Monday, December 24, 2012

Happy Holidays!

Wishing each of you and your families and friends the very best and safe holidays!

photo © Kathy Quan

Monday, November 26, 2012

What is Caregiver Fatigue?

Those of us who are tasked with caring for aging parents and other loved ones can become overextended very quickly. Caring friends and family can even believe they are helping by "delegating" to us so that our loved one doesn't have to do it. All too often these well-meaning people wouldn't dream of stepping in and helping. And they have a long list of reasons why not such as not wanting to interfere or step on toes!!

See the bits of frustration and anger growing in that paragraph? No matter HOW much you love the person you're caring for, it can be come too much more often than you'd like to admit.

Caregiving is one of the most demanding roles ever invented. And when caregivers don't set some limits and replenish themselves, the task reaches "impossible" very quickly. They simply burn out and can't function in that role.

Learn to prioritize, organize and delegate what you can. The more you can control, the easier things will be. Schedule tasks and don't procrastinate the ones you don't like. That just adds to your stress. Ask for help before it becomes overwhelming and have a spouse, friend or other loved one with whom you can vent as often as needed to release these feelings.


Wednesday, October 31, 2012

Devastation from Hurricane Sandy

Living in So CA, disaster preparedness is always in the back of your mind. But who would have conjured up the amount of devastation in the path of Hurricane Sandy?!

I have friends and family smack in the middle of the destruction from the Jersey Shore to NYC. Thankfully they are all safe. This is a nightmare we won't forget. My thoughts and prayers are with everyone who has been affected by this event.

Take care and be safe. Don't get taken by scams. Be smart.

Friday, October 12, 2012

Determing the Level of Care Needed

What are ADLs?
One of the most important ways of determining the Level of Care you need for a loved one is the number of ADLs they need assistance with along with the amount of assistance needed.

ADLs are Activities of Daily Living
They include the basic levels of self care; ambulation, feeding, dressing, bowel and bladder management (toileting), transfers (bed, toilet, wheelchair) and hygiene/grooming.

How Much Assistance is Needed?
Your loved one may be able to walk, but needs to use a walker, and must have help going up or down stairs. He can feed himself, but needs help preparing meals and cleaning up. He can dress himself if someone helps select his clothing and assists him with his socks and shoes. He can get undressed by himself. He needs help with bathing as he can't get in and out of the tub alone. He is able to use the toilet, but occasionally has accidents if he waits too long to go. Reminders would help.

Many private care, non-medical service agencies offer a wake-up and /or good-night care from a CNA (certified nursing assistant) or HHA(home health aide). wake-up careis comprised of a visit in the morning to help clients get ready for the day including grooming and hygiene which could include bathing if desired and dressing. The aide can prepare and serve a morning meal, and perhaps make a sandwich to be eaten at lunch.

The good-night care would be for bathing or bedtime care. Perhaps it could be scheduled to include meal prep for dinner or an evening snack. Or it can be schedule later in the  evening  and the aide can then tuck the patient in bed and make sure lights are out and the house is closed up and locked for the night.

Medication reminders can be given, but the medications have to be prepared in a med box, or the client able to dispense on his own from the prescription bottles. Only licensed nurses (RNs or LPNs)  can dispense medications. Medications can be set up in a med box and labeled by family members. Med boxes are available for once a day dispensing or with multiple sections for several doses a day.

If your loved one needs assistance with IADLs (Instrumental ADLs) such as housework, meal preparation, shopping, managing money, using the telephone, or using transportation you may need to hire care for more hours/day or days/week. Other IADLs can include safety and caring for pets or others such as a spouse. These issues can require even more care.

Make a list of tasks that are essential for someone else to help your loved one with, and those which you can assist with, and discuss with the caregiving agency.

