20.  Build your Self-Esteem:    Continue to pursue activities
and social contacts outside your home.  Do what you enjoy.  Go
to a movie, play a musical instrument, or get together with
friends for a card game.  It may not be easy to schedule these
activities, but the rewards for having balance in your life are
great.  Taking care of yourself benefits you and your
care-receiver.  Meeting your own needs will satisfy you and give
you additional strength and vigor to bring to your caregiving
tasks.
 
21.  You have rights,too.  Below is a Caregiver's Bill of
Rights.  After you read them, post and keep them fresh in your
mind.
 
Table 4
 
Caregiver's Bill of Rights
 
--  Caregivers have the right to receive sufficient training in
caregiving skills along with accurate understandable information
about the condition and needs of the care recipient.
 
--  Caregivers have the right to appreciation and emotional
support for their decision to accept the challenge of providing
care.
 
--  Caregivers have the right to protect their assets and
financial future without severing their relationship with the
care-receiver.
 
--  Caregivers have the right to respite care during emergencies
and in order to care for their own health, spirit, and
relationships.
 
--  Caregivers have the right to expect all family members, both
men and women, to participate in the care for aging relatives.
 
--  Caregivers have the right to provide care at home as long as
physically, financially and emotionally feasible;  however, when
it is no longer feasible caregivers have the obligation to
explore other alternatives, such as a residential care facility.
 
--  Caregivers have the right to temporarily alter their
premises as necessary to provide safe and livable housing for
care-receivers.
 
--  Caregivers have to right to accessible and culturally
appropriate services to aid in caring for aging care-receivers.
 
--  Caregivers have the right to expect professionals, within
their area of specialization, to recognize the importance of
palliative (ease without curing) care and to be knowledgeable
about concerns and options related to older people and
caregivers.
 
--  Caregivers have the right to a sensitive, supportive
response by employers in dealing with the unexpected or severe
care needs.
 
***********************
 
G.  Personal Care
 
22.  Personal care activities include: eating, bathing, shaving,
caring for the skin, hair and mouth, and transferring (moving
from chairs, toilets or bed).  During the course of our daily
lives these activities are taken for granted until weakness or a
disability makes them difficult to accomplish independently or
safely.  Providing assistance requires knowledge, patience,
skill and physical strength.
 
Bathing:    Bathing an older person may require strength,
special equipment and skills.  It is advised that caregivers ask
the elderly person's doctor and.or physical therapist for
special instructions on how to safely bathe the care-receiver.
 
Shampooing and Shaving:    Visits to a barber or hairdresser are
very positive experiences.  Individuals who provide this service
will often come to the home.  Wetting hair with alcohol or cream
rinse helps to remove the snarls.  Dry shampoos are available if
your family member is bed bound.  People who are diabetic or on
medication to thin the blood (anti-coagulants, i.e., Coumadin)
should use an electric shaver to reduce the risk of cuts.  It is
much easier and safer to shave another person with an electric
razor.
 
Skin Care:
 
--  Keep skin clean and dry, especially when people are having
problems with bowel and bladder control.  When washing, use a
mild soap, rinse well, and dry thoroughly.
 
--  Keep bed linens clean, dry and free of wrinkles.  Disposable
bed pads can be purchased at a drug store and can keep sheets
dry so that the caregiver does not have to change sheets so
often.
 
--  Massage skin gently using a light, circular motion.  Change
the position of older people at least every two hours,
particularly for those confined to a bed or wheelchair.
Encourage them to shift their weight between position changes to
redistribute pressure onto other areas.
 
--  Encourage good nutrition and adequate fluid intake.  As a
supplement to your family member's diet, give a multi-vitamin
every day to ensure proper nutrition.  Check with the physician
as to the appropriate supplement.
 
--  Use mattress and chairs that are soft and form-fitting
rather than rigid and hard.  (Example:  egg crate mattress and
sheep skin).  This spreads the weight over a larger skin area,
decreasing the pressure under the bones.
 
--  Encourage movement or mild exercise;  this helps stimulate
circulation which is good for the skin.  Combing hair and
helping with bathing and dressing are good ways for frail people
to get exercise and be more independent.
 
--  Watch for possible sources of pressure on anything that
would interfere with good circulation, such as tight shoes,
elastic cuffed socks or tight undergarments.
 
--  Bony prominences are prone to skin breakdown.  They are
heels, feet, behind the knees, hips, buttocks, sacrum, elbows
and shoulder blades.  A special air mattress may be ordered by
the doctor to prevent skin breakdown.
 
