How can a caregiver support group help me?

Remember that old adage, "trouble shared is trouble halved"? A support group is one way to share your troubles. In most support groups, you'll talk about your problems and listen to others talk; you'll not only get help, but you'll be able to help others, too. Most important, you'll find out that you're not alone. To find a community support group, check the yellow pages, or call a local organization that deals with the kind of problem you would like to address in a support group. (Examples are Alzheimer's, bereavement, stroke, disability, hearing or vision loss, or aging in general.) If it's a medical problem, ask your doctor or hospital.

Financial Planning

Many families find that discussing financial matters can be a very sensitive topic. Especially if a family member is ill, it can be difficult to discuss what the person's wishes are for when they are no longer able to make financial decisions for themselves. However, having financial affairs in order allows the person who is living with Alzheimer's disease or another related dementia the knowledge that they have taken care of their family.

Take Care of Yourself First

Helpful Tips for the Caregiver

        January 16, 2008

• Keep a diary/notebook to help you remember changes in health status, events, and appointments. You may wish to refer to your diary in an emergency situation.
• Have a list of the medications (if any) on hand, and in case of an emergency, take the medication bottle(s) with you to the hospital.
• Be informed about their medical condition/disability. What is normal, what is abnormal?
• List emergency and frequently called numbers by their telephone.
• Be familiar with legal/financial issues (if applicable) (i.e. power of attorney).
• Help them remain independent by letting them do as much as they can for themselves.
• Become familiar with the community help available.
• Know the physician, the pharmacist, the dentist, other service providers and Community Health Centre in your area.
• Have a back-up plan for care in case you are sick, or unable to keep a commitment (e.g. another caregiver on your team, which may be a family member, friend, relative, clergy, etc.). Keep a list of these people handy, for when you need them to help out on short notice.
• Encourage good communication.
• Take care of yourself!

Communicating with Agencies

• Have your diary/notebook handy.
• Write down your questions ahead of time.
• Prepare to invest time. Finding the right answer/person may take longer than expected.
• Have personal numbers handy (e.g. OHIP card, etc.).
• Be patient. You might have to repeat your story, or you may be put on hold or transferred.
• Record name and extension of the resource person and write down comments/impressions.
• Be specific, polite but firm.
• Phone in the morning or right after lunch.
• Speak up - never assume others know what you need.
• If you have to go for a meeting, ask what you need to take with you.
• If at first you don't succeed, try again!

Recognizing Caregiver Stress

December 6, 2007

Family Caregivers have become important members of the patient recovery and care team.  But at what price?

As the number of Canadian seniors continues to swell, caregiving - unpaid homecare services provided by family and friends - has become more widespread than ever before.  Over 4.5 million Canadians play a role in caring for an elderly family member or someone with long-term health problems.

Caregiving can be personally satisfying, but caring for a loved one on an ongoing basis can also be a source of significant stress.  Family caregivers have become important members of the patient recovery and care team, but with very limited financial and resource support.

As a result, caregiver stress and burnout have become hot topics amongst middleaged Canadians who are caring for elderly parents while looking after their own children and managing full-time careers.

Family caregivers under pressure

Studies show that the responsibility of providing unpaid care to a family member can have a significant psychological, medical and financial impact on a caregiver's well-being.

- 21% report their health has been negatively affected - e.g. fatigue, physical illness, depression
- 29% report altered sleep patterns
- 25% report increased financial strain
- Nearly half say caregiving has had a negative impact on their job performance
- Caregivers who are experiencing strain have a 63% higher mortality rate than non-caregivers

Is help on the way?

Federal and provincial governments have recognized that unpaid caregiving is an important component of an integrated healthcare system.  The Romanow and Kirby healthcare commission reports in 2002 acknowledged the critical role of caregivers and recommended they be included in a national homecare strategy.  The 2003 First Ministers' Health Accord established funding for a baseline Canadian homecare program.  Federal and provincial budgets since that time have increased homecare funding.

But additional reforms are needed, and pressure on governments for more action continues to build.


Lifeline Connections Fall 2007

Comfort Drawer

November 20, 2007

To help you through the long winter months it may be helpful to develop a Comfort Drawer. The idea of the comfort drawer was developed by Marie Lloyd, and was taken from the book Simple Abundance: A Daybook of Comfort and Joy, written by Sarah Breathnach. A comfort drawer is a drawer or box set aside just for you. This drawer is a place where you put all kinds of nice comforting items that you may need on a low day.

To decorate your drawer you can line it with nice flowery paper or whatever paper you choose, then add some nice smelling packets, so that when you open this drawer the aroma will be delightful. Next add the things that you most desire. This may include your old love letters tied up with a beautiful ribbon. Some other things to include could be some bath crystals and some candles to use for a nice relaxing bath. Other things to include may be a small box of chocolates, a book of poetry, a magazine of your choice, or anything that does not cost a lot, but will make you feel better.

So if you are having a day where you feel like you can not see anything happy go to your comfort drawer and see what you an find. Take out the bath salts, and candles, change the bed sheets and have a cozy soak in the tub to candle light and soft music, then curl up in your fresh bed and relax with your good book and chocolates! Ahh! Comfort.

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Dining with Dignity Even When it Seems Impossible!

  By Jo-Anne S. Kelly 
 August 1, 2007
 
The phone is ringing off the hook while you, the caregiver, have your hands full: tying the bib around Dad's neck; stirring the pot on the stove; wiping the tears from your toddler's cheeks while trying to bandage his skinned knee. You grab a quick snack of candy. Meanwhile, Dad is sagging in his chair, hungry, angry and perhaps, unaware of the turmoil surrounding him. As you attempt to feed him, Dad grabs the spoon and spills the pureed baby food all over himself and onto the floor.

Anyone who is a caregiver could easily see herself in this picture. How can you ensure that Dad and the rest of the family get the proper nutrition they need, while simplifying your life at the same time?

Food is more than just something to eat. Of course, most of us eat for pleasure and enjoyment, even Dad, bib and all. Food is love, security, and comfort. Food carries with it positive (happy times, holidays, hospitality) and negative (pureed food is for babies not older persons) associations.  Other considerations include religious, ethnic and cultural habits. Convenience, availability and cost are important too. It is said, "We eat with our eyes," so appearance and aroma are important. Let's not forget nutritional value! Sometimes a diet is modified for medical reasons such as low fat, high fiber or a tube feeding of a special formula. These modifications may impact negatively on the dining experience. Consider for a moment the person who must eat pureed foods.

Pureeing foods at home can be fraught with problems. Proper texture is difficult to determine and doesn't always turn out right. Contamination can be a serious problem. Are your hands really clean? Are all preparation surfaces (including the blender) bacteria free? Food is handled several times. Did you keep hot foods hot and cold foods cold? Was the final appearance of the product visually appealing? If not, you may want to inquire about the new frozen, molded, pureed products on the market. These items offer a consistent consistency, are safe, delicious, and have great aroma and eye appeal. They are timesaving, convenient, and may be heated on demand. Because the items are flash frozen, nutritional value is preserved. Best of all, the food looks like “real food," not baby food.