Tips for Hiring
My best advise is to make sure you're hiring from a licensed and bonded agency. Not all agencies are created equal and not all are required to be licensed by your state. Licensed agencies are overseen and required to adhere to state requirements and standards of care for hiring and supervision to ensure safe, quality caregiving. Unlicensed agencies are not overseen to ensure that they adhere to standards of care. Some may provide excellent care, but if they don't there's no one to answer to. A licensed agency will have experienced nurses and personnel to assist you with selecting the type of care needed; where as the unlicensed agency may be run by a lay person with no caregiving experience.

If you hire privately, be sure to check references and have them demonstrate how they will assist your loved one with ADLs before hiring. You should observe any caregiver in the care they provide to ensure they meet your expectations.

Additional reading...
You Won't Know What You Don't Know
Aids to Help Keep Aging Family Safe

Tuesday, September 11, 2012

Never Forget

Thursday, August 9, 2012

You Won't Know What You Don't Know...

At the risk of sounding too much like Yogi Berra (famous catcher for the Yankees), when it comes to caring for aging parents and loved ones, you won't know what you don't know until you know it.

We learned very quickly when we had children that they don't come with an instruction book. Parenting is about winging it most of the time, and sharing your successes and failures with your peers.

In the same way, aging loved ones don't come with instructions either. And many of the predicaments can be much more difficult to maneuver. In many ways it becomes even more important  to network with friends, family, co-workers, etc. to learn what they know that once they didn't know they needed to know either.

This is just one of the reasons I wrote the book The Everything Guide to Caring for Aging Parents; to share my experiences from both sides of the fence. As a home health and hospice nurse for over 30 years, I think I've seen and helped families cope with almost every scenario. And as a daughter/daughter-in-law with aging parents, I have lived through many of these experiences myself.  I hope you find it helpful!

Friday, July 27, 2012

Yogic Meditation Reduces Caregiver's Depression and Risks

Researchers at UCLA recently noted that caregivers caring for elderly with Alzheimer's dementia can improve their cognitive function and lower their own depression and mental and physical health risks and issues through a specific yogic meditation called Kirtan Kriya. 

By practicing this meditation researchers "found that meditation from yoga can help lower depression in caregivers, and may also improve their cognitive functioning. The researchers even found that the meditation was associated with a decrease in cellular aging from stress."

Wednesday, July 4, 2012

Happy 4th!

Wishing everyone a happy safe and sane 4th of JULY as America celebrates another birthday!

Thursday, June 14, 2012

Aids to Help Keep Aging Family Safe and Active

There are a multitude of items available on the market to assist aging people remain as independent and safe as possible. One of the better inventions is the rolling walker with the seat. Sometimes I want to borrow my mom's if I'm going to be somewhere where I need to stand for a long period of time. 

Be aware though that it's not a device to lean back and take a nap. Mom slid right out and on to the floor when she decided to just lean back and relax. Wasn't hurt, but surprised her.

Some of the other great tools include an "Economy Aluminum Shaft Reacher" for grabbing things from high spots, or picking up the newspaper off the ground. "Sock and Stocking Aid with Cord Loop" is great for putting on socks when the body just won't bend like it used to.

Raised toilet seats, commode chairs, bathtub benches, grab bars, gait belts, over bed tables,  hoyer lifts, overbed trapeze bars, hospital beds, tab alarms, wheel chairs, and a large variety of incontinence supplies (diapers, pullups, chux) etc. are widely available to help with the safety and Activities of Daily Living (ADLs) for our aging family and friends.

It may not be an App, but if there's a need, there's a device to help keep your loved ones active and safe.

Find a Hearing Specialist near you for your loved ones with Healthy Hearing.

Thursday, April 26, 2012

More Information About End of Life Decisions

Learn more about speaking with your loved ones about comfort care and end of life decisions...

Friday, March 23, 2012

Be Careful How You Say It

Communication is an art. It’s a two-way process that involves speaking as well as listening. Perhaps nine out of 10 people may hear the same sentence and understand it the way the speaker meant it; the 10TH person will hear something entirely different.

Recently, I was speaking with a group of nurses at our weekly hospice meeting. One of the nurses discussed how one of her home health patients had totally misunderstood his physician.

