Are you aware enough to recognize when you are experiencing caregiver overload? You may be fighting the fires of crisis after crisis in caregiving and yet not recognize when your own burnout is occuring. Some signs of burnout include: trouble sleeping, often feeling teary, an unusual amount of marital discourse, not feeling sociable with family and friends, depression, guilt, anxiety, anger, physical problems of your own surfacing, fatigue, and having to change your employment hours due to caregiving needs.

Being present, and connected is about the way you show up each day for yourself and for others. It isn’t always easy being present as a caregiver because there are so many things to worry about, especially when you are raising your children and taking care of aging parents. However, caregiver burnout is a very real issue and when you are going through the motions, not being aware, It can easily happen to anyone.

Strategies to Reduce Overload include:

• If you are unsure what you need and where to begin, you can hire a Case Manager to come in a do an assessment of your caregiving situation. However, you want an assessment that is as just as much as about you as it is the person you are caring for. From there a plan of care can be developed with action items to get your caregiving on track. A plan of care executed well is with a team approach in mind.

• Set Limits – Recognize what you can and cannot do in your caregiving role. Making compromises and adjust your expectations. And be willing to ask for help.

• Work with the care receiver. Your parent or spouse should be part of the process. Talk to them about their wishes without controlling them. For example: work with your loved one to develop a list of questions for the doctor prior to an appointment.

• Have Family Meetings to discuss problems large and small as well as future needs to be better prepared. Planning ahead will avert some crisis. Treat these like business meetings with an agenda contributed by family members ahead of time so that everyone feels their concerns are being addressed.

• Recognizing your own denial – This is a tough one, there are things we just don’t want to face as our parents or loved one ages. Someone from outside your family will often be better able to recognize problems and ways to fix or manage them. For example: someone with early stages of dementia is able to often hide the signs from other family members particularly if the person doesn’t live with a family member. We may want to think that our parent is handling things better than they are and therefore delay care they may really need due to our own coping strategies. Don’t get me wrong, it isn’t because you don’t care, its because this is an emotional process, its hard!

• Take time each day to unplug. Reconnect with yourself and your needs. It can be 10 minutes to meditate, have a cup of tea in front of a fireplace or on the porch enjoying the outdoors. Maybe it is reading a book for 30 minutes, a bath, or a walk alone with your spouse.

Today – Practice Being The Best You That You Can Possibly Be In This Moment – It is More Than Enough.

By Julie Fulmer-Mason

When a doctor takes the effort to simply prescribe a medication for a patient, there are a number of steps that need to be taken in order for the patient to take the “right dose” of that medication at the “right time”. These steps involve the patient going to the pharmacy to get the prescription filled, having the adequate finances or insurance coverage to afford the medication, understanding the directions of how to take the medication, and having an adequate reminder system in place in order to prevent any missed doses. The journey from the written prescription to the medication actually being consumed or used by the patient as directed is what the health care field calls “Medication Adherence”.

Unfortunately, poor medication adherence is a national problem that our health care system faces today. Of the 1.8 billion prescription medications dispensed annually in the United States, 51% are not taken correctly. This staggering statistic accounts for 125,000 medication-related deaths per year, 10% of all hospital admissions, and 23% of new admissions to care facilities (i.e. assisted living, independent care, nursing home, and skilled nursing). Taking into account the resources utilized during these medication-related ER visits and hospital/care facility stays, it costs Americans $290 billion per year for this very preventable, unavoidable problem! The health care industry has known for some time that improved medication adherence can lead to better health outcomes and reductions in health care spending. Unfortunately, the issue of medication non-adherence became the “big gorilla” in the room that nobody quite knew how to address. If insurers, government payers, health care facilities, and patients do not start to actively address this issue, the worry is that this “big gorilla” is going to turn into “King Kong” with the rising tides of the Silver Tsunami!

