Issue #2  

   

    Welcome to Caring with Confidence.

Information and Resources for Today's Caregiver.
     

Information and resources for today's family caregiver.

"The most important things to say are often those which I did not think necessary for me to say - because they seemed too obvious." ~ Andre Guide

  
    "A Guide to Problem-Solving"

If it at first you don't succeed, try and try again. Or else find someone else who can do it better

Powerful Tools for Caregivers (PTC) classes include a formal "Solution-Seeking Approach," for use when your weekly action plans don't work. In reality, most participants are good at modifying their action plans when obstacles appear. That is due in large measure to an emphasis put on:

  1. Setting realistic goals (If I plan to walk on Tuesday and Thursday, it's easy to change days, if necessary.)
  2. Finding pleasurable activities (If I find that I have more fun taking a water aerobics class than walking, I will guiltlessly switch. And if I didn't exercise, but found refreshing relaxation in a good book, that's usually satisfying, too.)
Nevertheless, the following guidelines are useful in almost any situation when you are faced with a challenge or decision, a nearly daily occurrence for most caregivers.

Step 1: Clearly identify the problem. This is not always easy. I may think the problem is there are not enough hours in the day. My daughter may be more accurate in suggesting the problem is that I insist on doing everything myself, rather than accepting the help offered by others.

Step 2: List possible solutions. Brainstorm: put down everything you can think of without judgment no matter how outlandish it may seem. Sometimes the wildest ideas lead to the best solutions. Sometimes you may have to gather more information to solve the problem; this is a good time to enlist the help of others who may be willing to do the research. I am more likely to take a water aerobics class if someone helps me find one at a convenient time and location. Similarly, I am more likely to consider an adult day center as a solution to my time crunch, if someone helps me explore available options.

Step 3: Try something. If the solution is a water aerobics class, I probably just need to plunge in. If the solution to enabling me to go the water aerobics class means finding an adult day center for my care receiver, I may have to weigh the benefits and limitations of available choices before making a decision. In either situation, however, giving the choice a fair trial is crucial. If I decide on the first day of aerobics class that the instructor is too militant for my tastes, or if my care receiver doesn't immediately adjust to the day center, quitting closes the door to all the benefits likely to accrue from sticking with it. Have you ever wanted to punch the person who shot down a suggestion you made by saying, "Oh, we tried that once, and it was a disaster"? That person was afraid of change. Show your courage by agreeing to keep an open mind for a two-month window.

Step 4: Assess the results. Did your plan work? Why or why not? Does it need fine-tuning or do you need to try something completely different? Do you remember "Do overs" when you were a kid? You didn't hit the ball, and you begged the other players to let you "do it over again." Amazingly, as adults we still have a multitude of "Do overs" available to us. Very few decisions are made for all time. Nearly everything can be rethought, reevaluated, or just put off until circumstances change.

We all know how pearls are made. When a grain of grit slips into an oyster's shell, the oyster encases it, secreting more and more of a thick mucus that hardens in microscopic layer after layer over the foreign irritation until it becomes a perfectly smooth, round, hard, shiny thing of beauty. The oyster thereby transforms both the grit and itself into something new, transforming the intrusion of error or otherness into its system, completing the gestalt according to its own oyster nature.

If the oyster had hands, there would be no pearl. Because the oyster is forced to live with the irritation for an extended period of time, the pearl comes to be. Something good can come from this irritating situation. In fact, it is essential. In school, in the workplace, in learning an art or sport, we are taught to fear, hide, or avoid mistakes. But setbacks and mistakes are of incalculable value to us, especially caregivers.

 
         
      "Choosing Adult Day Services"
by Daniel Kuhn, MSW, Mather LifeWays Institute on Aging

Most caregivers eventually turn to some form of help beyond that provided by other family members and friends. Adult day centers offer therapeutic activities and individualized services in a group setting for older adults with a variety of physical and intellectual disabilities. Those attending adult day centers can enjoy a structured recreation program with activities designed to provide some meaning and purpose to each day under the direction of a professional staff. The full schedule of activities throughout the day includes nutritious meals and snacks. Some centers also provide transportation, medication management and assistance with personal care needs such as bathing.

Persons with chronic medical conditions such as dementia typically enjoy the opportunity to be with other people in a place where their needs and abilities are understood. Adult day services also enable their caregivers to receive much needed relief from their caregiving responsibilities. As a general rule, adult day services may be useful to consider when one or more conditions are present:

  • The person with a chronic illness seems unable to provide any structure for her daily activities,
  • She is isolated from others for more than an hour or two each day and misses companionship,
  • She cannot be safely left alone at home,
  • The caregiver works outside the home or needs a regular break.
It is best to find the right fit between an adult day center and the person's needs if there is the luxury of choosing from more than one place in close proximity to home. Centers offer similar services but some specialize catering exclusively to those with dementia.

There are many ways to approach the decision to involve someone in an adult day center. First of all, the caregiver needs to be comfortable with the idea. Directors of day centers generally welcome exploratory visits. Sometimes a staff member will make a home visit to get to know the person being considered. When discussing this option with your relative, it is best to use a positive, calm and reassuring manner. Simple and brief explanations are most effective such as, "It's a place where you can meet some friendly people," or "The doctor wants you to try this out so I think it's worth checking out." Most people will follow the lead of their caregivers if the right tone is set.

Some people will have a good reaction to their first visit to an adult day center. Others may initially be put off by the new and unfamiliar situation. Staff members have much experience handling this dilemma and know how to ease the adjustment. Caregivers can expect some resistance but should realize that an adjustment period is normal. The payoff comes when your relative begins to enjoy the interaction with other participants and staff and feels safe and accepted away from home.

Most centers are open five days a week and some are open Saturdays too. It is customary to try out adult day services twice or three times weekly at first and then increase the frequency as one's comfort level grows. The cost of adult day services varies depending on types of services offered and locale. The range is from $50-85 per day. Medicare does not cover the cost so most people have to pay out of their own pockets. Financial assistance may be available for those with low incomes and assets through public sources such as the State Department on Aging or the U.S. Department of Veteran Affairs. A sliding fee scale may also be available for those not eligible for subsidies. Discounts are usually allowed for those who attend daily instead of a periodic basis.

Family caregivers often find out about local adult day centers through a social worker, nurse or physician. However, information about local centers can be obtained directly from your local Area Agency on Aging (AAA). Call 1-800-677-1116 for the AAA in your area. In addition, the National Adult Day Services Association (1-800-558-5301) maintains an extensive listing. For guidance on selecting an adult day center, check out the "Consumer" section of the Association's website at: www.nadsa.org

Adult day services are not for everyone since the choice depends upon the individualized needs of the person with a chronic condition and the caregiver. However, adult day centers have the potential to benefit both people. This option should not be overlooked as many caregivers can attest it has been the best choice they have made in behalf of their relatives and themselves.