Your Caregivers Handbook - From Senior
Mag
Your Caregiver's Handbook
A handbook for taking care of senior
parents
Becoming and then working as a caregiver for a
friend or family member is a pretty tough
undertaking. Choosing to do so is more than just
agreeing to take on a few added responsibilities.
It is in effect, choosing a
lifestyle.
Most people that require care are in a continual
state of overall decline. There are exceptions to
the rule, but generally, the care recipient requires very
little care to begin with, but escalates over time and
with decline in overall condition. More tasks need
to be added to the caregiver's list and there are seldom
any that are taken away.
This caregiver's handbook was created with the
goal in mind to give caregiver's an idea of what may lay
ahead, but most importantly, a reality check on the
situation at hand... what is reasonable, and when too
much is too much.
Introduction
You, the Caregiver, are very
important
Few people are prepared for the
responsibilities and tasks involved in caring for
the aged. To help make the task easier, it is
important to have a game plan in life which helps
determine where we are headed and how we are
going to get there. This guide will help to serve
as a road map which gives optional paths for
caregivers.
It is also an emphatic reminder that
those who care for other people can do a better
job of care-giving if time and attention also are
given to their own personal needs. It can not be
stated strongly enough; the caregiver is a very
important part of the care-giving
equation.
The success of this equation and the
continuance of its success is actually dependent
on how well the caregiver cares for him/herself.
In other words, if the caregiver becomes ill, who
will care for the care-receiver? Before you get
to that place, please read this
handbook.
This handbook explores a number of
different topics which can make the role of
caregiver easier, and at the same time, help the
person receiving the care. Throughout this
handbook, care-giving refers to the person
giving care, and care-receiver the elderly
person receiving the care.
Here are two checklists, one focusing on
the care-receiver and the other on
the caregiver. They are included as
general guidelines to help insure an optimal level
of health, safety and comfort for both your
care-receiver and yourself, the caregiver.
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top
Checklists
Checklist for
the care-receiver:
-
All legal and financial
matters are in order and
available
-
Physical and dental
appointments are kept annually or
more often if needed
-
The home environment is
clean, safe and
pleasant
-
Nutritional needs, exercise,
sleep and social activities are
maximized to the degree
possible
-
Personal hygiene and
grooming are done daily
-
Respite services have been
utilized monthly/weekly
-
Level of care is reviewed
monthly to ensure care-receiver is
able to remain in the
home
Checklist for
the caregiver:
-
I am getting out/exercising
at least once a week
-
I am getting at least seven
to nine restful hours of sleep a
night
-
I talk with or visit up to
three friends or relatives
weekly
-
I keep annual medical and
dental appointments
-
I am taking only the
medications as prescribed to keep up
my health
-
My legal and financial
papers, including wills, are in order
and available
-
I have checked a new resource
regarding care giving each week
-
I have read and am aware of
the Caregiver's Bill of Rights
-
I am eating three balanced
meals a day.
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List of
Needs
The first step in organizing a rational
care plan is making a list of needs. As family
members or friends care for an impaired elderly
person, several questions present
themselves:
-
What are his/her
needs?
-
What kinds of care are needed
to allow the elderly/impaired person
to remain in the community?
-
Who is going to provide the
care? When? How?
-
Should the care-receiver
remain in his/her own home, live with
the children or other relatives or
move to other surroundings (retirement
apartments, residential care,
intermediate care, skilled nursing
facility or other)?
-
How can living arrangements
be changed to help the person stay in
the home or become more
independent?
-
If outside services are
needed, does the impaired person have
the resources to pay for them? How can
they be obtained?
-
How can care be given to the
person in need without denying
attention to others (spouse or
children) for whom the caregiver also
has responsibility?
-
Do you as the care giver feel
tired or frustrated from caring for an
older person?
In answering these questions you are
developing an important List of Needs of
the impaired elderly person, and bringing into
perspective the caregiver's needs as well. The
questions do not have easy answers and the
solution may vary in every situation. The care of
an impaired older person can create stress that
affects the ability of the caregiver to continue
giving necessary levels of care. The stress
experienced may be physical, financial,
environmental and/or emotional in
nature.
Physical Stress: Providing
physical care to an impaired older person can
cause physical stress. General homemaking and
housekeeping activities such as cleaning,
laundry, shopping, and meal preparation require
energy and can be tiring, particularly when added
to existing responsibilities in one's own
home.
Personal care required for the
supervision of medications and the maintenance of
hygiene can also be stressful, particularly in
situations of acting-out behaviors, incontinence
(loss of bladder or bowel control), colostomies,
or assistance with bathing.
Lifting and transferring individuals
with limited mobility is not only tiring, but
also can result in injury to the caregiver or the
impaired person. In some instances there is the
additional responsibility of maintenance of
equipment such as wheelchairs or hospital
beds.
Financial Stress: The care of an
impaired elderly person has many financial
dimensions. For those services that cannot be
provided by family members (medical,
pharmaceutical, therapeutic, etc.), decisions
will have to be made as to where service will be
secured and how they will be paid. When money is
limited, many families assist with the cost of
care, causing financial burdens on all family
members.
Environmental Stress: The
proper home setting has to be chosen. If the
care-receiver elects to remain in his/her own
home, modifications such as railings and ramps
may have to be installed.
If the person cannot remain in his/her
own home, alternative arrangements must be
sought, such as moving in with a friend or
relative or specialized housing (retirement
hotels, senior apartments, residential care
homes, intermediate care facilities, or nursing
homes).
If the care-receiver is to remain in the
home, some major adjustments in the living
arrangements and patterns of daily living will be
necessary.
Social Stress: Providing personal
care up to 24 hours a day can cause social stress
by isolating oneself from friends, family and a
social life. The caregiver may find him/herself
becoming too tired or unable to have an
evening out even once a week, or once a
month. What can result is a build-up of anger and
resentment toward the very person receiving the
care, as the care-receiver is the cause of the
lost socialization.
Emotional Stress: All of
these factors often result in tremendous
emotional stress. Compounding these sources of
stress are the difficulties in managing one's
time, juggling multiple responsibilities, and
feeling the pressure of the increased
dependency.
For family members providing care, the
various forms of stress can result in different
feelings. Anger, resentment and bitterness about
the constant responsibilities, deprivation and
isolation can result.
This is also a time when many of the
unresolved conflicts from parent-child
relationships resurface and can intensify,
causing anxiety and frustration. There might even
be the unspoken desire, at times, to be relieved
of the burden through institutionalization or
even death of the care-receiver.
This desire is frequently and swiftly
followed by feelings of guilt. All of these can
be felt, then denied because they seem
unacceptable. The person giving care needs to be
assured that, in fact, these feelings are common
even though they may not be
expressed.
There are resources that can help
caregivers. The remainder of this book will
address those resources, such as joining a
caregiver support group, using community
resources and above all, caring for yourself the
caregiver.
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Types of Help Available:
Through Family or Friends
First make a detailed inventory of any
assets individual family members and friends can
contribute, including the assets of the impaired
elderly person needing the care. Assets include
available time, skills, space, equipment, the
strengths of the person in need care, and most
important money.
Sit down with all the family members (or
at least as many as are agreeable) and work out a
plan for giving help. This involves defining and
agreeing upon what tasks will be performed, by
whom, on which days, and so forth. For example,
Aunt Martha can cook, Uncle Peter can mow the
lawn and Mary can check on Mom twice a
day.
Care-giving Exchanges:
Some situations may allow for exchanging
support services such as the Caregiver Exchange
through Area Agency on Aging. A friend who has
similar caregiver responsibilities may care for
both impaired individuals one day a week in
exchange for your providing the care on another
day. Another exchange situation might include
making a spare room available to a college
student for his/her help with care of the
care-receiver, in return for free room and
board.
