|
|
|
| |
| Why a booklet on caregiving? |
|
|
Becoming a caregiver is often an unplanned and unexpected experience. Individuals may find themselves in the caregiver role with little time for assessing the situation or proper planning. Finding the right service or obtaining the information needed can take a lot of time and energy at the best of times. It can be especially trying in a time of crisis.
The purpose of this booklet is to provide some information and hints for individuals who are or anticipate becoming caregivers. If you need further assistance, please feel free to contact the Adults with Disabilities and Senior Services Branch and we will try to help you to obtain the information that you need. Our address and telephone number are shown directly below, or you may use the "Feedback" prompt below.
|
|
|
| Who is a caregiver? |
|
|
A caregiver provides some form of assistance to another person, the carereceiver, who is in need of help due to a physical or mental problem or both. The assistance needed can range from an occasional trip to the store for someone who is homebound to 24 hour care for a very frail senior.
A caregiver may be a family member (such as a spouse, daughter or son), a friend or a neighbour. Over 80% of the help received by frail seniors living in the community is provided by family or friends. The caregiver may or may not live with the carereceiver.
|
| |
| Planning ahead |
| |
Designing a support plan in advance with input from all members of the family has many benefits. The plan is designed to fit the specific needs and circumstances of the family. If something does happen, each family member has the satisfaction of knowing that a system is in place, what needs to be done, and who is to do it.
Though no one knows what the future may bring, possible scenarios can be outlined, with discussion centering on the following topics:
- Type of support that would be necessary
- Who will be the primary caregiver
- Availability and role of other caregivers
- Living accommodations necessary and available
- Financial resources available and who covers the cost
- Power of Attorney
- Services available in the community
- Meal preparation
- Transportation needs and availability
- Nearness to friends, family, church, activities
A little research may be necessary. However, determining what is available in advance is easier than trying to find the information in a crisis.
If such planning has not been done before something happens, care should be taken to avoid rushing in to provide support without stopping to think of the long-term consequences. It may be best to arrange for some temporary short-term measures and take some time to consider the long term effects on everyone concerned.
|
|
| Consider the alternatives |
|
The best situation for most older individuals is to be able to manage their lives by making as many of their own decisions as possible about their lifestyle. This enables them to live, shop, garden, socialize and worship where and as they wish. When this is no longer possible, alternatives must be examined. In some circumstances, minor alterations to the current residence make it possible for the individual to continue to live at home. In other situations, congregate or sheltered living, or a move to a retirement centre may be options. Canada Mortgage and Housing Corporation has excellent material on housing choices for older Canadians. Most publications are free.
When one door of happiness closes another opens; but often we look so long at the closed door that we do not see the one which has been opened for us.
Helen Keller
|
|
|
| How much care to provide? |
|
Each person is unique and each situation has to be considered individually. What may be sufficient care in one instance may be too much in another. The trick is to balance independence with realistic assistance. People need to be able to live life "their way" to the extent possible. Only the necessary care and support should be given.
|
|
| Look after yourself first |
|
Caregivers tend to focus all their attention and energy on the needs of the carereceiver. Often it is difficult to consider oneself before others. However, to avoid the risk of burnout and/or becoming ill, and to be able to provide adequate care to others, caregivers need to pay attention to their own needs and wishes on a regular basis.
Proper diet, exercise and sleep are necessary to maintain one's own strength and energy. In addition, caregivers need to have regular times to themselves, as well as time to spend with family and friends. Though usually one person is the primary caregiver, one person cannot and should not attempt to provide all the care.
Caregivers may experience many different kinds of feelings, including anger, embarrassment and guilt. Periods of depression may occur. It is not unusual to experience these feelings. When feelings keep you from making clear-headed decisions or if you become concerned about the kinds of feelings that you are experiencing, it may be helpful to talk the whole thing out with an objective outsider such as your family physician, a social worker, a minister or a family counsellor. Check under Counselling Services in the yellow pages of the telephone directory. Learning that other people have similar feelings helps to put things in their proper perspective. To admit needing help is a sign of strength and true caregiving, for oneself, as well as for the person receiving care.
Small, day to day problems can increase the stress faced by caregivers. Making a few changes can help a lot.
| Joy in one's work, pleasure in one's emotions, and satisfaction in one's thoughts, go to make the sum of happiness.
