How caregivers can better deal with caregivers' stresses Part 4

4.  Recognize that no one can do it (caregiving) alone.  How many family members and close friends can contribute to caregiving?  Can tasks and responsibilities be divided among family members?  The primary caregiver can make a list of needed help and supportive family and friends can pick their chores.  

For example, daughter who lives close to Dad may be the person who checks on Dad every day.  Another daughter volunteers to clean house and bring fresh cooked meals every Saturday.  Daughter who lives 1000 miles away flies in several times a year to help out and relieve her sisters for respite breaks.  A grandson takes over the yard work.  This family hires a neighbor lady/certified home health aide to check on their dad periodically throughout the day while the daughters are working.  By working together, this family honors their dad’s wishes and supports each other. 

How caregivers can better deal with caregivers' stresses Part 3

3.  If your loved one (who needs caregiving) is mentally capable, include him in planning his care.  Does Dad want to continue living at home?  Does he have a plan for how that can be accomplished when all his family members have jobs?   

What does he want done if he had a heart attack?  Does he want compassionate care but no heroics? Does he want CPR and full resuscitation efforts on the way to and continued after he arrives at the hospital?   Does he have a living will and durable power of attorney for health care?  If he is mentally capable, these decisions are his to make and he needs to help make plans for his care.  Caregivers may find their loved one changes his mind about what wants to have done.  As a person becomes older, frail and poor health develops, he may decide he wants compassionate care (not CPR and resuscitation efforts). 

How caregivers can better deal with caregiver's stresses Part 2

2.  Caregivers should learn about their loved one’s diagnosis.  Psychologist Dr Barry Jacobs says it well in his book, The Emotional Survival Guide for Caregivers:  “not having basic knowledge about the patient’s illness is like driving some pitch-black country road without headlights and being jolted by every dip and thrown by every curve.  Without understanding the rigors of the terrain, you’re hard-pressed to prepare yourself for the ride or even judge whether you’re up to the journey.  It’s reckless.”  [Jacobs, Barry J, The Emotional Survival Guide for Caregivers, (New York:  Guilford Press, 2006), 39.] 

Two of my family members have recently been diagnosed with heart disease.  What does a diagnosis of congestive heart failure mean?  How can my loved one best take care of his health?  Where should my family go for information?  First, his doctor will give pertinent information which my family needs.  Second, my family can get information and understanding from reputable websites like American Heart Association at http://www.heart.org/HEARTORG/ Mayo Clinic at http://www.mayoclinic.com/ or WebMD at http://www.webmd.com/.  Use reputable organizations for accurate information and support groups. 

How caregivers can better deal with caregiver's stresses Part 1

We’ve all seen it.  Mr. H lovingly cared for his wife for the last several years.  He seemed so healthy until the day he had a heart attack and died.  Everyone scratched their heads and wondered why he died so suddenly.  Researchers have found that the stress of caregiving can make people sick and even shorten their lives:  Surprisingly, a few simple things can make a difference.   

1.  Recognize that you are caregiving.  Researchers have shown that caregivers who recognize they are caregiving fare better.  “Are you providing unpaid assistance to a spouse, relative, or friend who is ill, disabled, or needs help with basic activities of daily living? Do you help with rides to the doctor, shopping, meals, bill paying, bathing, grooming, dressing, walking or transferring to a wheelchair, housekeeping, managing medications, or arranging services to be provided by others? If you provide services like these, whether or not you live with the person you are helping, you are a caregiver.”  Agency of Aging, Pasco-Pinellas County Florida,  http://www.agingcarefl.org/caregiver/caregiver  More information tomorrow.

Benefits and Risks of Caregiving

“Caregiving can be a gift in disguise—an experience that moves you toward a more meaningful connection with yourself and with others.”  [Goldman, Connie, The Gifts of Caregiving, Minneapolis:  Fairview Press, 2002), 7.] Many caregivers find satisfaction in caring for their elders who loved and nurtured them in earlier times; it’s a time of pay back to the precious Mother who wiped your nose, dried your tears and guided you into the adult you are today.  

The risks of caregiving

Caregiving puts additional stresses into life for caregivers.  As their days become too busy with caring for Mom, many caregivers postpone their own medical care.  In fact, 72% of caregivers report not seeing their doctor as often as they should.  63% of caregivers admit their eating habits aren’t healthy and 58% of caregivers find that their exercise habits have declined since they began caregiving.  Caregivers may find themselves becoming depressed:  watching your beloved Mother become old and sick breaks your heart.  The extreme stress of caregiving can shorten a caregiver’s life by 10 years.  What can caregivers and their families do to better cope?  More statistics about caregiving can be found at National Family Caregivers Association at http://www.nfcacares.org/who_are_family_caregivers/care_giving_statstics.cfm

Caregiving Statistics

29 percent of Americans (65 million people) provide care for their ailing, aged family members and friends every year.  66 percent of caregivers are women; typically she is a 49 year old married, employed woman whose widowed mother needs increasing amounts of help.  This typical caregiver also has her own children living at home.  The term for this caregiver has been coined:  ‘the sandwich generation’ because she is caring for her elders and her own children simultaneously. 

Why has caregiving become so common and needed?  People live longer now.  In 1900, a baby girl born could expect to live 48.3 years.  A baby boy born in 1900 had an average life expectancy of 46.3 years.  By comparison, a baby girl born in 2005 can expect to live 80.4 years while a boy born in 2005 has a life expectancy of 75.2 years (averages and all races).   The disease killers of 1900 (consumption including tuberculosis) and pneumonia have been treated and often cured by improved medical care and drugs, especially antibiotics.  By comparison, in 2005 the top three killers of Americans are heart disease, cancer and stroke.  Because of the improved medical advances, people are living longer and needing caregiving help in their later years. 

