We sincerely appreciate our caregivers and we thank them often. The work they do, their devotion and our work have brought tenderness into my life. I often tell my coworkers that my job has changed me. I am not making that up, anticipating my next raise!

Back in the dark ages, I found socializing to be awkward, embarrassment-inducing and

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“She’s running me ragged!” A client said that to me recently, speaking not of her small child but rather of her aging mother. A dutiful daughter, she finds herself sometimes overwhelmed with the tasks of caring for an aging parent. It is a common conundrum: how do we care for aging parents while maintaining sanity in our own full lives?

How long will it last?

One important criterion when you care for an elder is how long the current condition will last. If someone had a hip replacement, your role is time-bounded and the strategy is to be sure you have enough resources to weather a short-term crunch.

But sometimes the caregiving lasts for years, as with chronic conditions like COPD or with Parkinson’s Disease. In these cases, learning to manage your own stress is as important as being sure that Mom gets to the next medical appointment. A good maxim is to remember the admonition before each airline flight: put on your own oxygen mask first – you are no good to anyone if you pass out. Remember you are in a marathon, not a sprint.

Signs of Caregiver Stress

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Father’s Day changes dramatically once Dad is no longer independent, sometimes introducing questions of identity and authority as power is realigned. In early retirement, our fathers usually managed their own affairs and retained a psychologically important position of power in our lives – even if the life-long relationship has been more troubled than we might have hoped. But once Dad begins to depend upon us, the experience of honoring our fathers usually changes. Let us, then, take a moment to consider ways to celebrate this Father’s Day successfully, and perhaps to take a few lessons forward to the future.

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Karen Tannenholz works in our office, and last summer she faced the kind of sudden medical emergency we help many people through. Stressed families often imagine their circumstances are unique, but Karen’s story reveals threads common among many: feelings of growing confusion, helplessness, stress, anger, and even humor are all normal. Ultimately, deeper appreciation of each other can emerge as we navigate together through some of life’s most difficult passages. To hear Karen’s story, click 'Read More' below:

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I took a short break this afternoon, and when I tuned back into the world of news, I found that the expected winter storm Friday into Saturday was now being called a BLIZZARD WATCH!  Eighteen to twenty-four inches are being forecast with high winds. My goodness... 

We rolled into action to consider the safety of every shift change Friday and Saturday... will the roads the safe? Will it be snowing too heavily? How can we serve clients Saturday night and Sunday morning safely? We will work with families and caregivers to create a plan for any shift changes that may be made unsafe or impossible by this storm. We will be in touch wiht impacted families and caregivers.

In the meantime, this is the right moment to share two blog posts I wrote from a past winter storm/blizzard. They contain info about prepping clients' and the caregivers' homes, and other important information. Please review this and then get into action to get ready.

Who Will Shelter Your Elder Loved One in an Emergency?
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First Possible Winter Storm Coming, Eastern Massachusetts 
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Easten Massachusetts Winter Storm Forecast Upgraded To a Blizzard
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Intro to Habilitation Therapy for Alzheimerʼs Disease &
Related Dementias

Habilitation Therapy (HT) is considered by the Massachusetts Alzheimer’s Association to be the best caregiving practice that exists today. Learn about this comprehensive behavioral approach that will help both dementia patient and caregivers alike, which can help improve their quality of lives dramatically. HT helps difficult symptoms be reduced or eliminated, regardless of what stage of the illness the patient is current experiencing, by skillfully adapting to the capacities of the patient and communicating accordingly. Habilitation Therapy helps caregivers have positive and successful interactions with dementia patients, reducing stress, allowing greater enjoyment of each day.

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Truths & Lies I Told My Father

A person with dementia can be said to be inhabiting a different world with a different reality than the rest of us. Habilitation Therapy (HT) tells us that they cannot leave there to be with us, no matter how much we may want them to. (Alzheimer’s Association, 2011) It is the job of care partners to be with that person by traveling to their world. This is done by understanding what they are experiencing, and respecting — never negating — their experience.

If, in the world of a person with Alzheimer’s Disease or a related dementia (ADRD), she is 8 years old (not 80), and waiting for Mother to pick her up after school to go home and milk the cows, then that is the world to which care partners must travel. It doesn’t matter a bit that Mother died 50 years ago because that is not true in the reality where the person with dementia is living... (see the rest of this article here)

Alzheimer’s & Dementia: Environmental Impact

While vigilance must be maintained and approaches honed as the disease progresses, simple but vital changes to the dementia patient’s environment can make a real difference in quality of life, safety and ability to function more independently. Applying our understanding of what isn’t working right in the visual cortex of the ADRD brain is central to creating the right interventions.