When Community Agency Help in Needed:
When family or other volunteer help is
not available or cannot meet your needs,
caregivers or care-receivers may wish to seek
help from agencies.
A wide range of help may be available.
Some may be covered by private insurance,
Medicare (and/or a supplemental program of your
State). All of it can be purchased. Sometime the
service costs may be based on the income of the
care-receiver. Each agency has its own fee
structure; you may want to ask about their
arrangements before ordering the
service.
Types of Services Available to Impaired
Elderly
Adult Day Health Care: This is
for people who are physically and/or mentally
frail. It offers a range of therapeutic,
rehabilitative, and support activities, including
nursing, rehabilitation, assistance with life
activities, social work services, meals, and
possible transportation, provided in a protected
setting for a portion of the day, one to five
days a week, usually during weekdays.
Chore Workers/Handypersons
Services: Includes heavy-duty housecleaning,
minor home repairs, yard work, installing safety
devices, and winterizing homes.
Companionship Services:
Companions visit isolated and homebound
individuals for conversation, reading, letter
writing, and general light errands.
Escort Services for the Elderly:
These services provide personalized accompaniment
to service providers as well as personal
assistance.
Geriatric Assessment Units and
Special-Care Units: Specialized geriatric
units, both inpatient and outpatient, exist in
some hospitals and medical centers; e.g., SOCARE,
API They provide coordinated multi-disciplinary
diagnostic services to older patients.
Home Delivered Meals: Some
nutritional programs as well as well as
specialized meals-on-wheels programs
offer home delivered meals to the frail, homebound
aged. Subsidized programs ask for voluntary
contributions, while others may require full payment
cost for delivery of a hot, well balanced lunch, and
sometimes cold evening meal.
Home Health Aides: Provide
personal care to individuals at home (These
services may be covered by health insurance if
ordered by a physician.) Aides assist with
eating, dressing, oral hygiene, bathing,
colostomies, administering medications, etc., as
well as light household tasks.
Home Health Care: Organized
programs of nursing, social work, occupational
therapy, physical therapy, and other
rehabilitation services to individuals in the
home.
Homemaker Services: Provided by
non-medical personnel, services include shopping,
laundry, light cleaning, dressing, preparation of
meals, and escort services on medical
visits.
Homemakers can be of great help in
supplementing help provided by family members, or
providing relief when family caregivers need a
break. Homemakers can be secured through in-home
health care agencies, the Area Agency on Aging,
the Department of Social Services, and religious
groups and organizations.
Some agencies provide bonding and
training for their homemakers while others
provide only a registry of homemakers' names and
phone numbers, in which case you must thoroughly
check references and draw up a contract for the
required services.
Hospital and Surgical Supply
Services: Supply houses rent or sell medical
supplies and equipment like hospital beds, canes,
walkers, bath chairs, oxygen and other equipment.
Consult your Yellow Pages.
Housekeeping Services: These
usually include cleaning, shopping, laundry, and
meal preparation.
Housing Assistance: Housing
assistance programs exist to help in the search
for senior housing, shared housing, and finding
emergency shelters, such as Heartland Human
Relations and Area Agency on Aging.
Nutritional Programs: Congregate
meal programs feed many older adults as a group
in a senior center, community center, or school.
A noonday meal is provided, containing one-third
of the recommended USDA dietary allowance,
usually for a voluntary contribution.
Additionally, some centers provide recreational
and educational activities.
Occupational Therapy:
Occupational therapy, or OT, is restorative, to
enhance or restore skills necessary for daily
living. It should be provide by a qualified
occupational therapist who is referred by your
doctor.
Physical Therapy: Physical
therapy, or PT, is rehabilitative therapy to
maximize mobility. It should be provide by a
qualified physical therapist, usually recommended
by your doctor or hospital.
Respite Care Services: Respite
care programs provide temporary and in some
instances up to twenty-four hour care to give
relief to primary caregivers. The care may be
provided in the person's home, at an adult day
care center, or other facility.
Senior Service Teams:
Regional/County Mental Health teams working
together to provide mental health screening,
needs assessments, and short-term counseling
services to seniors.
Skilled Nursing Services: These
specialized services are provided for specific
medical problems by trained professionals through
local home care agencies. Your doctor must
prescribe nursing services.
Speech Therapy: Speech therapy is
provided by a qualified speech therapist to
overcome certain speech and communication
problems. The doctor usually recommends
this.
Social Day Care: Provide
supportive but not rehabilitative services in a
protected setting for a portion of the day, one
to five days a week. Services may include
recreational activities, social work services, a
hot meal, transportation, and occasionally,
health services.
Telephone Reassurance: Friendly
telephone calls are provided by agencies or
volunteers offering reassurance, contact and
socialization. Telephone reassurance can be a
lifeline for older people who must be left at
home alone during the day.
Transportation: Transportation
services provide travel by automobile or
specialized vans to and from medical care.
Community agencies and service providers such as
Dial-a-Ride, Red Cross Wheels, Cancer Society,
and Life Line are but a few.
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Caring for the
CaregiverCaregivers experience mixed emotions. Love
for your family member and the satisfaction you
derive from helping may coexist with feelings of
resentment about the loss of your privacy and
frustration at believing you have no control over
what happens.
You may find it hard to accept the decline
of the special person for whom you are giving care.
Such feelings will depend in part on your prior
relationship with your care-receiver, the extent of
your responsibilities as a helper, and daily
activities in your life (professional, social, and
leisure pursuits). Your conflicting emotions may
cause guilt and stress.
To guard against becoming physically and
emotionally drained, you must take care of yourself.
You need to maintain your health and develop ways to
cope with your situation.
Caregiver's Self-Rating Scale:
Below is a scale to evaluate your level of
care-giving. It has been adapted from an article in
Co-op Networker; Caregiver of Older Persons by
Judy Bradley. It is an excellent effort to provide
some guidelines for caregivers and to evaluate your
level of care and value which you give your
care-receiver and yourself.
The scale is a 1-10 continuum
which describes the various styles of
caring.
1. Abandonment |
to withdraw protection or
support or to actively abuse your
care-receiver.
|
2. Neglect |
to allow life-threatening
situations to persist or to display
consistent coldness or
anger.
|
3.
Detachment/Aloofness |
to maintain an air of detachment
or being aloof, perfunctory in your care,
no genuine concern, only obligation.
Concerned only with physical well-being
of your care-receiver.
|
4. General Support |
given freely, with a guarded
degree of warmth and respect, occasional
feelings of manipulation. Concerned with
both emotional and physical well-being of
care-receiver.
|
5. Expressed empathy |
the ability to feel what your
care-receiver feels. a quality
relationship where feelings can be freely
expressed and caringly received with
non-judgmental positive
regard.
|
6. Sympathy |
feeling sorry for care-receiver,
giving sympathy, focusing on the losses
experienced by
care-receiver.
|
7. Occasional
over-involvement |
care characterized by periodic
attempts to do for rather than
be with.
|
8. Consistent
Over-involvement |
care-receiver regarded as object
of series of tasks which must be
performed.
|
9. Heroic
Over-involvement |
care characterized by sometimes
frantic and desperate attempts to provide
for every possible need your
care-receiver has; increased dependence,
care-receiver not allowed
independence.
|
10. Fusion of
personalities |
between caregiver and
care-receiver. The caregiver's needs no
longer have any value or meaning; the
caregiver has abandoned him/herself to
needs of the care-receiver. |
You can place yourself on the Scale of
Care-giving to determine how you value your
care-receiver as compared to yourself. The low
numbers give little or no value (honor) to the needs
of your care-receiver. The high numbers (8, 9, 10)
give little or no value to your own needs as an
individual and as a caregiver. The numbers in the
middle are where you find a balance between
under-care and over-care. Neither of the two extremes
is healthy; they represent positions where you are
not helping your care-receiver.