What about when friends and family ask, “Is there anything I can do?”

1) Come for dinner Wednesday night...BRING DINNER.

2) Make us a pot of homemade soup (low salt, no cream, be specific).

3) Check with me before you go to the grocery store so I can add a few items.

4) Give the gift of home-delivered meals.

5) If you go out to eat, bring me a "people" bag.

6) Give a gift basket of staples such as tuna, peanut butter, pasta and sauces, cheese and crackers, dried fruit, herbal teas, bottled sparkling water.

7) Give gift certificates from local grocery store.

8) Take the kids out for an afternoon snack or early supper.

9) Come "sit" while I go out for lunch.
 

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Recharge

By Mary Damiano
July 4, 2007
 
Recharging your batteries is one of the most important ways to help your loved one.

R:  Rest.  One of the most important things a caregiver can do for the person they’re caring for is to take care of themselves.  A caregiver who wears himself out, and keeps going 24/7 risks burnout.   

E: Eat right.  Take a cue from your loved one’s diet and take the opportunity to eat healthy things as well.  Maybe you don’t have to adhere to such a strict diet, but eating right certainly never hurts.

C:  Communicate your needs to others.  Don’t expect anyone, even other family members to read your mind about what you need or what your loved one needs.  Let people around you know the things that need to be done and that occasionally; even you could use a hand. 

H: Hydrate.  Drink lots of water.  Water hydrates your body and keeps you energized. 

Take vitamins if you don’t get enough nutrition from your food

A:  Accept help.  This can be the hardest thing for the caregiver to do, but it’s one of the best things a caregiver can do for their loved one and for themselves.  When people offer to help, often caregivers turn them down because they don’t want to burden them or because they can’t think of something off the top of their heads.  Get over the notion that the only way to get it done is to do it yourself.  When you have a few moments, really think about the kinds of things that will make life a little easier.  Then when people ask how they can help, you’ll be ready.  When you tell someone something very specific, they’re more comfortable doing it, and you’ll get the help you need.  Helping makes people feel good about themselves.  Don’t deprive anyone of that joy.

R:  Respite.  Caregivers should make a point of getting away sometimes, to take a mini-respite for themselves.  A movie, lunch somewhere, window shopping or just walking along the beach or through a park can be enough to get some distance, and come back with a fresh perspective on things.

G:  Get enough sleep.  This is often the hardest one to manage because you’re on someone else’s schedule.  But sleep is one of the best things we can do for ourselves.  Eight hours are ideal, but the concept of getting eight uninterrupted hours of sleep might be impossible.  Try breaking sleep up.  Get what you can in one shot, but take a nap during the day.  A short nap can be very refreshing and just the thing you need to get you through the day.  

E:  Exercise.  Anything will help.  Walk around the block a few times a day when you have a few spare minutes.  Try yoga, something that will exercise your muscles, yet relax your mind.  Meditate.  Spend a few minutes alone and quiet. 

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Time out for the Caregiver

June 1, 2007

1. Sing at the top of your lungs for five minutes by the clock. Don’t worry about neighbors, they need a mood lifter, too.

2. Set your alarm clock 15 minutes later than usual. What a luxury to ignore habits, sometimes.

3. Eat dark chocolate. Sit quietly. Eat tiny bites and allow them to dissolve very slowly on your tongue. Taste and feel.

4. Hold a baby. Use all five of your senses to experience the miracle. Then look deeply into her eyes. Do you see the collective knowledge of our past?

5. Walk a dog or play with a puppy. Try to emulate how they express emotion. No, really. No one will see.

6. Put on great music and clean something thoroughly or dance with abandon.

7. Finger paint. (Really!) Make a mess. Get real sloppy, enjoy the feel. Then clean it all up and hang your masterpiece in a conspicuous place.

8. Make tea with lots of lemon and sit in a sunny spot to sip it slowly. Breathe the scent. Weather bad? Sit in a sheltered place and watch the sky change moment by moment – it always does. Don’t miss it.

9. Watch a terrific comedy or your favorite old movie.

10. Make chicken soup and serve it to at least one friend.

11. Walk in the rain without an umbrella. Best done in warm weather.

12. Double your time in the shower - use very expensive soap. Slather it everywhere.

13. Send yourself or someone else flowers. If budget is a concern, buy the flowers at the grocery market and deliver them to the friend or to your kitchen table. Repeat as needed.

14. Jump rope for five minutes, even if you only step over the rope with each revolution.

15. Call someone you haven't spoken to in a long time and catch up. If you owe someone an apology, give a heartfelt one – you’ll feel sooo good!

16. Don't watch the news or read the paper unless you only read the comics.

17. Buy a new item of clothing or accessory that's brilliantly colored. Flaunt it.

18. Listen to some classical music all the way through. Feel the emotion.

19. Read poetry for a half hour. Then do it again tomorrow.

20. Take a long, warm bath with mood lighting and a lovely scent.

21. Visit someone who is housebound, hold their hand, and talk about soft, pleasant things.

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Take Pride

April 18, 2007

Take pride in your efforts. Being a caregiver is not easy, and those who do it are special. Following the tips for Caregiving can help you feel good about yourself and the care you provide. Remember:

• Care for your own needs first. Your physical and mental health depend on it. Give yourself as much special attention as you give the person you care for.
• Help the person you care for to be independent. This is a gift to both of you.
• Recognize when you need extra help, and know where you can get it. A helping hand at the right time can make all the difference

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Sleeping problems and Sundowner’s Syndrome,

March 10, 2007
By Starr Calo-oy

Tips to help the Sleepless

Most people with dementia suffer from what is known as “Sundowner’s Syndrome.”  Late in the day, usually after dark, they become even more restless and suffer from heightened insecurity and confusion.  The many symptoms that accompany dementia such as lack of concentration, suspiciousness, paranoia and even combativeness are heightened as the day wears on and fatigue sets in.

 

They get tired more often and are much more difficult to work with or direct then.  There are “day noises” that have been common to them all of their lives, so they feel more secure when it is light outside and it is easier for them to sleep because of this.

 

However, at night, many of these familiar sounds cease and they tend to become frightened.  If their room is dark, it can cause them to panic because they may not know where they are, how they got there and who is lurking just outside their room.  They will get out of bed and seek out the light to feel more secure.  If you leave a night light on, you may see an increase in the length of time they sleep at night.  Another reason for the increase in agitation is because they cannot adequately communicate their needs such as having to go to the bathroom or being hungry and thirsty. 

 

Sometimes, they may be feeling depressed and no longer have the ability to communicate the need for companionship.  If they see others around them, at least there is a chance of someone giving them food and water, taking them to the bathroom or lovingly touching them if it is daylight.  But, when it is dark outside, in the house or their room, their perception is that they are the only person who seems to exist in their world.  If they wake up all alone and they can’t communicate their needs, it brings on overwhelming anxiety and sometimes, a catastrophic reaction.

