CAREGIVER'S HANDBOOK Assisting Both the Caregiver and the Elderly Care-receiver Produced by The Caregiver Education and Support Services Seniors Counseling and Training Case Management Services of San Diego County Mental Health Services 1250 Moreno Blvd.San Diego, CA 92110 (619) 692-8702 Robert Torres-Stanovik, LCSW, Editor First Printing - January 1990 Second Printing- July 1990 This Caregiver's Guide was developed and produced in booklet form by The Caregiver Education and Support Services, Seniors Counseling and Training Case Management Services of the San Diego County Mental Health Services; Robert Torres-Stanovik,LCSW, Editor. Because of on going changes and problems in collecting data, San Diego County cannot assume responsibility for the accuracy ofthe information printed herein, nor does this handbook provide listings of all resources. Copyright 1990***** The following is added at the request of the San Diego County Mental Health Services: The content of this document is public information and may be copied by governmental and non-profit entities for use in their caregiver training and related healthcare programs and for free distribution to the general public for those purposes. Reproduction of this Handbook for commercial sale and/or other for-profit purposes is prohibited. Copied to disk and uploaded on Feb 17, 1992 to SeniorNet(America Online) *Showcase and Exchange* by Mike Moldeven, a general member of SeniorNet. (NOTE by Mike): The titles of San Diego County governmental and community private sector entities, and their locations and telephone numbers were, in some cases, deleted as they would not be ordinarily available as resources to persons outside of San Diego County. However, most entities were identified as functions or in some other manner to facilitate identification of counterpart resources where the handbook is being used. Because of the different word processors, programs, fonts, etc., that will be likely used in downloading and portraying this document, and to aid in locating the Sections and Headings listed in this table of Contents, the page numbers are augmented by each Section being identified with an alpha and each subordinate major Heading being numbered sequentially same as in the Contents.. END NOTE Contents A. Acknowledgements B. Foreword C. Introduction 1. You, the caregiver, are very important 2. Check list D. Common problems in caregiving 3. List of Needs E. Types of help available 4. When community agency help is needed 5. Services available to impaired elderly F. Caring for the caregiver 6. Caregiver's self-rating scale 7. What can I do to help myself 8. Seek Information 9. Join a caregiver support group 10. Set realistic goals 11. Practice good communications skills 12. Communicate with your family and friends 13. Use community resources 14. Use respite care services 15. Maintain your health 16. Relaxation exercise 17. Laughter is the best medicine 18. Avoid destructive behaviors 19. Seek help 20. Build your self-defense 21. Caregiver's bill of rights G. Personal care 22. Bathing, shampooing and shaving, skin care 23. Toileting, constipation or irregularity 24. Assisting with eating, transferring, rest and sleep, tips for encouraging self-care H. Nutrition 25. Nutrients listed on food labels 26. Adapting meals for people with dietary restrictions 27. Four food groups 28. Common problems interfering with good nutrition 29. General tips for helping the older person to eat well I. Medical aspects of caregiving 30. Encouraging routine physical examination 31. Keeping records and managing medications 32. Choosing a doctor J. Emotional and intellectual well-being 33. Depression: signs and causes 34. Suicide prevention 35. Promoting emotional well-being 36. The importance of lifetime learning 37. Memory problems 38. Sensory problems 39. Confusion 40. Behavioral problems 41. Mental stimulation K. Legal/financial affairs 42. Compiling an inventory 43. A will and managing financial affairs 44. Durable power-of-attorney for health care decisions 45. Conservatorship of estate and/or person 46. Selecting and attorney L. Liability of caregiving 47. When is it time to stop caregiving M. Choosing a residential care facility N. Conclusion You, the caregiver, are incredibly important !O. Appendices Appendix A: Selected community resources Appendix B: Selected readings and references ***************** Caregiver's Handbook A. Acknowledgements by Robert Torres-Standovik, LCSWI I wish to especially thank the Beatitudes Center, D.O.A.R. for both their concept and much of the copy in the original *Caregiver's Guide, Help for Helpers of the Aging.* Without their initial guide, this might not have turned out as well asit has. Acknowledgement is also given to AARP's pamphlets on Caregiving, and to several books, which have been noted in Appendix B, especially *The Loss of Self,* by Cohen and Eisdorfer, for their invaluable ideas. Thank you to my family, Maida, Shawn and Sylvia for their loving patience for allowing me the time/energy to complete this handbook; thank you to my support staff of students Karen Zaustinsky and Laurie McFarland for their assistance with the initial stages of this handbook, and the typists Heidi Peters,Fatima Ruiz, and Ewald Brieske for their many revisions andre-revisions in order to arrive at this handbook; thank you to the San Diego County Senior Teams, the Southern Regional Resource Center, Frank Dwinnell, M.D., Stanley Rest, Ph.D., Donna Pasanen, the Telephone Friends, several caregivers and care-receivers for their assistance in editing, advising and encouraging me with this handbook. Special thanks to Mimi Campbell-Goodman for the bear graphics (Note from Mike: I deeply regret not being able to include the graphics. They are excellent.) A very special thanks to Ray Schwartz, my supervisor, editor, and above all encourager who was always close at hand with his red pen and some kind words. Caregiver Education Support Services (CESS) wishes you the very best of care. We care! CESS, a program under Seniors Counseling and Training Program, Case Management Services, would like your comments regarding our *Caregivers Handbook.