What can I do to help myself?
Acknowledge your feelings: Your feelings
have a lot to do with the way you view and cope with
care-giving. All feeling are legitimate, even those
that may seem disturbing to you (including anger,
frustration, and sadness). Recognizing and accepting
your emotions are the first step toward resolving
problems of guilt and stress. Learn to express your
feelings to family members, friends, or
professionals. Take the following caregiver Stress
Test; determine how much stress you are
under.
Caregiver Stress Test
The following test will help you become
aware of your feelings, pressures and stress you
currently feel.
Which of the following are seldom true, sometimes true,
often true, or usually true?
- I find I can't get enough
rest.
- I don't have enough time for
myself.
- I don't have time to be with other
family members beside the person care
for.
- I feel guilty about my
situation.
- I don't get out much
anymore.
- I have conflict with the person I care
for.
- I have conflicts with other family
members.
- I cry everyday.
- I worry about having enough money to
make ends meet.
- I don't feel I have enough knowledge or
experience to give care as well as I'd
like.
- My own health is not good.
If the response to one or more of
these areas is usually true or often
true it may be time to begin looking for
help with caring for the care-receiver and help
in taking care of yourself.
Seek Information:
Check your public library for books,
articles, brochures, videotapes, and films on
care-giving. Some hospitals, Adult Education Centers,
the Southern Regional Resource Center and CESS offer
courses on care-giving and additional information on
resources that you can turn to for help. Help is
available!
Join a Caregiver Support
Group:
In addition to offering useful information,
such groups provide a unique forum for caregivers to
come together and share their feelings in a
supportive environment. Groups help caregivers feel
less isolated and can create strong bonds of mutual
help and friendship.
Participating in a support group can help
mange stress, exchange experiences, and improve
skills as a caregiver. Sharing coping strategies in a
group setting lets you help others while helping
yourself. It may also help you to realize that some
problems have no solutions and that accepting the
situation is reality.
Set Realistic Goals:
Care-giving is probably one of the many
conflicting demands on your time. It is important to
set realistic goals. Recognize what you can and
cannot do, define your priorities, and act
accordingly. Turn to other people for help - your
family, friends, and neighbors. Prepare a list of
tasks for anyone who may offer assistance. The list
may include:
- running an errand for you,
- preparing a meal,
- taking your care-receiver for a
ride,
- taking our children after school one
day.
Practice good communications
skills:
Do not expect that others will ask if you
need help. It is up to you to do the
asking.
Communicate with your Family and
Friends:
Turning to family members or friends for
emotional support and help can be a mixed blessing.
Their visits may make you feel less alone and better
able to deal with care-giving responsibilities. They
can give you a break by spending time with your
care-receiver.
However, other relatives or friends can be
critical of the way you provide care. They may feel
the house is not kept clean enough; or they may not
like the way your care-receiver is dressed. Recognize
that they are responding to what they see at that
time and are lacking the benefit of experiencing the
whole picture and any gradual changes in your
care-receiver's condition. Harsh criticism may be a
response to their own guilt about not participating
more in the care process.
Try to listen politely to what is being said
(even though this might not be easy). However, if you
and your care-receiver feel comfortable with the way
you are managing the situation, continue to do what
meets your needs. Schedule a family meeting from time
to time to help other family members understand the
situation and to involve them in sharing the
responsibilities for care-giving.
Use Community Resources:
Investigate community resources that might
be helpful. Consider using in-home services or adult
day care. Employ a homemaker to cook and clean, or an
aide to help your care-receiver bathe, eat, dress,
use the bathroom or get around the house.
Use Respite Care Services:
When you need a break from providing care to
your care-receiver, look at respite care. For
example, a companion can stay with your care-receiver
for a few hours at a time on a regular basis to give
you time off. Or have your care-receiver participate
in an adult day care program where he or she can
socialize with peers in a supervised setting; this
gives your care-receiver a necessary break from
staying home all the time. Hospitals, nursing homes,
and particularly residential care homes offer
families the opportunity to place older relatives in
their facilities for short stays. The Residential Bed
Availability Hot Line, your doctor, and the Area
Agency on Aging can assist with
arrangements.
Maintain your Health:
Your general well-being affects your outlook
on life and your ability to cope. Taking care of
yourself is important and involves:
- eating three balanced meals
daily,
- exercising daily,
- enough sleep/rest,
- allowing yourself leisure
time.
Food is fuel for your body. Skipping
meals, eating poorly, or drinking lots of
caffeine is not good for you. Learn to prepare
and eat simple, nutritious, well-balanced
meals. Avoid alcohol above 2-3 ounces
daily.
Being physically active can provide you with
an outlet that is relaxing and makes you feel good.
Stretching, walking, jogging, swimming, or bicycling
are examples of invigorating exercises. Consult your
doctor before starting an exercise routine. Your
doctor can help design a program that fits your
individual needs.
Leisure time allows you to feel better and
more able to cope with your situation. Having time to
yourself to read a book, visit a friend, or watch TV
can also bring enjoyment and relaxation, and break
the constant pattern and pressure of
care-giving.
Sleep refreshes and enables you to function
throughout the day. If your care-receiver is restless
at night and disturbs your sleep, consult your doctor
and fellow caregivers on possible ways to handle the
situation. You may need to have outside help in the
evenings to allow you time to sleep.
If you are unable to sleep because of
tension, practice relaxation exercises. Deep
breathing or visualizing pleasant scenes can be
helpful. Continued sleep disturbance may be a sign of
major depression, which needs medical
attention.
Relaxation Exercise:
-- Sit or lie down in a comfortable
position. Close your eyes. Allow your mind to drift a
few seconds, go with it wherever it goes. Wiggle your
fingers and toes, then hands and feet, ankles and
wrists. Loosen tight clothes, belts, ties. Sway your
head from side to side, gently, gently. Now you have
prepared yourself to relax physically and
psychologically.
-- Now concentrate, still with your eyes
closed, on some one pleasant thing you really want to
think about; maybe it is a place you have visited in
the past, or your dream place of your own
imagination. It might be the seashore, or high on a
hill, or in a field of grass and flowers. Become
totally immersed in the place. Smell the smells you
best remember. See the sights it offers. Hear the
sounds. Feel it, whether it be water or sand or soil
or snow. Fully realize this place or situation you
are in: if it is on the sandy beach, sift your
fingers through the warm sand and smell it, hold the
sand to your cheek, smell the salt of the sea, search
the skyline for gulls and terns and low clouds in the
distance. Your body is totally weightless. You are
totally in control of this scene. It is so relaxing
and pleasant and beautiful, you are breathing slowly,
peacefully. This is YOUR place and no one can take it
from you.
-- After you have sufficiently experienced
your peaceful imaging, whenever you have a chance,
return to your special place, close your eyes again,
tune in, relive those these special few moments in
the world of your choosing where everything is
perfect and everything is yours. This relaxation
exercise can benefit you all day. Check your local
library or book store for books, audio tapes,
videotapes or films on relaxing and managing
stress.
Laughter is the Best
Medicine:
This is an old expression popularized by
Norman Cousin's book Anatomy of an Illness, in
which he describes his battle with cancer and how he
laughed his way to recovery. His hypothesis
and the subject of many studies suggests that there
are positive effects to be gained from laughter as a
great tension-releaser, pain reducer, breathing
improver, and general elevator of moods. It sounds
miraculous, is not proven, but studies continue.
Groups such as the International Conference on Humor
and many hospitals use positive emotion rooms
and humor carts. In short, humor therapy is
valuable and it helps us through difficult or
stressful times.
