Category Archives: General

Elderly Parent taking care of Spouse

Dear NurseTina,

My 90-year-old Father is caring for my 87-year-old Mother who has Alzheimer’s, is chair bound and needs major assistance with all daily activities –and I am concerned. Mom has fallen in the past –only I am not supposed to know this—a neighbor told me and Dad confirmed it.

At the last doctor’s visit my Dad lost 7 pounds and we were told he has high blood pressure (hypertension) which he has never had and is now on medications. Dad never complains, but I know him and can tell he is very tired (and he did mention that she is up most nights). Dad no longer can drive and so I see him almost daily and bring in meals; he “wants to take care of her”.  I also noticed lots of frozen food in the freezer –Dad thought this would be a good idea and save me taking him out shopping.  The doctor took me aside after the visit and told me they might be better in a nursing home. I promised them we would try and stay at home –At what point do I step in and where do I start?  

You are a good daughter and situations such as this are not unusual—with an action plan you may be able to take positive steps to help your parents to remain at home. A few things come to mind from these facts that you have shared. First, let’s talk about your mother and her care needs. You use the words “major assistance with all daily activities”. I would presume this means meals, meal preparation, setting up for feeding, showering/bathing, toileting, dressing, undressing, laundry, and many others.  From this short letter, I can understand that your father would be exhausted and you would want to step in and offer more support than daily meals.

I have seen frail, older men lose up to 20 pounds from their caregiver “responsibilities.” I use this word because that is how I have heard some men from that generation verbalize (read: define) this caregiver role. However, they do not have to be the only or sole person with these important caregiver duties and tasks.  As a daughter who luckily lives nearby, you could offer many supports to your parents and your father who is the primary caregiver.

First, consider that your parents may need to be assessed by a qualified geriatric care manager. These are specialized nurses or social workers who are credentialed to work with this special older adult population. They work all over the United States and can be located by zip code. This local support is important since they have access to community resources and linkages that can match your family’s needs with services in the community. For example, let’s look at one problem that might be identified after the GCM’s holistic and comprehensive assessment.  This could be that your father is not able to sleep soundly for a night as he is always ready to listen for, and be awakened by, your mother needing assistance to the bathroom and otherwise awake.  You might offer to sleep at their home a few nights a week so he gets some uninterrupted sleep.  Next, check the labels and ingredients/salt content on all the frozen food you mentioned. This change in his dietary habits and your dad’s new high blood pressure may possible be connected? You might want to check his blood pressure when you take him out shopping. On the topic of “out shopping” – even an outing to the grocery store is a very good thing for the primary caregiver. Caregivers need a physical and psychic “break” from their worries and responsibilities. The topic of the importance of pleasure in both the patients’ and the caregivers’ lives will be addressed in a future column.

As important as doing more for your dad so he gets a break is, it is also important to empower yourself with information. In this case you can visit the Alzheimer’s Organization website where they have an assessment based on the changes and behaviors you see in your mother. Visit www.alzheimers.org  for caregiver resources and more. This web site is a part of the National Institute on Aging and lists many resources for caregivers and families. There is also a toll-free call-in phone number (1-800-438-4380) and you can sign up for e-information.  The Alzheimer’s Association can be accessed online at www.alz.org. They offer a section entitled “Seven Stages of Alzheimer’s” to see where you believe your mother is (and note that not all experience the same symptoms or progression). But this is a useful guideline for families I have worked with and – as important –it lets you know that you are not alone in this journey. The National Association of Professional Geriatric Care Managers can be accessed at www.caremanager.org

As a nurse and from working in the home care industry for many years, and being a caregiver myself, I have seen that the care that family caregivers provide has become more demanding and complex. As hospitals discharge patients earlier than in past years, this trend may only continue. Because of this and other factors, the chances of all of us being caregivers (or coordinating someone else’s care) will likely increase. I hope these columns help provide you with needed information and resources for those of you who are already caregivers and also for those of you who may became caregivers in the future. Readers can e-mail questions or topics they wish addressed to tina@dearnursetina.com

Are You A Caregiver? If not now, at some point you may be!

