Chapter 4

CARING FOR BOTH OF US

Sometimes you may be so deeply concerned about the well-being of the person for whom you are caring that you forget your own needs. Don't "burn the candle at both ends" and become exhausted, emotionally stressed or ill. This could compromise your own quality of life and your ability to care for your family member.

You owe it to yourself and to your family to maintain your own physical and emotional health by:

• Getting sufficient sleep;
• Eating a healthy diet;
• Staying physically fit;
• Having periodic health check-ups;
• Not abusing alcohol and drugs;
• Spending social time with family and friends;
• Pursuing your own interests;
• Seeking support from family, friends, professionals, religious advisors or joining peer support groups; and
• Using appropriate in-home and community-based services.

Keep in mind that it is normal to feel angry, frustrated, or depressed from time to time. Caregiving can be a difficult, as well as a rewarding undertaking. If you are feeling stressed, angry, or depressed:

• Remove yourself from the situation by walking away, even if it's just around the house;
• Talk to someone to whom you feel close;
• Call a hotline;
• Talk with your doctor or other health professional; and/or
• Write down your feelings in a journal.

How Can I Improve Our Quality of Life?

Older Americans and their caregivers sometimes fall victim to myths that become self-fulfilling prophecies. One is that being old means being sick. The other is that old age and dementia go hand-in-hand. The truth, however, is far more positive.

Truth # 1. Old age and sickness are not synonymous. The majority of older people are healthy, and, if they are not, many chronic conditions and illnesses can be controlled or treated. Visit with your care receiver's physician on how to treat his or her illness.

Truth # 2. While the incidence of dementia increases as people age, the majority of older people score well on tests of cognitive functioning. Those who do not, often have underlying medical problems which account for decreases in cognitive functioning.

Maximizing The Care Receiver's Independence and Health

Keeping or restoring health in the later years often requires more effort and determination than when you were younger. It includes:

• A healthy diet. If your relative or friend has medical problems, you can ask the physician if changes in diet should be made and whether you should consult a registered dietician for additional information.
• Supplements of certain vitamins and minerals should only be given if ordered by a physician. Always remember that more is not always better, that nothing takes the place of a healthy diet, and that some vitamins and herbs can be dangerous if taken in excess or in the presence of certain medical conditions.
• Taking prescriptions as ordered by a physician. Drug interactions can cause symptoms that may mimic Alzheimer's Disease.
• Exercise. If your older relative or friend is reasonably healthy, he or she can begin a regular program of exercise including stretching, weight training, and low impact aerobics, after discussing it with his or her physician. Exercise can help one avoid accidents, improve strength and mobility, lower blood pressure, and it can help prevent or control some diseases. If your care receiver is frail or ill, you can ask the physician about what exercises may be appropriate. Over time, these exercises can help increase strength and mobility.
• Stay involved with family and friends.
• Take part in community activities, such as going to senior center activities.

Choosing Health Care Providers

When choosing physicians, check their qualifications. What is their academic background and experience? Are they board certified in their practice area? You may want to accompany your older relative or friend to the appointment and take notes. This helps to insure that you both understand what medical course of action is recommended, and it gives you the opportunity to observe the interaction between the doctor and your relative.

The health care provider's attitude toward older persons is important. Is he or she interested in caring for older persons, and is he or she willing to take the extra time to conduct a thorough examination? Can you and your relative ask questions?

One note of caution-If your relative is not in managed care, try to choose health care providers that are either preferred or participating providers if your insurance requires it to make standard payments. Otherwise, you may be responsible for a large percentage of the bill. This is also true for hospitals and all of their subcontractors, such as anesthesiologists.

If your care receiver is limited in his or her physical abilities, ask the physician about the possibility of having physical, speech, or occupational therapy.

When Your Care Receiver Lives With You

It is important for you, your relative or friend, and other family members to evaluate the positive and negative aspects of living together. This is especially true if you are an employed caregiver or if you have other family responsibilities.

Every family's situation is unique. Listed below are some of the benefits and drawbacks that may result. It is important for your relative or friend to take part in the decision, and to be a valued and contributing member of the family with meaningful roles, whenever possible.

Points to consider:

• If your care receiver needs considerable care you will save the expense of a long- term care facility or, at least, some in- home services.
• You know that your care receiver is getting the best possible care because you are either providing it yourself or directly overseeing the care.
• You will be able to make major decisions which can give you a sense of empowerment.
• You will have more time to spend with your family member.
• Your children will have an opportunity to spend more time with their grandparent(s) or other older relative, have an important lesson in compassion and responsibility, learn about their roots, and develop a sense of family continuity.
• If your care receiver is fairly healthy, he or she may help with household tasks, and/or with the children.
• You may have less time for yourself and/or other family members and if you work you may find conflicts between your job and caregiving responsibilities. Some employment versus care giving responsibilities may be relieved, especially in light of the technology revolution that is taking place where telecommuting may now be an option.
• Depending on your lifelong relationship, you may find that you and/or your relative resent changes in your relationship that may take place.
• You will lose at least some of your privacy.
• Other family members may resent the new arrangement.
• There may be less space for everyone in the family.
• You may find that hands-on caregiving is too physically and/or emotionally demanding.

If you decide that you do want to live together, you might want to try it on a trial basis. You might consider renting or subletting your care receiver's home on a short-term basis so that he or she has the option of returning home if the new arrangement does not work out to everyone's satisfaction.

You will want to consider what, if any, physical changes need to be made to your residence and how much they will cost.

Will Intergenerational Living Work?

As a guide, you may want to ask the following questions:

1. Is your home large enough so that everyone can have privacy when they want it?
2. Is there a separate bedroom and bath for your family member, or can you create an accessory apartment?
3. Are these rooms on the first floor? If not, can your relative climb stairs safely?
4. Can you add to or remodel your home to provide a first-floor bedroom and bath? Do you need to add safety features such as ramps and better lighting?
5. Does the bathroom have a shower, is it large enough to accommodate a wheelchair if needed, and can safety features, such as grab bars, be installed to prevent falls?
6. Are door openings wide enough for a wheelchair?