So for yourself and your
care-receiver:
- try to see the humor in being a
caregiver;
- write on a card Have you laughed with
your care-receiver today? and place it in a
conspicuous place in the bathroom or
kitchen;
- read funny books or jokes, listen to
funny tapes or watch humorous movies or videos
that make you laugh;
- share something humorous with your
care-receiver, a friend, or relative;
- attend social groups where there is a
lot of camaraderie, joy and fun;
- be aware of how often you smile; it
takes much less energy to smile than to
frown.
If you find that you are feeling
hopeless, and humor or laughter is not
affording you the up-lift you want, contact a
counselor. And remember, laughter is the best
medicine. Try it, you'll like it!
Avoid Destructive
Behavior:
Sometimes people handle stressful situations
in ways that are destructive. Instead of openly
expressing feelings, they overeat, use alcohol,
drugs, or cigarettes to mask their difficulties. Such
escapes do not solve the problem and are harmful to
health. If the strain results in neglecting or
abusing the care-receiver, it is a vary serious
problem. It is also against the law!
Seek Help:
You do not have to go it alone. Turn to
family members, friends, clergy members, professional
counselors, or a caregiver support group for help and
support.
Build your Self-Esteem:
Continue to pursue activities and social
contacts outside your home. Do what you enjoy. Go to
a movie, play a musical instrument, or get together
with friends for a card game. It may not be easy to
schedule these activities, but the rewards for having
balance in your life are great. Taking care of
yourself benefits you and your care-receiver. Meeting
your own needs will satisfy you and give you
additional strength and vigor to bring to your
care-giving tasks.
Caregiver's Bill of Rights
You have rights, too. Below is a Caregiver's
Bill of Rights. After you read them, post and keep
them fresh in your mind.
Caregiver's Bill of Rights
- Caregivers have the right to receive
sufficient training in care-giving skills along
with accurate understandable information about
the condition and needs of the care
recipient.
- Caregivers have the right to
appreciation and emotional support for their
decision to accept the challenge of providing
care.
- Caregivers have the right to protect
their assets and financial future without
severing their relationship with the
care-receiver.
- Caregivers have the right to respite
care during emergencies and in order to care for
their own health, spirit, and
relationships.
- Caregivers have the right to expect all
family members, both men and women, to
participate in the care for aging
relatives.
- Caregivers have the right to provide
care at home as long as physically, financially
and emotionally feasible; however, when it is no
longer feasible caregivers have the obligation to
explore other alternatives, such as a residential
care facility.
- Caregivers have the right to temporarily
alter their premises as necessary to provide safe
and livable housing for
care-receivers.
- Caregivers have to right to accessible
and culturally appropriate services to aid in
caring for aging care-receivers.
- Caregivers have the right to expect
professionals, within their area of
specialization, to recognize the importance of
palliative (ease without curing) care and to be
knowledgeable about concerns and options related
to older people and caregivers.
- Caregivers have the right to a
sensitive, supportive response by employers in
dealing with the unexpected or severe care
needs.
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Personal Care
Activities
Personal care activities include: Eating,
bathing, shaving, caring for the skin, hair and
mouth, and transferring (moving from chairs, toilets
or bed). During the course of our daily lives these
activities are taken for granted until weakness or a
disability makes them difficult to accomplish
independently or safely. Providing assistance
requires knowledge, patience, skill and physical
strength.
Bathing: Bathing an older person may require
strength, special equipment and skills. It is advised
that caregivers ask the elderly person's doctor
and/or physical therapist for special instructions on
how to safely bathe the
care-receiver.
Shampooing and Shaving: Visits to a barber
or hairdresser are very positive experiences.
Individuals who provide this service will often come
to the home. Wetting hair with alcohol or cream rinse
helps to remove the snarls.
Dry shampoos are available if your family
member is bed bound. People who are diabetic or on
medication to thin the blood (anti-coagulants, i.e.,
Coumadin) should use an electric shaver to reduce the
risk of cuts. It is much easier and safer to shave
another person with an electric
razor.
Skin Care:
- Keep skin clean and dry, especially when
people are having problems with bowel and bladder
control. When washing, use a mild soap, rinse
well, and dry thoroughly.
- Keep bed linens clean, dry and free of
wrinkles. Disposable bed pads can be purchased at
a drug store and can keep sheets dry so that the
caregiver does not have to change sheets so
often.
- Massage skin gently using a light,
circular motion. Change the position of older
people at least every two hours, particularly for
those confined to a bed or wheelchair. Encourage
them to shift their weight between position
changes to redistribute pressure onto other
areas.
- Encourage good nutrition and adequate
fluid intake. As a supplement to your family
member's diet, give a multi-vitamin every day to
ensure proper nutrition. Check with the physician
as to the appropriate supplement.
- Use mattress and chairs that are soft
and form-fitting rather than rigid and hard.
(Example: egg crate mattress and sheep skin).
This spreads the weight over a larger skin area,
decreasing the pressure under the bones.
- Encourage movement or mild exercise;
this helps stimulate circulation which is good
for the skin. Combing hair and helping with
bathing and dressing are good ways for frail
people to get exercise and be more
independent.
- Watch for possible sources of pressure
on anything that would interfere with good
circulation, such as tight shoes, elastic cuffed
socks or tight undergarments.
- Bony prominences are prone to skin
breakdown. They are heels, feet, behind the
knees, hips, buttocks, sacrum, elbows and
shoulder blades. A special air mattress may be
ordered by the doctor to prevent skin
breakdown.
- Watch for any redness or a break in the
skin and report it immediately to the doctor or
nurse, and keep the care-receiver off the
affected side.
Toileting:
- Safety features in the bathroom, such as
grab bars and raised toilet seats, make using the
bathroom safer.
- A commode or urinal may be necessary
when flexibility and distance to the bathroom are
a problem. They may be especially helpful at
night.
- Lack of control over bowel or bladder
functions can be embarrassing and older people
may try to hide it from caregivers and
professionals. Be sensitive to the older person's
feelings, and mention this to the doctor. Loss of
bowel and bladder control is not a part of normal
aging and often can be controlled.
- For the care-receiver with bowel and/or
bladder problems it may help to take them to the
bathroom every 2 hours. Specialized programs
exist to retrain a bladder and bowel function.
Check with your doctor or nurse for a program in
your area.
Constipation or Irregularity: Many
elderly become constipated due to medications and
inactivity. If your care-receiver is experiencing
this problem the doctor or nurse can suggest a stool
softener. Other important factors are:
- Eat plenty of fresh fruit, vegetables
and foods high in fibers.
- Drink at least 8 glasses of water a
day.
- Avoid constipating foods like cheese,
rice, bananas, etc.
- Exercise as much as is
tolerated.
- Be sure your doctor is aware of all the
medications being taken.
Assisting with Eating:
Eating can be very time-consuming,
especially if the older person must be fed.
Encouraging independent eating saves time for
caregivers, and promotes the independence and
self-worth of the older person. Try to relax yourself
and enjoy the time spent with your care-receiver.
Here are some suggestions for encouraging
independence:
- Check gums for areas of redness.
Dentures may not fit correctly and cause the
family member pain when chewing.
- Provide adaptive equipment such as plate
guards or special silverware with built-up
handles. These can be purchased from medical
supply houses (listed under Hospital Equipment
and Supplies in the Yellow Pages). An
occupational therapy evaluation can recommend the
best for each individual.
- Prepare finger foods which may be easier
to eat than those requiring
utensils.
- Encourage older people to use a straw,
cups with 2 handles, or a glass with ribbed
surface for independent drinking.
- If the older adult has limited vision,
consistent place setting of food and utensils
helps to know where to find silverware, beverage,
etc. Using the clock method to locate food
may be helpful; for example, Your meat is at 9
o'clock, your potato is at 12 o'clock and your
carrots are at 3 o'clock.
