The Real Cost of Care

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The most common question asked when a family is looking for care for an aging loved one is, “What will it cost?” While this question is not unexpected, it also isn’t easy to answer, and depends on a wide spectrum of considerations. The first, and perhaps most appropriate, question to be asked is: who will be best suited to provide the care?

Some family caregivers are able to be full-time care providers for their aging family members, either because they are naturally gifted in this role, or because they feel they have no other choice. If you are one who is naturally gifted, you probably see your responsibilities as meaningful and fulfilling. You embrace being a family caregiver with passion and creativity and even gain energy from the care and support you deliver to aging parents and family members. You were born for this work, and you live to serve others.

But if this isn’t you, there are many others who have the job of family caregiver thrust upon them for any number of reasons. You might be the one who lives closest to aging family members, or perhaps you don’t work full-time or don’t have young children to raise. You could also be in a spousal relationship, such as a daughter-in-law, and feel pressured into caring for the aging parent or grandparent simply because you are the youngest and newest family member. You could even be an older grandchild who is not yet living independently and as such you are expected to move in with grandparents to provide live-in care as a family responsibility. In any of these situations you could rightfully feel stressed, exhausted, guilty and frustrated in the role of family caregiver.

Others don’t physically provide all the care needed by their aging parents; rather, they coordinate that care through volunteers or paid professional caregivers. Several factors need to be in alignment for this caregiving role to be a possibility. You need to be a decision-maker with strategic skills to be able to create and manage a schedule and coordinate volunteers, or to choose an agency and work with it to create and manage your loved one’s care. There must also be financial resources if care will be hired, either privately or through an agency. If private help is hired, there is an added burden to becoming an employer with filing the appropriate state and federal hiring paperwork as well as collecting employee portions and paying all the employer costs involved with hiring employees, but that’s a story for another time.

Whichever situation best describes you, you are not alone. Whatever path you walk, there is always a cost for care. Often the price of care impacts your bank account or that of another, but that’s not the only way to calculate the true cost.

The natural caregiver’s cost can be felt in limitations to the pursuit of other interests, the inability to engage in social opportunities, and even a lack of focus on one’s personal and family health and welfare.

The forced family caregiver’s cost is more emotional in nature. Feelings of resentment, guilt, and anger may color your relationships with other family members and cause stress on your marriage as well. This cost has been disruptive in many family relationships. 

If you are the coordinator family caregiver with volunteer or privately hired employees your cost comes mostly in relationships. While you may still be able to pursue career, social, and spiritual relationships, being the boss is never easy, and if you aren’t gifted as a scheduler and sweet talker, you can get in big trouble quickly! Losing relationships means losing volunteers and/or losing employees if you aren’t an experienced manager with excellent people and communication skills. And, of course, if you are paying privately hired caregivers, there’s the organizational piece to all the paperwork and managing a payroll.

If you’ve hired privately or engaged an agency to provide the care, your cost is partly financial, and home care becomes more expensive with each passing year. Resources must be managed carefully to obtain the necessary care while keeping tabs on what is still in the bank account, and other family members may question how Mom’s money is being spent.

Being a family caregiver on any level always carries a cost, and the negative impacts may be felt in your physical, emotional, spiritual, or social well-being, as well as with your career options and family relationships. But if you feel called to this work, in whatever capacity, God will equip you and give you the necessary resources to do the work with a joyful heart. If you are the gifted caregiver give thanks for your calling. If you are the forced caregiver pray for patience, endurance, strength and resources to carry you through. If you are the coordinator caregiver give thanks for the ability to do what needs doing with the resources God has already provided, and thank Him for equipping you for the role you play in your loved one’s care. Home Instead has created an excellent family caregiver resource with lots of information to make your task easier and more manageable. 

Betsy and I hope you will join us this week here at Heart of the Caregiver and share your heart about what care really costs.

Home is Best…Sometimes

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When aging parents begin to need help, most want to continue living at home. Chris’s mom was able to grow older in her own home until her late eighties and my own mom did the same until she passed away peacefully at the age of 97. Both had help in their last few years, but mostly they maintained their independence and lived full, active lives. They were in relatively good health, involved in their churches and communities, and had family close by. 

