us, of course), and starting to fill the gaps of a rapidly thinning social circle of companionship.

Sometimes we get confused and think that now, we’re the boss of our parents.

A couple of days ago a woman shared her story with me about having to take her husband’s car keys away from him. He is furious with her. She’s guilty, angry, distressed and frustrated. Her husband’s Alzheimer’s is so far advanced that he simply can no longer safely drive – as his two recent accidents proved to everyone but him (and his doctor, who refused to “get involved.”)

Her husband blurted out to her in anger last week, “YOU ARE NOT THE BOSS OF ME!”

To which she replied, “No, but I am the boss of that car. I am the one who pays the insurance. I am the one who will have to clean up the blood from the people you hit. You are NOT DRIVING THE CAR!”

There’s no easy way to make this tough transition but to muscle through, much like some of life’s earlier transitions. We talk calmly – or shout loudly – but we keep on communicating. We keep saying, “I love you. I will be here for you. I will help you. But I won’t let you hurt someone else or get hurt yourself, if there is any way I can help it.”

And we know, as we’ve known all along, that we are not the boss of them. We’re just doing the very best we can, as our roles shift, our responsibilities change – once again – and we find a new balancing point in our lives.

Caregiver Courage

2010-02-15T09:47:00.000-08:00

Straight talk from a caregiver about guilt, fatigue, even the feeling that you wish your loved one would hurry up and die – these are the kinds of stories that I discovered in a blog I happened across this morning.

Dyingtohelp.com is a blog written by Lois Kelly about her caregiving experience for her dying mother. It’s written with love and humor; it definitely touched some of my own caregiving nerves.

Here’s one entry I love: “Big “C” and small “c” caregiver courage.” Ms. Kelly describes the kind of courage we see on TV with the rescue of a small boy from open water: “…screams of victory. Women and men crying. Dogs barking. The parents heaving, gulping frigid sobs as the EMTs wrap the boy in a silver space blanket, lift him in their arms and run to the ambulance.”

On the other hand, there’s caregiver courage – the kind that doesn’t make the evening news. Kelly describes it this way:

“The day-in, day-out caring for someone who is sick is courage, too, but small “c” courage. There’s no glamour. No big momentous event. No crowds cheering you on, slapping you on the back after you help the person you love inch his or her way into the bathroom at 3 a.m. Waiting outside the bathroom door, ready to help the person slowly, slowly get back into bed. This courage won’t make the six o’clock news. It won’t win special awards or recognition. It won’t even deserve a conversation when people check in with you tomorrow.”

Caregiver courage doesn’t get the recognition that big-screen courage gets. But at the end of the day, as Kelly says,

“This small “c” courage is Love. Love with a capital ‘L.’”

Top 10 reasons for in-home care

2010-02-09T09:13:00.000-08:00

If you could choose, where would you live?

Right now, I’m thinking someplace warm and sunny. A little warm water lapping on a sandy beach wouldn’t hurt, either. Maybe a hammock, a good book or two, a very light and fruity umbrella drink…that sounds pretty good to me!

But where would you live if you needed a little help? Would you rush into the nearest neighborhood nursing home? Would you sell everything and move out of your home as quickly as possible?

Not likely. More likely, you’d start looking for help to come to you. You’d look for options that would allow you to keep your dignity, your independence, your privacy as long as possible.

Today, more and more seniors and people with disabilities are looking at home care as the option they’d prefer – for life.

A great website, Ourparents.com, provides resources for in home care as well as an easy to use facility finder. They list the “Top ten reasons why baby boomers want to age in place” as including:

1) It allows you the most freedom in the least restrictive environment, something of high value to baby boomers (like me).

2) Its safe. Your home is one of the safest places, in terms of exposure to infectious diseases. Most homes can be made even safer with minor modifications to reduce stairs or add grab bars.

3) Healing and quality of life are important to baby boomers – and we truly believe that “there’s no place like home.”

4) Control, control, control. Baby boomers do love to be in control.

5) Personalization and one-on-one care – after all, for baby boomers, “it’s all about me” – right?!

6) Comfort. My home reflects what is comfortable to me – my favorite chair, my books, my hobbies and my “stuff.”

7) Aging is place has demonstrated effect on healthier, happier aging.

8) Staying in your own community – in your own neighborhood – help you retain roots that baby boomers value.

9) Technology – it’s a word we boomers love. We invented the internet, after all, not to mention the microwave and much of the other technology today’s generation takes for granted. Technology today is all about supporting a person to stay in their own homes as long as they choose to do so. Baby boomers can be expected to embrace this new technology.

10) We fear the loss of independence – almost more than we fear death itself. As baby boomers, we fear this loss for our parents, too.

These are ten great reasons that we will continue to prefer care in our own homes. But at the end of the day, we probably only need one: its home.

Did you know that your long term care insurance policy most likely covers the cost of caregiver training? Did you know that you (or a family member or paid caregiver) can get certified as a Personal Care Aide 100% online using the Institute for Professional Care Education’s e-learning course? Check it out at www.IPCed.com or call us at 877-843-8374.

Mel Gibson: The mission: leave something

2010-02-02T10:22:00.000-08:00

Don’t you just love that we’re all getting older? Celebrities over 50 are no longer the rarity; even some of those considered extreme “hotties” are aging, just like us.

Take Mel Gibson, for example. The handsome leading guy is now a well-seasoned 54 years old. I remember 15 or so years ago when Mel was the heartthrob of the Lethal Weapons movie franchise, one of my favorite little restaurants in California had Gibson’s photo on the back side of their table-top wine list. We’d read the wine list and turn it around to gaze on his face, whenever we’d go there for lunch. One day I asked the manager, “Why the photo of Mel? Does he have something to do with this place?”

“Not at all,” was the reply. “We just liked the photo.”

Recently Gibson was interviewed for his new movie, “Edge of Darkness,” a story about a father seeking revenge for his daughter’s death.

When asked about his age, Gibson replied, “This journey is more than half over. I’m way past the halfway mark. It’s kind of scary. And you ask yourself, ‘What the hell have I really done? What I have I accomplished?’ And it seems pretty puny…we’re all so transient. The mission is leave something.” (Reported by Geoff Boucher, McClatchy-Tribune, Jan. 28, 2010).

Yes, indeed. The mission is to leave something. It seems like the older we get – the farther past that halfway mark we travel – the more this mission seems to take on urgency. It’s time to take stock. It’s time to think about what we’re leaving behind.

Maybe that’s why so many of us find new passions in our past-halfway years. We start new businesses that follow our passions, rather our business sense. We volunteer; we organize; we reach out.

Consciously or unconsciously, we’re fulfilling our greatest mission: leave something.

Thanks, Mel, for the thought.

And thanks, too, for getting old right along with the rest of us.

Practical Caregiving advice

2010-01-25T09:20:00.000-08:00

Easy, practical caregiving advice – what a concept!

Too often family caregivers are overloaded with information. Getting on the internet often just compounds the problem, as hundreds of resources pop up – some great; some awful; sometimes hard to tell the two apart.

Last week, we visited my husband’s cousin in the hospital. This lively, energetic, independent 76 year old woman got hit by a car walking out of the supermarket last weekend. She was in the cross-walk and had looked both ways. A distracted driver simply didn’t see her, slamming into her right in the crosswalk.

The good new – her roasted chicken was saved. The bad: her lower leg was broken in about 6 places.

Her doctor has drawn a picture of her leg on a white board on the wall. I'm sure she shared it with everyone who visited - probably up until her discharge. It gave her, and us, a way to visualize her injuries. Now, if he had also put her treatment plan there, we could have visualized that, too, and how we could help.

And that’s where my mind went as I read the easy, practical advice from David Solie today on his blog titled "Hospital Quicksand: words are not enough."

Solie suggests buying a small dry erase board and writing what’s going on during a hospital stay, and what should happen afterward. Keep it simple and clear. Help the person hospitalized – and their family – make sense of what is often a confusing, overwhelming experience.

I love the example of Ellen, who wrote on her mother’s board on discharge day:

1. New Medication > Reduces fluid build up > take one every day
2. Walking > strengthens heart > 15 minutes, twice a day
3. Follow up > family doctor > 2 weeks.

Simple. Clear. Easy. As Solie says, “The board costs four dollars. The marker two dollars. The ability to understand and preserve control: priceless.”

Help for caregivers of Alzheimer’s

2010-01-14T08:00:00.000-08:00

I’ve had the privilege of viewing a series of DVDs this week presented by an incredible woman, Jolene Brackey. Not only do I recommend these training videos to families who have a loved one with Alzheimer’s or dementia, but I truly wish that everyone who cares for someone with memory loss would view these videos.

Jolene started her career in interior design but quickly discovered that she was given a gift for working with people with dementia. Jolene’s gift is clearly not just helping those afflicted with the disease; she is also gifted with sharing what she’s learned in a interesting, humorous way.

Jolene shares how individuals with dementia can be warm, loving and wonderful, even as they seem to forget who you are. She helps family members see that mom or dad isn’t really forgetting them – just remembering them from earlier days, when they were young. Throughout the series of DVD, Jolene shares how to think and talk differently to people with dementia, as well as how to add joy to their lives and to the lives of the caregiver.

Check them out – they’re an investment that will pay back many times in return in peace of mind as you create moments of joy with your loved one – no matter how advanced the disease process.

Jolene’s website: www.enhancedmoments.com

Training DVDs: http://enhancedmoments.com/catalog/index.php?cPath=22

Happy New Year!

2009-12-30T10:35:00.000-08:00

I hope you had a wonderful Christmas celebration. This year all of our children were home, even though that meant we celebrated on Christmas Eve day to make sure everyone was included. Maybe because this was special for us, I listened carefully to other people sharing their Christmas traditions:

Jim and Joan, who say, “Christmas is Christmas.” They celebrate on the 25th, no matter who is home. When their distant children arrive a day or two later, they open their presents then.

Nancy, who spent Christmas day alone, in her pjs, watching classic movies. Her children traveled to visit their father and spend Christmas with him. As a divorced parent, Nancy has learned to make adjustments and avoid the pain of holidays spent apart from loved ones. Actually, she looks forward to it and still loves the holiday.

My brother, Dan, who spent Christmas Day at a homeless shelter serving lunch. It’s his ministry and his way to celebrate his own blessings. The next day he was on a plane to Hawaii, so he had much to celebrate this year.

Our Christmas Day was spent visiting our aging parents – separately –in their retirement communities on opposite sides of town.

I think back on Christmases over the years: the first one away from my parent’s home; the first one as a new bride; the first one away from my children. Each of these experiences marked a passage of some sort; a measure of the change in life. Some left me feeling hallow and hurt; some signaled an exciting new phase of my journey through life.

This year I felt, for the first time, like a true “sandwich generation” mom – balancing parents and kids (adults, but still my babies); thinking about the passing of the torch to the next generation.

Wrapped up in our changing celebrations are feelings of home, of family, of love. Sometimes the holiday feelings we seek seem elusive; other times we feel richly and fully blessed.

My wish for you as we enter this New Year is that you will find many occasions – the special and the ordinary – to experience the feelings of deep contentment, joy and love. And that you’ll discover new ways to celebrate the changing seasons of life.

Caregiver Certification: why it matters to you

2009-12-07T16:05:00.000-08:00

Joe was a stubborn old man. Set in his ways, determined to do what he wanted, when he wanted, he was not about to let some young “girl” come in and help him with a shower.

“I’ve tried everything I know to do,” said one.

“Nothing ever works with Joe!” said another.

“I’m going to try what I just learned in my caregiver class,” said the third of the three caregivers huddled in the hall.

They knew that Joe hadn’t bathed now in several days, and his out-of-town daughter was coming to visit that afternoon. It would reflect poorly on their care if Joe was clearly a little too musky for comfort – not to mention making it tough for the daughter to relax and enjoy the visit.

One hour later Joe emerged from the bathroom with slicked-back, shiny hair and the scent of fresh soap, instead of the reek of body odor. The successful caregiver also had a glow, knowing she had achieved what seemed impossible. Even more important, it had been a positive experience for both Joe and his caregiver.

All three caregivers had good hearts. All three wanted to be the best caregivers they could be. The difference? Good training that taught the one caregiver important skills that increased her ability to be the best caregiver possible.

For family members selecting an assisted living community or home care agency this is a crucial difference. Compassion and a big heart are still vital, but skills training brings it all together and gives the compassionate caregiver the tools to deliver what the family is looking for – and the person receiving care really needs.

Personal Care Aide (PCA) Certifications are just emerging as one form of caregiver certification that is uniquely designed to prepare the caregiver for home-style caregiving. They typically cover all the basic skills required for care, including skills in communication, decision-making and respect for the rights of the person in their care. They reinforce, through the training, principles of independence, choice, dignity and privacy. A caregiver learns to see challenges through the eyes of the client, and to include families in the unit of care.

Many community colleges offer this level of training; high-quality, comprehensive PCA Certification courses are also readily available online through distance education schools. Within the coming decade PCA Certification will likely become the minimum standard for all direct-care workers.

For now, it is one way for families to feel increased confidence that the person providing care has more than a good heart: she has skills and a unique understanding of the difference a good caregiver can make in enriching the lives of the people in her care.

If you’re looking for a quality online caregiver certification course check out the Personal Care Aide Certification course offered by the Institute for Professional Care Education (www.ipced.com). IPC-ed is a school licensed by the Oregon Department of Education specifically dedicated to prepare individuals for work in care related professions.

Caregiver Certification eases fears

2009-11-23T16:03:00.000-08:00

I remember hearing a family member tell me that leaving their mom with a new caregiver and walking out the door to go to their own home reminded her of leaving her child at day care for the very first time.

It’s scary. It means trusting someone you don’t know well to care for someone you love and feel responsible for.

Your stomach churns and there’s a sick feeling deep down. Your mind circles around the fear: what if the caregiver doesn’t listen to her? What if she speaks sharply to her, or is rough with her?

You worry if she really has the skills and knowledge to provide the care your mother needs, and the judgment to know what to do if something awful happens (a fall? wandering off?).

You wonder if your mom will ever forgive you for not caring for her yourself; for turning to strangers to provide care.

There’s no easy way to get past these initial feelings when you place your precious loved one (parent or child) in the care of someone else.

Here’s one idea, though, that’s gaining a lot of traction nationally: make sure that the caregiver has solid, formal training with a certification to show for it.

That’s a tough requirement, since most states don’t require caregiver certification, and many areas don’t even have classes to certify caregivers. It’s a fast-growing field for training however, and new online courses make certification available to anyone with an internet connection. Ask – and expect – anyone who provides caregiving to your loved one to be appropriately certified.

It might not take away the initial “first day” jitters, but it will give you a sense that you’ve taken one more step to ensure the safety and care of your loved one.

Online caregiver certification courses are available from a variety of sources, including our newly launched Personal Care Certification course from the Institute for Professional Care Education (www.ipced.com). For details, go to our website or call us toll free at 877-843-8374.

Caregiver love means laughter instead of tears

2009-11-16T16:27:00.000-08:00

I’ve got 30 minutes until my next appointment and I need to buy a sweater. There’s only one person working the cash register, but the line is short so I should be OK.

In front of me are a middle aged woman and an elderly woman, probably her mother. They’ve got an arm full of items, but the cashier is working quickly, ringing each item up and folding it carefully.

The elderly woman hands a card to the cashier, who suddenly stops. She looks up at the woman and says, in a loud, slow voice, “This is your insurance card. Do you have any card that has a VISA or MASTERCARD written on it – down here in the corner like this?”

The woman looks through her wallet anxiously. I’m getting nervous for her (and checking my watch). She pulls out a few more cards: her social security card, a membership card, a Costco card. No credit card.

She glances up at her daughter with her head lowered and her eyes downcast. Their eyes connect. I wait for the blame to start: “Mom, what were you thinking?! How could you come shopping without your credit card?”

Instead, they both burst out laughing. The daughter quickly hands over her own credit card and the crisis passes.

For that moment, I forget all about my next appointment. All I can see is the warmth, love and patience that I have been privileged to witness.

Maybe the mom has a touch of memory loss. She might have Alzheimer’s disease and significant impairment. Her daughter clearly has spent the afternoon shopping with her, and clearly expects mom to pay for her purchases. It could have been one of those moments where caregiver stress maxes out the meter. The daughter could have simply lost her temper, and the mother ended up in tears.

Instead, they both end up laughing so hard there are tears in their eyes. They see the humor of the “senior moment,” and – instantly – the tension is gone.

Maybe they know, like so many other caregivers, that sometimes you’ve just got to laugh - or you might never stop crying.

Celebrate Family Caregiving

2009-11-10T12:52:00.000-08:00

Here are two things you need to know: First, this is National Family Caregiver’s Month and second, if you’re not a caregiver now, you’ve either been a caregiver in the past or will likely become one in the future.

My conclusion? We should all celebrate this month together, since we’re all in this together.

You might think, “What’s to celebrate about caregiving? Isn’t that just an awful task?”

Here’s what family caregivers tell me, over and over again: “It was the hardest thing I’ve ever done. It was also, in the end, the most wonderful thing I’ve ever done.”

