In hopes that all caregivers and care recipients can spare five minutes…
Check out Sarah Meyer’s 5-minute breath meditation audio.
med.stanford.edu/content/dam/
Robin
Category Archives: Caregiving – General
“‘Like Groundhog Day’: The challenges of caring for an aging parent”
This article in the Sydney Morning Herald is about the role reversal when children are now taking care of parents and what a difficult adjustment that is for everyone. The stories of three women are described.
Here’s a link to the article:
April 14 2017
‘Like Groundhog Day’: The challenges of caring for an ageing parent
by Cosima Marriner
The Sydney Morning Herald
“Grief before death – understanding anticipatory grief”
healthdirect is a government website in Australia with health information. This is a short article on anticipatory grief — the grief caregivers can feel though the care recipient is still living.
The full article is below.
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www.healthdirect.gov.au/unders
Grief before death – understanding anticipatory grief
healthdirect (Australia)
Carers often feel grief even though the person they’re caring for is still alive. This could happen if the person being cared for has a life-limiting condition (a condition that has no reasonable hope of a cure), or their personality has been affected by their illness. Although not everyone experiences this ‘anticipatory grief’, people who do can feel the same emotions and sense of mourning as if the person had actually died.
You may have a wide range of emotions, such as loss, dread, guilt and anxiety. Everyone reacts differently, and it’s good to accept that your coping method is unique.
The grief you might experience may not initially be for the person you care for, but for the life you currently lead. Becoming a carer can change your life dramatically, and you may feel like you’ve lost some of your freedom or social life.
The extra responsibility, and not being able to do anything without planning, can be stressful. You might feel guilty about feeling this way, but it’s a natural reaction to such a big change in your life.
Grieving before a person dies doesn’t necessarily mean that you won’t grieve when they pass away. Everyone reacts differently to these circumstances. While some people feel prepared for the death and have closure, others may start the grieving process all over again.
If you experience pre-death grief, it’s vital for you to talk to someone.
Dealing with conditions that affect a person’s personality and memory can be very traumatic, particularly if you’re caring for a relative or close friend.
Many carers find that they grieve for the loss of the person they once were. You might grieve for the memories that you have together, which the cared-for person will forget. You may grieve for the changes to their personality or for any future plans that they may no longer be able to carry out. You may feel conflicting emotions as the person you look after loses their mental functions or stops recognising you.
Terminal conditions
Finding out that someone you care for has a terminal disease can leave you feeling powerless and devastated.
If you experience pre-death grief, it’s just as vital for you to talk to someone and feel supported as it is when someone has already died. You might find that it helps to talk to friends and family, or the person you care for. A long illness means both of you have time to slowly prepare for the death, to say what you want to say or to share memories. One idea is to write about what the person has meant to you and then read it aloud to them.
You might also consider talking to a counsellor. It can help to discuss your feelings with someone who is objective and doesn’t have emotional ties to the situation. This can help, particularly if the person you care for is in denial about their condition. The counsellor can talk to you about your feelings, suggest ways that you can help the person being cared for, and discuss the difficult post-death decisions that you may need to make, such as organ donation.
Bottling up your emotions can leave you feeling overwhelmed and, in some cases, affect your health. So it’s important to find someone to support you.
Source: NHS Choices, UK (Grief before death), nhs.uk
“Some Seniors Just Want To Be Left Alone, Which Can Lead To Problems”
This is a good article on why some seniors refuse home health care after hospitalization. Medicare’s “home health benefit” is described generally.
Reasons seniors refuse care include:
* thinking that care is the first step in someone taking away independence
* not wanting strangers in the home
* not wanting someone to see hoarding or physical neglect in the home
* cost
On top of this, many seniors have:
* “unrealistic expectations of what recovering from a hospitalization will entail”
* compromised cognition, meaning they cannot understand their own needs or limitations
Some suggestions were given for communicating with seniors:
* Use plain language. For example: “A nurse will check your medications and make sure they’re all in order. She’ll assess if you need physical therapy to help you regain your strength. And she’ll teach you and family members how to care for you once home care is over.”
* Rather than saying “Look, we think you really need help,” say “We want to help you take care of yourself.”
* “Emphasizing that a physician has recommended home health care can also be helpful.”
* When meeting resistance from a senior, say “Tell me more. What are you concerned about?”
The full article is copied below.
Robin
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khn.org/news/some-seniors-just
Navigating Aging
Some Seniors Just Want To Be Left Alone, Which Can Lead To Problems
By Judith Graham
Kaiser Health News
June 15, 2017
The 84-year-old man who had suffered a mini-stroke was insistent as he spoke to a social worker about being discharged from the hospital: He didn’t want anyone coming into his home, and he didn’t think he needed any help.
