Aging Parents: Help for Caregiver Stress–The Best Stress-Relief Posts I’ve Found

Stress accompanies caregiving…

Yet caregiver stress differs from ordinary stress, eg. from the work place. Its “ingredients” differ: love, caring, devotion, loyalty, pushing oneself to–and beyond–the limit. Of course satisfaction, frustration, anger, resentment and fatigue are common byproducts–generating stress. Can non-caregivers appreciate this?

Unlike Supreme Court Justice’s Potter Stewart’s famous pornography quote: “I know it when I see it,” I believe we can only know caregiver stress if we’ve experienced it. With so much information about reducing caregiver stress (about 17,700,000 items on Google; 1.990,000 on Yahoo) shouldn’t we have learned to manage it by now? In an effort to try, the beginnings of a select list of stress-relief links concludes this post. Meanwhile, caregivers deal with–

Three apparent roadblocks:

1, One size doesn’t fit all (neither the elders we care for–nor us)
2. Non-caregiving family members often can’t/don’t appreciate the stress, and don’t help.
3. We’re often not very good at asking for–no insisting on–help when we need it. Is giving up “ownership” difficult? (True, they may not do as good a job as we.)

Knowing what happens to us when we’re stressed–cranky, short-tempered, impatient, overwhelmed, (you fill in)–should wave a red flag that we need relief. That’s a first step in solving half the problem. When we know our stress-relief activity, we’re can solve most of the other half.

Finding out what works. There’s something that relaxes each of us and helps us see solutions more clearly and move forward. We just need to discover it.

When counseling, I would suggest stressed counselees think–perhaps while taking a shower–about what they enjoyed doing that relaxed them. I vividly remember one teenager who said she remembered hooking a rug in middle school. She loved doing it; remembered it took her mind off her problems. She still had a lot of the string (rags or whatever) and tried it over the weekend. She excitedly reported it still relaxed her and she realized a few things. Different strokes for different folks.

If I were musical, I’d probably play the piano. It seems like a wonderful stress reliever. That said,  I’ve identified 3 stress-relief activities, often suggested by experts, that work for me and may for you.

1. Walking fast (but not overly-exerting), the same boring walk day after day for 30 minutes. No distractions (alone and no cell phone). I notice the same things again and again: homes, wildlife, flowers, even rocks. Forced to focus on my surroundings, my mind rids itself of problems and order replaces emotional and intellectual chaos. Solutions appear out of nowhere. Plus getting exercise; and doing something for ourselves, no matter how small, makes us feel better.

2. Gardening inside or outdoors, depending on season and where I am. No cell phone; sometimes music. Gardening (planting, pruning, pinching, weeding, deciding right plant for right place) absorbs me. Stress evaporates. Plus I’ve accomplished something.

3. Being with my pets. They say “Dogs have masters; cats have slaves.” No matter. Petting the dog or cat–or just watching them–slows things down, refocuses our thoughts, and–we’re told–lowers our blood pressure (haven’t tested that).

The beginning effort to compile links to caregiver stress-relief posts I like is below. It’s in progress; obviously incomplete. Recommendations welcomed.

Also check out The 2nd annual virtual Caregiving Conference, March 29, 2015. It’s free. Register on the Caregiving.com website: http://www.caregiving.com/2015/01/save-the-date-virtual-caregiving-conference-on-march-29/

The List  (in progress)

