Information on Grief and Loss

Getting the most from video chat

There is no doubt that video chat tools such as Zoom, FaceTime and Amazon Echo Show have made the isolation of older adults much more bearable. While not the same as an in-person visit, video chatting has been demonstrated to reduce depression in older adults by 50% when compared with other forms of connecting.

Video chatting with grandchildren is an art. Keeping their attention is a challenge, along with finding a “good time” to talk. Here are some tips you may want to go over with your loved one to help make video visits a positive exchange for all involved:

The physical environment. Pick a spot where the lighting is in front, not behind. “Backlighting” creates more of a silhouette, making it harder to see faces. Reduce background noise. (Turn off televisions. Move to a quiet room.) Mount phones or tablets on a tripod to free up both hands for gestures or showing off objects.

Create a routine. Make storytime with grandpa a regular activity before bed. Or maybe have grandma call while you are cooking dinner so the kids are entertained while you prepare the meal. Agree on a mutually convenient time that works for all three of you.

Prepare for the call. As the parent, ask your child what they want to share with grandma or grandpa and bring it to the phone station. Before handing the phone over to your child, give your parent a quick run down of interests in the last hour or day so they can be sure to inquire about activities that are top of mind. As the grandparent, have a favorite book or object at the ready that you want to share in return.

Bring out the inner hambone. The joy of video chats comes in the ability to interact. Kids love movement, silly faces and gestures that can be done together. Babies enjoy patty cake and peek-a-boo on video. And blowing kisses. Older children enjoy activities such as “Freeze Dance”—like musical chairs except the players freeze like statues until the music starts again.

Start with short, 5 minute visits. Work up gradually to longer visits as you all get used to this new medium.

Will we ever hug again?

Hugs are more than a symbolic display of affection.

They have actually been shown to release oxytocin, the bonding hormone, which calms our nerves and reassures us that we are loved and we belong. Like everyone, older adults have a basic need to hug and be hugged. And grandchildren are often the joyful purveyors of sweet, soul nurturing embraces. One reason hugging is so dangerous now is that close proximity means we breathe into each other’s air space. Since the virus is spread by tiny droplets in aerosol form, face-to-face hugs are especially risky.

Imagine that every exhale is like smoke. It wafts in the air, even from children, dissipating gradually over time. You can see why we wear masks! According to aerosol specialists at Virginia Tech, there are things adults can do—and teach children to do—so that grandma and grandpa may feel safe enough to be back on the hug circuit.

  • Always wear masks. They seem to protect both the wearer and the person on the receiving end of the hug.
  • Keep your hugs brief. 10 seconds, and then step away to a six-foot distance.
  • Look away from each other. Head-on or cheek-tocheek hugs put you right in each other’s jet stream. Instead, turn your heads so you are facing different directions.
  • Hold your breath. From the time you approach to the time you step back. Another reason or cue to keep the hug short.

A hug around the knees or waist from a little one is fine. The adult should turn their head away so they aren’t breathing down on the child.

An affectionate kiss on the back of the head is also relatively safe. Hold your breath and try not to exhale until you are appropriately distanced again.

Source: Dee Childers, Life Changes Elder Care, LLC


BALANCING FEAR WITH KINDNESSThere are many things to fear in our world today, the most recent being the outbreak of the COVID-19 coronavirus around the world.  But, recent events in my neighborhood completely unrelated to coronavirus reminded me how just easily our fears and biases can cause us to overlook concern for the welfare of others.

I live in a community that is known for kindness and a history of taking care on one another.  Unfortunately, a few criminal events rooted in domestic violence over the span of several months had our very close-knit neighborhood on edge (and the neighborhood Facebook page on fire).  Every “stranger” in the environment became a suspect with unusual sightings reported (and commented on) in great detail.

With this as background, it is no surprise that when doorbells rang unexpectedly at 1:30 in the morning, people responded with fear.  Most people admitted to not opening the door to a stranger in the middle of the night.  The few people who did open the door reported that a menacing-looking middle-aged man dressed all in black said he had lost his phone and asked to come in to use a phone.   He was turned away from multiple houses who reported a fear for the safety of their family.

As it turns out, the man ringing the doorbell was the mentally challenged father of a family who had just moved into the neighborhood.  He had left the house without his cell phone, had gotten lost, and he was himself panicked and afraid.  Gratefully, his daughter found him and was able to return him safely home – but not with the help of our usually kind and generous neighborhood.  Part of the reason people responded as they did was because this man did not “look like” the typical person in need.

I like to believe that had he been a young child or an obviously senile older adult that we would have been more responsive as a community. But, it WAS the middle of the night, and I have still instructed my teenage daughter to NEVER open the door in the middle of the night to a stranger no matter what the circumstance.  So, as a family, we have also discussed that we should have called the non-emergency number for our local sheriff’s department to request a welfare check on the stranger.

We immediately jumped to the fear-based conclusion that the stranger was up to no good when, actually, he was a fellow human in need.  We overlooked the fact that there are options available to safely balance the concern for our own welfare with the responsibility to extend kindness to a stranger.  It never occurred to us to request a welfare check in this kind of a situation, but I have been assured by several local law enforcement agencies that they would have viewed this as an appropriate use of services and would have been happy to come out to ensure the well-being of everyone in our neighborhood as well as the stranger in our midst.

So, whatever your position on the necessity to stock up on toilet paper and bottled water in the face of the current coronavirus pandemic, I hope we all remember to stock up on an extra supply of human kindness.  I have no idea what unexpected needs might present themselves in the coming days, but I plan to do what I can to help my friends, my neighbors and strangers as we navigate this uncharted territory together.  After all, I didn’t stock up on extra toilet paper, and now the store shelves are empty.  So, I hope that one of my neighbors will come to my rescue if we have a toilet paper emergency at my house.  Be safe and be kind!

Written by: Darra Wray

Darra Wray is a Care Consultant and Certified Senior Advisor with My Care Companions in Boise, Idaho, a company she founded to streamline and simplify the administrative side of care.  You can learn more about My Care Companions and the My Data Diary+ family information management software tool at



5 COMMON CAUSES OF BRAIN FOGYou need to stop by the grocery on the way home from work for two gotta-have items. One of the items is coffee, but you can’t think of the other one to save your life.

Every time you sit down to do that report for work, you can’t seem to focus and make any real progress.

Better wait to walk to the end of the driveway to get the mail because your neighbor, that you’ve only lived beside for five years, is in his yard, and you don’t remember his name.  You know you know it, but your brain can’t seem to reach it.

Sound familiar?
Even though you may feel like you’re losing your mind, it could just be a bit of brain fog. Thankfully, you can take steps to clear up the haze after you figure out what’s causing it.

What Is Brain Fog?
Brain fog is not a medically recognized term or diagnosable condition. It’s a common phrase used for a myriad of symptoms affecting your ability to think. Brain fog can include things like memory problems, lack of mental clarity, and an inability to focus, and put thoughts into words. Some people describe it as mental fatigue.