So the social worker canceled an order for home health care services. And the patient went back to his apartment without plans for follow-up care in place.
When his daughter, Lisa Winstel, found out what had happened she was furious. She’d spent a lot of time trying to convince her father that a few weeks of help at home was a good idea. And she’d asked the social worker to be in touch if there were any problems.
Similar scenarios occur surprisingly often: As many as 28 percent of patients offered home health care when they’re being discharged from a hospital — mostly older adults — say “no” to those services, according to a new report.
Understanding why this happens and what can be done about it is important — part of getting smarter about getting older.
Refusing home health care after a hospitalization puts patients at risk of a difficult, incomplete or slower-than-anticipated recovery. Without these services, older adults’ odds of being readmitted to the hospital within 30 or 60 days double, according to one study.
Why, then, do seniors, resist getting this assistance?
“There are a lot of misperceptions about what home health care is,” said Carol Levine, director of the United Hospital Fund’s Families and Health Care Project, a sponsor of the new report.
Under Medicare, home health care services are available to older adults who are homebound and need intermittent skilled care from a nurse, a physical therapist or a speech therapist, among other medical providers.
Typically, these services last four to six weeks after a hospitalization, with a nurse visiting several times a week. Some patients receive them for much longer.
Many seniors and caregivers confuse home health care with “home care” delivered by aides who help people shower or get dressed or who cook, clean and serve as a companion. The two types of services are not the same: Home health care is delivered by medical professionals; home care is not. Nor is home care covered by Medicare, for the most part.
This was the mistake Winstel’s father made. He thought he was being offered an aide who would come to his apartment every day for several hours. “I don’t want a babysitter,” he complained to Winstel, chief operating officer of the Caregiver Action Network.
Like many other seniors, this older man was proud of living on his own and didn’t want to become dependent on anyone.
“Older adults are quite concerned about their independence, and they worry that this might be the first step in someone trying to take that away,” said Dr. Leslie Kernisan, a San Francisco geriatrician and creator of the website Better Health While Aging.
Other reasons for refusals: Seniors see their homes as sanctums, and they don’t want strangers invading their privacy. They think they’ve been getting along just fine and have unrealistic expectations of what recovering from a hospitalization will entail.
Or there are circumstances at home — perhaps hoarding, perhaps physical neglect — that an older adult doesn’t want someone to see. Or the patient’s cognition is compromised and he doesn’t understand his needs or limitations. Or cost is a concern.
Robert Rosati, vice president of research and quality at Visiting Nurse Association Health Group, New Jersey’s largest private home health care provider, said about 6 percent of seniors who’ve agreed to receive home health care from his organization after a hospitalization end up refusing services.
Often, a breakdown in communication is responsible. Patients haven’t been told, in clear and concrete terms, which services would be provided, by whom, for how long, how much it would cost and what the expected benefit would be. So, they don’t understand what they’re getting into, prompting resistance, Rosati said.
Kathy Bowles, director of the Center for Home Care Policy & Research at the Visiting Nurse Service of New York, suggests a plain-language, positive way to convey this information. For example: “A nurse will check your medications and make sure they’re all in order. She’ll assess if you need physical therapy to help you regain your strength. And she’ll teach you and family members how to care for you once home care is over.”
“A lot of resistance arises from pride,” said Bowles, also a professor of nursing excellence at the University of Pennsylvania. “The conversation has to change from ‘Look, we think you really need help,’ to ‘We want to help you take care of yourself.’ ”
Emphasizing that a physician has recommended home health care can also be helpful. “In my experience, if a doctor says ‘I’d like a nurse to come see you and check that you’re feeling better,’ people are fairly responsive,” Kernisan said.
Instead of arguing with an older adult who says “I don’t want any assistance,” try to follow up by asking “Tell me more. What are you concerned about?” Kernisan suggested. “People really want to feel listened to and validated, not lectured to.”
This isn’t to suggest that persuading an older adult to accept unwanted help is easy. It’s not.
Last year, Winstel’s father had a medical device implanted in his spine to relieve pain from spinal stenosis — an outpatient procedure. Once again, he declined postoperative help.
Two days later, Winstel got a phone call from her dad, who had collapsed and couldn’t get up from the floor. Winstel said she’d call 911. “No, I don’t want someone coming in and finding me like this,” her father insisted. “You have to come.”