Mind you, most family caregivers don’t feel this way while they’re in the middle of caregiving. Those family caregivers typically identify more with feelings of exhaustion, frustration, stress and anxiety. They worry continually about their loved one falling, being left alone, needing more care, and – when they get a minute – about meeting all the other needs of their family, immediate and extended.

Sometimes, it’s not until the caregiving task is over and the caregiver gets some distance (and perspective – and rest) that they can look back and see what a rich, meaningful experience it was to care for a loved one.

Vicki says, “I got to know my father-in-law in a way that was so special. He and I became very close – it was a tremendous gift to me.”

Mary says, “I treasure every single minute I spent with my dad.”

Lorraine says, “I was my mother’s caregiver because she was my mom. It was an honor and a privilege to care for her.”

All three women remember how hard caregiving was. But all three women feel that their lives are richer because of their caregiving work.

This month, I celebrate Vicki, Mary, Lorraine and all the other family caregivers – past, present and future.

Sandwich Gen relationships take odd turns

2009-11-02T14:03:00.000-08:00

I had lunch with my mom the other day. She was positively glowing. She’s been talking for several weeks about her new friend; now I’m starting to wonder: when do you ask to meet your mom’s new boyfriend?

What an odd experience it is some days in the middle of the sandwich generation! On the one hand, my three young-adult daughters still need some guidance and support. We have long conversations about finding “Mr. Right,” and I worry about who they are dating.

Is he genuinely interested in her? Does he respect her and treat her well? Is he financially settled or focused?

Thinking about my mom and her new relationship I realize that I have the exact same questions about her new friend.

Of course, this is my mom, not my daughter. I’ve chosen – for now – not to say, “So when do I get to meet this guy?” but to let my mother call the shots. She is an adult, after all. I am her daughter, not her mother (as she’d be the first to remind me).

But all the same, mom, I really think I should meet him sometime soon!

Sandwich generation still needs time for self

2009-10-27T12:04:00.000-07:00

The term “sandwich generation” isn’t new. I was actually cleaning out my files during our last office move and found a newspaper article I’d written about the term over 20 years ago.

The experience of caring for our elders isn’t new, either, although it is becoming more and more the norm as our parents’ generation lives longer, healthier lives.

Blogger Kerri Zane recently wrote an article called “The crusty side of sandwich gen,” where she describes her experience being in the middle of what is nobody’s picnic: caring for her two teenagers, being a single mom, and helping her ailing 89 year old mother.

Her description of the challenges she faced after her father’s death are gripping: Figuring out how to do the tasks Dad always handled, while being in no way able to fill the emotional void he left behind.

“It is devastating for her and for me,” she comments, referring to watching her once “non-stop mom” now bedridden and frail.

Kerri finds a brief respite from her constant challenges during her morning workout. Kerri rightly sees these moments not only as important to her health and well-being, but truly essential to her sanity.

You might think that in 20 years those of us living in the sandwich generation might have gotten some breaks. We might have found resources, tips, ideas and technology to help us cope better.

Instead, I think perhaps our lives have gotten even busier. With cell phones and email we’re never out of touch, but that means we rarely get those precious times alone with our own thoughts. Our kids are doing more (that means more commitment from us); our parents are living longer (that means more expectations from us, too).

Like Kerri, my daily salvation comes during my walks. No phone, no conversation; just me and my thoughts. I try to notice the leaves, trees, streams; to find things in my surroundings that draw me out of myself and remind me that, indeed, life – though pretty tight here in the middle of the sandwich – is a very good thing.

Family caregiving brings joy with support

2009-10-20T15:52:00.000-07:00

I’ve been a part of a neighborhood book group for several years now. We meet once a month, rotating homes, and spend a few minutes chatting about our lives, families and work before plunging into what usually turns out to be a rousing discussion of our month’s book.

All of the members are women roughly similar to me in age and life situation. Most of us are mothers or grandmothers; most of us can readily identify with the life of the family caregiver.

Last evening as we discussed John Steinbeck’s “Grapes of Wrath,” we shared stories from our parents and grandparents of the hardships of the depression. Many stories brought tears to our eyes, as we talked of parents recently lost, or parents we’re currently caring for in one way or another.

One thing we each acknowledged was the life changing experience of being a caregiver for our parents. We talked of how hard it is at first, how the role-change is awkward and unwelcome initially. We shared how, in the end, the rewards of caregiving can far exceed the challenges.

The shift in roles from child to adult, from care recipient to care provider requires each of us to find our way through sometimes challenging, unknown territory. As we support each other, sharing our stories and offering support and encouragement, the way seems less overwhelming and just a little easier to bear. Knowing we’re not alone makes all the difference in navigating our way to a place where we find joy and reward in the role of caregiving.

Family caregivers, faith and waiting

2009-10-12T16:23:00.000-07:00

Three years ago, on a dark, late fall night, I sat in the parking lot of the ballet school waiting for my 14 year old daughter to emerge.

My phone rang, and I heard news that would change my family’s life.

“Your parents have been in an accident,” the voice said. “You need to drive to the trauma center to meet the ambulance with your mother.”

“Where’s my father?” I asked.

“He’s been taken to another hospital. You can call there and get more information.”

With that, our lives changed. I was thrown into the whirlwind of planning my father’s funeral, while trying to visit my mother as often as possible in critical care. We hosted visiting relatives, and tried to sort out tasks with siblings, all the while keeping everyone on speaking terms.

Every time I tell this story I hear similar stories from families who experienced the phone call that changed their lives.

Families whose loved one had a car accident, a heart attack, a stroke, or diagnosis of a terminal disease.

Families who got the news they never wanted to hear about the death of a young son or daughter serving overseas.

One thing I remember about those early days was the difficulty of waiting.

We waited, that night, in a “family counseling room,” my husband, daughter and I, for nearly 4 hours while the doctors tried to stabilize my mother enough for us to see her.

Then we waited, often hours at a time, for her to go through the numerous surgeries that would fix one bone after another in the weeks that followed.

We waited for a doctor to explain to us what to expect next, or a social worker to find out what resources might be available to help her.

Those moments of not knowing, of waiting for tests results or news of survival from another surgery, are some of the hardest moments of all. When we have the facts we can make a plan and start taking action.

How do we cope with the minutes, hours and sometimes days of not knowing?

This is, perhaps, time when our faith must take over. It is the time that we look deep inside and know that, whatever happens, we will face it somehow. We will find the strength to make a plan, to take a step, to continue going. Our family, our friends, our church and our beliefs will help us handle whatever is going to happen.

It’s easy to look back and think how very precious and fragile the gift of life is, but perhaps the most precious and fragile thing is the inner strength we must uncover so that when the phone rings, late on a dark, fall night, we can face the voice – and the challenge – on the other end.

Helping families keep helping

2009-10-05T16:38:00.000-07:00

She’s been sleeping on the couch for over a year now. Her mother is in her bedroom, and her brother, who helps care for her mom, is in her guest room.

I asked her how she does it, and she says simply, “This is my mama. She wants to be with us, and we want to be with her.”

At the same time, she works full time and sleeps poorly these days.

I worry a lot about her.

I worry that one day the lack of sleep will combine with an especially tough work day, and then her mom will be just a little more difficult that evening.

I worry that my friend will snap – like I might do, in the same situation. Like more than half a million caregivers each year snap and do something they’d never dream of doing.

They become abusers of an elderly person. And despite what we read and hear about on the news, more often than not, it’s a family member who is the abuser, not a paid caregiver.

You can see how it could happen. Deprive someone of sleep, demand tasks of her that she was never trained to do, and anyone of us could reach a breaking point.

But what if we provide her with easy-to-access help in caregiving, and with some support in tasks at home?

“Just a little help would make a world of difference,” my friend says, as I tell her about training available to her online. “I want to do what my mama would want, as long as I possibly can.”

Her name was Pearl.

2009-10-01T16:13:00.000-07:00

Her name was Pearl. She was one of the first persons to move into our brand-new memory care community.

Pearl was gentle, warm and loving. She was in the early stages of Alzheimer’s disease, even though she was only in her early 60s. We’d frequently find her in tears, saying, “I don’t know what’s happening to me,” or “Why can’t I figure it out?”

We would hug her, and assure her that, while we couldn’t answer her questions, we would be there to help her through whatever lay ahead.

After a while, we’d simply give her a hug and a smile every time we passed her. She’d lay her head on our shoulders, put her arms around us and simply soak up the affection and support.

Her daughter, a bright, accomplished young woman, faithfully visited nearly every day. She’d often leave with tears in her eyes. We became friends, as we supported her, too.

One day, a few months into Pearl’s stay with us, her daughter asked if she could talk to me in my office.

As she shut the door behind her, she said, “You don’t know my mother.”

A little mystified, I replied, “I know that this isn’t the mom you knew growing up – the disease is changing her.”

She said, “No, you don’t understand. The entire time I was growing up my mother never once hugged me. She never once said she loved me. She never, ever simply held me on her lap.

“Now, I watch my mom, every single day, hugging you and laying her head on your shoulder while you comfort her in her disease.”

Her words broke my heart. Tears ran down her shoulder as she talked about her childhood, and her mother’s focus on high society and her career.

We talked a little about the caregiving journey. About getting to know this new person her mother was becoming, and learning to love her and relate to her in a brand new way. At the end of our conversation, we were both emotionally wrung out.

I went home that night and gave my own kids extra long hugs. I told them that I loved them, and just sat and listened a little longer than usual.

Over the years, Pearl continued to be warm, loving and funny as she progressed with the disease. Her daughter remained her faithful daily visitor, often helping with her care or simply taking her for a walk. Her story became intertwined with ours, as her needs increased and our caregiving tasks changed.

We were honored to care for Pearl to the end of her life. After she passed, as we shared the daughter’s grief and sense of loss, we also celebrated her journey with her mother, getting to know a different side of her mom at a stage in life when she least expected it. Both Pearl and her daughter learned to love – and show that love – in an openly affectionate way that was completely new to them.

I’m confident that we shared the belief that, for us all, the experience of being Pearl’s caregiver was one that added to our lives, and created joy for her as well, right to the very end.

Caring for Mom or Dad from a distance

2009-09-14T15:50:00.000-07:00

I came across a great article titled Long Distance Caregiving: Advice for the 'Sandwich Generation' with tips on how to manage long distance caregiving. Today, many families are spread out over distance – sometimes measured in a few miles; other times in continents and days worth of travel.

It can be really challenging to help a family member from a distance. It’s really tough just to identify when help is needed, and what help is needed, let alone provide assistance.

It helps to have someone on the ground where your loved one lives who can help you figure it out, and then work with you to make sure that your loved one has the support he/she needs. Friends, neighbors and relatives may be able to help, but sometimes you need someone a bit more removed that you can trust to see the big picture. That’s where professional care managers may be able to help. Although they’re not inexpensive, they are generally more economical than cross-country trips. The National Association of Professional Geriatric Care Managers can help you find a care manager; their website is rich with resources to help you understand this service as well.

Family caregiving is challenging in the best case; at a distance it’s a very tough job. Here’s my advice: Get all the help you can!

Smart Medication Management Can Promote Compassionate Caregiving

2009-09-08T13:51:00.000-07:00

I invited Katie Huffstetler from the company Senior Living Communities to share an innovation her company is implementing to help with the challenge of medication management. Here’s her guest article:

It’s hard to move out of a family home into an assisted living community. If that community feels like home, however, that move can be just a little easier.

The company I work for recently announced a new initiative designed to reduce drug error rates and enhance residents’ quality of life by taking the med-cart out of medication management. In our communities, assisted-living residents will enjoy an in-suite, secure cabinet that houses their pre-packaged medication. Each pouch has a bar-code that nurses will scan into a community-wide computer system, recording when the medication is given and ensuring accurate dosage practices. With caregivers inputting information electronically, transcription errors are virtually eliminated.

For caregivers that means one thing … peace of mind. The added bonus of a decrease in institutional scheduling means residents can dictate when they would like to take their medication, just as they would if they were living independently. Although they will continue to take their medications as prescribed by their physician, residents will not be on a rigid, operational timeframe. Morning medication can be taken before or after their first cup of coffee, according to their individual preferences.

Did you know recent statistics estimate more than 25 percent of assisted living residents enter facilities as a result of poor medication management?

New technology gives us a tool to help people avoid this need, by better managing their medication at home. In our independent living retirement communities we’ve partnered with Concept Medical Technologies to provide MedAssure to the residents living there. MedAssure is a counter-top computer capable of storing and dispensing pouch-packaged medication at a scheduled time. Residents or caregivers program alerts into MedAssure and the computer notifies its user when it is time to take their medication. The machine continues to prompt users to take their medication until the correct pouch is removed.

MedAssure is also capable of sending text or e-mail messages to residents, family members or caregivers if they prefer a text reminder instead of an audible alarm. The computer gives caregivers a sense of safety without compromising Mom and Dad’s independence or their health.

These improvements are broad in scope, but it’s the little successes that mean the most when you’re a caregiver. The industry as a whole faces huge challenges when it comes to implementing operational changes that make residents feel at-home in their surroundings, but if we can agree to think like caregivers, we’ll understand that it’s not so much about efficiency or productivity as it is about putting a smile on the face of someone we love. For more information about Senior Living Communities, visit our Web site at www.senior-living-communities.com.

Celebrating life at the end

2009-08-31T14:11:00.000-07:00

Phones ringing at 1:00 in the morning never bring good news.

This weekend, our family experienced that 1 am phone call bringing news of the death of my husband’s mother. It wasn’t unexpected; in fact, it was a blessed relief for the entire family who had watched her growing increasingly weak and less responsive day by day over the past several weeks.

Early on, she would grasp our hands and say, “You know that I don’t want to linger. I just want to go quickly.” Initially we’d encourage her to hang on and fight, but, as time passed, it was clear that lingering wasn’t adding to the quality of her life. We begin to spend the time we could with her laughing whenever possible, talking about her many grandchildren and their adventures, and sharing life with her. Sometimes we’d simply sit and hold hands with her while we watched the news or one of her favorite shows together.

Until the last day, she’d usually grasp our hand with both of hers and hold on tight. Even when she couldn’t talk, she’d look in our eyes and communicate that she valued the time we spent with her.

On the last day, she no longer had the spark of life in her eyes, even though she continued to breath. She couldn’t speak; perhaps she could hear us and feel our touch, but we couldn’t see a sign of her spirit left in her body. We took our turns crying with her and each other; it was clear that we had lost her.

So when the phone call came, it was a blessed relief to know it was finally over for her physical body, too.

We were lucky to have all our children home this weekend. We had a chance to talk a bit about how we handle the death of loved ones, both personally and as a society. I instructed my eldest daughter to make sure I was cremated and put in a lime-green urn (she and I have a running joke about lime green being my favorite color), but mostly we talked about how right it is to mourn while at the same time recognizing that death is a part of each of our life journey.

My mother in law lived a good long life, just two weeks shy of her 91st birthday. This week as we gather with the large, close, extended family she left behind we will cry a little and laugh a lot as we remember – and celebrate – her life.

We need your stories!

2009-08-24T16:00:00.000-07:00

Are you a family caregiver? We’re looking for family caregivers willing to share their stories of challenges – and rewards – of the caregiving experience.

How have you managed the shift in the relationship with the person in your care? Do you feel like you’re “parenting your parent”, or has the shift taken you to a different sort of relationship?

Have you reached that point in caregiving where you feel that this experience has joy and meaning for you – not just exhaustion and frustration?

What moments were the most emotionally challenging for you in this process? Was it the initial phone call alerting you that things were not right – or the moment when you had to face a challenging task like taking the car keys away?

What has helped give you the energy, support and courage to continue as a caregiver, even when it got really tough?

As we continue to build resources for caregivers it helps us to hear stories from real live caregivers. Please share your stories with me via email at Sharon@aquiretraining.com. Let me know if you’re willing to chat with me on the phone, too – sometimes that’s the best way to share stories.

Thanks in advance for sharing your stories. Your experiences may help others who are just starting out on this incredibly challenging, rewarding adventure.

Caregiver Guilt

2009-08-18T08:03:00.000-07:00

Paula Spencer, senior editor at Caring.com wrote a great article on caregiver guilt titled “Aging and Caring: The secret guilt of caregivers” which I highly recommend both to caregivers and to professionals trying to better understand the challenges of family caregivers.

Paula points out that caregiver guilt closely mirrors what she calls “mom guilt.”

She’s so right, in my experience. Talking with families about leaving mom or dad off at their new retirement community or assisted living home, many report feeling like “leaving my kid at kindergarten or preschool the first day of school.” It’s a feeling of anxious uncertainty, wondering if you’ve made the right decision; if he/she will be OK; if the people in charge will do the right thing.

I believe strongly that becoming a family caregiver doesn’t mean we’re now parenting our parents; rather, we’re experiencing yet another role shift in our relationship as we have at various times throughout life. Still, the feelings of parenting seems pretty close to some of the guilt-feelings of caregiving. When your child (mom) is ill, should you just watch and see, or rush to the doctor? It always seems that whichever choice you make will inevitably be the wrong one…and more guilt rushes in.

Paula shares some great “rules of thumb” about handing guilt:

You can’t ignore this pesky emotion, can’t will it away. Guilt simply is. So straight off, don’t think there’s anything bad or wrong about your feeling it.