 

For example, imagine this: You are blind and there is no one near you who speaks your language.  No one know you and you don’t know anyone either.  No one can help to guide you to the bathroom and you really need to go immediately.  You have no one in the world that knows you anymore; you are lost.  If you truly closed your eyes and tried to imagine what I have just described, then you have an inkling of the sheer terror that someone with dementia feels, especially in the night.  Here are a few suggestions to help them:

 

Tip #1

Put a nightlight in their room and either a bedside commode or a nightlight in the hall and bathroom, to light their way, if they still are able to get up and toilet themselves.  If not…

 

Tip #2

Put an open intercom or baby monitor in their room, and put the mate for it next to your bed.  This way you will be able to hear them get up or call out.

 

Tip #3

Make sure your loved one (LO) takes an early afternoon nap.  If they won’t lie down, try lying down with them on their bed and snuggling.  Tell them that you need to be held like they held you as a child and that you can’t go to sleep without their arms.  Have soft music on low and you may get faster results.

 

Tip #4

If your LO is not in jeopardy of falling and wants to pace or wander all through the house, let them.  When they finally get tired, suggest they rest.  Portable gates can help keep tem out of unsafe areas.  All you have to do is secure them a little higher than you would for a baby or use two in the door jam rather than one.  If they are unsteady on their feet, try taking them for a ride in their wheelchair.  If they try to get up while in motion or even while sitting still use a lap belt for their own safety.

 

Tip #5

Try keeping a television on low at night, all night, but not on anything violent.  Put it on the Christian network.  The voices and low light may be just what your LO needs to help them start sleeping longer periods.  Most people think that they need total darkness and quiet but this is not true at all.  There is tremendous security in their hearing voices as they go to sleep.  I have found that they will stay asleep much longer with the TV on.  The best thing you could do for your loved one is to have a multi-CD changer on continuous play with music all night for them.  We do this in our home and have found a complete change in personality in a matter of days.

 

Tip #6

As a last resort, ask your doctor for something to help your LO sleep at night.  There are a wide variety of sleep medications on the market right now, but your doctor should take all the rest of the meds your LO is on into consideration before prescribing a new one.  Some meds take 1-3 weeks to get into the system so you need to ask the doctor how long before you will see relief.  Give the sleep medication to them as late as possible so its effects will last.  Do not expect them to sleep more than six hours at a time in the early stages of dementia.

In later stages they will sleep more than they are awake.

 

 

Contact the Better Sleep Council of Canada.   www.bettersleep.ca or info@bettersleep.ca.

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Parish Nurses Are Life Savers for Caregivers
January 18, 2007
By Melissa A. Goodwin

There’s a good chance you’ve never heard of parish nurses, but in fact, they just might be the best kept secret in elder-caregiving. Parish nurses can help you with your care of a loved one.

Parish nurses:

• Are registered professional nurses, licensed by the state, who are on the staff of a faith-based community.
• Are usually part-time and may or may not be in paid positions
• Come from all nursing specialties
• Provide health and wellness education and counseling
• Act as community liaisons and advocates for the ill and elderly
• Can help people understand complex medical information and refer them to resources for additional information and support 
• Always respect the confidentiality of individual family members
• Provide spiritual support but do not preach 

They can help you and your loved one if either of you:

• Feels confused by the complexity of the health care system
• Has a question about a medical condition, treatment, medication, or symptoms
• Needs help and doesn’t know where to turn
• Has recently been released from the hospital
• Needs the reassurance of a caring medical professional who will take the time to listen

For more information about Parish Nurses, go to the Canadian Association for Parish Nursing Ministry website:  www.capnm.ca
There is also a Parish Nursing Professional Practice Group in Saskatchewan.  The current contact is Judy Johnson and her phone number is 934-5137.

Source: The Caregivers Home Companion, http://www.caregivershome.com/news/timely_tips.cfm
Protecting Seniors & Caregivers from Work-at-home Schemes

November 28, 2006
By Janet Crozier
   
“Work minutes a day at home and earn enough to pay all of your bills.”
“Work part-time in your own home and make $500 to $1,000 your first month! It couldn’t be any easier!”

Con artists pitching work-at-home schemes rake in over $400 billion dollars a year by exploiting people, especially seniors on fixed incomes. They use appealing but unrealistic come-ons to lure unsuspecting seniors into parting with their hard-earned retirement money in the hopes of hitting it big financially.  Work-at-home schemes rarely include information such as what the business is, what its product might be, how new owners would contact possible customers, or what the total costs might be.

You’ve seen the promotions pasted on telephone poles, supermarket bulletin boards, newspaper classified sections, magazines and on television. They’re on Internet chat rooms, bulletin boards and message boards. Since anyone can post to a message board, the promotions can even show up online at the message boards run by honest organizations that seniors trust, such as AARP.

Work-at-home schemes come in many forms. Some of the most common scams include:

Medical Billing Centers: Seniors send money for software to run a bill collection service from their home. The scam artists promise that the “market is wide open” and they have “lined up” clients for investors. In reality, seniors stand to lose thousands of dollars in their investment. The software is only an assortment of forms and collection letters that anyone could easily create. The names of companies they send seniors are often randomly selected from the phone book.

Envelope Stuffing: This is the most common work-at-home scam according to the U.S. Postal Inspection Service. Seniors send money and the “business” will send them information about earning money by stuffing envelopes at home. What they actually get are instructions to sell this scheme to others by placing ads in newspapers to illegally entice new victims. They make nothing unless they recruit others to work for them. Called multi-level marketing, this scam is much like an illegal Ponzi pyramid scheme.

Assembly or Craft Work: This is promoted as an easy work-at-home job for seniors on a fixed income. All they have to do is send money for supplies to assemble into products such as aprons, baby clothes, jewelry and Christmas decorations. They are told that there is a ready market for the products or that the company will buy the products from them. However, the assembled items rarely meet non-existent quality standards or the seniors are told that they are responsible for selling the items themselves.

But seniors can defend themselves against work-at-home scams. Start by staying alert and using common sense. If a promotion seems too good to be true, it probably is!

Fraudulent promoters of work-at-home schemes leave many unanswered questions. Caution seniors you know not to send any money until they get clear and complete answers – in writing – to all these questions:

• What exactly do I need to do to earn money?
• What will I receive for my money? 
• Do I have to purchase anything? 
• What are the total costs to get in on the deal? 
• What quality standards must I meet for the products I produce? 
• Will I receive a salary? Or, do I work on commission? 
• Who pays me? 
• Do I have to sell anything or market the product or information? 
• Do I need to recruit others to the program? 
• How do I get my money back if I am not satisfied?
  

If the answers they receive don’t satisfy all their concerns, encourage them to walk away from the promotion. Chances are good that the promotion is really a scam.