1.  Avoid Caregiver Burnout–Slideshow: of 14 Ways–WebMD  http://www.webmd.com/healthy-aging/caregiver-14/slideshow-caregiver-burnout
2.  Caregiving.com http://www.caregiving.com/the-caregiving-years/  This is excellent with text and videos of “The 6 Stages of Caregiving.”
3.  Caregiver Stress: Tips for Taking Care of Yourself: Mayo Clinic http://www.mayoclinic.org/healthy-living/stress-management/in-depth/caregiver-stress/art-
4.  
From the Heart of a Caregiver  (affirms letting go)
https://generationsofcaring.wordpress.com/2015/03/22/from-the-heart-of-a-caregiver-thank-you/
5.  Managing Stress: Care for the Caregiver–BrightAngel (Alzheimer’s Foundation)
http://www.brightfocus.org/docs/pdf-publications/caringcaregiver_stress.pdf
6. The HelpGuide: http://www.helpguide.org/articles/stress/caregiving-stress-and-burnout.htm
This is long, excellent and very complete.
7.
Tips to Manage Caregiver Stress–WebMD:  http://www.webmd.com/balance/stress-management/caregiver-advice-cope
8. What Can I Do to Prevent or Relieve Caregiver Stress? US Dept. Health & Human Services: http://www.womenshealth.gov/publications/our-publications/fact-sheet/caregiver-stress.html#f
9
. In 2012 the Family Caregiver Alliance, Nat’l Center on Caregiving, updated statistics on caregivers, with many topics including “Impact of Caregiving on Caregiver’s Health.” (“an estimated 17-35% of family caregivers rate their health poor-fair”)

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And Check out “Newsworthy” (right sidebar). Links to timely information and research from top universities and respected professionals, plus practical information–to help parents age well.


 

 

HAPPY ST. PATRICK’S DAY–ps. If you’re seeing this after St. Pat’s Day*

*These are such excellent plants for elders that anytime you can easily buy one, which is around St. Patrick’s Day, why not go for it!

IMG_3913

Oxalis Regnelli –Shamrocks at Trader Joe’s in Arizona.

Bring interesting, fun to watch, blooming-year-round, easy-care Shamrock plants to elders for St. Patrick’s Day. Green or purplish leaves that open in the morning and close at night, they bring a little life into the home.

IMG_3914Seemingly at $4.99 –now $2.99–don’t they make great last-minute (or even extra) St. Patrick’s Day gifts for aging parents–or anyone we care about?!  Click link for earlier post about these and other easy-care, flowering-year-round plants.

—AND ENJOY A SPIRITED ST. PATRICK’S DAY.

 

Aging Parents and Vacation Planning

When parents are old–healthy or not–can we plan vacations very far in advance?…Very far away? Do we dare to go on vacation?

March: Vacation advertising increases. It looks enticing, yet caution often fills our thoughts and precedes our making a commitment.

  • Can we risk going?
  • If our elders are going to miss us, do we feel guilty?
  • Do we have confidence in the person who will care for them and contact us if problems arise?

We can decide to afford trip cancellation insurance. That covers one aspect. Yet our uncertainty  remains:
–Do we forgo a needed, well-earned or simply badly-wanted vacation?
–Will guilt and concern weigh on us emotionally and taint the trip?

A previously planned trip to Italy with friends presented this dilemma. We went. The night after our first day there, the call I dreaded came from a caregiver: “Mother was having very serious problems.” While it was awful to be awakened at 2 am with that call, I’d prepared a plan of action–just in case. I’d accomplished 1-4.  Now it was time for #5.

The Plan: 5 Necessities Before Going Away

1.  Make peace with the fact that parents’ emergencies are unpredictable; if we knew when to expect them, wouldn’t our life be easier?
2.  Make peace with the fact that we’re entitled to a vacation.
3.  Prepare detailed contact lists, along with itinerary, for everyone who might be involved should there be an emergency.
–If they need us, they can find us. It’s not rocket science, unless we’re in a cave somewhere.
–If they need another family member his/her contact info–phone, fax, email–is listed.
–If doctors are needed, their contact info–phone, fax, email–is listed.
–ditto for clergy information.
4.  Have a plan for getting to your parent’s home or bedside on a moment’s notice.
–Arrange beforehand to be met at the airport if flying is involved, plus having a back-up for that someone, should he or she be unavailable.
5. Check out options for an emergency return before leaving. I now know–on a few hours notice–how to fly from Milan to the West Coast the same day. Wish I’d thought to check that option before leaving.