Bliss Carman
|
- Learn from others who are in similar situations
-
Organizations exist which focus on a particular illness or disability. These groups are able to provide information, resource materials and hints on topics related to the illness and disability. Groups such as the Alzheimer Society, the Canadian Cancer Society, the Canadian Mental Health Association, the Canadian National Institute for the Blind and the Canadian Rehabilitation Council for the Disabled provide assistance to caregivers and to care receivers. Caregivers often have an opportunity to get together on a regular basis to share information and to provide each other with support.
A listing of such organizations is found in the Seniors' Guide to Services and Programs, available free of charge from the Adults with Disabilities and Senior Services Branch (see inside cover for the address and telephone number). The local Social Development office (listed in the telephone directory under Province of New Brunswick) will also know if this type of organization exists in your community. A listing of some organizations may be found in the yellow pages of the telephone book under Social and HumanService Organizations.
Though one person is usually the primary caregiver, that does not mean that s/he has to do all the work and make all the decisions. Discuss the situation with all other family members.
Include everyone, regardless of age, in the care to be provided. Individuals near and far can help in some way. One person may do the grocery shopping; another may look after the banking and income tax. Those at a distance may be able to provide financial support for a piece of equipment or be able to relieve the caregiver during a week of holiday time.
Do not forget the carereceivers. Though they may need assistance, there are ways in which they can be involved. It is vital to encourage and maintain their independence for as long as possible.
Feel free to ask for help. Others may not offer assistance because they may not be aware of how they can help or if their offers will be welcome. Involve friends and neighbours and take advantage of their presence to do some things for yourself.
Drugstores and grocery stores often provide a delivery service. Taking advantage of this service can save caregivers time and frustration. Don't be afraid to ask if the service is available.
It is also possible to hire someone to come in and stay with the carereceiver so that the caregiver can have an evening or afternoon out. Check the yellow pages of the telephone directory under homemaker services.
Accidents and illness can happen and they rarely give any notice. Therefore, all caregivers should have several people on stand-by who are willing to take over the caregiving responsibilities on a moment's notice. Having more than one person available is important since if something happens, and one person is not available, hopefully someone else will be.
Check the programs available in the community. Telephone books often have a section on Senior Citizens' Services. The Seniors' Guide to Programs and Services is also a handy reference. Talk to others in the community, especially those in a similar situation. If a needed service is not available, maybe a community organization is able to provide it.
Don't forget about the availability of the church. Local churches may have a visitor/pastoral care program which can provide comfort and support to both the caregiver and carereceiver.
- Involvement of the professionals
Get to know the family doctor, nurse, social worker and any other professional who may be involved. Developing a partnership and working together makes things easier for everyone concerned.
Since carereceivers have some type of physical and/or mental problem, the more both the carereceiver and the caregiver know about the illness or disability, the more help they can be to each other.
Determine the types of examinations needed and the frequency. Discuss the appropriateness of both caregiver and carereceiver receiving a flu shot.
Keep a diary, noting medications, food, exercise, complaints, particular events and reactions. Jot down questions that have arisen. This can be invaluable in discussions with the doctor, nurse or social worker.
Professionals usually have information about resources, so do not hesitate to ask questions. If the first professional you contact is not aware of what resources are available, seek his/her help about where to get the information that you require.
- Learn to do things "the easy way"
Providing care can be physically and mentally trying. There are a number of ways that providing care can be made easier. Whether it is the use of technology or learning how to move someone properly, it is important for caregivers and carereceivers to learn as many safe shortcuts as possible. This booklet provides some suggestions. Local distributors of various devices and physical aids are often listed under Home Health Services and Supplies in the yellow pages of the telephone directory.
An occupational therapist, nurse and a physiotherapist can provide advice regarding individual situations. An occupational therapist can help to assess the home, suggest any changes or modifications, provide advice regarding any tools and devices that are available, and ensure that everyone knows how to use them properly.
A physiotherapist is a valuable resource person for learning how to provide assistance without risking injury. Helping someone to change position, be it rolling over in bed, getting up from a chair or moving from the wheelchair to a car, must be done properly to avoid injury to both the caregiver and the carereceiver. Back injuries are a common result of providing assistance improperly. Time spent learning the proper lifting technique can save hours of frustration and pain later.