- Reminder: Treat older people who are
being fed as adults, not children. Disciplining
poor eating habits should be avoided. When they
lack interest in food, try to learn the reason.
For example, ask if they are thirsty or not
feeling well, or if the food in not appetizing on
this occasion.
Transferring: Moving people who cannot move
safely by themselves requires skill, knowledge, and
some strength. For every type of disability, there is
a specific technique to use. Ask a doctor, therapist
or attend caregiver training for specific techniques.
In all cases, remember:
- When lifting, do not add your own weight
to whatever you are lifting -- get close and keep
balance centered.
- Do not use weak back muscles to lift -
use your leg muscles because they are much
stronger.
- Do not twist when you are lifting -
instead, change the position of your feet so that
you face the older person, keeping your spine
straight.
- Balance is vital - spread your feet to
serve as a base for support.
- Your doctor can refer you to a physical
therapist who can teach you to transfer
safely.
Rest and Sleep: As we age, our sleep
patterns change. The elderly require less sleep time.
It takes longer for them to fall asleep. Also,
awakenings during the night increase. Scheduled rest
times are important.
A few naps during the day can refresh and
revitalize the care-receiver. However, if you notice
that your care-receiver is sleeping for brief periods
during the night, it could indicate a problem. Notify
your doctor and discuss your concerns.
Tips for Encouraging Self
Care:
- Allow the care-receiver to do as much as
possible; provide only as much help as needed.
When older people do all or part of their own
personal care, it is a form of exercise that will
help maintain strength as well as promote
independence. No matter how small the activity
(holding the soap, combing the front of the hair,
etc.) it is important that the person be able to
participate.
- Adapt the home to allow the
care-receiver to do more things. Install
equipment such as grab rails in the bathroom,
wheelchair-accessible sinks and mirrors, bath
bench for the shower or tub, and lights with
switches that can be easily reached.
- Seek the aid of therapists or nurses to
teach you how to perform personal care tasks
safely and effectively.
- Learn about the care-receiver's
disability and what you and others can do to help
him/her function as independently as possible. If
the older person cannot perform a certain
activity, see if there is a part that can be
done. For example, one might be able to
independently dress the upper body if sitting,
but require help dressing the lower body.
- Whenever possible, include the
care-receiver in making plans for his/her care.
Take suggestions and feelings into consideration
and encourage involvement in his/her own care.
Sometimes, slowing the pace of an activity allows
older people to do more for
themselves.
Be aware of changes in the care-receiver's
health and abilities. Your plans for care will change
as the care receiver changes.
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NutritionGood nutrition is important in order that
people live life to its fullest. Good nutrition is a
balance of proteins, carbohydrates, fats, vitamins,
minerals and water in the foods we eat. A healthy
diet helps to (1) provide energy; (2) build, repair,
and maintain body tissues and (s) regulate body
processes.
When meals are eaten in the company of
others, people not only benefit from the nutritious
foods, but also enjoy the chance to socialize. This
encourages good eating habits and promotes good
mental health.
Nutrients listed on food
labels:
The table that follows summarizes essential
nutrients (which you may also finds listed on food
labels) and their functions.
Adapting Meals for People with Dietary
Restrictions:
If an individual is on a special diet (low
salt, diabetic or low saturated fat), the Basic Four
Food Groups Guide (which follows) can still be used.
However, because diets are prescribed to control a
specific medical condition, certain foods may have to
be eliminated, modified in the preparation, or
limited in their intake.
It is important that caregivers obtain
specific instructions from a registered dietitian or
their doctor on which foods are allowed, how much,
and how they should be prepared.
Since some foods or medications may interact
with other medications and/or foods in a harmful way,
check with the pharmacist as to restrictions in any
medications' use before it is
applied.
Nutrients on Food Labels and their
Function
- Protein: For preservation and
repair of tissue; formation of antibodies to
fight infection.
- Carbohydrates: For energy; fiber
to help prevent constipation.
- Fat: For energy; healthy body and
skin.
- Vitamin A: For healthy eyes, skin, hair;
resistance to infection.
- Vitamin C: For healthy gums,
skin; healing of wounds, bones; resisting
infection.
- Thiamin (B1): For digestion;
healthy nervous system.
- Riboflavin (B2): For healthy
eyes, skin, mouth; use of oxygen from
air.
- Niacin: For healthy digestive
tract and nervous system.
- Calcium: For preservation and
repair of bones, teeth; muscle contractions;
blood clotting.
- Iron: For building red blood
cells to carry oxygen to all parts of the
body.
To simplify daily meal planning, foods are
grouped according to the nutrients they supply. Plan
your diet to include the recommended number of
servings from each group.
The Four Basic Food Groups
Meat Group: Provides protein, niacin,
iron, and Thiamin-B1. 2 servings daily. Dry beans and
peas, soy extenders, and nuts combined with animal or
grain protein can be substituted for a serving of
meat. 2 ounces of cooked, lean meat, fish or poultry
have the same amount of poultry as: 2 eggs; 1 cup
cooked dry beans, peas, or lentils; 4 tablespoons
peanut butter; 1/2 cup cottage cheese.
Grain Group: Provides carbohydrates,
Thiamin-B1, iron, and niacin. 4 servings daily. Whole
grain, fortified, or enriched grain products are
recommended. 1 adult serving is: 1 slice bread; 1 cup
ready-to-eat cereal; 1/2 cup cooked cereal, pasta,
cornmeal, rice or grits; 1 small muffin or biscuit, 5
saltines, 2 graham crackers.
Milk Group: Provides calcium,
riboflavin-B2, and protein. 2 servings daily: Foods
made from milk contribute part of the nutrients
supplied by a serving of milk. 1 cup milk has the
same amount of calcium as 1 cup yogurt, 1 and 1/2
slices (ounces) cheddar-type cheese, 1 and 3/4 cups
ice cream, 2 cups cottage cheese.
Fruit-Vegetable Group: Provides
vitamins A and C. 4 servings daily: Dark green leafy
or orange vegetable and fruit are recommended 3 or 4
times weekly for vitamin A. Citrus fruit is
recommended daily for vitamin C. 1 adult serving is:
1 cup raw fruit or vegetable, 1/2 cup cooked fruit or
vegetable, 1 medium fruit, such as an apple or
banana, 1/2 cup juice.
Common Problems Interfering with Good
Nutrition
Illness, disability and depression can
affect an older person's desire and ability to eat
properly. The following suggestions deal with common
problems that interfere with good
nutrition.
When the care-receiver say the food tastes
strange, it might help to:
- Check teeth for tooth decay or gum
infection,
- Avoid alcohol,
- Marinate meat, poultry and fish in sweet
fruit juices, Italian dressing, or sweet or sour
sauces,
- Drink plenty of fluids or suck on
candies to get rid of bad tastes,
- Serve foods at room temperature or cold
(Try milk-shakes or cheese),
- Use stronger seasonings such as basil,
oregano, rosemary, tarragon, lemon juice or mint
when cooking,
- Try new foods.
Cramps, Heartburn,
Bloating:
- Eat slowly,
- Eat small meals frequently,
- Avoid gas-forming foods, e.g., cabbage,
onions, nuts, beer, cola drinks,
- Avoid lounging immediately after eating;
stand or sit upright for one hour after
eating,
- Avoid fried, greasy and heavily spiced
foods,
- Try bland, low-fat, easily digested
foods,
- Chilled antacid may help, HOWEVER, check
with your doctor regarding the brand of antacid
to use.
Constipation
- Take high-fiber foods and plenty of
liquids,
- Exercise,
- Add bran when cooking or baking (1 - 2
tablespoons of bran for each cup of
flour),
- Drink hot beverages which act as
stimulants.
