In This Issue:

1. Care Giving 101
2. Care "Getting" 101
3. Caregiver Love:  Give of Yourself and to Yourself
4. AVOID IT! Caregiver Enemies
5. Giving Back Love
6. Caregiver Survival Kit
7. Ask Dr. Vanessa

This month’s newsletter topic is about “caregiving” and “care getting”. We include useful tips and ideas for caregivers to promote safety, health and prevent injuries from occupational therapist Dr. Vanessa M. Dazio; a special feature written by Marie Pietschmann who provided care for her father and her mother through a continuous span of 8 years; and a number of excellent Internet resources for caregivers.

This newsletter is about love--self love and loving others. For all caregivers, here is a special thanks for you and the people who help to support your effort.

1. Care Giving 101 by Vanessa M. Dazio, OTD, OTR/L

For many caregivers, providing hands-on personal assistance to another adult can be mystifying, stressful, and hazardous to health. There is an unbelievable amount of excellent written information about care giving available to anyone who needs it or looks for it. Despite the vast amount of available information, care giving is anything but simple!  

Care giving takes patience, skill, organization, knowledge and love. It also takes a coordinated team of “lifesavers”, helpers and friends. Care giving requires personal discipline, community involvement and government support.

If you are a caregiver, do everything you can do to find and use outside support and assistance. This is essential to assure mental and physical health. Many studies have linked care giving to serious health consequences such as increased risk of coronary heart disease; elevated blood pressure; and increased risk of developing hypertension; lower perceived health status; poorer immune function; slower wound healing; and increased risk of mortality. Personal discipline is required to maintain wellness.

If you know someone who is a caregiver, offer your help and support in some useful way through friendship or actual hands-on assistance. If you are an employer, offer caregiver friendly programs, provide paid leave and find ways to support a valued employee during care giving efforts.

Hope these 10 tips and ideas help!

TIP # 1:  Know Your Rights as a Caregiver: 

 You have the right to           

1. Take care of yourself.

2. Make a life for yourself.

3. Express yourself.

4. Conserve your energy.

5. Have fun, rest and relax.

6. Change your mind or the situation.

7. Say “no.”

8. Seek help from others.

9. Explore options.

10. Delegate as much as possible.

TIP #2 :  Know your strengths and weaknesses (use our handy form "Caregiver Roles" to help)

Take a few moments to carefully assess your strengths and weaknesses. Write them down. Let your other helpers read your list. Your weaknesses might be someone else’s strength. You might find willing and capable volunteers (lifesavers) to help you!   

TIP # 3:  Know how to safely lift       Plan ahead! Always pay 100% attention while lifting anyone or anything. Balance yourself with your feet apart and just under your hips. Wear good supportive shoes. Directly face the person or object you are lifting. Keep your nose even with your toes when lifting or moving a person or object! Grip firmly and stay very, very close to the person/object you are lifting. Use both your legs and both arms to lift. Never bend or twist your back when lifting, ever! Always try to eliminate strain (use help, energy saving devices or ergonomic postures to reduce effort).

AVOID BENDING WHEN LIFTING

TIP # 4:  Know when to provide assistance  

• Assist as much as necessary, but not more than necessary

• This helps the receiver to be involved and feel involved 

• This helps the caregiver to reduce strain each day and over time

TIP # 5  Be flexible and open to new ideas

1.  If a “lifesaver” (helper) unexpectedly shows up and offers help, accept the offer and do something else!

2.  Try new energy saving ideas

1. Look for helpful devices to

• reduce strain and physical effort

• make it possible for the receiver to do the task as much as possible

2. Ask for help from others.

• tell people what you need

• don’t be afraid to say you can’t do everything well

• ask people to help in ways that work for them

3. Consider new helpful techniques or ways to save energy while providing care or performing related activities.

3.  Be open to suggestions or different ideas.

4.  Occupational therapists: experts in helping people find ways to safely do.

• For more information refer to www.aota.org or SAFE Aging www.safeaging.com.

• Care/case managers:  www.caremanager.org  or www.cmsa.org

• Home health services:  Contact state health departments for details.

• Elder resources: There are many federal, state and local resources. Here is a good start: http://www.fcoa.org/AgingLinks/aginglinks.html

5.  Ask family, friends, church members for help.

TIP # 6:  Know how to solve problems

If a problem exists, analyze the following three things:

1. the way a task is being done

2. the environment

3. the equipment being used

TIP # 7:  If something is hard to do, dangerous to do or requires a lot of effort, change it!

