Tag: Caregiver

What are the two things that, usually, trigger a need to move a loved one into an assisted living facility (especially a person with a dementia or Alzheimer’s disease)?

Posted on August 31, 2022 by - #alzheimers, #caregiver, #dementia, Caregiver Information

I know, it is usually more than two things, but, these two, in particular, seem to ramp up the need for 24/7 in-home care or transitioning to an assisted living facility. Toileting and Bathing. Some helpers/caregivers can help a spouse or partner with toileting and bathing duties with no problem, but when it comes to an aging parent, they can’t seem to handle those areas. Some are willing to learn how to do these things safely and some are not going to do them at all. Still, others will do it in an emergency situation, but not all the time. Whatever you choose is the right decision for you.

August 31, 2022

Emotions, feelings, physical strength, and preparedness are all important factors in helping someone to toilet or bathe. Embarrassment, Stress, Rebellion, Stubbornness, Shame, and whatever else shows up will have to be dealt with respectfully. Everybody will feel embarrassed.

Helping Your Loved One with Privacy and Personal Hygiene

We all want to do our private business by ourselves. Imagine, that you have had surgery on your right shoulder and your left arm is hooked up to an IV bag on a pole. Now, imagine that you have to go to the bathroom badly and it is not to pee. Can you wait on a nurse? No. A side note, it is so much easier to let someone, you don’t know, who is trained in helping a patient poop and then clean their bottom, help you than it is to let a partner, spouse, or loved one help you. I was so embarrassed to have someone that I knew and loved to wipe my bottom. It was an awful feeling. The person doing the wiping was great and it did not seem to bother her as she said, “I’ve cleaned my kids’ butts, no big deal.”

Pooping is a normal bodily function. Peeing is a normal bodily function. Why did I wig out over having to go? Because I could not take care of my needs at the time. I was vulnerable. I was embarrassed. I needed help. I am the one that helps others, I don’t need help. Although, I am not sure that I could wipe someone’s bottom that I love or care about on a regular basis. I probably could in an emergency, but not all the time. I guess we really don’t know what we will or won’t do until we are put in the situation. I have learned to never say never. Some of you are thinking, “Well, if you did it once, then you can do it again and again.” Probably, but I don’t want to!

You better be strong and patient

It takes time, effort, and physical strength to help a loved one toilet and bathe. It takes someone that knows how to do these things appropriately and safely. It takes someone that is patient and kind throughout the entire process. Will both of you get over the embarrassment? If you can, then all the better to help your loved one be as independent as possible. Realizing that some help with toileting and bathing will help your loved one stay at home longer.

Safety needs for older folks and memory care folks

Grab bars are a must for the toilet and shower/bath. A raised toilet seat will help too. Non-slip decals need to be placed in the tub. Brighter light is a plus. Some bathrooms need to be heated with a ceramic floor heater or an oil-filled radiator heater. Be sure whatever you get, is appropriate and safe for a bathroom.

Schedule regular bathroom breaks every 2 – 4 hours. Give them time to get there. Pack your patience and a loving demeanor along with a loving tone. Give them directions and let them know what you are doing.

    • The toilet seat is right behind you. Squat down slowly to sit.

    • I am going to help you stand up now. Scoot your butt forward.

    • Lean forward and put your hands on my forearms when you are ready. Then ask them to raise/stand up. (Do not pull on their arms or legs. Hold on to the trunk of their body or their hips.)

Learn to wipe properly

If it is the opposite gender from you, learn to wipe properly. For example, an adult son, helping his mom toilet needs to know that to wipe a female, you wipe from the front to the back. So, put on your gloves and wipe from the vagina towards the rectum. This keeps fecal matter from getting into the vaginal opening and the urinary tract. Use wet wipes for cleaning and throw them in the trash can. Keep the private areas clean to lessen the chance of a UTI.