If you know any seniors that have been taken in by a work-at-home scam, file a written complaint with the company in question and make sure to keep a dated copy.   Some companies may refund their money.

For more information on work-at-home scams, contact:

• U.S. Postal Inspection Service   
  
• The Postal Service advises that you report work-at-home scams to your local postmaster or nearest postal inspector
• RCMP
• The RCMP investigates fraud throughout Canada.
• Federal Trade Commission
• While the FTC does not resolve individual consumer problems, your complaint helps the FTC investigate fraud. The FTC enters fraud-related complaints into Consumer Sentinel®, a secure, online database available to hundreds of civil and criminal law enforcement agencies worldwide. 
• Better Business Bureau
• The BBB explains how work-at-home schemes can waste your time and money and ruin your reputation.
  

To report fraud:

• Contact your local police service
• Contact your credit bureau 
• Contact Phonebusters National Call Centre toll free 1-888-495-8501 or 
• Report Economic Crime Online at the RECOL website
  

Janet Crozier has more than 30 years of experience working with older adults.  Ms. Crozier holds a Graduate Certificate in Aging and Adult Services and is a Certified Senior Advisor.  She has served on the Board of Directors of the Northeast Florida Area Agency on Aging  for many years and has been recognized nationally for her service to Medicare beneficiaries by the federal Medicare program.  Currently, Ms. Crozier is a full-time senior educator with Blue Cross and Blue Shield of Florida.
Source:  Caregiver Newsletter. http://www.caregiver.com/articles/general/protecting_seniors.htm
Walking, Rising, and Seating

By Northwest Regional Council/Area Agency on Aging

Seating in a Chair or on the Toilet
October 18, 2006
This is sometimes as difficult as rising and can be facilitated with the following techniques.

• Point out the chair as you approach it with the client.
• Approach the chair from the front and direct the client to bend slightly and place her hand on the chair arm on the opposite side.
• Then, while keeping her hand on the arm of the chair, direct her to “turn, turn, turn,” taking small steps until she is positioned with her back square to the chair. You may guide her by putting firm pressure on her hip and nudging her in the right direction.
• Once she is positioned, direct her to reach back for the other arm of the chair and ease herself down.
• Some clients have difficulty flexing their hips at this point. A little downward pressure with your hand on the nape of her neck may help get her down.
• For severely motor-impaired clients, a commode chair with arms placed over the toilet is very helpful.
  

Some complex maneuvers, such as getting in and out of the car, become even more difficult if the client is given time to “think” about what she is to do. At this point, she may realize that she cannot remember how to go about it and may get “stuck.” It often helps to keep up a casual conversation as you approach the car with her, open the door, and gently and unobtrusively position her for entry into the vehicle. The long-established pattern of movement will often take over.
In all these techniques, the principle applies of providing only as much help as the client really needs. Too much help can be as confusing as too little.

Rising from a Chair
September 12, 2006
This can become a serious problem for the more severely motor-impaired client. It can be frustrating and time consuming for both client and staff. When the task is approached in a step-by-step fashion, some of this frustration can be alleviated.

• The first step in rising from a chair is to move forward in the seat. Therefore, before attempting to transfer a client from a chair, ensure that she is positioned well forward.
• The second step is to position the feet back slightly under the seat of the chair and flat on the ground. The heels may be raised slightly, especially if the client has tight heelcords.
• The next step for the client is to lean forward, bring her body weight out over the feet, and push off with her hands either from her knees or from the arms of the chair. It sometimes helps to give the client gentle but firm pressure on the nape of the neck (not the back of the head) to bring the head forward and bring her center of gravity over her feet just as she is making the effort to rise. Some clients find it easier to execute this maneuver on the count of three, so their efforts and the staff members’ efforts can be coordinated.
• If the client does not succeed in rising from the chair and standing on the first try, you may offer her a hand to help her balance herself, but avoid trying to pull her up. It may confuse her in her efforts to rise, and you may be left supporting her whole weight. This is not safe for you or for the client. Rather, let her back down gently and try again.
• A client who is very weak and who has poor balance is likely to need a walker for ambulating. Position the walker in front of her and let her pull up on it while you guide her as she shifts her weight.

Walking
July 17, 2006
Although the client may show no signs of physical impairment, perceptual dysfunction can seriously impede her mobility.

• Walking through a crowded area is threatening for the client who is spatially insecure. If often helps if you offer her your arm and lead, rather than push, her through the area.
• A client may be able to move more securely if she is given a concrete visual target to head for, such as "the blue chair,” and if the route to the destination is clear of obstacles.
• It may be necessary to break down a long trip into several “legs.”
• Warning the client of obstacles and irregularities in the terrain may add to her security.
• A client who has an irregular gait or who has some physical impairment will walk more evenly if a rhythm is established. Take her arm firmly and use your body to set a somewhat exaggerated rhythm to the steps. This will encourage a more normal gait than verbal instructions alone would.
• A client who has difficulty coordinating the movement of a cane or a walker often responds well to instructions given in single words in the cadence of the walk, e.g., “Step, walker, step, walker.”

Source: Caregiver Tips, Northwest Regional Council/Area Agency on Aging, http://www.nwrcwa.org/tips.pdf

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Nine Ways to Get Someone to Eat
June 16, 2006
By Jennifer B. Buckley

A common nutritional problem that can affect care recipients in poor health is cachexia-anorexia and it especially involves those in advanced stages of Alzheimer’s, Cancer and AIDS. Cachexia-anorexia is a syndrome in which progressive and involuntary weight loss occurs. The people with this disorder are “wasting-away” from the lack of vitamins and nutrients and as a caregiver; this can be a difficult and frustrating event to witness.

The syndrome can be attributed to cancer treatments, medications, physiological problems like an obstructing tumor in the gastrointestinal track or psychological problems like depression. It is also possible the person you are caring for has a loss of appetite simply from not feeling well. Caregiver.com has come up with a list of ways to help your care recipient eat. This list doesn’t necessarily reflect the needs of care recipients on special needs diets such as diabetes or restricted salt intake diets. Remember to consult your physician about the specific dietary needs of your loved one.

1. Water, Water, Water. Make sure the person you are caring for has plenty of water to avoid dehydration, which can lead to appetite suppression.
   

2. Keep it small. Instead of three large meals a day, which can look overwhelming to someone in poor health, serve six small meals a day.
   

3. Bulk up on the amount of calories per meal. For instance, you can add protein powder mix to shakes or drinks to increase calories. 
   

4. Soft is better. Serve soft foods such as pudding, ice cream or fruit smoothies because they can be tasty and easy to digest.
   

5. Make it tasty. Don’t serve bland or sour tasting foods.
   

6. Put the power in their hands.  When possible, give the person you are caring for the decision-making power to decide what they would like to eat; it helps them to feel in control.
   

7. Make it pretty. Present appetizing looking meals by accenting the plate with a garnish (i.e. strawberry or melon). Also, make the dining experience pleasant for the person you are caring for by playing soft music or talking to them about the day’s events while they are eating to take their minds off not feeling well.
   