What can patients do? Quite simply, patients need to become advocates for their own health care and maintain complete control over their medication regimens. The two biggest problems patients face with their medications is forgetting to take them on time and not effectively communicating what medications they are taking to EVERY health care provider they visit. Some ideas to help patients improve their own medication adherence are:

• Get organized with a pillbox…If you take a multitude of prescriptions, the sheer sight of those similar looking amber or white-colored pharmacy bottles crowding your kitchen counter or medicine cabinet may be depressing. Also, the act of twisting and untwisting those child-proof prescription bottle caps multiple times per day may be a source of frustration. By organizing your medications in a portable pillbox, you can become liberated from your pill bottles every day, your medications can now move with you through your daily activities in life, and you know when you have missed a dose if your morning medications are still in the pillbox that night!

• Have a reminder system in place to prevent missed doses…The best way to remember to take your medications at the right time is to coordinate your medication doses with routine activities that you do at the same time every day, such as brushing your teeth, meal times, reading the newspaper, or brewing coffee. However, if you take medications multiple times per day or your lifestyle is far from routine, then a medication device that provides visual, audio, or electronic messaging reminder alerts may be a more beneficial option.

• Meet with your doctors and simplify your medication regimens…Every time you see a health care provider, YOU need to provide a written list of every prescription medication, over-the-counter medication, and vitamin that you are taking, including doses and directions. A good rule of thumb is to assume that your providers have no medication records for you and you need to provide the evidence! At every visit, engage your providers to review your medication list and see if they have any ideas in order to simplify your medications. Are there any of your medications that can be substituted with one of the new combination products? Are there any of your medications that come as a long-acting formulation, such that you can take it once-a-day instead of three-times-a-day? Is it still necessary to continue some of the medications that you are taking?

• Meet with your pharmacist and simplify your refills…Many missed doses occur when patients forget to refill their prescriptions on time. Your pharmacist is a great resource to work with in order to schedule the same refill dates for all your medications so that none of them are forgotten. If your pharmacy offers an automatic refill option, sign up so that you do not have to make that phone call every month. Also, if your insurance allows 90-day medication supplies, take advantage of only ordering your medications 4 times per year rather than 12 times per year!

• Keep it Simple…Patients tend to worry that some medications should not be combined with others, and as a result will tend to take their medications at 6 or 7 different times during the day. Unless a medication label specifically states that it needs to be taken 5 or more times per day, you should organize your medications in such a way that you only consume them at 4 daily dosing times (morning, noon, evening, and bedtime). Working with a pharmacist can give you a good idea of which medications can be taken together. Your medication adherence will improve dramatically by reducing the number of times you take your medications during the day!

About the Author:

Julie Fulmer-Mason is a pharmacist and the President of MedFolio, LLC. Julie received her Doctorate in Pharmacy from the University of California, San Francisco School of Pharmacy in 1998. Over the past decade, Julie has worked in the pharmaceutical industry and as a Clinical Ambulatory Care Pharmacist at the Veteran Affairs Health Care System in Palo Alto, California. Julie’s interactions with patients, caregivers, and health care providers motivated a passion of truly understanding the difficulties patients face with taking a multitude of medications. Instead of merely seeing patients to refill their pill boxes week after week, Julie empowered patients to become advocates for their own health care by finding methods in which they could fully understand, communicate, and live with their medication regimens. Based on these experiences, Julie started her own company, MedFolio LLC in 2008 not only as a means to advocate for the importance of medication adherence, but also to design products that truly help patients with independent 21st Century lifestyles to take control of their medications. Their first product, The MedFolio Electronic Pillbox, was released in 2011 and is targeted for the tech-savvy aging Baby Boomer generation…and their parents!

Caring for an elderly family member can be extremely demanding – especially if you are still working full-time. Even if you are not working outside of caregiving, Adult Day Care provides needed respite for you. Often Adult Day Care is a must, but you know it’s important that your loved one is well cared for during the day.

Adult care programs vary in their services depending on the facility and the needs of the aging parent. Some offer therapies (such as physical, occupational, speech). Others offer music programs, arts & crafts projects, discussions on current events, and times of reminiscing and visits from many community volunteers of all ages. Adult care programs all offer the ability to visit the facility before choosing one.

The cost of an adult care program varies depending on the location, the type of facility and the activities offered. Locally a full day of adult day care costs between $60 and  $80 per day. Most have a sliding scale, which is offered to lower income families, making it affordable for almost every budget.