Later, at the hospital, doctors diagnosed an adverse reaction to medication and a surgical site infection on her father’s back. “He lives alone. He can’t reach back there. He wasn’t caring for the wound properly,” Winstel explained.
Extensive, heated conversations followed, during which her father insisted he was never going to change. “For him, living independently carries risks, and he’s willing to accept those risks,” Winstel said.
She hopes the new report on seniors refusing home health care will jump-start a conversation about how to bring caregivers into the process and how recommendations should be conveyed. “As the daughter of someone who has refused care, understanding that this is something lots of people go through makes me feel a little less crazy,” Winstel said.
KHN’s coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation.
“The Five Love Languages of Caregiving”
This is a thought-provoking article written by a hospice social worker, Meredith Fields Lawler, LCSW, for Crossroads Hospice (based in several southern and midwestern states).
The ideas are based upon a book by Dr. Gary Chapman titled “The Five Love Languages,” which asserts that “people express and desire to receive expressions of love differently.” The five languages are:
#1 – Words of Affirmation
#2 – Quality Time
#3 – Receiving Gifts
#4 – Acts of Service
#5 – Physical Touch
The hospice social worker suggests you know which of those five languages your loved one “speaks,” and then tailor your caregiving accordingly.
Food for thought….
Robin
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crhcf.org/Blog/the-five-love-l
The Five Love Languages of Caregiving
by Meredith Fields Lawler, LCSW
Published June 28th, 2016
Crossroads Hospice Charitable Foundation
Love. It is such a simple word that has so many varying different expressions. There is the love we give to our spouse, which is different from the love expressed to our children, and yet different again in how we express love to our friends.
In 1992, renowned marriage expert Dr. Gary Chapman wrote a revolutionary book titled “The Five Love Languages” in which he helped us see that all people express and desire to receive expressions of love differently. Chapman’s book was focused on the marriage relationship, but since it was published, many companion pieces have been written about how these simple concepts are relatable to all relationships.
The caregiver role is one that is full of so many emotions and yet the central expression is love. It is true that some people give care out of a sense of obligation, but most have the driving force of love and devotion. Love is what gets them out of bed for the third time in the middle of the night as they hear their loved one calling. Love is what drives them to spend hours each week organizing medications. Love is what encourages them to sit down and listen to Mom tell the same story over and over again.
My sister, brother, mom and I all cared for our father when he was diagnosed with cancer and subsequently was admitted to a hospice program. Each of us loved my dad dearly, but how we expressed our love to him looked different. We are different people. Each of our relationships with Dad was unique and special. Love was so present in our caregiving in many ways.
Using Chapman’s iconic book, we will look at the Five Love Languages of Caregiving and how love is given and received in this relationship, and begin to appreciate and respect how different family members all express love and caregiving in their own unique way.
Using words that uplift and support caregivers can show them love and provide for their needs while on the caregiving journey.
Love Language #1: Words of Affirmation
“Love is kind. If then we are to communicate love verbally, we must use kind words.”
Dr. Gary Chapman
Jamie and her husband Carl cared for Jamie’s mother for many years before she passed away. First she was in their home and then they moved her into a nursing facility when she needed more care. Jamie made all the arrangements, planned transportation, signed the forms, packed her mom’s belongings and the many other tasks involved in moving a loved one into a nursing home.
The big day came and Jamie got to work getting her mom settled, but noticed that Carl was nowhere to be seen. She began to get frustrated as more time passed and still no sign of Carl. A couple of hours later, after all the unpacking had been done, Carl appears in the room and Jamie immediately gets angry with him. “Where have you been? I have been in here working myself to the bone and you have probably just been talking!”
Carl very calmly explains, “Yes, I have been talking. I have been talking to all of the staff. I introduced myself and told them about your mom and I was getting to know them. I have asked about their lives, their children and thanked them in advance for taking care of Grammy. I want them to know I care about them because then they will give Grammy more attention and affection when we are not here and I know that is a huge fear for you.”
In that moment, Jamie saw that Carl was being a caregiver in his way. He was giving words of affirmation to the staff and that is how he cared for her and her mother.
How to be a caregiver alongside someone whose love language is Words of Affirmation:
* Speak words of appreciation, encouragement and love to each other.
* Love does not keep a record of wrong. Use kindness in your words to each other and let the past be that; the past.
* Love is not demanding. When you need something, make a request and not a demand.
* Express gratefulness for what has been done and don’t focus on what has not.
The caregiving love language of spending quality time: Spending quality time with caregivers can communicate love to them and demonstrate to them your support.