There’s good guilt and bad guilt. Good guilt is the kind that causes us to examine our behavior and make a change, if necessary. If you feel guilty because, say, you were impatient with a parent with dementia, it’s like a little poke reminding you to try a little harder next time because hey, patience really is a virtue. Unfortunately what eats most of us alive is bad guilt. Bad guilt has no constructive underbelly. Bad guilt makes you feel guilty about a situation that you can’t help (your parent has to move into rehab, for example) or that is actually a positive for you (you’re hiring home care because you can’t do it all yourself)

Beware the oughts-shoulda-couldas. For caregivers, this refrain can sound like: “I ought to be able to handle this; I’m her daughter.” Or, “I shouldn’t feel so happy about going someplace without Dad.” Or, “I could have handled that better.” Things (and feelings) are what they are; stewing or denying wastes precious energy.

Guilt creeps in when we discount ourselves. Ironically, selfless people tend to feel proportionately more guilt. Because they work so hard aspiring to an ideal way of doing things for others, they tend to ignore the inconvenient reality that they have to look after themselves all the more. They may even forget that they, too, deserve extras and shortcuts. Or, when they finally get around to (by choice or force) having a Calgon bath or lunching out with friends, it feels as alien as it does great. That’s a sign you probably need to follow your self care with more self care.

Guilt loves high standards. News flash: Nobody’s perfect. No caregiver anticipates every fall or bedsore. Tempers boil. Germs sneak in. Bills slip through unpaid. Life happens, in other words, no matter how much you love the person or how much you feel you “owe” him or her. Aim to be a “B” caregiver instead of an A+ caregiver, and everybody’s going to be happier.

No mom is an island. No caregiver, either. I think it’s no coincidence that most of the “happy guilt” that creeps into a caregiver’s mind follows having the load lightened by getting help. It’s such a persistent canard that it’s somehow a sign of weakness to ask for or find assistance, and from as many sources of help as you can locate or who will offer it.

When my kids were little I learned that, as a working mom with three little girls, guilt would be a part of my life. Somehow, just accepting that seems to make it a little less powerful, and maybe lets us get on with life and do what we need to do, in our very own personal style.

Family caregiving: when relationships add to the challenge

2009-08-11T08:27:00.000-07:00

We’ve been discussing some of the most challenging aspects of family caregiving here among our team and we’re convinced that the relationship shift is probably right at the top.

Shifting from spouse and equal partners to care provider and recipient must be incredibly difficult. I know from my own experience that shifting from autonomous parent-adult child relationship to one where the parent is dependent on the child for care is challenging and disconcerting.

What about when one sibling sees the parent as smiling, happy and capable (the face she presents to them) while another sees a despondent, helpless elder (the face presented to sibling #2).

Then there’s the daughter that feels the need to resolve issues from childhood with a parent before it’s too late; issues that bring up long-buried feelings of anger, pain and helplessness.

I remember Emma who, suffering with advanced dementia, needed physical reassurance almost continually throughout the day. She’d hug us frequently, hold our hands and, in general, give and accept physical affection. I didn’t think much of it until one day her daughter came into my office and told me, “I don’t remember my mother ever hugging me as a child. She simply did not do that – ever.” It broke my heart to realize that this warm, loving woman had lived so many years of her life unable to give or receive affection from those closest to her.

As we’re working on creating materials to train and support family caregivers we’re curious: what’s the biggest relationship challenge you’ve experienced in caregiving? How did you resolve this challenge – how did it affect the caregiving experience?

Share your experiences with us, if you would. We’ll pass on what we’re learning.

Don’t parent your parents

2009-08-03T13:57:00.000-07:00

Remember your teen years? Most of us cringe when we think of the relationship (or lack thereof) we had with our parents during those years. Some of us (not me, of course!) still have secrets from our folks about our adventures during those tumultuous years…secrets that, God willing, we’ll take to our graves!

So why would we want to revert to a relationship with our own parents that echoes those years? Why has our culture assumed that as our roles shift in our later years – as they do throughout life – we’re moving to a “role reversal?”

Our relationship with our parents is one of the strongest forces in our lives – from birth onward.

We’re 100% dependent on them for our survival in the first years of live. As we mature and naturally progress through the stages of life, our dependency grows less and less, until we’re fully independent adults.

Along the way, of course, the relationship is fraught with challenges. Not all parents are up to the task, either physically or emotionally. Relationships can be difficult or destructive instead of nurturing and loving.

Whether the parental relationship is one that is fundamentally healthy or not, many adults in their prime years are finding that the relationship shifts once again. From living independent, largely separate lives, they begin to become more closely intertwined as the child steps into caregiving or advising roles.

It is a shift in roles, but it isn’t time to start “parenting” your parents.

It’s a time to respect them as adults. Allow them to make their own decisions, even if those decisions are not what you’d prefer. To collaborate in making life-altering moves (like leaving a long time home and moving into a care environment) and decisions about care.

Certainly there are times when our parents are no longer able to make their own decisions because of cognitive declines, confusion or memory loss.

That brings yet another shift in the relationship – but one that still reflects the need to treat our parents as adults, not as children.

Adults with whom we have long relationships, often winding and complex.

Adults in whom we’re willing to invest time, energy and passion they move into the latter phases of their lives.

Finding our path to this shift in roles is often difficult. It might include false starts and a need, from time to time, to reconsider our fundamental values in the process.

Let me suggest these values: dignity (respecting privacy, decision-making and adulthood); autonomy (the right to make informed, independent decisions about one’s own life, health and circumstances); independence (as opposed to surrender of abilities and decisions); choice (the right to select what one wishes).

Clearly, when mental function is compromised by diseases such as Alzheimer’s, some of these values may shift. The value of safety takes precedence over nearly everything else, but we’re still shifting roles within the context of adults, not children.

I don’t know about you, but I’d pretty much do whatever it takes to avoid going back to a relationship with my parents that feels like adolescence – theirs or mine. I have no interest in reversing the roles (even though imposing a curfew on them might be a little bit fun)!

What I’m interested in is learning how we travel through this next phase of life together, strengthening the relationship we have developed over the years so that it is richer, fuller and even more rewarding to us all.

Assisted Living offers options to families

2009-07-28T07:52:00.000-07:00

Johns Hopkins University Press just announced the publication of a new book about assisted living titled “Inside Assisted Living: The Search for home.” In it, the authors explore the premise of assisted living, which is that the social model of care leads to a higher quality of life than the medical model as nursing homes are designed.

In general, the authors found that caregivers in assisted living are “professional, pleasant, courteous and caring,” and that the people who live in assisted living are generally satisfied with their care. The authors interview elders living in assisted living, and explore with them issues like aging in place, financing and relationships.

As a recent owner and operator of assisted living and a long-time advocate of the social model of care, I believe that educating families about the benefits of assisted living is vital. Unfortunately, many professionals whom we typically turn to for advice about care, physicians included, don’t clearly understand assisted living or its benefits. They rely far too often on the historical solution: nursing care.

Consumers are making their preference heard, however. Today in the U.S., nursing home bed availability is holding steady or declining while new assisted living communities are being opened in every region of the country. Both families and elders clearly prefer living in an environment that feels more like home; less like a hospital.

If you’re just beginning to seek care for a loved one, be sure to explore assisted living options in your community. Because there is no national definition of care or services, you’ll need to ask questions to learn if this is an appropriate care setting for your loved one. Among the questions to ask, be sure to include these:

What is the limit of care my loved one can receive in this setting? Can he or she stay through the end of life here? Is hospice care available while remaining here as a resident?

What is the full cost of care, including rent, care, supplies or other expenses? Do you accept any third party payment from Medicaid if my loved one runs out of money?

How do you staff the caregivers? Are they trained and certified? What is the ratio of residents to caregivers during the day, evening and night?

Armed with this information you can begin to make an informed choice about assisted living as an option for care. Be sure, of course, to visit and talk to people living there, as well as other family visitors, if possible.

You may wish, as well, to read the book. According to Barbara Petty of Boom!, one of the reviewers of the book, it is “an excellent introduction for anyone who needs to acquaint himself or herself with assisted living in anticipation of having to choose assisted care for a parent or other loved one.”

Hospice: an important program to help family caregivers

2009-07-20T14:16:00.000-07:00

Yesterday we signed my mother-in-law up for hospice care. She has advanced cancer and, with a recent surgery, is now failing quickly. While she may yet perk up and start eating again, she is not ever going to get completely well. It was time, clearly, to focus most specifically on comfort care for her, rather than rehabilitative care.

It’s an emotional time for the whole family, but we have some comfort in knowing that she’ll be surrounded by professionals who are trained to make sure she is pain free and well cared for, right to the end.

Even though I’ve worked with Hospice agencies over the years in a professional capacity, it was good to hear about the benefits of hospice from the family point of view. Here’s a quick summary of hospice and how it can help families:

Why hospice? Hospice is a federally defined and regulated program that is dedicated to provide comfort care to individuals who are not prospects to “get well”, but who are in a declining phase of their disease. Staff who work in hospice are specially trained to comfort both the patient and the family, and to help them accept and find value in their last days.

What services do they provide? Hospice provides a full range of services to individuals who are eligible. A hospice team typically consists of an RN assigned to the patient, aides to assist with bathing or other care, social workers to help with arrangements, adjustments and emotional needs, pastoral care, and more.

Where does hospice provide care? Many people have mistaken notions about where hospice is provided. It can be provided at home, but it can also be provided in an assisted living or nursing facility. Hospice won’t provide staff for the daily care needs of the person, but it will support those caregivers and provide special care to make sure the person is comfortable through the end of life.

What does hospice cost? Hospice is fully covered for individuals who are on Medicare. If you have other insurance coverage it will become secondary to your hospice program and coverage.

What does it pay for? Hospice covers the cost of all the equipment (hospital bed, walker, commode, etc.), medication related to comfort and all of the professionals who provide services. You do not have a co-pay or any other financial obligation when enrolled in hospice care.

When is hospice appropriate? If your loved one has a disease that is progressive, without the possibility of recovery, hospice may be appropriate. You may remember a time when a person had to be certified as within 6 months of death for hospice to be allowed; that time constraint is no longer the measure of eligibility. If your loved one has dementia, he or she may be eligible now, and may continue to be eligible until the end of his or her life. If a person begins to get better, hospice can be cancelled.

How do I get connected with a hospice agency? Talk to your loved one’s doctor and ask for hospice to be ordered. At least request a hospice evaluation to help you determine if hospice is an option for your loved one. Ask questions and learn as much as you can about the services you are eligible to receive.

For more information about hospice programs, go to www.hospicenet.org.

Cultural challenges in caregiving

2009-06-26T08:50:00.000-07:00

If you’ve hired a private caregiver you probably know this already: the nation’s caregiving community is composed largely of individuals who are foreign born or from minority ethnic groups.

For many families, this is a challenge, but one that can be overcome.

Communication. Let’s start with the basics: communication. It’s tough to communicate with a caregiver who speaks limited English. It’s even tougher to ask this caregiver to communicate with an elderly loved one who may suffer from hearing loss, dementia or other conditions that impair communication in the best of situations. Yet caregivers from other cultures, who speak very limited English, can be compassionate, gentle, reliable sources of care for our loved ones. Try these approaches to bridge the communication gap:

Make sure emergency communication is possible. Can the caregiver call 911 in case of an emergency and clearly express the emergency? Can she relay the address and phone number of the location? Ask, “Tell me what you would do if the oven caught fire and you needed to call the fire department.” Listen carefully to what the caregiver says, and coach her if needed until you feel comfortable with her ability in this area. Print the address and phone number of the location clearly, and post it near the phone. We all know the feeling of forgetting our own phone number in a crisis – and that’s without a language barrier.
Let the caregiver know what you need to know each time you visit or call. Do you want to know how your loved one ate or slept? What activities he did during the day? How he seems to be feeling emotionally? Try creating a task sheet with each of these questions written out for the caregiver, and space for her to write in answers each day. Many foreign born individuals learn to read English but are hesitant about speaking it.
Learn a few words in the caregiver’s language. Try hello, thank-you and good bye, for starters. As you learn to respect the language of your caregiver, she will feel more comfortable in communicating with you in your language.
Encourage the caregiver to speak English by praising every attempt. Often people are reluctant to practice their English because they feel that their pronunciation is poor or they are embarrassed at their lack of skill. Try not to correct or criticize attempts, but praise them for each progressive success in the language.
Help your loved one communicate. If the caregiver is not able to freely communicate with your loved one, recognize that your loved one needs other companionship for communication. Spend as much time as you can simply talking to and listening to your loved one. Include the caregiver when you can to help bridge the gap between the two.

Values and traditions. Today’s American values provide many opportunities for culture clashes with the values and traditions of a caregiver from another culture. These can range from the caregiver who is extremely uncomfortable speaking with a family member of the opposite sex, to the caregiver who comes from a background of strong familial responsibility and can’t understand or accept our busy lifestyle. Learn as much as you can about the values and culture of your caregiver by asking questions and researching to avoid cultural misunderstandings and conflicts.

Diet. Caregivers often work through mealtimes, especially those that work full days or overnight. Many families assume that caregivers will eat with the client in the American family style. Talk about food with the caregiver, and your expectations for mealtimes. Your caregiver may not feel comfortable eating with your loved one, and may have distinctly different food preferences. Cover these topics to avoid misunderstanding:

Preparing food for your loved one. You may need to provide a menu and recipes or cooking instructions for even basic fare if this is not familiar to the caregiver.
Mealtime. In general, elders eat better in a social setting. If your caregiver isn’t comfortable eating with your loved one at mealtime perhaps she would feel comfortable with a cup of tea, visiting with your loved one while he eats. Explore this with the caregiver.
Preparation of the caregiver’s meals. Ask what the caregiver prefers to eat. Do you expect the caregiver to bring her own food? What about cooking meals in your loved ones’ home? Explore this, as some foods from other cultures can be distasteful during preparation to the American palate (especially to the older person).

Cultural differences between client and caregiver are facts of life for many families today. That doesn’t mean that care must be compromised, or communication limited. It does mean that we must learn to develop a greater awareness of the caregiver’s culture and sensitivity to working together for the best care of your loved one.

In the end, taking the extra effort can result in a rich, rewarding experience for everyone involved.

Book Review: Take your Oxygen First (Leeza Gibbons)

2009-06-18T09:34:00.000-07:00

I love it when a package arrives in the mail for me – especially when it’s unexpected.

Last week, I received a surprise package that contained the one thing I love better than a surprise: a book. It was Leeza Gibbons’ new book, Take your Oxygen First. I received a copy so that I could read and review it for you.

I’m just starting to read the book, but already I love it. The forward, written by Larry King, contains this line that sums up, for me, exactly what caring for a loved one is all about:

“For those who are just starting out on the journey of caring for a loved one and for those already caught up in its tremendous burdens, seeing that light at the end of the tunnel can seem all but impossible. [This book] shows caregivers that the act of giving care can actually be a life sustaining and empowering experience for them, for their families and for their loved ones as well.”

I have to admit I wasn’t really sure what the title was about until Leeza explains at the beginning of Chapter 1, after a 30 page introduction to her family’s story. She reminds us that, at the start of an airline flight, during the instructions on what to do in case of an emergency we’re told to “put your oxygen on first, before the child you’re traveling with.” For Gibbons, this idea applies to caregiving, too:

“If you think about it for a moment, you realize that if you ignore your own need for oxygen, there is a good chance you may be unable to help your loved one, and if that happens, you may put both yourself and your loved one in danger of serious injury or worse…if you don’t take care of yourself first, you’ll be unable to care for your loved ones in their time of need.”

I’m looking forward to reading more in this book. I’ll share with you some of the highlights that I find. But for today, this is the message for family caregivers in a nutshell:

It’s a tough journey, but rewarding for those who travel the caregiving path.

Your first task – everyday – is to take care of yourself so you can continue to take care of your loved one.

These shoes are made for walking (keeping track)!

2009-06-09T17:01:00.000-07:00

Here's a great idea - shoes with a built in GPS chip! (Story)

If you've ever cared for someone with Alzheimer's or memory loss who was a wander risk you know how stressful this can be. Literally - turn your back for a second, and the person can be gone. They're at risk and you're a nervous wreck.

Let's keep an eye on this product idea - it could be a real winner!

Sharing your story

2009-06-09T12:01:00.000-07:00

Last week I traveled to the Minnesota “outback” to attend my grandmother’s 98th birthday celebration. Nearly 30 family members made the trip; some from as far away as Guam; others from the neighboring town.

My mother and aunt stayed behind after all the other relatives left to care for grandma. She’s been declining rapidly lately, losing her long-treasured ability to care completely for herself. My mom, 76 and lacking in strength and mobility, is caring for her mother, helping her transfer from bed to wheelchair and back.

The day we returned home to Oregon, my sister-in-law stopped by with the latest installment of the challenges facing my husband’s parents, both in their 90s.

It’s a story that most American families are living today. We’re living longer. We’re healthier, too, until we hit that inevitable wall of age and decline. Most of us help our own family members rather than paying someone else to provide care – or we have a combination of both, like my family.

I’ve been thinking a lot about stories lately. Howard Gleckman’s new book, Caring for our Parents, is based on stories of real people facing real crises in managing their needs during the last years of their lives.

