Care for the Care Giver

NEW RESOURCES FOR CAREGIVERS FROM THE CENTER FOR MEDICARE AND MEDICAID SERVICES

CMS - ASK MEDICARE

The Centers for Medicare and Medicaid Services (CMS) has announced the launch of a new web site designed to provide support for caregivers. While the site focuses on caregivers of adult recipients of Medicare, much of the information is also useful for parents and others caring for children who have disabilities who are covered either by Medicare or Medicaid. 44 million adults provide such unpaid care for children or adults! The new site address is http://www.medicare.gov/caregivers. There is also an electronic sign-up for an e-newsletter for caregivers.

Definitions:

Medicare: federal program for the aged and disabled that provides comparable benefits nationwide
Medicaid: Joint federal and state program for low income individuals. Benefits may vary from state-to-state depending on state contributions to the program.

Web-based Resources:

http://www.strengthforcaring.com/ site sponsored by Johnson & Johnson provides resources and information.
www.caregiving.org/ National Alliance for Caregivers; also check out their Family Caregiver Navigator
http://www.aoa.gov/prof/aoaprog/caregiver/caregiver.aspx resources for caergiver support
http://www.uhfnyc.org/nextstepincare/ a multi-year, multi-dimensional campaign to change practice so that family caregivers are routinely involved in planning, decision making, and coordinating care, particularly around transitions in care settings (this will be updated when the dedicated website for the program is launched).
http://www.selfhelpweb.org/ National Self-help Clearinghouse

2007 FAMILY CONFERENCE PRESENTATION

Cate Walsh Vockley, MS, CGC
Coordinator of Education, Referral and Advocacy

Parenting

Includes all the tasks involved in raising a child. Parenting begins even before the child is born or adopted and may last until the death of the parent or child. Parenting is a part of the family relationship.

Caregiver Burden

The physical, emotional and financial costs of providing care, usually as they are felt or understood by an individual or individuals. These correspond with the amount of medical or behavioral problems in the individual requiring care (typically there is more stress when things change or symptoms are exacerbated). Whether a person has certain caregiver skills influences the level of burden felt by the caregiver – active coping skills and management strategies help. Support and involvement of others help.

What Is Stress?

Eustress: “good” stress that energizes psychologically and physically, and motivates

Distress: reaction to something that pushes us beyond our level of coping

Stages of Stress

Alarm Stage
1. Mobilizing energy: causes the carer to become energized
2. Fight or flight – work to resolve the issue or run from the issue
3. Usually involves a short amount of time – if resolved, things return to the normal state, if it lasts a long time or is not resolved, the situation moves to the next stage.
Stage of Resistance
1. Consuming Energy: uses energy
2. Usually occurs over a longer time frame. If it continues, how the individuals think and feel about the cause of the stress changes (“I can deal with this” - the stress is managed, OR illness results
Stage of Exhaustion
1. Draining energy
2. Illness results --> stress management intervention and/or medical help are usually needed

Effects of Stress on the Body

Stress--> Adrenaline released --> increased blood pressure and heart rate --> Muscle tension --> headaches, shaking, aches and pains --> Upset digestive system --> sickness, diarrhea, constipation, stomach cramps, etc. --> Changes in breathing pattern --> breathless, hyperventilation, chest pains --> sweating, tension, sleep problems, etc….

Self-assessment – AM I STRESSED?

NOTE: Any of us may experience some of the above feelings during stressful periods in our lives. However, if a care giver finds he or she is experiencing many of these characteristics, or if they continue for prolonged periods of time, help from someone outside the situation is essential.

Do I ever find myself trying to do it all and be responsible for all aspects of the caregiving?
Do I ever experience sleep disturbances, including the inability to fall asleep or stay asleep? Do I wake early and lay in bed dreading the day ahead? Do I experience restlessness so that even if I get a chance to rest and relax, I can’t? Do I have an increased reliance on alcohol to relax, pills to sleep, tranquilizers to calm down?
Do I have trouble getting out of the bed to start a new day?
Do I frequently experience aches and pains, including muscle aches or tightness, neck aches or headaches? Do I experience stomach or digestive problems without a specific cause? Do I have increased outbreaks of bursitis, arthritis, or other ailments?
Do I have difficulty concentrating, increased forgetfulness, or experience numerous small accidents? Do I have trouble carrying out normal daily activities? Do I have difficulty making decisions?
Do I say to myself “I Should be able to…,” “I can never…,” or similar statements?
Do I get frustrated by something I am unable to change?
Do I experience chronic health problems, migraines/headaches, and/or experience low energy or exhaustion?
Do I resist asking for and receiving help from others? Have I developed a fear of others, “can’t be bothered” about others, or do I blame others for everything?
Do I feel that my family has no idea what I must go through and do they simply not understand?
Do I experience emotional outbreaks, mood swings or weepiness, including anxiety, depression, anger, guilt or loneliness?
Do I still see my friends, go to church, enjoy social events or entertainment?
Do I drink, smoke, or comfort eat more?

