Every once in awhile I receive a letter from one of my readers letting me know that an article I have written has helped them in some way.  I am always so grateful when that happens because this is why I do this.  It is my joy to help make caregiving easier for those who have that calling or for those who suddenly find themselves in that position. 

I wanted to pass Greg’s letter along because he has found a great new way to make his mother’s bathing experience much better.  Thank you so much for sharing this with us, Greg.   Blessings.

“Thank you Shelley for the article!
 
This was a great read, and informative as I have been taking care of my 81 year old’s Mom showering needs for the past few years and I never gave special consideration to the things you mentioned. I could never understand why my
Mom would get so upset when it came time to give her shower. She wants to shower and she has always been very clean about her appearance. But she would get scared and very nervous. I do have a volunteer that comes in 4 times a week she is wonderful and she is a female. But My Mom does not feel as secure with her as she does with me. So I do it because I love her!!!
 
Your article made me approach my Moms showering requirements in a whole new light and now I make it an enjoyable experience for her. I call it Ladies day at the spa. My Mom gets a full shower and cleaned up and hair washed. I get her nicely dressed and do her hair for her. She feels so much more relaxed and it’s an enjoyable experience for us both. My Moms anxiety does not get as bad and she is much easier to shower and take care of this way. Perhaps you can pass this along to your other readers as a tip just to help out.
 
Greg”

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Look for a family practitioner or general practice physician to be the primary care physician for your loved one. General and family practitioners are trained to treat all aspects of a person’s health and well-being even though they have not specialized in a specific field. They treat the elderly as well as newborns, children and adults for everything from a splinter to a more serious illness.

Health Insurance Coverage

Choosing a doctor can be based upon several factors. One of the first aspects to look at is whether or not the patient’s health coverage is accepted by the physician being considered.  Most physicians will accept Medicare but it’s important to determine whether or not they will accept Medicaid and/or the supplemental policy if one is available.  If the doctor will accept the health coverage, the next thing to look at is accessibility.

Location and Accessibility

It is important to choose a doctor whose office is located close enough to be easily accessed for routine care and emergencies. If the elderly loved one is homebound, a physician who understands this and is willing to work around this detail to provide care is ideal.

Physicians can order home health nurses to draw blood, administer injections, take vitals signs and other basic medical procedures then report to the doctor. These procedures would normally be done at the doctor’s office, but when dealing with a homebound patient, getting them into the office may be a problem.

In addition, when transporting an elderly homebound loved one, distance to the doctor’s office can play a part in the convenience of the location. Determine if the time spent driving and the distance to and from a doctor’s office makes the doctor in question an acceptable choice for your loved one’s needs. If the doctor requires that your loved one must been seen at the office frequently, then distance can be an important factor when choosing the physician.

Office Hours

When choosing a doctor there are a few important questions about the doctor’s schedule that you should ask. What kind of office hours does the doctor hold? Do they have evening or weekend hours? How can you get in touch with them when the office is closed? Are the physicians who cover the “on-call” hours acceptible to you?

Hospital Choices

Most doctors have privileges at specific hospitals. When choosing a doctor, it is important to find out which hospital or hospitals the doctor has privileges at. This is the same hospital the patient would go to for emergency care, tests and surgeries in most cases. The size, location and reputation of the hospital may play a large role in your decision to choose or not choose a specific doctor.  Some towns and cities have specialty hospitals for certain conditions.  If your loved one has a condition that is treated by one of these specialty hospitals, it is important to determine if the primary physician has priviledges there.

Personality

Even the most qualified and credentialed doctor may not be the best choice for your loved one’s personal physician if their personality clashes with yours. You’ll probably want to choose a doctor that you genuinely like and feel comfortable with. Remember that you will need to be working closely with this person to advocate for the best health care for your loved one.  Imagine my surprise when I asked my father’s physician if he might be discharged in the afternoon only to hear him say “What part of HE WILL BE DISCHARGED TOMORROW MORNING did you not understand?”  However, there are also surgeons that I have worked with in the past who had terrible bed-side manners yet they are the ones with whom I would have trusted my life.

Choose a doctor who will take the time to speak with you as you advocate for your loved one’s health care. The doctor should be willing to listen to your concerns and answer your questions to your satisfaction. Remember, you are hiring them and paying them for their time.  The days of the primadonna physician OUGHT to be over.

Another consideration is the physician’s staff.

