The Road To Caregiving

According to the US Department of Labor, over half of America’s workforce is involved in some way with caring for an aging parent or relative. Up to eighty percent of this help is unpaid and according to AARP, the average caregiver provides personal care and does household maintenance chores for at least twelve hours per week. The road to becoming a caregiver for a loved one is often winding with a son or daughter occasionally “helping out”. Your parents slowly age and adaptations are made to accommodate gradual changes in their abilities. Perhaps you offer to help with their banking or write out the bills. If they need groceries you offer to drive them to the store or pick up a few things for them yourself. Maybe you go to the doctor with them to make sure they clearly understand what the doctor has to say. At this point, you don’t view yourself as a “caregiver”. You’re just being a helpful child.

As time goes by and your “helping out” becomes a necessity, it will dawn on you that you are in fact a caregiver. You realize one day that if you stop doing all those helpful things, your loved one won’t be able to function on their own. You now feel obligated to do all these things or to make arrangements so that they do get done. Your loved one’s daily functioning is now your personal responsibility. Welcome to the world of caregiving. You will soon realize what a demanding job this is particularly because you’ll also be juggling a job, family, and personal issues of your own. If your parent or loved one suffers a medical crisis, your level of providing care will rise dramatically. Although your desire may be to tackle this job totally on your own, doing that will surely result in stress, exhaustion, and even physical illness. No matter how much you love someone, where will you find all the hours in the day that you and your loved one need? Be careful not to allow yourself to reach the point of total exhaustion. If you use up all your time and energy to be a caregiver, you will no doubt be robbing you and your loved one of quality time that could otherwise be spent with each other. Be aware there will come a time when it makes sense to get some help. Be wary of taking on so much that you lose sight of your well meant goal of providing the best of care which your loved one both needs and deserves. The road to caregiving is long and full of potholes. Don’t let yourself get run over. Please share your thoughts and experiences below. Visit us at http://www.trilliumhomecare.com

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The Caregiver at the Doctor Visit

According to the Census Bureau, there are over 43.1 million persons in the United States that are 65 years of age or older. The elderly population is expected to double to 80 million when all the “baby boomers” have reached their elderly years. Due to advances in medical science these baby boomers will be living longer and that translates into huge numbers of people living with chronic conditions like arthritis, diabetes, osteoporosis, or dementia. A large population of chronically ill older people means that more and more seniors will be dependant on others for help with their activities of daily living – in short, they’ll have a caregiver whether it’s a family member or a professional from an agency.

Caregivers are now and will increasingly in the future be an important component of doctor visits for the elderly. According to a study by Jennifer Wolff, PhD of the Johns Hopkins Bloomberg School of Public Health, doctor visits that include caregivers are an increasing trend that has important benefits. Her study showed that visits that included a caregiver lasted at least 20% longer and resulted in less social conversation between the doctor and the senior and more biomedical information being given to the patient. This is really important because a trip to the doctor is all about communication and the exchange of information. Doctors need information from patients to provide an accurate diagnosis and to provide treatment options. The patient needs to be able to clearly discuss and understand what’s going on. This is where the caregiver’s presence can be very valuable.
A caregiver can help the senior with every aspect of the visit beginning with getting ready for the visit by gathering all the necessary medical history information and making a list of current medications and by preparing a list of symptoms for the doctor along with any questions the senior may have. During the visit, the caregiver can make notes for the senior and can remind them of any symptoms they may have forgotten and can relate to the doctor any changes in the senior’s general health and abilities. In effect, the caregiver is a second set of eyes and ears and can request further clarification about the diagnosis, treatment options, and what can be expected down the line. After the visit, a caregiver can support the senior’s compliance with the doctor’s instructions by encouraging them to follow the prescribed course of treatment along with taking their medications as prescribed and by helping them further understand the doctor’s instructions if necessary. This in turn can help reduce possible hospital readmissions.