While most older adults want to continue living at home, growing older there may not be the right choice for everyone. There are many options that need to be considered when making plans for the months or even years ahead. Considering all the possibilities takes some time, but it’s an investment that reaps great rewards if thoroughly done. Considerations include chronic health conditions, characteristics of the home environment, availability of local family and support systems, and financial resources. Choices might range from remaining at home with help or moving in with a family member to selling the family home and opting for a smaller, more manageable living space like a garden home or apartment. Big houses might require too much upkeep for creaky joints, and stairs can become a hazard as well. In addition, when one spouse passes away, the other might experience deep depression in the emptiness of a home shared for decades.

As increasing numbers of Baby Boomers retire, communities are springing up everywhere that cater to their desire for active healthy lifestyles and opportunities for social gatherings in adults-only neighborhoods that offer attractive single-story open floorplans with limited home and yard maintenance requirements. Continuing Care Retirement Communities have stepped up to offer levels of care that appeal to those who, because of health concerns, wisely anticipate future needs but are able to begin at an independent living level that offers frequent social gatherings along with housekeeping and nutritional support if needed.

Moving in with another family member may seem to be the best choice for some, but this is not necessarily as easy as it might appear to be on the surface. Having your mom or dad (or both) move in with you could bring invasion of privacy on both sides, as well as disrupting routines for everyone. This transition should be considered carefully, and ground rules established for all concerned to include meals, schedules, household responsibilities and expectations, and even parking priorities if a car is also being added to your driveway or garage.

Home Instead has some good resources on living options, but the bottom line is that you need to do your homework, and do it well, before you or others make a decision that results in insult or injury. The end goal is that your aging loved ones can live where they want to as they grow older, safely and happily, and able to be connected socially with friends, family, and their faith community.

Chris and I hope you’ll join us this week at Heart of the Caregiver and share your heart about helping your aging family members find the best living environment for their unique needs as they grow older.

Finding Balance in Everything

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The Balancing Act: Caregiving and Everything Else

It is rare that a family caregiver’s life is not filled with responsibilities related to many different parts of their world. Most of us don’t have the luxury of only playing this one role in life, and while most people in general wear many different hats, the job of the family caregiver is particular weighty.

In addition to caring for your mom or dad, you might also be managing your job or career, raising a family, nurturing a marriage, and maintaining friendships, not to mention cultivating your spiritual life! Really, it can be exhausting, and it seems there aren’t enough hours in the day! In order to successfully navigate these deep waters, you need to put some strategies in place that will bring equilibrium to each day, allowing you to grow and bloom where you are planted.

If you’ve been doing this for a while now, you probably recognize that prayer and prioritization are two crucial practices to keeping everything in balance. Daily prayer time helps you focus and allows your Creator to guide your thoughts on how to define your priorities each day. One of the lasting impacts I have gained from COVID-19 is that of reorienting my priorities to center around the people who are important in my life rather than the tasks and responsibilities. Those relationships have come into sharp focus as a major area of precedence in my daily schedule.

One great technique to implement is to begin each week by examining every area of your life and choosing one or two tasks or activities in each that you will complete by the end of the week. You will have some activities that occur daily, and others that happen only occasionally. Take this time to ask yourself hard questions about what is really important, and then be honest as you rank your priorities. At week’s end, revisit your list and celebrate your accomplishments! Take a walk, eat a cookie, call a friend and brag. Do something to give yourself a high-five for your victory! If, however, some things didn’t happen as planned, don’t beat yourself up; instead, pray for insight, seek counsel from others, and try changing your plan for the next week. Keep in mind that the goal here is not perfection, but improvement through continuous practice. Ask any yoga practitioner, healthy balance doesn’t happen overnight, but with years of effort, trial and error.

Betsy and I hope you will join us this week here at Heart of the Caregiver and share your heart about how you manage to keep everything in balance.

Who Can You Trust?