Brooke Shields’ story, which I shared last week, is one of guilt and anxiety about placing a mom in a care facility.

My own story is one of a healthy, hearty family laid low by the classic phone call; this time from a paramedic on scene at the site of the traffic accident that claimed my father’s life and severely injured my mother. What followed were days that blurred into night as I traveled between hospital and funeral home, work and my children’s schools, and tried to keep it all in balance. My mother traveled the route that many do at the end of their lives, but she did it backward: acute care to skilled nursing care to assisted living community. We experienced it all – and it wasn’t pretty. Even though I’ve been in the business of senior care for the past 30 years, my eyes were opened to the family experience in a brand new way.

We helped both my mom and my in-laws move from their homes into retirement centers. I use the word “helped” loosely – in my mom’s case we physically cleared a home and 5 acres of land that my parents had lived on for more than 20 years (with all the accompanying stuff); in my in-laws case we simply nagged and nagged until they finally made the move. Both moved into lovely retirement communities – not nursing homes.

Sharing our stories not only helps us gain perspective on our own challenges, it can help us join forces in taking steps for change.

Maybe the change you need is on a personal basis – like the family members who don’t see the needs that you see.

Maybe the change you need is much broader – like the inability to pay for the care your loved one desperately needs.

Sharing our stories may be one way we can help each other. There are currently some 52 million family caregivers in America today according to caregiver.org. That’s a lot of stories – and a lot of help!

Guilt and the family caregiver

2009-06-03T13:06:00.000-07:00

When my kids were little, they’d get sick and I’d start stressing. Should I take them to the doctor? Should I let the bug run its course?

Either option seemed to generate a bucket full of guilt. If I called in to the advice nurse the advice was – without fail – bring them in. I’d get to the doctor, and hear what sounded to my ears something like, “Don’t worry so much. All kids get bugs from time to time. Don’t be such an anxious mom.” The doctor would give me the “lots-of-rest-and-plenty-of-fluids” advice, and I’d be home thinking about the time I’d wasted and the expense of taking a kid to the doctor – again – who didn’t really need to go.

So the next time a kid got sick I’d say, “We’re going to just let this bug run its course. We’ll get plenty of rest and lots of fluids. I’m sure in a day or two she’ll be fine.”

A day or two later, the bug is no better so I finally take the child to the doctor. This time I hear, “Oh my god. Why on earth did you wait so long to bring the child in? She could have died!”

No matter which choice I made, I felt profound anxiety and guilt.

Caring for our aged parents seems to be much of the same: equal parts anxiety and guilt, no matter what we do.

As I read about Brooke Shields’ response to reporters finding out about her mom’s move into an assisted living community I thought about guilt.

It’s easy to let guilt guide our decision-making. It’s easy – but not wise. Just like my parenting guilt could have led me to take the kids to the doctor with each sniffle and sneeze, I learned to accept that either decision would most likely result in guilt. And then I made the decision that seemed, based on the facts as I knew then, to be the most appropriate.

With our aging parents we need to make decisions based on facts, too. We need to set feelings of guilt aside and ask ourselves – and our loved ones – what best meets their needs.

When my mom needed 4 people to help her to the bathroom, I had no option. I felt guilty about helping her into a nursing home, but I would have felt guiltier – and been a less responsible daughter – if I would have brought her to my home and then left her with no one to help while I attended to my own work and family needs.

While we’re not parenting our parents, we are making choices and decisions, often without their input, on matters that affect nearly every aspect of their lives.

Try these questions to help you check whether you’re making decisions based on fact – or on emotions like guilt:

Who can help? If your parent moves into a care community, someone will always be available to help. Often, more than one person will be available. Usually someone will be awake and ready to help even during the night. In a good care community, those helpers are trained and supervised by experienced caregivers. If you choose to leave your parent at home – yours or theirs – can they get the same level of attention and care?

What’s my role? Often I hear from family caregivers that are exhausted from nighttime demands, or from caring for their own family, doing their own work, and then trying to do the tasks their loved one needs. Sit down and chat? Go through an old family photo album together? Who has time for that?! If your caregiving tasks demand all the energy you have available, who can provide the companionship and company to your loved one?

Is there joy? I’m a profound believer in finding joy in caregiving. Yes, a lot of the care we provide to loved ones – whether 2 or 102 – not a lot of fun, but is necessary. At the same time, we find ways when we’re bathing the baby to laugh, make bubbles and sing together. What about when we’re caring for an elderly loved one? Is there joy being shared? Laughter? Find a way to discover the joy in the relationship, or get help with the tasks so you can find new ways to a joyful relationship.

Caregiving, like parenting, will naturally have moments of guilt, anxiety and despair. But if we’re caring because we’re family, caregiving can also be filled with deep satisfaction and joy.

Caring for a difficult parent – Brooke Shields shares

2009-05-26T14:44:00.000-07:00

Her name was Kathy, and she visited her father, faithfully and unfailingly three times each week.
Her father had advanced COPD, which meant he lived on oxygen, and frequently had difficulty with even the smallest chore. I’ve heard advanced COPD described as a feeling of drowning, as breathing becomes more and more difficult.

Kathy watched her father struggle more and more to breathe with each week that passed. One day she stopped by my office; I’ll never forget our conversation.

“My father was an alcoholic when I was growing up,” she began. “I never remember a time when he acted like he even cared about us kids, let alone wanted to help us succeed in life.

“He was often violent and brutal to us. I lived in fear of him until I finally got out of the house to go to college.”

Kathy told how she had distanced herself from her father and refused to let him become a part of her own children’s lives.

And then, somehow, the hospital had found her and contacted her when her father was admitted from home, no longer able to live alone and care for himself.

Kathy became the primary family caregiver. She helped her father move into our assisted living community, and she faithfully visited him three times each week. None of us knew about her history until that day when she finally shared it.

We cried together as she talked about her experience with an alcoholic dad, and the strange twist life took leaving her with the responsibility to now ensure his care.

I’ll never forget Kathy’s story, nor her brave efforts to build a relationship with a father with whom she’d never had a real relationship before.

Over the years, though, I learned that Kathy is not alone. Many, many adult children have become steadfast, loyal caregivers to parents who were never dedicated caregivers to them as children.

Brooke Shield’s story of caring for her mother who now has Alzheimer’s disease is just one high-profile example. Shields shares her painful decision to place her mother in an assisted living community after a reporter checked her mother out for lunch last week, causing Shields considerable anxiety and distress.

Shields had apparently planned to keep her mother’s move to the assisted living community private. It is personal, but here’s my message to Brooke and to the many other adult children of individuals with high care needs and strained relationships.

Do not be ashamed of finding a good care community for your loved one.

Be proud that you care enough to find good care for your loved one. Know that what you are doing – caring for a person who may not have cared best for you when you needed her most – is honorable and right.

I don’t know if I could have done what Kathy did, investing so much time and energy on a parent who made my childhood a living hell.

But Kathy’s caring – and Brooke Shields’ actions – give me faith that we can overcome our history and build relationships with our aged loved ones, and become better, stronger people as the result.

Caregiving for parents: the blessing path

2009-05-20T08:57:00.000-07:00

Here’s a great article on Oprah.com titled “How to care for your parents and keep your sanity.” Just the title alone got my attention. If you’ve ever cared for a parent, you’ll know that keeping your sanity is an important part of the equation. You know the days and nights that blur together, the feeling of uncontrollable laughter – or is it crying – when someone mentions the word “stress.”

The article starts with a story about the Navajo people, who believe “that caring for the elderly is a ‘blessing path’ in which the whole community should participate.”

If you’ve been reading my articles you’ll know that this is something I believe strongly in. I believe that, as caregivers, we need to access all the support and resources we can so that we can care with joy. We need to tell our friends, relatives and neighbors that we’ll take them up on their vague offers to “let me know how I can help” – and ask them to help in concrete, supportive ways. We need to hire, whenever possible, trained professionals to do the tasks so that we can focus on the relationship - something we can never hire anyone to do in our stead.

Martha Beck, the Oprah.com article’s author, ends with this very visual description of this journey:

“Rather than a long day’s journey into night, you’ll feel yourself making a long night’s journey into day: through fear and confusion to courage and wisdom. Receive this gift, the final one your parents can offer before they take off their shoes, jump out the window and fly home.”

Caregiving is a gift. It can be one of those gifts you’re really reluctant to open (how do I say thank you – and look like I mean it – for another poorly crocheted sweater?); or it can be a gift that offers you a new way to measure the value of days and the significance of life.

Family frustrations: caregiver challenges within the family

2009-05-13T09:45:00.000-07:00

My sister and I have never been really close. She’s three years younger than me, but very different in her preferences and lifestyle. She makes a living training horses, for example; I’m essentially afraid of all big animals.

It shouldn’t have surprised me, then, when my mom needed lots of assistance after an accident that my sister and I approached it from very different perspectives. My mom lives close to my home (my sister lives two states away), so naturally many of the day-to-day tasks fell to me and my family. Somehow that didn’t stop my sister from weighing in on a regular basis. The conversations often went like this:

Mom: “Sharon came by and took me to the doctor this morning.”

Sis: “I hope she didn’t just drop you off in the waiting room!”

Mom: “Well, I’m perfectly able to talk to the doctor without her in the room.”

Sis: “Still, she should have stayed with you through the whole visit. I don’t know what she was thinking!”

Of course, what I was thinking was that I have three kids at home, a business to run, a house, a husband and a dog. If my mom can manage any aspect of her care needs without my hands’-on help, I’m going to step aside and let her!

Most families, I’ve discovered, have similar sibling dynamics. One sibling (or sib-in-law) becomes the primary caregiver, responsible for the regular tasks like transportation, shopping, laundry and more. Other sibs, often living across the country (or maybe just a few miles away) are content to let the one sib do most of the work.

You’d think that the other family members would recognize the hard work of the caregiving sibling and be profoundly thankful – and you’d be wrong. Most often, siblings who don’t have the direct experience don’t really know what is involved, or how hard the caregiving sibling works.

It’s easy to second-guess someone whose shoes you haven’t walked in. It’s not easy being on the receiving end, though.

What can you do?

1. Take it easy. Recognize that only you know how much effort is involved for you to keep all your balls in the air. There’s no way anyone else can know exactly what your life is like, so don’t expect them to know. Try to breath, smile and say, “I’d like to see her give this a try!”

2. Pass the torch. This is especially important for those distance siblings who say, “What are you thinking – moving mom into an assisted living center?! She can’t be that much care!” Invite your mom to their house, and let them have a chance to see first hand exactly what mom does need.

3. Gather support. If you’ve got other siblings who can rally to your support, pull them in. In my case, my brother offered me constant support while my sister second-guessed every move I made – or at least it felt like it to me. So, every time I finished talking to my sister, I’d pick up the phone and call my brother. He would patiently reassure me that what I was doing was exactly right, and we could laugh together at my sister’s many comments.

4. Hold a family meeting. Every family should sit down together and talk about big decisions, preferably before those big decisions need to be made. Involve the parents, if possible, and talk about choices for care (at home with help? At an assisted living center? Sell the house? Rent to a grandchild?). Make sure you talk about money, too, as decisions come with price tags that often are surprising. For example, keeping mom at home, no matter what, is fine if mom can afford to pay for around-the-clock-care (expect to pay several thousands of dollars for 24-hour in-home care), but if money is restricted other options need to be carefully considered. If you can do this together you may be able to avoid some of the worst family conflicts.

5. Get company. You can take comfort from knowing that you’re not alone – in fact you’re more like most families than unlike them, if you have some sibling discord. You might want to join a support group of other family caregivers (check with your local hospital) to share your frustrations and get support. You’ll not only get an outlet for your own feelings, you’ll gain new friends and helpful tips for survival from others in similar situations.

My sister and I are closer these days, but we still see mom’s care from very different perspectives. Most days, I can smile and nod when I talk to her. Some days it’s not so easy. But like all family dynamics, it’s a work in progress.

The waiting list opportunity

2009-05-06T11:51:00.000-07:00

My mother lives in a retirement village in the suburbs of Portland, Oregon. It’s a community composed of seniors living in single-level duplexes spread over a several-acre campus. There are wide open green spaces, room to garden in front and back of most units, and a central building they call the “Ad building” (like on a college campus) where a lovely library, dining hall and activity spaces are provided.

My mother and father had been on the waiting list for 2 years before my father’s death. It took us several months after that, and many nagging phone calls, to finally get my mother to the top of the list and into an available unit.

Today, the village is sitting with several vacancies.

It’s not alone, either. According to the Milwaukee, Wisconsin Journal Sentinel today’s “double whammy of a sluggish home market and depressed stock prices” have left many seniors unable to make the move. It has also opened up space in the Milwaukee Catholic Home, a place that typically had up to 40 people on a wait list.

For seniors and their families that can make the move, this offers a unique window of opportunity to select the retirement or assisted living community that fits perfectly – with no waiting list delay.

Some seniors are renting their homes to younger family members while they wait for the market to improve so they can sell.

Others are simply pricing their homes to sell, even in this economy.

If you’re ready to make the move, you not only may find that you have a great selection of communities to choose from, but you may also have some unique bargaining power. Some communities are waiving their entrance fees, or allowing the person to defer paying them until their home sells. Others are offering move-in incentives. Look for incentives that help you defray the cost of moving your furniture and paying the first months’ expenses, as an example.

My mom wasn’t sure she was ready to move into the retirement village after my father died, but she knew she couldn’t stay in their farm-home alone. She moved, somewhat reluctantly, but now she says, without a doubt, “It’s the best move I could have made.”

It was the right time, to the right place for her. Perhaps this economic time will offer your loved one the right time to move into the right place for the next phase of their life.

Challenges with care eased by music

2009-04-29T15:01:00.000-07:00

There’s a beautiful story in a recent New York Times article that illustrates just how important music is to the person with memory loss.

Tom was a wanderer. When his wife, Elsie, came to visit him at a care unit for patients with dementia, he would give her a perfunctory kiss, then wander off through the rooms and stare out the window. Elsie tried to walk with him and hold hands, but he would shake her off, leaving her heartsick.

A music therapist at the facility, Alicia Clair, was searching for ways to help couples like Elsie and Tom connect. Ms. Clair asked Elsie if she’d like to try dancing with Tom, then put on some music from the ’40s — Frank Sinatra singing “Time after Time.” Ms. Clair said recently, “I knew Tom was a World War II vet, and vets did a lot of ballroom dancing.”

As Sinatra began singing, Elsie opened her arms, beckoning. Tom stared a moment, then walked over and began leading her in the foxtrot. “They danced for thirty minutes!” Ms. Clair said. When they were finished, Elsie broke down and sobbed. “I haven’t been held by my husband in three years,” she told Ms. Clair. “Thank you for bringing him back.”

It’s a lovely story, and it illustrates the power of music in the lives of the person with memory loss.

I remember the first time I heard one of our caregivers explain how she got a client to bathe. This client resisted everyone’s effort to help him bathe, and could quickly become angry and aggressive if pushed. We’d all tried every approach we knew, and then Wanda stepped up.

An hour later, the client was bathed, relaxed and smiling. We had to know: how did she do it?

Here’s what she said: “I just started singing with him. We sang, and walked, arm in arm to the sink. The room was already nice and warm, and the towels, soap and washcloth were already there (I did plan ahead at least that far). We stood in front of the sink and I turned on the water and just started splashing my hands in the water, all the time singing together and smiling.

“Pretty soon, his hands are in the water, too, and we’re soaping them up, laughing – and singing. Next, we washed his arms, slipped off his shirt and washed his torso.

“We got through an entire sink-and-washcloth bath just by singing and playing in the water together.”

It was a beautiful, relaxing and enjoyable event for the caregiver and the client, rather than a frightening time for both.

Music has some wonderful qualities. According to the article, people respond to music even when all other forms of communication no longer work. “Music, unlike language, is not seated in a specific area of the brain but processed across many parts. ‘You can’t rub out music unless the brain is completely gone.’”

If you can’t carry a tune, there’s good news for you, too. People with memory loss don’t seem to be picky: just start the music and let the caregiving – and relationship nurturing – begin.

Caregiving at one degree of separation

2009-04-21T16:50:00.000-07:00

My neighborhood has a women’s book club that includes about a dozen of us who live within 2 blocks of each other. Some of us have lived on the same street for more than 20 years. We’ve watched our children grow up together. We’ve celebrated birthdays, graduations, weddings and births of precious, new grandchildren together. When one neighbor’s home burned to the ground in the wee hours of the morning, the rest of us were there, almost before the fire trucks arrived.

We come together once a month to talk about our kids, our neighbors and – almost always – our book. We have laughed, cried and argued with each other.

Last night, someone asked, “How many of us are dealing with an aging parent?” All but two raised their hands. One neighbor has spent the last month with her mother who lives over 1,000 miles away, finally convincing her to move into a care facility for people with memory loss. Next month, she’ll return to actually make the move with her mom.

Several of us have lost parents over the past few years. We’ve spent hours at their bedsides, in hospitals, nursing homes and assisted living communities. We’ve shared our anger at “the system” and our frustrations at being classically squeezed between the needs of our children and our parents.

