devices, and winterizing homes.
 
Companionship Services:    Companions visit isolated and
homebound individuals for conversation, reading, letter writing,
and general light errands.
 
Escort Services for the Elderly:    These services provide
personalized accompaniment to service providers as well as
personal assistance.
 
Geriatric Assessment Units and Special-Care Units:
Specialized geriatric units, both inpatient and outpatient,
exist in some hospitals and medical centers; e.g., SOCARE, API
They provide coordinated multi-disciplinary diagnostic services
to older patients.
 
Home Delivered Meals:    Some nutritional programs as well as
well as specialized *meals-on-wheels* programs offer home
delivered meals to the frail, homebound aged.  Subsidized
programs ask for voluntary contributions, while others may
require full payment cost for delivery of a hot, well balanced
lunch, and sometimes cold evening meal.
 
Home Health Aides:    Provide personal care to individuals at
home  (These services may be covered by health insurance if
ordered by a physician.)  Aides assist with eating, dressing,
oral hygiene, bathing, colostomies, administering medications,
etc., as well as light household tasks.
 
Home Health Care:    Organized programs of nursing, social work,
occupational therapy, physical therapy, and other rehabilitation
services to individuals in the home.
 
Homemaker Services:    Provided by non-medical personnel,
services include shopping, laundry, light cleaning, dressing,
preparation of meals, and escort services on medical visits.
Homemakers can be of great help in supplementing help provided
by family members, or providing relief when family caregivers
need a break.  Homemakers can be secured through in-home health
care agencies, the Area Agency on Aging, the Department of
Social Services, and religious groups and organizations.  Some
agencies provide bonding and training for their homemakers while
others provide only a registry of homemakers' names and phone
numbers, in which case you must thoroughly check references and
draw up a contract for the required services.
 
Hospital and Surgical Supply Services:    Supply houses rent or
sell medical supplies and equipment like hospital beds, canes,
walkers, bath chairs, oxygen and other equipment.  Consult you
Yellow Pages.
 
Housekeeping Services:    These usually include cleaning,
shopping, laundry, and meal preparation.
 
Housing Assistance:    Housing assistance programs exist to help
in the search for senior housing, shared housing, and finding
emergency shelters, such as Heartland Human Relations and Area
Agency on Aging.
 
Nutritional Programs:    Congregate meal programs feed many
older adults as a group in a senior center, community center, or
school.  A noonday meal is provided, containing one-third of the
recommended USDA dietary allowance, usually for a voluntary
contribution.  Additionally, some centers provide recreational
and educational activities.
 
Occupational Therapy:    Occupational therapy, or OT, is
restorative, to enhance or restore skills necessary for daily
living.  It should be provide by a qualified occupational
therapist who is referred by your doctor.
 
Physical Therapy:    Physical therapy, or PT, is rehabilitative
therapy to maximize mobility.  It should be provide by a
qualified physical therapist, usually recommended by your doctor
or hospital.
 
Respite Care Services:    Respite care programs provide
temporary and in some instances up to twenty-four hour care to
give relief to primary caregivers.  The care may be provided in
the person's home, at an adult day care center, or other
facility.
 
Senior Service Teams:    Regional/County Mental Health teams
working together to provide mental health screening, needs
assessments, and short-term counseling services to seniors.
 
Skilled Nursing Services:    These specialized services are
provided for specific medical problems by trained professionals
through local home care agencies.  Your doctor must prescribe
nursing services.
 
Speech Therapy:    Speech therapy is provided by a qualified
speech therapist to overcome certain speech and communication
problems.  The doctor usually recommends this.
 
Social Day Care:    Provide supportive but not rehabilitative
services in a protected setting for a portion of the day, one to
five days a week.  Services may include recreational activities,
social work services, a hot meal, transportation, and
occasionally, health services.
 
Telephone Reassurance:    Friendly telephone calls are provided
by agencies or volunteers offering reassurance, contact and
socialization.  Telephone reassurance can be a lifeline for
older people who must be left at home alone during the day.
 
Transportation:    Transportation services provide travel by
automobile or specialized vans to and from medical care.
Community agencies and service providers such as Dial-a-Ride,
Red Cross Wheels, Cancer Society, and Life Line are but a few.
 