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Family caregivers often find themselves in the uncomfortable position of having to trust people that they don’t know well. There are several occasions where this might happen. If you are new to the role of being a family caregiver, you might need to accompany your dad to a doctor’s appointment or go with your mom to her hairdresser’s salon. These interactions require a certain degree of trust, but your dad or mom probably already has a trust relationship that you can also adopt. Not so when it comes to allowing complete strangers to come into your mom’s home in a health-related capacity. When home health, hospice, or even private duty home care aides are needed to give your aging family members the care they need it’s easy to understand why you might have questions or concerns.

Whether this situation arises with long-term hired help or in utilizing short-term respite options, someone needs to make every effort to determine the trustworthiness of the person or people to whom you are entrusting the care of your aging parents. This job usually falls to the family caregiver.

If you are working with a professional service that hires individuals to provide home health, hospice, or home care services, check to see if they are licensed by your state, and if they are insured against theft to protect your loved ones’ valuables. Ask if they run background checks, do drug testing, and check references. A good company will do all of these and have reviews online as well. These will tell part of the story but maybe not all of it. Hatchet jobs are common in today’s “cancel culture” so ask for personal testimonials from current or former clients if you still have reservations. A trustworthy company will be able to provide these in short order.

If you are thinking about hiring privately, interviews are a good starting place, but professional references and even background checks are also important elements in determining the safety and comfort of your mom or dad. These might be difficult for you to obtain as a private citizen, but they are significant considerations.

Recommendations from others in your community are beneficial, but you still need to do your due diligence when hiring an individual or organzation you can trust with providing care for those you love. And, as with all things, you will want to cover this entire process with prayer and ask God to lead you to the right people or resources that will lead to the best outcomes for both you and your aging family members.

Chris and I hope you’ll join us this week at Heart of the Caregiver and share your heart about finding others you can trust to provide care when you can’t be there.

Are You an Eagle or a Groundhog?

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You know those days when you just want to stick your head in the sand and pretend to be invisible? While ostriches actually don’t bury their heads in the sand in real life (it’s just a myth built from an optical illusion), we probably all know people in our lives who sort-of do!

We all have these days from time to time, and most family caregivers certainly have more than their share of challenging days. Perhaps you are caring for an aging parent with advancing dementia who doesn’t even know who you are most days. Maybe your career aspirations suddenly came to a screeching halt when your mom fell and broke a hip, requiring that you be there around the clock to care for her needs. Maybe your dad has cancer that has not responded to treatments and you realize that your mom can’t continue to care for him because it’s gotten to be too much. All of these are very real family caregiver situations that come up at the most inconvenient times, and there are many more.

When you feel like you just can’t handle one more thing, and you want to run away from everything, it’s time to take a few deep breaths and step back from the situation. Take a moment or two to pause, think, pray and breathe. Jesus did this often throughout his ministry, even when everything seemed to be about to come crashing down around Him! God’s son took time regularly to step back, go away for a little while, and focus on the source of His strength and wisdom. Repeatedly in the Gospels we see Jesus slipping away for a period of time to pray, commune with His Heavenly Father, and seek guidance and strength for what lay ahead. (See Mark 14:35, Mark 6:46, Luke 5:16.)

There’s no weakness in needing to take some time to gather yourself, take stock of the situation, collect your thoughts and find your center. This doesn’t make you a groundhog, running and hiding; rather, there is wisdom in taking the time to plan and set your course before you start your journey. Like the eagle, from this place you can look over the entire situation and determine your flight plan. Those few minutes can mean the difference between succumbing to a groundhog’s instinct to duck for cover and achieving the eagle’s majestic soar! 

What situations make you want to run for cover? Is it the hurtful words or resistance to care from an aging loved one? Is it criticism from other family members who are always quick to point out where you failed, but never seem to be able to find the time to pitch in and give you a break? Is it feelings of self-inadequacy to meet the care needs of your aging parents? Is it worries about balancing caregiving with nurturing your marriage, family or career?

Whether or not the groundhog sees its shadow this week, life goes on with both good times and bad. We celebrate the good times and, hopefully, we learn from the hard ones. Whatever your circumstance, you can find a way to soar like the eagle if you keep on going. Remember that God will never leave or forsake you, and He will always provide exactly what you need at just the right time. Through prayer, scripture study, conversations with trusted friends and advisors, or even a few minutes of solitude and quiet time, you can find the courage to continue through your caregiving journey. 