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The Details

Mother was having medical issues as we prepared to leave. If friends weren’t involved, I might not have gone. Living 3,000 miles away, I lived with a constant–but not burdensome–awareness: I might need to get to the West Coast on a moment’s notice. While I’d done it previously for Dad’s quintuple bypass surgery, thoughts of vacationing on another continent were unsettling.

Years earlier I’d attended an aging parents program that included a short film featuring an adult child whose married life was consumed by concerns about her parents’ needs and health issues. Her ongoing apprehension was such that every time the phone rang, she stressed. It seemed plausible that she would make herself sick and that her husband would book a one-way flight to a far-away place–alone!

While admittedly the film seemed exaggerated, I remembered it as the trip neared. Second thoughts about going toyed with my rational self. The latter prevailed.

Night 1–Milan: the phone call. Mother was home with a caregiver who phoned while family attended a birthday celebration and weren’t answering phones. After giving her instructions, I made immediate plane reservations, using the 4 most important words I know in such cases (mentioned often on this blog) “I need your help.”

In the wee hours of the Italian morning, the airline personnel seemed to go out of their way to get me to my destination in the shortest time possible.

#4 (above) went like clockwork.  Many years ago I spoke with my brother and a good friend about their flexibility should I need to fly back on the spur of the moment. My brother was there, at the ready.

At the house our frail, semi-asleep mother could barely keep her eyes open–in no condition to appreciate the new Italian sweater I brought–or anything for that matter. But I knew she was glad I was there and I was glad to be there.

With a list of Mother’s doctors contact info and an updated list of her medications always in my wallet, (another necessity as we know), I could immediately communicate intelligently with her doctors. Turned out medication– too much, some unnecessary–caused the problem. So simple, yet emotionally and physically draining for everyone involved.

What I learned?

  • When stress is high, it’s comforting to know we have a plan–don’t have to worry about certain things and we do have some control over others.
  • When coming a distance, having someone who cares and shares our concerns there to meet us is welcoming and supportive.
  • Having essential information at hand makes communication with professionals effective and efficient.
  • Last but not least, when the unexpected happens and we can’t do it alone, “I NEED YOUR HELP” are four important words.

I also learned we have good friends who we had to suddenly abandon in Italy. They survived; so has our friendship. And mother lived 2 more years..

Check out “Newsworthy” (right sidebar). Links to timely information and research from top universities and respected professionals, plus practical information–to help parents age well.

Aging Parents: Make Elderly Happy~Thanks to St. Patrick’s Day

St. Patrick’s Day. Another opportunity to make elderly people happy: happiness created by anticipation if we’ve planned ahead to do something with them; unexpected happiness from an unexpected gift or communication. And you don’t have to be Irish to participate.

A NYC ad campaign, ubiquitous in the NYC subways throughout the ’60’s and 70’s, proclaimed: “You don’t have to be Jewish to love Levy’s real Jewish Rye.” Likewise in NYC, we don’t have to be Irish to love corned beef and cabbage, catch the spirit, and participate in St. Patrick’s Day festivities. Every important politician, it seems, is Irish that day, marching–with high visibility– in the popular  St. Patrick’s Day Parade.

4 Ideas to Lift Spirits and Make Elders Happy:

Oxalis regnellii Shamrock Plant

Oxalis regenlli /Shamrock Plant~Click to enlarge

1.  A clover plant giftoxalis regenlli is a three-leaf clover–a perfect St. Patrick’s Day gift for elders. It needs little care, likes light but doesn’t require much sun and if it’s getting dry, we’re warned–the clover begins to droop. Its leaves open each morning, close each night, and it flowers throughout the year. Hard to kill, fun to watch, and easy to love.

The one above is a bad example, with only one flower. (Result of going on vacation.) The only work is cutting off the dead flowers. Doesn’t cause any allergies unless you eat it!

Usually Trader Joe’s sells inexpensive oxalis plants for St. Patrick’s Day. Perhaps due to the cold NY weather, there were none yesterday when I shopped there. Don’t know the situation in warmer climates.That said, there’s still time to purchase one in florist shops or at nurseries and corms/bulbs are sold on-line (Click oxalis link above.)