Do you like the physician’s staff? Are the doctor’s employees personable, respectful and pleasant? If you find receptionists, nurses and other staff members to be rude, then perhaps you should consider other physicians. These are the people you will be working with to schedule appointments, update prescriptions and access patient information. If you find them difficult to work with initially, it might improve over time but don’t expect it to automatically occur.

Ask the doctor if they have a Family Nurse Practitioner or a Physician’s Assistant in practice with them. These medical professionals assist doctors in caring for patients in many private practices. Decide if this is acceptable to you for your loved one’s care. If not, then you may need to continue looking or specify in the patient records that care must be provided by the doctor.  Keep in mind though that Nurse Practitioners and Physician’s Assistants generally have more time to spend with the patient and are trained to be patient advocates.  They are also often more accessible.

Making the Choice

After taking all of these factors into consideration, decide which physician you would like to care for your loved one. Schedule a new patient appointment and commit to making the new relationship work.

In a study reported by Deborah B. Gentry, it was determined that nearly 40% of adult children acting as caregivers had serious conflicts with one or more siblings regarding the care of their parents.  Many times, this was due to the lack of participation of one of the siblings, arguements over finances or disagreements on where Mom or Dad should live.  With a help of a mediator, these issues can be sorted out in a private, non-threatening setting where the family (including the parents) meets together.

Eldercare mediators have taken classes in this type of mediation.  They may be nurses, social workers, gerontologists or they may also be attorneys themselves.  (If they are attorneys, they do not practice law during the  mediation service.)

What does an eldercare mediator do?

• they are a neutral 3 rd party who helps with decision-making processes
• they help clear up misunderstandings within the family by knowing the right questions to ask
• they provide for expression of feelings and yet, keep the family on tract
• they help the family heal hurts, avoid blame and self-pity
• they help the family consider as many options as possible
• they provide for future modification of the decisions made

Mediators do NOT:

• Make any of the decisions themselves
• Provide family therapy
• Practice law

Who is involved in the meeting?

• Parents and siblings should be present.  The meeting may also include spouses, grandchildren, other close relatives, close family friends, caregivers, medical providers, pastoral leaders and lawyers.

What is discussed at the meeting?

This is up to the family members but some ideas for discussion include living arrangements and possible assistance for the parent(s), driving ability, end-of-life provisions, financial concerns, trust and estate issues, division of responsibility amongst the siblings, etc.

The advantages of hiring a mediator are that parents (or spouse) must give permission for the meeting to take place, thereby maintaining their dignity and autonomy by being involved as much as possible.  Also, if help is needed, financial and task responsibilities can be divided up equally among the children (siblings) or a care contract for a sibling that volunteers to be the primary caregiver can be discussed.  Obstacles are more easily overcome when using a mediator who can keep the family focused on the goal of caring for the parent (or spouse) in the best possible way.  Family relationships are also improved because everyone is kept in the loop.  Those siblings who are unable to attend due to physical constraints can participate by telephone or even on the internet.

The cost of an eldercare mediator is about $100.00 – $300.00 per hour but is a good investment in maintaining or building family unity and working to provide a good outcome for your aging parent(s) or loved ones.

Eldercare mediators can be found through state and local Area Agencies on Aging, attorneys specializing in elder law, geriatric care managers, Alzheimer’s Association (especially support groups) and the health department.

Ironically, later in the day, I was reading a story about MSNBC anchorwoman, Mika Brzezinski and her forthcoming book “All Things at Once” where she describes the day she fell down a flight of stairs while holding her 4 month old daughter.  She had been up all night working at the newsroom and because she couldn’t sleep (during daylight hours), had let her caregiver go home early.  She stated that she had picked up the baby and was talking 100 words per hour and walked right off the top of the stairs, landing with her on top of the baby!  The “baby” is now almost a teen and is fine, but can you imagine the horror, the pain, and the guilt that went along with that experience ? 

In the interview, she went on to say that at that point she learned to ask for help.  “If you’ve got a career that you need to nurture, there are going to be times when you need to transfer your authority to others. I will forever regret that I didn’t get help sooner so I could get through that rough patch in my career. ”

I’m sharing this story not just to talk about career vs. caregiving but to say that we must not wait until something awful happens before we ask for help.  Many of have careers and even if we don’t, we may have children and a husband who need our time and attention, as well.  We must not get to the point where we are too keyed-up to even sleep.  We must not let our families go on with their lives without us. We cannot afford to be the one who is admitted to the hospital with heart problems, anxiety disorder or something even worse while our care-recipient is left behind.  When we want to say No to something, we must say No !

