Foster independence and offer respect (advice for caregivers)

Local support group member and volunteer Denise is reading the book How to Care for Aging Parents.  She is offering occasional reports on the highlights of the book.  She has read the second chapter, which is about the caregiving role.  Here are Denise’s take-aways.  Other than the first paragraph of Denise’s notes (which applies to adult children caregivers), all of the rest of the information applies to all caregivers.

Robin

*******************************

Denise’s Notes to

Chapter two – “Your Parent and You”
of the book “How to Care for Aging Parents”
by Virginia Morris and Robert Butler
2004

Chapter 2 acknowledges how common it is to still feel the push and pull of the parent/child relationship, no matter how old you are. It recommends hiring a good therapist to tackle those issues, but goes into some detail as to how to approach them on your own. At a minimum you must find ways to set aside your parent’s ability to push your buttons so you can do an effective job of caregiving with as little frustration as possible.

It also has some good words of advice for ALL caregivers.

The first is to foster independence wherever possible. It is difficult to watch a loved one struggle with tasks that were once easy for them. Sometimes we worry about symptoms or frailty contributing to an injury, but we all need exercise. Any amount of movement helps maintain flexibility, balance, even good bowel health. Doing for oneself is also good for the brain. Maintaining one’s identity and dignity can help ward off depression and, possibly, the onset of dementia. It actually takes more patience, time and effort for you, as a caretaker, if the person is slow or messy about some tasks, but it does worlds of good if you are both willing.

Try not to be overprotective of the person you care for. If you feel they are taking excessive risks, start by expressing your concerns rather than bossing around a grown adult. Perhaps your elderly mother doesn’t know breaking a hip can be fatal. Offer solutions to reduce the risk and still allow the activity to continue. If you’re worried she isn’t steady enough on the stairs, suggest moving her bedroom downstairs to avoid them all together. Remember, you only have so much influence dealing with a competent adult. We all have the right to make risky decisions. We do it every day when we get in the car, smoke a cigarette, even eat fatty foods. Some people would rather die living fully than live longer, just like the saying:

*** Life is not a journey to the grave with the intention of arriving safely in a pretty, well preserved body, but rather to skid in broadside, thoroughly used up, totally worn out, and loudly proclaiming, “Wow! What a ride!!!” ***

There are times when it is appropriate to step in and forbid someone from exercising their independence. If the safety and/or health of themselves and/or those around them are seriously threatened you have an obligation to intervene. If you find medication is being misused, you should take steps to dispense them properly. You may find it necessary to pay bills to prevent utilities being shut off or turn off the gas when someone is incompetent to use the stove. Many of us have had to take away car keys. Its not easy. Enlist the assistance of a doctor, if you are unable to manage it on your own. They can report to the DMV, which will suspend or revoke the license, depending on the doctor’s statement.

If you find yourself in doubt about where to draw the line; whether to step in and, if so, how; seek advice from someone with experience. Since this book is all about helping aging parents, it suggests asking a Geriatric Care Manager, Hospital Social Worker or Geriatric Department, an Area Agency on Aging, or Adult Protective Services, which is part of the Department of Social Services.

The second bit of good advice for all caregivers is a big reminder to offer respect. Remember, you may be in their shoes one day. Some suggestions to that end are:

– If the person you’re caring for is inactive, take the time to ask their opinion on various topics to keep them involved in daily life around them. If they’re up to it, read the newspaper, magazines or pick out a recipe together. Don’t forget to listen to their comments and answers.

– If they are unable to speak, assume he or she understands. Explain what’s going on and reassure that his or her needs and preferences are being considered at every point. This is where having those conversations ahead of time come in handy.

– Never speak about someone as if they aren’t present, when they are.

– Don’t be afraid to ask that other caregivers do the same. Correct them if they are behaving in a disrespectful way or doing anything you feel the patient would feel uncomfortable with, if they could speak for themselves.

Keep in mind that IF you’re dealing with someone who is exceptionally difficult you could be dealing with a bigger problem. For instance:

– Unremitting orneriness, social withdrawal, or refusal to eat can be signs of depression. Seek medical advice.

– Complaining, calling constantly, or becoming sick at just the wrong moment (like when you’re about to leave on vacation) can be a way to control you. Get a reliable backup caregiver so you have respite.

– Between 2-5% of elderly people living in the community (not long term care facilities) are excessively suspicious or paranoid. Seek a psychiatrist with elder experience. Treatment is usually carefully balanced medication.

– At least 5% of people age 65 and older suffer hypochondria or undifferentiated somatoform disorder. In the former, a person is obsessed with the idea they have a serious illness. In the latter, a person complains about symptoms (fatigue, loss of appetite, abdominal pain) that have no medical basis. Psychotherapy doesn’t help either of these conditions. Your best bet is a good, firm doctor to sort out the real medical issues and be firm about the imaginary ones.

-Denise