However, it still places extra demands on the budget. Potential ways to offset cost of adult day care include Medicaid, some long term care insurance plans, Program of All-Inclusive Care for the Elderly (PACE), Veterans and Medicare Advantage Part C. To find out about funding available in your area, review the individual programs to see what type of coverage is available.

If you need help with finding facilities in your area or sorting through the requirements to qualify for getting your loved one into the facility, you can contact Lisa at The Shifting Path: By phone: 408-219-7231 or by email: lisa@theshiftingpath.com

Noticing the early warning signs is important. One of the biggest early warnings is getting lost.If not addressed early enough, it can become dangerous for not only your loved one to be on the road, but also for other drivers and families out there.

First it is important to look at the cause of your parent getting lost.  Sit down and talk with your parent about the situation that occurred.

• Did something along the way distract him/her while driving? Is this the first time it has occurred and was just due to something unusual that day?

• Find out if they have noticed other moments of forgetfulness that are of concern -  greater than not knowing where they put the car keys?

• How does your parent feel about driving? Does it feel stressful to them? Can they easily see traffic lights and street signs? Or do they find themselves driving closer and closer, slowing by the sign to see it?

• If your parent is on more than one consistent medications check with their doctor to see that those medications are not interfering with each other and causing other side effects. Certain medications or combinations of medications can affect senses and reflexes.

Ensuring regular doctor check-ups is important. Getting their eyes, hearing and reflexes checked is vital. Another area of concern could be sleep. Anyone, no matter their age, can appear to be intoxicated when poor sleep is involved. Have their doctor help them establish healthy nighttime sleep conditions to ensure proper rest when driving.

If all of the above has been done and your loved one still gets lost frequently or has other issues when driving, it’s time to make the difficult decision of putting on the brakes and having them turn in their keys. Just because they are no longer able to drive, it doesn’t mean they have to loose their independence. Talk to them about redefining their independence by reframing the situation into a positive form.

AAA has a Senior Drivers Program where you can get driving fitness tips, videos and more, including state License Policies and Practices. They also help with planning for continued mobility (post driving), which is extremely helpful.

Visit: http://www.seniordrivers.org/home/ for more information.

It’s also important because if a crisis occurs, you want to be prepared with the back-up support you need.

First, you must have a doctor’s Power of Attorney in order to talk to a provider. A power of attorney (POA) or letter of attorney is a written authorization to represent or act on another’s behalf in private affairs and business. A doctor will not talk to you unless you have this document in place.

Therapists can help with issues such as depression and anxiety that aging parents and spouses may possibly be struggling with on and off. There can also be a lot of confusion and frustration involved on their end because things are happening to them that they don’t understand.

Also, having a good therapist on-hand to help in dealing with speech difficulties after a stroke, makes life much easier for you and your loved one.

If you are being assisted by an in home caregiver or long term care caregiver, you will want to make sure you get a daily report of how your loved one did each day and the activities they did. This helps prevent double work, and it also gives you a good assessment of not only how your loved one is doing, but also how well the care provider is doing their job.

Be sure to get to know your pharmacist because this is the person who will be more aware of the different medications your loved one is taking – especially if your loved one is seeing several different doctors.

Keep all care provider information in an easy to access place so you can call with questions or be prepared in case of an emergency.

When you do call, get organized before hand. Prepare a list of questions, have all the information you need handy, such as POAs, lists of medications and any symptoms. Ask questions and make sure you understand the answers – have them repeat any information if needed and take plenty of notes.

Better care and effective communication with all the providers leads to a better quality of life for your loved one.

res·pite/ˈrespət/Noun

1. A short period of rest or relief from something difficult.

Respite means getting time away for you, the caregiver, to do things for yourself, which will rejuvenate you and help come back fresh and energized.

When it comes down to it, respite is about self-care. It’s vital to take time just for yourself to avoid burnout and exhaustion.

Going too long without respite care, you are more likely to develop physical and emotional health problems. Your loved one needs you, so the worst thing you can do is burn yourself out to the point where someone else needs to take care of you now.

