Aging/Gerontology, Book Review, End-of-Life, Grief/Grieving/Bereavement

What to Do about Mama?- Book Review

Book Review- What to Do about Mama? By Barbara G. Mathews and Barbara Trainin Blank

What I like about this book is the different perspectives on caregiving as there are many contributors. This provides any individual or professional reading the book with different scenarios, which include common situations and feelings.

The authors also describe their own care giving experiences. For Barbara Matthews, she became a caregiver for her mother-in-law. Ten years after her father-in-law died, her mother-in-law came to live in her hometown. At first, the response was no, but as health problems began to appear, the move happened. A family meeting with all helped “seal the deal” for her to relocate and be closer to family to have assistance as needed.

Another health crisis occurred creating a cycle of hospitalizations and rehabilitations. She then moved in with Barbara and her husband on the first floor of their house. Increasing assistance was added as her mother-in-law required it. Eventually, hospice services were put into place which also gave Barbara a break (respite) from providing total care.

For Barbara Trainin Blank, she was the caregiver for her mother who lived quite a distance away.  After her father’s death, her mother began presenting with forgetfulness which progressed. Her mother did not want to go to a nursing home or residence and Barbara did her best to honor this by having assistance come to her mother’s home environment. She became a long distance caregiver, an advocate, an organizer, and in some ways an unpaid care manager-organizing all the details of her mother’s life from medical appointments, to home care workers, arranging transportation, etc.

Caregiving itself has a different definition for each individual providing it. It is hard work from what I have read in the book and witnessed myself in interactions with clients and family. While I have children myself, caregiving for an adult is very different.  The needs of a child can be more or less than the needs of an adult and much easier to carry/lift a child than an adult! Also, as Barbara pointed out to me, for her an important difference between caregiving for children vs. care giving for older adults is that the first is a hopeful process preparing the child for a good future and the second is a process of trying to make life as comfortable as possible for the aging adult as they proceed toward the end of life.

Some common themes in the book are:

Care giving responsibilities:

Local or long distance caregiving?

Alone in acting as a caregiver or shared responsibility?

Potential tasks: financial care, physical care, respite, paid caregivers, volunteers, professional assistance.

Caregiving profiles:

Some quit their jobs to provide caregiving to a spouse or other family member. Some are trying to balance work with raising a family and caregiving (sandwich generation), some are alone in their caregiving role while others have siblings or other family member’s support/assistance. Some are caregiving locally and some long distance.  It is difficult to watch a parent, spouse, child or friend deteriorate and age, just as it is difficult for the person this is happening to, to admit they are aging and deteriorating, and need help.

Roles and Responsibilities:

If you can, define what the person needs assistance with: IADL’s Instrumental Activities of Daily Living; cleaning, meal preparation, shopping, transportation, finances, medical appointments, medication management, communication and/or ADL’s- Activities of Daily Living; bathing, toileting, dressing, feeding, ambulating(mobility). Determine who is assisting with what and whether the individual in question will allow the assistance.

Caregiver emotions and need for self-care:

This to me should be a no brainer; everyone needs some help and should be open to accepting and asking, but it is not easy for everyone to do so.

Self-care should be regularly scheduled as much as possible into the daily and weekly routine.

  • Arrange or accept assistance from family, friends, agencies/organizations, paid companions or homecare workers, and perhaps volunteers.
  • Take vacations or days off if you cannot go away on vacation (financial reasons, other commitments)
  • Give yourself a night off every once in a while.
  • Schedule your own appointments and keep them for medical reasons and check-ups, beauty salon appointments, to go grocery shopping, etc.

Regarding emotions and support for the caregiver:

  • Look into support groups whether run by professionals or volunteers.
  • Seek assistance of a counselor or therapist if you think it would help.
  • Call or schedule coffee breaks or lunches out with friends to talk.

Family Relations:

Communication is important between family members, between professionals and family, between other caregivers, and one person needs to be the designated person as the main contact. As a professional, I can state it is easier to have one family member to talk to, to share information with. If a phone call will not work or is not possible, then a group email addressed to the main contact with the other family members cc’d is another option. This way everyone is in the loop and aware of what is happening and the information is written.

