Chapter 5

LIVING DAY-TO-DAY

As caregivers, you become involved in day-to-day efforts to keep things going. You tend to forget that each day can be an opportunity to try new approaches and activities that will make a positive difference in our life and the life of those we care for.

Some things that can bring about positive changes for the better include:

• Standing back and taking a look at your situation-what is working well and what isn't-and finding ways to make changes for the better.
• Establishing routines that effectively meet your care receiver's needs.
• Physical, speech and occupational therapy and/or exercise.
• Assistive devices, which range from special eating utensils to specially equipped telephones, that increase independence and safety.
• Improved nutrition.
• Carefully monitoring medications and their interactions.
• Intellectual stimulation.
• Social interaction.
• Spiritual renewal.
• Employing home and/or health care personnel who demonstrate that they really do care and who will work to foster independence.
• Finding ways to economize on your work load.
• Filling each day with activities to which you can both look forward.

Sharing Time Together

Obviously, if you want your care receiver to live with you, you will want to share times together.

• Set aside times to talk.
• Involve your care receiver, if possible, in family outings and social events. Even errands, such as shopping, can be something of a social event. Be sure to give your relative a chance to participate in decision making.
• Invite other family and friends to your home, and let them know that you are available to come to their house as well. You want to ensure that other family members do not feel that they have been "displaced." Reassure them that they are as important to you as ever.

Hands-On Caregiving

If your older relative or friend needs considerable help, a well-planned routine can make the more demanding parts of your caregiving day go more smoothly, take less time and help to ensure that your care receiver does not develop problems which could be prevented.

• Make a list of all the things you need for morning and bedtime routines, buy several of these items, and have them close at hand. If you use items in several different places, have duplicate items stored in these rooms.
• If your older relative needs a lot of assistance, have someone help you with the morning and bedtime routines. Getting up and going to bed often are the most challenging times of the day.
• Practice good oral hygiene that includes tooth brushing, denture cleaning, and cleaning around the gums, preferably after every meal. Persons with disabilities or medical problems may need special care in addition to daily hygiene routines.
• If your older family member is disabled, has poor eyesight or cognitive impairments, you may need to remind them about personal hygiene and/or assist them. Poor hygiene can result in rashes or sores and other problems that could cause discomfort and serious infections.
• There are new commercial products that make incontinence much less of a problem than it once was because they help keep clothes and bed linens clean and dry.
• Older persons with limited movement should be turned in bed on a regular basis to prevent skin breakdown and sores. Pressure relieving mattresses help to prevent pressure sores. It is important to move older persons with disabilities at least once an hour.
• Make lists of:
  • Morning and bed time routines;
  • Medical personnel with their area of expertise, addresses and telephone numbers;
  • Home health agencies;
  • Other people who can help or fill in if you need additional help;
  • Where needed items are kept, such as thermometers and blood pressure monitors;
  • Medications, when they are to be taken, and where they are stored;
  • Exercise schedules and directions;
  • Emergency contacts in addition to 911.

These lists and other needed information can be put into a clearly marked notebook and kept where others can easily find them in your older relative's room. This book should be complete enough so that someone filling in for you will know exactly what is needed and what to do.

EXTRA TIPS:

Safety

Quick, easy, and readily available ways to communicate with others that can help in an emergency are a must for you and your older family member or friend. You can get:

• A cordless speaker phone with memory so that you can simply hit one button in an emergency to get help without compromising the safety of your care receiver.
• A cellular phone if you and your care receiver travel.
• A signal system which will summon help with the push of a button.
• A specially equipped telephone with speed dialing, a large digital display for easy reading, and ring and voice enhancer, if your care receiver has hearing problems.
• An intercom or baby monitor that will alert you if your care receiver is having problems when you are in another room.

If your family member is disabled, you will want to ensure that he or she:

• Has a clear path through each room, that there are no rugs or raised room dividers to trip over, and no slippery floors. You can carpet the bathroom with all weather carpeting to help prevent falls.
• Uses a cane or walker, or is secure in his or her wheel chair. If your older relative is weak, a tray that attaches to the wheel chair can prevent falls and it gives your care receiver a place for drinks,` magazines, etc.
• Cannot fall out of bed. Position your older relative in the middle of the bed so that she or he can turn over without fear of falling.