If you are participating in a committee that is becoming burdensome, doing work such as cleaning or running errands that could be “resourced out” to another capable person, working with the local women’s group with whom you have nothing in common, not asking your family members (I’m talking siblings here) for help (even little bits of help), please reconsider your actions.  

Don’t wait for a 911 moment.  Just say No. 

Almost every country and culture in the world celebrates the New Year, although it is not celebrated at the same time of year in every culture.  They also seem to have certain foods that they partake of on New Year’s Eve or New Year’s Day in order to bring them good luck in the new year.  Let’s take a look at a few of them.

In the southern parts of the United States, black-eyed-peas are eaten in order to bring prosperity throughout the new year, and are often combined with collard greens (and often ham hocks or hog  jowls). The black-eyed-peas represent “eating coins” and thus gaining wealth.  The collard greens are representative of money (as are kale and cabbage).  At many southern New Year’s celebrations, you will find a dish caled Hoppin’ John which is made from black-eyed-peas, ham hock, rice and other ingredients.  Sometimes a shiny dime is placed in the dish and whoever receives it on their plate gets an extra helping of good luck. 

In many parts of the United States, ham is served.  The hog symbolizes prosperity throughout other parts of the world, as well.   Part of this is because as pigs root for food, they are always “rooting forward” symbolizing progress.  In Italy, the fatty parts of the hog are served too, symbolizing fattening of the wallets.  The pig is also used as a good luck food in Austria but comes in the form of little pink pig cookies. 

In Asia, long noodles play a part in the New Year’s celebration as a food that symbolizes long life, but the noodle must not be broken before it is entirely in the consumer’s mouth.  For the Chinese, oranges and tangerines are also consumed as foods to ring in their new year.   A recent explanation has it that the words “luck” and “wealth” in Chinese sound much like the English words “orange” and “tangerine” respectively.   Dumplings are also eaten because they are said to resemble nuggets of gold.

Another green leafy vegetable, cabbage, is said to bring luck and good fortune to the Germans (in the form of sauerkraut) and the Irish because it is green and resembles paper money.

In Italy, lentils are thought to be of good fortune for the new year because of there resemblence to coins or gold nuggets.

Pomegrates are consumed at the new year as a symbol of abundance and fertility in Turkey and other Mediterranean countries.

In north America, Asia AND Europe, fish is often a “good luck” food representing “moving ahead” into the new year because fish swim forward.  Eating fish is also associated with abundance because fish swim in schools.  Perhaps this is why our family always had poached salmon with dill sauce on New Year’s Day.

Several countries serve round or ring-shaped cakes as part of their New Year’s celebration as they represent having come full circle.  In Greece, there is the Vassilopita (often containing a hidden coin); in Italy, they have panetonne; in Mexico, the Rosca de Reyes and in Holland, the donut-like Ollie Bollen. 

Long ago, I had a small catering company and was called to deliver a special tray to an Iranian family who was celebrating their New Year (in March, the first day of spring).  The tray consisted of gold foil wrapped coins, apple, garlic, a nut candy and colored eggs making up a grouping that consisted of seven edible things that began with the letter “S” (in Persian language). This tray was to be placed on the dinner table or next to an additional non-edible display as a symbol of sweetness, love, prosperity, health, beauty, purity, opulence, patience and actually a few other hopes.

Some traditions arise out of natural circumstances.  In Spain, 12 grapes are eaten at midnight,  1 for each strike of the clock or 1 for each month passed symbolizing the coming of a “sweet” year.  This tradition is said to have begun around 1909 when there was a surplus of grapes in the Alicante region of Spain.

In some cultures, rice is also a part of the New Year tradition.  In the Scandanavian countries, a sweet rice dish is served containing a hidden almond.  Whoever received the almond was said to have good luck throughout the coming year.  (It’s surprising to me that with all these hidden coins and nuts that no one choked!  My mother actually used to wrap coins in waxed paper and hide them in my birthday cakes! )

When I had New Year’s Day parties at my house, we had a fortune cake…..I wrapped little paper fortunes around a fancy toothpick, covered the edge with foil and then stuck them into the cake.  Each person chose a fortune with their slice of cake. 

