Caregiver Corner, by ResponseLink of San Diego and ElderCare Talk Radio

The loss of a loved one, be it a pet, friend or family member effects us,  both physically and emotionally.  Although one may not verbalize the effects of a loss, it is important to be aware of the stages of grief so you may be supportive during this time.  The stages of grief have no specific length of time and may continue for weeks, months or years. Research suggests that between 50-80% of people experience disruption of thought processes, emotional, physical and interpersonal functioning for at least the first few months after a loss (Bonnao & Kaltman, 2001).

The Stages of Grief include: Denial, Anger, Bargaining, Depression and Acceptance.  Each stage carries with it a set of behaviors and it’s own time frame. In many cases one may vacillate between stages.  For purposes of supporting someone you love (including yourself), it is important not to judge someones grief. Every person has their own timetable and trying to coax someone out of grief may backfire or create an uncomfortable relationship going forward.  However, grief counseling can be an important component to working through issues of loss and also may be of assistance in helping someone obtain closure. 

If you feel that someone you love needs assistance in the area of grief counseling, or you want to know the ‘right’ things to say or do in support of a loved one who is grieving, contact a hospice in your area and ask about counseling and support groups for loss and grief.  Most hospices provides supports groups at no charge and counseling for those families who have been under hospice care.   Some of the archived programs on the ElderCare Talk Radio website on hospice may also be helpful.

Taking care of a loved one, whether a spouse, friend or family member can be very stressful. Caregiving ranges from a phone call to check on health status all the way to providing hands on care on a daily basis.  Sometimes the stress of long distance caregiving can rival that of providing hands on care because of the helplessness of being so far away and not being able to really ’see’ what is going on with your loved one.  Also, not being in control of how care is being administered or by whom, can be very stressful.

It is always best to be pro-active in learning about the status of your loved one, and taking steps to be in the loop on an ongoing basis. Don’t wait until a devastating event such as a fall or a drained bank account happens to take action.  There are certain categories of caregiving that are very helpful to have in place before the need arises, including documents such as DNR’s (do  not resuscitate), Advance Directives, Wills, Trusts and the all important POA’s (both health care and legal powers of attorney).  There are several websites that provide the paperwork to help get started, but the real precursor should be a frank discussion of what the person you care for wants and needs into the future.  I recommend looking at 5 Wishes to help facilitate answering the important concerns.

The second category in which being proactive is vital is the ongoing healthcare of your loved one.  If you are able to accompany our loved one to doctor visits, do so on a regular basis. If you are not able to personally be there, I recommend a care manager. They will report to you what concerns the physician has as well as discuss medications and medication management concerns.  Many seniors over-medicate and don’t even realize it. Medication management if often a key aspect of remaining independent and should not be taken lightly. 

The third category is finance.  Scammers prey on those most vulnerable, including people that live alone and are easily swayed.  Junk mail (both ‘e’ and snail) regularly solicit seniors with ‘too good to be true’ products. Additionally, shredding of all un-needed bank solicitations is important, as they are electronically embedded with personal information, easily pulled by dumper divers.

Finally, assist your loved one with making their surroundings as safe as possible. Clutter is a major problem with seniors. Sometimes they don’t want to give up anything, or they don’t have the energy to clean up regularly, making for an unsafe living space. Grab bars and other safety items should be installed for assistance and the subject of home safety should be discussed on an ongoing basis.  A care manager can assist with this as well.

So, to sum it all up,  the message of the week is to be pro-active and leary of new people in your loved ones lives, monitor the financial situation and home safety situation frequently and make sure legal documents are in place and stored where they can be easily located.

The sentence “Toto, we’re not in Kansas anymore” conjures images of a frightened girl in a strange world, who relied on her ‘little dog’ for comfort.  That feeling of reliance on a pet for comfort is common among all pet owners and continues on into our elder years. 

Many people give up pets when they retire, so not to be encumbered with the care and maintenance of another creature.  Understandable, if you have an extremely active lifestyle. However, when we begin to slow down a bit, pets can actually help bring back a bit of ’spring to our step’

Most cats and dogs are low maintenance, especially as mature adults. They supply joy, comfort, friendship and protection.  We’ve all heard the stories of pets literally saving the life of their owner.  Myself, I find great solace in my pets when having a bad day or when I’m not feeling well.  Plus, it’s always nice to have someone who will listen to your hopes, worries, fears and silly jokes.  Pets are non-judgemental, don’t care what you are wearing, how much money you make, or what your hair looks like that day.  They care about you, just because you are part of their world. 