While we don’t see each other much outside of our monthly book club meeting, we do know this: when it comes to being a caregiver to an aged loved one, we’re all doing it. We do it alone, often, but we know we’re together in facing the challenges of family caregivers everywhere.

Last night when we took a count, it was clear that it’s something we are all doing today. And those that aren’t personally caring for an elderly parent know someone – first hand – that is providing this care. It’s a small comfort, but perhaps, ultimately, a large movement toward increased resources, improved quality of care and better options for our aged loved ones.

After all, we’re all at the frontline of this effort today.

Transitions: making the move

2009-04-15T11:36:00.000-07:00

You’ve finally reached the point and the decision: you’re going to help your mom, dad or other family member move from home to a care community. What should you expect? What can you do to make the transition better for both of you?

Make the move easy. When you’re planning moving day, make sure you consider how to make the move as quick and easy as possible.
* Enlist the help of every family member possible.
* Offer your loved one an option – their choice – of staying while you move their belongings or going to lunch or for a ride, while other members of the family make the move.
* Minimize the amount of things moved. Many older people enjoy the process, once the decision has been made, of gifting their items to various family members, reflecting on the items heritage or meaning during the process. Ask your loved one to select just those things he needs for basic comfort and then either store or get rid of the rest. Most moves entail downsizing significantly, so start that process off right by not bringing too much in the first place. Besides, a less crowded space feels bigger.
* Move as quickly as possible, and then relax a bit with your loved one. Allow time in your moving day schedule for a dinner together, a drink or light meal at the end of the moving day. This is a chance to focus on the relationship, not just the task of moving. That’s important on moving day.
* Leave. There will come that moment when the work’s essentially done, you’ve relaxed and chatted a few minutes, and there’s not much more to be done. You may have that feeling like you’re leaving your child at daycare for the first time in the pit of your stomach, but you need to make your exit. You need to give your loved one time and space to begin his own journey of adjustment.

Visit. Some care communities may advise you not to visit for the first few days or even weeks. Unless this is a firm requirement, smile, nod, and plan your next visit. It’s important to your loved one to know that you haven’t done the much feared “dumped at a nursing home” maneuver. Your regular visits will reassure your loved one that you’re still going to be involved, even though his physical residence has moved. Make an effort to make your visits about the relationship, too, not just tasks. Moving your loved one to a care community can relieve you of many tasks; it will never take the place of your relationship, however. Focus on your relationship by:
* Bringing in picture of your children or other family members
* Sharing meals together when you visit
* Taking walks together or taking your loved one for a drive in the countryside
* Talking about your regular daily life and routine
* Encouraging other family members, especially youngsters, to visit regularly, too.

Get acquainted. On your visits, try to get acquainted with the staff at the new community. Meet the front desk people and the manager, the dining room staff and the housekeepers. Introduce yourself, smile and thank them for their work. You’ll gain the trust and respect of important people involved in the welfare of your loved one; you’ll also know who to turn to if something goes wrong. You may want to get acquainted with other residents and their families as well, a step that frequently speeds the settling in process.

Be patient. It takes time for a person to adjust to a move. Some people will adjust quickly; others will still be adjusting several years after the move. Be patient, and let your loved one adjust at his own pace. Complaints may be frequent initially, especially about food. Listen, sympathize, but don’t rush to the manager demanding changes unless you witness the problems yourself, too. Be patient with staff, too, especially in new communities. It takes time for everyone to learn their jobs and to do them flawlessly. Expect some level of human error - housekeeping that miss a garbage can, for example, or soup served a little cool, but expect excellence in any personal care or services that are delivered. If the community laundry is cleaning your loved one’s clothes, expect that some items will go missing, and other items might get shrunk or bleached. Keep your loved one’s irreplaceable clothes or jewelry at your house, or launder them yourself (be sure to let the staff know).

Tune in to your own reactions. Be aware of those moments when you feel a wave of sadness wash over you for the losses your loved one has experienced. Feelings of sadness and guilt are normal, common reactions. You might think, “I should have cared for her myself,” but don’t let these feeling drive you to actions that make matters worse. Often, family members who are racked with guilt turn their feeling toward those providing the care, relentlessly finding fault, blame or error. If you find yourself complaining on every single visit, check in with your own feelings to see if you may be turning your own feelings of guilt or anxiety toward the people caring for your loved one. If you think you might be feeling more than the usual level of sadness or guilt, get help. Find a counselor, pastor or good, patient friend to listen and help you work through your emotions.

Many people find moving to a care community one of the most difficult tasks they do as caring family members. But most find that they’re happier, healthier and better off because of the choice, often sooner than they would ever have expected. It just takes a little effort on your part to make the transition.

Caregiving takes an emotional toll on the whole family

2009-04-08T11:03:00.000-07:00

My friend Vickie came into my office today for a meeting. We had a chance to catch up after the meeting and I asked Vickie about her current work/family situation.

“I’m working as a caregiver for my father-in-law these days,” Vickie said. “He has late stage Parkinson’s disease and requires help with everything. We have a lift to get him in and out of bed; I’ve got to care for his catheter; it’s just a lot of work.”

I asked her how many hours each week she spent helping her mother-in-law, assuming that she traveled to their home for a few hours each day.

“That’s the hard part,” she said. “They live with us. The caregiving never ends – I can’t begin to count how many hours each week I work.”

She was excited to be out of the house for the meeting as it was just about the only break she could see on the horizon.

As I listened to Vickie I heard what I hear so often from family caregivers: the work is not only physically challenging, but emotionally draining as well.

It’s hard to be the “rock” that your family relies on. It’s exhausting, no matter how much help you get from other members of the family.

Vickie’s husband, mother-in-law, son and grandchildren are all involved in Grandpa’s care. But at the end of the day, the person they all turn to is the one with the experience and training as a caregiver – Vickie. And of course, Vickie being the person that she is, worries about them all even when she’s not there.

I don’t really have an answer or a solution. What I know is that family caregivers need our emotional support, maybe even more than they need help with actual caregiving tasks.

They need us to thank them for their work, to honor and validate their importance in our families’ lives, and the contribution they make to society as a whole.

It’s not much, but it might make a difference for Vickie and all those other caregiving family members just getting through another challenging week.

Families need caregiver training to add skills to loving care

2009-04-01T14:49:00.001-07:00

Caregiver training is the number one topic of conversation in our office lately. We initially developed our Caregiver Certification course for people working for in-home care agencies. In-home care is one of the fastest growing segments of all senior care, and our own division of in-home care is growing at a phenomenal pace.

We’ve also been hearing stories from individuals all over the world, seeking training to become experts in caregiving.

One school in Fiji is now using our online course to train students to become caregivers throughout the islands.

Today, I responded to a woman in Mumbai, India regarding this training. She cared for her own mother through the stages of Alzheimer’s disease, and realized that she didn’t have the knowledge and skills to provide good care. At one point, she says, “I could not take it anymore.”

As she searched for answers, she says, “It then dawned on me that I was basically giving in to the situation and giving up on her.” She determined to learn as much as she could about caregiving, and found approaches that have really helped her mom. Now she wants to help others with similar diseases, but knows that she is not fully prepared for this.

We hear stories nearly every day from family members who are realizing the same thing: they want to provide care, but they’re not trained or prepared to do it well.

Family members provide somewhere between 70 and 80 percent of all care to seniors in this country. Most are caring with their hearts; many realize they need more skills training, too.

For families – and professionals – training can add essential knowledge and skills to a caring, compassionate heart.

Family caregivers are heroes, worthy of their own stamp, and a whole lot more

2009-03-23T08:33:00.000-07:00

Family caregivers are heroes, worthy of their own stamp, and a whole lot more A U.S. postage stamp honoring the more than 50 million family caregivers may be released by 2011, according to a news report last week.

“The objective of the campaign is to bring awareness of the issues facing family caregivers to the general public, healthcare professionals and public policy officials. A family caregiver is a relative or friend caring for a loved one who is chronically ill, disabled, or living with the frailties of old age and needs assistance. Family caregivers provide nearly 90 percent of the services needed by their loved ones. These services were conservatively valued at more than $375 billion in 2007,” according to the report.

The commemorative stamp is currently under consideration by the U.S. Citizens' Stamp advisory Committee, and you can sign a petition for support of the idea at: www.thefamilycaregiver.org/.

While the honor and recognition that a commemorative postage stamp brings is a wonderful thing, I must admit to thinking, “Most family caregivers could use a lot more than just a stamp!’ Caregivers need some practical help as well.

That thought led me to a new website I’d like to share with you: www.agingcare.com. It’s about as packed full of helpful information as anything else I’ve found, from care and housing suggestions to advice about money, legal issues, and care products. It also has a great community forum, offering family caregivers the chance to exchange ideas, tips, and frustrations with each other and with experts. Check it out!

It’s not easy being green

2009-03-17T15:05:00.000-07:00

For some reason – maybe the fact that yesterday was St. Patrick’s day - that refrain from Kermit the Frog came to my mind.

In fact, it’s not easy being anything when we’re talking about family caregiving - except maybe "blue."

It’s not easy being patient – when you’re tired and simply want to get through the tasks to the end of the day.

It’s not easy being compassionate – when you have to wonder if the person in your care is really, truly doing his best.

It’s not easy being cheerful and fun-loving – did I mention being tired all the time?

A new email friend of mine shared with me that she has slept on the couch for the past 2 years so her mother can have her bedroom. Did I mention being tired all the time?

Yesterday was St. Patrick’s day. St. Patrick is the patron saint of Ireland, but we don’t really know much else about him.

Perhaps, like a caregiver, he worked in quiet solitude, helping others gain quality of life to the end of their lives.

Perhaps, like a caregiver, he was tireless in his efforts to bring comfort to those who were troubled, physically or spiritually.

Perhaps, like a caregiver, he sacrificed so that he could do what he believed, in his heart, was his God-given mission on earth.

The weary, devoted family caregiver today will probably never become thought of as a saint.

But then, I’ll bet Patrick never thought that would happen to him, either. I'll bet he never even considered that one day, people would wear green and celebrate his day.

Who knows? Maybe someday we'll all celebrate the true saints that are today's family caregivers.

Need a caregiver? Do's and don’ts of hiring unemployed family members to be caregivers for a loved one.

2009-03-10T17:13:00.000-07:00

Most of our clients are in the business of providing care to seniors in assisted living or other community based care settings.

We’re hearing recently that the current high level of unemployment is causing some of our clients to lose their residents to family members needing work – and pay.

It makes sense, certainly, to pay a loved one who desperately needs the work and income to care for mom, rather than paying strangers.

It makes sense, at least, only if the unemployed family member is prepared, capable and ready to provide care.

If I were considering hiring an unemployed cousin to care for my mother, here are some of the questions I’d be asking:

1. Does she have the temperament to be a good caregiver? Is she patient, compassionate, and caring by nature? I might consider how she handles pets, children, friends and neighbors. People who are by nature good caregivers tend to be that way with everyone in their sphere of contact. You can tell the good caregiver in your family – she’s the one who remembers that you hate chocolate, and buys vanilla cake for the party. She’s the one who will rush to pick up the fussing baby, and gently rock it back to sleep. If you think about your relatives, you’ll know who would make the best caregiver, and who probably wouldn’t. That’s question #1.

2. Does she have the time to be a good caregiver? Just because a loved one is unemployed doesn’t mean that she will devote the time to your relative you need. Caregiving means making a commitment to the person receiving care, and to you. Just being present (and spending most of the day job-seeking online) isn’t caregiving. Neither is adding an elderly loved one to a family with children, no longer going to daycare to save money.

3. Does she have the training to be a good caregiver? Fortunately, this doesn’t have to be a make-or-break item on the list. Good caregiver training is available in many places in almost every community. Great books, guides and workbooks are available; there are even online courses for comprehensive caregiver training available and affordable.

These are the first three questions I’d ask myself if I was considering hiring a family member to care for my mom. It’s a good starting point for a very important decision.

When the "Pro" becomes the family caregiver

2009-03-04T10:16:00.000-08:00

Wendy Finch is our Vice President of Business Development. She’s been with the company for over 12 years.

But two years ago, she became a family caregiver.

Her mom’s mother, Wendy’s grandmother, became ill and needed a little help with her daily activities. She wanted to stay at home – no, she insisted that she was absolutely, positively going to remain in her home.

Less than a year later, she fell and broke her hip. Against all of Wendy’s professional experience and advice, she was determined to go home.

Wendy’s mom quit her job to become her caregiver, but grandma needed 24 hour care, around the clock.

So the family began the challenge of finding and hiring personal caregivers.

They chose to hire caregivers directly, since they had an “expert” in the family. They’d save money that way, and be able to afford better care, longer, with the resources grandma had at her disposal.

What followed was a scene that family caregivers everywhere can relate to. The daily phone calls (“what do we do when she refuses her medicine?”). The no-show caregivers. The need to find qualified individuals to hire to replace caregivers who could no longer cover all the care needs.

Most of all, the exhaustion and the continual sense that caregiving is a job more challenging than raising a child. If, in fact, raising a child takes a village, caring for a beloved elder takes a full city of people, resources and energy.

Today, Wendy is the staunchest support of our newest online course, the Caregiver/Personal Care Aide Certification Course. She knows what caregivers need to know to provide high quality care, whether they’re related to the person or not. She knows that often – in the middle of the night, or the middle of the afternoon, caregivers are alone with the person in their care, and need all the help in caring and coping they can possibly get.

Wendy’s family, supported by paid, trained caregivers, cared for her grandmother right to the end of her life. She stayed in her home, just like she wanted. She was lucky, too, to be surrounded by family members who not only wanted to do the right thing, but who also had the training and experience to know what that right thing was.

The experience has helped Wendy better understand what other family caregivers are going through too. It’s no longer just a professional awareness; it’s personal, too.

Long Term Care Insurance covers caregiver training

2009-02-24T16:48:00.000-08:00

A few weeks ago we got a frantic phone call in our office.

“Can you help me?” the caller asked. Always the optimist, I replied, “We’ll certainly try!”

The caller, a physician living in southern California, began by briefly telling me his story.

“My wife had a stroke not long ago,” he said. “I want to keep her at home and care for her, but I’m still working as a physician. I’ve got insurance to help pay for my wife’s care, but the caregivers I have hired need to be ‘certified.’ Can they get certified by you, through your online Caregiver’s Certification Course?”

I reassured the caller that we would be happy to talk with his insurance company to allow them to preview the course and discuss whether it met their qualifications. I explained to him that our company also provides online nursing assistant training, approved by the State of Oregon, as well as a variety of other approved courses. I gave him the link to see more course details, including sample course modules.

A week later, we got a call back from our physician friend. His insurance company had fully approved the online Caregiver Certification course as meeting their requirements, and he was ready to enroll the two private caregivers he had just hired.

Yesterday the phone rang again, just as I was getting ready to leave the office.

“My grandpa wants me to take the Caregiver’s Certification course,” said the caller.

She asked me a few questions about the course, specifically how an online course works and how she could finish her course, and then she shared with me her own story.

“I’m going to be caring for my grandpa, and he wants me to get trained. This online course fits into my schedule, since I can do it from my house or from my grandpa’s house.”

Smart grandpa! I know if one of my family members wanted to become my caregiver, I’d want them to have the training and skills to do it to the best of their ability.

Research shows that trained caregivers can continue to provide care up to 2 ½ years longer than caregivers without training and support. Not only is that worth the investment, but it is also worth the time and effort.

It’s an added benefit, too, if you can get the course covered by your insurance provider, or maybe even your employer.

If you want to explore these options for yourself, contact us. We’ll be happy to help you!

What do we do with Mom? Facing the needs of our aging parents

2009-02-18T13:55:00.000-08:00

A friend cornered me at a social even last Saturday night.

“How do I get my parents to agree to move into assisted living?” he asked.

My first thought was, “Do you seriously expect me to answer that question on my way to get another glass of wine, at a party?!” but then, because I am so passionate about helping our parents the best way we can, I stopped to talk more about this.

It’s a question about 1 out of every 5 of my friends seem to be having these days.

What do we do with Mom?

How do we help Dad?

How do we make sure they’re OK, and maybe happy, too?

These are the questions we are all facing in our lives.

There are no “one-size-fits-all” answers out there. But there are some themes to guide us.

Quality of life. For me, this is the BIG ONE. I don’t really care where my parents choose to live. I don’t care whether they get help or not. I DO care if they are happy. If they are lonely, bored, depressed, or seem to have lost interest in life, they need a change. It won’t be enough for you to promise to visit more often – they need a bigger change than that.

Safety. This is the other BIG ONE. When my parents lived way out in the country – on the farm where they had lived forever, with their dogs, cows, goats, gardens, (wells and septic tanks, too), they were “happy.” But driving to the stores for simple groceries meant curving, country roads and at least 20-30 minutes. Driving to the doctors’ office, an increasingly more frequent outing, meant journeys of 45 minutes to an hour and a half, minimum, each way. The wood stove, the well, the garden, the hike from their house to the bottom of the hill to the barn – these things had lost their romance and now just looked like a great place to get injured. With driving being less of a good solution for either of them, how could they safely manage?

For both my parents and my in-laws, the solution was a senior living community. For my parents, it was a matter of safety. They chose a community, still out in the country, of cottages. It has a central “village” of services they can easily walk to, and a van if they need it for longer outings.

