Tag Archives: caregiving

Tips on hiring in-home care aides

In order to honor our elder’s wishes to age in place, it’s important to make sure they have the proper support. That may include hiring in-home care aides to perform housekeeping and some basic medical tasks. This is especially true for those of us who are long-distance caregivers.

Finding a good fit can be a challenge. Some elders may resent the idea that they need help and sabotage any hopes of securing care services. Those with dementia may become more confused or combative with a stranger in the house. Even those who are willing to accept a care aide in the home may find their routines are disrupted, which may cause short-term distress.

I was fortunate that my mother’s aide, hired through a local home health care agency, was a wonderful woman who clicked with my mother. Not only did she offer my mother a helping hand, she offered her companionship. My mother had a very set way of doing things so I know she probably was a challenge for the aide at times, but I so appreciated the aide’s services. I knew I could trust her and that my mother was receiving the support she needed to stay in her home.

MarketWatch published an article that has helpful tips on what you should look for when choosing an in-home care aide. Beyond the basics like a background check, it’s important to know the aide’s skill set, availability, and career aspirations. Going through a home health agency can offer some peace of mind, but can be more expensive. Word of mouth can be a good way to find a caregiver in your community. When it comes to hiring a care aide, hands-on experience may be more key than formal education.

There are websites and apps that allow one to hire a caregiver remotely, which can be useful for long-distance caregivers but can be a bit more of a gamble without that in-person assessment. Long-distance caregivers should consider a video call before making any hiring decisions. Don’t overlook your gut instinct; if you feel an aide is not the right fit, don’t hesitate to take action. It’s not unusual to cycle through a few care aides before finding a good fit.

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When Money Habits Change — Dealing with Dementia

This is such an important topic and I’m grateful for Kay Bransford’s excellent blog post. As my father’s dementia progressed, simple tasks like paying for groceries or a fast food meal became a challenge that caused my father to become angry and accuse others of trying to rip him off. My mother eventually had to take over those tasks. After my father’s death, my mother’s loneliness made her susceptible to the barrage of telemarketers who would call on a daily basis. As a long-distance caregiver, it was difficult and frustrating for me to try and manage from afar.

Click on the link below to read the helpful post on Dealing with Dementia:

There were a few odd conversations with my Mom when things didn’t make sense. But the most alarming thing was when I realized my parents had changed their decades-long habit of giving every January. I started to notice that my mother was writing checks to charities that they had never previously supported. I would read…

When Money Habits Change — Dealing with Dementia

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CDC weighing new opioid prescribing guidelines

Anyone who is dealing with chronic pain or caring for someone with a chronic pain condition being treated with opioids will want to pay close attention to the Centers for Disease Control’s updated opioid prescribing guidelines for doctors.

The public comment period has ended and a draft of the guidelines has been completed. The CDC’s final recommendations will follow.

I all too well remember the 2016 guidelines. Doctors were warned about the upcoming changes in 2015, the year my mother died, and those guidelines (along with the doctors’ gross misinterpretation of the guidelines) caused my mother to die an agonizing death. Others sadly experienced a similar fate. Some people who had been on a successful maintenance regimen of opioids found themselves suddenly cut off by skittish doctors. Some people turned to the illicit drug market. Others committed suicide because they could no longer endure the pain.

NPR reviewed the draft document of the revised CDC guidelines. Officials blamed doctors for misapplying the CDC’s 2016 guidelines, saying it was supposed to be a “roadmap” not a “rigid set of rules.” But it’s difficult to put all the blame on doctors across the county who apparently were in fear of losing their medical license if they didn’t follow the CDC’s guidance. Clearly something or someone made them fearful enough to go against their medical training and harm their patients.

America’s overdose crisis prompted the stricter prescribing guidelines in 2016, and states in which opioid overdoses were epidemic passed laws to further restrict opioid distribution. This knee-jerk reaction, after these same states welcomed a flood of opioids from Big Pharma for years, had an unfortunate outcome for those who did use opioids responsibly to treat chronic pain conditions in which no other medications were effective.

My mother had intractable cancer pain in the last several months of her life. The CDC guidelines were not supposed to be implemented for those with cancer. But my mother’s doctor didn’t believer the cancer had returned and that she was dying. She believed my mother had become dependent upon the drugs and started limiting her prescription until she finally let my mother’s opioid prescription run out while the doctor was on vacation. My mother suffered mightily because of the doctor’s misinterpretation and fear of the CDC guidelines.

