Help For The Caregiver

It's a typical scenario: You start by caring for your parent, spouse, or sibling an hour here, an hour there. But once your loved one's Alzheimer's disease has progressed beyond the initial stages, that's no longer possible. Pretty soon, you are devoting full-time to watching over your patient. Presto - you've become an around-the-clock caregiver!

Most often, the progress of Alzheimer's disease requires significant changes to the family's schedule and commitments. A caregiver trying to do most of the work alone will soon find it an impossible task. Even with several caregivers taking turns, it's not uncommon for everyone to feel frustrated, depressed, and despairing. Generally, when these feelings get out of hand, it means that something ought to be done to make care a more manageable process for all concerned.

The emotional stress of watching your loved one go downhill cannot be overestimated. Do not be ashamed or embarrassed to seek relief. Even the physical demands can be exhausting. Lifting, bathing, dressing, toileting, and feeding your loved one must be performed carefully in order to prevent injuries to both your loved one and yourself. However, when you get pressed for time, trying to care for your loved one and your household, being careful could easily become the last thing on your mind.

Sooner or later, caregivers realize they need help. But where do you look?

To get started, it is suggested that you make contact with a social worker connected to your local hospital, county or state agency on aging, or local religious or charitable organizations. You can find these in your yellow pages under "social services" or "human services." Another route to pursue is your local department of health. These agencies can help you with financial advice, assistance with tax or Medicare forms, locating special-needs housing, and services that provide transportation and meals.

What are the sources of information about available services?

The Eldercare Locator is a nation-wide service to help families and friends find information about community services for older people. The Eldercare Locator gives you access to an extensive network of organizations serving older people at state and local community levels. The Eldercare Locator can connect you to information sources for a variety of services including:

  • home delivered meals
  • transportation
  • legal assistance
  • housing options
  • recreation and social activities
  • adult day care
  • senior center programs
  • home health services
  • elder abuse prevention
  • nursing home ombudsman

The Eldercare Locator is a resource to help you find these community services for seniors through a national toll-free number (l-800-677-1116).

Occasional Needs

If you already spend most of your time at home, you may wish to have someone step-in so you can run errands - or simply take a much needed rest. In many areas, volunteers organized by religious, local government, or community groups will step-in for a few hours. Adult day-care programs offering personal care, meals, recreational activities, and some therapies should be available for short and long periods. Not all of these are expensive - often churches, synagogues, YMCAs, and hospitals run such programs on a sliding scale, based on your ability to pay. You may even find one that's free!

Part- and Full-Time Help

If you need more than occasional help, you may want to look into hiring a health care aide to come to your home on a regular basis. These aides can bathe, dress, and feed the patient, administer medications, and even shop, cook, and do light housework.

Aides can be hired directly or through an agency. The advantages of hiring one yourself are that you have greater control over who you choose - you do the interviewing, screening, and you pay them directly (no add-on fee from an agency). The biggest disadvantage is that, if the person doesn't work out or fails to show up one day, you're stuck with no help. Home health agencies spare you the search and much of the hassle. They're also equipped to send you a replacement aide immediately.

In the later stages of the patient's Alzheimer's, you might consider a hospice program, which can take place in your home or in a nursing facility. Hospice programs are designed primarily to manage (ease) the patient's pain and to help patient and caregiver cope with impending death. Home hospice care can be given by a visiting nurse, social worker, home health aide, clergy, and volunteers. Durable medical equipment like hospital beds, medical supplies such as incontinent pads, and medications are also covered in such a plan. The National Hospice Helpline at l-800-658-8898 can give you information on hospice locations in your area.

Institutional care ranges from residence centers for ambulatory patients who need only limited assistance to nursing homes for bed-bound patients with continual needs. Your agency on aging should have a list of licensed facilities. It is recommended that you visit several facilities to see how staff interacts with patients. You may want to make a point of coming during visiting hours so you can talk to residents and their family members and see how they like the facility. (Another suggestion: If you like what you see during the day, come back one night to see if the night staffing is adequate to meet the needs of all patients.)

Help for You

The person most often overlooked in the caring process is the caregiver. It is critical not to neglect your own needs. You'll be a less effective caregiver in the long run if you cannot admit your own limitations and play to your strengths. Here are a few tips:

  • Learn as much as you can about your loved one's medical condition up front, so you know what to expect and can anticipate problems. You'll be better equipped to organize the home environment and set up a routine to minimize disruption and maximize the quality of family life for all members.
  • Don't try to play the martyr and take everything on yourself. Let other family members and friends know that you can't do it without their help. You're not doing the Alzheimer's patient or your family any favors by trying to isolate them from one another. Get a commitment from all family members to contribute to the care in whatever ways they can. This begins with a firm, spoken consensus that you are all in this together, and that you all agree on the best course of action. Decisions that are unanimous - or as nearly unanimous as is humanly possible - spread the responsibility among family members more equally.
  • Get appropriate legal and financial advice from the start. Make sure every detail is nailed down, so you can concentrate on the important business of caregiving.
  • Seek out other caregivers for information, comfort, and a "reality check." Look for a caregiver support group, which can provide you with much needed emotional support, as well as help in finding the right resources.
  • Make sure you get regular breaks to restore your energy and sense of self, so you can better carry out your duties as caregiver. Allow yourself the time to do whatever it is you like to do. You should also consider taking a vacation, even if it's only for a few days. Hire a home health aide to cover for the times you're gone.
  • Accept changes in the patient's behavior. Your control of the caregiving situation will be frequently challenged. Remember to simplify, reassure, and reinforce things for the patient.
  • Use your body wisely. To prevent back injuries, never bend at the waist to pick up or move the patient. Instead, flex at the knees and hips and push up using the upper leg muscles. Try to work at waist level as much as you can. When transferring the patient from bed to chair, point your feet in the direction of the move; this prevents the twisting of your spine, a potentially hazardous movement.
  • If you have to put your loved one in a nursing home, try not to feel unduly guilty. You've done everything in your power for your loved one, and it is no longer enough. Thousands of families with a loved one who has Alzheimer's have made this wrenching decision.

Resources for the Caregiver

Wendy Lustbader has produced a video (60 minutes) on caregiving entitled: A Prescription for Caregivers.

Filmed in front of a live audience of caregivers, this presentation is packed with humor and stories from real life. Topics include: heeding resentment as a warning sign of doing too much, the many varieties of guilt options for self-care, and figuring out how much care is "enough." Both caregivers and professionals who assist them will find ideas on how to make life better for the giver and receiver of care. The video normally sells for $30.00, but Ms. Lustbader is giving our readers a special price of $20.00.

She is also the author of two books: Taking Care of Aging Family Members ($16.00) and Counting on Kindness ($14.00).

To order these resources, add $3.00 for shipping/handling and mail to:

Wendy Lustbader
1917 25th Avenue East
Seattle, WA 98112
Telephone: 425-462-5722.