Love Language #2: Quality Time
Spending quality time with the people you love is something that most of us enjoy, but for some, this is the ultimate expression of love. For those whose primary love language is Quality Time, sitting and talking, enjoying an activity together and being fully present is the ultimate way to give and receive love.
Mary and her husband Brad cared for their adult daughter who had developmental delays. Mary was the primary caregiver and did not work outside of the home. Brad was a hard worker and a loving provider for their family. For many years, he worked to build his business and provide financial security for his family.
He thought he was doing the most loving thing, but Mary was not happy. She was sad and felt so alone most days. Long days of caregiving would deplete her of any energy she had left. She would often say that she wished Brad would work less and spend more time with her, and yet Brad felt he was doing what would help her the most, as she wouldn’t have to worry about finances.
But, what Mary wanted was him. She wanted his attention and his love. They slowly began to figure this out and Brad began to make time with Mary more of a priority. He would arrange for someone to watch their daughter so they could go to dinner alone. He began to call her during the day, not to talk details, but to see how she was feeling and engage in her everyday life. Even when he had to be away for work, he created ways for Mary to feel his love and planned events for them once he returned.
As Dr. Chapman states, “One of the by-products of quality activities is that they provide a memory bank from which to draw in the years ahead.” Brad began to speak Mary’s love language and she was able to caregive from a happier, more secure place and peace returned to their home.
How to be a caregiver alongside someone whose love language is Quality Time:
* Learn to really listen when your loved one is speaking. Look them in the eye and do not attempt to complete another task while they are talking to you.
* Acknowledge their feelings without trying to “fix” anything, watch their body language and do not interrupt. Be fully present!
* Arrange for help with household chores to free up more quality time together.
* Make the time for quality activities — no more excuses.
Love Language #3: Receiving Gifts
“Almost everything ever written on the subject of love indicates that at the heart of love is the spirit of giving.”
Dr. Gary Chapman
Gift-giving is one of the oldest ways people express their love to one another. Whenever we attend a happy event, a wedding, baby shower, birthdays, or graduations, we bring gifts!
We honor people by spending time thinking about them, picking a gift out just for that one special person, wrapping it and presenting this beautiful visual representation of love. Very often, the dollar amount is not nearly as important as the time and thought devoted to the act of gift-giving.
Richard lived in an assisted living center and had three sons who all cared for him in their own way. His oldest managed his finances and ensured that everything was paid on time and that his money was being invested wisely. Richard’s middle son took him to doctor’s appointments, the grocery store and kept in communication with the staff at the facility. And Richard’s youngest son was the free spirit. He jumped from job to job and passion to passion.
He did not take on any “official” tasks in caring for his dad and his brothers would often get angry with him, and with Richard, because Richard would defend his youngest son. He would tell the other boys, “You don’t see him like I do. He comes and visits and always brings something: an article he thinks I will like ripped from an old magazine, a new shirt he found at Goodwill, his leftovers from lunch. Nothing big but he comes, he visits and he brings me something that lets me know he is always thinking of me. I feel loved by all of you, including your little brother.”
Richard was able to accept loving care freely given by each of his sons in all their unique and beautiful ways.
How to be a caregiver alongside someone whose love language is Receiving Gifts:
* Accept their gifts with gratitude and love no matter how small, even if you don’t like it.
* Honor the wisdom that one of the greatest gifts you can give is the gift of self. Be present for each other and slow down! Try not to rush around completing tasks, but give of yourself and your spirit.
* Bring them a gift — a small token of your appreciation that you are caregiving together. This will go such a long way in helping someone with this love language truly feel like you are a team.
* Acts of service support caregivers tangibly, showing them love through your outpouring of acts and service into their life.
Love Language #4: Acts of Service
Jan was caring for her father in her home, and her sister, Martha, lived close by and was an active caregiver as well. Jan and Martha worked so well together taking care of their daddy. They had love and respect for one another in the process of caregiving.
It was Martha’s practice to come by every day after work and check in on her dad and sister; she also knew that Jan’s love language is Acts of Service. So, when she arrived she would immediately take over whatever task Jan was doing and say something like, “I’ve got this. I can tell you have worked so hard today. Let me finish loading the dishwasher and cleaning up the kitchen.”
This was their routine to the point that when Jan saw Martha’s car turn the corner, she was filled with love for her sister and love for the caregiving process. Martha helped to fill Jan’s “love tank” so that the everyday duties of caregiving never felt crushing. She knew her sister understood her and appreciated her.