8. Write it down. Keep a food diary about the person you are caring for and include: what food they have problems or complications digesting and their daily food menus, and review it with their doctor or dietician for feedback. They may be experiencing digestive problems or irritable bowl syndrome due to their menu.
   

9. Work it out. Try and get them moving to work up an appetite. If overall exercise such as walking isn’t possible, have them fold the laundry or peel vegetables

 Source:  Caregiver Newsletter. http://www.caregiver.com/articles/general/get_someone_to_eat.htm

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Tips for Traveling (Part 2)
March 1, 2006

Wandering and Anxiety
The person who wanders when at home, may do so in an unfamiliar place.  In the event that this happens, have the person wear a Medic Alert bracelet or necklace that clearly explains that she has a dementing illness.  Put a card with the name and address of the hotel where you are staying in the person's pocket.  You may want to carry a recent photo of the person in case he/she gets lost.
Traveling may also make the person more anxious.  Bring along an anti-anxiety medicine "just in case."
Toileting and Bathroom Issues
Toileting is an issue that requires some forethought when you are traveling.  If you are driving, stop at the rest area toilets every couple of hours.  If the person needs assistance in the bathroom and you may be in there for  a while, bring along an "occupied" sign for the washroom door.  Have on hand a full change of clothing and a supply of disposable underwear.
Bathrooms in unfamiliar places, such as hotel rooms, may pose problems, too.  Be sure to keep the way to the toilet well-lighted, and turn on the night-light in the bathroom.
A Few Extra Tips
A few more travel tips to keep in mind:  If you're driving, never leave the person alone in the car.  Try to bring along a relative or friend to share in the driving.  And if you're traveling by plane, you may want to notify the airline ahead of time, so it can provide any needed assistance.

Tips for Traveling (Part 1)
February 10, 2006

    Traveling long distances with a person in the early stages of dementia may still be quite enjoyable.  As dementia advances, however, traveling becomes unpredictable as the person becomes more confused.
Preparing for a Trip
Prepare for a trip by gathering important documents:  insurance cards, passports, your physician's phone number, refills on medication and a copy of medical records in care the person with dementia needs to see a   while away.  Make sure you keep track of all the documents and medications.  Packing them in carry-on bags so they will not get lost en route is a good idea.
Remembers to bring sufficient funds or a credit card with you in case you must change your plans suddenly and return home.  Also, you may want to bring along a brief letter from your physician to the airline or hotel to expedite a change in plans.
Sticking to a Routine
When traveling, try to follow the routine that is followed at home.  And be sure to allow plenty of time for everything.  Bathe and dress the person without rushing, have leisurely meals at restaurants at non peak times and stay with favorite food choices.  Plan for rest periods throughout the day.  For example, if you're taking a tour by bus, you may want to remain in the bus so the person can take a nap instead of visiting all the sites.

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Involving Others in Your Caregiving
January 11, 2006
By Ryan Mackey

        As a caregiver, receiving some extra help or consideration from others goes a long way to helping you deal with the daily rigors of life. Given the right help and proper respite time, you will feel better about your overall role, and be stronger emotionally and physically to continue your caregiving. Because much of the burden of care falls on one person in the family, other family and friends should be considered as viable alternatives. Talking with your loved one and establishing a plan surrounding your caregiving, their finances, and the sacrifices that must be made, is essential to quality caregiving. Consider these recommendations for involving others when providing the primary care for a loved one in need:

• Allow your spouse to share some of the responsibility by taking care of the children, giving you some free time, or maybe cooking dinner one evening.
• Seek help through community health care agencies able to have someone come out to support your caregiving efforts.  
• Have a friend assist you in caring for your children or running an errand for you if you are busy. 
• Keep the entire family aware of the situation and let them know if something needs to be changed or altered from the plan already established.
• If you work outside of the home, see if your company or boss is willing to be flexible with your hours and see if they have any advice that may help you juggle work and caregiving.
• Incorporate the entire family in your caregiving, for instance, a long distance relative may give you money for groceries, or a friend may help you do the shopping. 
• Join a support group which may open you up to other caregivers in the area who can further assist you in learning about services available such as volunteer services and local elderly programs.
  

 Source:  Caregiver Newsletter. http://www.caregiver.com/articles/caregiver/involving_others.htm

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Checklist of Dos and Don'ts for Diabetic Foot Care
December 21, 2005
By Susan Kelly, RN PHN

• Check your feet every day for cuts, cracks, bruises, blisters, sores, infections or unusual markings
• Use a mirror to see the bottoms of your feet if you can't lift them up.
• Check the colour of your legs and feet.  If there is swelling, warmth or redness, or if you have pain, see your doctor or foot specialist right away.
• Clean a cut or scratch with mild soap and water and cover it with a dry dressing, every day.
• Trim your toenails straight across so that they are even with the tips of you toes.  Cut toenails when they are soft - after a bath or shower.  Use nail clippers (instead of manicure scissors) which have a smaller, straighter cutting edge and a longer handle.
• Wash and dry your feet every day, especially between your toes.
• Apply a good skin lotion every day on your heels and soles.  Wipe off excess lotion and allow your feet to dry before putting on socks.
• Change your socks every day.  Cotton or wool seamless socks allow your feet to breathe.  Wear light coloured socks to detect drainage (bleeding from a blister).
• Always wear  a good supportive shoe that has a wide toe box, with 1/2 inch between the tip of the toe and the end of the shoe; a study sole and uppers made of natural materials, such as leather.
• Buy shoes in the late afternoon when your feet are slightly swollen.
• Exercise regularly.

Responding to Wandering Behavior in Alzheimer's Disease
October 11, 2005
From Christine Kennard, Your Guide to Alzheimer's Disease.

It is estimated that 60% of the 4 million Americans that have Alzheimer's will wander away from home or their caregivers and get lost. Wandering behavior is a potentially life threatening situation. Here are a few simple steps that you can take to make your response, and the professional agencies response to wandering behavior more effective. It may help save the life of your loved one and will help minimize the time the Alzheimer's sufferer is lost.

Home Prevention Measures for Wandering

• Place a dark colored mat by the front and any doors that exit outside
• Paint external doors the same color as the walls, this camouflages them
• Label internal doors with their function i.e. bathroom, bedroom. You can also label doors that you want to have out of bounds with labels such as 'Do Not Enter' or 'No'
• Install warning alarms on external doors so that you can encourage free movement around your house or apartment but respond quickly day or night to the warning bells.
• You can design a garden that allows access outside but always leads the wandering person back to the house. This is great for people with Alzheimer's who are very restless or agitated and who like or need to walk a lot.
• Keep some 'scented clothes' around just in case the police need to use them in their search for your loved one
• Have a recent photograph to assist police or other agencies who may be called on to search for the missing person
• Remember the clothes your loved one is wearing that day so that you can inform the authorities if they need to be involved
• Discreetly label the clothes of people with Alzheimer's with their home telephone number
  

Your Initial Response to A Lost Person Situation
Look around your property in the immediate area. Look in cupboards, cellars, outhouses.  Remember someone with Alzheimer's will not necessarily respond if you call out their name, so do not assume they are not in a room just because they do not answer you.
It is helpful if you can get another family member or friend to help you just incase you miss the wandering relative as you search.
Call 911 if you search is not successful. If weather conditions are extreme you need to take quick action. Police and search agencies will be helped by accurate information.