* If we can offer further services or if you have any comments orimprovements regarding this manual, write us at: Seniors Counseling and Training Program, Case Management, DHS, 1250 Moreno Blvd, San Diego, CA 92110. B. Foreword Older citizens are more likely to be disabled or dependent due to medical problems. These problems change a person's relationships with family and friends. A husband, daughter, or friend may find that they are now also a *caregiver,* the person primarily responsible for seeing that a patient's physical, psychological, and social needs are met. Another person now depends on them for basic physical needs. Regardless of whether the disability is due to progression of a chronic illness such as heart or lung disease, stroke, dementia, arthritis, or the combined effects of multiple medical and social factors, the caregiver role is a profound change for both people. These adjustments are often stressful, as well- established patterns must be abandoned, and new adaptions developed. This provides opportunities for personal growth, but also, in variable, causes emotional turmoil and distress. Being a caregiver is rewarding, but also can exhaust a person physically and emotionally, leading to illness and inability to further provide care. This book is directed primarily at the caregiver. This is not a*how to* book focused on problems of the ill patient. Rather, it offers practical approaches to common caregiver problems. Staying healthy, avoiding depression, remaining active, making friends, enjoying pleasurable activities are an essential part of any human life, including those of caregivers. Serving as the primary caregiver for an ill loved one should not make life meaningless. Caregivers for frail and ill older people should read this book. Family members who are not primary caregivers should also read this book to become more aware of the problems facing caregivers. Caregivers, other family members, and care-receivers will find the resources, tables, and questions useful in improving the quality of life for all concerned. Mr. Torres-Stanovik and staff of the San Diego County Mental Health Services have performed an important service for the frail elderly and their caregivers. J. Edward Jackson, M.D.Director, Seniors Only Care Clinic and Alzheimer's Disease Diagnostic and Treatment Center University of California, San Diego **** C. Introduction 1. Few people are prepared for the responsibilities and tasks involved in caring for the aged. To help make the task easier, it is important to have a game plan in life which helps determine where we are headed and how we are going to get there. This guide will help to serve as a road map which gives optional paths for caregivers. It is also an emphatic reminder that those who care for other people can do a better job of caregiving if time and attention also are given to their own personal needs. It can not be stated strongly enough; the caregiver is a very important part of the caregiving equation. The success of this equation and the continuance of its success is actually dependent on how well the caregiver cares for him/herself. In other words, if the caregiver becomes ill, who will care for the care-receiver? Before you get to that place, please read this handbook. This handbook explores a number of different topics which can make the role of caregiver easier, and at the same time, help the person receiving the care. Throughout this handbook, *caregiving* refers to the person giving care, and*care-receiver* the elderly person receiving the care. Below are two checklists, one focusing on the care-receiver and the other on the caregiver. They are included as general guidelines to help insure an optimal level of health, safety and comfort for both your care-receiver and yourself, the caregiver. 2. Table 1 Check list for care-receiver __All legal and financial matters are in order and available __Physical and dental appointments are kept annually or more often if needed __The home environment is clean, safe and pleasant __Nutritional needs, exercise, sleep and social activities are maximized to the degree possible __Personal hygiene and grooming are done daily __Respite services have been utilizedmonthly/weekly __ Level of care is reviewed monthly to ensure care-receiver is able to remain in the home Check list for the caregiver __ I am getting out/exercising at least once a week __ I am getting at least seven to nine restful hours of sleep a night __ I talk with or visit up to three friends or relatives weekly __ I keep annual medical and dental appointments __ I am taking only the medications as prescribed to keep up my health __ My legal and financial papers, including wills, are in order and available __ I have checked a new resource regarding caregiving each week __ I have read and am aware of the Caregiver's Bill of Rights __ I am eating three balanced meals a day. ****************** D. Common Problems in Caregiving 3. List of Needs The first step in organizing a rational care plan is making a list of needs. As family members or friends care for an impaired elderly person, several questions present themselves: -- What are his/her needs? -- What kinds of care are needed to allow the elderly/impaired are-receiver remain in his/her own home, live with the children or other relatives or move to other surroundings (retirement apartments, residential care, intermediate care, skilled nursing facility or other)? -- How can living arrangements be changed to help the person stay in the home or become more independent? -- If outside services are needed, does the impaired person have the resources to pay for them? How can they be obtained? -- How can care be given to the person in need without denying attention to others (spouse or children) for whom the caregiver also has responsibility? -- Do you as the caregiver feel tired or frustrated from caring for an older person? n answering these questions you are developing an important *List of Needs* of the impaired elderly person, and bringing into perspective the caregiver's needs as well. The questions do not have easy answers and the solution may vary in every situation. The care of an impaired older person can create stress that affects the ability of the caregiver to continue giving necessary levels of care. The stress experienced