Here follow some concrete examples.... (see here for the rest of this article)

Alzheimer’s & Dementia: Emotions Rule

Habilitation Therapy (HT), a comprehensive behavioral approach to caring for people with Alzheimer’s Disease and related dementias (ADRD), is considered to be a best practice by the Alzheimer’s Association (Alzheimer’s Association, 2012). HT is best used for every interaction a person with ADRD has with their care partners, from the moment they rise until they fall asleep at night. One of Habilitation Therapy’s primary goals is to create day-long positive emotional states for dementia patients (Alzheimer’s Association). His or her capabilities, independence and morale are thoughtfully and continuously engaged to produce a state of psychological well-being.

Why such an enormous focus on emotions?.... (see the rest of this article here)

Alzheimer’s & Dementia: The Eyes Have it

Seeing is believing, yes? In our day-to-day world, we believe that what we see around us is pretty much what others with healthy eyes can see. We see a clear glass filled with milk sitting on a white table, and we assume that others can see a clear glass filled with milk sitting on a white table, too.

But that’s not necessarily true if someone has Alzheimer’s Disease — they may only see the white table. Though it is not widely recognized, it is a fact that people with several types of dementia (but especially Alzheimer’s Disease) experience significant changes in the way their brains take in and interpret visual information, generally unconnected to eye health and function. These changes follow several predictable patterns that powerfully influence the behavior of people with dementia... (see the rest of this article here)

Habilitation Therapy for Alzheimer’s & Dementia

According to Silverman, Flaherty and Tobin (2006), …”[I]t is a better understanding of the psychology of dementia – how a person thinks, feels, communicates, compensates, and responds to change, to emotion, to love – which may bring some of the biggest breakthroughs in treatment….”

A parent, sibling or spouse has been just diagnosed with Alzheimer’s Disease or a related dementia (ADRD). In a somewhat perfect world, family members would receive an orientation to the disease, and learn how it affects their loved one’s behavior. They would quickly begin to learn how to deliver daily care and maintain best function. They would find out how to prevent many common, difficult behaviors, and address those that arise with some consistently applied, fairly easy-to-use psychosocial interventions.

The entire family and all other members of the care team in this somewhat perfect world would receive training and ongoing support to learn and apply Habilitation Therapy (HT), accepted as the best standard of care and psychosocial intervention by the Alzheimer’s Association (Massachusetts/New Hampshire Chapter), where it was first developed in the 1990s...(see here for the rest of this article)

Note: The following was published in our monthly column "Living and Loving: Elder Care in the 21st Century" in Gate House News' Concord Journal.  We will continue this theme of Alzheimer's and dementia in this blog with periodic articles on the subject.

The weeping elderly woman is pleading. “I want to go home! Please find out why my ride isn’t here!” Exasperated, her daughter snaps at her, “You are already home, mom! I keep telling you, why can’t you remember? You moved in with us last year!” More weeping, snapping, pleading and exasperation follow. Around and around this goes, several times a day. Both women end up beside themselves with frustration, sadness, anger, and fatigue.

While looking at books at their local library, a man suddenly jumps to his feet, announcing loudly to his wife, “I have to go to the bathroom, now!” Five seconds later, he wets his clothing, urine puddling around his feet. “I asked you to go before we left home and you refused! Why can’t you control yourself?! I can’t take you anywhere like this!” she says to him in despair and exhaustion. They are both embarrassed and ashamed, a wedge stands between them and tension hangs thick in the air.

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Massachusetts Alzheimer's Association
Greater Concord MA "End Alzheimer’s" Kickoff

Tuesday, August 7, 5:30 pm - 6:45pm
Concord Council on Aging
Harvey Wheeler Community Center
1276 Main Street
Concord, MA 01742

The National Private Duty Association (NPDA) recently asked us to present a webinar for a national audience of both professional and family caregivers to discuss the Habilitation Therapy curriculum recently developed by the Commonwealth of Massachusetts and the Alzheimer's Association.  I was certified in the first class given using this curriculum designed to help people managing Alzheimer's Disease and other related dementias.  The reception to our presenation was so good that the NPDA has asked us to present a series of three more webinars on the topic. We will post details on those as soon as they are scheduled. 

You can watch and listen to our webinar on Habilitation Therapy for Alzheimer's at your convenience.  Fill out the simple registration form to proceed.

Caring Companion Home Care of Concord, MA was selected by the industry's most prominent national trade organization, the National Private Duty Association (NPDA), to deliver a consumer seminar entitled "When Dementia Strikes: Managing Care and Making the Most of Each Day."  It will be delivered as a free webinar on May 16 at 3:30 PM EST.