For my in-laws who already lived in town it was a matter of happiness. Socially outgoing people, they had lost nearly all of their life-long friends and companions. Staring at each other and watching golf on TV was getting old; the quality of life was quickly slipping away.

I won’t say it was easy in either case. It didn’t happen quickly. But we all agree today: it was a good thing. It was the right thing to do.

Stress of family caregiving adds challenge and opportunity

2009-02-11T12:13:00.000-08:00

If you’re a family caregiver you won’t be surprised about the statistics related to stress and the caregiver.

It won’t shock you that the morbidity rate (illness) and the mortality rate (death) are both higher for caregivers than for non-caregivers.

You’ll probably nod at the most recent findings that caregivers experience higher stress in their marriages or personal relationships, too.

It’s a very stressful job, being a family caregiver.

Stress is our bodies’ way of handling the unknown or the feared. In nature it is a useful response to fright or a threat: the heart races, the adrenalin pumps and senses sharpen. The body is ready for fighting or fleeing – quickly. I’m sure you’ve noticed how quick it can happen if you see something in the middle of the road, for example, when you’re driving 60 miles an hour. In an instant you can feel the adrenalin surge through your entire body.

The problem with stress is that emotional situations cause our bodies to react in much the same way. Over time, the stress wears at us physically and emotionally. We may feel exhausted all the time. We may be irritable and jumpy.

In nature, stress is a powerful positive force. I believe that it can become a powerful, positive force for caregivers, too, if we can learn to recognize the early signs of stress – and then take action.

Perhaps your highest level of stress comes from not knowing what you’re going to find each time you walk into your parent’s home. Listening to your body, perhaps you realize that this is the moment when the adrenalin starts flooding, and you feel anxious and out-of-control. After all, you have no control over what you’re going to find, but you know whatever it is you’ll have to manage.

What could you do to reduce this stress point? Maybe you could call first on your way over, so you get some sense of what to expect. Maybe you could get another person – paid caregiver, neighbor, or family member – to drop by first and set the stage for your arrival to be less stressful.

Changing your caregiving relationship to one with less stress very likely will include some of these keys:

1) Get help. If you have felt the entire caregiving burden was on your shoulders, you need to stop – listen to your body – and take action. Set aside your personal sense of responsibility or your feelings that you should do it all, and get help. Ask your family, your church, your local senior center – get help. Knowing that it is NOT all on your shoulders may be the single most important thing you can do to reduce your personal stress.

2) Get support. Support may come from a different place than actual help with caregiving tasks. Support may come from your best friend, over a cup of coffee or a glass of wine. It may come from a formal or informal support group of other people, going through some of the same things you’re struggling with. It may come via an internet support group or email support team. It doesn’t really matter where it comes from – support is vital to reducing your stress and giving you the strength to continue as a caregiver.

3) Take time out. Your body’s stress is telling you to take a break. It’s telling you to step back and breathe deeply. You won’t be able to do this on your own. Most likely, you’ll need help. Respite – short term help – is available in many assisted living communities. Many in-home care agencies will provide short term help, too. Look for it wherever you can find it, and take a break.

Listen to your body. Learn to feel, hear and notice when your own stress level increases. Use this new awareness as an opportunity to take action to reduce your own caregiver stress. It’s a vital step to surviving – and thriving – as a caregiver.

Caregiver training essential to delivery of quality care

2009-02-04T13:19:00.000-08:00

You need to hire a caregiver for a loved one. Perhaps you have a niece or nephew who needs a job, and who would love to help you. Maybe someone you know has recommended a good private caregiver they have used.

Hiring a private caregiver is a solution that many, many families use to assist in providing care to a loved one. Privately hired caregivers may be less expensive per hour than agency caregivers – and that makes sense when you realize that hiring an agency caregiver involves paying a portion of the wages of a supervisor and other support staff. For many families, the extra price is worthwhile because of the extra support they receive.

But for many families today, hiring a relative, neighbor, church friend or other private caregiver is simply the best solution to a challenging situation.

If this situation describes your current needs, here are some things to carefully consider:

1) Selecting a caregiver: Just because someone is available isn’t quite enough to qualify him as a good caregiver – although sometimes, out of desperation, that’s a major consideration. A good caregiver will have some personality traits that are more important than experience; traits like patience and caring, warmth and a sense of humor. The best caregivers are also creative problem-solvers – that skill allows them to provide care even when they don’t know exactly what they’re supposed to be doing or have never done the task before. How do you know whether the person you’re considering has these traits? The best way is to look at the person’s history. If you don’t personally know this individual, talk to 2-3 people who have known the person for at least a few years. Ask about these traits, and try to determine if this is a part of the individual’s personality. Here’s the key when interviewing candidates: Past behavior is the best determinant of future behavior. This is not, unfortunately, the job to see if your nephew’s rehabilitation for anger management was successful!

2) Caregiver Training. There are no national requirements for training of in-home caregivers. There are some basic parameters for home health aides and nursing assistants, and some states that have specific requirements, but in general, for caregivers, on-the-job training is often the only training they may receive. That’s not enough for you and your loved one. Demand at least a certificate level of training – it’s now easily available, and affordable, too, through a variety of classes as well as fully online through web-based training professionals.

Caregiver training is essential for in-home, privately hired caregivers. They have no support or supervisor to call when they run into questions about best care. Unlike a nursing assistant, there is no nurse down the hall they can contact for nursing or medical questions.

They may have no one to relieve them if the stress of caregiving becomes too great on a particular day, evening or night. That, and the fact that in-home private caregivers often spend hours alone with the person in their care, makes them vulnerable to stepping over the line from caregiving to abuse or neglect. This can be unintentional, as when the caregiver simply snaps and slaps at the hands of a person who won’t stop grabbing at him. It can be refusing to answer a call for help, if it’s been one of those nights and the caregiver simply can’t go assist one more time.

Any of these scenarios can happen, and happen without your awareness. Training – high quality, thorough skills building – can help prevent abuse and neglect while it builds stronger skills for coping with caregiving tasks and with caregiver stress.

Finally, consider training that provides the caregiver with an opportunity for career advancement, or with the ability to get their services covered by long-term care insurance policies. Courses that are provided by valid training organization, especially Certificate programs, will help you and your caregiver receive additional benefits beyond improved skills.

3) Stay in touch with the caregiver. Ask the private caregiver to keep track each day with notes about what he did that day, and what the person in his care required. You can use something as basic as a spiral notebook and a pen. Review his notes at least weekly, and talk to the caregiver about events he records. Give the caregiver your cell phone number and the number of at least one or two other people he can call in case of an emergency. Let the caregiver know that you understand that caregiving can be stressful, and give him permission to call you if he ever feels overwhelmed by the job.

Private in-home caregivers work today for many families all over the U.S. With some good planning, training and support, you can make it work for your family, too.

On living in a retirement community

2009-01-27T14:32:00.000-08:00

For years I’ve been writing about my efforts to get my parents and my in-laws into senior housing. As a senior care professional, I know how important independence is to seniors but I also know how much faster people fail when their movement slows, social interaction is reduced and nutrition start getting overlooked for the sake of convenience. So for our parents, I wanted them to gain from the benefit of living with others in an active senior environment. I wanted them out of the driver's seat, too, if the truth be told.

We’re lucky in that both parents could afford this option. We live in a community with lots of housing choices, too. My mom chose a faith-based non-profit community of cottages; my in-laws a large for-profit high-rise closer into the city center.

The choice didn’t come easy. My in-laws, in particular, resisted the decision for a very long time. My mother-in-law was determined to die in the house she had lived in for the past 50+ years, just like her own mother did.

And then last Saturday night she fell. Right away my father-in-law pulled the emergency cord. Within minutes someone had come in to help calm them both and call 911. When the ambulance came the staff greeted them and make sure everything went well during the transfer to the hospital.

By the time we met them at the hospital, everything was fine. My father-in-law exclaimed over and over how glad he was that they lived where people could come to help immediately. "We have buttons or cords in almost every room!" he kept exclaiming.

My mother-in-law? Her main worry was whether she’d miss the special Sunday Brunch the next morning.

Is retirement housing or assisted living an option for you or your loved ones? Whatever your answer, focus on quality of life. Focus on what will increase your loved ones’ interaction with others, what will increase their physical activity and what will help ensure that they get good nutrition and, if needed, medication assistance. Think about how their move will affect you, too. Will it free you to focus more on your relationship and enjoy your time together, or will it cause you to spend even more time doing chores and handling responsibilities?

At the end of the day, it’s not where we live – it’s a matter of living a life rich with joy and meaning. It is, in a nutshell, about making it to Sunday Brunch!

Assisted Living companies in bankruptcy: what can a family do?

2009-01-19T16:19:00.000-08:00

Every day I see a new article on another assisted living company entering financial difficulties. Some are filing for bankruptcy; many are on the brink.

If you have a loved one in an assisted living community, what should you do? Many families are feeling anxious about their loved ones' care as major companies like Sunwest Management Inc., one of the largest retirement housing providers in the country, files for bankruptcy protection in one state after another.

I know, from my own days as an owner and operator, when money is tight it's hard to focus on care. It's very hard to think about training and energizing employees who may not even be with you next month - or next week.

You spend hours every day looking for areas where you can cut expenses without hurting the people in your care.

As Eric Carlson, the director of long-term care for the National Senior Citizens Law Center said in a recent Denver Post article, "When facilities are losing money, they're tempted to cut staffing below safe levels."

If my own mom were in an assisted living or retirement community that was on the verge of bankruptcy, here's what I'd be looking for:

1) Basic life necessities: Food, water and heating. Stop in from time to time during a meal. Don't call ahead; just drop by. When communities are cutting beyond the point of reason you'll see meal portions reduced, dining rooms understaffed, and food served warm (when it's supposed to be cold) or cold (when it's supposed to be warm). Believe it or not, many companies in trouble delay paying utilities until the last notice, causing risk of basic water, sewer and power. I've heard more than one property manager talk about paying the utility bill out of her own pocket just hours before the shut-off was scheduled; I've never heard of a community getting all the way to shut-off, though. To me, that's a testament to the dedication of most community managers - they'll do everything in their power, literally, to keep the residents well cared for.

2) Talk casually to your loved on about call-lights, if they have them. Ask how long it takes someone to arrive. If the community is cutting too deep into staffing response times will lengthen dramatically. Let your loved one know who else to call if no one is coming to assist in a timely manner (for example, when is it appropriate to directly dial 911; when should they call you so you can ensure care?)

3) Sit in the lounge, living room or lobby and simply observe staff. If the company is managing their financial difficulties appropriately the staff providing direct care to residents - including housekeepers, maintenance staff and caregivers - will continue to be cheerful and talkative while they work. They won't show noticeable stress and anxiety about their own jobs. You should observe polite conversation (instead of stressed frustration and anger); hopefully even laughter and hugs when appropriate.

4) Pay attention to cleanliness and maintenance. Deep cuts can result in a building with a feeling of grime instead of polish; a lack of routine maintenance will result in light bulbs dark and toilets that run without stopping. In a busy assisted living or retirement community it doesn't take long for these things to become noticeable.

5) Finally, watch your loved one for signs of stress or anxiety. If he or she stays on top of the news a little anxiety will be normal; more than a little may mean that staff members are sharing their own stress with your loved one. Nothing causes a compassionate resident more despair than hearing, over and over, the trials of the people who provide them with daily services and caring attention.

If my own mom were living in a community in trouble, these are the things I'd watch for. And I'd know, seeing one of more of these conditions appear, that it was time to look for another home for my mom, before the company's difficulties became my own.

Alzheimer’s Caregivers can keep loved one out of nursing home for extra year and a half with simple training

2009-01-14T11:10:00.000-08:00

Here’s the opening sentence to a new report that sheds exciting light on help for individuals caring for people with Alzheimer’s or memory loss:

The findings are stunning: Offering simple training to people struggling to care for loved ones with Alzheimer's disease not only eases their burden ---- it even can keep patients out of nursing homes for an extra 1.5 years. (Source)

The challenges in implementing what seems to be a simple solution to save families thousands of dollars in nursing home expenses is a common one for all caregivers: time and access.

For family caregivers, having enough time to attend training classes, let alone support groups, often means making complex arrangements to get someone else to stay with their loved one or find somewhere to leave the person with the memory loss.

Attending classes is challenging, too. Many are not available in rural areas; travel and expenses make traditional classes simply out of reach for many families.

But for family caregivers, technology offers exciting new solutions. The internet offers a wealth of resources and information on nearly every disease.

Internet based caregiver training can provide exactly what the caregiver needs to learn, when it’s needed. It can be accessed from the comfort of home, too, helping families avoid the need to travel to classes or fit them into a busy schedule, not to mention finding a caregiver for their loved one while they’re away.

Are behaviors a challenge? Find out how to prevent behaviors from happening, or how to appropriately respond when they do happen.

Is your loved one losing weight or having difficulty eating? Is showering a constant struggle? Going to the doctor mission: impossible?

One of the major benefits of taking online classes is that learning can be on-demand. That means that the caregiver can access the training they need at the time they need it. It eliminates the experience of attending a series of classes and then finding yourself, months from now, thinking, “I know they covered that in the class, but I can’t remember exactly what they said to do…”

Caregivers across the nation are finding the internet a tool to get support, too. Email or internet forums can become a tool for beginning conversations, getting custom tips and advice, and, in general, feeling less alone in the caregiving challenges.

Many websites offer information; many forums allow caregivers to share their experiences and support other caregivers.

Some, like Caring forMom, offers online training and support, all in one location.

For caregivers of people with memory loss and Alzheimer’s disease – for all caregivers, actually – technology today offers much more than peace of mind. It can offer real savings in terms of money that would be spent on facility care. It can also offer families the chance to do what they really want to do: keep their loved one at home and continue to provide the care needed.

Senior Citizens: How we look and how we feel are two different things

2009-01-08T13:54:00.001-08:00

Here's a video my brother sent me last week - it makes me smile as I can relate only too well. Point (besides fun): our bodies may be growing older but in our minds we're still young and sexy!

Point #2: your mom/dad thinks this way, too!

Family Caregiver’s Resolution

2009-01-07T15:09:00.000-08:00

No matter what your year was like we get, by benefit of the modern calendar, to turn the page and start fresh in the new year.

As a family caregiver it may be hard to tell day from night, let alone pause to mark the passing of one year and the start of the next.

But here’s the challenge I’d like to make to every family caregiver for the year to come:

Find a way to make caregiving joyful.

“Ha,” you say. “Caregiving is a tough job. There’s little to be joyful in it.”

It is a tough job, no doubt about it.

My brother-in-law’s father, recovering from heart surgery, has become so ornery that none of his sons can stand to be around him. They still dutifully shop for his groceries and offer to drive him wherever he needs to go. When he couldn’t live alone, they arranged for an out-of-work nephew to stay with him for a few weeks. He’s their dad, and they have a responsibility to be involved in caregiving, no matter how challenging it is.

But I give them kudos for not trying to move dad in with one of them. Instead, they found a family member who needed the work and who, by his emotional distance, wasn’t so personally affected by dad’s behavior as the sons are.

Here’s what I encourage you to do in the year ahead:

FIRST: Remember the reason you’re involved in caregiving. It’s undoubtedly because of a relationship. You’re a son, a daughter, a spouse or a significant person in the life of the person you’re providing care to. You didn’t have to become a caregiver, so why did you step into that role in the first place?

SECOND: Imagine the “perfect world” scenario. Just finish the sentence, “In a perfect world…” In a perfect world, your loved one wouldn’t need care; he or she would be perfectly independent and healthy. But setting that aside, in a perfect world, what would your relationship as a caregiver look like?

“She’d say thank-you more often.”

“He’d actually laugh at my feeble attempts at a joke.”

“She’d recognize me and remember our happier times.”

Notice that each of these endings focus on what the person you’re caring for would do? None of them focus on things that YOU can do.

Let’s take it a step farther: what would YOUR actions be, in a perfect world?

“I’d come in with a smile every day, rested and relaxed.”

“I’d bring small gifts – fresh flowers, home-baked muffins or a new book or magazine, each time I visited.”

“I’d be happy to be providing care instead of feeling resentful and frustrated so much of the time.”

NEXT: Think about the steps you need to take to achieve those last statements – the ones about yourself.

“I’d come in with a smile every day, rested and relaxed.” – what would that take? Do you need to get a caregiver to relieve you every few days so you can take guilt-free breaks from caregiving? If so, what do you need to do to make that happen?

Actually, all of the statements that caregivers make above depend on one thing: getting a break.
That leads us to the FINAL step: Pursue the break you need, so that you can regain the quality of the relationship. Find a way to make the relationship you have with the person in your care once again joyful.

It won’t be easy. It might be expensive – in time, emotion or money. But make this your goal for the New Year, and see what amazing things you can accomplish.

Share your goals and resolutions.

A christmas wish for family caregivers

2008-12-24T11:40:00.000-08:00

At my home town (Portland, Oregon) we’ve got more snow than ever recorded for this time of year. In fact, we’ve only had a white Christmas a few times in the last century. This year, we’ve got a foot of snow or more covering the ground.

But our family is among the lucky ones. We have no one ill or in the hospital; no one traveling from out of town that hasn’t already arrived and our aging parents are safely residing in communities that are devoted to their care and comfort.