For a weary caregiver, (regardless of what their primary love language is) offering to help in tangible ways will sing love to them. “Let me know if I can do something for you,” is a lot less meaningful than “I would like to come and mow your yard on Wednesday. Let me know if that works with your schedule.” Offering very real help during a time when it can be hard for caregivers to even know what they need is a sure way to show your love and appreciation.
How to be a caregiver alongside someone whose love language is Acts of Service:
* Create a list of things you would like to do to help (bring a meal, clean their bathrooms, do laundry, go to the grocery store) and ask them which day would be good for them.
* When you are visiting, look around. If there is a broom handy, start sweeping while talking. If you notice that they are low on household staples when you leave, run by the store; drop those things off to them during your next visit.
* Get a group of friends together and have meals delivered a couple times a week.
Love Language #5: Physical Touch
Sadly, this life is full of crisis — auto accidents, illness, lost jobs, divorces and of course the death of dear loved ones. Crisis is all around us, and when these moments come, the natural instinct of many is to reach out and offer a hug. Physical touch is a way that all cultures show love and concern to each other. During times of crisis, we all long to feel loved, heard and supported.
Caregiving can have many crisis moments. “There are no more treatments.” “Your mother needs to be admitted to the hospital.” “The cancer has spread.” “I am so sorry, but you need to find another nursing home for your husband. He can’t stay here.” These are all statements that caregivers have heard and they each bring tremendous stress and sadness. For someone who has the primary love language of Physical Touch, a hug, a loving hand placed on the shoulder or a holding of the hand will all convey that you are present in their crisis in a huge way.
Barbara and her wife Vicky cared for Barbara’s brother, Gary, who was on hospice after a lengthy battle with cancer. He was living at an inpatient hospice facility and everyone knew that his time was short. Barbara was Gary’s primary caregiver and had been taking him to appointments, helping him through chemo, cooking for him, cleaning his home and doing all the other tasks of caregiving for many years. Barbara and Gary’s love for each other ran very deep
Vicky began to see her wife withdraw into herself as Gary began to slip away and become less responsive. Barbara would sit in the room with Gary, her arms tightly wrapped around herself, and every few minutes, she would reach out and touch Gary. Vicky realized that Barbara needed love. She needed to have a physical reminder that she was a good caregiver and had done well.
Vicky made a conscious decision to offer her love to Barbara in the ways that she needed. She held her hand, stood by Gary’s bed with a hand on Barbara’s shoulder and wiped her tears away as she cried. She was physically, and thus emotionally, present for Barbara.
As Gary took his last breath, Vicky held Barbara and supported her weight as she wept for her brother. Vicky did not let go and Barbara will say she does not remember much of that day except that “Vicky was there. She did not say much but she was with me. She held me, she loved me and I knew I could face tomorrow because she was going to be with me.”
How to be a caregiver alongside someone whose love language is Physical Touch:
* Find ways to offer your physical presence to them through a hug, holding a hand, stroking stoking their back or gently rubbing their shoulders.
* Do not shy away from their touch even if this is not your love language. If you did not grow up in a “touchy” family, it may seem awkward at first. Be patient with yourself as you learn to express love in a different way.
* Having something soft to hold can help someone whose love language is physical touch. When you have to leave, bring them a pillow to hold or a blanket to lay across their lap. This can be a great comfort.
All five of these love languages are important and should be present in any relationship. If someone you love has the primary love language of Gift-Giving, Gift Giving that does not mean that you never hug her or complete a task for her. As Dr. Chapman says say, all of the love languages will convey love, but when you find the one that really speaks to your loved one, that language that one will sing of your love for her.
My siblings, mother and I were able to love each other and my dad in very real ways and we are continuing even though Dad is now gone. My dad taught us about love — about meeting people where they are and loving them in the ways that they need. So even though Dad is not here physically with us anymore, his loving spirit will always be alive in our hearts.
* All stories are based on actual caregivers but the names and some details have been changed to protect confidentiality.
About Meredith Lawler, LCSW
Director of Outreach Programs at Crossroads Hospice Charitable Foundation
Meredith Fields Lawler is a Licensed Clinical Social Worker and the Director of Outreach Programs at Crossroads Hospice Charitable Foundation. A graduate of the University of Arkansas School of Social Work, Meredith has dedicated her career to medical social work, the elderly, hospice, death and dying and grief recovery work. In addition to her work at the Foundation, Meredith maintains a private practice in which her specialty is older adults undergoing life transitions, trauma, grief and loss. Meredith makes her home in Tulsa, OK with her husband and their three boys.