Caregiving is a demanding and difficult job and respite helps to maintain a healthy life-balance.

Activities such as a book club, walking/hiking, playing bridge and an exercise class, are all examples of respite. Essentially respite is about the caregiver taking care of themselves and finding additional joy and fulfillment in outside activities.

Respite should not be confused with receiving help from others for caregiving responsibility – that’s not the same as respite care.

Types of respite care services:

In-home respite

Informal family support and relief

Online caregiver communities and video workshops

Volunteer or paid companionship

Personal care or skilled health assistance

Out-of-home respite

Adult day programs

Residential respite care

Caregiver support groups

How to Select Independent Providers

Although you are anxious for relief, taking time to find the right person is essential for your peace of mind and your loved one’s safety. Make sure you:

• Are clear about the tasks you need help with and have listed them in writing.

• Screen each candidate both over the phone as well as in person to make sure he or she is a good fit.

• Agree on a compensation schedule and pay for services after they are completed – never in advance.

• Request work and professional references and be sure to follow up with them. You can even conduct a background check. Ask your local police department, legal aid service or attorney for referrals to reputable investigators.

There are several non-profit and state agencies that will help pay for respite care. Also, some states use waivers through Medicaid to apply federal funds to offset respite costs.

To learn what is available in your area from your state, check Family Caregiver State Contacts. Research individual programs such as Medicaid, Veterans’ Benefits and your loved one’s long-term care policy for means of coverage.

It’s important to first identify the needs of the senior. Once you have done that, you can then narrow down your choices and pick a facility that meets their individual needs.

Below are some basic definitions of each type of facility courtesy of the Assisted Living Federation of America (ALFA) and the California Registry to help you understand the differences so you can choose the right facility:

• Assisted Living – is a residential setting that offers choices in personal care and health related services. It’s a long-term care option that combines housing, support services and health care, as needed. Assisted living is designed for individuals who require assistance with everyday activities such as meals, medication management or assistance, bathing, dressing and transportation. Some residents may have memory disorders including Alzheimer’s, or they may need help with mobility, incontinence or other challenges. Residents are assessed upon move in, or any time there is a change in condition.

• Independent Living – is a residential living setting for elderly or senior adults that may or may not provide hospitality or supportive services. Under this living arrangement, the senior adult leads an independent lifestyle that requires minimal or no extra assistance. Generally referred to as elderly housing in the government-subsidized environment, independent living also includes rental assisted or market rate apartments or cottages where residents usually have complete choice in whether to participate in a facility’s services or programs.

• Congregate Housing – is similar to independent living except that it usually provides convenience or supportive services like meals, housekeeping, and transportation in addition to rental housing.

• Residential Care Facility – is a small residential care home, licensed for 2 to 6 people and provides a safe, comfortable and dignified environment for those who need help intermittently throughout the day and night. RCF’s are not allowed to provide skilled nursing services (unless there is a credentialed RN or LVN individual working in the home), but they can provide assistance with all daily living activities, such as bathing, dressing, toileting, urinary or bowel incontinency care. For those elderly suffering from Alzheimer’s disease or other kinds of dementia RCF’s can be an ideal care setting because there are few people for the resident to have to deal with, and the number of staff is small, one or two people. There is a lot of close supervision and support for the Alzheimer’s patient, which can lower anxiety and stress. In a residential care setting an elderly person still has the ability to carry on as normal a life as they wish or are able. They can go shopping, have friends and family visit whenever they want, go for walks, dine out, etc.

• Continuing Care Retirement Community – A continuing care retirement community (CCRC) is a community, which offers several levels of assistance, including independent living, assisted living and nursing home care. It is different from other housing and care facilities for seniors because it usually provides a written agreement or long-term contract between the resident (frequently lasting the term of the resident’s lifetime) and the community which offers a continuum of housing, services and health care system, commonly all on one campus or site.

• Nursing Home – Provides 24-hour skilled care for the more acute patients. Patients generally rely on assistance for most or all daily living activities (such as bathing, dressing and toileting).