Contact a local hospital to determine the availability of a therapist in your area.
|
|
| Communication |
|
Devices are available that can save steps and be important in case of an emergency:
- A bell attached to a walker, wheelchair or bed
- Bicycle squeeze-type horn or a pull cord bell by the bed
- Emergency Response Team for use when no one else in in the home
- Arranging procedures with the police if the carereceiver tends to wander away from home
- Telephone services
- extensions in various rooms
- cordless telephone on a walker or wheelchair
- push-button telephone with large numbers and memory dial
- emegency and backup-caregiver telephone numbers in large print by the telephone
- telephone volume set at the appropriate level
Contact the Sales Office (the telephone number is in the front of the telephone directory) regarding additional services and features.
|
|
| Additions/Changes to the resicence |
|
A few changes to the home can make caregiving a lot easier as well as promote greater safety. Consider the following
- Entrance
- Installation of a sturdy ramp wich is movable and easy to clean under
- Hand rails on both sides of all stairs to provide additional support
- Proper lighting to avoid shadows
- Door levers instead of knobs for easier access
- Room location
- conversion of a downstairs room into a bedroom wich attached bath, or the installation ofa stair elevator for someone who has difficulty managing stairs
- Floor Covering
- Deep carpets and scatter rugs make walking with a cane or walker or using a wheelchair difficult and dangerous
- Shiny floors contribute to falls due to reflection or slipperiness
- Patio/Balcony doors
- A gentle ramp providing access to the outdoors for individuals with walking difficulties or in wheelchairs
- Furniture
- Arrange furniture to ensure that sufficient room is available for walkers, canes, or wheelchairs
- Sturdy furniture for individuals to lean on for support in rising andsitting without fear of it tipping
- Chairs at the appropriate height and with arms
- Contrasting "doilies" on chair backs or arms to be more easily seen by visually impaired individuals
- Trays that fit over the arms of a chair provide a handy surface for drinks, crafts, books, etc.
- Furniture that is protected so that spills and stains may be easily cleaned
- Lamps that go on and off by a a touch of the hand
- Bedroom
- A hospital bed allows for adjustment of height, angle, and use of side rails if needed
- Installing a "trapeze" which is a triangular device susended over and clamped to the bed to assist the person in pulling him/herself upright
- The trapeze is also available with a floor stand and can be used with a chair or a bedside commode
- A grab bar next to the bed for getting in and out of bed
- Adjustable-height, self-standing commode for the bedroom, primarily for emergency needs
- Bathroom
- Taking a shower may be easier for some individuals than taking a bath
- For individuals who have difficulty standing for any length of time, a stool can be placed inside the bathtub
- A hand held shower head enables individuals to take a shower while seated and still have control of the water
- For those who prefer a bath but have difficulty getting in and out of the tup, a special apparatus operated by hydraulic water pressure is available to assist
- Grab bars in the bathtub which are sturdy and firmly affixed to the studs inside the wall and which are no more than two inches fromthe wall so that arms will not slide through and cause injury
- Non-skid decals on the floor of the tub
- Consider replacing the bathmat with bathmat with bathroom carpeting which is easily cleaned, doesn't slip, and soaks up puddles
- Railings around the toilet as a helpful aid to sitting and rising
- An elevated adjustable toilet seat
- Grab bar directly in front of the toilet, mounted vertically so that the individual can reach out and pull him or her self to a standing position
|
|
| Meeting personal needs |
|
In some situations, establishing a regular, predictable, simple daily routine is of benefit to the carereceiver and reduces agitation and confusion. Adaptation is important. If one idea does not work, do not hesitate to try another.
Meeting the personal needs of the individual can sometimes be difficult. Even though some of the topics may cause embarrassment, broaching the following issues can make life a lot more comfortable for everyone.
Sleeping patterns usually change as we get older. Sleeping fewer hours and waking during the night is normal and no cause for alarm. To encourage sleep, consider the following:
- Avoid naps during the day
- Exercise during the day but not just before going to bed
- Limit caffeine intake in the late afternoon and evening
- Check for such things as soft music, a dark room, good ventilation, the right temperature, and a comfortable mattress
- A warm bath
- Relaxation exercises
- A glass of warm milk
- For cold feet, a pair of loose wool socks
Some sleeping medications may actually cause insomnia, confusion and agitation and should be used for only a short time under a doctor's care.
As we age, we are often less active physically. Therefore, fewer calories are needed within a balanced diet. Some guidelines to follow are:
- Enjoy a variety of foods
- Emphasize cereals, bread, other grain products, vegetables and fruits
- Choose lower fat dairy products, leaner meats and foods prepared with little or no fat
- Prepare food in larger amounts and freeze meal-size portions for a quick meal at a later date
- Avoid magic weight loss diets
- Achieve and maintain a healthy body weight by enjoying regular physical exercise and healthy eating
- Limit the use of salt, alcohol, and caffeine
- Use herbs and spices to add flavour and colour to food
- Small, frequent meals at regular times are easier to digest than one or two big meals
- Drink 7 - 8 glasses of water per day
- For individuals who have difficulty eating or chewing properly or who need extra calories, check with a doctor, dietitian, or pharmacist regarding the advisability of supplements
- Inquire about Meals-on-Wheels, or arrange amongst other caregivers for alternating meal preparations
- Have a regular dental check-up
Attractive and functional clothing helps to maintain dignity, keeps morale high, increases feelings of independence, and lessens time required for upkeep.