Betsy and I hope you will join us this week here at Heart of the Caregiver and share your heart about how you soar above difficult days.

Questions to Ask

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Are you wondering if your parents or other aging loved ones are beginning to need a little help to continue living independently? If so, you aren’t alone, and  you probably have some questions about how to get them the help they need.

Everyone’s first question is usually about the cost of care, but that question is premature. Before anyone can tell you how much care will cost, you should first understand what kind and how much help is needed, along with answering lots of other unknowns.

What kind of help your parents need will determine necessary skills and resources. If all your parents need is basic housekeeping like dusting, vacuuming and laundry, that could easily be covered by a part-time housekeeper, or even an older grandchild who lives close by. Chris lived with his grandmother when he was in high school so his commute was closer, and he did lots of little things to help her maintain her independence during those years. If, however, your mom or dad’s needs are more personal in nature, like help with bathing, toileting, and dressing, it might feel embarrassing or inappropriate for you or another family member to provide the necessary care. In times like these it might be best to hire a home care provider who can come one or more times weekly to take care of what needs doing for your aging loved ones. Often your home care company will do the housekeeping chores as well as the personal care requirements so you know your parents are well cared for. 

Next you need to assess how much help is needed. Some people need someone to be with them every day, while others only need someone to come once or twice a week. Overnight care is best for those who have balance or mobility issues and frequently need to get up in the night for bathroom needs, and also for anyone with advanced dementia. Of course, a loved one who would not be able to leave the house independently during an emergency should not ever be left alone.

Home Instead has developed a Care Calculator that can help you assess objectively what kind of care and how much care your mom or dad might need. When you complete the survey questions, your results will be sent to the Home Instead office and someone from the Client Care team will reach out to interpret how much care is needed. This is a free consultation and does not obligate you to Home Instead in any way.

Now you must consider your available resources since you have a pretty good idea of how much care is needed. Can any local family members or close friends and neighbors pitch in and help out? Are there community-based services like your Area Agency on Aging or the Alzheimer’s Associationyou can tap into? Does your parents’ church have a list of individuals that are available to help out on an occasional basis or in an ongoing arrangement? Does your dad or mom’s care require medical training? You should start by looking at what services can be obtained for little or no cost. Once you have taken the time to assess your resources and come up with a plan, check to see if any additional care is needed. If it is, it is likely time to ask the cost question at this juncture.

If the required care is more medical in nature, you might need to engage an agency or trained individuals like certified nurse aides (CNA’s) or even licensed practical nurses (LPN’s). Private funds or a Long-term Care Policy are commonly used to cover costs. Medicare doesn’t pay for services like home care and personal care for individuals still living independently within our communities, so that probably isn’t an option. For those needing someone to be with them 24/7 without family involvement this becomes extremely expensive for one-on-one medical care, but the alternative is moving into an Assisted Living Facility, which is still private pay in most cases, or into a Skilled Care Facility (like a Nursing Home). The pandemic has certainly heightened our awareness of the health risks associated with facility living during a viral outbreak, and almost all older adults would prefer to grow older in the comforts of the home where they currently live.

From here the cost of care becomes a simple math problem, at least in terms of what comes out of someone’s bank account…or does it? The outright cost would be calculated by how many hours of care are provided by someone earning a paycheck, divided by the hourly rate associated with the care being provided. Genworth has a good cost estimator here. But what about the cost to personal lives, relationships, careers, marriages, and families? There is always a cost associated with being a family caregiver, and with providing the necessary care to a loved one. What is the actual cost burden to you, the primary family caregiver? 

Chris and I hope you’ll join us this week at Heart of the Caregiver and share your heart about asking questions and finding answers to help your parents age in place.

Wondering if Mom or Dad need a little help?

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As we all grow older many things change in our lives. Some changes are sudden, like an unexpected fall that breaks a bone or simply shakes confidence in one’s balance. Others occur gradually, like loss of hearing or reduced flexibility. These changes may impact one’s ability to live independently while keeping up with the daily tasks that used to be simple and routine.