The patient, whom I’ll call Sam (for confidentiality reasons), was very sick with cancer. He had undergone major surgery and some chemo and radiation treatments. At a follow-up visit the physician ordered more tests. After those results came back, the physician told Sam that they had “done everything we can do for you.”

The physician was very fond of Sam, and it was quite difficult to deliver this news. He didn’t elaborate, thinking Sam understood that his treatment had not been successful and there were no more options. The doctor told Sam that he should prepare himself for an eventual death and get his affairs in order. He shook his hand and quietly left the room.

Sam was elated. He thought the news was great. His take on this was that his healthcare team had done everything they can. The treatments had worked and his cancer was cured. Now he didn’t need any more treatments and could get on with his life, and yes prepare for that eventual death down the road. 

Sam went home to celebrate. He called his home-health nurse and conveyed what the doctor said. She knew it was a misunderstanding and her heart sank for him. She called the physician and told him what had happened, who then called Sam to explain. The news was certainly not what Sam wanted to hear, but his prognosis was poor and he had decisions to make about his short-term future and end-of-life care.

This story gives us pause to be careful how we say things, and even when the conversation is painful, we should make sure the listener understands.

Sunday, February 19, 2012

Important Terms Affecting End-of-Life Decisions

2013 ALTY Blog Award Nominee

When a diagnosis is bad and the prognosis perhaps even worse, the ability to cope and deal with a new set of terms and tasks can be overwhelming.

End-of-life care choices will be some of the most important decisions of a lifetime for anyone choosing to control how and where they will die. Choices made will guide and drive the matters that are most important to ensuring a peaceful, comfortable death with dignity and maximizing the quality of life up until the end.

Some of these decisions can be made long before end-of-life care ever comes into play. If these choices no longer fit they can be changed or revoked anytime. Understanding some important terms used in end-of-life decision making is vital to making appropriate choices.

Advance Directives
Advance directives or healthcare directives are general end-of-life care terms describing:
  • A Healthcare Proxy or Durable Power of Attorney for Health Care (DPOAHC) is a person (such as your spouse or adult child) you appoint to act on your behalf in the event you are unable to make decisions for yourself.
  • A list of instructions regarding your medical care wishes such as resuscitation (CPR) or inserting tubes i.e. to help you breath with artificial help (ventilator) or a feeding tube in the event you cannot swallow. These instructions can be as detailed as desired. Beware that advance directives can be treated differently by individual states or provinces. They do help to reduce the burden on family members.

Withdrawing Care
When everything possible has been done, the physician or nurse may mention the term “withdrawing care.” This important term means that the current course of aggressive care and treatment will end. For instance, treatments such as chemotherapy and radiation will be stopped. In advanced stages of illness or dying this can mean withdrawing various levels of life support measures such as ventilators, artificial feedings and dialysis.

What withdrawing care does NOT mean is that these measures should ever be abruptly ended and the patient sent home to die without any support systems in place. Hospice or palliative care should be brought in to help make this transition. For instance, even patients who have been on a ventilator won’t usually die immediately upon its withdrawal. They may experience some air hunger, which is a subjective experience of not being able to breathe in enough air. Comfort medications, such as low doses of morphine can help with the breathing difficulty, or Ativan to control the anxiety and panic associated with not being able to breathe adequately. These medications need to be available to ease these symptoms and allow the natural dying process to take its course.

Comfort Measures
Comfort measures is a term for the care which will be implemented to assist the patient as he moves into the next stages of dying. This may be accomplished with a variety of medications and treatments to manage such symptoms as pain, anxiety, depression, constipation or breathing difficulties. Comfort measures can also include non-medical techniques as massage, therapeutic touch and guided imagery along with spiritual and emotional support for the patient, family and caregivers.

Symptom Management
Hospice and palliative care often get the bad rap of “immediately putting patients on a morphine IV drip so they will die quickly.” Any quality hospice or palliative care organization does not do this. If this is the case for you or a loved one, you have the right to revoke and call in another team.

