Finding Closure, Saying Goodbye

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Life, by its very nature, requires many different types of closure. Sometimes closure yields a wonderful feeling, like a runner completing a marathon. Graduations, weddings, moving out of one’s childhood home all involve some sort of closure, but these events also bring the excitement of new opportunities, unexplored horizons, and causes for celebration. When the time comes to say goodbye in the relationship of the family caregiver and the loved one for whom you care, creating opportunities for closure is important to the health and well-being of both parties. With careful consideration, this closure can create good memories and positive feeling of confidence and love. Done well, caregiving closure feels satisfyingly good for everyone involved.

Caregiving closure requires more than a little planning, and it’s important to have intentional conversations with your loved one regarding decisions related to how their care will change in the days and weeks ahead. Talk together about their fears, concerns, and preferences. Perhaps you also have some of these feelings! Those for whom you care will appreciate being a part of the decision-making process, and the plans should come together more smoothly because of the caring communication you share.

If dementia is part of this equation, you will need to exercise much caution in how you approach the issue of transitioning care. Change of any kind can negatively disrupt someone whose mental state is compromised by Alzheimer’s disease or other dementias. You will need to tread carefully and gauge how much you can reasonably share. Minimizing stress is essential to a successful transition, whether the change is to a new living environment or a new care provider. 

Finally, take time to say goodbye, whether you are physically moving out of the area or just needing a mental break for an extended period of time. Part of letting go, of bringing closure, is experienced in stages similar to those we feel in grief. God allows us to endure grief in stages so that we can only bear as much as we are able to at any one time. The same is true for closure. Walking this pathway as a Christian will enable you to let this experience enrich you and your loved one as you each move into a new season of life, stronger and more complete as believers, and better equipped for the challenges and opportunities that lie ahead.

Chris and I have enjoyed sharing our hearts with you over the last four years here at Heart of the Caregiver. We hope that the words of encouragement, equipping, and empowering we have offered have given you strength and hope for your season of caregiving. This will be our last blog post at Heart of the Caregiver, and after September 20 this domain will no longer be ours. Thank you for joining our conversation each week. We know that God will continue to work mightily in your life as you seek His will, listen to His voice, study His Word, and follow His calling as a family caregiver. Go about each day and strengthen everyone you touch by sharing your heart, His heart.


New Seasons of Caregiving

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While we are still technically in summer, already the days are growing shorter, and the leaves have begun to show a little color. I don’t know about you, but Chris and I always welcome the end of summer because it brings a time of endings and new beginnings. 

As a family caregiver, perhaps you can embrace this season of change with feelings of celebration and hope. Maybe you could even see this as an opportunity to go back to school in a sense: try to embrace each day’s challenges as an opportunity to learn new strategies, try out different ideas, stretch yourself to become more than you were in days past. Build an arsenal of new ideas for ways to manage behavioral challenges and environmental hurdles. Ask friends, your Bible study group, or local professionals in the home care industry to help you brainstorm innovative ways to approach your hardest situations. Find a support group and share advice with others walking this path with you. Pray for wisdom and strength, gather your thoughts, and step forward this week into a new season of caregiving with confidence and courage.

Promote yourself to a new class of caregiving and celebrate with each new day the opportunity to care for the one you love. Leave yesterday’s defeats behind you, but learn from it first, both in the hard times and in the good memories. Both can teach you valuable lessons and make you a better caregiver. Take notice of every life lesson each day and add each one to your quiver of resources. Keep a journal to help you remember and organize these bits of wisdom and knowledge. Everyone involved will benefit from your expanded resources, revived focus, and renewed energy.