Living will and durable power of attorney for health care--what's the difference?

Living Will and Durable Power of Attorney for health care.  Who needs them?  We all do.

If you were injured/ill and could not speak for yourself, what medical treatments would you want done for you?  Would you want to be kept alive on a respirator?  Would you want a feeding tube for artificial feeding and hydration?  A living will is the legal document which allows us to state our wishes about life-prolonging treatments if/when we could not speak for ourselves.  It is only used when you cannot speak for yourself and doctors believe there is no hope for recovery.

A durable power of attorney for health care document appoints a person of your choice who makes those life and death decisions.  You would name a person that you trust (and who knows your wishes) to make the life-prolonging decisions. As with a living will, the durable power of attorney for health care is only used when you are injured/ill and cannot speak for yourself and when doctors believe there is no hope for recovery.  

Each state has its own version of these documents.  For example, Missouri’s version of these can be found (and is free) at the Missouri Bar at http://www.mobar.org/uploadedFiles/Home/Publications/Legal_Resources/Durable_Power_of_Attorney/final-dpa-forms-fillable.pdf  
This information and a copy of the Missouri version of the Durable Power of attorney and Living Will can be found in Chapter 6, All Things Medical of my new book, Caregiver's Guide:  Care for Yourself While You Care for Your Loved Ones. 

Advanced directives --legal documents for health care

Do you remember the Karen Quinlan case which resulted in the development of advanced directives? 

Advanced directives include legal documents such as a living will and/or durable power of attorney for health care.  This tragic story began in 1975 when a young woman collapsed at a college party and stopped breathing.  When paramedics arrived, they resuscitated her and rushed her to the hospital where she never recovered.  Doctors called it a ‘persistent vegetative state’ which meant they did not expect her to wake up from the coma and recover.  Months later Karen was no better and all hope of recovery was past.  But no one knew what to do in this situation:  medical equipment such as respirators and feeding tubes could keep a person alive at the most basic level (a heartbeat and breathing, etc).  And no one felt  they could stop the respirator.  What should they do?  The moral and ethical aspects of this case made people think.   

I remember the news reports talking about what Karen would have wanted for herself—they reported friends who told what Karen had told them, but no legal documents (such as advanced directives) had been developed at that time.  Karen’s family petitioned the court system for permission to turn off the respirator and the legal issues took months.  In the meantime, the doctors/nurses weaned her off the respirator.  However, tube feedings and hydration kept her body alive for years.  Karen died in 1985 (10 years after her collapse.  

Do you have an advanced directive (either a living will and/or durable power of attorney for health care) to state what you would want done for you?  What’s the difference between a living will and a durable power of attorney for healthcare?  More tomorrow. 

HIPPA Confidentiality Form

If your dad had a heart attack and was hospitalized, could you call and get information from hospital staff and his doctor?  If your dad had put your name on the HIPPA Confidentiality Form when he was admitted, the answer is yes.   

Parents, if you were in a car crash, injured and could not speak for yourself, could your adult son gain information from the ICU nurses about your health?  If your adult son’s name is on the HIPPA Confidentiality Form, the answer is yes.  If his name is not on that paper, the doctor and hospital staff are not allowed to give information because of the federal HIPPA law. (That paper may be referred to by a different names but HIPPA Confidentiality Form is descriptive and will let medical people know what you are referring to.) 

The HIPPA confidentiality paper is a paper each patient fill out at your doctor’s office once a year and at every hospital visit.  This paper tells who you approve to receive your medical information.  

The HIPPA law of 1993 protects our medical information.  I’m sure we all approve of that goal.  We just need to stop and think about who we want to receive our medical information in case we were involved in a car crash or medical situation and could not speak for ourselves.  

Which brings up another question?  Do you have a living will or durable power of attorney for health care?  More tomorrow.

Caregiver's Guide: Care for Yourself while you care for your loved ones

RRRRIIING. 

“Hello? 

Hi, are you Jon Jones?  My name is Bertha Smith and I live in Memphis, Tennessee.  Your mama parked her car in front of my house and walked to my door.  She said, ‘I’m lost, please call my son Jon.’  She found your phone number in her purse and asked me to call.  How soon can you come get your mama?”

As Jon hung up the phone, thoughts flew through his head.  “Memphis is 200 miles south of here.  She hasn’t been to Memphis in many years.  How did Mom get down there?  How do I get her home?”

Picking up the phone, he called his wife. “Honey, I know you’re at a business meeting, but I need your help.  Mom drove herself to Memphis and we need to go get her.”

Jon’s wife met him at home and Jon explained his plan.  “It’s eight o-clock now.  If we leave now, we can be in Memphis before midnight.  I can drive Mom’s car and bring her home if you will drive my truck.  We should be home around 4 A.M.  I know you have to work tomorrow, and I’m sorry but I need your help.”

When Jon and his wife arrived in a poor midtown Memphis neighborhood, they found his mom in good health and spirits.  She had knocked on the door of a kind, caring Memphis resident who allowed her to stay with her family all evening.  The lady had fed Mom and treated her well.  As Jon, his wife and his mother were leaving, Jon told her, “I can’t thank you enough for caring for my mother. 

Jon asked his mother why she drove to Memphis.  She replied, I was going to the bank.  Why would I go to Memphis.” 

I changed the names but this situation was our family’s slap-us-in-the-face reality; Mom-in-law (and we, her family) faced a problem.  This scenario is the opening in chapter 1 of my new book.