2. A gift of an Irish beverage: Guinness, a bottle of Bailey’s Irish Cream, a bottle of whisky, or tea. According to IrishCentral.com, “Ireland is famous for Guinness, obsessive tea drinkers and some of the best whiskey on the planet.”

3. A gift of foodIrish Soda Bread:
BX0216H_Irish-Soda-Bread_s4x3.jpg.rend.snigallerythumb.jpeg –a particularly good gift for aging parents, grandparents and elders we care about. I loved it when my counselees’ would bring some, made by their mothers, to my office.  Some bakeries are selling soda bread now.  (Link gives video and recipe for those who have time and like to bake).FN_Corned-Beef-Cabbage_s4x3.jpg.rend.snigallerythumb.jpeg

        --Corned beef and cabbage or shepherd’s pie: –to eat at home (ours or theirs). Otherwise plan to cook a favorite food and call with a dinner invitation; or take elders out to dinner so they can eat whatever they wish. In any case, add an Irish beverage–Guinness? whiskey? Bailey’s Irish Creme? Irish coffee? tea?

4. Unexpected communications: elders prefer a phone call or a snail-mail card to email.

We didn’t have to be Jewish to love Levy’s Rye Bread. Likewise, we needn’t be Irish to love the St. Patrick’s Day spirit. Can we take advantage and use this opportunity to lift the spirits of our parents and grandparents?

         

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Check out “Newsworthy” (right sidebar). Links to timely information and research from top universities and respected professionals, plus practical information–to help parents age well.

Aging Parents: Is It Better To Have A Friend Be Your Doctor?

January 20th’s NY Times, Science Section’s “Hard Cases” column, Too Close to a Patient for Comfortmakes the case, based on AMA guidelines and other sources, that objectivity in medical care may be compromised by doctor-friends. “Medical care supplied by a relative — or an old friend, or a trusted employee — just seems so logical. After all, who could care for you more? But that is just the problem…”

The article triggered 2 thoughts and a dilemma:

1. When I was too young to know about medicine, I remember hearing that a doctor could not do surgery on a family member. Might have been true—or not. A playmate was having surgery. She was 9.

2. In graduate school, the professor in “Techniques of Counseling” gave us a practical list of counseling do’s and don’ts followed by his saying something like: “Be forewarned: if you’re trying to counsel a family member, your emotions will dictate and you may forget this.”

If the emotional ties of friendship can interfere with doctors’ objectivity, how do we reconcile this when it comes to helping aging parents, the elders we care about, and ourselves?

Boomers and those older, remember doctors who knew your family, possibly made house calls, and definitely made hospital visits. It was more “warm and fuzzy” then. Today’s efficiencies, however, dictate something entirely different.

I hear people say “It’s not the doctor’s “bedside manner” that matters. Agree. Knowledge and expertise are most important. But it helps if we feel s/he cares about us, doesn’t it?

Three people immediately come to mind. They don’t have friends as their doctors; yet they’re confident in their doctor’s ability to is do what’s best for them and they feel a certain bond–perhaps a professional-type friendship. Another commonality: they make every effort to take care of themselves to the best of their ability. It appears doctors appreciate this.

1. Several weeks ago I reconnected with a friend, living in a large city in the west with excellent healthcare available. I was unaware that she has a serious, unusual vision problem. Asking about her doctor, she related she did the research and now has the best doctor–adding she was concerned that, because she’s now on Medicare, it would be a challenge finding a doctor who would take her. Then she said, laughingly, something like “When we met he told me he isn’t taking new patients, but I’m ‘vibrant’ so he’s making an exception.”

2. Sr. Advisor R, at 101, has obviously had many doctors over the years. This last year a new best ophthalmologist  (taking few new patients) has been doing his best to maintain her sight, which was rapidly worsening.