You know – the kind of mental exhaustion where you tell yourself if you can just make it to the weekend, you’ll get some rest. That should help. Next week will be easier. The problem is that when the weekend rolls around, there are a gazillion more things to do and stress about. So, you end up not getting the much-needed rest. Or if you do, it doesn’t seem to help the problem in the slightest.

That’s because to resolve brain fog, you have to figure out and address what’s causing it. 

On a cellular level, brain fog is believed to be associated with high levels inflammation and changes to three primary hormones: dopamine, serotonin, and cortisol. One theory behind the underlying reason for brain fog symptoms is that higher levels of inflammatory molecules, including adipocytokines and histamines, stimulate microglia activation.

Five Common Causes of Brain Fog
According to one study, the most commonly reported brain fog triggers were fatigue, lack of sleep, prolonged periods of standing, dehydration and feeling faint. Sometimes, a trigger can’t be avoided. However, if brain fog is an ongoing issue for you, taking a look at and adjusting your lifestyle habits might be warranted.  Let’s look at some common causes:

1. Stress
In the short-term, stress can make you irritable, anxious,  distracted and forgetful. Over time, elevated levels of cortisol, the stress hormone, can chip away at your physical, mental and emotional healthChronic stress actually damages your brain.  Stress shrinks dendrites, kills neurons, and prevents new cell growth in the hippocampus – essential to memory. While it’s doing all that, it causes your amygdala, the fear and emotional center of the brain, to increase size and activity. This makes it harder for your brain to learn new information and remember it.

2. Lack of sleep
Sleep deprivation can have serious short-term and long-term consequences for your overall and brain health. After just one night of skimping on sleep, the results can be seen in delayed reaction times, glucose levels, mood, headache, impaired memory, and hormone balances. Recent research shows that not getting enough sleep may even shrink your brain. You’ll want to aim for eight to nine hours of sleep per night. But don’t forget, quality matters too.

3. Diet
Diet can also play a role in brain fog. When it comes to your brain, you literally are what you eat. What goes into your mouth has everything to do with what goes on in your head. You have a “second brain,” the enteric nervous system, in your gut which communicates with the brain in your head.

To get the most brainpower out of your diet, you will want to include fatty fishes, foods with probiotics, whole grains, leafy greens and lots of lean protein. If you’re missing essential vitamins and minerals, your brain function will reflect it. For example, a vitamin B-12 deficiency can bring about brain fog.

Also, food allergies and sensitivities can make your thinking fuzzy. The most common culprits are:

  • Processed meat (sodium nitrates)
  • Dairy
  • MSG
  • Alcohol
  • Artificial sweeteners

Dehydration can also contribute to sluggish thinking.

4. Hormonal Changes
Hormonal changes can also trigger brain fog. The brain and entire body rely on a complex symphony of hormones that work to keep one another in check. So, when levels of one hormone fall too low or climb too high, your whole system, including brain function, can be thrown off.

For example, levels of the hormones progesterone and estrogen increase drastically during pregnancy. This change can affect memory and cause short-term cognitive impairment. Similarly, a drop in estrogen level during menopause can cause forgetfulness, poor concentration, and cloudy thinking.

5. Medications and Medical Conditions
Brain fog is a common side effect of many drugs. If you notice symptoms upon taking a medication, talk with your doctor. Lowering your dosage or switching to another drug may alleviate the problem. Brain fog is a well-known side effect of chemo and is referred to as chemo brain.

Medical conditions associated with inflammation, fatigue, or changes in blood glucose level can also be the cause of mental fatigue. For example, brain fog is a symptom of:

  • chronic fatigue syndrome
  • fibromyalgia
  • anemia
  • depression
  • diabetes
  • hypothyroidism
  • autoimmune diseases such as lupus, arthritis, and multiple sclerosis

Diagnosis and Treatment of Brain Fog
No matter what you think is causing your brain fog, it’d be a good idea to get checked out by your doctor. However, there isn’t one test specifically for the condition. When you get to your doctor’s appointment, you can expect to have a regular physical examination with some follow-up questions.

Your doctor may feel additional blood work is necessary to rule out the brain fog being a symptom of a more serious issue. Blood work can identify the basic health markers, glucose levels, nutritional deficiencies, organ function, hydration, and more.

Your doctor can then suggest possible solutions to implement based on the exam, questions, and tests. Treatments are different depending on the determined cause. Your physician may advise you to get more sleep, switch medications, start taking nutritional supplements, or something else. You may need to try out different treatments before you find one that works for you.

Brain fog is an annoying symptom that can arise for a wide variety of reasons. It may feel like you’re going to be stuck in that sleepy mindset forever, but there are plenty of ways to wake your brain up. Try out different treatments until you find one that works. Then, make adjustments as necessary to prevent the condition from returning. One day, you’ll clear away the fog, and the sun will shine again!

Contributing Author: Kayla Matthews writes about wellness, productivity and stress in the modern world for websites like Make Use Of, BioMed Central, and The Huffington Post. To read more posts from Kayla, subscribe to her blog, Productivity Theory.

Source: The Best Brain Possible with Debbie Hampton, Author | Writer | Online Marketer, at: CLICK HERE.

Debbie Hampton recovered from a suicide attempt and resulting brain injury to become an inspirational and educational writer. She is the author of Beat Depression And Anxiety By Changing Your Brain and a memoir, Sex, Suicide, and Serotonin, being re-released next month. Debbie writes for The Huffington Post, MindBodyGreen, and more. On her website, The Best Brain Possible, she shares information and inspiration on how to better your brain and life.


What a doctor wishes patients knew about the end

As a hospice and palliative medicine physician, my job is to help reduce suffering. At the end of life, that job becomes especially intense when time is short, when machines and data seem to be taking over, and so many intense emotions surround a body that is trying to die.

BJ Miller

BJ Miller

But here in that narrow trench, both providers and patients do have power to shape their experience together, especially if they take the time to have a few crucial conversations. In the spirit of palliation, here are a few things, as a physician, I wish I could share more often with patients and their caregivers.

You don’t need to be dying to receive palliative care

In hospitals, it is still common for palliative care clinicians to be pulled aside by a well-meaning though misinformed nurse or doctor who says, “This poor family is miserable, but they’re not ready for palliative care yet.” They imply that either the patient is not dying, or the patient does not realize that he or she is dying. But what this statement does is to conflate hospice or end-of-life care with palliative care. Palliative care is an approach, framed within the context of serious illness, where easing suffering is the goal. So, you just need to be sick and suffering to qualify for palliative care, not necessarily dying any time soon. Don’t be afraid to say you want it.