*******************
 
F.  Caring for the Caregiver
 
Caregivers experience mixed emotions.  Love for your family
member and the satisfaction you derive from helping may coexist
with feelings of resentment about the loss of your privacy and
frustration at believing you have no control over what happens.
You may find it hard to accept the decline of the special person
for whom you are giving care.  Such feelings will depend in part
on your prior relationship with your care-receiver, the extent
of your responsibilities as a helper, and daily activities in
your life (professional, social, and leisure pursuits).  Your
conflicting emotions may cause guilt and stress.
 
To guard against becoming physically and emotionally drained,
you must take care of yourself.  You need to maintain your
health and develop ways to cope with your situation.
 
6.  Caregiver's Self-Rating Scale:     Below is a scale to
evaluate your level of caregiving.  It has been adapted from an
article in *Co-op Networker;  Caregiver of Older Persons* by
Judy Bradley.  It is an excellent effort to provide some
guidelines for caregivers and to evaluate your level of care and
value which you give your care-receiver and yourself.
 
The scale is a 1-10 continuum which describes the various styles
of caring.  Circle the number or numbers which best describe
your level of care.
 
Table 2
 
1      2      3      4      5      6      7      8      9      10
____________________________________________
                      Scale of Caregiving
 
       1.  Abandonment:  to withdraw protection or support or to
actively abuse your care-receiver.
 
       2.  Neglect:  to allow life-threatening situations to
persist or to display consistent coldness or anger.
 
       3.  Detachment/Aloofness:  to maintain an air of
detachment or being aloof, perfunctory in your care, no genuine
concern, only obligation.  Concerned only with physical
well-being of your care-receiver.
 
       4.  General Support:  given freely, with a guarded degree
of warmth and respect, occasional feelings of manipulation.
Concerned with both emotional and physical well-being of
care-receiver.
 
       5.  Expressed empathy:  the ability to feel what your
care-receiver feels.  a quality relationship where feelings can
be freely expressed and caringly received with non-judgmental
positive regard.
 
       6.  Sympathy:  feeling sorry for care-receiver, giving
sympathy, focusing on the losses experienced by care-receiver.
 
       7.  Occasional over-involvement:  care characterized by
periodic attempts to *do for* rather than *be with.*
 
       8.  Consistent Over-involvement:  care-receiver regarded
as object of series of tasks which must be performed.
 
       9.  Heroic Over-involvement:  care characterized by
sometimes frantic and desperate attempts to provide for every
possible need your care-receiver has;  increased dependence,
care-receiver not allowed independence.
 
      10. Fusion of personalities:  between caregiver and
care-receiver.  The caregiver's needs no longer have any value
or meaning;  the caregiver has abandoned him/herself to needs of
the care-receiver.
 
You can place yourself on the Scale of Caregiving to determine
how you value your care-receiver as compared to yourself.  The
low numbers give little or no value (honor) to the needs of your
care-receiver.  The high numbers (8, 9, 10) give little or no
value to your own needs as an individual and as a caregiver.
The numbers in the middle are where you find a balance between
undercare and overcare.  Neither of the two extremes is healthy;
they represent positions where you are not helping your
care-receiver.
 
7.  What can I do to help myself?  Acknowledge your feelings:
Your feelings have a lot to do with the way you view and cope
with caregiving.  All feeling are legitimate, even those that
may sem disturbing to you (including anger, frustration, and
sadness).  Recognizing and accepting your emotions are the first
step toward resolving problems of guilt and stress.  Learn to
express your feelings to family members, friends, or
professionals.  Take the following caregiver Stress Test;
determine how much stress you are under.
 
Caregiver Stress Test
 
The following test will help you become aware of your feelings,
pressures and stress you currently feel.
 
Table 3
 
Mark with S,O,U             Sometimes true    Often true    Usually true
 
-- I find I can't get enough rest.
 
-- I don't have enough time for myself.
 
-- I don't have time to be with other family members beside the
person care for.
 
-- I feel guilty about my situation.
 
-- I don't get out much anymore.
 
-- I have conflict with the person I care for.
 
-- I have conflicts with other family members.
 
-- I cry everyday.
 