She was initially concerned that he thought “She’s old, I can’t do much.” R made him realize she takes very good care of herself (corroborated by the lab tests her primary care doctor sent), lives in her home by herself, and will do everything possible to maintain her independence. He, like her other doctors, respects that–and her. For several months there was no improvement. 12 weeks ago there was slight improvement in one eye. I drove her to her last appointment and there was even more improvement in that eye. The doctor was cautiously optimistic; said to be sure to call immediately if she noted any change–not to wait for her next appointment. He wasn’t a friend but he cared. R’s spirits lifted.

3. Next I check with my friend of decades, who had polio as a child. In her mid-70’s, she has seen countless doctors who were not friends. “Confidence in them,” she says, is a must or she finds a new doctor. She has made changes over the years, as allowed in her health plan.

And we learn a tip–

She writes thank you notes after each appointment. The notes aren’t a hidden agenda to make them like her, she says, but actually to let them know that she’s very appreciative of their help. In addition, reading her note must make them think about her again after her visit. “It puts you on a level that most patients aren’t on,” she says.

A tip for us personally? And for those we care for and about. .

 

Related: New England Journal of Medicine‘s May 2014: Ethical Challenges in Treating Friends and Family..

VA Aid and Attendance Pension to Get New Eligibility Rules

Veterans’ Important Aid and Attendance Information
Reblogged from AgingCare.com

Help! Aging Parents has presented information for–and about–Veteran’s since a June 2010 post. This reblogged post by John Roberts, Esq. offers new and important information, in hopes that as many Vets and their spouses as possible have this information in a timely manner, read the proposed regulations, and submit comments in the link provided at the end of the article– if they feel the need.
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February 12, 2015  |  16 Comments  |

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VA Aid & Attendance Gets New Eligibility Rules

Editor’s note: This is part one of an overview of some of the proposed changes that will impact veterans and their caregivers.

Have you or a family member benefitted from elder care reimbursed by an Aid & Attendance pension?

An Aid & Attendance pension can provide a wartime veteran with up to $21,466 this year ($1,788 per month) to cover care at home or in assisted living. The surviving spouse of a wartime veteran can get Aid & Attendance pension reimbursement for up to $14,353 per year or $1,196 per month.
Source for Veteran’s Pension Rates
Source for Surviving Spouse Pension Rates
The Department of Veterans Affairs gave notice on January 23, 2015 that it will be changing the rules for pension eligibility. You have an opportunity through March 23rd to comment on the proposed changes. (My addition, Susan)

The web address to connect with the VA and comment is posted at the end of this article.
Read HTML version of proposed rules (24 pages–my addition, Susan)
Read PDF version of proposed rules
Here’s part one of an overview of some of the proposed changes that will impact veterans and their caregivers:

Net worth will track Medicaid asset amounts; assets will include your annual income.

Across the country, VA claims processors have been inconsistent about the amount of assets that veterans and their spouses who’ve applied for Aid & Attendance are allowed to have.

$80,000 has been the most commonly mentioned asset amount, but there has never been a written rule. The new “proposed net worth limit” will be a nationwide number that tracks Medicaid’s maximum community spouse resource allowance. This amount is currently $119,220.

But unlike Medicaid, the VA’s calculations would add an applicant’s annual income and assets to see if a veteran or spouse is over the $119,220 limit. “The amount of a claimant’s net worth would be determined by adding the claimant’s annual income to his or her assets,” according to the new rules.

There will be no hardship exceptions. The VA has concluded: “we do not believe that a hardship provision is warranted” because the proposed income and asset limit is greater than the $2,000 SSI asset limit that Social Security allows for people who’ve been impoverished by disability.

The VA would calculate (or recalculate) a claimant’s net worth when it receives a new pension claim after a period of non-entitlement, gets a request to establish a new dependent, or finds information that net worth has increased or decreased. An example of a change in information would be the income tax reporting that is required whenever anyone sells real estate, such as a house.

Your home doesn’t count as an asset, but there is a two acre lot limit.