The 2022 guidelines make some improvements, according to pain specialists interviewed by NPR. There is no specific limits on the dose and duration of an opioid prescription. Clinicians will be encouraged to use their own judgment in deciding what is a safe and effective dose for each patient. And the CDC will stress more clearly that the guidelines are not “intended to be applied as inflexible standards of care” or as “law, regulation or policy that dictates clinical practice.”

While the new guidelines still discourage opioids as a first-line therapy for common acute pain conditions and for chronic pain conditions, it does acknowledge that opioids can play a role in chronic pain treatment, especially if other approaches have been tried.

If you or a loved one is running into issues of doctors not willing to manage your pain properly, keep pushing. Find another care provider. No one should have to die in agony because of bureaucratic guidelines. As NPR points out, the 2016 prescribing guidelines didn’t have the intended effect of reducing opioid overdoses. All of that suffering, all for nothing.

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When dying at home isn’t always the best option

Jp Valery/Unsplash

A New York Times article published today discusses a topic near and dear to my heart: the challenges of dying at home.

I have written about this topic extensively, including in my book, The Reluctant Caregiver. I also published an article, “Why dying at home is not all that it’s cracked up to be,” on The Caregiver Space that generated a passionate discussion. Some people thought I was anti-hospice, and that definitely isn’t the case. I think home hospice care, when it’s available in a well-funded and well-staffed form, is a wonderful concept that can support a good death.

But as Paula Span points out in her NYT article, there are challenges and limitations in real-world home hospice care. One issue that I can personally relate to is pain management. My mother suffered because I could not adequately manage her cancer pain at home with the drugs available to me. There was also the battle with her doctor just to get her enrolled in home hospice, which came much too late to be effective.

Caring for the dying at home can be physically strenuous. I struggled to move my mother in bed to change sheets and prevent bedsores. Before she was bedridden, helping her to and from the bathroom was also a challenge. I was a 40-year-old woman in decent shape. But for elder spouses of the dying who may have health issues of their own, it can be overwhelming and untenable.

Palliative care specialists at Harvard Medical School recently published an article in the New England Journal of Medicine suggesting improvements to hospice care, and I agree with their recommendations. For those determined to die at home, it’s essential to have have sufficient home health care services so that families are not overwhelmed. This includes nursing care and personal aide services but also equipment like medical beds. The authors also suggest alternatives that are underutilized, such as inpatient hospice care. This was a suggestion that was made in my father’s case, but there was no bed available at the time of his hospital discharge, so he was sent to a skilled nursing facility instead. We met with the inpatient hospice representative and I appreciated the personal aspect of the care, wanting to get to know him, asking what kind of music he liked, etc. I so wish he could have died in that setting. It’s what I would want for myself.

Hospice units within hospitals is another alternative. This offers access to end-of-life care such as pain management but rooms can be configured to be more home-like by removing unnecessary monitoring machines and having hospice-trained staff provide palliative care. It can be a good alternative in areas without freestanding inpatient hospice facilities.

It’s important to think about these options for yourself and your loved ones now so that you are better prepared to make the best choice for your situation when the time comes.

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Nutritional options important part of palliative care

I came across an interesting discussion recently about whether Ensure and other nutritional beverages marketed towards older people are really the best option.

The discussion that followed the geriatrician’s perspective included interesting pros and cons. It made me think about my parents’ experience with the beverages. My father had never been a fan of milkshakes or similar beverages, but he seemed to enjoy the Ensure drinks, so I would ship cases of them to the memory care center where he spent the last year of his life. My mother existed on Ensure for the last month or so of her life. I have regrets about that, wishing I had taken time to make her something that she would have enjoyed more.

This is why I’m such a strong believer in expanding inpatient hospice and providing more robust home hospice care. As the sole caregiver for my mother at the end of her life, things like whipping up something delicious for her to eat didn’t cross my mind because I was so busy focusing on the “important” things, like her pain medication, treating her bedsores, etc. While I managed to mainly keep her suffering to a minimum, there was no joy in her final weeks.

Those with dementia may struggle with solid food as they enter the final stages of the disease, so liquid forms of nutrition may become a necessity. Homemade smoothies, puddings and milkshakes may interest those who have grown tired of the commercial products. If you can, consult with a nutrition specialist or dietitian about tasty, safe options for your loved one. Bringing loved ones small moments of joy can also lift the spirits of family caregivers.

