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Showing posts with label eldercare. Show all posts
Showing posts with label eldercare. Show all posts

Caregiving Journal - Misunderstandings


Today I had a miscommunication with Pa over coffee. Before starting to serve coffee I asked Pa if he’d already made himself a cup. He confirmed he had and I asked him if he’d added the new creamer in the fridge. He said he hadn’t and that he drank the coffee black.

So, I proceeded to serve my sis her coffee, then prepared my own. As I started drinking my cup, Pa asked, “Where’s mine?” I said, “Oh, did you want another cup? You usually don’t drink more than one.” Then Pa mentioned that he hadn’t had any coffee yet today. “You didn’t?” I asked, “but we just had a whole conversation about you making a cup of black coffee without the cream.” Pa corrected me, explaining that he hadn’t been talking about today, but another day. Needless to say, I served him a cup of coffee, but I wondered what exactly went wrong. Pa tried to blame the odd misunderstanding on the paper-shredder noise, but he wasn’t using it at the time.

So I think back to two weeks ago when the flu left me with laryngitis, and I had to whisper everything to communicate for 2 whole days. Pa told me not to talk to him until I got my voice back and sounded “normal”. While I was offended at the time, I now realize that it’s likely my whispers were unintelligible to him.

A week after that, my sister came into the room Pa was sitting in to ask her to turn down the volume to his computer. She was hearing the TV show Pa was watching in the next room, even though the door to her office door was closed, and Pa had headphones on. (Yes, he was wearing headphones and Sis could still hear the show in the next room with the door closed.)

In the last few weeks when I’ve tried to ask Pa something, he often does not respond. I usually end up calling him loudly to get his attention and then repeating whatever it was I said. If we haven’t made eye contact yet, he often isn’t listening.

I had interpreted Pa’s behavior as passive aggressive behavior or that he was mad about something. However recently, the last few times when I’ve walked up to Pa to tell him something, he’s jumped and clutched his chest out of fear from my having surprised him, even though I was talking as I walked up. I’ve now started raising my voice to gain Pa’s attention.

It’s becoming pretty clear that Pa’s hearing is a big problem. After 26 years working at the airport, the noise damage has taken a toll. It concerns me that recent studies have found that older adults with hearing loss have increased risk of cognitive decline, and Pa’s own mother died from dementia.  Pa has mentioned considering a hearing aid before. I think now’s a good time to start exploring his options.

Lessons Learned – 1) Don’t raise your voice. Get someone’s attention before speaking to them. 2) Get close to them when talking. 3) Make eye contact to be sure the person knows you are speaking to them.

Caregivers - Have you had a sensory perception misunderstanding? What did you discover? How did you augment it?
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Caregiving Journal - Lessons in Sensitivity


Today Pa had a doctor’s appointment. Pa phoned me at work shortly after I arrived to tell me to cancel his appointment. I told him it was too late to cancel. He said he’d go next week. I told him the appointment was this week, not next week and it was too late to change it. Pa said he knew my sister did not want to drive him so I told him I’d come pick him up if she wouldn’t. In the end my sister drove him, but told me how Pa didn’t want to go to the doctor because he didn’t want to spend money. Since the doctor’s appointments are not expensive, and take place seldom, I knew this was simply an excuse.

Later Pa was in good spirits after he saw his doctor, so I confront him. I ask why he didn’t want to go earlier and he mentions not wanting to burden us driving him. When I ask about the financial concern he mentioned to my sister, he admits that both issues bother him (spending money and burdening us to drive him).

A couple days before this, on a quick trip to the store shortly before they closed for the night, my sister decided not to take Pa along. Pa wanted to go, but they were just 15 minutes to closing and she didn’t think he’d have enough time to walk the place quickly. As Pa is just 1 ½ months post knee surgery, his walking is still labored.  Sis was being sensible, but not sensitive to Pa and they argued when she returned from the store. Pa took offense, stating that sis was embarrassed to be seen with him. While this was not true, it was how Pa interpreted being left out of the trip.

About two weeks before this, when I was sick with the flu, I had sis take Pa to his post-surgery follow up appointment. After the appointment, on the drive home, Pa phoned me from his cell phone asking to go out to eat breakfast. Since I was still sick, I asked that they go eat out without me. When they arrived at the house just a few minutes later, I knew they’d skipped breakfast. When I asked what happened, Sis said Pa wanted to come home, and for the rest of the day, Pa didn’t speak to either of us. Later that day, Pa blew up and complained that he wanted to eat out for breakfast. Pa was trying to be subtle by saying he wanted to go home, but he actually wanted to eat out with the family.

Lessons Learned – 1) We must be cautious of the things we say, even in passing, with our loved ones. Oftentimes with lessened abilities, sensitivity is increased and little things can be misinterpreted and considered offensive. 2) Sometimes convenience is hurtful. Try to include your loved one even when it may take longer or on the flipside, go out and do things your loved one wants even when it’s more convenient to stay home.