The VA net worth limit “would not consider a claimant’s primary residence, including a residential lot area not to exceed 2 acres, as an asset.”

So, if your home sits on a farm or a plot of land greater than two acres (87,120 square feet), the extra land would disqualify you, “unless the additional acreage is not marketable. The additional property might not be marketable if, for example, the property is only slightly more than two acres, the additional property is not accessible, or there are zoning limitations that prevent selling the additional property.”

It doesn’t matter that you are not living in the home, even if you are being cared for in another state. The VA “would exclude a claimant’s primary residence as an asset regardless of whether the claimant is residing in a nursing home, medical foster home, or an assisted living or similar residential facility that provides custodial care, or resides with a family member for custodial care,” according to the new rules.

But soon after you sell the home, the sale proceeds count as assets. “Proposed § 3.275 would also provide that if the residence is sold, proceeds from the sale are assets unless the proceeds are used to purchase another residence within the calendar year of the sale,” the VA says. For instance, if you sold your house in December, you would have only a few days to decide what to do with the sale proceeds.

If you rent the home, the rent counts as income. “Any rental income from the primary residence would be countable annual income under § 3.271(d) for pension entitlement purposes (and thus would be part of net worth under proposed § 3.274).”

Additionally, the VA “will not subtract from a claimant’s assets the amount of any mortgages or encumbrances on a claimant’s primary residence.” Conversely, you could take excess assets and pay down a primary residence mortgage without causing a transfer penalty.

A 3-year look-back on asset transfers can cause a 10-year penalty period.

Unlike Medicaid, which has a five-year look-back to catch any disqualifying asset transfers, the VA has never in the past imposed a transfer penalty on veterans who gave away money to qualify for the Aid & Attendance pension.

But now, the “new requirements pertaining to pre-application asset transfers and net worth evaluations” will “establish a 36 month look-back period and establish a penalty period not to exceed 10 years for those who dispose of assets to qualify for pension. The penalty period would be calculated based on the total assets transferred during the look-back period to the extent they would have made net worth excessive.”

The transfer of a ‘‘covered asset” would “mean an asset that was part of net worth, and was transferred for less than fair market value. Transfer of “a smaller covered asset amount” would incur a shorter penalty period.

If you make a transfer during the three-year look-back period, then you must have clear and convincing evidence that transferring the asset was not “for the purpose of reducing net worth to establish entitlement to pension.”

Otherwise, the VA will deny your Aid & Attendance benefits for months or years, based on how much you transferred. The amount you transferred will be divided by “the maximum annual pension rate at the aid and attendance level” and the result (quotient) is the number of months you will be disqualified.

In the example of “a surviving spouse with no Dependents” the applicable MAPR (Maximum Annual Pension Rate) is $13,563, and the monthly penalty rate is $1,130. So, the formula for the penalty period is $10,000 ÷ $1,130 per month = 8 months.

After the penalty period is imposed, there will be a very tight time frame to solve the problem.The VA will only recalculate the penalty if (a) they made a mistake or (b) “if all of the covered assets were returned to the claimant before the date of claim or within 30 days after the date of claim.”

The regulations don’t explain how a veteran would know they needed to get assets back if the VA doesn’t give notice of the penalty during the month after the claim is filed.”Return of covered assets after the 30-day period provided would not shorten the penalty period,” according to the new regulations.

The VA justifies their strict time frame by saying the “[n]umerous penalty period recalculations would detract from the primary mission of paying pension benefits to those in need.”

Also be aware that, “[e]vidence showing that all covered assets have been returned to the claimant” must be provided to the VA within 3 months of the penalty notice.”

Do you have a problem with any of these changes? Do you have an experience with the Aid & Attendance program that can help the VA reform its Aid & Attendance rules more fairly?

Read proposed regulations and submit comments.

In my next article, I’ll provide more in-depth information on how the proposed changes will impact the cost of caring for a loved one and the restrictions the VA plans to place on Annuities and Trusts.

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