Change options

• organize

• eliminate

• remove

• replace

• adapt

• create

Tip # 8:  Get Organized

1. Gather and post all telephone and emergency numbers

• doctors and health care professionals

• family, friends, other volunteers or helpers

• pharmacist

• community agencies

• church information

• delivery services

2. Gather all medical papers, articles and brochures into one book or file

• make sure you know and understand the basics of safe medication use, purpose of prescribed medications, schedule, and side effects

• gather related medical information into same file

• keep an ongoing list of questions ready for doctor/health care visits

3. Gather all legal papers into one book or file

4. Keep all important papers, books and files in one easy to reach and

• easy to find container

• keep a list of helpers names, phone numbers and interests

• have emergency information written down and clearly explained

• keep a diary of daily activities

Here are some SAFE Aging resource handouts you can use.

• Record Your Plans and Solutions

• Emergency Numbers List

Tip # 9:  Plan Ahead

1. Know what you want to accomplish each week

2. Make daily goals (use a “to do” list)

Refer to our handout, "Know What You Want to Accomplish"

TIP # 10:  Save your time and energy

1. Eliminate any unnecessary steps and think efficiently

2. Minimize low value activities

3. Simplify

4. Determine priorities

5. Slide things

6. Work and tools within easy reach (not above chest or below knees)

7. Use the best tools and equipment in the proper situation

8. Make the best working conditions possible

• good lighting

• comfortable clothes and environment

• pleasing colors

• good ventilation

9. Organize to permit best sequence of motion

10. Avoid holding when possible 

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2. Care “Getting” 101 by Vanessa M. Dazio, OTD

The Care “giver” gives constant personal love, energy and devotion to the receiver. Often, as a result of providing care giving assistance, the care giver’s own personal life style changes. Health declines. Work roles may change. Finances may suffer as a result of decreased work hours, early retirement, passed up job promotions, reduced retirement benefits, etc. Personal relationships with friends and family change, and even involvement in interesting daily life activities go by the way side! 

It is important to protect physical and mental health and wellness. Daily life leisure, social, and play patterns may change, but they should not be eliminated. This can happen easily, but it can also be controlled with effort, patience, vigilance and discipline!  

Health and wellness is essential to be a safe and effective caregiver. In order for the care giver to “give”, the care giver must also get! This is about “care getting.”

Here are 10 TIPS for Care “Getting”:

1. Care for yourself!

1. Take care of your health and well being.
2. Take preventive measures to assure your safety.
3. Do pleasant physical activities every day just for you.
4. Get regular preventive medical check-ups.
5. Drink plenty of water (8-10 glasses of water daily).

• it keeps your muscles and skin toned
• transports oxygen and nutrients to the body’s cells
• eliminates toxins and waste from the body
• regulates body temperatures
• reduces fatigue levels

6. Make sure you get rest and sleep.
7. Eat a well balanced and nutritious diet.

• eat a variety of fruits, vegetables, proteins and carbohydrates
• nutritious foods provide essential vitamins and nutrients
• nutritious foods can help control many illnesses

8. Use proper postures to avoid injury.

2. Be good to yourself!

1. consider getting an occasional massage to reduce tension and stress
2. award yourself with an ice-cream cone, a favorite food, or special present
3. ask for help (don’t be shy!)
4. get and accept outside support
5. recognize risk factors (obstacles to comfort, safety and well being) that could cause you harm, and work to reduce or eliminate them
6. get 10 hugs and 10 kisses every day

3. Do fun things every day

1. do something you like to do
2. do something you want to do for yourself
3. this can be as simple as taking a bubble bath, reading a chapter of a book, talking to a friend on the telephone, walking outside, etc.

4. Laugh a lot

1. laughing improves breathing and circulation
2. laughing fosters healing
3. laughing stimulates the immune system
4. laughing unleashes natural pain
5. laughing changes your focus
6. it makes you and others feel good

5. Smile a lot

1. It takes 43 muscles to frown and 17 muscles to smile. It is 2.5 times easier to smile than frown. Therefore, smiling is energy efficient!
2. Smiling is infectious, it is good for you and for others.

6. Arrange for planned time away every week

Know what you want to accomplish, and plan for it. To be a healthy caregiver you want to allow for time away every week to care for your physical and mental health. Here are a few ideas!