--  Watch for any redness or a break in the skin and report it
immediately to the doctor or nurse, and keep the care-receiver
off the affected side.
 
23.  Toileting:
 
--  Safety features in the bathroom, such as grab bars and
raised toilet seats, make using the bathroom safer.
 
--  A commode or urinal may be necessary when flexibility and
distance to the bathroom are a problem.  They may be especially
helpful at night.
 
--  Lack of control over bowel or bladder functions can be
embarrassing and older people may try to hide it from caregivers
and professionals.  Be sensitive to the older person's feelings,
and mention this to the doctor.  Loss of bowel and bladder
control is not a part of normal aging and often can be
controlled.
 
--  For the care-receiver with bowel and/or bladder problems it
may help to take them to the bathroom every 2 hours.
Specialized programs exist to retrain a bladder and bowel
function.  Check with your doctor or nurse for a program in your
area.
 
Constipation or Irregularity:    Many elderly become constipated
due to medications and inactivity.  If your care-receiver is
experiencing this problem the doctor or nurse can suggest a
stool softener.  Other important factors are:
 
--  Eat plenty of fresh fruit, vegetables and foods high in
fibers.  --  Drink at least 8 glasses of water a day.  --  Avoid
constipating foods like cheese, rice, bananas, etc.  --
Exercise as much as is tolerated.  --  Be sure your doctor is
aware of all the medications being taken.
 
24.  Assisting with Eating:    Eating can be very
time-consuming, especially if the older person must be fed.
Encouraging independent eating saves time for caregivers, and
promotes the independence and self-worth of the older person.
Try to relax yourself and enjoy the time spent with your
care-receiver.  Here are some suggestions for encouraging
independence:
 
--  Check gums for areas of redness.  Dentures may not fit
correctly and cause the family member pain when chewing.  --
Provide adaptive equipment such as plate guards or special
silverware with built-up handles.  These can be purchased from
medical supply houses (listed under Hospital Equipment and
Supplies in the Yellow Pages).  An occupational therapy
evaluation can recommend the best for each individual.  --
Prepare finger foods which may be easier to eat than those
requiring utensils.  --  Encourage older people to use a straw,
cups with 2 handles, or a glass with ribbed surface for
independent drinking.  --  If the older adult has limited
vision, consistent place setting of food and utensils helps to
know where to find silverware, beverage, etc.  Using the *clock*
method to locate food may be helpful;  for example, *Your meat
is at 9 o'clock, your potato is at 12 o'clock and your carrots
are at 3 o'clock.*
 
--  Reminder: Treat older people who are being fed as adults,
not children.  Disciplining poor eating habits should be
avoided.  When they lack interest in food, try to learn the
reason.  For example, ask if they are thirsty or not feeling
well, or if the food in not appetizing on this occasion.
 
Transferring:    Moving people who cannot move safely by
themselves requires skill, knowledge, and some strength.  For
every type of disability, there is a specific technique to use.
Ask a doctor, therapist or attend caregiver training for
specific techniques.  In all cases, remember:
 
--  When lifting, do not add your own weight to whatever you are
lifting -- get close and keep balance centered.  --  Do not use
weak back muscles to lift - use your leg muscles because they
are much stronger.  --  Do not twist when you are lifting -
instead, change the position of your feet so that you face the
older person, keeping your spine straight.  --  Balance is vital
- spread your feet to serve as a base for support.  --  Your
doctor can refer you to a physical therapist who can teach you
to transfer safely.
 
Rest and Sleep:    As we age, our sleep patterns change.  The
elderly require less sleep time.  It takes longer for them to
fall asleep.  Also, awakenings during the night increase.
Scheduled rest times are important.  A few naps during the day
can refresh and revitalize the care-receiver.  However, if you
notice that your care-receiver is sleeping for brief periods
during the night, it could indicate a problem.  Notify your
doctor and discuss your concerns.
 
Tips for Encouraging Self Care:
 
--  Allow the care-receiver to do as much as possible; provide
only as much help as needed.  When older people do all or part
of their own personal care, it is a form of exercise that will
help maintain strength as well as promote independence.  No
matter how small the activity (holding the soap, combing the
front of the hair, etc.) it is important that the person be able
to participate.
 
--  Adapt the home to allow the care-receiver to do more things.
Install equipment such as grab rails in the bathroom,
wheelchair-accessible sinks and mirrors, bath bench for the
shower or tub, and lights with switches that can be easily
reached.
 