For more information on the types of facilities, visit the Assisted Living Federation of America (ALFA) and the California Registry.

If you need further assistance in choosing a living facility that is right for your loved one, contact Lisa at The Shifting Path to help you narrow down the choices to prevent wasted time and energy visiting facilities that don’t meet the criteria for your needs.

Being a part of the sandwich generation, it’s important that we not only lead by example, but also that we preserve our sanity by leaning on the support systems around us.

You are not weak to ask for help. Quite the opposite is true. You are keeping yourself strong; and keep in mind that capable organizations are created solely for the purpose of supporting you, the Caregiver.

In fact, people like being asked to help! It makes them feel good. Just think back to the last time you helped someone. How did you feel? Probably great, right? That’s exactly how others feel when you ask for help.

You don’t have to do it all yourself.

Here are 5 things you can do right away to start getting the help and support you need:

1. Make a list of family friends, and neighbors who can help you, include their phone numbers and email addresses.

2. Make a list of tasks that they can help you with, whether it be grocery shopping, picking up prescriptions, help with transportation to doctor’s appointments or even reading a book or doing a puzzle with your loved while you take a break for a few hours. Also note their availability.

3. Local organizations, such as Heart of the Valley, Alzheimer’s Association, American Diabetes Association, in home care service companies can serve as forms of help and respite.

4. Caregiver support groups can be found in local hospitals, community centers, disease specific organizations, hospice care organizations, and long term care facilities.  Many give support specific to your family needs. They provide a safe place to make connections with those who are experiencing the same challenges, as well as challenges that have not yet been experienced. In this environment caregivers are able to express their needs. Support groups provide help on topics that are most important to the caregiver with advice from experts in the field of aging on emotional care, working effectively with your aging loved one, reliable products and services, and preparation for future needs.

5. Adult Care Centers are another resource that can provide much-needed respite for caregivers, allowing you to spend time taking care of yourself while having the knowledge that your loved one is being cared for in a friendly, caring, and knowledgeable manner.

Providing for an aging parent can be stressful. If you don’t take care of yourself it will become draining and unmanageable to take care of the needs of your loved one. It’s important to be surrounded by others who can help.

Local Caregiver Support Groups

Cupertino – Cupertino Senior Center- meets the 2^nd Tuesday of the month from 3-4:30

Alzheimers Specific Support groups

No matter what your age, it’s never too early to start discussing options for the legal, financial, and practical decisions that come along with eldercare.  Preparing in advance is much easier, preferably while you or your loved one can still participate fully.

However, regardless of whether there’s a need now or you are planning ahead, it’s important to do your research and find a financial planner and an attorney who understands the laws and regulations, both federal and state, that affect elderly persons. It is best to choose a Certified Financial Planner-Personal Financial Specialist (CFP-PFS) which is the most significant credential, Certified Public Accountant (CPA)  or a Chartered Financial Consultant (ChFC)

Here are three key things to do when searching for the right professionals to suit your needs

1. Get referrals and check backgrounds with the CFP board or other relevant professional organization. Anyone can call themselves a financial planner without being licensed. Again, it is best to choose a CFP who must commit to continuing education on financial planning and ethics.
2. Interview candidates and ask if they’re fee-based versus portfolio percentage based, how long they have been in practice and what credentials they hold.
3. Make a decision based on what your needs are as well as choosing someone you are confident is professional and will be able to handle your information and questions in a timely manner not only today, but also years down the road.

Once you’ve found the right candidate for your needs, the three most important tasks and questions for your parents/ or you and your spouse will be:

1. Assess your overall financial picture.
   
   You have worked hard all your life to save for retirement, so it’s smart to think about how you plan to pay for all the potential expenses that might incur as well.
   

• Start with creating a worksheet of expenses to get an idea of how much income you’ll need in retirement. Things like mortgage or rent, utilities and phone, food, clothing, entertainment (including dining out) transportation, insurance premiums and other regular expenses.
• Write down other expenses, such as travel, out-of-pocket medical expenses, home repairs and other items.
• Figure what your income will be. What you’ll receive from social security, retirement, wages, investments and other sources.
• Keep in mind inflation and also that your expenses in retirement may be quite different from current expenses since your habits and routines are likely to change, your financial planner can help you to gauge inflation.
• Is there anything you need to be doing or know about now, such as tax laws, to be better prepared later?