Don’t wait for your doctor to bring up hospice

What a doctor wishes patients knew about the end

Doctors tend to wait too long to acknowledge when death is close. And as research has made clear, the closer we feel to the patient, the more wildly we overestimate their prognosis.
The median length of stay in hospice care in the United States is 24 days.
As a rule, this is too short. So here’s an inside tip for patients and loved ones starting to wonder about hospice. In an effort to get primary physicians to think sooner about recommending hospice, researchers came up with the “surprise question.” As in: “Doctor, would you be surprised if your patient died within a year?” If the answer is no, then that doctor should start considering a referral to hospice. But there is nothing stopping you from asking the surprise question yourself. If you live with advancing chronic illness and are thinking about how you want your life to go, you might turn the table and ask: “Hey doc, would you be surprised if I died in the next year?” This is a good and bold way to open an honest dialogue with your doctor and get the sort of support you need.
The healthcare system is wired to extend physical life, without much regard to the psychological, spiritual, or financial costs. With advances in technology, we are able to prop up a body practically indefinitely. And it’s well known that doctors tend to presume you want aggressive care, even when care geared toward your comfort may be more in line with your wishes. Unless you say otherwise, the doctor’s presumption rules the day. This means that at some point you may need to say “no” to that next treatment. So be sure to look up now and again and check that the care you’re getting is the care that suits you.

It’s OK to laugh

Deaths from dementia have more than doubled in US, report says
In my book, “A Beginner’s Guide to the End: Practical Advice for Living Life and Facing Death,” someone tells of their stepfather wearing a shirt that read, “I’m so old I can’t find my own nuts,” with a doodle of a squirrel on it. His dying wish was to make his daughter laugh, and it helped both of them immensely. To honor him, she buried him in that shirt, sealing his personality in death as it had been in life. Illness isolates people, not just physically. When we get sick, people around us start censoring themselves. The solemnity is supposed to be a form of kindness, perhaps, but it can feel more like yet another loss, almost a premature death. As patients and caregivers know, illness and its indignities offer plenty of rich material for humor. The joke is only on us if we don’t find some way to laugh back.

Those guardrails on the hospital bed go down

Dr. Marianne Matzo is a PhD nurse who researches sexuality at the end of life. She told me a story about a patient who died in his hospital bed while he and his wife were in the middle of oral sex. Dr. Matzo tells this story as a triumph rather than a tragedy: The couple had found a way to maintain intimacy until his last breath. We are still living when we are dying. When those guardrails go down, it is possible to cuddle or caress one another. Those moments are about feeling connected, sexually or otherwise, and finding ways to be in that body while you have it. They are about reminding yourself and each other that you are still here, both of you, able to love and be loved. This is how healing works, and it is very much possible to be healed — to be whole — even as your body falls apart.

To the caregivers: Don’t be afraid to leave the room

In their final days and hours, dying people are usually in and out of consciousness; even when awake, they are often delirious. That means your loved one might say or do things that are completely out of character. Behavior ranges from sweet to insufferable. I met an elderly woman at a conference once who nervously relayed the story of her husband hurling strange and vulgar accusations before losing consciousness for good. Now there was trauma on top of sorrow. I wish someone had told her earlier about the very normal condition of deathbed delirium.
I also wish that caregivers knew it was OK to leave their loved one’s bedside. How many times will they have spent hours gathered in the room, not eating or sleeping for days, barely blinking, not wanting to miss that last breath, only to have the person die just when they nod off or use the bathroom?
As any hospice worker can tell you, this is also a well-known phenomenon. It’s almost as if the presence of others — especially deeply loved ones — gets in the way of the dying person’s final step. That big moment may need to happen alone. What dying people seem to need at the very end is to know that the people they love are going to be OK; that life will go on and that you — the person they care for — will be able to take care of yourself. So, the kindest thing you can do is to demonstrate that care by leaving the room when you need to. Just be sure to give a kiss and know that it may have to be the last.
Source: CNN BJ Miller, M.D.
BJ Miller, M.D. is a hospice & palliative medicine physician who sees patients and families at the UCSF Helen Diller Family Comprehensive Cancer Center. Miller’s career has been dedicated to moving healthcare towards a human centered approach and he advocates for this on a policy as well as personal level. He is the co- author of “A Beginner’s Guide to the End: Practical Advice for Living Life and Facing Death.”
The opinions expressed in this commentary are his own.

What Happens When a Senior Can No Longer Care for Their Pet?

Howard Cutler knows the joy animals can bring to people. His childhood memories are filled with stories of his family’s two beloved dogs and cats. After moving into a senior housing complex in Atlanta, Georgia, Cutler acted on his love of animals and adopted a Shih Tzu named Ollie from a fellow resident who could no longer care for the animal. For seven years, the pair was inseparable until Cutler’s Parkinson’s disease forced him to move to a different assisted care facility that didn’t allow pets.

“He was my friend and my companion, and giving him up was very difficult for me,” Cutler explains. As much as he wanted to keep little Ollie, Cutler knew he needed to rehome his beloved pet. He began looking among his neighbors in the senior complex to find a new owner. “Ollie was loved by everyone there, but I was worried that I wouldn’t find the right person.”

Cutler was fortunate to find the perfect fit in his friend and neighbor Nancy Markovich. “Howard was heartsick that he had to give up Ollie,” Markovich recalls. “So, I offered to adopt the dog and promised to take good care of him.”

Ollie’s veterinarian, Dr. Duffy Jones, says pets provide much-needed comfort and companionship to people of all ages, especially seniors. “The value that animals bring to people is amazing,” he says. “I’ve seen older pet owners who are struggling financially choose not feed themselves so they can feed their animals. Their pet is the reason they get up in the morning.”

But when aging pet owners find themselves unable to care for their animals, surrendering the pet is often the best course of action. “Most owners understand they’re sick and their pet needs more care than they’re able to provide,” Dr. Jones says. “They want to make a plan for their pets; It’s a real source of comfort.”

Senior Pet Owners Must Plan for the Unexpected

Dr. Jones encourages all pet owners to devise a succession plan for their animals as early as possible. Having a “plan b” in place before the pet owner becomes too ill, needs to move to a care facility or passes away will offer invaluable peace of mind for the owner and added security for their pet. He offers the following tips for creating a contingency plan for a loving animal:

  • Consider adoption. Ask friends and family who are familiar with the pet if they are willing and able to offer the animal a new home. Those who interact with the pet regularly will be better equipped to determine if the animal’s size, personality, routine, etc. would fit well with their schedule and lifestyle.
  • Talk to a vet. Veterinarians have many resources at their disposal and can often help rehome a pet. No-kill shelters can also be a useful option, and there are many non-profit rescue organizations around the U.S. that will also assist older adults in finding new homes for their animals.
  • Get the owner’s input. Be sure to let the pet owner have a say in the decision. Ask them who they would like to look after their pet. “In some cases, older people don’t have a lot of family around and their friends are going through similar transitions, so they worry what will happen to their pets,” explains Dr. Jones. “Animal owners are visibly relieved when we tell them we’ve found their pets a new home. It’s not uncommon for them to cry.”
  • Allow for a smooth transition. Ideally, the current owner will be able to help the pet transition to its new home. The goal is to help the animal and new owner build trust and become familiar with one another incrementally. Try having the new owner come for extended visits with the pet, take the animal for walks and care for it in the new home for short periods before full-time ownership begins. Small steps are easier on everyone involved compared to an abrupt change.
  • Rehomed pets aren’t gone forever. While evaluating prospective adopters, discuss the possibility of allowing the original owner to continue visiting with the animal. Even a monthly visit with a cherished furry friend can brighten up a senior’s day.