Source:  http://alzheimers.about.com/od/caregivers/a/wander_caregive.htm
Overcoming Dental Fear
September 20, 2005

The fear of going to the dentist is not a laughing matter. If the fear is great enough, our teeth go unattended and a number of problems follow suit. Too often our loved ones are already in poor health, adding dental problems to the list is not going to help.

Dental fear is very similar to post-traumatic stress disorder. The person involuntarily re-experiences the trauma of a painful or frightening time as a patient, and then adopts behaviors to avoid the recurrences. Simply going to the office will induce a "flash-back", even when nothing frightening is happening. The fear stems from a feeling of powerlessness and the dental visit becomes even more stressful. To recover from this fear, the dental patient must regain a feeling of empowerment.

• Accept the dental patient's fears and feelings as real and valid.

• The dentist should be caring, someone who is not condescending, and will not belittle or deny the patient's feelings. Coping techniques will be useless in a hostile environment.

• The night before the appointment the patient should try to get a good night's sleep without medication to help induce sleep. It is important to avoid a "hangover" which will make the patient agitated.

• Schedule a morning appointment, or as early as possible. Get it over with so everyone doesn't spend the day worrying about the dental visit.

• Bring a Walkman and listen to relaxing and enjoyable music in the waiting room and during the procedures. Some dental offices even offer this service now. Check with your dentist.

• The patient should breathe deeply (in through the nose, out through the mouth), especially during injections.

• If the smells are bothersome, bring a sachet to sniff, or place a small amount of pleasing scented oil below the nostrils. Lavender is a natural relaxer.

• Arrange for a reward after the appointment - start with a great big hug and then do something fun.

• To avoid emergency visits and reduce the number of non routine visits, make sure that appropriate and complete dental hygiene is part of the daily routine.

• If the dental fear is disabling, it would be wise to seek the help of a professional counselor

Source:  http://www.caregiver.com/articles/general/overcoming_dental_fear.htm?source=newsletter

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Caregiver Survivor Tips
August 11, 2005


Source:  http://www.upperarkansasareaagencyonaging.org/caregiver.html

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Nip Depression in the Bud: Warning Signs to Look For
July 8, 2005
By Mary Damiano
 
While caregivers are defined as the people taking care of those needing help, they sometimes overlook the fact that caregiving responsibilities can take a toll on their own health.

In addition to physical ailments, caregivers are at risk for depression. Depression can strike anyone, at any age. Caregivers need to be especially aware of depression because of the great load they carry. Many caregivers work at a full-time job and take care of a family in addition to their caregiving responsibilities. They often sacrifice their own health, well-being and social life in order to do everything that needs to be done.

One common denominator among caregivers is the desire and the belief that they must do everything themselves. Often, caregivers do not ask for help, opting instead to inadvertently play the part of the martyr. This leads the caregiver to become overwhelmed and an overwhelmed person is fertile ground for depression to dig in and take root.

The great strain caregivers face on a daily basis can lead to depression. One way to stop depression before it strikes is to be aware of the warning signs. According to the Administration on Aging, here are some red flags that depression might be creeping in:

• Sad, discouraged mood
• Persistent pessimism about the present, future and the past
• Loss of interest in work, hobbies, social life and sex
• Difficulty in making decisions
• Lack of energy and feeling slowed down
• Restlessness and irritability
• Loss of appetite and loss of weight
• Disturbed sleep, especially early morning waking
• Depressive, gloomy or desolate dreams
• Suicidal thoughts
  

If you feel yourself exhibiting these behaviors, do not discount them. They should be taken as seriously as you might treat a fever that won't go away or a persistent cough.

Below are some expert tips on what caregivers in particular can do to stop depression before it gets out of control:

• Talk regularly with family, friends, or mental health professionals— it is very important that you do not isolate yourself. Join a local support group, or find one online. Share your feelings so they don't build up and escalate into problems.
• Set limits— this can be hard for caregivers, because they are used to taking on everything that needs to be done. It's okay to say no to taking on more than you can handle.
• Eat nutritiously, exercise regularly and get enough sleep— this can be difficult because of the irregular schedules caregivers must keep. But think of it this way: your body and mind are machines, and they must be properly maintained in order to function at their best. Nutritious food, exercise and sleep are the things that fuel these machines. Just as you would not let your car run out of gas, don't let your body run out of its fuel.
• Let go of unrealistic expectations— caregivers often have unrealistic expectations of themselves, and therefore push themselves to meet these goals. Accept the fact that you can't do everything. Ask for and accept help, from friends, family and local agencies. Whatever you do, don't be a martyr.
• Keep a sense of humor— we all know that laughter is the best medicine, so go ahead and take a few spoonfuls daily. Relax with a funny movie or TV show. Put on a comedy tape to listen to while you do your chores. Find the humor in everyday things.
  

Source:  http://www.caregiver.com/articles/print/nip_depression.htm

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Early Signs that Assistance May be Needed for Elderly Parents
June 7, 2005

Early identification of potential needs, which can become a problem, will help avoid a crisis and provide security and peace of mind for elders and for their loved ones.
When visiting an elder parent the following signs may indicate that outside help is required:

•  Personal Care Needs
• wearing the same clothing day after day
• noticeable body odour
• unkempt or untidy appearance
• not getting dressed in the morning
• feet and nails in poor condition
• soiled underwear hidden in drawers or closet
• sleeping for longer periods of time
• Nutritional Needs
• weight loss of 5 pounds of more - clothing seems to be hanging or too big
• very dry hands, feet, arms and mouth, dry cracked lips - could indicate dehydration
• feeling weak or having no energy
• little food in the fridge
• food in the fridge is moldy or past the "best before date"
• eating tea and toast for lunch and dinners
• Physical Condition
• complains of becoming "short of breath" when climbing stairs, or walking for short distances, or after bathing and dressing
• stumbles more often or increase in falls
• needs help getting out of a chair
• forgets about taking medicines, puffers, blood thinners, etc...
• increased forgetfulness or confusion
• Social Condition
• isolating self indoors
• spending more time alone
• not answering phone, doorbell
• declines all social invitations
• stops attending church or community activities
• Environment
• house/apartment untidy
• appliances left on
• valuable items (jewelry, money, credit cards) misplaced
• no clean laundry in drawers

Excerpt from "When and How to Seek Help for Elderly Parents" by John Schram

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Preventing Falls and Fears
May 10, 2005
by Sharon Roth Maguire, MS, APRN-BC, GNP, APNP

Most caregivers are aware of the importance of preventing falls. When a fall occurs, the results can be life-changing. While we all realize the significance of a broken bone that may result from a fall, what we sometimes fail to acknowledge is the broken spirit that may occur after a fall. Many elders who fall never fully regain the confidence in their ability to navigate around their home or near steps. They may experience a fear of falling again that may cause them to limit their activity. They may have a permanent disability not only from the physical consequences of the fall but from the emotional consequences as well. What then can be done to reduce the likelihood of falling? There are four major risk areas to target when you think of fall reduction: environmental risk, age-related risk, health-related risk, and medication risk.

