What a respite worker HAS to know!

After you have hired your worker, you have to give her/him all the tools necessary to do a great job.  They need to know as much as possible about the care of your loved one but of course, will not be able to read your mind.

With this in mind I will point you back to the post I made earlier about the binder with all the information in it.  It is great for anyone stepping in, whether respite workers, family, or neighbors.

It is important to keep it up to date.  I realize that you have a lot of your plate but keeping this binder up to date will insure that you can leave at anytime and the person replacing you will have access to the correct information about medications, doctors, appointments, etc.

Updating it might be a thing you can do when you are doing your test run with the respite worker.  That way you can have peace and quiet and be able to really look it over.

I know mom’s medication changed a lot due to her being on blood thinners.  It seemed like every blood test meant a different dosage and the prescription bottle didn’t change so I had to keep on top of it.

Also it is great to include any information about how your loved one acts.  Mom liked country music so I tried to keep it on.  She had favorite tv shows she liked to watch. Favorite food and drinks should be included. Anything quirky about your loved one should be discussed.  Basically anything that would make the transition easier on your loved one and the respite worker.

What other information do you think should be in the binder?  

Interviewing the respite caregiver

Hiring anyone to take care of your loved one requires checking them or their agency out carefully.  Some agencies require background checks on all their respite workers but do NOT assume they do.  The only way you are going to feel comfortable leaving your loved one with someone else is to assure yourself by checking everything out first.

Most people find respite workers through and agency.  Although I was aware of our local respite organization, I also could have went on the internet and searched for “respite workers Hastings, Nebraska” and several agencies would have popped up.  You could also check with your medical team or local Health and Human Services department to see who they suggest.

Respite care providers in Nebraska requires several trainings.  Different caregivers will choose to only work with certain ailments and age groups.  The training includes medication delivery, bathing, first aid, CPR, emergency care, psychology and emergency care.

Interview any possible respite workers carefully since they will be working for you.  Make sure they are aware of all the responsibilities they will have.  Ask if they feel comfortable with the level of care your loved one needs.  Make sure they are aware of the medical needs they will need to able to take care of along with any other needs.    Make sure they want to take care of a patient in your age range and level of disability.  Some respite caregivers are more comfortable with youth, only females, people able to use the restroom, bathe themselves, etc.

Trust your instincts.  If something doesn’t feel right, even if all the paperwork makes it seem like it should work, keep looking for the respite worker that makes you feel good about it.

To me it was important that my respite worker would get along with mom so she was included in the interview.  Mom had reactions to certain people so naturally I picked one that mom seemed ok with and that treated mom with respect.

Then we did a trial run where the respite worker came and I left (even though I just went outside).  The first time was only about an hour to see if it felt right.  We were lucky and found one right away.  I have talked to caregivers who tried several before they found the right one.

It is always good to have more than one but mom didn’t like too many people in her environment so we stuck with just one.

Next post we will discuss the information that has to be readily available for the respite caregiver.

Do you have any experiences with respite providers that might help others in their searches?  Any questions you think they should ask?

When the caregiver needs a caregiver – lessons it taught me.

Recently I took a fall and badly injured the knee I had replaced last fall.  Suddenly, I needed someone to do certain things for me.

It really puts it into perspective how the person we are taking care of feels.  Here are five items that I really never thought much about:

1.  PrivacyI had none.  I had to have someone help with bathing and for some reason that was very stressful for me.  We all have the same parts so what is the big deal?  It is a big deal.  Even though the person we are taking care of might be close family, they might still want privacy.  See what you can do to give them as much as possible.

2.  My schedule – Suddenly I had to do things when it was convenient for someone else.  Everyone was terrific about working with me but it was odd to have to have to have someone take out my dog, cook my meals, etc.  Being independent one day and then not the next was hard.  I will keep this in mind to see if people I am caring for would like things done on a different schedule if I can.