Dr. Jones says euthanizing a pet should be the last resort. “Some older people think that putting a pet down is best because the animal is so bonded to their owner,” he says. “We usually try to talk them out of it, explain that there are so many other options and then we work with the owner to rehome their pet(s).”

When Is It Time to Rehome a Senior’s Pet?

With so much research touting the physical and mental benefits that animals provide to humans, Dr. Jones advises that older people keep their pets for as long as possible. Unfortunately, though, circumstances do change. If either the pet or their elderly owner is living in a neglectful situation or experiencing a reduced quality of life, then it is time to explore alternative options. It can be difficult to balance the health, safety and happiness of both the senior and their pet, but it must be done.

Dr. Jones sympathizes with family members who don’t know what to do about their aging loved ones and their furry friends. “For caregivers, the thought of taking care of a person and their pet can be overwhelming,” he notes. “Sometimes older people haven’t trained their pets well, which can amount to behavioral problems and unsanitary conditions. But what people don’t see is that these animals mean so much to their owners. Separation often causes physical and emotional decline in both parties.”

Balance What Is Best for the Senior and Their Pet

Markovich has no regrets about adopting Ollie. She tried to make the transition as smooth as possible for both pet and owner. Cutler now receives the care and assistance he requires while Ollie gets the love and stimulation that dogs thrive on. Markovich inherited Ollie’s food and water dishes from Cutler and even places them in the same spot in her apartment at the senior housing community. The twosome goes for daily walks and Markovich hopes that she’s kept Ollie trained to Cutler’s standards.

Every month, Cutler gets to see his favorite companion when Markovich brings Ollie for a pet therapy visit at the assisted living community. “When he comes to see me, he’s overjoyed,” says Cutler. “When Nancy is ready to leave, he goes to her side to let me know he was happy to see me, but he is leaving with Nancy. I feel sad about that, but also happy that I was able to find a good home for him.”

Markovich is equally grateful for the opportunity to help a friend in need and to find the loving companionship that a pet brings. “Ollie sits by me on the sofa, sleeps on my bed and we are thick as thieves. He is a true blessing for me,” she remarks.

Source: AgingCare  by Candace Rotolo

The End-of-Life Doula Movement

The End-of-Life Doula MovementA doula shares her role in bringing comfort and empowerment to dying patients.

In ancient Greece, doulas were servants who supported women through childbirth. The reemergence of doula work began in earnest during the 1960s, this time featuring trained professionals providing emotional, informational, and physical support. The essence of being “of service” remains.

Doulas establish relationships with clients, gaining trust and developing rapport, clarifying the goals, fears, and wishes of each expectant family. Then, during labor, a birthing doula provides continuous support—wiping a brow, holding a hand, fetching ice water, rubbing an achy back, suggesting positions and breathing techniques, whispering encouragements, and ensuring all invited are operating within their preferred roles. As a laboring woman weathers the ups and downs, the doula remains steady and calm, believing in the woman and in the process.

More recently, doulas have begun offering support to people at the end of life as well. Dying and death offer many striking similarities to birthing. There’s unpredictability. There’s a unique unfolding of events. Time fades away, as do the usual distractions of daily life. As doulas, we tune in. We listen more deeply. We feel compelled to take each moment as it comes, knowing we cannot make assumptions. Clients face intensity, doubt, and suffering, which takes many forms, including spiritual, emotional, physical, intellectual, and psychological. There’s difficulty. There are heightened feelings and reactions. Dynamics shift and sway, threatening our sense of foundation—the anchor to our past, present, and future.

Both birthing and dying become a sort of liminal space, thresholds to mystery. Doulas honor them as such. They are rites of passage that have three distinct features. As people enter into the rite, the initial experience is one of severance. We exit the usual pace of our schedules. We separate from our responsibilities. We put life on hold.

In early labor, women generally return to or remain at home (in their comfort zone), giving full attention to the beckoning task at hand. They shift between working through intermittent contractions and preparing for their journeys into motherhood (gathering supports, nourishing themselves, arranging and organizing).

In early dying, we often notice changes in a person’s breathing, communication, and physical activity. People spend more time sleeping, less time socializing, and occasionally appear to be in a separate realm. In the case of both birthing and dying, consciousness and presence seem to waver between complete embodiment of awareness and what seems to be a level of dissociation with the reality those surrounding the person are experiencing.

Gradually, people enter the transition period of the rite. For birthing women, this could be considered the time between laboring and delivering the baby, ie, pushing. Contractions now bring different sensations and the body propels the process onward. Hormones shift and surge. The end goal is within sight. Women may experience exhaustion, exhilaration, fear, and excitement.

In the case of death, a person enters into active dying, the time of deep rest. Sometimes this is a quiet, peaceful phase. Sometimes there’s persistent pain and relentless agitation. Loved ones and care teams attempt to meet the needs of the dying person and lessen suffering as much as possible. It can be a time of great worry. Support people ask: How long will this go on? Am I ready for it to end?

Birth and death end relatively abruptly due to the incomparably momentous nature of both. For birth, it is the emergence of new life. For death, it is the end of a life. Reintegration is the final act of the rites of passage. A woman is reincorporated as “mother” into her community. Anything beyond death remains best understood by belief systems and mortal imaginings. We are without certainty. Survivors of the deceased reemerge as mourners, however.

How Might Doulas Serve? 
The main task of a doula is to offer emotional support. In every word, touch, approach, and method used, we bring careful attention to the inner well-being of our clients. We believe in people. We honor life and the mysterious enigma of death. Our aim is to listen deeply and provide personalized, nonjudgmental care to promote our clients’ growth and sense of agency.

Doulas have a number of compassionate offerings available to clients, although personalization is always key. We align with the goals, wishes, and needs of our clients and we respect their choices. Throughout the University of Vermont Larner College of Medicine’s End-of-Life (EOL) Doula Professional Certificate Program, we illuminate ways of being a doula (the heart of the work) and ways of doing doula work (techniques and approaches), including the following:

• discovering a client’s wishes;
• working through a client’s anxieties;
• honoring and holding sacred space;
• leading guided imagery, visualizations, and breathing exercises;
• promoting informed consent;
• assisting with legacy and completion work, as well as advance directives;
• conducting life review sessions;
• providing resource referrals;
• coordinating care; and
• vigil planning and sitting.

Doulas support both the dying person and their natural network, knowing that by attending to the needs of loved ones or incomplete life tasks, we enable our clients with more opportunities to consider deeper meaning and connection. We expect that different personalities will present at varying points along the spectrum of disbelief, anger, sadness, and acceptance. The components of grief are not good or bad, right or wrong—they just are. And doulas meet people where they are as they vacillate, remaining neutral and caring.