Each caregiver or main contact has their own definition of “doing one’s part.” Caregiving one’s parent(s) is not easy and can be difficult at times as the child-parent dynamic changes. It is reverse roles and now the adult child is parenting the adult parent!

I have worked as a case manager with older adults for 14 years and fortunately I have known most of my clients for that length of time. It is hard to watch someone become frailer. I imagine it is more difficult and more emotional for a family caregiver re: a parent, child, spouse or other family member.

Barbara Matthews shared with me that over the past year of working on her social media sites, this “caregiving in a nutshell” definition has evolved:

Caregivers get involved with care giving to meet a need, solve a problem, or deal w/ a crisis.  The situation often improves—for a while.  Many times caregivers do not take into account the process of aging cannot be controlled, needs will increase—sometimes over many years, or how heavy the burden can/will become.  Therefore, it is important:  to have realistic expectations about care giving, to be prepared for the unexpected, to communicate expectations clearly to the “others” and to develop a care giving contract of shared responsibility to be signed-off on by all.

The book is worth reading and is very comprehensive.

By Victoria Brewster, MSW

Aging/Gerontology

Aging: Yay or Nay?

I came across an article in the Montreal Gazette in the Opinion Section titled: “Growing old is no fun” on August 2nd with individual responses to the article on August 5th in the Editorial Section under Your Views.

The gist of the article is aging and getting older has not happened as expected. Many thought retirement would offer more time for hobbies, traveling, volunteering, time spent with grandchildren and other leisure interests. Some are finding as they age their health is worsening, mobility and strength is diminishing and they need more assistance with routine tasks of shopping, meal preparation, cleaning, transportation to various appointments, and with finances. Older adults are living longer and in some cases outliving their retirement funds.

Due to the cost of basics like food, clothing, access to healthcare and home maintenance whether one owns or rents, these costs are often more than what an older adult can afford or has in their bank account.

On the other side of all this, for those who are healthy, active and have the financial means, getting older is viewed as a time to enjoy life, to pursue leisure and hobbies and should one require assistance with routine tasks, to hire private help as needed.

Older adults have much knowledge, have witnessed and lived through a huge chunk of history, are wiser, and have much to offer. They can mentor individuals related to past employment sectors, mentor youth through intergenerational programs, share stories related to life their experience, offer friendship and more.

As a society, aging or getting older is an area that needs a modern look that describes reality both positive and negative. As one individual quoted, “…As we age, we take the good and try to apply it to what we are still able to do. People need to keep busy doing what they enjoy and live day by day.”

Another said, “Some of us run out of money each and every month and live with daily pain, to say nothing of our dwindling energy. I do not fear death, but do fear living each of the months ahead with a thinning wallet and growing pain.”

Both of these quotes show reality for those that are retired and aging, but they also describe changes that are needed and wanted. There must be a starting point.

By Victoria Brewster, MSW

 

 

Aging/Gerontology

In Praise of Our Aging Population

I recently read an article in Zoomer Magazine titled: “Age Before Beauty” which focused on the show Downton Abbey. The character Dowager Countess of Grantham played by Maggie Smith, age 78, is seen as the family matriarch who makes witty comments.

As a professional who works with older adults or seniors, I am happy to see an actress who falls into this category held in high esteem and with a positive light. There are many other actresses who fall into this category and as they have aged continue to exemplify professionalism and to me are role models for all that are 65+, think Meryl Streep, Diane Keaton, Shirley MacLaine, Helen Mirren, and Sally Fields to name a few.

If media through movies, TV, magazines, radio (commercials) and the internet continue to do this and focus on the positives of aging than perhaps society will do the same. Why is it that youth is what is revered? While I enjoyed my youth, I look back and wish the wisdom and knowledge I have now, I had then.

I link the words optimism, vitality, strength, wisdom, inspiration, and role model to the aging process. My hope is that the general population will do this as well.

Written by Victoria Brewster, MSW

Aging/Gerontology, News, Social Work/Helping Profession/Mental Health

Dementia: A Feared Diagnosis and the Emotional Journey

I attended a lecture on Long Term Care Placement from the Perspective of a Caregiver a few days ago at a local private non-profit Alzheimer’s organization. Even though I am a professional, I wanted to further learn the process from the caregivers perspective. Although the placement process was focused here on the province of Quebec, much of the information shared about the emotional journey, the questions to consider in readiness for placement was for everyone, anywhere.