3.  Sleep – I hate to sleep on a schedule.  You get used to getting up and going to bed when you want but when others are helping, you adjust.   I couldn’t get up to get to the rest room so had to watch my drinking habits.  It was hard to move around to get comfortable also but I lived.  This will make me consider ways to make my “patients” more comfortable at night.  When mom was here, we put a baby monitor in her room so I could hear if she needed help in the night.

4.  Irritability – I try to be pleasant all the time but I found out that I can be a real crab when I am hurting.  I have had people tell me that the people they were caring for were real bitchy at time and now I definitely understand how that could be.  Mom never really complained but when she wanted to could be VERY stubborn.  She would just look at me with a gleam in her eye and say “NOPE”!  When she said that, there was no reasoning with her.

5.  Medication – I confess that I am not the best at taking my meds on a strict schedule.  I also take supplements like calcium and vitamins.  Due to outside help, these were looked at very carefully.  I felt like I was a little kids being spied on.  I realize that medications can all have interactions with foods, drinks and other meds but I was on top of that and having someone question it made me irritated.

Now, none of this is complaining.  People have to do what they have to do but it really opened my eyes to how what I was doing might make someone else feel.  It is easy to get in a habit and just do things without really thinking how the other person might feel.  Take time to see how what, how and when what you are doing might be interpreted by the person you are caring for.

Ask them if you could do things differently to help them.  Ask for suggestions but be prepared, you might get them.

 

Always have a back up person in case you can’t be there to be a caregiver

This just sounds like common sense but too many times, one person feels like they are the only one capable or willing to take care of the loved one.

Recently, I was sick for over 3 weeks.  Had my mother still been with us, who would have been able to take care of her?  I would not have been able to be with her as I could have given her my chest congestion,cough and other symptoms.  Symptoms that are bad for you would be possibly fatal for someone with a compromised immune system.

It does not always have to be an illness.  It could be a family emergency that takes you away like another family member ill, having a baby or a death.  Also, sometimes it is job related.   Sometimes you just need to have a break.

If your loved one has family and friends around that could step in or if you would have had to hire someone if you have an emergency, it is important that you have enough information available for the “replacement” to do what you do on a daily basis.

If family and friends are not available, make sure you have a medical team (CNAs, CMAs, bath aides, nurses, etc) up to date with the necessary information.  You can find employees like this through your local health department, senior center, Area on Aging or your health professional.

This can be as simple as having a representative of their agency come out, visit with you and your loved one.

For example, you need to have the medication schedule written out with where and how the medications are bought.  What is a typical daily schedule?  Are there any food allergies?  Does food need to be prepared in a special way?  Where is any non medical equipment (special eating tools, bath aids, etc) that you use? Is there anything that brings out bad behaviors in your loved one?  What calms them?

What to you is automatic may not even occur to someone else.

This is why I think it is critical to have the binder that was discussed in a previous post.  It has the doctors involved with your loved one, medications, other treatments such as physical therapy or any other therapy, etc.  It also has a copy of all legal paperwork such as living will, DNR, etc.

A calender is also necessary for medical appointments that are coming up.

So bottom line, make sure everything in the binder is kept up to date.  It will give you peace of mind in case of emergency.

 

 

Food and Drug Interactions – Some surprised me.

Most people are very careful when starting medications to watch for possible problems with current medications.  Pharmacies automatically check for interactions if you stay with only one pharmacy.  But what about reactions between your meds and your food or drink?

How to avoid food and drug interactions

Below is a list of COMMON food-medication interactions for blood pressure, for instance – and common food ingredients, like calcium or grapefruit.  But, there are many more.  As always, talk to your doctor about any concerns you have.

Who knew that salads could be bad with blood thinners?

Taking medications such as warfarin or  Coumadin ® in combination with large amount foods high in vitamin K – such as leafy greens – may cause the medication to not work as well. Watch the amount of this type of food you are eating to get the best results with blood thinners..

Alcohol and some medications can be toxic

Avoid taking massive doses of Tylenol and Tylenol-containing products with alcohol, as it may result in liver toxicity. Avoid taking metronidazole for infections with alcohol, which may result in flushing, vomiting, and increased heart rate.