Meals

As people age, they sometimes experience problems with chewing and swallowing, but there are ways to minimize these problems. The need for certain nutrients in older person's diets may also change.

Avoid foods that are high in:

• Saturated fats.
• Salts, chemical preservatives and additives.
• Sugar and calories that do not enhance nutrition, but may add to excessive weight gain.
• Make sure they drink enough fluids.

Caring for Your Home

• If your older relative is confined to bed, consider having a vase of flowers (even if they are artificial) on the table or next to the bed, and open the curtains to let the sunshine in.
• Use light-weight, plastic easy-grip glasses, or cups with handles. If there is a lot of spillage, try a drink holder with a lid and plastic straw insert.
• If clothes are wrinkled, you can put them in the dryer with a wet towel or sponge on a warm setting. This often saves a lot of time ironing.

If your care receiver is incontinent, you can:

• Use washable or disposable pads on the bed above the sheet,
• Place rubberized sheets underneath the bed sheet, and
• Use a stain and water resistant mattress pad.
• Use water-resistant pads or heavy towels on the wheelchair or furniture that your care receiver uses. If you travel, keep pads in the car for use on the car seat and when visiting other places.
• Purchase washable or disposable incontinent briefs.

Exercise

In consultation with your care receiver's physician and physical therapist, you can plan a routine of exercises. Exercises, even for the older person who uses a wheelchair or is in bed, help to improve:

• circulation,
• lung and heart function,
• posture,
• mental alertness.

If appropriate, vary the exercises and challenge them to do better. Exercise with them. If they are confined to a bed or wheelchair, try to get them to exercise at least five minutes every hour, and again, regularly change their position to prevent pressure sores.

Clothing

Regardless of your age or physical condition, you want to look and feel your best. Today's clothing options make that a much easier goal to reach. When buying clothing, consider the following:

• Clothing that is washable and wrinkle- free saves on dry-cleaning bills and ironing time.
• Slacks and skirts that have elasticized waistbands or tie waistbands are easier to get on and off and are more comfortable.
• Clothing with snaps or zippers and some that button down the front are easier to put on.
• Shoes that will not slip off easily and have a non-skid tread.
• Interchangeable and color coordinated clothing. e.g. slacks and tops that can go with several others.

Entertainment, Entertaining and Travel

Create activities that you and your care receiver can look forward to. There are many activities that frail and disabled older people can enjoy. You can:

• Choose a TV program to watch each day rather than having the TV going nonstop.
• Get large print and talking books from the library and read together.
• Check for special events that are low-cost or free. Invite a friend or family member to join you, preferably one who can drive or help you if your care receiver has a disability.
• Go out to lunch or for the early-bird specials at restaurants.
• Visit an art-hobby store and see what is available in the way of arts or crafts projects that you and your care receiver can enjoy.
• Invite family or friends over for dinner or lunch. If you have limited funds to entertain or do not have time to prepare food, have them over for dessert or snacks. Ask each of them to bring something.
• Plan day trips to local places of interest. Again, invite a friend or family member to join you.
• If you can afford to do so, go on a vacation. You can share the adventure and expense with other family members or friends. Many places offer senior discounts. Make sure they can accommodate your needs, especially if your care receiver is disabled. Large hotel and motel chains now go out of their way to help if you make your needs known to them. In addition, there are companies and organizations that plan trips for persons with limitations in their mobility. Many travel books have special sections on accommodations, travel, and activities for those with limited mobility.
• If you have the room, invite friends or family members to come and stay with you for awhile in your home.
• Check colleges, religious organizations, and community centers for free courses and other activities.
• Visit museums, galleries, botanical and zoological parks or a petting zoo.
• If appropriate, get a pet. Your local shelter or humane society have pets available for adoption.
• Get a computer with Internet access so you can e-mail friends, join in chat rooms, learn about things that are of interest to you, and enjoy computer games.
• Ask your local Area Agency on Aging about friendly visitor, volunteer, and telephone reassurance programs.

Many fraternal, religious, and social organizations have activities specifically for older people. This can be a great way to extend your circle of friends and supportive network.