APPROACHES TO MANAGING STRESS

A Caregiver’s Bill of Rights by Jo Horne

I have the right:

To take care of myself.
This is not an act of selfishness. It will give me the capability to take better care of my loved one.
To seek help from others even though my loved ones may object.
I recognize the limits of my own endurance and strength.
To maintain facets of my own life that do not include the person I care for, just as I would if he or she were healthy.
I know that I do everything that I reasonably can for this person, and I have the right to do some things just for myself.
To get angry, be depressed, be anxious and express other difficult feelings occasionally.
To reject any attempts by my loved one (either conscious or unconscious) to manipulate me through guilt and/or depression.
To receive consideration, affection, forgiveness, and acceptance for what I do, from my loved ones, for as long as I offer these qualities in return.
To take pride in what I am accomplishing and to applaud the courage it has sometimes taken to meet the needs of my loved one.
To protect my individuality and my right to make a life for myself that will sustain me in the time when my loved one no longer needs my full-time help.
To expect and demand that as new strides are made in finding resources to aid physically and mentally impaired persons in our country, similar strides will be made towards aiding and supporting caregivers.

What to do when you can’t remove the stressor?

Change to be proactive – don’t wait for the cause of the stress to happen. Be educated; know what to expect as the situation moves forward, whether it’s information about a progressive disease, an upcoming event, or a relationship.

Twenty Ways to Care for Caregivers

Laugh about something everyday.
Take care of yourself physically.
Eat a well-balanced diet.
Talk with someone every day. Talk to an objective person when issues arise.
Don’t overload your daily “to do” list – be realistic. Don’t "should" on me and I won’t "should" on you!
Let family and friends help. Give them printed material on the disorder so they can better understand your relative. Give them a chance. Make specific requests and/or define tasks they can do
Give yourself permission to have a good cry. Tears aren't a weakness, they reduce tension.
Exercise. A brisk walk counts.
Get adequate rest.
Try a bowl of Cheerios and milk before bed to promote sleep.
Avoid noisy and/or tension-filled movies at night. The late news itself can add to stress. Skip it.
Reduce daily caffeine intake.
Get professional help if you feel your support system isn't adequate or if you feel overwhelmed.
Take a break every day, even if it's only 10 minutes alone in the backyard.
Explore community resources and connect yourself with them. Participate in a local support group. SHARE your feelings with family and friends.
Listen to music.
Learn relaxation techniques, like progressive relaxation (one muscle group at a time, tense for 10 seconds and then relax) (or bubble baths!)
Meditate.
Regularly attend one or more support groups and education workshops.
Give yourself a treat at least once a month: an ice cream cone....a new shirt or dress....a night out with friends....a flowering plant, or just ask for a hug or kiss (more than once a month!).
Read your Caregiver's Bill of Rights (and Today's Caregiver magazine)
Delegate responsibilities.
Know your limitations. If you wear yourself out, who will care for your loved one, or for you? Caring for yourself is not selfish!
Give yourself credit! Boost self-esteem.
Change the way you look at the world (change your perceptions)

General Resources

Educational support, especially focused on behavioral management
Consider individual and/or family counseling if there are significant difficulties in dealing with the stress of being a caregiver.
Support groups
Anticipatory guidance regarding grief and loss
The 36 Hour Day: A Family Guide to Caring for Persons With Alzheimer Disease, Related Dementing Illnesses, and Memory Loss in Later Life by Nancy L. Mace, Peter V. Rabins

Meditation

The Relaxation Response by Herbert Benson, M.D. Page 162 tells you how to meditate:

Sit quietly in a comfortable position.
Close your eyes.
Relax your muscles, beginning at your feet and progressing up to your face.
Breathe through your nose. Become aware of your breathing. As you breathe out, say the word "ONE" (or a focus word or phrase rooted in your belief system), silently to yourself. For example, breathe IN...OUT, "ONE"; breathe easily and naturally.
Continue for 20 minutes. Try and finish without an alarm; take your time standing up.
Practice makes perfect. If you find your mind straying, gently pull it back and repeat "ONE." Wait two hours after meals to meditate since digestion seems to interfere with the Relaxation Response.

Practice this once or twice a day, or whenever you feel particularly under stress, for example, at the onset of a migraine.

Role of the Family Practitioner and/or Internist

Someone you should know about your caring role – YOUR physician!

Respite Care Resources

Place of worship
County Social Services
Local medical facility
Online: Find respite care through the ARCH National Respite Network Locator at: www.respitelocator.org/index.htm
This site also has listings of camp facilities that accommodate kids with special needs and their families.

Factors Causing Stress

(from a UK survey – will be very dependent on timing of the questions in relation to when the diagnosis was made)

The concerns fall into several categories:

Parents
1. Child’s comfort, pain
2. Child’s enjoyment of life
3. Guilt
4. Public reactions
5. Responsiveness of health care professionals
6. Everyday frustrations
Relationships with professionals
1. Dissatisfaction with how diagnosis was communicated
2. Quality of relationship with primary care provider
3. Dis-coordination of care
Issues relating to family and friends
1. Lack of respite care/isolation
2. Treatment of siblings
Child-centered issues
1. Communication
2. Lifting
3. Administering medications and therapies
4. Safety
5. Socializing
Level of support
1. Inadequate financial support
2. Difficulty in identifying resources
3. Need for duplicate reporting of personal information (the same forms for numerous agencies)
4. Assistance with adaptations need for child (financial and technical)
5. Limits on respite care
Employers
1. Issues related to need for numerous absences to care for the child
Practical problems
1. Transportation
2. Education

LINKS AND RESOURCES

www.heartsofcourage.com - Helping special needs families lighten the load
www.caregiver.org - Family Caregiver Alliance, National Center on Caregiving
www.nfcacares.org - National Family Caregivers Association - educates, supports, empowers and speaks up for the more than 50 million Americans who care for loved ones with a chronic illness or disability or the frailties of old age
www.carepoints.org - A community of parents and professionals who strive to enhance the quality of life for medically complex children and their families.