Like a birth doula, an EOL doula can help prepare clients and their loved ones for what is to come. In the case of pregnancy and a terminal diagnosis, there’s time to plan. EOL doulas can help families develop wishes for this often overwhelming period. Just as a birth doula inquires about a client’s postpartum plans, an EOL doula can ask about a postpassage plan: What expectations do you have? What might help you feel most supported? What do you have in place and what can we consider arranging?

These conversations require grace. Doulas need to recognize the appropriate moments to broach these topics—or, if clients and their loved ones are not ready, to plant seeds for future talks. Minimizing surprises helps enhance people’s sense of confidence as they enter into the unknown. We can alert people to what commonly occurs, nurturing foresight and readiness.

This focus on planning and plan implementation is integral in doula work. It’s how we ensure support is unique to each client. It’s how we respect each client’s dignity. We assist families with preparing for loss. Additionally, doulas help arrange clients’ calendars to honor their priorities for time spent while weighing energy levels. We ask questions such as the following:

• Which appointments and visits are most important?

• Can we create a meal train so that friends, neighbors, and family members can deliver food and necessities?

• Are there any additional services available that we might consider suggesting?

• Would our clients like to finalize expressed wishes for care (before, during, and after dying)?

• Can we work through some options for visualizations, keeping clients’ “special places” in mind, as we develop a personalized script to read?

• Would our clients like to complete a life review?

• Can we work on legacy gifts together?

• Can we plan for the vigil time (ie, how the clients would like their spaces to look, smell, and sound as well as who they would like to have present)?

• Are there readings or rituals we can explore and include?

Doulas carefully consider how we fit into the care team. Is a social worker already drafting funeral plans with the family? Is the hospice chaplain or priest from the client’s church meeting regularly to discuss existential questions? Would an aunt love to organize the creation of a giant photo collage? Is there a brother who feels compelled to manage the appointment and visitor schedule?

Doulas don’t duplicate. We provide complementary care, honoring the roles of all involved. No two clients will require the same level and type of doula support.

Why Does Doula Support Work?
Studies repeatedly demonstrate positive outcomes associated with birth doula care. According to researchers, “The presence of a trained doula providing continuous support to laboring women and their partners appears to have a significant effect on rates of instrumental vaginal deliveries and cesarean sections,”1

Furthermore, say the authors of a study comparing doula care with standard care, “Continuous support during labor may improve outcomes for women and infants, including increased spontaneous vaginal birth, shorter duration of labor, and decreased caesarean birth, instrumental vaginal birth, use of any analgesia, use of regional analgesia, low five-minute Apgar score, and negative feelings about childbirth experiences. We found no evidence of harms of continuous labor support.”

They add that “Continuous support from a person who is present solely to provide support, is not a member of the woman’s own network, is experienced in providing labor support, and has at least a modest amount of training (such as a doula), appears beneficial.”2

Why might continuous support from a doula be advantageous? When reviewing similar benefits of birth support in their research, Gruber and colleagues speculate: “Communication with and encouragement from a doula throughout the pregnancy may have increased the mother’s self-efficacy regarding her ability to impact her own pregnancy outcomes.3

We imbue our commitment to positive regard into our approach to care—every touch, gesture, and conversation. We do not dip into internal reserves to replenish a client’s sense of emptiness. Instead, a doula believes in the inherent wisdom and strength of each human being and their limitless potential to evolve. We recognize the tendency toward self-doubt during times of intensity and firmly believe in people’s capacity to find their footing and next steps, even—especially—when they feel lost or overwhelmed.

In the throes of liminal space, doulas remain the calm in the chaos. We encourage a thoughtful slowing down when many feel rushed to get past a hurdle. We nurture contemplation as clients consider tumultuous periods, questions, and crossroads. We turn toward and lean into suffering with our abiding faith in people and know we are not meant to “save” or “rescue” people from their journeys.

Might there be comparable opportunities and equally beneficial reasons to include doula support at end-of-life in addition to birth? In a study investigating the effectiveness of lay health workers, researchers from Stanford University Medical Center found that “Patients with advanced cancer who spoke with a trained nonclinical worker about personal goals for care were more likely to talk with doctors about their preferences, report higher satisfaction with their care, and incur lower health costs in their final month of life.”4

In these cases of research on birth and death, a nonmedical emotional support person provided the listening ear required to forge connection, cultivate honesty, and improve outcomes. Satisfaction went up; costs went down.

Barriers to Providing Doula Care
There are a few marked obstacles EOL doulas face as they enter the field, the most pressing being role recognition and financial structures. Currently, there’s no credentialing body overseeing doula work. Doulas are not licensed professionals. This remains true of birth doulas, who have been completing training protocols since the early 1990s with the inception of DONA International, the oldest and largest doula training organization.

There are myriad options for becoming a doula (birth and EOL). Most programs are rigorous and comprehensive although they range in terms of the breadth of topics covered, length of studies, and required assignments.

In recognition of this burgeoning field, the National Hospice and Palliative Care Organization (NHPCO) has established an End-of-Life Doula Advisory Council that “provides information and resources to NHPCO, its members, affiliated organizations, and the general public to promote awareness and understanding of the end-of-life doula role. It also informs those constituents of the benefits of doulas for dying people and their families, and guides them on incorporating doulas into existing services and how to access outside doula providers.”5

Doulas and medical teams need to work collaboratively, respecting our common goal of providing superb, holistic care. Increasingly, hospice and palliative care programs are including doulas on their teams, although mainly in a volunteer capacity thus far.

How do doulas establish this new role? Doulas often balance this effort in the workspace and in the public sphere. When serving clients, we are introducing our scope of offerings. We are indirectly educating as we allay the fears of care providers who wonder about our place in the realm: Will doulas invade? Will we push people to the side? Will we take over? Will we make/question medical decisions? What do we do? What is our agenda?

Doulas have numerous jobs, activities, exercises, and techniques to administer, but we are also there as a companion, witness, and listener. This requires graceful flexibility. Meeting people where they are means not always adhering to a premeditated itinerary. We need to be versatile and adaptable while remaining within our scope.

As team members witness doula work, they begin to value our contributions and realize what we offer is augmenting what’s already available. We add harmony. We complement care. We acknowledge the varied personalities and gifts of those present and involved.

Doulas do not offend. We are anodyne in our neutrality. Our presence is innocuous and does not arouse anxiety. We offer support without drawing attention to ourselves. This is not ego work; this is heart work. While supporting clients, we become caregiving chameleons. There’s shape-shifting involved. We read the room. In accordance with the needs of the moment, we step forward or back.

Financial structures also present issues for doulas. Charging fees for this type of work has been and will remain a challenge. Doula work primarily has been a private pay transaction or volunteer work. Insurance programs offer very little in the way of coverage. In a few states, birth doulas have worked to pass legislation to require Medicaid coverage, but the low reimbursement rate has prevented most practicing doulas from completing and filing the necessary paperwork.

There is some potential for more inclusionary coverage as hospitals shift away from fee-for-service models to value-based reimbursement.6 Also, choices for care and long term care programs offer options for fund allocations, which could perhaps include doula support.

Core Care Components
What remains at the core of doula efforts, and enhancing the experience of death at large, is our fellow humans. How do we want to be treated? How do we want to be honored? What would we want for ourselves? What can we make available and possible?