Have you and your loved one misunderstood each other? What things do you do differently to keep the peace? What did you learn?
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Case Study - Caregiver Burnout


“Amy” is a sandwich generation caregiver who has reached a critical pointing her caregiving – “caregiver burnout” and has become short-tempered and desperate and misses many days from work trying to care for her mom, “Margaret.” The following information details how we could help support Amy and her family so Amy doesn’t lose her job, and Margaret continues to receive good care.
            On the Family Caregivers Alliance website, there is a page on working caregivers[1] with helpful questions we can ask Amy.
  1. Firstly, we have Amy consider what she needs help with and the times she needs the help. We know Amy has a job, and may benefit from being able to return to work, secure in knowing her mother will be well cared for, or able to attend doctor’s appointments in her absence.
  2. Second, we have Amy consider what level of care is needed for her mom, Margaret. Amy may like someone to prepare her mom meals, keep the house clean, or simply drive Margaret to and from appointments so Amy doesn’t have to miss work.
  3. Next, Amy needs to consider what type of in-home care Margaret’s Medicare or health insurance covers. For costs exceeding the insurance, we must consider how much Margaret can afford to pay, or perhaps how much her siblings are willing to split with her.
  4. Lastly, we need to help Amy to locate elder care resources near her home.
In considering that Amy has used up most her sick leave, and may be in jeopardy of losing her job, we start focusing on bringing in help for Margaret so Amy can continue working. Amy decides against a full-time live-in caregiver; costs can range from $700 to $3,000 weekly[2].  Since cost is a concern, we have Amy consider hiring in-home day help for Margaret. We ask Amy to consider an agency like “Visiting Angels”[3] or “NW Senior Resources,[4]” where private caregivers can be hired to help out in the home. Amy will determine how long and for how many days of the week. We make a suggestion for Amy to start with hiring in help 2 to 3 days a week and that any and all appointments for Margaret will be scheduled to take place on those days so Amy does not miss work for them. The hired caregiver, will be given notes from Amy to take to the doctor, and a recording device to record the medical visits so Amy is able to catch up on what she misses.
            Next we help Amy look at Margaret’s Medicare benefits to determine coverage for in-home caregiving help. BenefitsCheckUp.org[5] is a good starting point for Amy. Here she can complete a questionnaire to find out what programs exist for assistance as well as benefits that may be covered for Margaret’s in-home care. We have Margaret complete the questionnaire entitled “For Older Adults and Families Raising Children”.[6] The questionnaire considers veteran status, abilities, housing, employment, programs of interest, finances (including monthly income for the household), assets, and the number of children in the household.
            Once Margaret’s Medicare benefit is confirmed. We help Amy consider how many days of care this will cover. Although we would ordinarily have a family consider the 50-50 rule, “the idea that adult siblings should divide caregiving responsibilities 50-50”[7], for Amy’s two siblings who live over 1,000 miles away, this is impractical. For the remaining caregiving costs, we suggest that Amy negotiate a payment plan with her siblings so they can instead equally share the financial burden. Another alternative would be to split caregiving costs and time based on what each sibling may have to give. “One sibling may have a good income but live at a distance. This sibling could contribute more financially, while another sibling who makes only enough money to get by on can help by providing hands-on parent care that may keep down some of the costs. A third sibling may do a little of each.”[8] If Amy and her siblings are unable to reach an agreement, we may need to connect them with a family mediator to negotiate a caregiving plan.[9] Together, in a family meeting the mediator may be able to help them make a written agenda, listen, get specific about needs, divide up tasks and not to expect total equality.[10]
            Once payment and Medicare coverage is ironed out, we have Amy interview and select an in-home caregiver. After this process is completed, we help Amy to locate a volunteer for respite care to give Amy a break at least once or twice a week so she can recover and feel renewed. If Amy is unable to secure a good in-home respite caregiver volunteer, we help her to locate Adult Day Care services for Margaret. Perhaps just on Saturdays, Amy will have Margaret attend a local Adult Day Care so she can have Saturdays off.  According to “Sarah Care” adult day care is the most affordable type of senior care.[11] With Margaret at day care, Amy would have a bit of respite to rest and have some personal time.
We also want Amy to connect with other caregivers, and since she’s free in the evenings, we search support groups so she can share with others like her. Unfortunately the support groups we find in Portland, all run during Amy’s work hours. In Multnomah County, there are caregiver support groups that run from 2:00 – 3:30pm, 3:00 – 4:30pm.[12]  In Washington County, the caregiving support groups also run during business hours (2:00 – 3:30pm, 4:00 – 5:30pm, 3:30 – 5pm, and 10:30am – 12:00pm.)[13] We therefore help Amy decide that she may instead find a more convenient support network in a place like “Caregiver Village” online. “Caregiver Village members connect with friends, participate in book clubs with celebrity authors, journal, play mystery games, solve puzzles, and learn valuable information about caregiving.”[14] With an online support group, Amy can get started sharing with others right away, until she is able to locate a local support group that operates after business hours or on weekends.

 Have you ever experienced caregiver burnout? How did you overcome your stress and did you have support?


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