- Washable clothes are easier and cheaper to maintain than those requiring dry-cleaning.
- Having an ample supply of clothing allows the individual to change often and does not necessitate continual laundering.
- Expect clothes to wear out faster when laundered more often.
- Choose clothing with a minimum of buttons, fasteners, zippers.
- Fasteners should be easy to use and reach. Centre front fasteners are easier to operate than those on the side or back.
- Short-length jackets, coats or capes are less bulky for senior people who sit a lot or who are confined to wheelchairs.
- Ensure that frequently used shawls, ponchos, lap robes are washable
Problems may arise if the individual is unable to get to the bathroom in time due to the distance the bathroom is from the bedroom, being confined to bed or needing assistance. Consider:
- Portable commode at the bedside
- Encouraging the use of the bathroom at regular intervals, usually every two hours
- Program for strengthening muscle tone
- Protecting furniture and beds
- Adequate supply of underwear
- Use of protective liners and pads
- Making the bed in several layers (i.e., water-proof pad and sheet) so that, when the
individual is incontinent, one layer is easily removed
Care in these areas is often neglected and can lead to painful sores and in-grown nails. If problems develop, discuss the situation with medical personnel. Day to day care can include:
- Keep the skin clean and dry.
- Keep finger and toe nails trimmed straight across. If the nail is very thick or difficult to trim, consult a professional for advice.
- Use body lotion on dry skin, especially elbows, knees and the bottom of the feet.
- Use body lotion on dry skin, especially elbows, knees and the bottom of the feet.
- Overuse of soaps, antiperspirants, perfumes and hot baths can further dry the skin.
- Watch for pressure sores in people who spend a lot of time sitting or lying down.
- Sores begin as red areas and are more common over bony areas such as heels, hips, shoulders, shoulder blades, spine, elbows, knees, buttocks and ankles.
- Encourage the individual to change position frequently.
- Protect vulnerable areas with "floatation" cushions that the person can sit or lie on.
- Heel and elbow pads made of synthetic sheepskinlike material can protect bony areas.
- Select pads and cushions that have soft washable covers and shields against spills and odours.
- Avoid rough fabrics next to the skin.
- Examine the skin on a regular basis for anything that looks suspicious.
Satisfaction with one's hair style adds tremendously to feelings of dignity and self-worth. Points to consider include:
- Select a style that is easy to care for and requires minimum effort.
- Shampoo the hair as part of the regular shower or bath.
- Possibility of a regular visit to a hairdresser or of the hairdresser to the home.
Special devices are available to make hair washing easier for individuals who have limited head movement. The shampoo board fits around the neck and collects the run-off when hair is misted prior to shampooing or when rinsed with a gentle mist. Check with the local hairdresser or a beauty salon equipment supplier.
- Warm, washable slippers or socks with non-slip soles
- Footwear that is easy to put on and take off
- Use of velcro fasteners rather than shoe laces
Constipation is a concern to many individuals. However, daily movements are not necessary and the regular use of laxatives may make the situation worse. Try the following instead of laxatives:
- Well-balanced diet, including bran, prunes, prune juice and 7 - 8 glasses of water daily
- Adequate exercise
|
|
| Exercise |
|
Exercise is important to maintain bodily functions and for healthier living for both the caregiver and the carereceiver. With any part of our body, we need to use it or we risk losing its functional ability. Therefore, a regular exercise program is important. However, exercise should not be painful. Depending upon the individual situation, you may wish to seek medical advice before considering the following:
- Walking - if using a cane or walker, ensure that it is used properly
- Stretching exercises
- Treadmill, with sturdy side rails
- Walking with someone. Get a therapist to demonstrate how to support the other person properly.
- Cycling or an exercycle
- Adult-sized tricycles with wire baskets for groceries, coat, etc.
- Swimming
- Exercise with music
|
|
| Medications |
|
It is important to be knowledgeable about the medications being taken. Medications are necessary in certain circumstances, but overuse or improper use can cause severe problems. On a regular basis review with the doctor or pharmacist the medications being taken. Obtain the answers to the following questions:
- Why is the individual taking the medication?