If you have the opportunity, ask your aging loved one(s) if there were any “good luck” foods served to them in their childhood during New Year’s celebrations.  You might be surprised.

Ironically, I know exactly what I didn’t know in my dream.  I know that I have a lot of guilt over the circumstances of his death .  He wasn’t treated well at the hospital; I HATED seeing him propped up in a chair.  I wasn’t there when he passed away in the middle of the night.  Nobody was.  I wish I could change that and therefore I go over and over it in my mind, trying to rewrite the past but realizing that it is impossible to do so. 

According to Dr. Vickie Rackner, author and keynote speaker, “Guilt is a pain that tells you there’s a mismatch between the person you’d like to be and the person you were in that moment.”  At “that moment”, I would have liked to have been the person who stayed at the bedside 24/7 and the person who KNEW to argue for hospice care and kept my father at home .  I regret that I wasn’t.

Dr. Rackner also states that regret and guilt are distant cousins.  Certainly they are related because regret often leads to guilt.

In the book, “The Emotional survival Guide for Caregivers” by Alexis Abramson, Barry J. Jacobs, PsyD states that when a loved one dies, guilt is the 2nd most predominant feeling in a former caregivers’ experience.  There is guilt that they didn’t do enough, guilt that they are now “free” of the burden of caregiving, guilt that they have their own life back.  This guilt can last 6 months or even longer. It comes and goes but is eventually replaced by the knowledge that the disease process and God’s plan were the biggest factors overall.

Guilt is a part of all aspects of caregiving.  Caregivers are often overburdened and torn between what they need to accomplish for their employer, their spouse, their family and their care recipient.  What was NOT accomplished often leads to feelings of guilt. ( I missed the soccer game; I missed spending quiet time with my spouse; I ran in, dropped off groceries, and ran out of my Mother’s house without stopping to chat at length.)  When I was caregiving for my father, I would often feel bad that I didn’t make the time to sit with him and play cribbage or watch T.V. as often as he wished I would.  There was just too much to do.  We DID play Cribbage at least 2 hours almost every night but as he always said “I have all day !”  He did; I didn’t.

Anger can also lead to feelings of guilt.  We feel badly about being angry that we are stressed, overwhelmed, over-worked, tired, etc., so then we feel guilty which leads to anger back to guilt and more anger….a never-ending circle.  Guilt will also cause us not to take care of ourselves, perhaps because we believe we don’t deserve the care  – which of course, will lead to anger, to guilt…and you get the picture.

In order to get rid of the guilt, it is important to acknowledge that feelings are JUST feelings, nothing more.  You must forgive yourself for your imperfections.  You are only human and no human is perfect.

While you cannot change events or all of the activities in your caregiving role, you CAN change your feelings about them and you may be able to change some of the actual activities themselves.  For instance, if you are finding it difficult to have any quality time with your care recipient because you are too busy doing chores, hire some of them out.  (If expense is a problem, The Area Agency on Aging has a scholarship program for a certain number of hours per month where caregivers can do light housework).  (Meals on Wheels may be available in your area to deliver some hot food to your loved one or perhaps your church may have a program.) When you are able to spend some time with your loved one, you can get to (RE)know them better, and enjoy them.

In the last couple of years, there has been a lot of talk surrounding the book The Secret and the laws of attraction.  Part of that philosophy involves a change in the way you look at the world and your role in it.  You CAN change the way you perceive your caregiving role from one of burden to one of gratitude for the experience.  Changing your perception will cause you to (consciously or subconsciously) change your actions in order to align the two with each other.

You must remember that it is absolutely imperative to take care of yourself and to continue to enjoy life.  Do not feel guilty about those things that you do just for yourself (I’m speaking in moderation, of course).  They will make you a happier person to be around. Do not become a matyr; it does nobody any good. 

So how does this all relate to my dream and my feelings of guilt ?  As I thought it through, I decided that I did the best that I could with the knowledge that I had at the time, so I forgave myself .  I had cared for my father in my home up until the last week and a half of his life and I am proud and grateful that I was able to do that.

With the holidays approaching, I wanted to mention something else that Dr. Vicky Rackner stated.  “Consider giving yourself a holiday gift.  Forgive yourself for one choice that brought you guilt.  Forgive one other person for one action that disappointed you.  Forgive the world for the bolt of unfairness that stood between you and an old dream.”

I hope that you can do that.