According to the study by Dr. Wolff, seniors and loved ones who have been accompanied by a caregiver to a doctor ended up being more satisfied with their overall care and were shown to be more likely to remember important information after their visit to the doctor. Please share your thoughts and experiences below and visit us at http://www.trilliumhomecare.com

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Preventing Dehydration

It’s been slow coming but summer has finally arrived. It won’t be long before we start hearing TV and radio announcements about municipal “cooling centers” being opened. These announcements point to the importance of staying hydrated, particularly in the summer. This is especially critical for the elderly and the frail. Dehydration can quickly lead to heat exhaustion or heat stroke for this group. Older people are at a greater risk of dehydration for several reasons. While a younger person’s body naturally cools itself through the production of perspiration, this mechanism may not work as well in a senior due to natural aging changes and the assortment of medications they may be taking for a variety of chronic conditions. These medications include antihistamines, antidepressants, motion sickness medication, anti asthma drugs, diuretics which are often prescribed for hypertension, and some heart medications. In addition, as we get older our kidneys are less efficient at conserving water and unlike camels, we can’t store it. By the time your aging loved one’s body sends them the “I’m thirsty” signal, they may be well on the way to being dehydrated. Seniors who have dementia may simply forget to drink and those who suffer from neurological disorders may have difficulty swallowing. Those who are frail need assistance to drink. Any combination of these factors can lead to dehydration.

According to the CDC (Center for Disease Control), there are signs of dehydration to look for: dizziness, confusion, constipation, increased fatigue, increased body temperature, dry mouth, reduced sweating, sunken eyes, and low blood pressure. As a caregiver, taking extra measures to keep your loved one hydrated requires vigilance but in this case, an ounce of prevention is definitely worth a pound of cure. Be sure to offer fluids on a regular basis, at least every couple of hours. Although plain, clear water is the best choice, any liquid is better than none so offer your loved one their preferred beverage frequently. Be sure to serve beverages with meals and encourage more than a sip of water to wash down medications. Try serving foods that are naturally “wet” such as soups, yogurt, ice cream, and smoothies. Encourage your loved one to drink small quantities frequently rather than a lot at one time. A frail senior needs at least 6 cups of fluids per day but consult their doctor if they take diuretics, have kidney disease, or have congestive heart failure. How do you make sure your senior gets enough fluids? Please share your thoughts and experiences below. Visit us at http://www.trilliumhomecare.com

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Time To Hire A Professional Caregiver?

Hindsight is 20/20 but it’s important not to get to that point when it comes to making care decisions for an elderly parent or loved one. Very often, by the time you’ve made the decision to get some help from a professional caregiver, you’re already past the point of burnout. You’re more exhausted than you ever thought could be possible and you wonder why you didn’t get help sooner. Guilt very often plays a part in your delayed decision because you feel it’s something you should have been able to do for your loved one so they could remain comfortably in their homes as they aged. Your role as caregiver slowly and almost imperceptibly increases and perhaps on a deeper level you don’t want to see that your loved one needs more help than you can give. Be careful not to miss the signs that your parent or loved one can’t go it alone.

*How’s their personal hygiene? Do they bathe regularly or is there an odor about them? Is hair combed and are teeth brushed? Are they wearing the same clothes for days on end?
*Is the house clean and being maintained? Is there a lot of clutter or unopened mail? Is the garbage taken out on a regular schedule? Is there an odor of urine when you step inside?
*Are nutritional needs being taken care of? Is there any spoiled food in the refrigerator? Is there food in the cupboard? Have they lost any weight and are they remembering to eat?
*Is your loved one able to drive safely? Are there any unexplained dings or dents in the car? Do they get to where they’re going without incident? Do they get lost in familiar location or when traveling a route they’ve taken many times before?
*Do they miss any doctor or dentist appointments? Are they able to follow the doctor’s directions? Do they take their medications as prescribed? Do they remember to get prescriptions filled?
*Is your loved one maintaining a social life? Do they stay in contact with friends and relatives or have you become their sole source of human interaction? Have old hobbies or interests gone by the wayside?

If you see some of these changes, it may be time to get some help. There is nothing to be gained from ignoring the signs. Getting some help to keep your loved one safely in the home they want to be in, is truly an act of love. Please share your thoughts and experiences below. http://www.trilliumhomecare.com

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Hiring a Caregiver Privately?

According to the National Alliance for Caregiving, more than 65.7 million Americans provide informal care for a family member or loved one. Most of us come by the role of caregiver gradually. We start by “helping out” when we notice a parent or loved one is having some difficulty taking care of some routine tasks they once managed well. In time our list of responsibilities gets longer and our loved one needs much more help. And then it happens….we see there is so much more to do than we have hours in the day for. Perhaps there’s been a medical crisis or an accident. We realize some outside help is needed.