Example 1: A 66-year-old man is diagnosed with prostate cancer. Online there are so many options and so many terms. How is his wife supposed to help when he comes back home after the surgery he has been told he needs? She is worried . . .

Example 2: A daughter goes to her 94-year-old mother’s home and finds a full carton of milk spoiling in a kitchen cabinet. Last week, her mother reported that she drove to the store and when she got there her mother could not remember why she went; nor did she know how she drove back home. The adult daughter is worried about her mother’s safety and wonders if she may have dementia and might be in need of supervision. She wonders – “where do I start”?

Example 3: A healthy 56-year-old man is scheduled for “routine” gall bladder surgery after a few visits to the emergency room with this recurrent pain. He confides in his wife that he is worried . . . he has read the reports in the news and watched TV shows about antibiotic resistance and infections in hospitals. They both wonder – is there a proactive role they can play in infection prevention?

This column is all about caregiving and what you need to know about taking care of yourself and perhaps about caring for someone you love. Whether an adult “child” caring for your aging parent, a wife caring for your husband before or after surgery, or a parent caring for your child with special needs, these and the examples above, can make us caregivers. And I am sure—if you think of family and friends who are also caring for someone—you know you are not alone! The “Commission on Long-Term Care” just released their report to Congress on September 30th. This 130 –page treatise states that “most people who receive[long-term services and supports]LTSS in the home rely on family caregiving”(Commission on Long-Term Care, 2013, p. 12). They define family caregivers as “a relative, partner, friend or neighbor who has a significant relationship with, and provides assistance for, a person who has functional limitations”(Commission on Long-Term Care, 2013, p. 12). Astoundingly, testimony to the Commission reported that “an estimated 62 million family caregivers provided care at some time during the year in 2009”(Commission on Long-Term Care, 2013, p. 12).

This column is for you and ALL about your needs, while helping those in your care. These columns will usually address a topic or care problem (e.g. not just a medical diagnoses or health problem) impacting the person and their caregiver.  I say this because our health care system seems to identify a diagnosis and then THAT is the focus—this column is about you, the caregiver –and your loved one and how this health problem impacts your family and others. I believe we need to be more holistic in our approach to illness and health and this tenet will be reflected in future columns. The emphasis will be on improving health and access to information and the glossary of health care –which can be daunting at times –even for health care professionals! Future columns will offer health education, free resources, innovations, and more. It is not (all) about the medical diagnoses that sadly sometimes becomes the sole focus. This column is about empowerment and support –perhaps providing you with useful information, books, tools,or websites that might also help you in your journey toward health.

You and I know and value your work as a caregiver, which has an intrinsic value, but it also has afinancial one. In fact, the value of family caregiving has been estimated in 2009 to be worth $450 billion dollars(Commission on Long-Term Care, 2013, p. 12). This family caregiving figure has been noted to exceed the large amounts spent on caregiving that was paid for(Commission on Long-Term Care, 2013, p. 12). For purposes of clarification, paid caregivers include nurses, aides, and others who assist in care.

As a nurse and from working in the home care industry for many years, I have seen that the care that family caregivers provide has become more demanding and complex. As hospitals discharge patients earlier than in past years, this trend may only continue.Because of this and other factors, the chances of all of us being caregivers at some point in our liveswill likely increase. I hope these columns help provide you with important and needed information for those of you who are already caregivers and also for those of you who may become caregivers in the future. Readers can e-mail questions or topics they wish addressed to tina@dearnursetina.com

Reference

Commission on Long-Term Care.(2013). “Commission on Long-Term Care Report to the Congress.” Retrieved from http://www.gpo.gov/fdsys/pkg/GPO-LTCCOMMISSION/pdf/GPO-LTCCOMMISSION.pdf