If you have aging parents, over time, you might have begun to notice little changes that make you or others wonder if your parents need help. These gradual changes are easily missed, especially if you live locally and see your aging parents regularly. When your brother from out of town asks when Dad stopped doing yardwork, or why your mom never seems to cook anymore, you might be caught off guard.

Betsy certainly experienced this when she would go to visit with her mother with months in between visits. In Sarah’s last few years Betsy expressed concerns to her brother about her mother’s increasing difficulty with getting out of her recliner and walking to the bathroom. He came by almost every evening after work to check on their mom, but he usually arrived during Jeopardy or Wheel of Fortune, when she was sitting in her recliner. He rarely saw her get up until Betsy expressed her concerns, and then he got Home Health involved. The therapy she received kept Sarah walking for several more years than she might have had.

If both spouses are still in the home, you should know that spouses tend to cover for one another when one begins to slow down physically or mentally. The healthier partner may protect the other by doing more of the cooking or housework, or they might even make excuses. “Your dad is just waiting for better weather to get to the yard work; those old bones get cold this time of year!” A friend shared that when her husband and father-in-law went out of town for the weekend she was left in charge of her mother-in-law. During those few days she was shocked to learn that her mother-in-law could no longer tell time, turn on the stove, or even bathe herself. When the men returned from their weekend the family had a quick meeting and got help for their aging parents. 

Many people in their 70’s and 80’s begin to need help long before care is needed, and a little help will go a long way to keep your parents living independently while staying safe and healthy. The important thing is to start the conversation before those needs get too far along. Next week we’ll talk about questions to ask as you explore options for finding the help that is needed.

Betsy and I hope you’ll join us this week here at Heart of the Caregiver and share your heart about wondering if your parents need help.

The Power of Words

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Caregiving can be a very lonely place to find yourself. If the one you care for has limited mobility, it’s hard to get out and run errands or even just escape your all-too-familiar environment. If communication is also impaired or challenging because of hearing deficits or dementia, you might feel isolated and overwhelmed. But words have power, and words give life. The Bible speaks of this dynamic power in the first book of the Old Testament. In Genesis we read that God spoke all creation into being. In Genesis 1:3 we read, “And God said, “Let there be light” and from there He spoke seven more times, each phrase bringing more detail to life in the world where He made us. The Word is personified in the Gospel of John. In John 1:1-5 we read, “In the beginning was the Word, and the Word was with God, and the Word was God. He was with God in the beginning. Through him all things were made; without him nothing was made that has been made. In him was life, and that life was the light of men. The light shines in the darkness, but the darkness has not understood it.”

Words, spoken or written, have the power to bless or to curse, to encourage or discourage. Because we are made in God’s image, we have the power to give life through our own words. Family caregivers desperately need to hear or read words of encouragement often to help them get through each and every day as they pour out themselves in care of others. Oftentimes those around you don’t even know where to begin when searching for the right words, to offer hope and encouragement that will lift you up and carry you through difficult times. Words seem empty when an observer perceives as impossible your burden of caring for an aging parent, spouse or loved one.  As the caregiver, you must help other family members and friends understand what you need to hear, and how they can build you up with their words. Make a list and share from it when someone offers to help. Don’t be reluctant to let others see your struggles; after all, even superheroes need refuge and support from time to time! 

Offers of help, invitations to get together for lunch or coffee, even asking how you are doing and then being quiet and listening to your honest answer are all ways to support and strengthen you when you are struggling to stay afloat. An offer to pick up groceries should be responded to with a list of what is needed. When someone tells you that you are doing a great job, don’t downplay your own efforts. Here’s a great list of things to say to a family caregiver from caregiving.com. For those caring for someone in the hospital or with a traumatic injury, brainline.org gives additional questions caregivers need to hear.

During these long months of social isolation, every family caregiver knows that at the end of the day there’s so much more we could have done, but you are using the wrong measuring stick if all you see is what you didn’t accomplish! Instead, look at everything you DID get done. Make a list, and I think you may be surprised by all the tasks you completed while caring for another. Those written words are small victories that happened as you went about living, and when you review them those words will give you a little endorphin boost. Give yourself some self-love and a pat on the back. You did your best, and that’s enough for today.