I bring all of this up because, loss and depression can be significant obstacles to happiness in our elder years. Pets can help alleviate those feelings and bring  joy in their place.  Studies have shown that pets have a significantly positive effect on our physical health. Just petting a cat or dog can lower blood pressure and relieve anxiety.

Many people don’t feel needed and lose their sense of purpose as they age. Children aren’t around much, maybe they can’t get around as easily as they once did. A pet provides a reason to get up in the morning, a reason to get dressed and get going. Someone (the pet) is looking forward to seeing them every day. That, in itself brings great value to one’s life.

If you had family pets in the past, think about bringing up the topic to your elder loved one (not recommended, however to suprise anyone with a pet).  The San Diego Humane Society has a Seniors for Seniors program, where pets are adopted out for only the microchip fee of $5. They match up a pet seven years old or more with the senior.  How great is that!

Assistive technology often gets a bad wrap from those to could really benefit from a bit of help.  Sometimes the issue is fear of the unknown or fear of of loss of independence. What is ironic is that the whole idea is to use assistive technology to be able to retain independence!  Although some technologies may, indeed, be intrusive to ones autonomy, most are not and are truly helpful in helping the person in need to navigate through their day with more success.  Assistive technology includes low tech devices like canes and grab bars, all the way to monitored ‘nanny cams’ and motion sensors which detect movement within in a residence.

Like all things, take what you need and leave the rest, but at least be aware of what is available.  As a guest on our local news over the weekend, we previewed a few low-tech options and they are offered here for your review: http://www.kusi.com/news/goodmorning/83201722.html.  The best way to start is to review which activities of daily living you or your loved one are having difficulty in completing, whether due to pain, stiffness or just plain lack of ability to complete the task.  Activities of daily living include everything from getting out of bed, using the restroom, grooming, bathing, dressing, navigating the rugs/floors, turning switches on and off, cooking, cleaning, taking medications, using the phone, writing checks…just everything.  Then, at your next visit to your healthcare provider, ask about what items you need that may require a prescription for medicare or other insurer to cover.  Also, look into what others are using to help the successfully complete the task, or go to your local medical supply store for a gander at all the amazing assistive products available to us today. 

Home safety is the category that always pops out first for me.  Feeling safe and confident in ones residence is vital to our well-being.  Grab bars, properly installed, provide confidence in the shower and tub.  A medical alert provides confidence after a fall or post rehab. It also provide peace of mind for the wearer and for their family.  Each assistive device is there for us to be able to live independently.  If you feel a walker or a cane is in your future or the future of your loved one, have some fun with it – get a cool looking device in the favorite color of the patient.  Knowledge is power, only if you take action. So, be proactive in learning about assistive technology and your loved one can retain independence while you get the confidence knowing that a little goes a long way in reducing your stress level when utilizing assistive technology.

Many seniors take multiple medications, with the average person over 75 taking at least four different medications on a daily basis.  This number doesn’t include vitamins or supplements.  That said, it is important to be on top of management of your loved ones (and your own) medications and learn about the risks, benefits and side effects of each.

Most of us don’t read the inserts that accompany medications, not only is the type usually too small, but many of us are not in a position to go through all of the contra-indications and warnings, especially if we are not feeling well. If we did, we might question our true need to ingest the medication!  There is an easy to navigate web site at www.drugs.com where you can enter the name of a medication and a list of the side effects and drug interactions will pop up for you.  I find it a valuable tool, especially if you, as a caregiver, find medication bottles without the inserts and want to create a folder for yourself and your loved one containing this important information. The more information you and your loved one know about their medications, the better patient they can be and the more pro-active they can be in their own care.

As a caregiver, medication management is going to be a top priority for you. It is important to have a discussion with the prescribing physician regarding medications, and the ongoing need for your loved one to continue taking them.  I have personally seen cases where people possess multiple bottles of medications, many expired and taking them, once in a while, is appropriate. Sometimes they don’t even know what the medications are for!  Supplements, when combined with certain medication ingredients may also exacerbate side effects. Weight loss or gain in a person may also have an effect on medication metabolizing and should not be ignored – dosage for a 115lb woman may be different than for a 150lb woman, question your doctors on this important factor.