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Being less active during pandemic may have health consequences

The pandemic’s impact on health goes beyond those who contracted the coronavirus. Even those who managed to avoid the infection may have suffered consequences to their health, and in an area that many take for granted.

In December, I fell while walking my dog. I slipped going down a moderate slope in the park and landed straight on my rump. The fall knocked the wind out of me for a minute, but I was fortunate not to break or sprain anything. My back was very sore and remained so for about a week. I treated it using over-the-counter pain medication and homeopathic balms. My mobility was limited and I was forced to slow down and take it easy, but fortunately I fully recovered and don’t have any lingering issues.

I’m in my late 40s and in decent health. This was a minor fall, but it reminds me that as I get older, recovery from such incidents takes longer. We often take our mobility for granted, but the pandemic may have a lingering impact on our physical conditioning, making us more prone to falls. Studies suggest that some older adults have experienced a decrease in mobility during the pandemic, The New York Times reported.

Those who now work from home full-time may be moving less than when they went into the office, even if they drove to work. Pandemic restrictions may have shut parks, gyms, malls, and other outlets that older people used to exercise. Depression and anxiety can dampen the desire to exercise. Those who did contract COVID-19 may have battled lingering symptoms that made exercise difficult. And those who received benefits from physical and occupational therapy may have not been able to receive those services during the pandemic.

What geriatric health experts are concerned about is that decreased activity levels may result in worse physical functioning, which is key to older adults’ ability to live independently. A fall can lead to a lengthy recovery and trigger a fear of falling again, creating a vicious cycle with significant health consequences. The good news is that we can engage in simple activities that will help us reverse the impacts of our sedentary lifestyle and regain our mobility. Walking, yoga, and tai chi are all great ways to get moving and improve physical functioning.

Take inventory of your mobility and your elder loved ones and make an action plan if you desire to increase your mobility. Taking small steps now can make all the difference in keeping ourselves and our elder loved ones living independently.

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A thoughtful end to ‘After Life’

I’m a big fan of the Netflix show “After Life” created by and starring Ricky Gervais. While the subject matter and profuse profanity make it a show that not everyone will enjoy, I find its take on death and the grieving process refreshing and poignant.

The third and final season debuted this month and I was blown away by one scene in particular, which felt like my mother was speaking to me from beyond the grave.

As I’ve written about extensively on this blog and in my book, The Reluctant Caregiver, my mother was reluctant to discuss any end-of-life issues, but she did give me a poem she had copied by hand and said she would like that read after she died. She didn’t want any service and she chose cremation over burial so it was left to me, her only child, how to honor her wishes.

The poem she chose is the poem that is read during a very moving scene in the final season of “After Life.” When the actress began reciting the poem, I almost jumped out of my seat and my breath caught in my throat. The poem is fairly well-known but still, what are the chances that the poem my mother chose was the one that was recited on a TV show?

I chose to honor my mother’s wishes by not only reciting the poem after her death, but having it imprinted on her urn. You can read the poem below.

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Vision for the new year

I hope you had a peaceful holiday season. Mine was spent mourning my beloved cat Rosalie, but the holiday break allowed me time to honor her memory in various ways. Her urn arrived this week, and Katie Patton of Blocks from the Heart has done such a magnificent job in capturing Rosalie’s spirit.

And to usher in the new year, I took the plunge and adopted a pair of tuxedo cats named Dorian and Serena. They are young, just a year and a half. I do feel like Rosalie’s untimely passing was a signal from the universe that an opportunity was presenting itself to welcome a new energy into my home and my life. It was a rude awakening, but one that I hope will inspire new endeavors into my caregiving advocacy work. Adopting young cats is also a good lesson in letting go of routines and looking at things from a new perspective … like when a kitty climbs to the top of the kitchen cabinets!

Serena and Dorian

As for vision … I attend a monthly women’s healing circle that involves a variety of spiritual disciplines and meditations. It’s been a virtual respite during the isolation of the pandemic. Each year, the teacher draws a spirit word for each participant, and mine for 2022 is vision. I’m interested in exploring that concept.

To kick off the year, I’m taking a course in children’s book writing. I have an idea for a children’s book that would feature my rescue dog Murphy’s story and connect it to children who have also experienced trauma. I don’t know what will come of it, but I think it is good to flex the writing muscles in a new direction.