If the person you are helping has a dementia, remember that they can sense emotions so keep calm and carry on. Do not make a big deal out of anything. Do not mention clothes or the mess. Sing a song and carry on. They are going to have an accident.

Nighttime Accidents:

Either they cannot make it to the toilet on time or they have no awareness that they need to “go,” The unawareness may be due to a dementia. It may also be that they have no warning from their brain signals that they have to “go.” They do not feel the urge. Sometimes, they feel the urge too late and can’t make it on time. Shit happens,  literally. Use the adult undergarments. Don’t call them diapers. Absorbent underwear with pads under the bottom sheet in the pelvic area may help protect the mattress. If urinary or bowel incontinence is an issue at night, go ahead and place two bottom sheets on the bed with pads in the appropriate place. Keep the mattress dry. That way, you can strip off the top layer, get them cleaned up, and back into bed without too much fuss.

You may also try using an absorbent menstrual pad under the absorbent underwear to catch excess urine.

If they have a poop incident at night, you may have to strip them, get them in the shower, and wash them. Place some Vicks Vapo Rub under your nose to block some of the smell.  Lotion them and redress them. If they are calm, then back to bed, and if not, go to the kitchen for a little snack or treat. Rinse the poopy clothes in the toilet to get as much fecal material off as you can. The same goes for the sheets and blankets. Launder in the washing machine. Sing a song and soldier on. The calmer you are the calmer they will be. If they do not have a dementia, the calmer you are the less stressed they will be. It is okay, it was an accident.

Do’s and Don’ts

Learn their habits. When do they normally poop? After breakfast? After the second cup of coffee? After dinner? When do they usually pee? Another useful tidbit … wear easy-on and easy-off clothes. Help them to maintain their privacy and dignity as much as possible. Dignity is based on people’s feelings, emotions, and perceptions & other peoples’ reactions to them. Watch your tone of voice. Do not use words of any kind that associate with a “baby-state.”

    • Close the door when they are in the bathroom. Give them privacy (if it is safe).

    • Cover the top of their lap with a towel.

    • Give them extra time to sit. Bodies need to relax to pee and poop.

    • Knock before opening a door.

    • Turn your head away when they are pulling their pants up or down.

    • Do not discuss their business with others.

    • Do not restrict their fluid intake because of incontinence. You may slow it down after dinner, but never stop them from drinking. You need to encourage drinking throughout the day.

Let’s move on to showering.

Showering or bathing 3 times a week may be sufficient. You can use wet wipes for underarms, privates, feet, and rolls (where skin touches skin) on the other days. Lotion is good for their body and so is a face moisturizer. Clean clothes and underwear every day. Teeth brushed twice every day and flossed once a day.

Shower day:

    • Gather all supplies you will need (shower chair or bench, body soap/wash, pouf with a handle, 3 washcloths, shampoo, conditioner, shaving cream/gel, razor, 3 towels,  robe, body lotion, etc.) Some use a barber’s cape to cover them.

    • Heat the bathroom with a heater.

    • Deep breathe and get yourself in the right frame of mind to help them.

    • Follow them in and help them toilet and undress. While they are on the toilet, start the shower and check the temperature before putting them in. A hand-held shower head is very useful. Warmer than lukewarm water, but not hot.

    • Have them use the grab bars and guide them to the shower seat. ** Note: if you know that you will be the one washing the private parts and bottom …Latex gloves on, have 2 washcloths ready, and use one for their front and one for their backside. Rinse well and then have them sit. **

    • You may drape a towel over their lap and shoulders to maintain dignity.

    • Allow them to wash on their own. You only help if they can’t get everything washed.

    • Wash the hair and condition it, first (always rinse well).

    • Wash the body from face down. Start with the face, neck, and ears. Then proceed to the shoulders, back, right arm, and left arm. Front of body, under breasts, right leg, right foot, and toes, left leg, foot and toes, Be gentle when lifting limbs. You may have to ask them to lean forward or to the side. Have them clean their bottom and private parts, if at all possible. This is easier while they are standing. Decide what works best for them, private parts first or last.