Others have a difficult time managing medications and don’t have a solid system in place to ensure they are not double dosing or missing dosages.   Medication dispensers run the gammit from a small six slot container for daily dosages, all the way to automated systems that can store a week or a month’s worth of medications.  Of course, one must have a trusted source to fill the containers on a regular basis.  This could be a family member, church friend or a paid professional care manager. 

If your loved one is exhibiting mood changes, anxiety, sleep disorders, stomach disturbances, lack of appetite, or any other unusual symptom or behavior, it would behoove you to, not only consult your health care professional, but also check the side effects of their medications. If one is taking multiple medications, the side effects are layered and may cause significant physical and/or psychological disturbances.  Consult the physician and ask if a medication could be taken at a different time of day or at a lesser dosage, or be eliminated all together.  Lastly, make sure that all medications are purchased from the same pharmacy and show the pharmacist all medications and supplements that are being taken, as again, these may influence the effectiveness of the prescribed drugs and how they react within the body.

Lastly, adequate fluid intake is vital to medication metabolizing for both effectiveness and being flushed out adequately. Many seniors do not ingest enough fluid on a daily basis.  Dehydration can lead to a toxicity that influences behavior and may also contribute to the development of a UTI (urinary tract infection) that can cause cognitive impairment behaviors that are similar to Alzheimer’s Disease.

Everyone, at some point in their life, will know a caregiver, be a caregiver or need a caregiver.  Being a caregiver means having some type of responsibility for another person; be it financial, emotional, or physical.  Up until a few years ago, family members ‘took care of their own’ so to speak.  However, with changing family structures and the increasing need for women work outside of the home, the professional homecare industry has come into existence.  Although professional homecare may not fully replace the type care a family member might provide, in the emotional support sense, they certainly provide appropriate assistance to family members in the area of Activities of Daily Living. Activities of daily living include, bathing, dressing, driving, shopping, etc.

Currently, prices range from $19 – $23 per hour varied rates for 24 hour care. Most company’s have a minimum of 3-4 hours, however some offer less, some require more.  The rates are driven by both the level of assistance needed by you or your loved one and the tax/insurance burden.  There are options for low income families which need to be researched in advance, as they often take weeks or months to come through, learn about those options through Aging and Independence Services at 800.510.2020. When interviewing a caregiver or agency, make sure to ask what each level of care includes.  They range from companion, or homemaker through to certified nurse assistants. 

If your loved one has a long term care policy, check the wording in the policy for when the homecare reimbursement may be activated. There is criteria that must be met in order for the policy to payout. You can also, outside of the insurance realm employ a Case Manager or Nurse Case Manager to oversee the care of your loved one and report to you on a regular basis, rates are all over the board on this one and can reach over $150 an hour for this service. However, if your loved one is coping with cognitive impairment, this is a great option, especially when dealing with multiple symptoms and medications.

You also may want to use a caregiver, for respite care. This will provide you, the caregiver, with a much needed break.  Caregiver burden can create a great deal of stress, and if left unchecked, will lead to a multitude of health issues for the caregiver. Remember, you can’t be any good to your loved one if you are discouraged, sick and burnt out…respite care may be just what you need.  Caregiver agencies, Senior Centers, Adult Day Health Centers, friends, other family members and many Assisted Living Communities can assist you in getting some respite by caring for your loved one.

Bottom line, be proactive in looking into what your loved ones needs are and will be in the future. Plan for your loved one requiring some type of caregiving and be prepared in advance, saving you from a stressful situation in the future.  Also plan for your own respite. There are several quality homecare agency’s and care management company’s on our web site www.responselinksd.com. They are a good start for your research. Also you may want to tune into ElderCare Talk Radio, Sunday’s at 2pm on am1170, KCBQ for weekly information and inspiration for seniors and caregivers.

Each week we will offer information, inspiration and resources for family caregivers that will help you provide quality care for your loved ones.

Authored by Joanne Price, Director of ResponseLink of San Diego County, distributors of medical alert systems, visit www.responselinksd.com for more informaton. Joanne is also the host/producer of ElderCare Talk Radio, airing weekly on KCBQ, am1170, visit www.eldercaretalkradio.com for more information. She is also co-author of ‘Fall Injury Prevention for Older Adults…and Those Who Care’ available nationwide at www.amazon.com.