Great Expectations

Home Care is a very flexible and cost-effective way to provide a safety net in your parents’ home requiring a minimal adjustment for them in the rhythm of their daily lives.

Even though home care creates a minimal change in lifestyle for your parents, it is has a strong undercurrent of emotion and expectations for the entire family. Home care is a life transition. Having a virtual stranger coming into your home to help manage the most basic aspect of living can trigger feelings of loss and deep emotional responses.

For the senior in need of care, loss of autonomy, independence and privacy are very real. This may be piled on top of other recent losses in health and relationships. No one, in my experience, has EVER welcomed the need for home care as it is usually follows some sort of loss or series of losses.

For the family, namely, the adult children, guilt, fear and inadequacy are feelings that are very relevant and real as well. Many, if not most, adult children wish that they had the time or lived close enough to provide the care they feel their parents deserve. Fear enters in with the control and direction they lose when hiring someone to provide the care. Feelings of inadequacy can surface, especially if they had attempted to provide the care themselves and it became overwhelming.

Rest assured that these emotions are all very natural and if your are feeling any of these things it is best to acknowledge the emotions as they come to the surface. Often, it is the act of hiring outside help that brings these feelings to the forefront. If these feelings are left unaddressed they can have detrimental effects on the success of home care assistance.

Often when people are not aware of or do not want to acknowledge these intense emotions, there is a tendency to place great expectations on the caregiver placed in the home to help. No matter how hard the caregiver works, they will never be a replacement for the adult child. The caregiver is an individual with their own history and personality. They will not immediately understand every nuance and preference of your parent.

Clearly defining tasks and reviewing skill is vital to beginning this professional relationship, which most reputable home care agencies will do with an in-home assessment and a plan of care. Once the expectations are established, they should remain constant as the caregiver establishes a rapport with the family. This takes time and can be a source of anxiety for both the adult children and the parents.

The focus of the caregiver should always be on the safety and well-being of the client. Housekeeping duties can be included, but shouldn’t be at the expense of quality care.  Obvious adjustments should be made if they are not appropriate or working out as anticipated. Clearly, if a caregiver is just NOT the right personality, that should be addressed as soon as possible, but not before careful consideration. If the caregiver is competent and professional, it may help to wait a little while rather than rush into a change. Learning the temperament and rhythms of a new client takes some time. After a while, the caregiver will develop a regular routine based on these daily rhythms and will increasingly be able to anticipate situations and changes and how best to deal with them.  

In short, no one can care for your parents like you can. However, if your situation requires outside assistance, do your best to understand the limits of the professional home care relationship and guard against placing unrealistic expectations. If the home care professional provided is caring and competent, provide space and flexibility for the relationship to develop. In the end this will help both the adult child and the parent ease into this life transition with minimal discomfort.

 

Nearly one-third of people over the age of 65 are hard-of-hearing while nearly 50% of people over the age of 85 suffer from some form of hearing loss. Because hearing loss is usually a gradual process that begins in one's forties, it is commonly not recognized until it is significant. It is important to be able to recognize signs of hearing loss, have it diagnosed and treated.

Symptoms of hearing loss:

• Have trouble hearing over the telephone

• Find it hard to follow conversations when two or more people are talking,

• Need to turn up the TV volume so loud that others complain,

• Have a problem hearing because of background noise,

• Sense that others seem to mumble, or

• Can't understand when women and children speak to you.

Hearing loss in seniors can lead to others mistakenly thinking that seniors are confused, difficult or apathetic. Additionally, the senior may be embarrassed by the loss and resist seeking out medical help. The inability to fully communicate can lead to frustration and isolation. The key here is communication and enlisting the following strategies to bring these seniors back into the conversation:

• Make sure that you are looking at the listener and you are in a well-lit area.

• Don't shout, this can often create increased sound distortion.

• If there are 2 or more people present, make sure that only one person is speaking at a time.

• Address them directly by saying their name before starting a conversation so they have time to focus.

• Many people with hearing loss rely on lip-reading. Keep your hands away from your mouth and avoid smoking, chewing gum or eating while talking.

• Slow down a little but not too much. A natural and unhurried rate of speech allows the hearing impaired person to capture more words, read lips and facial expressions.

• If one ear is better than the other, make sure you are directing your speech to the better ear.

• Hearing loss can include certain sound distortions. They may hear your voice but not be able to decipher certain words or pitches.