Don’t take antidepressant, arrhythmia, transplant, seizure, high blood pressure, and high cholesterol medications with grapefruit juice.  

Studies have shown that mixing certain medications with grapefruit juice can cause dangerously high blood levels, which leads to an increase of potentially life-threatening side effects. These medications include

  • Lipitor ®
  • Zocor ®
  • Plendil ®
  • Valium ®
  • Tegretol ®
  • Pacerone ®
  • Prograf ®

Potential potassium overdose

When taking ACE-inhibitors like Altace ® or lisinopril and potassium diuretics – such as spironolactone or triamterene – be careful when eating foods rich in potassium such as bananas, apricots, raisins, and lima beans. The combination causes the body to retain too much potassium.

(I did not know the above one and encouraged mom to eat a banana a day while she was on spironolactone and diuretics.)

Osteoporosis medications and some antibiotics shouldn’t be taken with calcium

Taking osteoporosis medications and some antibiotics with calcium-fortified foods and drinks such as milk, orange juice, bread or antacids will make the medications less effective. Be sure to take your medication two hours before or four hours after eating calcium-rich foods and drinks. Aspirin and other over-the-counter pain medications taken without food can cause stomach bleeding.

Never take aspirin on an empty stomach

Aspirin and other over-the-counter pain medications taken without food can cause stomach bleeding.

Thyroid Medication

Certain thyroid medications cannot be taken at the same time as calcium, grapefruit juice, magnesium, antacids as it will change the result.

There is a great site to type in the drug names and see what interactions there are.  It can be as simple as juice causing problems.  Check out all the drugs your loved one is taking to see if you need to set up the medication differently based on which ones can go together.

It is www.drugs.com.

What drug interactions have you learned?  Let us know.

 

Dehydration – What to Watch For

Dehydration – It’s is easier than you think

I always thought that it would hard to get dehydrated.  After all, you get thirst, you drink, right?

Not so.  In fact, in elderly it is very easy.  It occurs when the body has lost too much fluid AND electrolytes (mineral compounds the body needs to keep the correct temperature and maintain the fight fluid balance.

In elderly, they may not want to have to run to the bathroom all the time or wake in the night to go to the bathroom so they limit their fluid intake.  Although it makes sense to them, it can be deadly.  Certain illnesses make elderly more sensitive to this.  For example, Parkinson’s can make it difficult for someone to swallow or hold a glass to drink from.

It can go on for a while without becoming serious but severe dehydration can  be fatal and is a common  reason of hospitalization of elderly.

Dehydration can be caused as a side effect of medications like diuretics or laxatives or illness  such as diarrhea, vomiting, heat stroke, high blood sugar (hyperglycemia) , infections or excessive exercise.

The most common signs of dehydration in the elderly are thirst (although some elderly have a decreased sense of thirst), confusion, irritability and poor skin elasticity.

It is difficult to detect dehydration until the condition is moderate or severe in nature.

Things to watch for:

(The following can also be signs of many other medical problems but it will give you an idea of what to look for)

  • Thirst – some people have a decreased thirst as they age
  • Dry mouth, dry tongue with thick saliva – can be heard sometimes when talking
  • Headaches
  • Difficulty passing urine or reduced amounts that are dark yellow
  • Dizziness that becomes worse on standing
  • Weakness
  • Sleepiness
  • Urinary tract infections
  • Dry, warm skin
  • Flushed face
  • Fever
  • Irritability
  • Malaise
  • Constipation – fluid is used to soften and move stools
  • Cramping in arms or legs

 

Possible Treatments for Mild Dehydration

  • Drinking lots of fluids – make sure there are fluids available wherever they sit and perhaps some on their bedstand.
  • Eat food and drink with sodium and potassium to restore electrolytes: broths or soups (contain sodium); fruit juice, soft fruits, vegetables (contains potassium); sports drinks like Gatorade that contain electrolytes

Caution – Be aware of any dietary restrictions when adding food or drink as certain medications can interact with certain foods/drinks.  Potassium  needs to be monitored  in certain people.