Options are empowering. There is work to be done. There is a place for doulas by the bedside. As I explained in my book, Cultivating the Doula Heart, “We are sensitive and affirming, soothing in our care. We are not dismissive. We do not minimize a person’s interpretation of what they are undergoing. Through all the ways we doula, we promote empowerment and healing born of processing and bravely facing that which threatens one’s sense of intactness. This healing—not in the sense of a cure, but in the sense of an unbroken soul—generates peace in the face of chaos.”7

— Francesca Arnoldy is the author of Cultivating the Doula Heart: Essentials of Compassionate Care.

Source: Todays’ Geriatric Medicine

Caregiving Language – Use It to Uplift and Embrace

Caregiving Language - Use It to Uplift and EmbraceIf you are caring for someone who is living with Alzheimer’s disease, maybe you can relate to this experience:

“Are you with me or not?” my father asked sternly.

“Yes, I’m with you!” I replied without hesitation.

Alzheimer’s disease had progressed between the mid- to late-stage of the disease for my father.

I scanned his face and the area for clues. None. I had no idea what he was talking about.

He looked annoyed at me – at my inaction. “We have to get going, now!”

“How about you take the lead? I’ll be right beside you.”

He walked to the front door. We stood there and waited.

It turned out, we were waiting for the train from California to England to fight with our “fellow countrymen.” My father’s never been to England. His fellow countrymen are Armenian, not English. And, of course, no train travels from California across the ocean, but none of that was important.

Even when someone is making so little sense, how you respond as a caregiver matters to your relationship with them. Even when a person with dementia can express himself, we might still be left asking ourselves, “What is he talking about?” You can’t be a mind reader, and you don’t have to be. Choose your words carefully with kindness to help this person feel secure and safe in your company.

The Negative Nature of Our Language

The words we choose impact how secure we help our care recipients feel. Oftentimes, we don’t realize how our language affects others.

After initial mishaps, I learned to align with my father’s requests.

When he says he wants to drive somewhere, I hand him the keys. Like the improvisational artist, I try keep the scene moving, having no idea what to expect. The fact is, he cannot legally drive anymore.

After he moved to California from his Wisconsin home of 45 years, I knew the new setting would be disorienting and he no longer had a car to drive. With some confidence I’d reply, “You had the car last. I don’t know where you parked it.” My strategy was to go along with him, not argue or correct.

He’d take the car keys and walk rapidly, pause, look at the car keys – two postal box keys, two house keys and a car key fob. Confusing to a man who was used to plain similarly sized keys. Distracted by something else, he set the keys down. Each time, I thought, Phew, that was a close call!

Ask yourself, “Do my words push people away or do they bring them closer?”

Our goal is to give verbal hugs with language that embraces. I aligned with my father’s request to drive and even handed him a set of keys. We want to uplift those we care for with our remarks.

It’s quite a challenge, because the English language limits our choices.

We speak mainly in either-or, black or white and yes or no. There are few words to describe the greys, the in-betweens and the maybes. Furthermore, our use of language tends to skew negative.

For example, consider one deflating yet all-too-frequent response to a compliment. A server, receptionist or a customer-care employee, may reply, “No problem.” After I uplift a person with words of praise, hearing “no problem” is deflating. I wonder, when did this become a “problem?”

It might feel more uplifting to reply with, “You’re welcome” or “My pleasure.” These words can feel more like an embrace.

Consider practicing these three tips to embrace and uplift with your words.

Language-Use Tips

Say what is.

Instead of saying what we don’t want or what isn’t –

“What did you think of that?”

“Not bad!”

“What would you like to eat?”

“Not ham!”

Practice using words to express what we want.

“I’m really in the mood for a small piece of roast beef. That would really hit the spot, right now.”

We spend so much time on the exception or what we don’t want, we can lose sight of the plentiful buffet of options before us.

Keep things positive with encouragement such as, “I’m in the mood for…” and keep a conversation going rather than shutting it down with a negative. Reread the italicized replies, above and take note of how you feel.

In general, this negative slant in our language-use, may be one reason our goals are elusive. When we focus on excluding or what we don’t want, that’s what we often get. When our attention and efforts are aimed toward what we want in life, we’ll have a better chance of achieving it.

Habits are hard to change. When we muster the courage each day and commit to apply these skills, we’ll have a better chance of success in day-to-day care of our loved one. Adding an improvisational tool will help, too.

The goal with improvisation is to keep the scene moving. The primary way to accomplish this is to respond affirmatively. Improvisational artists will say, “Yes.” They’ll also add “and” followed by a new piece of information.

While presenting a keynote recently, I briefed a volunteer and then asked her, “May I have $5.00?” She replied, “Yes.” As she reached into her pocket, she asked, “And may I have a $20?”

The audience laughed. She kept the scene moving, instead of refusing with “No” or “I don’t have a “five.”

Practice responding in such a way that you align yourself with your care recipient’s interests. Instead of shutting down communications and creating feelings of insecurity, you’ll strengthen your relationship and find space to add a touch of humor.

Add Humor
When the conversation is flowing, it frees-up creative energy. In the example above, the attendee’s response was a win-win. I got what I wanted and her clever response got her even more. Plus, we entertained the audience.

Interactions that include laughter (even smiles) bring people closer and strengthen feelings of security.

Are You with Me?

As my father and I stood at the door waiting for a train that would never come in our lifetimes, I remained clueless. I had no idea what he had in mind. Without challenging his resolve, I asked tangential questions.

“Do you think the train will take us from California to England?”

He looked at me quizzically.

“I mean, will we need to board another train?”

Trying to assess my sincerity, he replied, “We’ll be traveling through the night, making many stops to pick up others.”

Oh my! This is going to be a challenge. What the heck is he talking about? I tried another approach.

“Since we’ll need our strength, shall we eat, first? I’ll check the schedule to make sure we don’t miss the train.”

“Sure, let’s eat. Let’s make sure we don’t miss the train.”

After all that, I learned we were in the midst of WWIIHe had been paging through an issue of LIFE magazine.

In my personal experience as a caregiver, I have found that using these strategies results in uplifting and embracing communications and improving our relationships.

Source: Homewatch Care Givers – By Brenda, Avadian, MA, The Caregiver’s Voice

8 Facts to Know About Lewy Body Dementia

Most people mistakenly believe that all types of dementia share similar symptoms, like the hallmark signs of forgetfulness and confusion that are associated with Alzheimer’s disease (AD). However, Lewy body dementia (LBD), the second most common type after AD, is characterized by unique symptoms that make it difficult to diagnose and treat.

It’s important for family caregivers who are looking after aging loved ones to familiarize themselves with some of the basic signs of various age-related diseases like LBD. Noticing strange new behaviors or quirks early on can help ensure a senior gets the medical attention they need in a timely manner.