1. Movies alone or with others (whatever makes you feel happy)
2. Picnic at the mall, in a park, by a pond, on a mountainside, in a valley, etc
3. Attend a local support meeting
4. Have a pleasant meal with friends
5. Take a walk in the park
6. Go for a swim
7. Go on a date with your spouse, children, grandchildren, friends, etc.
8. Go to the library, enjoy the peace and quiet
9. Take a class for absolute entertainment or to learn something new
10. Join a club for fun
11. Participate in a sport or sport event that makes you feel good
12. Read a magazine or a chapter of a special book
13. Listen to the birds, enjoy the wind, the sun, the rain, etc
14. Listen to music you love
15. Dance to a favorite song
16. What are your ideas?

7. Manage your pain and stress

1. Pay attention to pain. Pain is protective. Respect it.
2. Aches and pains are warning signs.
3. Respond quickly to any signs of pain, stress or discomfort.
4. Change behaviors that cause pain or stress.

8. Control Your Anger

Anger is a feeling or emotion that ranges from mild irritation to intense fury and rage. Anger may result from frustration when our needs, desires, and goals are not being met. When we become angry, we may lose our patience and act impulsively, aggressively or violently. 

Uncontrolled anger may lead to health problems, resentment, physical aggression such as outbursts, intimidating or threatening behaviour; verbal abuse, alienation, violence, destructiveness, etc.

To control anger, here are some suggestions: 

a. Become aware of it, monitor it. Cues to anger are:

1) physical:  rapid heart beat, tightness in chest, feeling hot or flushed

2) behavioural:  pacing, clenching fits, raising the voice, staring

3) emotional:  fear, hurt, jealousy, guilt, rage, etc

4) cognitive/thoughts:  hostile self talk, images of aggression, revenge, etc.

b. Develop immediate and preventive strategies to manage anger

1) take a time out

2) use deep breathing

3) stop your thoughts

4) develop an exercise program

5) change your beliefs

c. Get professional help if you are unable to control your anger

1) anger must be controlled

2) take immediate action

9. Conserve your energy 

1. Schedule rest breaks

2. Use gravity and momentum to reduce your work load

3. Use delivery services (such as pharmacy or groceries)

4. Shop by phone or computer

5. Use power whenever possible

6. Avoid any unnecessary tasks

7. Keep frequently used items within easy reach

8. Place items commonly used in sequence together

9. Place items concerned with similar or related functions closely together

10. Learn about helpful resources  

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3.  Caregiver Love: Give of Yourself and to Yourself
by Vanessa M. Dazio, OTD

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4. AVOID IT!  Care Giver Enemies  by Vanessa M. Dazio, OTD

Anger: Avoid it! Uncontrolled anger is dangerous and must be immediately controlled. Seek professional help!

Being Alone: Avoid it! Care giving and isolation are a deadly mix. Caregiving requires interaction and involvement with others. Call your local church, friends, and other family members, ask for help. Call your local community support services. Do not try to provide care giving all alone. Discuss care giving requirements with your trusted health care professionals.

Complication: Avoid it! Try to keep things as simple as possible. If complicated, look to see what can be changed. 

Compulsion: Avoid it! Avoid the compulsion to do everything perfectly. This can make life too difficult and too miserable. 

Depression: Avoid it! If your care giving activities are affecting your outlook on life, make an early visit to your physician. Do not wait!. Talk about your feelings before getting overwhelmed.

Extremes: Avoid it!

a. Avoid extremes in posture

• be aware of your body position

• muscles are strongest and most efficient when they are well balanced

• avoid bending and twisting

• avoid reaching above your shoulders or below your knees

b. Avoid extremes in the environment

• high temperatures can cause dehydration, exhaustion, heart problems, difficulty breathing

• low temperatures can cause sensation loss, grip strength loss, decreased blood flow

• noisy environments can make concentrating and hearing difficult

• dark environments are a safety hazard and can cause slips, trips, falls, coordination changes, muscle strain, fatigue and many other hazards

c. Avoid overexertions! (Overexertion is force)

• do whatever you can to eliminate strain

• work within your best comfort zone

• get plenty of rest

• avoid excessive lifting/ lowering, pushing/pulling, holding/carrying

(a) get help from others

(b) change the environment to reduce your effort

• maintain good physical conditioning

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5. Giving Back Love by Guest Columnist, Marie Pietschmann

My beautiful father fell and fractured his hip. When he was hospitalized, we found he had suffered a small stroke, had mild dementia, and a cancerous lung tumor. It was time to give him back some of the love and care that he gave us for so many years.