This is the first Christmas that my in-laws (both in their 90s) are living in a retirement community after moving out of their home in the late summer. They’re happy, and they have no worries about frozen pipes, trees falling on the house, walking to the mailbox, or running out of groceries before they can safety travel to the store. They don’t need to worry about the roof or the gutters; the sidewalk or driveway.

My mother-in-law calls regularly to make sure we’re OK. In her voice, instead of the customary worries and concerns, I hear a lilt. She’s happy, warm and comfortable. She’s making new friends and enjoying the companionship. And she doesn’t even have to cook if she doesn’t want to.

I know that we’re lucky. Many families are just starting the process we began more than two years ago when we determined that the family home was no longer safe for the parents alone.

Some families are just now recognizing the problem. The solutions seem very far away. Christmas can heighten the anxiety about an aging loved one’s safety, as you see, maybe for the first time, how much the steady advancing of time has worn away at the person you love.

Holidays are a time that many families first notice their loved ones’ decline. That awareness can cast a pall over the entire holiday.

What should you say? What should you do?

Here may be a place to start: “Hey mom/dad. It looks like you could use a little help around here to make things a little easier for you. You certainly have worked hard all your life and deserve whatever help you can get now! Don’t worry; I’ll help you figure out what works for you, and you don’t have to do anything that you don’t want to do. Let’s just give it a try together, OK?”

If you think it’s time for your loved one to move to a retirement or assisted living community, ask them to simply give it a try with a temporary stay. Take them to visit and have a meal there (or 4 or 5). With my in-laws, it took several months and several visits. The last visit included all of their children and spouses – a group of about 10 of us – touring and sharing lunch. Finally, we got them committed to making a deposit and going back to prepare their home for sale.

We wondered if it would ever happen, but, at the same time, we were determined to let them take it at their own pace, as long as the pace kept moving forward.

Today, we’re convinced that it was the right move for them. It has given them a new sense of community; new friends; security and comfort. It has given us a tremendous gift of peace of mind, especially during the holidays and this cold, snowy winter.

My Christmas wish for you is that, no matter your situation, you find a way to peace of mind about your loved one. And patience, and persistence, and joy.

Caregiver Skills - How to videos teach needed skills

2008-12-19T14:34:00.000-08:00

We've been developing our training videos for caregiver and nursing assistant training. One website, Howcast.com has great tools we've been using to build these training videos. Here's a sample: How to take a blood pressure (to learn more go to our website, CaringforMom):

Today I got their Holiday email with samples of How-to videos for the holidays and thought you'd like to see them. I know I'm going to check some of these out!

See more how-to videos on topics of all sorts at the Howcast website - it's a great site to know!

The family caregiver: should you feel guilty about moving mom or dad out of their home?

2008-12-17T11:53:00.000-08:00

It’s been a cold, snowy week here in Oregon. The schools are closed and people are being advised to stay inside and off the roads if at all possible.

I called my mom first things to see how she was doing. She moved into a retirement center about a year ago – not entirely of her own free will. From time to time I wonder how much she misses her old home, set far out in the country surrounded by acres of pasture and woods.

She began our conversation this morning by telling me how no one wanted to walk outside in her village. The risks from a fall are simply too great at their age to take the chance.

My mom, of course, gets restless and starts calling her neighbors. “I have to get out to do laundry anyway,” she says. Her cottage is right next door to the laundry room; her closest neighbor is just one door further down.

By the end of the day yesterday she had joined one friend across the lawn for lunch (“she had made enough soup for an army!”) and spent the rest of the afternoon at her nearest neighbor’s place playing a 3-D version of Scrabble that’s her current favorite game.

I was, at that moment, so very thankful that my mom had moved into a close community of seniors. She’s not at home, alone, trying to stay warm and occupied.

She’s active, healthy and happy. Her mind and her heart are filled with activity and companionship.

We have much to be thankful for this holiday season!

Caregivers at the holidays - a brief word of advice

2008-12-10T14:29:00.000-08:00

Holidays. The time of year when we’re all supposed to be jolly, worry-free and generous.

In reality, many families find it a time for stress. The pants fit too tightly; the calendar is jammed with way too little “down” time; and the relatives are coming.

Some families find holidays a time of discovery: mom or dad simply can’t function as in the past. Something needs to be done. Now, it’s a matter of who, when, what and how…and you know it won’t be easy.

Some families find holidays a time for renewed rivalry: you live closest to mom and run errands for her every week. Your sister, living worry-free (at least in your mind) on the other coast, cruises into town and is instantly the favored child.

It’s hard to get into the holiday spirit. It’s even harder to remember that, amidst all the noise, shopping and food, holidays are a time to celebrate life.

After all, whichever version of the holidays you celebrate, at the root is a celebration of life. The birth of a child who truly changed the world. The commemoration of an eternal flame and a new beginning.

You’ll find lots of tips, suggestions and ideas for getting through this holiday season in newspapers, magazines and online. But perhaps the best one of all is simply to remember why we celebrate, and to think, mindfully, every day, about the gifts of life that you’re thankful for.

And wear elastic-waist pants.

A Thanksgiving Story

2008-11-25T15:46:00.000-08:00

Three thanksgivings ago we sat down at the extended table with our extended family and felt so incredibly blessed we could barely speak. My father had survived a small stroke; my husband’s father had survived a heart attack and bypass surgery. We didn’t expect to all be together that year, but we were.

A year later, my father was dead and my mother in the hospital, unable to join us for Thanksgiving dinner. We rushed, somewhat numbly, through dinner, avoiding the traditional recitation of blessings.

This year feels a little like that particular Thanksgiving, on a global scale. It’s hard to find things to be thankful for (if you actually open your investment reports). It can be frightening, as companies and individuals we have long looked up to for leadership are faltering – maybe even failing.

And yet. Today the sun shone through the piles of golden leaves. I walked to work the long way, savoring perhaps the last nice morning of the month, feeling healthy, alive and filled with thanks.

Today, we had a chance to help a whole group of individuals begin their journey to become caregivers and nursing assistants. We connected with business associates who are challenged but persevering; and several who are thriving.

My children are spread out all over the globe; one in India and one in Israel. They’re studying, volunteering, and traveling. They’re excited about their adventures and fully engaged in their work of growing into global citizens.

Our table will be a little lighter this year for Thanksgiving dinner. Our bank accounts and investment portfolios are certainly a lot lighter. But when I count my blessings this year – out loud – the list will be long.

Happy Thanksgiving.

On caregiving - Fall into winter

2008-11-19T12:25:00.000-08:00

It’s a beautiful fall day – the sun is shining, the sky is that special kind of transparent blue, and the leaves are already starting to fall. Standing by the kitchen sink this morning, I could see a constant rain of leaves floating down – sort of an odd “sky-is-falling” sensation.

I think today how very lucky I am, heading into this fall with good health, a happy family and work that I love. This isn’t true for every family, however. Just yesterday as I was waiting to see my doctor for an annual check-up, I overheard the man who entered just before me sharing how difficult and stressful his life is right now.

He’s lost his job and worries about losing his home. He’s a little past middle age, making these losses hard to take, and harder to recover from. Clearly, he’s not alone in our society today. Many people are hurting and many people have no idea how they’ll recover.

When we were younger, it was easy to think, “I’ll just get another job.” I’d say to my family, “Money is a renewable resource, so let’s enjoy what we have. We can earn more.”

As I get older the renew-ability of money seems less of a given. I know if I had to change jobs or careers now, it would be much more challenging than it was in my younger days. Individuals who have retired, assuming their pensions were secure and adequate, and now experience rising costs or disappearing pensions face an uncertain and frightening future.

Fall is, inherently, a time of reflection; a time when the bright fresh colors of spring and summer fade and fall away, and the cold slumber of winter begins. Our economic cycle seems to mimic nature, with October being a month of dramatic financial and stock market drops, perhaps preparing us for a winter of less abundant prosperity – this year, at least.

As my team and I work hard to bring more training and resources to the people who struggle to continue to care for their loved ones, I believe, more deeply than ever, that together we can find the joy even in winter. We can, perhaps, cozy up to a warm fire, create new friendships that give us encouragement and laughter, and come out next spring richer for our experiences.

So bring on the winter – we’ll get through together.

What it means to be a family caregiver

2008-11-12T12:22:00.000-08:00

A few days ago someone said to me, “My mom is in an assisted living community so I guess I’m not really a caregiver.”

As we talked, the person shared how he visited several times each week; how he interacted with staff on his mom’s behalf; how he took her to doctors’ appointments and other needs.

It didn’t take long to realize that he was, in fact, a caregiver.

This morning I read a story written by a daughter that made me feel incredibly sad. The daughter shared how she was never treated by her mom as a valued daughter and was always compared to her brother, the perfect child.

Now, with her mom elderly, falling, losing her ability to think, remember and reason, she was turning on this daughter who was investing hours of her day, every single day, to helping care for her mom. This daughter was feeling more angry, resentful and hurt with every passing day. She believes her mother’s behavior is intentional and is designed to hurt her – and she’s losing the quality of her own life quickly, as the result.

This daughter is a caregiver, too. She’s a caregiver in desperate need of better understanding of the aging process her mother is experiencing, however. The harder she tries to make her mother happy, the more defeated she feels.

I want to tell this daughter that what she is experiencing is the disease her mother has – not a personal attack. The memory loss, probably related to Alzheimer’s disease or another form of dementia, is causing her behavior. It may be making what has been a lifelong pattern even more pronounced. It is certainly causing both the mother and the daughter much anguish and distress.

Family caregivers, whether hands’ on or indirect, whether close or across the country, are an invaluable part of the caregiving network in our country.

If we can give them support and the training they need to make it a joyful experience rather than a gut-wrenching experience we’ll be doing exactly what we need to do.

Caregiver Training Resources

Caregiver Christmas gift ideas

National Caregiving Month - reasons to celebrate

2008-11-05T15:25:00.001-08:00

The month of November has been proclaimed National Family Caregivers Month by President Bush. According to the proclamation, "National Family Caregivers Month is an opportunity to recognize those who serve a cause greater than self and contribute to the well-being of their loved ones."

As I read that I thought, "That's a great gesture, but will the real caregivers even know about it?" So many family caregivers trudge day to day with too little sleep, too little support, and too much hard, hard work.

In my recent meeting with a group of family caregivers, participants shared how they've come to turn to the internet for answers to many of their perplexing questions.

"Is it really Alzheimer's?"

"What are the side effects of the new medication?"

"How do I keep him safe during the day when I need to run to the store?"

For family caregivers the internet is a resource that they can turn to at 4 am or at 4 pm. They can do quick research while they keep an eye on their loved one at the same time.

My team at aQuire Training Solutions just added another resource for family caregivers: Caregiver Courses available 100% online.

Many family members want to keep providing care but have never been trained. They need to know how to help keep their loved ones joints moving (called range of motion); how to prevent bladder and bowel incontinence; how to keep providing care - and keep their sanity - when disease processes cause challenging behaviors.

These Caregiver Courses offer training in these subjects, and about 20 others. All combined, a caregiver can earn a Caregiver's Certification through this course, a good way to feel a sense of accomplishment while gaining new skills.

But here's the catch: sometimes caregivers are so exhausted from their 24 hours a day work that they miss these handy news releases.

This is the perfect opportunity for friends and family members at a distance to help. Maybe you can't provide the daily care for your loved one because of distance or time constraints, but you CAN help support those that do provide the daily care. With the holidays coming, it's the perfect time to give a caregiver in your life with the gift of support and education.

Let's give all caregivers a reason to celebrate during National Family Caregiving Month!

How to Stay Young

2008-10-30T09:41:00.000-07:00

The following great list of things to do to stay young has been in my files for a long, long time. I lost the source, if I ever had it, so if you know who originated this, let me know, and please accept my apologies for not acknowledging you...

1. Throw out nonessential numbers. This includes age, weight and height (especially weight!). Let the doctor worry about them. That is why you pay him/her.

2. Keep only cheerful friends. The grouches pull you down.

3. Keep learning. Learn more about the computer, crafts, gardening, whatever. Never let the brain idle. " An idle mind is the devil's workshop." And the devil's name is Alzheimer's.

4. Enjoy the simple things. Walks in the fall leaves, a glass of wine or cider shared with friends, a warm fire and a rain-proof home; these are some of the best things of fall. Find someone and enjoy them together.

5. Laugh often, long and loud. Laugh until you gasp for breath. Call a friend who always makes you laugh, and make a plan to get together soon.

6. The tears happen. Endure, grieve, and move on. The only person who is with us our entire life, is ourselves. Be ALIVE while you are alive.

7. Surround yourself with what you love, whether it's family, pets, keepsakes, music, plants, hobbies, whatever. Your home is your refuge.

8. Cherish your health: If it is good, preserve it. If it is unstable, improve it. If it is beyond what you can improve, get help.

9. Don't take guilt trips. Take a trip to the mall, to the next county, to a foreign country, but NOT to where the guilt is.

10. Tell the people you love that you love them, at every opportunity.

Life is not measured by the number
of breaths we take,
but by the moments
that take our breath away.

-Anon.

Live Longer: Life Expectancy Can Vary as Much as 20 Years

2008-10-21T11:00:00.000-07:00

A news story in last week's Baltimore Sun caught my attention with its headline: "20-year life gap separates city's poorest, weathy."

The story tells the difference in the life expectancy in West Baltimore's impoverished neighborhoods - 63 years, and the affluent Roland Park area - 83 years.

Clearly, there are lessons for us all in living longer, healthier lives. I'm not sure all of them have to do with money, either, although financial well-being is directly tied to longevity in nearly all studies. According to the story, for every increase in $10,000 in a neighborhood's median household income, residents lived 3.4 years longer. But even among neighborhood's not so financially divergent there may be lifespan differences of up to 10 years.

While homicides account for much of the inner-city's lowered life expectancy, other factors such as nutrition and exercise account for at least some of the difference. Of course when you are concerned with survival, you don't have much energy left to think about fresh fruits, vegetables and exercise.

For Americans, living in neither the wealthiest nor the poorest neighborhoods, we do have choices. It appears those choices can lead to significant differences in live span, too.

So like our mothers always said: "Eat your vegetables!" Eat some fresh fruit, too.

Go for a walk today.

Live longer and healthier.

Overcoming the Fear Factor for the Sandwich Generation

2008-10-14T09:39:00.000-07:00

Franklin D. Roosevelt, in his first inaugural speech, used the phrase we are hearing echoed today: "...let me assert my firm belief that the only thing we have to fear is fear itself—nameless, unreasoning, unjustified terror which paralyzes needed efforts to convert retreat into advance."

Today, we hear this phrase related to the economic uncertainties and fears.

But this weekend, as I talked with a friend who is sandwiched between her 25 year old daughter and her elderly father, I thought about this phrase in relation to the challenges we share as members of this sandwich generation.

She expressed great fear that her daughter is making choices today that will affect the rest of her life.

She fears for her father, who just found a frightening lump.

My own daughters are living on the other side of the world; one in India and one in Israel. I could be filled with fear for them, as I watch the news and know that these two areas of the world are filled with risk and unrest.

The fear and the worry can be consuming. These feelings can create a background level of stress that makes it harder to sleep; harder to eat healthy foods; harder to maintain our relationships.

Recently researchers found that our thoughts directly affect how our brain functions. We can, from all evidence, think ourselves happier by what we choose to focus on.

When we specifically think of things we're thankful for, the happiness centers of our brain become more active.

I assume that when we worry or focus on our fears, the opposite thing occurs: the parts of our brain that cause depression, unhappiness and despondency become more active.

This weekend, Karen and I made a choice to fight this natural tendency to obsess on the worry and fear. Surprisingly, some of the steps we chose to take really work:

1) Spend time with friends. Talk about what's worrying you, but then make a choice to talk about things that make you laugh or take your mind off your worries. We toured an historic old home in our community and talked about how much daily life has changed over the years - and how thankful we are to have today's comforts.

2) Take a walk. Exercise, combined with fresh air and sunshine has proven value in lifting our spirits and improving our feelings of well-being.

3) Do your "gratitudes." Every day, think of four things you're thankful for. Say them out loud. Try to be creative, and name new things each day. Many studies have found that this one step alone will improve your sense of happiness. Certainly focusing on the things that we are grateful for takes our focus away from our fears and our worries - in itself, a very positive step.

4) Take action. Where you can, take action to relieve your worries. If something is nagging at the back of your mind, let it come forward where you can deal with it. It might as simple as making a plan to visit a parent at a specific day and time. It may mean sending an email or writing a note and putting it in the mail. Action can defeat worry and fear. Do something.

5) Find simple joys. A warm wood fire, a glass of good wine, a book that makes you feel happy inside - these are simple pleasures that can create a feeling of well-being and happiness.

6) Get a pet. My dog Bella is a big furry mess this time of year. She brings in so many leaves when she rushes in that it can look like it's fall inside the house as well as outside in the yard. But Bella unfailingly greets us with a level of joy that is hard not to respond to. She is always excited to see us; always eager to be with us; always overjoyed with even the smallest measure of attention. Pet therapy is now an tested approach to healing and improving feelings of well-being.