And speaking of changing seasons, when Chris and I created Heart of the Caregiver four years ago, there were very few resources out on the web that offered support and encouragement for family caregivers caring for aging loved ones. We wanted to offer a resource based on our personal caregiving experience and our Christian values as well as lessons learned over nearly two decades of owning two franchised offices of Home Instead. Our goal was to encourage, equip, and empower family caregivers in undertaking their calling to care for their husbands, their wives, their aging parents, grandparents, and other family members. Since we first launched this resource in September of 2017, we have experienced many changes. Today there are lots of great resources to be found on the web, and in the coming weeks Heart of the Caregiver will be changing both our name and our focus. The name change is not our choice, but we trust and believe that God will take this challenge and use it for good. We hope you will come along on this journey with us and see how God continues to work in our lives and our ministry. Watch for details in the coming weeks, and as always, we hope you’ll join us here at Heart of the Caregiver and share your heart about your new seasons in caregiving.

When Facility Care is Needed

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Few people look forward to giving up their home and moving into a care facility, but for some that decision may become necessary in order to receive the best care possible.

A significant number of people today receive care in their homes and wish to remain there until their death, and in those rare families where financial resources are truly unlimited, all levels of care are technically possible to be provided “at home”. This isn’t a reality for most families, however, and sometimes events can occur that will necessitate facility care. Sometimes that is temporary, and sometimes it is a permanent solution. Either way, it’s good to be prepared for this possibility and learn about your options before that time comes, if it does.

A major cause of the need for facility care is an injury. A fall that results in broken bones or an automobile accident, for example, can cause someone to need to move from a regular hospital to a skilled nursing facility for rehab. While it is also quite possible to do rehab at home by using a combination of home health and home care, facility care in these cases is most common, and is especially beneficial if the person receiving care needs regular and ongoing prompting to do the necessary exercises for recovery.

Another issue that can push someone toward facility care is the onset of a chronic illness that gradually removes the ability to stand and walk. This was the case for my sister and brother in law who elected to move to a facility and leave their home. My brother in law has Parkinson’s, and the loss of mobility and frequent falls he was experiencing at home led them to search out alternatives. This involved them selling their home, and was a difficult decision, but one that was right for them. 

The onset of Alzheimer’s disease or another dementia may absolutely necessitate facility care. Frequently as these diseases progress the stress and strain on the rest of the family is so great that it causes significant decline in those trying to care for their loved one at home. We have witnessed several cases of the otherwise healthy, non-afflicted spouse dying of stress related causes prior to their life partner, leaving them with no one. A facility based approach would have been far better in these situations. 

Whatever your situation, its good to look at the available options and to talk things over thoroughly with your family, friends, your pastor, and your financial advisor. Knowing your options and making plans ahead of time is always a good idea. 

Betsy and I hope you will join us this week at Heart of the Caregiver and share your heart about needing facility care.

Memory Concerns and Walking by Faith

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Noticing a decline in cognitive ability, either in yourself or someone you love, is certainly a cause for concern. We know a lot about Alzheimer’s disease and a host of other dementias these days, but we still don’t know enough about any of them to have a cure, and this can be downright disheartening to the one receiving this kind of diagnosis for themselves, a spouse, or a relative. My Bible study this morning was a reminder that in whatever we are facing, we should never give in to fear, but push ahead in faith that God is in control, and He will direct our paths. Maybe this seems easier said than done, but if you have any experience with faith walking, you will know what I’m talking about here. So, let’s get into this week’s topic through a lens of faith instead of fear.

Over the past months have you noticed a decline in your mom’s memory? Does your dad seem forgetful or even foggy at times? Do you feel like you can never remember where you left your car keys, or do you walk into a room in your house only to realize you have no idea why you came in or what it was you meant to get? If these kinds of observations keep you awake at night, the good news is that it might be Alzheimer’s Disease or some other type of dementia…OR it might not. 

Sometimes organic or biological problems mimic the symptoms of dementia when, in fact, the “cure” might be found in a few good nights’ sleep or a prescription for an antibiotic!

Many types of stress can cause forgetfulness. This stress can be from external or internal causes. A recent move, the death of a loved one, a marriage or divorce, a hospitalization or extended illness can all cause short-term memory loss. Polypharmacy, or taking lots of different medications that interact with one another, can also cause dementia-like symptoms. This can easily occur when an older person is hospitalized and treated by a hospitalist physician for the acute condition that caused the hospitalization while also continuing with other medications prescribed by their regular doctor. Even something as simple as a bladder infection left undetected can rapidly scramble one’s thought processes and leave loved ones anticipating an unwanted diagnosis of Alzheimer’s disease in the days ahead.