I thought back on his gentle smile and tender touch and knew the task ahead was formidable, but I would do my best. He made it so easy. He never complained and tried to do what he could do to help. As the disease progressed, we had to prevent him from wandering to assure his safety. Then we eventually had to use diapers. The first time I had to diaper him, we both cried. 

My brother made the care easier, he helped as much as he could, spending as much time as possible with Dad. We eventually enlisted the aid of Hospice and hired a caregiver during the day so we could both work full time jobs. Our problems were compounded when my mother fell and broke her hip. Now we had two parents in walkers with Dad on a serious downward spiral!  My brother and I coordinated our schedules, and stayed with our parents at night and after work and weekends. Our hearts ached seeing them deteriorate when they were so strong and vibrant. 

Caregiving was never easy. There were issues to face such as anger, resentment and fatigue. Our own family lives were compromised, but all of our family members rallied around and helped. Coordinating our parents care was crucial. It included supervising medications, making and traveling to and from appointments, doing their normal household activities such as cleaning and maintaining the house and lawn; doing laundry, grocery shopping, preparing nutritious meals.  

We struggled for six months until Dad had to leave us. It was good to know we were all involved in his care. We gave back love! My mother’s care continued for another seven more years, but that’s another story!

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6.  Caregiver Survival Kit

If we could reach across the internet to give you a caregiver survival packet, we would indeed. Instead, here is the kit. You can put one together yourself. Find a treasured little box, or a colourful little bag to hold your kit. When you have a quiet moment, every so often, take your kit out and treasure the symbolism.

1. Toothpick: To remind you to pick out the good qualities in others
2. Rubber band: To remind you to be flexible, things might not always go the way you want, but it will work out
3. Band Aid: To remind you to heal hurt feelings (yours or someone else)
4. Pencil: To remind you to list your blessings everyday
5. Erasure: To remind you everyone makes mistakes, and it is okay
6. Chewing gum: To remind you to stick with it, and you can accomplish anything
7. Mint: To remind you that you are worth a mint
8. Tea Bag: To remind you to relax daily and go over your list of blessings

Author is unknown. (if anyone does know the author, please let us know)

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7.  Ask Dr. Vanessa

Question: My mother lives in another state. I really can’t get a straight answer from her about her health, or her safety at home. Can the SAFE (Safety Appraisal For Elders) help us?

Answer: Thanks for asking about the SAFE. The SAFE might be a good start. It can really help to open communication, and develop personal awareness. The SAFE^SM provides the structure for an individual to systematically think about personal health and life influences, abilities in activities of daily living, ergonomic risk factors, emergency planning and in-home safety.

Questions can be answered independently or with the assistance of others, at a comfortable personal pace. Although there are no right or wrong answers, answers are scored impartially and without bias to determine and highlight potential health and home safety risk factors that could lead to ill health or injury.

A score identifies a potential level of risk and is developed to make visualization of risk easier. You can’t fix something if you don’t know about it.

Once potential risks are identified, we prepare a risk adjustment plan or a “RAP.” A RAP provides information and ideas about health and home safety based on identified potential risks highlighted in the SAFE^SM. The completed SAFE and the RAP can be used as a way to open communication with the family, increase personal awareness, track changes over time, and identify strategies to reduce or eliminate potential risk factors.

If you believe your mother is seriously at risk, of course, the best course of action is to request an appointment with her physician. Another option could include asking an occupational therapist, (a trained health care professional), to make an in-home visit to determine safety and health. For more information about occupational therapists, refer to www.aota.org.

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Internet Resources for This Newsletter

• www.safeaging.com

• www.nfcacares.org

• http://www.nlm.nih.gov/medlineplus/caregivers.html

• www.samhsa.gov

• http://www.caregiving.org/04finalreport.pdf

• http://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=1104

Other resources:

Caregiver Workshop Series (CHARMS, Inc. and SAFE Aging, 2005)

25 Simple Ways to Make Life Easier and Safer (Vanessa M. Dazio, 2002)

No Pain is Your Gain (workshop by Vanessa M. Dazio, 2003)

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