On the legislative front, I hope some of the caregiving initiatives can be salvaged from the BBB plan. I know I sound like a broken record, but caregiving issues deserves bipartisan support because it’s something that touches all of our lives, regardless of political beliefs. Caregivers, from frontline hospital and nursing home workers to family members tending to loved ones at home, have sacrificed so much and it’s well past time that we as a society support better funding so that they get the support they need.

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Reflecting upon 10 years since my father’s death

It has been 10 years since my father’s death. So much has happened in the past decade, but I’ll never forget where I was when my mother called with the worst news of my life, in the middle of the newsroom at the Atlanta Journal-Constitution. I had been waiting for that awful call for quite some time, and some part of me wished for it, because it pained me so much to see my father suffering in the late stages of dementia. But of course there was no immediate sense of relief upon my father’s passing, just sadness and regret.

I do still carry feelings of regret and guilt to this very day, and probably always will. I discuss this at length in The Reluctant Caregiver, and urge others not to judge themselves too harshly. In that spirit, I am taking a look back on what my father inspired me to do over the last decade.

  • I began this blog, The Memories Project. What began as a way to document memories of my father and process my grief has become the foundation of my dementia and caregiver advocacy platform. I have also met so many fellow caregivers through the blog and am grateful for their wisdom and their support.
  • I wrote a book, which was a life goal of mine. My collection of personal essays on family caregiving, The Reluctant Caregiver, won a gold medal at the IPPY Awards. An essay from that collection won the Rick Bragg Prize for Nonfiction from the Atlanta Writers Club. A story I wrote about my father, “French Toast,” was included in the Chicken Soup for the Soul: Living with Alzheimer’s and Other Dementias collection. I know my dad, a lifelong lover of books, would be proud.
  • I finally made it to Ireland and visited my father’s hometown of Belfast, Northern Ireland. This was at the top of my bucket list and has been one of the best experiences of my life.
  • The privilege of sharing my father’s story through a variety of outlets, including NPR, AlzAuthors, Caring Across Generations and the Aging in America conference.

The decade since my father’s death has been the most difficult of my life, but also the most rewarding. I hope that you can take time this holiday season to recognize and reflect upon the highs amidst the lows of your own caregiving journey. Give yourself the grace that you deserve.

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How pandemic helped motivate interest in ‘virtual assisted living’ technology

One aspect of the pandemic that could be seen as a benefit to family caregivers is the embrace and expansion of technology that assists with basic tasks in our daily lives. While some of us were already utilizing such services before the pandemic, many others learned the convenience of having groceries delivered to their home, for example.

A sandwich caregiver interviewed by MarketWatch recounted what a major benefit it was to have groceries delivered. She used to spend a good chunk of her day off taking her elder parents to the grocery store. When the pandemic struck, she shifted to grocery delivery and signed up her own family as well. Sometimes it is the simple things that can make all the difference. A caregiver reclaiming a few hours of her life each week can have a major impact on her wellbeing and those in her care.

Of course, there is always a price to pay for that convenience, and I never forget the fact that there is a human being who is picking out my groceries and delivering them, putting their own lives at risk to complete a chore for me. I always make sure to tip well.

Zoom and other video calling tools also exploded in popularity during the pandemic. While some are understandably suffering from Zoom fatigue at this point, for those families who were able to get their elder loved ones comfortable with the technology, video calls served as an important lifeline for those separated during the pandemic. Being able to check in on an elder loved one from afar with a simple video call helped put a family caregiver’s mind at ease. Of course it’s not the same as being able to hug and socialize in person, but for elders who otherwise may have been completely isolated, video calls kept the connection to family intact.

Remote tools, whether for working, socializing, or caregiving, are now receiving greater public interest, which is sparking investments from major technology companies like Amazon, who has developed a caregiving hub called Alexa Together. While there are security, privacy, and ethical concerns when it comes to monitoring technology, overall I think these tools can be helpful for the long-distance caregiver.

From my experience, I found tools such as a cellphone designed for older people, fall-sensing technology, and automated shipping of supplies to be of great help as a long-distance caregiver. As I wrote in my book, The Reluctant Caregiver, I was able to convince my mother, long skeptical of high-tech gadgets, to embrace these tools to help keep her living at home safely, versus having to enter assisted living.

As I grow older, I will be watching this growing field of technology with interest.

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