Alzheimer's Disease and Related Dementias (ADRD) cause grief for families and increasingly complex cases for home care agencies. The Alzheimer's Association and the Commonwealth of Massachusetts have developed an innovative new program to train family and caregivers in the use of Habilitation Therapy to reduce the care challenges in these difficult cases.  Participants will learn about best practices in the industry as the country faces this growing challenge.

"We are truly honored to have been selected to deliver this information, among the roughly 17,000 thousand homecare agencies nationwide," says Caring Companion owner and long-time Concord resident, Jim Reynolds. "We owe this to our Concord office director, Dr. Deborah Bier, who has become a recognized expert on dementia and home care." 

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Caring Companion Home Care has adopted and trains our caregivers in habilitation therapy when caring for clients with Alzheimers Disease and related dementias (ADRD). This approach was developed at the Massachusetts Chapter of the Alzheimer's Association, and is considered to be the best standard of care for all types of dementia. Sadly, it is not in as widespread use in all aspects of elder care as it should be.

Habilitation therapy is a comprehensive behavioral approach to caring for people with dementia. It focuses

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Planning elder care is fraught with emotional minefields. Perhaps nothing is harder than when dementia or Alzheimer's strike, and a loved one’s skills or judgment has degraded and family action is required. This may mean taking away car keys, insisting that a caregiver comes part of the week, or that the elder move to live in a facility.  This is always easier if you know that your parent, when entirely competent, had expressed a preference for how to handle the situation. The trouble is that we find that many families have not made such plans.

This is the first of a series of blog posts on lessons learned on navigating that difficult terrain.  In future posts, we will address how to handle situations when someone’s competence has declined due to dementia, stroke, or other factors. For today, we will assume the elder is competent to make decisions.  This leads to our first recommendation:

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For those living near Concord MA, a great opportunity is coming to help prepare you or an elder loved one for important upcoming decisions related to aging and end of life issues.  Families dealing with senior care or aging parents, with Alzheimers or dementia, may especially want to take advantage of this chance for thoughtful reflection on issues facing older family members.  On Sunday, March 25, the Wright Tavern Center at First Parish Unitarian Universalist church in Concord will sponsor The Five Wishes—A Workshop to Help You Make Important Decisions.

I have participated in this planning in my own family and have helped clients with aging parents through similar decision processes. I find the structure and guidance of this process to be thoughtful and a great stress reliever.  If you have an aging family member, I highly recommend this workshop for either or both of you.

The workshop is led by Sue Dobbie, RN, BS, CPN, a member of Concord's First Parish UU.

From the brochure:

"Five Wishes looks at the personal, emotional, spiritual needs

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By Susanne Liebich (photo at right)

Editor's Note: This program is an excellent example of what we believe here at CCHC: that our clients are first and foremost people with challenges, not full-time patients.  The difference living this point of view is profound, as this article makes abundantly clear.

The healing power of dance… I stand here to vouch for its validity.  And in particular, I want to tell you about a technique called Dance for Parkinson’s Disease developed by Mark Morris Dance Group in 2001. This technique is not about therapy, yet it is therapeutic. It is not about exercise, yet for most, it is a wonderful workout using the whole body in different ways. Dance for Parkinson’s Disease is a pedagogy that integrates ballet with imagery, balance, mobility exercises, expression and enjoyment of the art dance. It’s about creating something aesthetically beautiful and creative with the body. It’s about appreciating dance for dance’s sake in a group setting and to explore the range of physical and creative possibilities that are still very much open to individuals with Parkinson’s.

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Download a flyer for this web conference here

Caring Companion Home Care of Concord, MA and the nonprofit National Private Duty Association (NPDA) will host a consumer education web conference entitled Depression and Older Adults – What Every Caregiver Should Know on March 13, 2012, at 8 p.m. EST. The live and interactive program will provide advice on how family caregivers can work with professionals to identify this condition and develop an effective plan of care for a loved one with depression. Caregivers will learn how to identify key issues and problems, locate needed experts and resources, and outline a plan to provide the best care for a parent. The event is free of charge and anyone can participate.

“Unrecognized, untreated depression is widespread among elders, who may present somewhat different symptoms, and who may need different types of treatment than younger people,” said Deborah Bier, PhD, director of the Concord office of Caring Companion. Bier holds a doctorate in therapeutic counseling, and has spent more than 20 years working with people of all ages with physical, cognitive and emotional disabilities. “Effective treatment can bring about an amazing improvement in quality of life and ability to function. This webinar is the type of increased public education and awareness that’s sorely needed.”

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