Once you’ve made the decision to get help, it’s easy to believe all you have to do is hire someone. If you choose to hire someone directly to care for your loved one be sure you know what goes with your new role as employer. This means that now you have switched jobs from “caregiver” to “accountant” because you will now have to take care of payroll and tax requirements since the IRS views you as the caregiver’s employer. According to foxbusiness.com, if the caregiver you hire earns more than $1000 a quarter or over $1900 a year, you’ll have to file payroll taxes including Social Security and Medicare taxes, Federal Unemployment Tax, state unemployment and disability insurance taxes levied on the employer, and advance payments of the earned income credit if your employee is eligible. These thresholds and figures may change yearly so you will need to verify them every year. You also have to know what taxes your employee has to pay and will have to provide a Form W2 to your employee by January 31st of every year. In addition, you’ll need to pay for worker’s compensation and disability insurance in case your caregiver gets hurt while caring for your loved one.

If the caregiver you hire claims to be working as an “independent contractor” and no money should be withheld for any taxes, they are wrong. According to the IRS an independent contractor has total control over their work hours, their responsibilities, and schedules. This does not apply to your employee because the caregiver will be providing the services you want on the schedule and terms you set. Failure on your part to fulfill your accounting duties as the employer of a caregiver will alert the IRS, set you up for an audit, and can even result in compromising your own personal taxes. You’ll have to pay back the unpaid taxes along with interest and possible penalties. Be certain you make the correct decision when hiring a caregiver. Are you prepared to be an accountant in addition to dealing with all the work and responsibility of caring for a loved one? Share below and visit us at http://www.trilliumhomecare.com

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Older Adults and Medication – Part 2

As you get older or someone you care for enters their “senior” years, you have to be very careful about which medications are used. Older adults usually have several chronic medical conditions they are dealing with at any given time so that means they’re probably using a variety of drugs. The more medication you take, the greater are the odds that you can end up dealing with the effects of drug interactions. In addition, seniors are more sensitive to some drugs due to the natural changes in their bodies as they age.

Among the most commonly used and abused drugs are non-steroidal anti-inflammatory drugs (NSAIDS). Long lasting versions include Feldene and Indocin which are available by prescription while shorter acting ones include Motrin, Advil, and Aleve. Because the shorter acting NSAIDS are available over the counter, there’s a misconception that they must be totally safe but keep in mind that they’re mean for short term use only. In fact, all NSAIDS carry a risk of indigestion and ulcers and in the over 75 age group there is a possibility of bleeding in the stomach or colon especially if your senior is taking aspirin or a blood thinner like Coumadin for their heart. In addition, NSAIDS can increase your blood pressure so if you’re taking medication for hypertension which is very common in seniors and you take an NSAID for your arthritis, the medications are fighting each other.

Other medications to use with caution include muscle relaxants and over the counter allergy and cold medications. Muscle relaxants such as Flexeril and diphenhydramine , which is the active ingredient in Benadryl and over the counter sleep aids like Tylenol PM, can cause confusion and grogginess along with blurred vision. This can be particularly troublesome for seniors since it can increase the risk of falling. If your senior takes something to help them sleep and something else because their allergies are bothering them, you can see how easily they could be double-dosing without realizing it!

In light of the fact that there is an endless list of possible drug combinations you or your loved one may be taking, it’s important to keep a CURRENT list of all drugs being used, including any over-the-counter medications and herbal supplements. Take this list with you to every doctor visit and ask lots of questions. If your doctor prescribes a drug, be sure you are clear about what it’s for and how to properly take it. Ask if it will interfere with anything on your list and if any adjustments need to be made. Be sure to get all your prescriptions filled at the same pharmacy so the pharmacist can also keep track of any possible interactions. Using a pill organizer at home can help you keep track of whether you’ve taken the medication as prescribed. If you start noticing a possible side effect to a medication, don’t just stop taking it without contacting your doctor. Follow his advice and be safe. Do you have any tips for managing your senior’s medications? Share below and visit us at http://www.trilliumhomecare.com

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Older Adults and Medications – Part I