Diarrhea
- Eat small meals frequently,
- Drink clear liquids,
- Avoid high fiber and greasy
foods,
- Replace fluid loss with liquids between
meals.
Nausea, Vomiting
- Avoid unpleasant odors,
- Eat small meals frequently,
- Chew slowly and thoroughly,
- Sip cool, clear liquids between
meals,
- Rest after meals with head
elevated,
- Avoid hot, spicy, strong-smelling foods
or fried, greasy foods,
- Try foods which are cold or at room
temperature, and low-fat food,
- Eat dry or salty food,
- Try fresh air and loose
clothing.
Dry or Sore Mouth
- Drink plenty of liquids,
- Suck on ice chips,
- Suck on popsicles made of milk or
non-acid juices,
- Dunk or soak foods in
liquids,
- Use extra gravies, sauces, salad
dressing,
- Rinse mouth frequently,
- Suck hard candies or chew
gum,
- Eat sweet or tart foods if no sores in
mouth,
- Artificial saliva can be
used.
General Tips for Helping the Older
Person to Eat Well
- Plan meals and snacks to include the
person's favorite foods.
- Use a variety of foods from each of the
four food groups,
- Prepare foods that provide a variety of
texture, color, and temperature,
- Provide a pleasant setting, i.e.,
flowers, place mats, matching dishes, good
lighting.
In addition to books, recipes and
literature, the organizations listed below are
valuable in providing tips, ideas, counseling, and
reminders that you are not alone. They can help make
the gradual transition to improved eating habits:
(Addresses listed were local San Diego. For same or
counterparts in your locality check your telephone
directories or contact United Way: American Heart
Association; American Diabetes Association; American
Cancer Society; Arthritis Foundation; Dietetic
Association; United Ostomy Associates.)
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Emotional and Intellectual
Well-being
Each human being is a combination of body,
mind, and spirit; we should be aware of how these
parts interact. For example, people may have powerful
emotional responses while facing the many challenges
which life presents. Thus, some may often appear
cheerful and optimistic while others are anxious and
unhappy. In later years, we usually continue our
basic moods, but the ways we express our feelings
often become more obvious.
Depression: Signs and
Causes:
In the midst of losses, such as physical
changes, death of friends or loved ones and reduction
of income, older people may begin showing signs of
depression. Some things to look for are:
- inability to concentrate or make
decisions,
- lack of feelings of enjoyment, or
enthusiasm even for doing those things that were
favorites,
- little interest in eating (causing
weight loss) or changes in eating habits
(overeating causing weight gain),
- lack of interest in being with other
people, or loss of sex drive
(libido),
- feeling unwanted and worthless,
sometimes leading to the thought that life is not
worth living,
- sadness or crying spells for no apparent
reason,
- problems with sleeping (sleeplessness
during the night or excessive sleep during most
of the day),
- feeling tired most of the time,
regardless of adequate rest.
If older people brood about their
unhappiness, much of their energy is focused on
worry. Part of that worry may relate to the fear that
they will become forgetful and unable to manage their
affairs. This worry can lead down the path to more
depression, which may cause physical
problems.
In exploring the cause of depression, the
following questions should be asked:
- Is there a physical or medical problem
causing the depression?
- Have there been changes in hearing,
seeing, moving, or other body
functions?
- What social contact does the
care-receiver have?
- What are the opportunities for
usefulness?
- What kind of personal losses (death of
friends, relatives, or pets) have there
been?
- Is the older person getting proper
nutrition?
- What kind of mental stimulation is the
person getting?
- Has there been a difficult adjustment
following retirement?
- Is the focus entirely on the past or is
there some enthusiasm about coming
events?
- Is there a possibility of reaction to
medications?
- Is there a dependency on alcohol or
drugs?
Once these questions have been answered,
steps can be taken to relieve the depression. It will
take some work from both the caregiver and the
care-receiver to change habits and routines.
Prolonged depression causes biochemical changes in
the brain, usually requiring treatment with
medication. The doctor is a good person the contact
to find help for treatment of depression. Other
resources are County Mental Health Centers,
psychologists, counselors or clergy.
Suicide Prevention
Suicide among the elderly is a significant
and ever increasing problem. Statistics show that 27
percent of all suicides in San Diego county (1985-87)
were committed by people 60 years of age and older.
Nationally, elderly (65+ years) made up 12.3 percent
of 1987 population and committed 21.0 percent of
suicides. Elderly complete one suicide every 1 hour
and 21 minutes, or each day 17.7 seniors committed
suicide.
Unlike other segments of the population, the
elderly do not often make threats or mention suicidal
thoughts to others. Therefore, it is important that
caregivers also know other warning signs:
- Depression - feelings of sadness,
hopelessness, a sense of loss and statements as
"Life isn't worth living" are common before a
suicide.
- Chronic or terminal illness.
- Withdrawal and isolation - suicidal
people may pull away from family, friends and
others close to them.
- Behavior changes - sudden changes such
as irritability, aggressiveness or changes in
eating and sleeping habits can signal
problems.
- Making final arrangements - a suicidal
person may give away valued possessions, making
out a will, make a plan for suicide, or write a
suicidal note in preparation. They may purchase
weapons or stockpile medications.
Suicide can be prevented. If the person you
care for shows any of the warning signs, you
can:
- Ask - don't be afraid to ask directly if
the person is thinking about suicide. It is not a
taboo subject. You will not be putting ideas into
the person's head. It can be a relief to the
suicidal person to talk openly about their
feelings.
- Listen - let the person express his/her
feelings and concerns. Don't worry about saying
the right things - just listen.
- Show you care - tell the person you care
and want to help. Take active steps to make sure
the person is safe; remove weapons, pills, etc.,
and stay with him/her.
- Get help - make sure the suicidal person
gets in contact with a professional counselor or
other helpful person who will know what to do. Or
have the suicidal person call (suicide
prevention/crisis intervention Hotline in your
community. Telephone numbers for such local
resources should be at the front of your
telephone directory.) A crisis counselor can help
figure out the best way to handle the situation
and give referrals to other
resources.
Death and Dying Interventions Elderly
terminally ill encounter anxiety and fear regarding
death:
- fear of the process of dying; will there
be pain?
- fear of losing control; will I be at
another's mercy?
- fear of letting go; I can not leave
family and friends to an uncertain
future.
- fear of seeing how others will avoid
me.
- fear of losing my caregiver; will he/she
be turned off emotionally to me?
- fear of the unknown after
death.
- fear that my "life's script" has been
meaningless, unfulfilled, a waste.
You may wish to ease these fears through an
open discussion of these fears and
intervening:
- Regarding the death process, a "faith
system" may be of great help; if you can get the
person involved in his/her religious faith, the
subject of death is well covered.
- Regarding fear of letting go and
isolation, assist then person to get his/her
"house in order." This entails a will, funeral
arrangements, burial plot, etc. Also attempt to
have the person and family involved discuss the
situation.
- Regarding meaninglessness of one's life,
have the person do a "Life Script," whereby
he/she writes all the good things done for
others, all accomplishments, etc. Then discuss
with the person that had he/she not been there to
do what he/she did at that time, no one else
would have, and society would have been the worse
for it. So he/she did make a difference. Truly,
no person is an island!
Promoting Emotional
Well-being
It is important to help the elderly remain
involved in decision-making as long as possible. You
must stress that needing help with everyday
activities does not mean that they cannot make
decisions for themselves. Also, granting others the
right to decide does not mean you are ignoring or
abandoning them. Caregivers need to be sensitive to
the right combination of giving just the right amount
of assistance and no more.
Ways to promote good mental health in the
elderly:
- encourage socializing with friends and
relatives through visits, phone calls or
letters.
- arrange fun times such as parties or
outings.
- help start new hobbies or revive old
ones.
