April 7, 2013

Caregiving to a Parent or Loved One – Part 1


Part 1 of 3 parts

Depending on whether you are on the receiving end or the one giving the care, there are many issues that are in play and it can be trying on both sides. Another factor that many people forget about when talking about caregiving is the degree to which the parent or loved one is disabled. I wish I could have had something like this available to me when I was battling giving care to my first wife over ten years ago. I was fortunate that when it started, she took it on herself to call in a couple of social agencies and eventually hospice. It did not relieve the pressure and stress I was feeling, but it did take a lot of the burden off.

The following blogs are some of the ideas and steps you need to consider and keep in mind if you are put in the situation of caregiver. This series includes this blog and two others. Here are a few of the issues you need to consider:

1. Consider a Medical Power of Attorney. Why other writers always leave this to later in the discussion, I do not understand. This is the most necessary and most important part of caring for a loved one or close relative and needs to be accomplished before it is needed. If your loved one was considerate during this time, and you are the person trusted to take care of them, then get the papers drawn up now rather than after the fact, when you may need to go before a judge to put it in force. Then sometimes other relatives may decide that they are more responsible and oppose the wishes of the parent, or loved one. While your loved one is in their right mind and can clearly show this, this is the time to sign legal documents, not after the person is already near death or incapable of signing legal documents.

In some states, other documents may be required, so check this out. Most times a medical power of attorney is sufficient to allow a trusted family member make financial decisions while a loved one is under medical care. This is no longer in effect when the loved one becomes capable of managing their affairs or the medical treatment has ended. Often a power of attorney is drawn up at the same time and can be very specific in purpose and powers. It is important to discuss this with a loved one before they are receiving medical care because both forms need to be notarized. If the parent or loved one wants special provisions in either the medical power of attorney or the general power of attorney, it is best to have the family lawyer draw up these papers early enough to prevent hostile or untrusted relatives from finding a way to contest these.

I was twice fortunate because my wife knew what her mother's plan was. Since she will still able, she called the attorney and had the papers drawn which would prevent her mother from stepping in and dictating her care. When my parents were at this point in their lives, my father was very clear in stating that my sister would have the responsibility, and my brother and I could be called upon if necessary.

2. Know when to ask for help. No, I am not talking about the person needing the caregiving. I am talking about you as the caregiver. Forget about family pride and bringing strangers into your parent's or your home. There is no need to stress yourself out and do damage to your health when there are agencies available that can give you assistance and guidance and in a sense take some of the burden off of you. Not asking for the right help from your doctor or your parents' doctors is not the way to be the best caregiver.

Instead of pushing yourself and possibly other family members to exhaustion, learn to rely on others as well. If you are new to caregiving, learn that there can be aids like installing toilet lifts in the bathroom, trapeze bars above the bed, or even medical devices that may aid in caregiving. Talk to the parent's physician to find out what will work and ask what community agencies are available to provide assistance. Better to have assistance early and make yourself more valuable to your loved one. Some agencies' services are covered under Medicaid, Medicare, or maybe even private insurance policies. A little time spent early checking this out will prevent problems when you need the help.

3. Don’t take things personally. Remember that some individuals, who are ill, disabled, and elderly, may say things they don't mean. Try to forgive and forget, but do realize that this could be as a result of pain or a medication. Please be aware of a sudden personality change and report this to their physician immediately. A personality change may mean a medical problem, or a bad reaction to a medication or combination of medications. To be sure, always consider all possibilities.

4. Understand memory loss doesn’t equal crazy. Caregivers need to be careful here as they often make this mistake when is reality; the caregiver may be off balance. Memory loss or forgetting something happens to all of us at different times and for different reasons. Some of the reasons include a medication, disability, old age, and stress. In general, the medical condition of a parent or loved one may make memory loss very noticeable so you need to be alert for them. How you handle this, can affect how they feel about themselves, and could affect your future relationship with them.

Some of the suggestions I find valuable is a voice-activated recorder, a small notebook and some pens for making lists of things whey want to remember or want to accomplish. If they do use these, never ignore what the list says and be willing to assist them like filling in names when incomplete or phone numbers they have forgotten. Be prepared to listen when the parent or loved one repeats things and don't become exasperated at them for repeating something several times.

Finally, there could be a medical reason that needs to be addressed if they suddenly have become ‘foggy brained.’ If this happens, speak with their physician as soon as possible to investigate the cause.

Learn to listen first and act second. Some people just want another person to listen to their problem. This can be hard for people who have “take charge” personalities and want to protect their family from outsiders. Never act or do something for a parent or loved one unless they ask you to take action. Even then, you may hesitate and think about the proper way to handle the situation. I had an aunt that wanted to see an old friend one more time, but her sister was the caregiver and would not do this because she disliked the person. I stopped by on my way to see another aunt (my mother only had sisters), and this aunt asked me to stop by and ask her friend if she would come visit her. The caregiver aunt followed me outside and asked me not to do this and was very insistent.

Since I was going to be in the same town to visit my other aunt, I decided to talk this over with her. This was wise on my part, as my aunt knew what had transpired between the two several years earlier and said I had better take her friend to see her, as she was sure that her sister wanted to patch up the relationship before it was too late. My aunt even suggested we go immediately and see if her sister's friend could travel that day. She was and my aunt said she was coming along to stop her sister from preventing this. When we arrived, there was a scene and my one aunt was very angry with me. The aunt that had come with me tried to make peace, but this was not possible that day. The friend did get to see her and was very happy that we had made it possible and my aunt passed two days later.

On the return trip to take them both back home, my aunt's friend said she appreciated seeing her friend and repairing their friendship. She then handed me some money and I said no. She said this was from my aunt and she did not want to explain that I had refused. So in one day I had made one aunt very happy and another one very unhappy, and for the right reasons. Even my aunt whom I was planning to see was happy that I had helped when needed. It is sometimes difficult to know what is best and checking things out is often the best way to handle things. At the funeral a few days later, the daughter of my deceased aunt thanked me and said how happy her mother was the last day. Even my angry aunt admitted that I had done the right thing as she had seen how happy it had made her sister.

In conclusion, as a caregiver, learn how to make things pleasant for the parent or loved one while not losing your place in the day-to-day activity. Rely on others to assist you and make the best use of the different service agencies available. They often can make your load a lot lighter and your time as a caregiver more fulfilling. Learn about ways to assist your loved one while they are under medical care, such as using a Medical Power of Attorney. Finally, try to forge a better relationship by being a good listener and trying to understand that memory loss doesn’t always equal dementia; it may just be a by-product of a medical condition or medication.

1 comment:

Leslie Kernisan MD MPH said...

This is an insightful and practical list! I hope many caregivers find it.