When you are younger and in need of medication for an illness or injury, things are pretty simple. You go to the doctor, get a diagnosis, fill your prescription, and a few days later you’re feeling better. If you get a headache or pull a muscle at the gym, you pick up some over-the-counter analgesics and in a bit you’re back to your busy life good as new. It never occurs to you to monitor what you’re taking because you’re not taking a lot of medications with a lot of frequency. That changes as you reach your senior years. As you get older, it’s typical to be dealing with more than one chronic condition resulting in taking multiple medications which are very often prescribed in multiple doses. In fact, the average older person takes at least four prescription medications and at least two over-the-counter drugs on a regular basis. Seniors over 65 are responsible for the purchase of 30% of all prescription drugs and over 40% of all over-the-counter drugs. You can see where this is going. As you get older or someone you care for enters their senior years, it becomes increasingly important to manage medications.

Seniors are particularly vulnerable to problems with medications for a variety of reasons. The more medications are taken, the greater the odds are that they may have an interaction that could be dangerous if not unpleasant. It’s not uncommon for a senior to simply stop taking a medication because of its side effects. Between 40% and 75% of seniors stop taking their medications at the right dosage and the right schedule. This issue is compounded by the fact that older adults are more sensitive to drugs because of their now slower metabolisms and organ functions, thus keeping drugs in their system for longer periods of time. Physical problems such as poor vision or a weak grip due to arthritis can result in dosing errors. Cognitive and memory issues can prevent the older adult from following the doctor’s orders and since so many seniors live alone there’s no one to assist them with nor monitor their use of drugs. Simply forgetting is a major reason medication doses are skipped by the elderly. With an increased number of chronic conditions the typical older adult sees a number of different physicians — the endocrinologist for their thyroid, the cardiologist for their heart problems, and so on. Multiple doctors equal multiple medications that can conflict with each other. You can see why studies have shown that any combination of these factors causes 30% of hospital admissions of older adults. It’s apparent that being able to manage an older adult’s medications is critical to their well being and even their ability to remain independently in their own home. Next time we’ll talk about which medications to be especially cautious about and what action you can take to help keep your senior safe with their medication. Visit us at www.trilliumhomecare.com

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Isolation In The Elderly

According to the study “A Review of Social Isolation” by Nicholas R. Nicholson, which was published in The Journal of Primary Prevention, over 40% of Seniors who live at home are living in isolation. This is an alarming statistic in light of the fact that there is an increasing trend for seniors to “age in place” and the senior population in the over 65 age group is predicted to more than double in the next 25 years. The alarming part is that social isolation is a major health problem in older adults and is expected to dramatically increase in the near future. Studies have proven that this isolation and resulting lack of social activities can be directly linked to an increase in cognitive decline. In addition, by not belonging to a social network seniors don’t benefit from the positive encouragement of their friends to comply with healthy practices such as not smoking or staying active. Another health risk of isolation is depression which can worsen many conditions that seniors suffer from such as chronic pain, diabetes, heart disease and dementia.

Isolation can happen for a variety of reasons—some by choice and some as a result of unexpected events. The death of a spouse often leaves the mate feeling alone and so sad that they can’t bear to keep up their old friendships with others. It’s also not uncommon for children to live a long distance away leaving get-togethers something that happens during the holidays or vacations. Getting older with now impaired vision or hearing can prevent a senior from driving and thus limit opportunities to get out. Problems with urinary incontinence may make it seem inconvenient to go anywhere and sleeping issues at night may make daytime drowsiness a deterrent from outside activities. If there are any safety issues with crime in the neighborhood, the senior may be reluctant to leave their home.

If you know or care for a senior living alone, there are things you can do to help prevent their isolation from the community. Encourage them to stay connected whether by phone or email or Skype. Make sure to regularly schedule and keep doctor and optometrist appointments so that vision or health problems are dealt with and won’t keep the senior house bound. Encourage involvement with others, whether it’s the local senior center or church group. If transportation is a problem, check into public transportation or community based volunteer drivers.If your senior is capable of and interested in caring for a pet it can give them a sense of purpose. It’s amazing how many people you meet just out walking the dog! You may also consider hiring a companion from a home care agency to assist with transportation and running errands or simply to provide some social contact and interaction. Small changes add up and make a big difference. Social isolation doesn’t happen overnight and can’t be remedied overnight. Do you have any tips on how to keep your loved one involved in life? Share below and visit us at www.trilliumhomecare.com

