We are about to enter the "Holiday Trifecta" period, with Thanksgiving and New Year's sandwiching Hanukkah and Christmas. Whether we rush to enjoy the bacchanalia of celebration, or slow down for a period of reflection, all of us who play a role in managing care for an aging family member know the stresses of holiday travel and celebration. We strive to include the elder as much as possible, to avoid taxing him or her too much, to meet the care needs, and (we hope!) to build yet another loving holiday memory for family members of all ages.

Celebrating year-end holidays can be even more taxing if travel is involved. Here are a few tips to make holiday celebrations as positive as possible for everyone:

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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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I have to confess. I am a list-maker. My excuse is that I am a visual and kinetic learner. Seeing the words in front of me and the actual movement of writing help me to remember what I have to do, or buy or who to call. 

It may not be polite to carry a list of the following communication tips, but you can review them and try a few at a time. They are even useful in everyday life, especially when meeting new people.

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25 years ago, walking to an Ocean City, NJ beach with my three-year-old daughter, I sang at each street corner. "Stop, look and listen, before you cross the street. Use your eyes, use your ears, and then you use your feet!"

Approaching a person with dementia is significantly different than greeting a friend or family member. It is important for you to know that their brain is changing. They are confused or anxious. They may not remember you, that you were coming, or why you are there. To ensure that your appearance does not startle a person with dementia or put them "on edge", try the following, which is very similar to that little song: 

Direction

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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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Summertime vacations always bring an increase in calls from concerned adult children with some flavor of this question: “During vacation, we noticed Dad is slowing down. We think he might need help at home, but we aren’t sure. How can we tell?” The decision is not always clear -- keep reading for tips we have developed working with many families.

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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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Teepa Snow is a dynamic, inspiring, insightful coach for professionals and families who support Alzheimer's patients. She will appear in Newton on Wed May 29, 2013, to give a FREE seminar, entitled Essentials for Your Journey Together. This is a rare chance to see such a gifted speaker on Alzheimer's Disease.

At Caring Companion Home Care, we use videos of some of Teepa's training when we train our own caregivers to work with Alzheimer's patients. She is funny and empathetic, and her West Virginia accent stays in Massachusetts ears long after the video ends. If Alzheimer's is an issue in your life, take the chance to see Teepa.

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This past week the Boston Marathon bombings put parts of the city and suburbs on lockdown, providing an unwelcome example of a type of emergency families rarely plan for: terrorism and police actions. Most people who care for elders think often about the elder’s own health crises, and all of us have to plan for blizzards, power outages, and related events. But reassuing a frightened elder during an act of terrorism? Not so much.

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Congratulations to our own Dr. Deborah Bier, PhD!  The Home Care Association of America, the home care industry's largest trade organization, has asked her to deliver another of her popular series of webinars training professionals and families who are dealing with Alzheimer's Disease and Related Dementia (ADRD). In 2012, Debbie's first webinar was so popular that they immediately asked her to deliver three additional sessions on similar topics. We learned later that her sessions were being downloaded by agencies around the country to use in their training. Quite a compliment to her work, and a demonstration of the high quality we try to deliver at Caring Companion.

Debbie's trainings and webinars are based on a program developed by the Alzheimer's Association of Massachusetts and delivered through the state's Executive Office of Elder Affairs.  We use the approach, called "Habilitation Therapy," in training our caregivers for dementia clients.

Details of the webinar are below. 

Alzheimer's Disease and Related Dementias (ADRD) require a many resources to manage on a daily basis, draining caregiver energy, time, finances and patience. But there are proven methods to make care easier, safer, and more enjoyable for both patient and caregiver. Learn some of these little-known best practices, used successfully by both professional and family caregivers alike.

Deborah Bier, PhD, is the director of care for Caring Companion Homecare in Concord MA and has been a holistic psychotherapist for 25 years. Certified by the Commonwealth of Massachusetts's Office of Elder Affairs and the Massachusetts Alzheimer's Association, she trains dementia caregivers and coaches dementia families. Her particular expertise is in helping multi-generational families apply wellness approaches to managing chronic illness. She holds a doctorate in therapeutic counseling, and is a widely published writer and speaker specializing in health and healing.

Probably the single greatest reason we are called to serve families is to provide care following a fall by an elder. Particularly when people have lived in a home for decades, we see that homes and people have not adapted to the extra care needed to prevent falls. These are preventable events, and families with elders will be well-advised to attend Emerson Hospital's free workshop.

Falling - Don't let it happen to you or someone you love

“You’re never too old to improve strength and stamina,” I find myself saying to yet another new home care client at our first meeting. This time, it’s a delightful woman who is no longer able to care for herself. It’s not due to a specific disease or injury. It’s a generalized weakness and a loss of mobility developed over time that keeps her now from doing her own personal care, housework, and errands.

She’s lost her independence to a large degree because of too little walking, stretching, lifting, and reaching. As it common, she’s also developed a terror of falling, which keeps her even frozen to the couch – a fear that becomes a self-fulfilling prophesy, as more muscle loss causes greater unsteadiness on her feet. Surely this is the harbinger of some future fall if it’s allowed to continue in this direction.

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Yesterday I attended a presentation by Dr Gregory Martin, Chief Medical Officer of Emerson Hospital in Concord MA.  Dr Martin highlighted, with justifiable pride, a recent program by Emerson to reduce their already-low rate of hospital infection. Anyone familiar with current elder care issues at hospitals knows the concern that the facilities can be a petri dish of infection, and with frail elders and compromised immune systems, the risk of becoming sicker in a place designed for healing is one of the frustrating ironies in today's health care world.

As a home care agency owner, I was particularly interested in his remarks about reducing infection for clients with catheters, since so many of our clients have them. 

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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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Readers and others often ask us how to start conversations with parents about planning for the parents’ potential care needs and other aspects related to their declining capabilities. As we approach the holiday season, this is an especially good time to have these conversations – key family members who may be available only during holidays are often present, and it may be easier, even given holiday activity, to find some time for a quiet conversation. In hopes of facilitating a successful discussion this holiday season, we offer a few thoughts about what needs to be discussed, and how to conduct a conversation with an elder family member to plan for a time when he or she may not be able to manage independently.

First, as you approach the conversation, you will typically find best success if you think of it as

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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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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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A recent blog post addressed how to conduct difficult conversations with an elder whose skills may be declining, but who is still  clear-minded enough to reason. Today we discuss territory where you often must act more independently, because Alzheimer’s Disease and Related Dementia (ADRD) has compromised your loved one’s ability to choose wisely. This is thorny territory.

This situation reinforces the importance of our focus from last column: Start these conversations before they are needed. By the time Alzheimer’s or dementia strike, elders are at risk of making decisions that put them in danger they do not recognize.  Advanced age and even the appearance of dementia are not a license to remove all sense of independence from the elder, but the family must be willing to

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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.