Gary’s article can be found immediately below.

“Coumadin^®, available generically as warfarin, has been widely used to reduce the risk of stroke for well over 50 years. Dwight Eisenhower, Richard Nixon and George Bush senior were all taking Coumadin during their active years of former Presidency. Despite millions of prescriptions written annually for this medication, practical, easy to use information remains a challenge.

One of the most common and historical needs of managing warfarin is diet, specifically, dietary vitamin K. Physicians use warfarin to increase the bleeding time in patients at risk for developing unwanted blood clots. The goal is to prolong the bleeding just time enough to prevent clot formation where it isn’t needed (the heart and lungs for example) but allow clotting to take place for normal blood vessel bleeding repair. While warfarin prolongs your bleeding time, dietary vitamin K increases the body’s natural ability to form clots.

The simple blood test called an INR test measures that active anti-clotting effect of warfarin. The higher the dose of warfarin, the more potent or longer the blood takes to clot. A diet high in vitamin K can reduce the effect of warfarin and lower the number of the blood test result. For this reason, it is important for patients to keep a consistent intake of dietary vitamin K to help maintain safe levels of protection warfarin provides without interfering too much.

It is difficult to monitor vitamin K intake when food and beverage labels do not provide this information and the FDA does not require it. While professionals teach vitamin K is abundant in leafy green vegetables – there are many hidden sources patients and their care givers need to know about. Salad dressings and some mayonnaise are good examples.

The vitamin K registry

An easy to use, extensive vitamin K database is available for patients and their family. The vitamin K diary allows you to simply type the first few letters of a food or beverage you’re interested in and a menu of products is displayed listing the serving size and the amount of vitamin K. The vitamin K registry can help you keep balance and choice in your diet. A printable version is also available to assist in creating grocery lists for the Coumadin patient.

The vitamin K diary

The vitamin K diary is an interactive resource for patients or caregivers to keep track of vitamin K intake. While using of the vitamin K registry as a source guide, the vitamin K diary allows the user to record the vitamin K (listed in micrograms) consumed for each meal. The diary, offered as a word document, calculates the total daily and weekly intake of vitamin K. The vitamin K diary is best used 7 days prior to the patient’s blood test to best evaluate the effect of diet and shared with the patient’s healthcare provider.

For other helpful resources on maintaining your quality of life, visit www.PTINR.com  ”

Registration for the ceremony was offered several weeks ago, but no one was turned away for not having registered previously.  Upon arriving, we were given the chance to choose an ornament to place on the Christmas tree in honor of the loved one being remembered and a marker to write on it.  There were 2 different shapes of ornaments: round and heart shaped.  There was also an assortment of colors from which to choose.  I hadn’t thought of it before, but the colors would be very important to some people, for instance, my nephew passed at the tender age of 6 (hit by a car) and his very favorite color was green. His siblings wrote messages on green balloons at his funeral and “sent them up to him”.

I chose a red heart for my father ( I think because my heart is still bleeding for him) and a white heart with sparkly green swirls for my nephew.

After enjoying a wonderful brunch in the foyer of the church, we went into the worship area for prayers, hymns and a presentation by author and grief support facilitator, Joanne Petrie.  She was a wonderful speaker and stressed that grief may come not only from the loss of a person, but the loss of a situation – divorce, the loss of a job, the loss of a home, (and I’ll add, in the case of many caregivers, the loss of freedom or the life once lived).  She also stated that recovering from grief does not put you back to “normal” but leads you to accept a “new normal”.  How profound.

After the presentation, there was another song and then the names of all loved ones represented on this day were read one by one.  As the name was read, the family members came up to the tree and placed the ornament there.  Many stood for a moment of silence or placed a kiss on the ornament.  Many cried.

The ceremony ended in prayer for those we had lost and for those who will carry on.  Hugs abounded. 

I am now a fan of Ceremonies of Remembrance.  It was a wonderful experience and something that a family member or friend could do each year without traveling to a graveside which might be a long distance away.  I hope that many churches, temples and synagogues will adopt this kind of ceremony if they have not already done so.

I must add that the ornaments were given back to the family members at the end of the ceremony and now my father’s ornament rests on our tree at home in a place of honor.  (I will send my nephew’s ornament to my sister.)

Courtesy of Tena home health products are some tips to reduce stress during this busy season, written by Ann Cason, a caregiving expert and founder and director Circles of Care.