But there’s only one way to find out what’s really going on…you have to step toward mobilizing faith and away from paralyzing fear.

Schedule an appointment to see your doctor as soon as you have concerns about memory issues or personality changes. He or she can perform both memory tests and blood work to assess the concerning conditions and give a probable diagnosis. If necessary, you or your loved one can be referred to an appropriate specialist to get further information and come up with a good treatment plan going forward. 

If that diagnosis is, in fact, Alzheimer’s or another dementia, there are promising new treatment options that can slow memory loss and improve quality of life, as well as resources to help you and your mom or dad with next steps and setting expectations, but these may come with unpleasant side effects and their cost may also be prohibitive. Still, there’s no benefit to postponing this inquiry. Being afraid to get a diagnosis only gives the offending illness or disease longer to do damage. Left untreated, a bladder infection can spread to other vital organs and the blood stream, but in most cases the simple administration of an antibiotic for a few days will clear up both the infection and the brain fog caused by it. Left untreated, Alzheimer’s disease or other dementias will advance however they can, robbing their victims of memories, relationships, and even the ability to care for themselves. With the right drug therapies, the disease’s progression can be slowed, quality of life improved, and hope regained for a cure in the nearer future. 

Chris and I hope you’ll join us this week here at Heart of the Caregiver and share your heart about how caring for someone with memory loss impacts your faith walk today and in the days ahead.

The Importance of Taking Pills

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While we touched on this last week, we think it’s worth further consideration. Managing a medication schedule becomes more challenging for many people as they grow older. When we are younger, we might not take any daily pills, unless vitamins and supplements are in our day-to-day regimen. Usually these pills are taken early in our day and then we are free to go about our activities with no thought to pill schedules unless the doctor puts us on an antibiotic for a short period of time.

As we grow older, our doctor might put us on a little something for blood pressure, cholesterol, thyroid medication, or others. Gradually one pill every morning becomes several over the course of the day, some taken with food, some not, and before you know it you need those big pill organizers just to keep everything manageable and trackable!

Add to this equation forgetfulness and things can start going downhill quickly! For you as the family caregiver this can look like pill organizers that have random pills here and there throughout the system, or empty prescription bottles with no pills left to go into the organizer. Sometimes dementia creates paranoia, and your mom or dad might stop taking their pills because they think someone is trying to poison them. In this instance, they may pretend to take their pills and then spit them out a moment later.

There are several things you can try to help keep your loved ones on track with their maintenance medications. First, be sure they have an adequate pill sorter system that considers all the different times of the day they take their pills. There are lots of options for pill sorters and organizers, so do some digging and find the right one. There are even automated pill dispensers for the home that will give an alert when its time to take medications and then dispense the correct pills when a button is pushed. I won’t put a link here, but if you do a Google search on automated pill dispenser you will see lots of options. Some pharmacies will prepackage pills in long cellophane strips in the correct groupings so at the proper time you just go to the box and tear off the next blister pack. These can be very handy if your parent’s medications are highly consistent over time. Ask your pharmacist if this sounds like the right plan for you. 

If you are present when your parent takes his or her medications and you think they are avoiding the doses, try to create a calm and pleasant environment when it is pill time. Find something enjoyable to watch on television or have “teatime” with a flavored tea or coffee. Create a routine each day that incorporates something your parent enjoys with taking the pills. If your parent’s doctor approves it, you can always crush the pills and put them in pudding, yogurt or applesauce to get the medication administered when nothing else works.

Missing a pill here or there might not seem like a big deal but having a strategy to keep your parents on their medication schedule is critically important to helping them live their best life possible as they grow older in your care.

Betsy and I hope you will join us this week here at Heart of the Caregiver and share your heart about staying on top of medication compliance.

The Challenge of Chronic Conditions

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Many people today live with one or more chronic medical conditions. Medical advances have come far in allowing people with chronic and debilitating conditions like diabetes, heart disease, breathing problems and arthritis to live longer and more productive lives, but at some cost.