Feelings of fear are probably not our greatest concern today. They can, however, as FDR said, result in paralysis that can negatively affect other areas of our lives. Taking simple steps to overcome fear and worry is one positive step we can all begin right now.

Life in the Retirement Center - it's all a big party

2008-10-08T09:55:00.000-07:00

From time to time I've shared my experiences with both my mom and my in-laws. My mom lives in a retirement village made up of attached cottages. She loves her new friends there, and most of all she loves the ability to travel without worrying about her house, yard, garden and plants. Because her cottage doesn't come with many amenities, it's very affordable for her, leaving her enough each month to do what she loves - travel. So she's home from time to time between her trips to visit relative all over the US, her annual Hawaii get-aways, and her volunteer trips to places far across the world.

My in-laws, both in their 90s, just this past summer agreed to give up their home and move into a retirement community.

My father-in-law says, "We've moved to the Penthouse." He loves their 5th floor apartment overlooking the beautiful courtyard. He also loves Friday evening "wine tasting" which, last time we talked, he described as a "wine-drinking contest" for the old folks. "They just keep pouring and pouring," he explained. He laughs as he talks about how handy it is just to slide down the wall to the elevator and ride home.

For my mother-in-law, moving was a painful experience. She had determined to live out her life in her home of 57 years, even when it had clearly become a burden and a danger. Only after persistent, repeated family discussions did she finally relent and agree to move.

Last week they took the bus to a nearby casino (she loves to play the slots). She joined a knitting group. She marvels at how many nice, active people there are still alive in her age group (she had lost all of her long-time friends, and felt pretty lonely for peer companions).

Clearly, life isn't all a big party when you're 90+. Hearing is a challenge for her, and getting around is tough for my father-in-law. But living in the "penthouse" and going to weekly wine tastings isn't all bad. And smiling more, talking more, and enjoying what's left of their lives is truly quite wonderful - for them and for us.

Caregivers Need a Break

2008-09-29T10:08:00.000-07:00

Family caregivers, especially adult children caring for aging parents, need a break.

We've known for years that caregivers have a higher rate of illness - even death - than the person in their care. We know that caregiving is stressful physically, emotionally and psychologically.

We know that high blood pressure, sleepless nights, colds and depression are common problems among caregivers.

Now, another study of baby boomer adults caring for parents reaffirms these impressions, finding that "helping a parent results in a downward trajectory of health and well-being for the child." ("Routine Caregiver Duties Create Overload," Times of the Internet, Sept. 26, 2008)

Among the issues are the challenges of balancing many roles. Most baby boomer generation family caregivers are also working, managing their own household and caring for kids or even grandkids. They have parent-teacher conferences with their children, and then rush to their parent's home for caregiver meetings.

They are sandwich generation people, pressed down and put on the grill.

Giving caregivers a break may be as simple as giving them access to tools to help them cope. It may be offering support in terms of training for their role, so that as they face caregiving issues with their aging parents they know how to respond.

Knowledge, after all, can be one of the greatest stress relievers of all. And providing support in the form of access to training is something that can be done by anyone, from anywhere.

If you know of family caregivers that need a break, consider ways to help them gain access to caregiver training and resources. Contact us - we'll help.

Preventing Memory Loss - It's Easier than you Think

2008-09-25T09:26:00.000-07:00

Most people who have a loved one with memory loss from Alzheimer's or another disease affecting the brain have a fear running through the back of their minds:

"Will I lose my ability to remember and reason? Will I get Alzheimer's disease, too?"

We do know that many forms of Alzheimer's disease have a genetic component, but we also know another thing that is a little more of a secret:

You can take steps NOW to prevent your own memory loss. These simple steps are incredibly effective, and easy to incorporate into your daily life, starting right now.

Don't believe me? Consider this information, taken from the long-running Nun Study in Minnesota, where an entire group of nuns have committed to participating in a study of aging and memory loss, including autopsy after death. Among the nuns are women whose brains, upon autopsy, looked like typical Alzheimer's brains but whose functioning was essential normal throughout their lives. Their secret? They diligently incorporated some of the very steps you can take today.

Exercise. No doubt about it: exercise will preserve good health and improve poor or marginal health. Many instances of memory loss are caused by small strokes in the brain. Best prevention for stroke? Exercise. It doesn't have to be in the gym; it doesn't need to be intense. It just needs to be regular and of long enough intensity and duration to make your heart work a little harder and cause just a little glow of sweat. Good rule of thumb? 30 minutes every single day of vigorous walking, dancing, swimming or whatever you enjoy doing.
Eat Right. Again, nothing you're not hearing from many sources today. But something most of us could improve on. Two food choices can make a significant difference in your brain health: variety and color. Try for as broad a variety as possible in your meals, especially in the fruit and vegetable department, and go for foods that are intensely colored: beets, berries and peppers, for example. Make those two changes and you've done quite a lot for your future brain health.
Keep learning. Read the paper and news magazines. Listen to talk shows that are on the opposite spectrum as your usual way of thinking. Then find someone to talk to about what you're learning, hearing and thinking. If that's too argumentative for you, join a class. Learn to play the piano, speak Spanish, or cook vegetarian. Free or inexpensive classes for adults abound in this country. Consider volunteering in student tutoring or teach a class yourself. Keep learning and keep your brain active and healthy.
Nourish friendships and stay socially involved. Staying socially active is important for overall life happiness as well as brain health. That doesn't mean you need to have a circle of 50 friends; a few close friends who make you laugh and enjoy life are just as effective. But don't lose touch, and do reach out to make new friends from time to time.

Four easy things that you're probably already doing in one form or another. But focusing on these four vital areas can help you preserve your brain health as long as possible.

What's Happening to Mom? - Taking the First Step

2008-09-24T12:41:00.000-07:00

Carrie has a full-time job and two kids still at home. When her dad became ill and passed away unexpectedly, Carrie spent a lot of time with her mother, talking to her about what she would be doing with her life now.

Carrie worried about depression becoming a problem for her mom, and her mother being alone, but what she discovered was that her mother seemed unable to manage even the simplest daily tasks. Cooking seemed to be completely beyond her; even daily dressing, bathing and grooming tasks seemed overwhelming.

In just a few days, Carrie began to suspect that her mother had been experiencing a decline in mental functioning for a long time – her father had been “filling in the blanks,” and no one in the family had even noticed her mother’s failing. Carrie needs to figure out what to do to be the most helpful to her mother right now – at the same time she’s coping with the loss of her father, as well as her own full-time work and family demands.

Figuring out how to face this challenge in addition to your own life demands is the first step you’ll need to take. Learning to cope with your loved one’s needs without losing your mind is your biggest challenge, however!

The First Step

Get a diagnosis. This is the first step you need to take, and the sooner you take it the better. You may wish to go directly to a research center that specializes in Alzheimer’s disease (most university hospitals have these kinds of programs). Or, you may need to start with a family doctor, and go from there for further tests, if necessary.

A visit to the doctor for a thorough check-up is the first important step.

You may hear, “There’s nothing wrong with me – I’m not going to the doctor.” Right off the mark, you need to learn some new skills.

Start with this one: Reassurance. “Dad, I’ll go with you, and I’ll stay with you the whole time – it’s no big deal.”

If that doesn’t work, try bargaining. “Mom, if you’ll just do this for me, we can go to lunch together afterward and have a nice, long chat at your favorite restaurant.”

If that still doesn’t work, try diversion: “Honey, I need you to go to the doctor so the kids will stop nagging me. I’m getting sick and tired of the nagging – it’s up to you to get those kids off my back.”

These are skills you’ll develop and learn to use like a pro over time. You’ll find that you need a whole new set of skills to be most helpful to your loved one, and keep your own sanity intact.

The least useful approach both now and in the future is argument. You might also call this debate, persuasion, or explanation. Whatever you call it, it won’t work! When the brain functioning is impaired, even slightly, a factual presentation is likely to be futile. Logic is frequently one of the first brain functions to diminish, so no matter how grounded in facts your arguments may be, you just won’t win. Try some of the other “tools” for accomplishing necessary goals.

Janice had tried every logical approach she could think of to get her husband Mac to agree to go to the doctor for testing. Each time she brought it up, Mac simply refused to go. “I’m perfectly fine,” he’d say.

Finally, at her wits end, Janice said, “I promised the kids that we’d both get to the doctor for a check-up. I’ll go first if you’ll go after me.” Reluctantly, Mac agreed to go. Janice got a same day appointment, and took Mac in before he was able to change his mind and refuse again.

Once you get an agreement to go to the doctor, you’ll want to consider the following things:

Accompany your loved one to the doctor – all the way in. Don’t send him or her into the examining room alone.

Make notes about what you’ve observed – details and facts, suspicions and observations. Take your notes with you, and don’t hesitate to read them to the doctor, or simply give them to the doctor. Can you do this in front of your loved one? Try it – you may be surprised how accepting your loved one is with the facts you present, especially if you word them as facts. For example, “Dad got lost coming home from the store last week. It was kind of scary for us both.” If you just can’t read your notes in front of your loved one, simply hand them to the doctor or nurse to read. Be prepared for your loved one to become suspicious about what you might have to say “behind my back,” and make an effort to include your loved one in your discussions with the doctor if at all possible. Most individuals with early stage memory loss are keenly aware of what they are losing, and this is distressing to them as well. Talking about it openly can actually be very freeing for both of you. Whispering about things tends to reinforce our society’s stigmatizing of diseases causing dementia. Choosing to openly discuss all of the facets of memory loss and dementia can help both you and your loved one face this disease rather than feel that it needs to stay “hidden.”

Ask for tests. If your loved one has just suffered a significant loss – from a spouse to a beloved pet – be aware that depression could be the problem. Untreated, lingering depression can cause a person to act like they have dementia or another brain impairment. With appropriate medication and perhaps a “friendly visitor” program or brief talking therapy, your loved one may be able to work through the depression and re-gain complete mental functioning. Other physical problems like bladder infections, pneumonia, or vision or hearing losses can look on the surface like Alzheimer’s disease. These problems are generally completely treatable, and what looks like dementia can be totally reversed if the underlying health problems are addressed. Be aware that simple things like drug interactions, dehydration and malnutrition – fairly common problems for the elderly person living home alone – can cause the appearance of dementia. Ask the doctor to test for these and similar treatable physical ailments before you both assume that your loved one has dementia.

Expect your loved one to be much more lucid at the doctor’s office than what you’ve observed. This can drive you nuts, especially if the doctor is not experienced in diagnosing dementia, and looks at you like you’re the one with the problem! This is so common that, fortunately, the medical community is beginning to catch on, and educate doctors to look beyond the “perfectly normal” presentation in the office. Be prepared that your loved one may even be able to ace the “mental status exam” that a physician can complete in 2 minutes during an office visit. If this happens, ask for a referral to a neurologist, or seek out an Alzheimer’s diagnostic center at a nearby University or teaching hospital. Don’t let this distress you. Take a deep breath, and know that what you’re going through is very common and normal. Keep at it until you find a doctor who is really able to see what you’ve been seeing, and help you find an appropriate treatment plan.

Ask about medications. Once the physician has ruled out treatable problems, and has determined that your loved one likely has a disease like Alzheimer’s, ask about medications. The drugs currently available to “treat” Alzheimer’s disease and other dementias work best during the earliest stages of the disease. During this time, medications can be truly helpful, and can help your loved one regain some functioning, and, barring that, can delay significantly the progression of the disease. Imagine giving your loved one a year or two of extra independence, and what a difference that can make to him or her, both personally and financially. Ask about those medications!

What's Happening to Mom? - what to do when you first discover - or just suspect - your loved one has Alzheimer's disease

2008-09-17T11:07:00.000-07:00

You’re reeling from the diagnosis the doctor gave you. Your loved one has dementia – what is that? What does it mean for him (or her) – and for you?

You’ve come to visit your loved one after being away for a while – and something clearly is not right. Is it Alzheimer’s disease? Is it something else – or just you?

You’ve just lost a parent, and the surviving parent seems to be totally unable to cope. You’re dealing with your own sense of loss, and struggling to make sense of what’s happening to your surviving parent at the same time. You need help!

You’re one of the millions of family members who is forced to face the daily consequences of the diseases causing memory loss and dementia, and figuring out what to do now is your first – and most important – challenge.

The Discovery

Typically, the discovery of a disease causing memory loss and dementia comes on slowly. You may be able to look back and realize that there were hints for months, maybe even years, before the moment when you came to the conclusion that Mom or Dad was not just become more and more “eccentric.” Some professionals refer to this period before the discovery as a period of “denial” when family members simply refuse to accept that something is really wrong.

More often, however, family members just don’t put all the clues together until something happens to bring the concerns to the forefront. That could be one pivotal event – Dad went out for a drive and got lost for hours before coming back home.

Or, even more commonly, the discovery comes on slowly, as, over time, you notice more and more signs of a change in your loved one.

Perhaps you realize that bills are not getting paid. Perhaps you notice that your obsessively neat parent forgot to shave for 2 or 3 days in a row, or neglected to change clothes for several days. Perhaps you notice a change in behavior – a use of language that seems out of character; a need for continual contact or reassurance that is unusual.

Perhaps your loved one looks at you with no recognition – or asks you why you never come to visit when you were just there yesterday.

Perhaps your loved one turns on you and threatens to call the police and report you for stealing money, wallets or possessions.

If you’re like millions of other family members facing this moment of discovery, your first reaction may be dismay, especially if you have other responsibilities in your life.

What now?

How on earth do I cope with this, in addition to my regular, busy, full-time life?

We'll explore these questions, and begin answering them, in future articles. Join us!

Families Need Support, too

2008-09-16T16:37:00.000-07:00

This evening we're going to participate in the family support group sponsored by our local hospital.

We'll be talking about ways families can get support while they're busy providing care to their loved ones. One of the pieces we'll talk about is holding a family council or a family meeting. Based on our experiences we'll share ideas on when, where and how to get the whole family involved in the process of providing care - or at least supportive of those family members that do the direct work.

Families can be torn apart when caregiving decisions become difficult. When to get help ("Our Mom needs help? Are you sure?"); how to get help ("I hope you're not going to ask me to help pay for it!"); and heaven-forbid, the discussion about moving mom or dad out of the family home into a retirement center, assisted living community or nursing home ("I promised Mom she'd never have to leave home").

But you probably know exactly how this goes. The child living furthest away, doing the least amount of daily work, is still the saint, while the busiest child, helping every day with tasks big and small, is rarely the most valued and appreciated by the aging parent.

So tonight we'll go meet with some families who are right in the middle of this situation, and who come together, leaving their warm, cozy homes to venture out at night, for a little support and encouragement.

Sometimes all we can give is a little help. But sometimes that's all that's needed.

If you'd like a copy of our booklet titled "Holding a Family Council: A Guide to Family Decision-Making about Long Term Care Issues" email me at Sharon@aquiretraining.com.

Stuck in the Middle, but Still Smiling

2008-09-15T11:47:00.000-07:00

Stuck in the Middle, but Still Smiling

Where it all began, May, 2005: After years of teaching about, counseling with and writing about them, I've become one. One of the people stuck in the middle - the "sandwich generation," we so fancifully call them.

In addition to the challenges we face raising three teenage daughters, my husband and I are now helping BOTH of our parents make a well-considered change in their living circumstances - hopefully before something happens that forces this change.

Both my husband's and my parents are getting to the point where if one little thing happens, staying in their own homes will not be an option. You know them - the people who, at age 92, are still "several years" away from needing to move from their home. We're encouraging them both to move into a retirement community that offers them all the benefits that they don't have in their isolated lives at home.

Of course, they've been balking - big time. We decided to use a little psychology – always a good thing when you’re the ones plastered in the middle – and we convinced each set of parents that we needed their help getting the other set of parents to agree to a move. Each set thinks the other “really needs to move!”

When we finally got both sets of folks to agree to tour – together - a beautiful, new retirement community close to our home, it took about a month to set a date convenient to all - and that's after two cancellations. Then, when we arrived, both my mother and mother-in-law stood there with jaw set, saying, "No way are we moving in here with these old people!"

By the end of the tour (three hours later), they had softened, and realized that this could actually be fun - a good thing!

Of course now they want to tour several other communities to comparison shop, and of course, they want us to come with them. We, who have SO much extra time in our lives!

Then there are the kids: our eldest away at college, still needing her mom and dad to help her through the challenges she's facing being away from home for the first time in her life. The middle daughter, who calmly cruises along - until the high school pressure builds up, at which point we have major DRAMA, as the girls like to say. And then there's the youngest one, who's determined to chart her own course in life, and not follow in her older sisters' footprints, no matter what it takes!

And we're stuck in the middle. No peanut butter and jelly on this "sandwich" - just lots of time-consuming, emotion-draining listening, coaching and guiding.

But last Mother's Day, as we made the round of the parents, we saw in their eyes a new energy, and an excitement for a new phase in their lives. They couldn't stop talking about what it's going to take to get their homes ready to sell, or what they should do with all their (tons and tons and tons) of belongings.

The Mother's Day cards I got brought tears to my eyes, and even had me sobbing out loud (thank-you again, daughter #1).

And just for a day, I thought what a blessing it is to be surrounded by family, even when the pressure is coming from both sides. Being "smushed in the middle" isn't such a bad thing after all.