• Minimize extra noise in the environment when have a discussion, like turning the TV or dishwasher off.

• If possible, avoid having discussions in settings that may have sudden loud sounds like busy streets, near construction areas or near airports.

• Depending on the level and type of hearing loss, certain words are almost impossible to understand, try rephrasing the sentence or find a different word. Don't repeat the word or sentence over and over again.

• Avoid sudden changes of topic. When the subject is changed clearly state the new topic and look for acknowledgement before proceeding.

• Write specific information, such as appointments, directions and schedules down, if you are talking over the phone, have them repeat the information back as many words and numbers sound similar.

• Understand that illness or tiredness may affect any person's ability to follow a conversation.

• If the listener looks confused, clarify that they understood what you were saying.

The best course of action to take if you suspect hearing loss is to see a doctor as soon as possible to determine the cause and treatments available. If you suspect hearing loss in a senior that you are caring for or that you care about, remember to be compassionate about discussing the possibility of hearing loss. It is important to be supportive regarding the options and opportunity for treatment. Motivation for the decision to seek treatment should be to increase their quality of life by providing the ability to participate in all social interactions to the best of their ability.

Medicare may not be enough to cover your health care needs as you age. But how do you know what kind of health plan will work for you?

Do you provide assistance for an older person who needs care? People of all ages can be caregivers, but it is very common for older people to become caregivers to their spouses or other loved ones, and – too often – they begin to neglect their own health at an age when they should really be paying more attention to it.

Caregiving is both mentally and physically stressful, and caregivers are considered to be at increased risk for physical health problems and depression. If you are a caregiver in your senior years, it is even more important that you take care of your own health.

The Health Effects of Caregiving

Whether caring for an ailing spouse or another loved one, many caregivers become so concerned with their care-providing role that they neglect their own health, putting themselves at increased risk of:

• Poor physical health: 16 percent of caregivers say that their health declined after they become caregivers.
• Psychological stress: Approximately half of all people who provide Alzheimer's care, a common type of elder care, report experiencing distress. The effects of psychological stress can be widespread and may include depression, burnout, alcohol and drug use, and other problems.
• Self-neglect: Caregivers are more likely than non-caregivers to eat poorly, be sleep deprived, not exercise, not rest when ill, and postpone medical appointments.
• Death: Caregivers are at higher risk of dying than the general population.

Caring for Yourself While Providing Care

When you’re involved in the stress and chaos of providing elder care, or any type of caregiving, it can be difficult to take a step back and focus on yourself. Keep in mind: The loved one you are caring for will be the first to benefit when you make your own health a priority.

Follow these suggestions for taking care of yourself while providing elder care:

• Participate in stress-reducing activities. Find things that you like to do to relieve the stress of caregiving. Take a yoga class, garden, meditate, or spend time with a friend. Do these activities regularly and you’ll have a better sense of control over your situation.
• Get your own medical care. You may be spending a lot of time at the doctor with your loved one, but don't use that as an excuse to skip your own medical visits. Make sure that you are getting regular check-ups and any testing vital for your own good health.
• Exercise regularly. Exercising will help reduce stress and keep you in good physical shape. Book regular appointments for yourself to take a brisk walk, attend an exercise class, or do some other type of physical activity that you enjoy.
• Take breaks. It is important that you get some time away from caregiving, though this can be especially difficult if you are providing elder care for someone who needs around-the-clock attention. Don't be shy: Ask another family member to step in and help. A friend or neighbor might be willing to give you a break. Also inquire about respite care resources in your community; options include day visits or short stays at a senior care facility.
• Practice positive self-talk. Many caregivers impose a huge burden on themselves, so it is important for your psychological health to replace negative thoughts with positive thinking. For example, instead of telling yourself, "I never do anything right," try focusing on the positive by thinking, "My aging parents enjoy spending time with me." If possible, talk about this with your loved one, who may be able to give you peace of mind by letting you know exactly what you are doing right.

As you begin to focus on your own health, you will feel more vital and energized, which will improve the quality of care you give to your loved ones.

Get more information in the Everyday Health Senior Health Center.

When an aging parent begins to experience dementia or Alzheimer’s disease, aggressive behaviors can develop that hurt.

Dementia can cause personality changes that include aggression and verbal abuse. It’s not unusual for a parent experiencing cognitive decline to pinch, hit, kick or overreact to criticism or minor stress.