Managing conditions like these requires careful attention to details like medication compliance, regular checkups, following strict dietary guidelines and exercise protocols. If your loved one is also resistant to change or has memory loss issues you could have a recipe for a bad outcome. A lifestyle of managing chronic conditions requires an intensity of schedule that most older adults simply cannot handle without help. Typically, people dealing with this challenging lifestyle have a lower quality of life and a higher usage of the healthcare system.

When you are a family caregiver, it’s up to you to make this complex checklist run smoothly day after day, but how will you accomplish such a daunting task? There’s no easy answer, but here are some suggestions for creating a winning strategy.

First, if your loved one doesn’t use some type of pill box to keep up with what medications are taken when, you need to get organized. Consider (or learn) what the medication schedule is, and then get a pill organizer that works with a daily or weekly schedule. This is beneficial in two ways. First, each day’s pills are pre-sorted, making a medication schedule very manageable. Second, when filling the week’s pill boxes, you will quickly know if a prescription needs to be refilled and get that done before it runs out. This is particularly important during the uncertainty of the pandemic with its shortages and closures.

You will also need to manage regular checkups with primary care doctors as well as specialists who treat specific chronic conditions. This can become quite complicated when you are managing several different conditions. It is advisable to have those you care for give permission to their medical practices to release information to you so you can be well informed of what treatments are prescribed and lifestyle and diet changes are recommended so you can create a plan that incorporates these recommendations.

Finally, don’t let a slip-up defeat you. Be gentle with yourself and those you care for; nobody is perfect, and when anyone is hit with a new diagnosis that calls for big changes it’s going to take some time to figure out how to find your center and your balance again. Seeking wisdom and guidance through prayer, bible study, and Christian fellowship can really help you find the strength to give support and guidance to those you care for and love.

Chris and I hope you’ll join us this week here at Heart of the Caregiver and share your heart about how to keep everything running on track as you help manage chronic conditions.

Managing Care: Pets!

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One of the unexpected changes that COVID brought to our culture is a tremendous increase in house pets. During 2020, there were puppy shortages everywhere, and nobody saw that coming. Betsy and I both grew up in homes that had dogs, and in her later years Betsy’s mother wished dearly that she could have had a small dog, but her mobility would have made caring for a pet very difficult. 

It’s fairly common for family caregivers to care for a loved one that has a dog or cat. Pets can be rewarding or challenging, depending on the home situation and the animal in question. If your loved one has a beloved dog or cat that is well socialized and comfortable with you and others, you might not have any problems…unless you are allergic to pet dander! When your biggest problem is cat hair on your black pants or a friendly dog that pesters you constantly for affection, you can probably manage this situation easily. But if the pet is anxious or aggressive, you have a different story entirely. In cases like this you need to set boundaries for your own safety as well as the safety of your loved one and other visitors to the home.

Dogs (and sometimes cats) that have lived in isolated settings with older family members can become very protective of their owners when others come to visit or give care. Older animals are even harder to train to accept new people in the home. Advanced age affects animals much as it does people, and if your dad’s dog can’t see, hear, or smell like she once did she could feel afraid and overly protective of her “person” if your dad can’t do the things he once did to care for her. Fear, anxiety, and confusion can lead to loud, sharp barks and snapping teeth, and this can create an unmanageable environment for the family caregiver or other support services entering the home to provide wellness checkups, therapy, or hospice care.

If the pet cannot be put outside in a contained area, having a crate or a separate room for the pet to be in while strangers are in the home can protect both pets and visitors. It’s good if your pet is already familiar with the crate prior to needing this intervention strategy so that it will feel more familiar and less like a penalty box. If your pet is not already crate trained, start this process with lots of little treats to give as incentives for entering the crate, and try not to leave your pet confined for long periods of time. A walk or active play period before strangers come to the house is also a good idea, so your pet is tired and ready for a rest. In the worst case, you might need to consider letting an aggressive pet go to live with another family member if no other solution can be found, but this should truly be a last resort, and hopefully the pet can come for frequent visits.