Signs to watch for in severe dehydration

  • Signs and symptoms of mild dehydration become worse
  • Confusion
  • Irritability
  • Lethargy
  • Poor skin elasticity
  • Decreased consciousness/ fainting
  • Lack urine output
  • Shrunken eyes
  • Moist, cool extremities (arms, legs, etc.)
  • Severe muscle contractions in the arms, legs, stomach, back
  • Rapid and faint pulse
  • Low blood pressure
  • Rapid breathing
  • Convulsions
  • Bloated stomach
  • Heart failure

Possible Treatments for Moderate to Severe Dehydration

  • Severe dehydration is a medical emergency and should be treated at the hospital
  • Replenishment of water and electrolytes through intravenous therapy or oral rehydration therapy (solution of salts and sugars taken by mouth; this treatment is most often for dehydration caused by excessive diarrhea)

Tips to Avoid Dehydration

  • Encourage them to drink appr. 6-8 glasses of fluid a day (Water is best).  Of course this depends on exercise and temperature.  If they are reluctant to drink a big glass, try several smaller glasses.
  • Check body weight regularly, fluctuations of 2-3 lbs per day may indicate irregular fluid intake
  • Avoid being in the hot sun for long periods and ensure extra hydration for longer exposure
  • Keep a water bottle on hand and  try to drink often
  • Broths or soups (contain sodium); fruit juice, soft fruits, vegetables (contains potassium) as part of general diet.
  • Make sure the glasses they use are appropriate for them.  Perhaps they need a straw or a cup with a lid to avoid spills.

Bottom line, dehydration can be serious but is usually easy to avoid.  It just takes being aware of liquid intake.

Do you have any tips on how to avoid dehydration in elderly?

Human Touch – As Important As Air?

That may sound a little dramatic to most people but if you stop to think of it, we all need the human touch.  Think back to a time when you were hurting, either physical or emotionally, and someone came along and either touched you on the shoulder or held your hand and things seemed to get better.

There have been many studies done on this with a good deal of articles written on it but I prefer to just tell you my thoughts on it.

Everyone likes to be touched in a friendly manner.  Babies are cuddled for a reason.  It helps to establish a sense of safety and peace.  In some hospitals, preemie babies are held by women hired to just do that…they rock the babies and cuddle with them.  It has been proven to help them.

Senior citizens or other people that require caregivers are just the same. I believe the need for touch increases when people age or are sick.  They need to feel a connection to the world.  They tend to receive the least amount of touching of any age group.  Seniors are most likely to live by themselves and have less physical contact with the outside world.  But, as people age, they tend to be more likely to need touch and be touched than younger people.

Having someone take their hand, stroke their arm, or rub their feet can make them feel loved and reassure them that they are valued and not alone.   Isolation can be swept away with a single stroke of the hand. It helps with other problems as well such as depression, feelings of isolation, lack of self-esteem, and anxiety. 

Bottom line, we need to be touching the people we are taking care of.  Below are several ways you can touch someone without it being obvious.

  1.  Put lotion on either the hands or the legs.  Mom had dry skin as she aged so I would just put lotion on every day or two.
  2. Holding hands.  When Mom was in bed, we would watch tv until she fell asleep.  I would just lightly hold her hand.
  3. Massage.  Although Mom never got a massage and I am not sure she would have, a massage is a safe way for someone to get the touch needed.  It can be as simple as a neck rub or as much as a full body massage.
  4. Brushing their hair.  Mom loved to have her hair brushed and I can remember as a child I did too.  One of the perks of going to get a haircut for women is the great shampoo that goes along with it.
  5. Just resting your hand on their shoulder or knee while in a seated position can be reassuring.

I really believe that touch is critical.  Seniors sometimes only have one or two people they see on a regular basis and in most cases, they are busy and do not have the time to spend quality time.

If you are a caregiver, please take the time to touch your loved one in some way every day.  It does both of you good.