- What is the medication expected to do?
- What are some of the possible side-effects of the medication? Which require medical attention if they occur?
- How often is the medication to be taken?
- When should the medication be taken, including time of day, before or after meals?
- Are there any activities or foods that should be restricted while the individual is on the medication?
- Are there any other medications (prescription or non-prescription) that should not be taken at the same time?
- For how long will the medication have to be taken?
- When should a doctor or nurse be notified?
Remember: Medications include not only prescription drugs, but also over-the-counter materials such as eyedrops, sprays, cough remedies, aspirin, etc.
To keep track of whether or not medication has been taken (or given) each day, consider purchasing a plastic pill box which is divided into days and hours. Clearly labelled egg cartons can also be used for this purpose.
|
|
| Activities |
Many activities can be modified to compensate for disabilities.
- Sports
- Golf, horseshoes, shuffleboard, bowling and ping-pong are only a few of the activities that can be adjusted to meet the needs of the senior.
- Reading
- Large print books or use of a magnifying glass
- Books with large pictures
- Supports which hold a book in the proper position, whether the individual is in bed or sitting upright
- Being read to
- Books on tape
- Proper lighting to avoid glare
- Games
- Checkers, Monopoly, Scrabble, Dominoes, Chess, card games
- Puzzles - jigsaw, crossword
- Music
- Crafts
- Sewing, crochet, woodwork, knitting, embroidery, quilting, needlepoint, ceramics,
drawing, leatherwork, electronics
- Hobbies
- Ham radio
- Stamp, stone or coin collecting
- Painting
- Gardening
- In a flower box or flower pot if no longer able to bend
- Bird-watching
- From the living room or the patio
- Setting up a bird feeder in the back yard
- Computers
- For fun and entertainment
- To keep in contact with others
- Television, radio
- Use of ear phones provides privacy to everyone
- Remote controls are helpful for individuals with mobility problems
|
| Outings |
Plan ahead. Allow sufficient time for the individual to get ready without having to rush. If the day is sunny, ensure that the carereceiver has protection against the glare of the sun. Check for:
- Appropriate parking facilities.
- Information and application forms regarding parking permits for individuals with disabilities may be obtained from your local Motor Vehicle Office.
- Accessibility into the building and elevators.
- Movement inside the building, especially for a person who uses a walker or wheelchair.
- Accessible bathrooms with grab bars.
- Readable menus that cater to special diets or preparation of foods.
- Amplification for people with hearing difficulties.
|
| Power of Attorney and Wills |
A Power of Attorney enables one person to make decisions and sign documents for another. Contact the Public Legal Education and Information Service of New Brunswick, P.O. Box 6000, Fredericton, E3B 5H1 or telephone 453-5369 to obtain further information and educational pamphlets on this and other legal topics.
Important documents should be kept in a safe place and be readily accessible. A will should be included with these documents. Knowing the wishes of the senior in regard to medical care and funeral preferences will provide the peace of mind that their wishes are being carried out.
|
| Conclusion |
This pamphlet has outlined a few ideas and suggestions that will hopefully be of value to caregivers. Other materials are available that expand on many of the areas and a short list of helpful books follows. In addition to the written material, we often need an understanding ear. Don't hesitate to reach out to one another.
To know how to grow old is the master work of wisdom, and one of the most difficult chapters in the great art of living. Henri Frederic Amiel
|
| Helpful Books |
Check with your local library or book store for the following books as well as for others in the same subject area. If they do not have a copy on hand, ask if they can obtain a copy for you.
Chapman, Elwood N. 1988. The Unfinished Business of Living: Helping Aging Parents Help Themselves. Los Altos, California: Crisp Publications, Inc.
Gillies, John (1988). Care Giving: When Someone you Love Grows Old. Wheaton, Illinois: Harold Shaw Publishers.
Mace, Nancy L. and Rabins, Peter V. (1981). The 36-Hour Day: A Family Guide to Caring for Persons with Alzheimer's Disease, Related Dementing Illnesses, and Memory Loss in Later Life. New York: Warner Communications Company.
Rhodes, Ann (1989). Guidance and Support in Caring for the Elderly. Montreal: Grosvenor House Inc.
Thompson, Wendy (1987). Aging is a Family Affair: A Guide to Quality Visiting, Long Term Care Facilities and You. Toronto: NC Press Limited.
|
|