2. Are you prepared to pay for care? What are your options?
   .
   With an uncertain future for Medicare, you should have a Plan B in case these expenses will need to come out of pocket.

• Find out what long-term care costs are where you live.

• Research the types of long-term care coverage available, what’s covered and what’s not so you know what all your options are. Medicare coverage may not pay for many of the long-term care services that people often need, so it’s a good idea to know what’s covered and what’s not now.

• Find out what public programs you are eligible for, what they cover, what private financing options are available, and which ones work best for you.

3. Is your will and trust (if applicable) up to date and reflective of your wishes?

• What are your preferences for medical treatment should you become seriously ill using advance directives? Particularly if you have a chronic illness, look at disease specific situations that occur and include those in the directive.

• Identify and document who will manage your affairs if you cannot. Discuss this with your attorney and your loved ones.

• Discuss and document your preferences. Be sure to organize and collect important documents in one location and create copies of everything and keep them in a separate location. Let your loved ones know where they can find them.

It’s a good idea to establish you and your spouse’s – or your parent’s – wishes now to ensure that they’ll be taken into account should you become unable to express yourself in the future.

While it’s easy, and sometimes natural, to feel as if your role as “the child” has now become that of parent and caregiver, it’s important to remember they are still your parent – an adult whose needs and desires are important to respect.

Here are some tips on how to keep healthy boundaries and respect on both sides.

1. Talk about it now. Be prepared. While your parents are still able to care for themselves, it’s important to discuss the possibility that they may need you to become their caregiver at some point in their lives. Find out what is most important to them, so you can honor their wishes later on.

2. Remember to have fun.Don’t talk only about the medical issues. Keep the relationship healthy and add a little laughter into yours and their life. Besides, laughter helps ease any tension or stress that goes along with caregiving. Caregiving can be a very rewarding experience; it’s all about keeping perspective.A study reported by the Journal of Mental Health Counseling in 2003, showed that “possessing hope and utilizing laughter and humor to cope with life’s stressors and losses” are especially important to elderly people as they experience a decline in their independence.However, laughter is just as important for your well-being. So laugh and have fun – a lot! Take a few moments out of the day for hot chocolate, a game of cards, and a puzzle, or just to sit outside and enjoy the fresh air and the view.

3. It is just as hard for them, as it is for you. Aging is hard for everyone but especially for the elderly who may be in denial and won’t make it easy for you. Keep in mind that it’s difficult for them to come to terms with the fact that they need help with things they’ve been so independent with their entire lives.

4. Put yourself in their shoes. You know how hard this is for you as their caregiver, imagine that you are your parent and slowly have to let go of control and independence of your life.A loss of independent living may negatively impact a person’s mental health, thus reducing his or her ability to cope. Be empathetic. You want them to still be able to make as many choices as they can. You may think you know what is best for them, and you might, but the more you can empathize, the easier it will be for you, and them, to cope. This isn’t to say it’s ever easy – just easier.

5. Don’t’ forget the little things. Sometimes the things that may seem silly or unimportant                 to you are very important to your parent. Respect their needs and perspective even if it is not                 your own. By stopping to see their view, you are showing them the respect they deserve.                         They will more likely be willing to work with you when they know that you want to help                       meet their needs and concerns.

6. Remember the little things for yourself too. In the process of giving so much to another it’s important to remember to take care of ourselves.Go on a date with your spouse or your best friend. Take your kids to a movie while your spouse cares for your parent. Get a massage. You will be unable to care for others if you don’t care for yourself first. So be sure to get plenty of rest, nutrition and take a little extra time just for yourself each week.

Caring for elderly parents while also trying to balance your own life can be an emotional and              stressful, and also a rewarding time. Remembering these six tips will help ease some of the                stresses.

And if all else fails remember to set limits and take a breather if you feel the tension building              to anger. Coming back with a fresh perspective will make all the difference in the world.