may be physical, financial, environmental and/or emotional in nature. Physical Stress: Providing physical care to an impaired older person can cause physical stress. General homemaking and housekeeping activities such as cleaning, laundry, shopping, and meal preparation require energy and can be tiring, particularly when added to existing responsibilities in one's own home. Personal care required for the supervision of medications and the maintenance of hygiene can also be stressful, particularly in situations of acting-out behaviors, incontinence (loss of bladder or bowel control), colostomies, or assistance with bathing. Lifting and transferring individuals with limited mobility is not only tiring, but also can result in injury tothe caregiver or the impaired person. In some instances there is the additional responsibility of maintenance of equipment such as wheelchairs or hospital beds. Financial Stress: The care of an impaired elderly person has many financial dimensions. For those services that cannot be provided by family members (medical, pharmaceutical, therapeutic, etc.), decisions will have to be made as to where service will be secured and how they will be paid. When money is limited, many families assist with the cost of care, causing financial burdens on all family members. Environmental Stress: The proper home setting has to be chosen. If the care-receiver elects to remain in his/her ownhome, modifications such as railings and ramps may have to be installed. If the person cannot remain in his/her own home, alternative arrangements must be sought, such as moving in with a friend or relative or specialized housing (retirement hotels,senior apartments, residential care homes, intermediate carefacilities, or nursing homes). If the care-receiver is to remain in the home, some major adjustments in the living arrangements and patterns of daily living will be necessary. Social Stress: Providing personal care up to 24 hours a daycan cause social stress by isolating oneself from friends,family and a social life. The caregiver may find him/herself becoming too tired or unable to have *an evening out* even once a week, or once a month. What can result is a build-up of anger and resentment toward the very person receiving the care, as the care-receiver is the cause of the lost socialization. Emotional Stress: All of these factors often result intremendous emotional stress. Compounding these sources of stress are the difficulties in managing one's time, juggling multiple responsibilities, and feeling the pressure of the increased dependency. For family members providing care, the various forms of stress can result in different feelings. Anger, resentment and bitterness about the constant responsibilities, deprivation and isolation can result. This is also a time when many of the unresolved conflicts from parent-child relationships resurface and can intensify, causing anxiety and frustration. There might even be the unspoken desire, at times, to be relieved of the burden through institutionalization or even death of the care-receiver. This desire is frequently and swiftly followed by feelings of guilt. All of these can be felt, then denied because they seem unacceptable. The person giving care needs to be assured that, in fact, these feelings are common even though they may not be expressed. There are resources that can help caregivers. The remainder of this book will address those resources, such as joining a caregiver support group, using community resources and above all, caring for yourself the caregiver. E. Types of Help Available: Through Family or Friends First make a detailed inventory of any assets individual family members and friends can contribute, including the assets of the impaired elderly person needing the care. Assets include available time, skills, space, equipment, the strengths of the person in need care, and most important money. Sit down with all the family members (or at least as many as are agreeable)and work out a plan for giving help. This involves defining and agreeing upon what tasks will be performed, by whom, on whichdays, and so forth. For example, Aunt Martha can cook, Uncle Peter can mow the lawn and Mary can check on Mom twice a day. Caregiving Exchanges: Some situations may allow for exchanging support services such as the Caregiver Exchange through Area Agency on Aging. A friend who has similar caregiver responsibilities may care for both impaired individuals one day a week in exchange for your providing the care on another day. Another exchange situation might includemaking a spare room available to a college student for his/her help with care of the care-receiver, in return for free room andboard. 4. When Community Agency Help in Needed: When family or other volunteer help is not available or cannot meet your needs, caregivers or care-receivers may wish to seek help froma gencies. A wide range of help may be available. Some may be covered by private insurance, Medicare (and/or a supplemental program of your State). All of it can be purchased. Sometime the service costs may be based on the income of the care-receiver. Each agency has its own fee structure; you may want to ask about their arrangements before ordering theservice. 5. Types of Services Available to Impaired ElderlyNote: See Appendix A for a list of names and telephone numbers of the agencies mentioned below. (Mike: Appendix A is presented in this SeniorNet version minus the telephone numbers which are only applicable to San Diego County. Users of this Handbook might want to identify counterpart agencies in their county or.service region and list them in the Appendix by name and telephone numbers.) Adult Day Health Care: This is for people who are physically and/or mentally frail. It offers a range of therapeutic, rehabilitative, and support activities, including nursing, rehabilitation, assistance with life activities, social work services, meals, and possible transportation, provided in a protected setting for a portion of the day, one to five days a week, usually during weekdays. Chore Workers/Handy persons Services: Includes heavy-duty housecleaning, minor home repairs, yard work, installing safety. John Cottingham NEW ADDRESS: [log in to unmask]