Minimizing environmental risk would include things like providing for hand rails near the toilet and tub to make it easier for the individual to get up or get balanced; using non-skid throw rugs, or better yet, no throw rugs at all; keeping pathways to and from the bathroom, bedroom, and kitchen free of clutter.

Reducing age-related risk would include things like accommodating for vision and hearing changes that make it more difficult for the older adult to interpret their environment and to see or hear clearly. Eyeglasses should be of the correct strength, in good repair, and clean. Lighting needs to be increased but not to the extent that it produces glare. A night light will help reduce the dramatic and often times blinding changes in light when going from a darkened bedroom to a brightly lit bathroom. Hearing aids should be cleaned regularly as wax may accumulate and prevent them from working properly. Hearing aid batteries should be replaced regularly to ensure good function.

Reducing health-related risk requires a good healthcare partner and a motivated patient. Osteoporosis is primarily a disease that affects older women and those who have taken medications known as long term steroids (often used for the treatment of severe arthritis and asthma). These medications cause bones to become increasingly fragile and break even without trauma. Older adult women should be screened for osteoporosis to determine the density of their bones and if medication management is required. All older adults should get regular weight bearing exercise and eat a well-balanced diet to maintain their bone health. Older adults need as much calcium as pregnant women (1200mg/day)! Vitamin D requirements also increase with age (400-600IU/day) and are essential for healthy bones as well.

The last category for risk reduction is medication awareness. As we age, we are at risk of taking many medications for many ailments prescribed by many providers; a situation known as polypharmacy. There is much research and increasing awareness of the potentially hazardous effects of polypharmacy. It is well documented that the more medications an individual takes, the greater their risk of side-effects, drug interactions, and falls. Certain medications are particularly dangerous. Anti-anxiety medications like Valium, Xanax, and Ativan; sleeping pills like Ambien, Restoril, and even Tylenol pm have been implicated in increasing fall risk. Discuss your loved one’s medication regimen with the prescriber and focus on reducing or eliminating those drugs that increase risk of falling. Should your loved one require extended care some- where other than home, be sure to ask what their fall reduction program has to offer.

Fear of falling is a very real phenomenon that is as important to reduce as the physical consequences of a fall; both can be life changing and demand our attention to reduce the likelihood of a fall occurring.

Source:  http://www.caregiver.com/magazine/2005/mar-apr/falls_and_fears.htm

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Some of the Challenges Caregivers May Expect
April 8, 2005

Caregiving can change your relationship with your family members, whether the person needing care is your parent, spouse, another relative or an adult child.
The following may be some of the challenges that you may encounter:

• A Shift in Dependency usually results when parents become frail and need assistance to maintain as much independence as possible.  Because this often alters the parent-child dynamic within relationships, tensions or difficult emotions may arise.
• Finances become an issue when the care receiver's resources are insufficient to cover the expenses of daily living, health, and housing.  Because so many people experience difficulty talking about money, this important topic is often left until too late.
• Stress related to competition and collision between roles can be related to parenting, housework, employment, maintaining social ties, and eldercare, as well as potential isolation, dealing with health care providers, and significant life changes.
• Ignorance about the aging process can lead to difficulties judging whether a senior's behavior is normal or a cause for concern, and also difficulties with decision-making
• Emotional responses to the changes that accompany aging and frailty and the demands of caregiving can surprise many.
• Ignorance about the workings of the health care system  and community resources can result in inappropriate expectations from the "system", poor decision-making, time-consuming run-around and inflated emotional states during crisis.
• Difficulty setting limits on involvement, coupled with unrealistic expectations, a strong sense of duty or loyalty, a commitment to caring, and guilt can feed an inability to say no to demands and expectations of family members or the health care system.
• Lack of planning for the future is common to many families.  It means that important discussions are avoided because they are awkward.  Things can become really tense if these awkward discussions come up during a crisis.  Typical topics that need discussion and planning include:  housing needs as frailty increases; finances; how caregiving will be carried out in the family; the care receiver's preferences regarding heroic measures; and dying and death, after death services, power of attorney and distribution of the estate.

Source:  Hubberstey, C.,  Rutman, D., Hume, S., & Tate, B. (Family Caregivers Network Society) (2003)  Resource Guide for Family Caregivers   Canada.

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10 Essential Tools for Family Caregivers
March 4, 2005

There are many choices and options available to help family caregivers in making their caregiving manageable.  Once you are a family caregiver, what do you need to know to master the challenged of caring for your loved on at home?  We offer the following glimpse into what you can expect

1. Learn about the disease:  Knowledge is power.  You may feel overwhelmed.  Learn about treatments, course of disease, and support programs.  Think holistically and seek information from many different places.  For Family Caregivers it is important to know how disease may effect mobility, emotions, and cognition of the patient because these changes will effect you.
2. Stress:  Recognize the signs of stress.  You can't eliminate but you can manage stress.  Stress in Caregiving effects problem solving ability, one of the most important job functions.
3. Talking to the Doctor and other health care professionals:  What is the main problem confronting my loved one?  What do I need to do?  Why is it important to me?  Do they know that I am the primary Family Caregiver and what I am responsible for?
4. Community Resources:  Trying to understand the maze of services needs a resource guide.  Call disease associations, social service agencies, faith communities.  Keep track of programs and give feedback.  You can't do everything by yourself.
5. Financial/Legal Planning:  Stretch out your resources.  Family caregiving can be costly and has many surprises.  Bring your banker/financial/lawyer planner into the loop immediately.
6. Relax, Rejoice, Reconnect...  Caregiving is a marathon not a sprint, you need to take time for yourself.  If you get sick who will be caregiver?  Know your respite care options.
7. Making Your/Their Home Safe:  Minor adjustments improve physical health and reduce stress.  Major renovations such as ramps and bathrooms refits are common.
8. Creating a Family Plan:  Hold  a family meeting to clear the air. Holding a family consultation can be a great way for resolving differences in caring styles and solutions.
9. Home Care vs Institutionalization:  Trust, Caring and Understanding needed.  This is a business relationship and may not meet the high family demands you have set for your loved one.  Be prepared.
10. Balance Caregiving with the Workplace:  Let your employer know what you are juggling.  Family leave is important and legislated.  Know your rights.
    