Facts About Lewy Body Dementia

  1. It affects millions of seniors. 
    According to the Lewy Body Dementia Association, LBD affects approximately 1.4 million individuals and their families. Although it is widely unknown, it is the second most common form of dementia after Alzheimer’s disease.
  2. LBD is not Alzheimer’s disease.
    Many people use the terms “dementia” and “Alzheimer’s disease” interchangeably, but dementia is an umbrella term used to describe a progressive neurological disorder that affects cognitive function, of which there are many different kinds. Alzheimer’s is one form of dementia that is characterized by impaired memory, issues with decision making, trouble with problem solving and difficulty learning new skills.
    There are crucial differences between AD and LBD. For one thing, people with LBD experience unpredictable changes in cognition, regardless of the time of day, whereas people with Alzheimer’s tend to have more trouble in the late afternoon and evening—a symptom known as “sundowning.” Those with LBD also tend to have more visual hallucinations and movement issues, while the hallmarks of AD include memory loss and trouble performing familiar tasks. Furthermore, abnormal alpha-synuclein protein deposits in the brain called Lewy bodies are the hallmark biological marker of LBD, unlike Alzheimer’s, which is caused by the accumulation of beta-amyloid plaques and tau tangles in brain tissue.
  3. LBD is difficult to diagnose.
    As with Alzheimer’s, LBD can only be conclusively diagnosed through an examination of brain tissue after a person has died. However, medical advancements have significantly improved the certainty with which doctors can diagnose living patients.
    Doctors consider the person’s symptoms, interview their family members, perform physical and mental evaluations, obtain a family and personal medical history, and conduct blood tests and brain imaging tests like MRI, PET and CT scans. Symptoms of LBD include problems with depth perception, hallucinations (often visual), delusions, paranoia, Parkinsonism (body stiffness, tremors, trouble walking), and physical issues like heart rate and blood pressure fluctuations, constipation, and fainting spells. To be diagnosed with LBD, an individual must have dementia as well as several of these symptoms.
  4. Medications and LBD can have adverse interactions.
    An accurate, timely diagnosis of LBD is essential to avoiding dangerous medication reactions. Many drugs prescribed to people with Alzheimer’s disease and Parkinson’s disease—especially antipsychotic drugs used to control hallucinations—can have a dangerous effect on people with LBD. Neuroleptic malignant syndrome (NMS) is a neurological disorder brought on by a negative reaction to antipsychotic medications that often occurs in people with LBD. Individuals who develop NMS can experience muscular rigidity, high fever, variable blood pressure and severe sweating. Anticholinergic medications, benzodiazepines and over-the-counter sleeping pills can also have negative effects on seniors with Lewy body dementia.
  5. Parkinson’s disease and LBD are very similar.
    People with LBD often exhibit the same symptoms as those with Parkinson’s disease dementia (PDD). While the two conditions start off differently, their biological underpinnings are closely related, and people with Parkinson’s disease can be diagnosed with either PDD or LBD. The factor that physicians use to distinguish between these two conditions is the timing of the onset of cognitive symptoms. People who develop dementia within a year of their Parkinson’s diagnosis are thought to have LBD, while those whose dementia symptoms start beyond the one-year mark are thought to have PDD.
  6. LBD affects sleep quality.
    Sleep issues and dementia often go hand in hand, but there’s a specific sleep condition that appears to disproportionately affect people with LBD. Studies indicate that as many as two-thirds of LBD patients struggle with REM sleep behavior disorder (RBD). RBD is an ailment that causes movement, speaking and gesturing during the REM (rapid eye movement) stage of sleep, which is usually characterized by paralysis in healthy individuals.
  7. Like most dementias, LBD is unpredictable.
    One of the biggest challenges facing seniors with LBD and their families is the fact that symptoms of the disease tend to worsen and improve erratically. Periods of mental fog, aggressive behavior, movement issues and vivid hallucinations can last seconds, minutes, hours or days. Fluctuations in symptoms can be caused by underlying infections, medications or general progression of the disease. Because of this, it can be nearly impossible to determine how far LBD has progressed in a given individual. However, if the exacerbating factor is capable of being fixed (like a urinary tract infection), then the person with LBD can often return to their prior level of functioning after receiving treatment for the secondary issue.
  8. LBD has no cure.
    There is currently no way to cure or halt the progression of LBD. Instead, treatments are aimed at controlling the cognitive, psychiatric and motor symptoms of the disorder. Those who have been diagnosed with the condition may benefit from palliative care, which focuses on using drugs and nonpharmaceutical treatments to manage symptoms and improve a patient’s comfort and quality of life. For instance, cognitive issues may be addressed with cholinesterase inhibitors, a type of medication that promotes brain cell function by regulating the neurotransmitter acetylcholine. To improve sleep quality and minimize the effects of RBD, careful treatment with clonazepam (Klonopin) or melatonin might be prescribed. Levodopa may be used to mitigate the motor effects of severe Parkinsonism. Occupational, speech and physical therapies are the most common nonpharmaceutical approaches to helping people with LBD manage their condition and maintain day-to-day functionality. Average life expectancy after diagnosis is about 8 years, with progressively increasing cognitive and functional disability.

Source: AginCare by Anne-Marie Botek

How You Can Help Seniors Facing the Holidays Alone

How You Can Help Seniors Facing the Holidays AloneImagine waking up alone on Christmas morning, with no one to share in the joy of the holiday with you. Imagine getting dressed the way you always do, having breakfast the way you always do, and watching TV as you always do—nothing special about this day, no grandchildren squealing with delight as they tear open packages under the tree, no family dinner to look forward to later.

That is the scenario faced by tens of thousands of seniors who have no living family members or whose relatives who live far away and can’t visit at Christmastime. These seniors may come from a variety of faiths or backgrounds, but what they have in common is an estrangement from the holiday season, their faith traditions and all the seasonal merriment.

According to the National Center for Health Statistics, as many as half of all long-term care residents have no living relations. Of those who do have family, around 60 percent of them never receive a visitor.

If that statistic makes you feel sad, consider it may be just the tip of the iceberg. It’s possible a similar number of seniors who reside at home or outside a care facility also lack regular visitors, either because they have no relatives or because their families are disengaged.

This holiday season, you have the opportunity to make a positive contribution to the lives of these forgotten seniors. Here are some ways you can make the holidays merry for them.

Problem: Family members live far away and can’t travel to visit during the holidays

Solution: Go high-tech

Help arrange a real-time video chat between the senior and his or her family members using a tablet computer. Software programs like Skype and FaceTime offer free or low-cost options for video conversations.

If the video chat goes well, don’t restrict it to the holidays. Offer to facilitate regular face-to-face teleconferencing each week or month.

Problem: Seniors receive no gifts or greetings during the holidays

Solution: Be a Santa to a Senior

The Be a Santa to a Senior®  program, sponsored by Home Instead Senior Care®, makes the holidays merrier for those who will not be receiving gifts or visitors during the season. You can submit the senior’s information to a local participating Home Instead Senior Care office and allow him or her to be surprised with a personally delivered present. And while you’re at it, don’t forget to pull an ornament off the giving tree yourself to provide a gift for a lonely senior.