Pets give older adults companionship, comfort and joy. They break up the monotony of social isolation to some extent, providing loving nuzzles, comic relief, and unconditional love. But when in-home care is needed, pets can also require strategic action for successful caregiving.

Betsy and I hope you will join us this week at Heart of the Caregiver and share your heart about navigating pets while giving care.

God is Good All the Time

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Caregiving comes as seasons in our lives. At times, your season of caregiving can feel long and lonely, but as Christians we can always be assured of the fact that God doesn’t change like the seasons; He never fails us, never leaves us stranded, never abandons us or allows us to be burdened with more than we can bear. The saying, “God is good all the time” is true, and as a family caregiver you can lean fully into that truth.

For the Christian caregiver, caregiving is a responsibility that finds its foundation and center in prayer. Prayer frames the responsibility of caregiving and supports every aspect of the caregiver’s life. Prayer gives us strength when we feel weak, it cushions us when we fall, it lifts us when we rise again, and it illuminates our path as we continue to push ahead in our season of caregiving. Daily prayer time is essential to maintaining balance and cultivating creativity as we answer our caregiver calling.

The structure of caregiving is found in the promises and assurances expressed in Scripture. The Bible is filled with words of wisdom, encouragement, strength, and hope. Some of its promises are spoken by the patriarchs and prophets of the Old Testament. Other assurances are found in the words of Jesus, the disciples, and other New Testament authors who wrote letters of encouragement, edification and direction to the early Church. One of the beautiful mysteries of God’s Word is that while men wrote these documents, God inspired their thoughts and phrases in such as way that they are not static words on a page; these truths still live today and when applied to our experiences and struggles they breathe new life into each one of us, supplying the strength, support, and hope we need for the days, weeks, or months ahead. 

Caregiving’s fulfillment lies in Christian fellowship, worship and praise opportunities shared with those you care for. Much joy can be found in singing hymns or praise choruses, studying scripture together, praying and discussing God’s love and activity in your individual lives as well as the time you share together. Putting scripture verses in visible places around the house can give you encouragement and support when you are struggling through a difficult day. 

Trust in the Lord with all your heart (Proverbs 3:5) or Be still and know that I am God (Psalm 46:10) are great verses that remind us God is with us and we can lean into Him when we don’t know what to do next. I Corinthians 1:4 reminds us that God “…comforts us in all our affliction so that we will be able to comfort those in any affliction with the comfort with which we ourselves are comforted by God.” Grab your Bible and look up your favorite verses about God’s presence, strength, endurance, comfort, or any other words that have meaning for you as a family caregiver. If you don’t have great handwriting, choose a pretty font on your computer and print out the verses. Ask a friend (or child or grandchild) to help with this task; it’s another way to involve your support network. These constantly visible scriptural reminders of God’s constancy and goodness can get you over many seemingly insurmountable caregiving hurdles.

Chris and I hope you’ll join us this week at Heart of the Caregiver and share your heart about God has demonstrated His goodness in your caregiving season.

Conversations About Life’s End

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Family caregivers are uniquely placed to have deep and meaningful conversations with those they care for. These talks can range from reflections on life, regrets or heartaches, joys and celebrations, faith, and end-of-life issues when the time is right for this discussion. These conversations are important to your aging loved one, so be sensitive to when the subjects can be approached gently and not feel forced or rushed. There are rich nuggets of wisdom and knowledge to be gained from thoughtful open-ended questions and encouraging comments to continue and deepen the discussion.

The conversation about the end of one’s life can be tender or awkward, depending on how the subject is approached and how the family caregiver reacts. My mother and I spoke many times about her final wishes, and usually she was the one to bring up the subject. She had a notebook where she kept items like a copy of her will, a list of people to call when the time came, her banking information and rough draft of her obituary. I would sit down with her at her dining room table and together we would talk through how she wanted things handled when her time came. She also had a living will, a Power of Attorney, and information designating my brother as her Executor. In her final days I got out the notebook and reviewed everything so I would know just what to do.