Source:  The Family Caregiver Newsmagazine. (www.thefamilycaregiver.com)

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Meditation: Still Waters Run Deep
February 1, 2005

Meditation is a process that, over time, brings about profound changes These changes include actual increase in energy and decrease in debilitating physical and emotional problems. Meditation, practiced as little as ten minutes twice a day, has been shown to impact a person's overall well being. Here are some answers to questions you might have as a novice to meditation.

How do I get rid of thoughts that interfere with "just letting go"? You don't have to get rid of these thoughts or be in a particular mood in order to meditate. The essence of meditation is accepting what is, and finding the stillness within that reality. For example, if thoughts continue to come in, over and over, just observe yourself thinking these thoughts. Let the thoughts turn into pictures. Notice all the details of the thought from different perspectives. As you continue to let the thoughts or mood unfold, observe the phenomenon of your interior life, much as you would observe a flower unfolding. You will find that over time, even the most repetitive thoughts contain something new. 
What do I do if I am uncomfortable in sitting? Here are two approaches you might want to try: 

(1) If you are physically uncomfortable, just straighten your back, re-adjust your position, and relax. Maintain your focus on the interior life while you gently re-adjust your position. (2) Allow the discomfort to persist, and sit through it. Notice the difference between discomfort and actual pain. If we develop the ability to sit through minor discomforts, we often find they simply go away. 

What if external distractions occur? It is important that you take the time to remove yourself from the outside world. A time when no one is home or anyone who might distract you is asleep, is ideal. Take the phone off the hook. Create a mindset that allows you to ignore all sounds, except emergencies. If outside sounds and distractions occur, consider them to be the music of life that goes on around us all the time. The important part about meditating is to focus on your interior stillness and rhythm within the larger orchestra of life. 

Meditation is an opportunity to transcend the everyday practical considerations of life in order to reach the source of the wellspring of our essence. For some, tapping this wellspring comes easily, for others, it is more difficult to break away from the stresses and burdens we perceive as our reality. It will take time and practice to lay the path which leads to stillness, peace and release waiting within the meditative mind set. Dealing with all the practicalities of meditation is like choosing a bucket and taking it to the well. It may take a little effort to get there and to lower it into the wellspring. The rewards, however, are refreshing to both mind and body.

Source: Dr. Marie DiCowden; http://www.caregiver.com/articles/general/wellspring_source.htm

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Tips for Communicating with Confused Persons
January 7, 2005

Create a calm environment.  The tone of your voice and your facial expressions are very important in speech.  Try not to over-react to a situation.  Take things slow and smile whenever possible.

• Do NOT assume the person cannot understand what is being said.  NEVER talk about the person as though he/she is not present.
• Avoid quizzing the person on names or dates.  Not knowing the answer embarrasses the individual.  If you want to ask questions, try to know the answers beforehand and help the person to answer, often when given a cue the confused person will be able to answer adequately.
• Use gestures when trying to get your message across.  Try using more than one sense to communicate such as touching as well as talking.
• Try to appeal to the person's sense of humor, but never laugh at them.
• Be reassuring.  If you don't know the answer about someone or some thing, try "I'm sure everything is all right."
• Praise the person's actions whenever possible.  Compliment a new hairdo or outfit that may be new to you.
• If the person starts or continues to walk while you are talking to them, keep moving along in front of him or her.  Do not try to stop the person.  If you need to change directions, ease into the move by distraction.
• Do NOT argue about statements you know to be untrue.  This may be different from what you were taught; however, insisting something is true to someone who believes facts to the contrary can only make the situation worse.
  
•  Example:  The person insists her husband will be joining her for dinner and you know her husband is deceased.  Reminding her he is gone may prove very upsetting (she may not believe you and become angry).  The best approach is to distract the person on to a different subject.  A temporary change of subject will often solve the problem and get the person's attention on to a different thought altogether.

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Tips for Caregivers during the Holidays
December 1, 2004
 
Holiday preparations can be overwhelming for caregivers of family members. Many caregivers wish to hold on to holiday traditions, but their old traditions don't always fit with new realities.

One caregiver related that she used to love baking and having her house full of family and friends during the holidays. But the combined stress of trying to keep her husband's care schedule and preparing a holiday get-together was too much.

Experienced caregivers offer the following suggestions to help you and your family keep the holiday without the hassle.

• Invite guests to the home of the care receiver so that he or she will be comfortable and not have to be taken out.
• Suggest a potluck meal or ask guests to take responsibility for preparing a meal. Make clean-up easy by using festive paper plates and cups.
• Keep the number of guests manageable. Noise and hectic activity can be difficult for a person who is frail or confused.
• Talk to family and friends before they arrive. If the care receiver is confused, has trouble eating or has any behaviors that guests might not understand, explain the circumstances to them and tell them how to approach the situation.
• Take the hassle out of gift giving. Consider giving a gift of love such as an offer to reserve conversation time with a friend or a promise to attend a grandchild's school play. Caregivers who wish to purchase gifts should consider giving one gift per family, mail-ordering purchases or asking a neighbor or friend to help with shopping.
• If guests ask what they can bring, suggest gifts that really will help -- frozen prepared foods, an IOU for caregiving that offers you respite time, a trip to the beauty or barber shop for your care receiver, or an offer to run specific errands.
  

One caregiver said that she thought for years that nobody could do it except her. But when she learned to ask for help, she found that holiday joy doesn't depend on doing everything the same way it's always been done.

Source: Iowa State University  http://www.extension.iastate.edu/General/holiday/caregiver.html

Caregiver Stress Test
November 1, 2004

The following test will help you become aware of your feelings and the pressures and sets you currently feel.  Responses are:
Seldom   Sometimes   Often   Usually   Always

• _______ 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 besides the person I 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 like I have enough knowledge or experience to give care as well as I'd like
• _______ My own health is not good

If your response to two or more of these areas is "Usually" or "Often" it may be time to begin looking for help caring for the care receiver as well as help in taking care of yourself.

Source:  Robert S. Stall, M.D.  (2002)  Caregiver's Handbook  Buffalo, New York: Author

Checklist for the Caregiver
October 1, 2004

Caregiver's need to remember to take time out for themselves.  Here is a checklist of some of the things caregivers should not neglect.

• I am getting out/exercising at least twice a week
• I am getting at least seven to nine hours of restful, sound sleep a night
• I talk with or visit up to three friends or relatives weekly
• I keep my annual medical and dental appointments
• I am eating three balanced meals a day, or four to five small nutritious meals a day
• My legal and financial papers, including wills, are in order and available
• I have kept up with my hobby or special interest
• I do something special for myself at least once a week
• I acknowledge my feelings as they come up and I take the initiative to attend a support group, or speak to a friend or counselor about them if I need to

Source:  Hubberstey, C.,  Rutman, D., Hume, S., & Tate, B. (Family Caregivers Network Society) (2003)  Resource Guide for Family Caregivers   Canada.