-- I worry about having enough money to make ends meet.
 
-- I don't feel I have enough knowledge or experience to give
care as well as I'd like.
 
-- My own health is not good.
 
If the response to one or more of these areas is *usually true*
or *often true* it may be time to begin looking for help with
caring for the care-receiver and help in taking care of
yourself.
 
8.  Seek Information:    Check your public library for books,
articles, brochures, videotapes, and films on caregiving.  Some
hospitals, Adult Education Centers, the Southern Regional
Resource Center and CESS offer courses on caregiving and
additional information on resources that you can turn to for
help.  Help is available!
 
9.  Join a Caregiver Support Group:    In addition to offering
useful information, such groups provide a unique forum for
caregivers to come together and share their feelings in a
supportive environment.  Groups help caregivers feel less
isolated and can create strong bonds of mutual help and
friendship.
 
Participating in a support group can help mange stress, exchange
experiences, and improve skills as a caregiver.  Sharing coping
strategies in a group setting lets you help others while helping
yourself.  It may also help you to realize that some problems
have no solutions and that accepting the situation is reality.
 
10.  Set Realistic Goals:    Caregiving is probably one of the
many conflicting demands on your time.  It is important to set
realistic goals.  Recognize what you can and cannot do, define
your priorities, and act accordingly.  Turn to other people for
help - your family, friends, and neighbors.  Prepare a list of
tasks for anyone who may offer assistance.  The list may
include:
 
-- running an errand for you, -- preparing a meal, -- taking
your care-receiver for a ride, -- taking our children after
school one day.
 
11.  Do not expect that others will ask if you need help.  It is
up to you to do the asking.
 
12.  Communicate with your Family and Friends:    Turning to
family members or friends for emotional support and help can be
a mixed blessing.  Their visits may make you feel less alone and
better able to deal with caregiving responsibilities.  They can
give you a break by spending time with your care-receiver.
 
However, other relatives or friends can be critical of the way
you provide care.  They may feel the house is not kept clean
enough;  or they may not like the way your care-receiver is
dressed.  Recognize that they are responding to what they see at
that time and are lacking the benefit of experiencing the whole
picture and any gradual changes in your care-receiver's
condition.  Harsh criticism may be a response to their own guilt
about not participating more in the care process.
 
Try to listen politely to what is being said (even though this
might not be easy).  However, if you and your care-receiver feel
comfortable with the way you are managing the situation,
continue to do what meets your needs.  Schedule a family meeting
from time to time to help other family members understand the
situation and to involve them in sharing the responsibilities
for caregiving.
 
13.  Use Community Resources:    Investigate community resources
that might be helpful.  Consider using in-home services or adult
day care.  Employ a homemaker to cook and clean, or an aide to
help your care-receiver bathe, eat, dress, use the bathroom or
get around the house.
 
14.  Use Respite Care Services:    When you need a break from
providing care to your care-receiver, look at respite care.  For
example, a companion can stay with your care-receiver for a few
hours at a time on a regular basis to give you time off.  Or
have your care-receiver participate in an adult day care program
where he or she can socialize with peers in a supervised
setting;  this gives your care-receiver a necessary break from
staying home all the time.  Hospitals, nursing homes, and
particularly residential care homes offer families the
opportunity to place older relatives in their facilities for
short stays.  The Residential Bed Availability Hot Line, your
doctor, and the Area Agency on Aging can assist with
arrangements.
 
15.  Maintain your Health:    Your general well-being affects
your outlook on life and your ability to cope.  Taking care of
yourself is important and involves:
 
-- eating three balanced meals daily,
-- exercising daily,
--enough sleep/rest,
-- allowing yourself leisure time.
 
Food is fuel for your body.  Skipping meals, eating poorly, or
drinking lots of caffeine is not good for you.  Learn to prepare
and eat simple, nutritious, well-balanced meals.  Avoid alcohol
above 2-3 ounces daily.
 
Being physically active can provide you with an outlet that is
relaxing and makes you feel good.  Stretching, walking, jogging,
swimming, or bicycling are examples of invigorating exercises.
Consult your doctor before starting an exercise routine.  Your
doctor can help design a program that fits your individual
needs.
 