Elderly in large family gatherings

Of course we all want to include our elderly whenever there is a family event.  They are the reason we are here?  But, sometimes large gatherings can be very stressful for elderly or people with disabilities.  Consider the following:

1.  Hearing – What to us may be normal noise can be very loud and confusing.  Mom preferred that we visit her one family at a time.  She said that all the noise and commotion made her nervous.  She loved us coming but handled it much better when there were only two or three of us.

2.  Children – Children like to play with things.  They can be loud and playful.  We accept this as kids being kids.  When the grandkids were jumping around near mom, she was afraid they would either fall on her or knock something into her.  Because she was fragile (without really looking it), this could have caused a major problem.  She was on a blood thinner and any cut or hard bump could have been serious.  She also was nervous when small kids came to her house because of her medication.  In order for it to be handy for her, we left it on the table as a reminder to take it but when grandkids came around, she was afraid they would get into it.

3.  Medication – Anyone who takes medication has to have it on a fairly regular schedule.  Make sure if you are having someone to your home to make sure they have their medication with them and that they remember to take it.  It is easy for them to forget with all the excitement.

4.  Bathrooms – Some elderly have problems with either incontinence or bowel problems.  Make sure that they are close to a bathroom and have supplies in case they are needed such as pullups.  We never traveled without some.  Of course you have to be discreet but that is easily done as long as you think it out ahead of time.

6.  Diet – Keep in mind that texture and taste has to be taken into consideration.  Chewing and swallowing is affected with alot of medical conditions.  Make sure plenty of fluids are available.  Spices should be kept to a minimum on some dishes so they can eat without having problems later.

7.  Transportation – Make sure that someone is going to pick them up and take them home.

8.  Length of stay – It is easy for elderly to tire out.  They may have a rest schedule at home.  Try to limit the time they are away from home or provide an area where they can lie down for awhile.

Although you have to take all these things into consideration, it is also important for our family members not to be forgotten.  If they don’t want to attend for whatever reason, maybe take a plate of food to them or drop in later just to say hi.  Loneliness can be very depressing and many seniors suffer from it.

November is Caregiver’s Month – Celebrate Yourself!

Following are some very interesting facts about caregivers in the United States.    Here are some very interesting facts about caregivers:

 

  • 39% of all adult Americans are caring for a loved one who is sick or disabled – up from 30% in 2010
  • Alzheimer’s is driving the numbers up.  15 million family caregivers are caring for 5 million loved ones with Alzheimer’s
  • It is NOT just elderly who need caregivers.  The number of special needs children is rising too.
  • Wounded veterans need care too.  As many as 1 million Americans are caring in their homes for service members from the Iraq and Afghanistan wars who are suffering from traumatic brain injury, post-traumatic stress disorder or other wounds and illnesses.
  • It’s not just the women doing the caregiving.  Men are now almost as likely to say they are family caregivers as women are (37% of men, 40% of women).  36% of younger Americans between 18 and 29 are family caregivers as well.
  • Family caregiving is serious work.  Almost half of family caregivers perform complex medical/nursing tasks for their loved one.
  • Family caregivers are the backbone of the Nation’s long-tern care system.  Family caregivers provide $450 BILLION worth of unpaid care each year.  That is more than total Medicaid funding and twice as much as homecare and nursing home services combined.

These facts are from the Caregiver Action Network – www.caregiveraction.org – 202-772-5050

You are a very vital part of your loved ones life.  Too many times, caregivers just do what needs to be done without thinking they are doing something special.  After all, these are our loved ones we take care of but YOU ARE SPECIAL and so is what you do.

Very Interesting Article About FLU shot

From time to time I see articles that look good to me.  I found this one today and thought I would post it.  I have no idea if these theories are sound or not.  I have absolutely no medical background but it seemed to have valid points.  Read it and see for yourself.  As always….CONSULT a DOCTOR for facts.

http://www.thesurvivaldoctor.com/2013/10/26/flu-shot-heart-attack/