--  Seek the aid of therapists or nurses to teach you how to
perform personal care tasks safely and effectively.
 
--  Learn about the care-receiver's disability and what you and
others can do to help him/her function as independently as
possible.  If the older person cannot perform a certain
activity, see if there is a part that can be done.  For example,
one might be able to independently dress the upper body if
sitting, but require help dressing the lower body.
 
--  Whenever possible, include the care-receiver in making plans
for his/her care.  Take suggestions and feelings into
consideration and encourage involvement in his/her own care.
Sometimes, slowing the pace of an activity allows older people
to do more for themselves.
 
Be aware of changes in the care-receiver's health and abilities.
Your plans for care will change as the care receiver changes.
 
************************
H.  Nutrition.
 
Good nutrition is important in order that people live life to
its fullest.  Good nutrition is a balance of proteins,
carbohydrates, fats, vitamins, minerals and water in the foods
we eat.  A healthy diet helps to (1) provide energy;  (2) build,
repair, and maintain body tissues and (s) regulate body
processes.
 
When meals are eaten in the company of others, people not only
benefit from the nutritious foods, but also enjoy the chance to
socialize.  This encourages good eating habits and promotes good
mental health.
 
25.  The table that follows summarizes essential nutrients
(which you may also finds listed on food labels) and their
functions.
 
26.  Adapting Meals for People with Dietary Restrictions.  If an
individual is on a special diet (low salt, diabetic or low
saturated fat), the Basic Four Food Groups Guide (which follows)
can still be used.  However, because diets are prescribed to
control a specific medical condition, certain foods may have to
be eliminated, modified in the preparation, or limited in their
intake.  It is important that caregivers obtain specific
instructions from a registered dietitian or their doctor on
which foods are allowed, how much, and how they should be
prepared.
 
Since some foods or medications may interact with other
medications and/or foods in a harmful way, check with the
pharmacist as to restrictions in any medications' use before it
is applied.
 
Table 5    Nutrients on Food Labels and their Function Protein:
For preservation and repair of tissue;  formation of antibodies
to fight infection.
 --  Carbohydrates:   For energy;  fiber to
help prevent constipation.
 --  Fat:   For energy;  healthy body
and skin.
--  Vitamin A:   For healthy eyes, skin, hair;
resistance to infection.
--  Vitamin C:   For healthy gums,
skin;  healing of wounds, bones;  resisting infection.
-- Thiamin (B1):   For digestion;  healthy nervous system.
 --Riboflavin (2):   For healthy eyes, skin, mouth;  use of oxygen
from air.
--  Niacin:   For healthy digestive tract and nervous
system.
 --  Calcium:   For preservation and repair of bones,
teeth;  muscle contractions;  blood clotting.
--  Iron:   For
building red blood cells to carry oxygen to all parts of the
body.
 
To simplify daily meal planning, foods are grouped according to
the nutrients they supply.  Plan your diet to include the
recommended number of servings from each group.
 
27.  Table 6:   The Four Basic Food Groups
 
Meat Group:  Provides protein, niacin, iron, and Thiamin-B1.
2 servings daily.  Dry beans and peas, soy extenders, and nuts
combined with animal or grain protein can be substituted for a
serving of meat.  2 ounces of cooked, lean meat, fish or poultry
have the same amount of poultry as:  2 eggs; 1 cup cooked dry
beans, peas, or lentils;  4 tablespoons peanut butter;  1/2 cup
cottage cheese.
 
Grain Group:  Provides carbohydrates, Thiamin-B1, iron, and niacin.
4 servings daily.  Whole grain, fortified, or enriched grain
products are recommended.  1 adult serving is:  1 slice bread;
1 cup ready-to-eat cereal;  1/2 cup cooked cereal, pasta,
cornmeal, rice or grits;  1 small muffin or biscuit,  5
saltines, 2 graham crackers.
 
Milk Group:  Provides calcium, riboflavin-B2, and protein.
2 servings daily:  Foods made from milk contribute part of the
nutrients supplied by a serving of milk.  1 cup milk has the
same amount of calcium as 1 cup yogurt, 1 and 1/2 slices
(ounces) cheddar-type cheese, 1 and 3/4 cups ice cream, 2 cups
cottage cheese.
 