Over-the-counter medications may be used for mild pain in the beginning; as the pain increases, stronger medications can be used. Stronger comfort medications like Vicodin, Norco, dilaudid and morphine are commonly used for moderate to severe pain and/or advanced breathing difficulties. These medications are carefully titrated (doses increased in small increments) from very minute amounts until effective symptom management is achieved. Symptoms can often be controlled for a long time with very small doses.

For patients who might not be used to anything stronger than aspirin or ibuprofen, changing the strength (dose) of these stronger medications in small increments should be as slow as needed to achieve symptom control while maintaining the desired level of alertness for quality of life. This is just one reason why it is highly recommended to start palliative care or hospice early enough so that symptoms aren’t so far out of control and the patient is the stage of actively dying. It can take some time to reach proper symptom management.

Antidepressants, anti-anxiety medications, anti-nausea medications and bowel regimens (including medications, increased fiber and fluids, and daily habits) are useful in helping control other common end-of-life symptoms, such as depression, anxiety, nausea/vomiting and constipation or diarrhea.

End-of-life care and the dying process have so many unknowns that make it a scary experience for many people. Through knowledge and education many of these unknowns and fears can be conquered. The journey can become a more pleasant time to share the gift of spending the time left in peace and comfort in the company of family and friends.

Jeanette R. Stevens RN, BSN, CCRN, CHPN, “Care Until the End.” Nurseweek West, October 10,2011.

Mayo Clinic Staff; “End of Life: Caring for a Dying Loved One.”

“Pain Control Methods and Standards of Care.” Hospice Patients Alliance.


Thursday, January 26, 2012

Advance Directives Allow Choices and Support Medicare Savings

All the hoopla about “death panels” during the 2010 battle for healthcare reform spooked too many older adults into thinking they would be deprived of curative healthcare because they were older and the care too costly.

That talk has died down for the most part; however, the idea continues to haunt many when they think about end-of-life choices and hope their wishes will be honored and not limited to palliative care alone.

The results of a recent University of Michigan study, published in the Journal of the American Medical Association, show promise that advance directives and other end-of-life care choices have not had an impact on the quality of care provided. Nor have older Americans been denied curative care if they desired it, according to the study.

In regions of the country where curative care is the norm, the cost of medical care has surprisingly declined (and Medicare savings have increased) because of growth in the number of patients choosing palliative care instead of more costly aggressive care. The Michigan study showed that patients in those regions with advance directives received quality comfort care according to their final wishes. Many died at home instead of in hospitals, as was their wish.

The study’s results may encourage people to strongly consider their quality of life concerns and make their end-of life choices known to their families and their healthcare team. Even many study participants who chose treatment-limiting instructions also allowed for limited trials of intubation (inserting breathing or feeding tubes) and mechanical ventilation if needed. But their instructions also made it easier for their proxy (appointed person who has the legal power to make healthcare decisions if you cannot) to stop the treatments if they weren’t effective.

End-of-life care decisions require careful consideration; they can be as specific as you want or need them to be. Although impossible to address every scenario, it’s imperative to discuss the scope of your wishes with your family; your spokesperson and your healthcare team so that your intentions can be met. For instance, do you want everything possible done or do you want quality of life and freedom from pain and suffering (palliative care) if there is no hope of a cure?

If you would like to help people make important decisions in their healthcare, consider any of the online healthcare degrees.

Thursday, January 5, 2012

What is Palliative Care?

Palliative Care is about managing symptoms for those with chronic or fatal illnesses. It's something we're going to hear more about in the next few years.

Quality of life and managing pain and other symptoms instead of just prolonging life will help us all be comfortable in our last days.

Palliative Care also helps those with chronic symptoms of pain, nausea, shortness of breath, etc., from diseases such as Rheumatoid Arthritis, MS, and COPD, to live more comfortable lives with a better quality of life. Here's a great article to help you understand more about Palliative Care.