Someone you know and love has been diagnosed with Dementia. Now what? A plan needs to be created. Caregiving whether informal or formal decided upon by family, friends, public and private sector professionals with the choices of: at home with assistance coming in, a residence or LTC (nursing home).

“Unfortunately, we don’t get a course in school telling us what to do and how to be helpful when an aging parent develops dementia. We may not even be clear about what the word means. A startling reality is that by the time a person is 85 years of age, the odds of developing Alzheimer’s Disease, presenting as dementia, are about one in two” –Carolyn Rosenblatt.

Questions to Consider:
•One question at a time-do the evaluation in stages and start the process early.
•What can the person diagnosed with Dementia still do on their own?
•What do they need help with?
•What is their cognitive state?
•Has their condition deteriorated, health wise?
•Can the person with dementia be part of the process as in what are their thoughts?
•Pay attention to non-verbal cues as well.
•Do you wait until the person who has dementia has progressed to the point that cognitively they do not understand and will not resist placement?
•As a caregiver, what are you values and preferences re: placement?
•For the one with dementia, what are their values and preferences?
•Legalities re: paperwork and who makes decisions needs to be decided, power of attorney or mandate by all involved.

Further Tips:
•For those who are not the official caregiver, avoid criticizing the main caregiver.
•Listen, work as a team to discuss the various wishes.
•Budget cuts and a lack of funding for local health services and what this means for support services like local Alzheimer’s Associations & organizations, support groups, lectures and presentations along with turning to the internet to learn about the disease, what to expect, i.e., symptoms and characteristics of the disease are important.
•Acknowledgement by the family that this is happening and real!

One of the most difficult tasks is for the family whether child, parent or spouse, is to go through your own emotional process or you will have great difficulty in making these future decisions. ‘Losing’ a parent, spouse or child to Dementia has its own grieving process. The person is not who they once were. They cannot do for themselves what they used to do. The memories slowly disappear along with the ability to recognize family and friends-none of this is their fault and is part of the disease, but as an onlooker is hard to witness and be part of.

“It was vital for me to recognise that Alzheimer’s (the underlying cause in Mum’s case), debilitating and horrible as it is, also brings moments of catharsis, laughter and joy. The key was the realisation that the source of my overwhelming sadness had little to do with her. It stemmed from either my comparisons with the past, my anxieties about the future, or my fear over my own eventual frailty. The result was that I was missing being in the present, and upsetting her by lacing our time together with regret and sadness. I was treating her as already incapacitated, not truly being with her even though we were in the same room. She would talk to me, but all I could hear were my own questions: where is the woman I knew so well? What happens next? But when I managed to switch off this destructive internal dialogue and be with her in the “now” (which is what people with difficulty in forming short-term memories do a lot of the time), we actually had a blast.” – Alex Andreou

One could compare their parent to children in some ways, emotionally, verbally, behavior wise. It is a mental switch to see an adult parent as both an adult (because of the size and age) and then see and be witness to the fact that their behavior and needs are more like a childs.

“We love our children unconditionally – regardless of their ability at a particular age, or their relative lack of complex cognitive ability, memories and experience. We recognise the gift that is their near-Buddhist ability to exist in the moment. Why not our parents?” – Alex Andreou

Words to live by…..

Written by Victoria Brewster, MSW

*First posted at: http://www.socialjusticesolutions.org/2013/02/05/dementia-a-feared-diagnosis/

Aging/Gerontology, Social Work/Helping Profession/Mental Health, Videos

Elder Abuse

by Victoria Brewster, MSW

Elder Abuse: A topic many do not want to think about, but unfortunately it is a reality.
Take a look at the video below and give me your thoughts. The video is educational, worth watching and a great teaching tool. Share it with others.

http://www.youtube.com/watch?v=s_LG3EtcFco&feature=share&list=PL6114E161CE0C0CD2

Social Work/Helping Profession/Mental Health

Geriatric Social Worker

This is worth reading from the perspective of a geriatric social worker-one who works with seniors…..

http://www.socialworker.com/home/Feature_Articles/General/I_Am_a_Geriatric_Social_Worker%3A_A_Walking,_Talking,_Living_Resource_For_All_Your_%22What_Ifs%22/