Understand that it’s not personal
Coping with a parent who has dementia is never easy. It’s important to understand aggression and negative behaviors are caused by triggers that can be controlled. One of the most difficult things to do is not take hostility and anger personally.

Handling aggressive outbursts
Acknowledge that your mother or father is upset and reassure them.

Don’t argue. If you need some time to get collected, leave the room.

Use distraction. Try to refocus your parent’s attention to something pleasant. Humor, music or a gentle back rub might help calm angry outbursts.

Don’t react by being upset. Use role playing with siblings, friends or your spouse to practice remaining calm and collected.

Try to understand what your parent is really trying to say. Dementia makes it difficult to communicate. Personality changes stem from lack of inhibition and judgment about how to behave appropriately.

Be patient, don’t ask questions that are difficult to answer or might be overwhelming. Focus on your parent’s strengths in conversation and always remain calm.

According to the UK Alzheimer’s Society, call for help if you need it. Never try to restrain a person with dementia who is acting violently. Give them space.

Try to identify causes
A study published in the American Journal of Psychiatry, found depression, combined with dementia can contribute to hurtful, aggressive behavior that might require treatment with medications. Other causes include taking too many medications and sleep disorders. Speak with your parent’s health care provider about options.

The Centre for Addiction and Mental Health (CAMH) suggests patients with dementia do best when they have contact with the same people, are allowed to care for themselves as long as possible, stay in the same living situation and follow consistent routines. Try to identify whether any of the aforementioned are making things worse.

Losing a parent to dementia can hurt. Understanding how to deal with a parent's aggression and hostility can make it easier to cope and help calm hurtful criticisms, verbal and physical outburst and overreactions. Remember too, that it’s important to talk to family, friends or a support group about your feelings.

As your parents age and need assistance with life's tasks – anything from balancing a checkbook to dealing with insurance claims – its hard to know how to take charge, without taking over. How do you help your parent, without making them feel as if they're losing their independence? How do you get the job done without condescending, or making them angry?

How many times have you found yourself "showing" someone how to do something by doing it for them? It's human nature. But while it might make sense to show by doing when you are "teaching" someone younger or less familiar with a particular topic than you are, it usually leads to anger when you do this when you are "assisting" someone with a task that he previously has been perfectly capable of handling himself.

It was probably hard enough for your mom to agree to let you help her pay her bills and balance her checkbook after your dad died. And even once she agreed, it wouldn't be surprising if she told you that she didn't know why you were insisting on helping her since she is perfectly capable of doing it herself.

The truth is that acknowledging that you need help with the business of life is really, really hard for most seniors. If they come to the point where they need your help, they are confronted with their own limitations. And those limitations won't "get better" in most cases. Deep down, your mom knows that this is the beginning of the end of her independence as she has come to know it.

So, how do you take charge without taking over?

1. Let them take the lead

If possible, do the tasks alongside your mom rather than doing it for her. While this approach might take longer than doing it yourself, you allow mom to retain some self esteem by letting her take the lead.

2. Ask what they need help with

Let your dad tell you what aspects of a particular activity he needs your help with, and if possible, try to limit your assistance to just those things, at least for now. Of course, if your dad doesn't have a realistic picture of what he can do for himself, you will need to gently find a way to help him see your perspective.

3. Be respectful

Ask permission before you just jump in. For example, when you take your parents to a doctor's appointment, don't just assume that they want you to come into the examining room with them. Instead, ask them if they'd like you to be there the whole time, or if perhaps you can just be called in toward the end of the visit to make sure that YOUR questions are answered.

4. Set up invisible safety nets

For example, if you come every Sunday and set up your mom's medications in a weekly medication management system, you can have some expectation that she will take the correct medications at the right time. But it wouldn't hurt to also have a way of checking that once or twice during the week. This might take the form of a medication management visit by a home care company or trusted friend or relative or perhaps daily medication reminder phone calls from you.

5. Ensure safety

Make a distinction between safety and everything else. When your dad's safety is on the line, you might just have to take charge by taking over. On the other hand, if you'd just prefer that something be done a certain way or at a certain time, there might be an opportunity to loosen the grip a bit.

Your job as your parent's caregiver is to keep them safe, comfortable, and happy. As long as you keep that in perspective you should have no trouble taking charge without taking over.

Sheri Samotin is a Certified Professional Daily Money Manager, Certified Professional Coach and founder of LifeBridge Solutions, a one-stop shop for family transition coaching, caregiver coaching, medical billing advocacy, money management, household transition services, and estate administration support.