    • Drape a terry cloth robe around them (it helps in the drying process).

    • Try to pat dry and not rub vigorously (again, you want them to do everything they can do).

    • Look at the skin for any red or cracked places. If there are some, contact their primary care doctor. You may need to use a skin protectant like Calmoseptine.

    • Lotion everywhere, except between the toes. Make sure between the toes are completely dry. Make sure the genitals, perineal area, and bottom areas are dry as well.

    • Ask them about their normal routine for shaving. Some men shave in the shower and some shave after their shower at the sink. Ask the ladies if they want to shave, as some may no longer shave or even need to shave their legs. Ask them about shaving their underarms too.

    • Ask them if they prefer the morning, evening, or afternoon for a bath/shower.

When you need to help them wash body parts:

    • If you need to help them wash, use latex gloves (this barrier may make them and you feel more comfortable).

    • Use a clean washcloth for the genitals area and another clean washcloth for the anal area

    • For females, clean from front to back. Washing the inner thighs, labia groin and perineum.

    • dry the skin folds and skin underneath the breast.

    • Apply face moisturizer

    • Apply lotion.

    • Apply deodorant.

    • Brush teeth.

    • Get them dressed in clean clothes and comfortable for a little rest afterward. They will be tired. Give them their favorite drink or snack.

    • For males, clean the tip and shaft of the penis and the scrotum & perineal area. For uncircumcised men, pull back the foreskin, wash, rinse and place the skin back into position.

    • Wash the anal area (where the poop comes out). Use a clean area of the washcloth with every pass.

    • Be quick, gentle, and efficient. Rinse well.

Always have clean sheets once a week after a bath. The little things do matter.

Yes, you will have a load of laundry to do after bath time. Accept it.

Pat

Are there any positive benefits to being a family caregiver?

Posted on February 3, 2022 by - #alzheimers, #caregiver, #caregivers, #ms

Sandwich generation

February 2, 2022

So often we talk about the stressors and negative consequences of helping a loved one. But, what about the positive things that can happen? There actually are some benefits.

Care giving is full of ups and downs. Every day may be different. Different is not always a bad thing. You may even have more pleasant days than bad days. I know, some of you are thinking that pleasant days are not what you experience. I get it, not everything is going to be pleasant.

Think back to a rough day. One where it took you three hours to get them dressed and fed. Maybe, it was a day that they did not recognize you and they balked at every turn. It gets emotionally draining. We tend to remember all the problems and struggles that we deal with. Why? I am sure our amygdala has something to do with it. LOL. Look, we remember it because it messed with our plans. We hit a resistance or barrier of some kind. Did we shift our focus or try another way or even try again later? Nope. We pushed through and made it happen. What was left in our wake? Wasted time. Hurt feelings. Frustration. We just reinforced all of the negative feelings. We forgot to focus on the small victories. They can still get dressed and they can still eat. They can still get out. Your unmet expectations are what really caused the “problems.”

While we are focusing on a dementia or Alzheimer’s related issue today, it could be any chronic health condition that causes a decline in our loved one. A physical decline and/or a mental decline happens in a lot of other diagnoses.

There will be difficult days as a caregiver

I wish that I could tell you there are predictable patterns. It all depends on what area(s) of the brain are affected. Their brain is failing. You may experience a problem with the bathing issues and someone else may be dealing with the 500 questions a day issue (the same 500 questions). Maybe, they are still quite mobile and wander off, repeatedly. You must realize that all of these behaviors are UNCONTROLLABLE for folks with dementia. Alzheimer’s is the most common dementia. Analyze your own response to the frustration. See what you can modify or change to make the process go more smoothly. If you find yourself getting more and more frustrated, it is past time for you to take a break.