- listen, talk, and share
feelings.
- assure privacy.
- treat with respect, not as little
children unable to think for
themselves.
- encourage movement and
exercise.
- help find ways to be as useful as
possible.
- strive to keep the lines of
communication open.
The Importance of Lifetime
Learning
Research shows that reaction time may be
slower in older people but they can still learn.
Families and friends may need to be patient in
waiting for responses. It is also important to
remember that short-term memory may not be as good as
it was.
The brain helps link people to the world. If
we are able to process and understand what we see,
hear and absorb from our senses, our experiences will
become more meaningful.
Sometimes older people are incorrectly
labeled as "senile"; the misconception is that they
are no longer able to think for themselves. However,
for the most part, older people continue to make good
use of their creative powers, and as is true for all
parts of the body, the brain usually will function
better if it is used regularly.
Lifetime learning means exploring new ideas,
whether this is from reading, listening to radio or
television, trying a new hobby, or trying a new
recipe. It can include lively conversation with
friends and family. What it boils down to is a
willingness to keep exploring the many adventures
that life has to offer.
The benefits of lifetime learning include
more enthusiasm for life, less boredom and
depression, increased feeling of self-esteem and
self-respect, more interest in the surrounding world,
and new ideas to share with family and
friends.
Memory Problems:
Memory loss can be one of the hardest
problems for both the care-receiver and the
caregiver. Some memory problems are treatable, some
are not. Therefore, it is important for the doctor to
determine the causes of memory loss in the
individual.
Forgetfulness, even inability to recognize
familiar faces and places, might result from such
treatable causes such as malnutrition related to
improper eating habits, alcohol, side effects of
medications, loneliness, isolation, few chances to
socialize with others, sensory impairment (decreased
vision, decreased hearing), surgery or accident
resulting in injury to body, viral infections or
other illness, or depression or other mental
illness.
Sensory Problems:
People who have losses in hearing and vision
may have trouble understanding things consequently
negatively affecting their emotional well-being.
Basic aids to hear and see are vital. At times an
older person may be cut off from the world because of
wax in the ears or worn out hearing-aid batteries.
Glasses may need to be adjusted or perhaps just
cleaned. Good lighting, without glare, is important.
Magnifying glasses or large print can make reading
easier.
Confusion:
For people who are confused, the following
tips can be useful:
- Make changes in routines
gradually,
- Be clear about reminders for
appointments or meetings,
- Write simple directions in large, clear
print,
- Use large labels (words or pictures) on
drawers and shelves to identify
contents,
- have clocks and calendars clearly
visible and mark off passing days,
- Make certain that medicine is being
taken regularly,
- Confused or forgetful patients must have
assistance with their medications,
- Encourage consumption of nutritious
foods,
- Encourage movement and/or exercise as
this will increase circulation of the blood and
help improve bodily functions, including the
ability to think.
Behavioral Problems:
For people who are acting out, being
disruptive, or have other undesirable behaviors, it
is best to not antagonize or confront but to
temporarily remove your presence from the person,
giving the message that "I love/care for you but not
this behavior." Below are some suggestions to
minimize undesirable behaviors:
- Avoid confrontation. If the behavior
deals with disrobing, offer brightly clothes
which make the person feel good.
- Don't argue. If the person becomes too
agitated, change the subject/object to something
completely different.
- Reduce stimulation. Lower lighting,
reduce noise (radio, TV) to soothing music,
minimize items in the area to a few possessions
known to the person, and avoid
clutter.
- Promote familiar objects,
pictures.
- Walk slowly with the person to reduce
anxiety and stress the muscle
tension.
Mental Stimulation:
Because many older people enjoy recalling
events from past years, families and friends should
encourage the sharing of stories. Activities which
stimulate the brain (visiting with others) can
contribute to the goal of continued lifetime
learning.
Often, older people can become happier, more
productive individuals when they are encouraged to
perform fun, brain-stimulating activities. The
following activities are especially good for
homebound elderly:
- sew or knit,
- be a friendly telephone
caller,
- be a foster grandparent,
- be a pen pal,
- be a reader to children at an elementary
school,
- save stamps for collectors,
- write favorite recipes on cards and
share them with others,
- read books, magazines,
newspapers,
- do puzzles (jigsaw,
crossword),
- try artwork (calligraphy, painting,
drawing),
- write or record memoirs, poetry,
thoughts,
- keep a joke book,
- care for pets or plants,
- listen to soothing music,
- take correspondence courses,
- play musical instruments,
- start or re-arrange a family photo
album,
- volunteer, at libraries, hospitals,
museums, schools, Retired Senior Volunteer
Program (RSVP),
- bake for self and others,
- plan a potluck or brown-bag lunch at
home,
- tutor or visit with children and
youth,
- type for self and others,
- participate in radio call-in
shows,
- learn to use a computer.
In addition, older people who are physically
able should be encouraged to participate in swimming,
bowling, gardening, dancing, miniature golf, nature
walks, mall-walking, jogging, shuffleboard and other
activities outside the home.
Drawing, writing, reading, crafts, taking
classes, and other hobbies encourage creativity.
Indoor games including chess, checkers, monopoly,
cards, billiards and Parcheesi provide interesting
relief from boredom as well.
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top
Legal and Financial
AffairsOlder people continue to be concerned about
management of their assets and property. However,
they may be unable to participate because of illness,
confusion or loss of memory. It is important to
involve them whenever possible.
Compiling an
Inventory:
Develop an inventory which lists all assets
and liabilities of the older person. The following
items should be included: bank accounts, pass books,
certificates of deposit, money market funds, stocks,
bonds, precious metals, jewelry, real estate deeds,
promissory notes, contracts, insurance policies,
safety deposit boxes (including location of the key),
and retirement or pension
benefits.
Location of the records for each asset and
liability also should be included. Other important
documents, such as birth and marriage certificates,
social security numbers, divorce decrees and property
settlements, income tax returns (state and federal),
death certificate of spouse (if any), and wills
(including the attorney's name and executor) or trust
agreements, should be listed and the locations
designated.
If able, the older person should compile the
list. If unable, a family member, attorney, banker,
accountant or certified financial planner can help
compile the inventory which should be copied and kept
in a safe, obvious place, possibly with a relative or
friend. It is important that the document be updated
every year.
Managing a Will and Financial
Affairs:
An objective of financial and estate
planning for older people is to plan for the orderly
distribution of the estate upon their death,
according to their desires.
Consequently, it is important for people to
have a will drafted, which incorporates the above
inventory and states how property is to be disposed
of upon death. Everyone over the age of 18 should
have a will or a similar legal
document.
If a person does not have a will, an
attorney should be consulted immediately. Proper
planning is essential and powers of attorney or trust
agreements should be executed while a person is still
competent.
Otherwise, transfer of responsibility for
management of the person's financial affairs to
someone else must be completed through a court
action, and costs spent in clearing up Probate
problems come directly out of the person's assets,
diluting whatever estate is left after
death.
Remember, as caregivers concerned about the
financial affairs of a care-receiver, you should not
get directly involved without legal authority. Acting
without clear legal authority, even with the best
intentions, can cause serious
problems.
The legal mechanisms available for surrogate
decision making are: durable power of attorney (DPA),
probate conservatorship, and durable power of
attorney for health care (DPAHC).
Durable Power of Attorney is a written legal
document giving someone other that the
Principal the authority to handle the
Principal's financial decisions. It must be signed by
the Principal while the Principal is still legally
competent. The DPA is valid without time limit until
the Principal either revokes the DPA or dies, or the
court revokes the DPA due to
mismanagement.
The preferences of the Principal regarding
the management of assets can be specified. This power
to manage assets can be transferred immediately or
can be designated to go into effect when it is
determined that the Principal has become mentally
incapacitated.