If your area doesn’t have a Be a Santa to a Senior program, look for similar opportunities through retailers and faith communities.

Problem: Isolation during the holiday season

Solution: Take a drive

Many seniors face the challenge of being isolated throughout the year. Physical frailty and giving up the car keys can keep a senior cooped up at home. This can be especially depressing during the holiday season.

If you are a private one-on-one caregiver, you can help alleviate the senior’s isolation by taking him or her for a ride to view holiday lights and decorations or to tour the fall foliage. If the senior gets around reasonably well, take him or her to the food court at the mall to sit and view the bustle of shoppers and the beautiful decorations.

If you work at a facility, try to arrange a holiday lights field trip for your residents who are capable of participating. You might be able to find a community sponsor to provide vans and additional supervision.

Problem: Seniors can’t share family memories because relatives are absent

Solution: Pull out the photo albums

One of the best parts of gathering with family during the holidays is sharing the “family lore”: funny or poignant stories of past events. When seniors have no living relatives, it means they can no longer share that story of the time the dog tipped the Christmas tree over or that time when Uncle Joe’s Santa beard fell off and revealed him as a fraud to the shocked young cousins. You can step in and act as a surrogate family member by asking to see family photos and encouraging the senior to tell you stories about the people and events pictured.

Problem: No way for a senior shut-in to volunteer during the holidays

Solution: Perform acts of charity from the living room

Many people volunteer for charity work during the holidays. If a senior you care for was one of the people who volunteered, he or she may feel they are missing out on a key part of their traditional holiday experience.

You can help them by participating in acts of charity right from their residence. They can buy a box of holiday cards and address them to troops stationed overseas. Or they can crochet blankets for babies at the children’s hospital. When you help them perform an activity that ‘gives back’ to the community, you let them engage in a meaningful way with the holidays and may boost their self-esteem and overall sense of well-being.

Of course, while caring for a lonely senior during the holiday season, it can be difficult to maintain professional boundaries. You may want to “go the extra mile” to express your fondness for some of your clients, but do not give or accept gifts if your employer’s policy prohibits it. Remember your presence in a senior’s life may be the greatest gift of all—no other present necessary.

How do you brighten the holidays for your clients? What challenges do you face? Tell us more in the comments!


How to Stay Sane During the Holidays as a Sandwich Generation Caregiver

If one can believe the old Westerns, frontier women were the ultimate multi-taskers. They could rock a cradle with their foot to quiet a squalling baby while pounding out bread dough with their fists, minding a full crew of young kids and maybe dodging a few bullets in the process. Oh, yeah, and since it was just days before Christmas, these women would also be knitting gifts for the family during odd bits of time.

That scenario sounds like a walk in the park compared to the lives of some modern caregivers, especially those who belong to the sandwich generation. These men and women work overtime to raise children while caring for their aging parents. During the holiday season, nearly every parent has one, if not several, school holiday performances to attend and church or other religious programs to participate in. Many have a full-time job, which often requires attendance at office functions outside of work hours, not to mention festivities during work time that require a big smile and a batch of homemade cookies. Sound familiar? All of this is expected in addition to maintaining traditions and holiday cheer at home.

Prior to an aging parent’s health issues, the busy season described above would be a “normal” Christmas for you and your family. Things would be rushed but still mostly pleasant. Not now. The house sits undecorated, your favorite cookie recipes have been swept into a corner on the kitchen counter, you’re behind on your holiday shopping and when you attend your kids’ programs, you fight to make yourself look like you actually want to be there. The addition of caregiving is often the tipping point between enjoying the holiday season and teetering on the edge of insanity.

Caregivers Tend to Spread Themselves Too Thin

You think back. Mom had always been helpful, doing some of the baking and stepping in when you needed help with the kids. Dad was good natured and would even pitch in with some decorating tasks when your husband was traveling. Now your parents both need help. Lots of help. Your kids still need you. Your spouse needs you. You feel like everyone wants a piece of you. You feel angry and that leads to guilt. Why does this feel so unfair? And where is the will to celebrate? What’s a caregiver to do?

You know this is your new normal, at least for the present. And it’s still the holiday season. Somehow, you must carry on and make it special for your children and your parents. It’s tough, but it is possible to find a balance and stick to it.

Getting used to this new normal will take some sacrifices from everyone in your family. It’s important to have a frank discussion with your kids and your spouse. If your parents are still cognitively sound, it’s important to talk with them, too, even if they aren’t keen on hearing you out. Tell them that you love them and that this holiday season will still be fun and special, but that it’ll be a little different compared to previous years.

Accept That the Holidays Have Changed

Your kids will understand if you only make a few different types of cookies this year rather than your usual massive spread. Just focus on the favorites. When decorating, don’t let storage bins full of lights and ornaments overwhelm you. Pick out your favorite decorations that mean the most to your family and ask the kids to pick out a few of their favorite items as well. Even if the holiday celebrations have been downsized, you’ll know that the most important traditions are still intact.

Include your kids in the cooking, decorating and visiting with your elders. If you can convince them to do something for their grandparents, that is even better. Having a few extra pairs of hands to help is a game changer, so dictate a few tasks for your kids to do around your house and your parents’ place(s).

Learning to say no to invitations or at least scale back on your commitments is important, too. Consider allowing someone else to host the big family dinner, purchasing your dish for the office potluck instead of making it yourself, or asking other close families if your kids could tag along for holiday activities like the tree lighting ceremony or ice skating.

Because I had so many elders to care for at once, I had several apartments and rooms at long-term care facilities to decorate. My house got less attention. Baking got whittled down to the classics as well. My own Christmas cards got short shrift. But my sons, my elders and I enjoyed this time together and that is what’s most important.

Likely, you will find you must follow a similar pattern. You can’t do everything the same as you did when the kids were young and your parents were healthy. Life has changed. Accepting that change is your first step toward keeping your sanity. In the end, you may find that a more low-key approach to the holidays leads to the development of new traditions. The upside of focusing less on the food, frills and gifts is that you have more time to spend with the people you love.

The Holidays Will Go On

If you find yourself feeling guilty or running low on holiday spirit, it may help to reflect on holidays past. How did your parents cope with the aging of their own parents? Remember when you were in grade school and Grandma had a heart attack? You weren’t stunted for life because your mom couldn’t complete all the traditional duties for the family that Christmas. You instinctively understood. Maybe this peek at real life even helped you grow and learn how family steps up to care for one another.

Holidays are undeniably hard work. When you add elder care to the mix, the most wonderful time of the year can seem like anything but. The only way I know of to avoid feeling overwhelmed is to determine what really matters to you and your family and only do those things. Do as much for your parents as you can, but if they have in-home care or live in a long-term care facility, let the professional staff do their part. Do as much as you can for your kids, but let them grow up a little and witness the cycle of life and the demands that elder care places on you. It’s likely that your family doesn’t truly understand the lengths you go to to ensure everyone is healthy and happy. A glimpse behind the veil might awaken in them a whole new sense of appreciation for all that you do.

Source: AgingCare by Carol Bradley Bursack