My brother had no clue what our mother wanted done because he would change the subject whenever she brought it up with him. He couldn’t handle thinking about a time when she was gone, so he just couldn’t let her explain everything to him. While I think it frustrated her, everything worked out because I was the one who knew everything that had to be done at the end. 

Not everyone is comfortable having conversations about end-of-life issues, much less freelancing these discussions. There are many facets to consider and decisions to be made. Using this checklistmay help to navigate the conversation. AARP offers resources as well. Planning My Way is a good website for additional tools and clearly explains that by planning early you can feel empowered and your loved one can feel the dignity and respect of knowing that their closing chapter will be written the way they would like to be remembered. Having a knowledgeable attorney is also wise, but many choices can be determined prior to the first meeting with your lawyer. 

Betsy and I hope you will join us this week here at Heart of the Caregiver and share your heart about how to approach end-of-life planning with your loved ones.

What’s Your Back-Up Plan?

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Every family caregiver needs to have a backup plan in place for those times when they can’t be there. What’s yours? Have you given it any thought? Very few people have simple, predictable lives; for most of us life is messy and complicated, without the added complexities of becoming a family caregiver. 

Family Caregivers shoulder a lot of additional responsibility when they accept their role in caring for an aging loved one or spouse. In addition to the responsibilities they already have, they must now also handle the needs and wants of another person, and sometimes handle the other’s obligations as well. We make God laugh when we try to tightly control our lives, because He is always in control, and He already has a plan laid out for us.

Sometimes you will have the luxury of planning to be away from your caregiving responsibilities, for events like attending your child’s graduation or taking that vacation we discussed last week. Other necessary absences are unexpected, like an illness or necessary surgery. Whatever the circumstance, having a backup plan that you can activate long-range or quickly is essential to being a responsible and prepared family caregiver.

The great news is that none of us are alone in this! The better you get at building a support team around you, the more confident you will feel when you need to activate your back-up plan. No matter how skilled, how flexible, how healthy and well balanced you might be, there will be times when you have to trust someone else to step in and give you a hand when you can’t be there. When this situation arises, you don’t want to be scrambling and trying to figure out what to do at the last minute. It is much better to have your resources already in place so the transition to the alternate plan can be as seamless as possible for you and those you care for.

Knowing where to turn to find the help you need is the first and most important step to help you win at caregiving. For this, you want to fully understand and be able to communicate your responsibilities to someone who can help you put a plan in place. You might have this conversation with other family members, your pastor, a parish nurse, someone in the medical community, or a professional provider in the senior care industry. You could also talk with a friend who has been down this road before and ask where they found their best resources. Keep in mind that having these strategic conversations doesn’t mean you are weak or incapable of fulfilling your caregiving commitments. It actually demonstrates that you are looking ahead and taking full advantage of every opportunity to make certain your loved one has the care they need, even if you can’t be there.

Next, you will want to explore the avenues that have been suggested to you and choose the best path forward for your specific circumstances. Plan now for time to dig deeper within your chosen direction. Ask questions, describe in detail what would be needed, and listen to your heart even as you listen to the answers being given. Don’t be afraid to be brutally honest or to challenge statements that seem less than committed to the task at hand. A family member who suggests they might be able to help you out probably won’t be available when a crisis arises. You must feel your way carefully through this part, but don’t let the process frighten you. Remember, God is STILL in control, even through your planning process. Let Him direct your path and bring forward the best solution to meet your needs.

Once you have your back-up plan in place, you will want to periodically revisit it, just so things don’t get out of phase. Touch base with the people or company who have committed to be your Plan B. Revisit and update the care needs of your loved one. Maybe even involve them periodically in a respite-care situation so you can take a break and they can build a relationship with your loved one. Then when you have to be away unexpectedly there is already familiarity with the situation.

When you work through this process all the way to the end, you’ve positioned yourself and your loved one in the best possible situation. You’re doing a great job as a family caregiver, and if you need help in a pinch, you’ve got that covered as well!

Chris and I hope you’ll join the conversation this week here at Heart of the Caregiver and share your heart about having a backup plan for caregiving.