Financial decisions made by an individual
given DPA by the Principal are binding on the
Principal and his/her successors, so caregiver and
care-receiver are urged to seek the advice of an
attorney.
Probate Conservatorship or Conservatorship
of Estate allows for the management of the
Principal's money and other property when the
Principal presently lacks the capacity to either
decide or appoint another to decide financial
decisions in his/her behalf.
Court proceedings to designate a conservator
are required. This is a difficult and extreme
procedure but may be necessary if the care-receiver
is already incapacitated to the extent that he/she is
unable to manage personal financial
affairs.
Durable Power of Attorney for Health Care
(DPAHC):
is a written document which must be signed
by the Principal while he/she still has the capacity
to make decisions. The DPAHC gives someone other than
the Principal authority to make medical treatment and
health care decisions on behalf of the Principal for
up to the maximum of seven years after the document
is signed.
It allows one to specify ahead of time how
he/she wishes these decisions to be made. Wishes
regarding extraordinary supportive care, including
breathing machines and tube feeding, can be addressed
in the Durable Power of Attorney. All adults should
have a Durable Power of Attorney for Health
Care.
Lantern-Petris-Short (LPS)
Conservatorship:
(Laws vary from state to state, check your
state for comparable laws) or conservatorship of
person is a court-ordered process which enables a
person to get the psychiatric and/or medical care
needed but by reason of mental illness is
refused.
The court determines if the Conservatee, in
addition to receiving the necessary psychiatric
treatment, may also retain or be denied the right to
vote, possess a driver's license, enter into
contracts, or refuse non-psychiatric medical
treatment.
The Conservator may be a relative, friend or
an appointee from the Conservator's office. The
Conservator may be given the right to require and
authorize the conservatee to receive involuntary
psychiatric and/or medical treatment and supervises
and assists in making proper living arrangements,
including placement in a Residential Care or a
nursing home when indicated by the
doctor.
In order to start the process, one consults
either with his/her attorney or calls the Office of
the Counselor in Mental Health. An individual has to
be adjudicated to be gravely disabled before being
placed on an LPS conservatorship. Grave disability is
defined as the inability to provide for one's food,
clothing, shelter and proper medical care due to a
mental disorder.
Selecting an
Attorney:
It is important to select an attorney who is
knowledgeable in the areas needed (estate planning,
will drafting, probate or conservatorship). Ask
friends or other professionals for recommendations,
or contact a Lawyer Referral Service, County Bar
Association, or Senior Citizens Legal Services.
Before agreeing upon a particular attorney, ask if
he/she has previously done what you
require.
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Liability of
CaregivingAnyone who accepts the responsibilities of a
caregiver must also understand that there are a
number of legal duties or liabilities that come with
it.
Many states including California have passed
elderly abuse laws. Caregivers are bound by these
laws in two ways: not to abuse the elder person
(physically, mentally or monetarily) and report any
incidents of abuse or suspected
abuse.
As a caregiver, you must provide a clean and
safe environment, nutritious meals, clean bedding,
and clothes. At the same time, if you are in charge
of the elderly person's finances, you must use that
money properly, purchasing necessary services for the
benefit of the person to whom care is given. Failure
to provide care, failure to get care, and failure to
purchase care are all forms of abuse or
neglect.
In addition, caregivers may not physically,
sexually or psychologically abuse the person
receiving the care. Yelling, screaming, withholding
affection, etc., are as much an abuse of the person
as is striking the person with the hand or with
objects.
Therefore, if you are contemplating
becoming, or are now a care giver, you must be ready
to accept the physical, psychological and legal
duties to provide the necessary
care.
If you are reaching a point where you are no
longer able, physically or emotionally, to provide
the proper care, we urge you to consider the
alternatives to personal care-giving and to seek help
with this decision from a counselor or one of the
resources available in Appendix A.
47. When is it Time to Stop Caregiving?
As we have stated repeatedly throughout this
booklet, care-giving is a very stressful situation.
Stress either causes or exacerbates some 70 to 90
percent of all medical complaints, including tension
and migraine headaches, high blood pressure, asthma,
nervous stomach, bowel problems, and chronic lower
back pains. There is research evidence indicating
stress plays a role in a person's susceptibility to
heart disease, stroke, and cancer.
Stress has also been implicated in
psychological disorders such as anxiety reactions,
depressions and phobias, as well as poor work
performance, drug and alcohol abuse, insomnia, and
unexplained violence.
If you are experiencing any of the above, it
is extremely important that you learn and use various
techniques for stress reduction (some are mentioned
in this booklet), come to the decision, both for your
well-being and that of your care-receiver that it is
time to stop caregiving.
Below are some telltale signs which can help
you assess when you have reached this fork in the
road; seek help professional help, utilize more
stress reduction methods, or stop
care-giving:
- snapping at the care-receiver constantly
even over little things,
- being constantly irritated,
- seldom laughing anymore,
- feeling constantly tired or
pressured,
- losing sleep, failing to fall asleep for
hours, sleeping restlessly all night
long,
- yelling or screaming, or having crying
fits, or rages frequently,
- withholding affection, feelings of
goodwill from the care-recipient,
- withholding food, baths, dressing
changes, etc.,
- constantly blaming the care-receiver for
your being in this situation (his/her isolated
caregiver),
- refusing to go out anymore, even for a
walk because he/she needs me,
- withholding expenditures for goods or
services he/she needs because he/she is going to
die soon and it is wasted money,
While these are not exclusive, they
indicate a classic picture of caregiver
burnout. The treatment for caregiver
burnout is simple -- get help and get away for
extended periods, either through stress
management respite help or through a complete
change in care-giving.
No one can remain a full-time caregiver
forever; the job is much too strenuous and stressful.
The point we wish to set forth is: When should I
say this is my limit; I am not able to do any
more. Be honest with yourself, and when that
limit has been reached, STOP! Research
alternatives, request help from qualified
professionals, and rest easy, because you did the
right thing!
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Choosing a Residential Care
Facility
In making the decision to seek an alternate
living arrangement for your care-receiver you will
first need to consult with your physician. The
physician can be your best ally since most facilities
require a current complete physical exam and the
physician can assess the level of care your
care-receiver needs.
This is important in order to determine
which type of licensed care facility you will be
seeking, from the Acute Hospital to Sub-acute Skilled
Nursing Facility (SNF), Intermediate Care Facility
(ICF) or Residential Facility for Elderly (RFE) (more
commonly referred to as Board and Care or Retirement
Homes). The RFE is for non-medical care and
supervision which may include personal services (help
in bathing and grooming, guidance in dressing, aid in
taking self-administered medications) and help with
other daily living activities.
Seek a licensed facility, since people who
need care and supervision are often defenseless
against abuse or exploitation. The law requires that
care facilities be licensed. So when you select a
care facility, check for the license to assure the
protection provided by law and quality care for your
loved one.
What Should I Look for When I Visit a
Care Facility?
It is ideal if both you and your
care-receiver could preview a care facility prior to
deciding. Both prior to and during the preview
process you have the opportunity to further discuss
your feelings in making the decision. Since you have
many things to do during your visit, you will find
the outing less stressful and easier afterward to
evaluate if you organize your thoughts beforehand,
write down the questions you wish to ask, carry this
checklist during your visit and make notes while
looking around and talking to different people. Some
items you may want to cover during your initial visit
to insure quality care are:
- Ask to see the facility
license,
- Look closely at the building and
grounds,
- Talk to some facility
residents,
- Talk to the facility administrator who
is in charge of daily operations,
- Talk to some facility staff
members,
- Ask to see a copy of the Admission
Agreement.
Contact your County or State Department of
Social Services for a copy of their Consumer's
Guide to Community Care Facilities or
equivalent.
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