Fruit-Vegetable Group:  Provides vitamins A and C.
4 servings daily:  Dark green leafy or orange vegetable and
fruit are recommended 3 or 4  times weekly for vitamin A.
Citrus fruit is recommended daily for vitamin C.  1 adult
serving is:  1 cup raw fruit or vegetable, 1/2 cup cooked fruit
or vegetable, 1 medium fruit, such as an apple or banana, 1/2
cup juice.
 
28.  Common Problems Interfering with Good Nutrition.   Illness,
disability and depression can affect an older person's desire
and ability to eat properly.  The following suggestions deal
with common problems that interfere with good nutrition.
 
When the care-receiver say the food tastes strange, it might help to:
 
--  Check teeth for tooth decay or gum infection,
--  Avoid alcohol,
--  Marinate meat, poultry and fish in sweet fruit juices,
Italian dressing, or sweet or sour sauces,
--  Drink plenty of fluids or suck on candies to get rid of bad
tastes,
--  Serve foods at room temperature or cold (Trymilk-shakes or cheese),
--  Use stronger seasonings such as basil, oregano, rosemary,
tarragon, lemon juice or mint when cooking,
--  Try new foods.
 
Cramps, Heartburn, Bloating:
--  Eat slowly,
--  Eat small meals frequently,
--  Avoid gas-forming foods, e.g., cabbage, onions, nuts, beer, cola
drinks,
--  Avoid lounging immediately after eating;  stand or sit
upright for one hour after eating,
--  Try bland, low-fat, easily digested foods,
--  Chilled antiacid may help, HOWEVER, check with your doctor
regarding the brand of antiacid to use.
 
Constipation
--  Take high-fiber foods and plenty of liquids,
--  Exercise,
--  Add bran when cooking or baking (1 - 2 tablespoons of bran
for each cup of flour),
--  Drink hot beverages which act as stimulants.
 
Diarrhea
--  Eat small meals frequently,
--  Drink clear liquids,
--  Avoid high fiber and greasy foods,
--  Replace fluid loss with liquids between meals.
 
Nausea, Vomiting
--  Avoid unpleasant odors,
--  Eat small meals frequently,
--  Chew slowly and thoroughly,
--  Sip cool, clear liquids between meals,
--  Rest after meals with head elevated,
--  Avoid hot, spicy, strong-smelling foods or fried, greasy foods,
--  Try foods which are cold or at room temperature, and low-fat food,
--  Eat dry or salty food,
--  Try fresh air and loose clothing.
 
Dry or Sore Mouth
--  Drink plenty of liquids,
--  Suck on ice chips,
--  Suck on popsicles made of milk or non-acid juices,
--  Dunk or soak foods in liquids,
--  Use extra gravies, sauces, salad dressing,
--  Rinse mouth frequently,
--  Suck hard candies or chew gum,
--  Eat sweet or tart foods if no sores in mouth,
--  Artificial saliva can be used.
 
29.  General Tips for Helping the Older Person to Eat Well
--  Plan meals and snacks to include the person's favorite foods.
--  Use a variety of foods from each of the four food groups,
--  Prepare foods that provide a variety of texture, color, and
temperature,
--  Provide a pleasant setting, i.e., flowers, place mats,
matching dishes, good lighting.
 
In addition to books, recipes and literature, the organizations
listed below are valuable in providing tips, ideas, counseling,
and reminders that you are not alone.  They can help make the
gradual transition to improved eating habits:  (Addresses listed
were local San Diego.  For same or counterparts in your locality
check your telephone directories or contact United Way:
American Heart Association;   American Diabetes Association;
American Cancer Society;   Arthritis Foundation;   Dietetic
Association;   United Ostomy Associates.
 
**************************
 
I. Medical Aspects of Caregiving
 
30.  As a caregiver, you are in a position to help your
care-receiver along the road to good health care by encouraging
routine physical examinations.  You are valuable in helping the
care-receiver talk to their doctors and other medical personnel.
You can follow through with their medical treatment at home.
 
However, it is important to remember that the primary
responsibility for medical treatment rests between the doctor
and the patient.  If there is any doubt about what you should or
should not do, the doctor should be consulted.  You can help
your care-receiver to understand his/her medical treatment and
encourage the care-receiver to be involved in making decisions.
In medical treatment, it is often tempting to decide what is
best for the patient, but it is best to recognize the
care-receiver's need to choose.  We all need control of our
lives, and this is especially true for a person who needs the
help of others.  If there are serious concerns about decisions
 
John Cottingham         NEW ADDRESS:          [log in to unmask]