Looking after a sick or severely disabled family member can put a lot of stress on the caregiver, who has generally had little or no training in home-care.

The person needing the care generally has a range of needs - physical, emotional, social and spiritual. Sometimes the complexity of the demands is so overwhelming that caregivers don't take time to establish any sort of system which in turn leads to an even more burdensome role. They keep on, on an ad hoc basis, becoming increasingly exhausted.

A knowledge of basic home-caring procedures can be reassuring and relieve a lot of the strain.

Organizing the Nursing Environment

• Ideally, the furniture in the patient's room should be arranged to have easy access to the bed. The furniture should include a bedside table, a comfortable chair for when he is sitting out of bed and the floor should be non-slip; preferably covered for coziness.
• The room should always be adequately heated or cooled and fresh.
• If there is not sufficient cupboard space, build a shelf to contain nursing paraphernalia - plastic bags for refuse; personal care equipment - brush, comb, toothbrush and cup, and fresh face-will cloths and towels, soap, extra glasses (that cupboard or shelf will save you many trips in and out).
• Keep all medications out of the reach of the patient who has memory impairment or confusion.

Bathing

• If the person is afraid of getting into the bath, a bath chair may help. If he prefers showering, a shower stool may be used. Always run the cold water before the hot water and mix well. A rail beside the bath or shower may help him to get back into a standing position.
• A roller-towel fastened to a secure bar can enable him to dry himself in privacy.
• If he cannot get out of bed, then he will have to be given a bed-bath. This is better managed by someone who has had training or by two people. If you do not have the help of a bath aide, ask the nurse to demonstrate how to give a bed-bath.
• Wash his hands and face several times a day to freshen the patient and wash the genital areas after toileting.
• Attend to nails immediately after bathing as they will be more pliable.
• If you notice any changes in the patient's skin, report them immediately to the nurse or doctor.
• Hair-care for a bed-bound person can be a problem. Molded plastic vinyl shampoo basins, with attached hoses which drain into a bucket, are available at drugstores and through mail-order catalogs. The equipment provides support for the neck while the hair is being washed. After thorough rinsing, to avoid scurf build-up, see that the hair is properly brushed and dried. Dry shampoo powders may also be used; but watch for scurf build-up, if it is not completely removed.

Prescriptions

• Do not run out.
• Know the pharmacy hours; including emergency arrangements.
• Always check with the pharmacist about drug mixes.
• Be very vigilant that correct doses are taken at prescribed times.
• If any unusual symptoms show up, call the doctor immediately as they may be due to a sudden allergic reaction to some drug or due to the drug reacting negatively with some food.

Diet

• It is important to maintain a good nutritional diet.
• Present food in as attractive a manner as time and energy permit.
• For some patients, several small meals may be better than three larger meals (check with the doctor before making any changes).

Exercise

• There are exercises suitable for even chairbound and bedbound people. Do not introduce an exercise regimen without first consulting the doctor or physical therapist.

Entertainment

You may not only be responsible for meeting physical needs but additionally for meeting emotional needs. Part of this can be met by introducing some form of entertainment. Among possible options may be:

• encouraging more visiting by friends and family, whether other adult children, siblings, remote cousins or old friends, music; especially where there has been a lifelong interest in music
• reading (large print books are available for those with vision problems)
• television (especially for many elderly women the "soap operas" become a surrogate family; and "game" shows maintain a competitive interest)
• talk shows which discuss "human interest" topics
• crosswords
• hobbies that are still manageable
• crafts
• talking to grandchildren or old cronies about "the past"
• card games or other games such as monopoly

Whether we are sick or well, we do need peer company; peers act only as someone to talk to but they can be confidants. Even as the caregiver needs to vent frustrations and perhaps discontent with the status quo, so do their bedbound or housebound care-recipients.

Sleeping

Proper rest is essential for us all. There are several needs that must be met to ensure that the person gets proper rest.

• The room should be comfortably either warm or cool, depending on the season.
• Enough pillows for comfort should be provided.
• Several layers of bed-clothes, instead of one very heavy layer, is usually more comfortable.
• The room should be comfortably darkened.
• A dim, but functional night-light may help if bathroom visits are necessary.
• Reading until sleep-time or soft radio talk or music shows can be soporific.
• Constipation, pain or leg cramps are among conditions which may affect sleep patterns. If there is a problem, consult the doctor.

Lifting

Improper lifting techniques may not only damage the caregiver's physical health, they will make the care-recipient feel insecure and may lead to injury.

• Ask the nurse or physical therapist to demonstrate proper lifting techniques. Learn the appropriate action to move the patient in the bed; from the bed to the chair; from the chair to a standing position; how to make the bed with her in it; how to get up and down stairs; in and out of a car - whichever lift is required.
• The handicapped person should be encouraged to participate in the lift to the extent that his residual abilities will allow.
• A mechanical hoist may help with some lifts.
• Lifting techniques should be practiced under supervision of a relevant professional.

Avoiding Pressure Sores

Pressure sores can cause untold misery to an already debilitated person. Therefore it is essential for every measure to be taken to prevent them from developing.

• Change his position in the bed at regular intervals (ask the nurse or doctor what they recommend).
• Keep the vulnerable areas clean and dry.
• Do not drag a patient in the bed as the skin may tear.
• Make sure the bed is crease-free and crumb-free.
• Be careful when either giving or removing a bedpan; always roll or lift the patient; never drag him.
• A water-cushion or water-bed may help someone who is practically immobile.

If pressure sores do develop, consult the doctor or nurse immediately. Follow any care-plan they recommend. Usually a nurse will monitor the bedsores and provide treatment.