Chris and I hope you will join our conversation this week here at Heart of the Caregiver and share your heart about the power of words in your life.

Being a 2021 Caregiver

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If 2020 taught us anything (besides diligence in practicing hand-washing techniques) it was that every caregiver is a hero! Caregivers come in all shapes and sizes. They come from diverse backgrounds, have a wide variety of skill sets, and range in age from very young to ancient! Some caregivers practice their skills in career form, while others give care by volunteering with family members, friends, or organizations with whom they affiliate. Some caregivers are reluctantly obligated to this role because they believe there is no other option, while others willingly embrace the responsibility of caring for others as their calling.

One outstanding feature that defines a great caregiver is an intangible quality that comes from their heart. The heart of the caregiver is a powerful engine that feeds their extraordinary passion for caring for others. It is this unique characteristic, this overpowering drive, that pushes a caregiver out of their comfort zone and into the lives of others, enriching those lives and influencing our society in countless ways. Whether caring for family members, patients, facility residents, neighbors, or private clients, a caregiver exudes all the qualities of a true hero: selflessness in the face of adversity, diligence to the task at hand, unwavering commitment to helping those in need, and that intangible quality that inspires complete trust.

So, are you a caregiver? If your answer is yes, then Betsy and I salute you for the important role you play in your family, your community, and your world. Thank you for making a difference in the lives of so many people around you! During this past year you have been a fortress of protection, a song of hope, an oasis of comfort, and a cure for loneliness to those for whom you care. You have been an example to many, and a hero to many more. If you are not a caregiver, then think about who the caregivers are in your life and take some time this week to recognize them for what they do. By showing your appreciation, you will uplift and empower these special people to continue their important work!

This week at Heart of the Caregiver, Chris and I are singing our praise for caregivers everywhere for their selfless commitment to caring for others. We hope you will join our conversation and share your heart about a special caregiver who has touched your life during the pandemic.

Needing Christmas

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Most years Chris and I feel like the holidays are so crazy busy that we’ll just be relieved when it’s all over…how about you? Even during this strange COVID year we find that as we get closer to THE DAY it seems like there’s just not enough time to get everything done. Even family caregivers get caught up in the mad rush and your care schedule seems to turn upside down in all the hubbub!

This year I think we all needed Christmas to come a little early. I know people who put their Christmas trees up on November 1! Shopping for gifts has been largely done online to avoid being out in public places and risk contracting the virus. The postal service, always extremely busy during this time of year, has seen its’ volume increase exponentially as COVID impacts this sector of our society as well. Seasonal concerts and performances became virtual events, family gatherings have been cancelled, and even churches are advised to suspend meeting in person as the virus continues to spread following our Thanksgiving celebrations across the country. Hospital wards are full, people are dying, and while the vaccine rolls out, we begin to hear the warnings of negative side effects and unknown dangers to come. Wow, what a Christmas this is setting up to be!

But wait, the bad news isn’t all there is. It’s easy to get caught up in all the bad news and begin to believe you have nothing to celebrate, but that is just not true!

We all need to stop, take a deep breath, and remember our reason for celebration.

Jesus was born into a world that was chaotic, messy, and in political turmoil. He came at a time that was terribly inconvenient for Mary and Joseph, since they were traveling and didn’t even have a place to spend the night. He came at a time when nobody was expecting him, nobody was ready for him, and nobody even cared…except for the angels, and the shepherds, and the wise men, and the impact of His coming grew from there. Jesus came to bring Christmas! When Jesus was born, people everywhere, throughout the ages, got the best gift ever. It came at an unimaginable cost and was given without restriction to everyone throughout the ages, including you and me. That gift, come as an infant, grew to be the savior of the world!

This Christmas season I’d like to invite you to join Chris and me as we reflect on the true reason for our Christmas celebration, and find our rest in the One who loves every one of us, warts and all. As we sing the carols, light candles, and read scripture, let us all be filled with an overflowing sense of joy, hope, peace, and love. Let His light shine through as you care for those in your life who depend upon you.

Chris and I wish you a very merry Christmas, and we hope you will join us at HeartoftheCaregiver.com and share your heart about who Jesus is to you in this season of light and hope.