Leisure time allows you to feel better and more able to cope
with your situation.  Having time to yourself to read a book,
visit a friend, or watch TV can also bring enjoyment and
relaxation, and break the constant pattern and pressure of
caregiving.
 
Sleep refreshes and enables you to function throughout the day.
If your care-receiver is restless at night and disturbs your
sleep, consult your doctor and fellow caregivers on possible
ways to handle the situation.  You may need to have outside help
in the evenings to allow you time to sleep.
 
If you are unable to sleep because of tension, practice
relaxation exercises.  Deep breathing or visualizing pleasant
scenes can be helpful.  Continued sleep disturbance may be a
sign of major depression, which needs medical attention.
 
16.  Relaxation Exercise:
 
--  Sit or lie down in a comfortable position.  Close your eyes.
Allow your mind to drift a few seconds, go with it wherever it
goes.  Wiggle your fingers and toes, then hands and feet, ankles
and wrists.  Loosen tight clothes, belts, ties.  Sway your head
from side to side, gently, gently.  Now you have prepared
yourself to relax physically and psychologically.
 
--  Now concentrate, still with your eyes closed, on some one
pleasant thing you really want to think about;  maybe it is a
place you have visited in the past, or your dream place of your
own imagination.  It might be the seashore, or high on a hill,
or in a field of grass and flowers.  Become totally immersed in
the place.  Smell the smells you best remember.  See the sights
it offers.  Hear the sounds.  Feel it, whether it be water or
sand or soil or snow.  Fully realize this place or situation you
are in:  if it is on the sandy beach, sift your fingers through
the warm sand and smell it, hold the sand to your cheek, smell
the salt of the sea, search the skyline for gulls and terns and
low clouds in the distance.  Your body is totally weightless.
You are totally in control of this scene.  It is so relaxing and
pleasant and beautiful, you are breathing slowly, peacefully.
This is YOUR place and no one can take it from you.
 
--  After you have sufficiently experienced your peaceful
imaging, whenever you have a chance, return to your special
place, close your eyes again, tune in, relive those these
special few moments in the world of your choosing where
everything is perfect and everything is yours.  This relaxation
exercise can benefit you all day.  Check your local library or
book store for books, audio tapes, videotapes or films on
relaxing and managing stress.
 
17.  Laughter is the Best Medicine:    This is an old expression
popularized by Norman Cousin's book *Anatomy of an Illness*, in
which he describes his battle with cancer and how he *laughed*
his way to recovery.  His hypothesis and the subject of many
studies suggests that there are positive effects to be gained
from laughter as a great tension-releaser, pain reducer,
breathing improver, and general elevator of moods.  It sounds
miraculous, is not proven, but studies continue.  Groups such as
the International Conference on Humor and many hospitals use
*positive emotion rooms* and *humor carts*.  In short, humor
therapy is valuable and it helps us through difficult or
stressful times.
 
So for yourself and your care-receiver:
 
--  try to see the humor in being a caregiver;
 
--  write on a card *Have you laughed with your care-receiver
today?* and place it in a conspicuous place in the bathroom or
kitchen;
 
--  read funny books or jokes, listen to funny tapes or watch
humorous movies or videos that make you laugh;
 
--  share something humorous with your care-receiver, a friend,
or relative; --  attend social groups where there is a lot of
comeraderie, joy and fun;
 
--  be aware of how often you smile;  it takes much less energy
to smile than to frown.
 
If you find that you are feeling hopeless, and humor or laughter
is not affording you the up-lift you want, contact a counselor.
And remember, laughter is the best medicine.  Try it, you'll
like it!
 
18.  Avoid Destructive Behavior:    Sometimes people handle
stressful situations in ways that are destructive.  Instead of
openly expressing feelings, they overeat, use alcohol, drugs, or
cigarettes to mask their difficulties.  Such escapes do not
solve the problem and are harmful to health.  If the strain
results in neglecting or abusing the care-receiver, it is a vary
serious problem.  It is also against the law!
 
19.  Seek Help:    You do not have to go it alone.  Turn to
family members, friends, clergy members, professional
counselors, or a caregiver support group for help and support.
 
 
John Cottingham         NEW ADDRESS:          [log in to unmask]