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Aging and Sleep

When we’re young we often burn the candle at both ends when it comes to our sleep habits. We stay up late watching TV, socializing with friends, or doing schoolwork and then get up the next morning and go to work or school. Weekends are “catch-up time” with some power sleeping —-or not. Somehow we survive these erratic sleep habits. That all changes as you get into your senior years and sleep becomes much more important. It allows your body to restore its energy levels and it refreshes the immune system so it can help prevent disease as we age. In addition, sleep improves concentration and memory function. As you get older your sleep changes and you can’t bounce back from lack of sleep as you once did. Your body produces less melatonin so you wake up more often at night. In addition, an aging internal clock makes you wake up earlier in the morning while making you sleepier earlier in the evening. You generally need more time to fall asleep and any noises you hear at night may awaken you more readily than when you were younger. The problem is that as you age you still need seven to nine hours of sleep at night, just as you did in your early adult life. According to the National Sleep Foundation, almost half of older adults experience insomnia at least a few nights per week. In the over 65 age group, 13% of men and 36% of women need more than a half hour to fall asleep.

As you get older, there are a lot of factors that can directly affect your sleep. Most seniors are dealing with multiple health issues such as arthritis, heartburn, lung disease, or heart problems and the pain and discomfort they result in can keep you awake at night. These health issues are usually accompanied by a litany of medications and they too can affect the quality of sleep. These medications include anti-depressants, diuretics, decongestants, and high blood pressure medications. Psychological issues like depression and neurological illnesses like dementia are an additional source of sleep problems.

There are steps you can take to ensure a good night’s sleep. Many of them are simple lifestyle changes such as avoiding caffeine and alcohol at least 6 hours before bedtime and not eating heavy meals late in the day. Sticking to a regular schedule for going to bed and getting up in the morning (even on weekends) gets your body into a regular routine. Getting regular exercise reduces stress and according to the Feinberg School of Medicine results in dramatic improvement in the quality of sleep. Limit the amount of liquids you consume for a couple of hours before you go to bed. Getting up to go to the bathroom is the major cause of waking at night for seniors. If you make these changes yet are unsuccessful in getting a good night’s sleep, it’s time to talk to your family doctor. Do you have any good sleep tips to share? Visit us at www.trilliumhomecare.com

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Falls Don’t “Just Happen”

As caregivers, I’m sure every one of us has a story they can relate about a senior or loved one who’s fallen and hurt themselves badly. In fact, among the elderly, falling is the major cause of injury and hospital admissions. According to the Centers for Disease Control, one in three adults in the over 65 age group will fall in any given year. These falls are the leading cause of both their fatal and nonfatal injuries with fractures of the spine, hip, and forearm taking the lead. Statistically, in the over 75 age group, falling more often then not results in an admission to a long term care facility for a year or longer. These are pretty frightening statistics.

We’re all pretty familiar with tips about how to prevent falls in an elderly person’s home. Making the home safer by eliminating hazards is the first line of defense since over half of all falls happen at home. Some things we need to do include tacking down loose carpets, removing any clutter from stairways and floors, installing railing in all the stairways, and making sure there is plenty of bright light in the home. We can also make additional modification to the home by installing grab bars near the toilet and in the shower/tub area. Shower chairs and transfer benches allow a senior a safe stable way to get in and out of the tub.

Besides modifying the home for safety issues it’s also important to try to determine what other factors may contribute to your loved one’s risk of falling. If your loved one is inactive they will certainly have muscle weakness. This lack of strength and flexibility is a very strong risk factor for falling. Helping them do some weight bearing exercises can reduce this risk. Vision problems like glaucoma and cataracts can contribute to falls. Make sure your loved one has a regular eye exam. Some medications can cause dizziness or confusion and should be discussed with the family doctor if you suspect this is happening. Proper nutrition to get adequate vitamin D and calcium can lower the risk of hip fractures. These are all steps you can take as a caregiver to help prevent falls. Just remember that falling isn’t an inevitable part of getting older. There’s a lot you can do to prevent these falls. Do you have any other tips? Share below and visit us at http://www.trilliumhomecare.com

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