Focus on what they CAN do

Next time, focus on what they can do. See what they can do for themselves, even if it takes longer. What would you consider a success, taking their limitations or bad days in to account? Go in with a smile and a warm fuzzy feeling in your attitude. They will pick up on that. Spend a few minutes talking with them. Touching them gently on the arm or shoulder. Use the phrase, “we are going to _____________ now.” One thing at a time. One arm at a time. Speak to them and tell them what “we” are doing in a calm, loving voice. Take a break, if they need to. You will still complete the tasks much easier and faster if they are helping and not fighting you. How ever long you think it should take … multiply that by 4. That is your timetable.

Remember, they can sense emotions and feelings

It will be in the small things that you will see what you have accomplished. Their calmness and trust will be so amazing. Even if they are no longer verbal, they sense emotions and do it quite well. They may look at you and not know your name or maybe not even who you are. But, they know that you are someone that cares about them, that loves them because they sense it.

You have a purpose. To help someone that you love have the best quality of life possible for them.  It feels good to have a purpose. It feels good to help someone that you love. They have helped you and now you get to help them.

You being there is important. None of us want to be alone. Your time, effort and attention provides comfort to them. I hope that brings you comfort and joy.

You find yourself talking with them. For the first time, in a long time, you are having a real conversation. Telling and listening to stories.

You will be changed by this experience. Maybe you figure out what you want and what you do not want when you reach their age. Maybe you see the things that you need to take care of now, so your kids won’t have to struggle to find the information needed.

You probably will never receive an award for being a helper or care giver to your loved one. You may never even be appreciated. You may never be acknowledged for what you do or what you have sacrificed.  Did you really do it for the accolades? Probably not, but some people do.

What if you haven’t been close and they need you now? Could this be a time of mending fences? Could this be a time of moving forward? What about resolving old hurts or negative feelings?

Caregiving teaches you a lesson about control

Care giving can teach you a big lesson about control. As in, you are not in control and you cannot control the outcomes. That, sucks! It is a lesson that we all need to learn. We can do our best. We can make plans. We can implement the plans. But, we have no control over the outcome.

Your own kids are watching you. They are watching how you act towards your mom, dad, spouse or partner. They are listening to what you say. They are observing what you do and how you handle problems or stressful situations. You are modeling for them what to do and how to act. Your attitude towards your loved one may very well become their attitude towards you when you need their help.

Even with all of the positives of helping a loved one … we all need to take breaks to rest and recharge.

Pat

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Why a HIPAA release authorization document is so very important

Posted on July 21, 2021 by - Uncategorized

HIPAA A HIPAA (Health Insurance Portability and Accountability Act) release form.  This HIPAA release form allows you or whoever is designated to have access to medicaland health information.  Medical information comes from hospitals, labs, physicians’ offices, insurance companies, rehab facilities, therapy, pharmacy and anything else to do with medical issues. Those entities cannot disclose any information without a signed HIPAA release.

Medical information for anyone over age 18

Anyone over the age of 18 years old will need a signed HIPAA authorization form in order for someone else to have access to their medical information or to even receive any medical information on them from a medical provider. So, if you do not have a signed HIPAA authorization form, the doctors cannot give you any information on the condition of your loved one.  Insurance companies  or health plans will not give you any information on the status of bills or anything else about the insured. You cannot get medical records or any health information. You will be stuck! Talk about stress and frustration increasing by the minute. It does not matter that you are related. It does not matter what you want or your loved one wants. You must have a HIPAA release form in place. So, get it done and get copies to regular providers, including insurance company. At the very least, have one signed and ready to use. Some of you may be wondering, “why?” It is because of protected health information (PHI) rules that went int effect many years ago.

Medical providers and Healthcare providers

Call the medical providers to see if you need to sign their paperwork or you can provide your own. You may be able to download a generic HIPAA release form online, make sure it is legal in your state. Tennessee https://www.tn.gov/content/dam/tn/human-services/hs/HS-2557_revised.pdf **This does NOT work for banking information.**