Caregiver ALERT! Reduce STRESS and BURNOUT Now!

Foreign I'd like to welcome everybody to today's presentation on common issues facing caregivers and family caregivers. I'm your host, Dr. Donnelly Snipes. In this presentation we'll define caregivers and family caregivers. Go figure. Explore how caregiving impacts each piece of life and explore how caregiving distress can negatively impact the welfare of not only the caregiver, but also the cared for person. In terms of this presentation, couple definitions. A cared for person is someone who needs assistance to stay Safe or with ADL's. This can be children. You know, children can't cook, can't go to the grocery store. They need caregivers. People with certain disabilities who are unable to live independently and older adults who may be struggling with, live with aging in place or unable to live independently. That's really who we're talking about today. Any human being that requires assistance because they are not able to live in totally independently. A caregiver is anyone who helps care for someone. And before the class started I had a question about whether we were going to talk about nannies. And that's not really what I had in mind for this presentation. But a lot of what we're going to talk about is applicable because it's this. There are the same sorts of issues are going to arise whether you're caring for children or you're caring for someone with a disability or someone who is older and even to a great extent someone who's in hospice. What I'm talking about with caregivers today, you know, we're really thinking about teachers who, home health people, case managers, medical personnel and, and again, we'll put in nannies today. A family caregiver is a caregiver who is somehow related to the care recipient. There are some differences in the stressors and the perception of the stressors for family caregivers versus non family caregivers, if you will. Because if it's a family caregiver, it's someone that you really love as a caregiver. As a therapist, I really, I care about my clients, but it's different as a family caregiver. You may feel a lot more obligation to do things that would be not expected of a hired caregiver, for example. And so we're going to try, I'm going to try to talk about both of those as we go through today's presentation. Caregiving varies in frequency, intensity and duration. If you're thinking about an older adult when there may be some times during their aging process where they're relatively Independent. And then they fall and break their hip and they get sent home from the hospital, but they still have a lot of problems with the mobility. They can't get to the physical therapists there are, they can't drive to go get their groceries, etc, so during that episode, the intensity and duration of their care is a lot greater than once their hip heals and they're kind of back to steady state and we'll see this ebb and flow. We're seeing it in my grandparents right now where they're, they're in their mid-90s and some days or even some weeks they will be fine, but then something will happen, generally a medical issue of some sort, or they will fall and then there will be a period of intensified care. And having to know that having to plan for that is important, but it's also stressful because it can make it really difficult to plan your life if you don't know when grandma or grandpa or mom or dad is going to call and say, hey, I fell and broke my hip, I need you to come stay for a month. Oh my gosh. Okay. Caregiving, regardless of whether you're a hired caregiver or a family caregiver, requires time and energy. For non family caregivers like nurses and case managers and counselors, this is our caseload. But depending on the severity of the case, depending on the intensity of the needs and the frequency that you need to see somebody is going to impact how many people you can have on your caseload. And in some agencies, you're required to have a certain number of people on your caseloads. It's not about billable hours, it's about number of people under your care. And that can get really exhausting if you suddenly have 15 people on your caseload and they're all in high level of intensity. For family caregivers, you're redirecting your time from something else you were planning to do or you were doing. When you have children, you were footloose and fancy free prior to, you know, having children. All of a sudden you've got this baby in the house that needs to eat hours. You know, your, your life changes. It's just the way it is now. You chose that and you're going to make accommodations just like if you move your loved one into your house or if you choose to be willing to assist your loved one age in place. It may not have been what you anticipated, it may not have been on your to do list that in 2025 I'm going to start being A full time caregiver for, for grandma. And that's a choice you have to make. And that can be a really difficult choice because it involves a lot of change. Even if you're just part time, if you will, even if you're just episodic, it can still cause a lot of upheaval and take energy. Remember, we only have a certain amount of energy and it may take energy from other aspects of your life that are really important. So you've got to reapportion your time. I know my father right now when my grandparents start having issues or whatever, he has to drive three hours down to where he is, where, where they are to take care of them. My, my grandfather has relatively uncontrolled diabetes even though he's got a pump and everything else. And he's got a lot of peripheral neuropathy which we talked about the past couple weeks. And as a result he has difficulty cleaning his insulin pump. And there are other issues that may come up. And so my father's constantly worried about are they doing okay? Did they fall, what's going on with them? Because they're also very private people and they don't want anybody in the house. They finally agreed to have a 40 hour a week caregiver come in to work with them and you know, that was an adjustment process but they finally accepted her. She hurt her ankle or something a couple weeks ago and she hasn't been able to come into work and they've refused to let anybody else come in. So my parents anxiety has gone way up. As I mentioned in other videos and I mentioned at the beginning of this one, there are services that provide a lot of in home monitoring and can notify you when things change, when there's a change in the routine which if the cared for person will allow that, that actually can reduce a lot of stress on the caregivers because you're not wondering, well, did, did grandma fall when she was in the tub? Or am I assuming that no news is good news? You know, what's, what's going on? Physical impact of caregiving for caregivers and family caregivers. And I tried to highlight some of the benefits so I don't sound like it's just all drudgery and whatever. Caregiving is hard. It's a labor of love. Whether you're doing it as a paid caregiver or whether you're doing it as a family caregiver. It's hard in, in every possible way. The benefit physically of caregiving is potentially increased strength. If you're having to help grandma or dad up and down, out of bed and up off the floor and whatever else, you may develop more strength, more stamina. If you're doing more house cleaning and stuff because they can't do it, you may develop a little bit more stamina. So if we're trying to embrace the dialectics here, the good with the, that can be a benefit. Now, physically, there are a lot of drawbacks that need to be addressed. It doesn't mean that they are guaranteed. Most of these drawbacks can be mitigated, but you got to be creative and you have to plan autonomic nervous system dysregulation. And this is something we talk about in pretty much every video. Your stress response, your autonomic nervous system gets activated when you have someone that you care about that is either living in your home or aging in place and you're, you know, commuting to be with them. You may be hyper vigilant to indications. You know, I haven't heard from mom. She always calls at noon and I haven't heard from her. And it's almost 2 o'. Clock. You know, the anxiety may start creeping up, or if you're living in the house with them, you may become more hyper vigilant every time they groan or move weird or something like that. And that can be exhausting. It could mean, you know, if they have pain, it could mean they slept wrong. It may not be anything. That's a super big deal. But as caregivers, we can be stressed. When my son came home from the hospital when he was an infant, he stayed in the neonatal intensive care unit until he went in an entire week without stopping breathing. And then they sent him home. I was like, excuse me. And, and I know we're talking about kids now, but the same sort of issue is true. I was hyper vigilant for months after he came home, definitely for the first few weeks after he came home, and worried that he was going to stop breathing in the night. So I wasn't sleeping well. And most of the time when he would stop breathing, it was when he was eating. So it was terrifying to feed him. And I was, you know, watching for every indication while, while he was feeding. And I was stressed about bringing him home. And of course they didn't send him home with a heart monitor or anything. It was just like, well, if he starts turning blue, smack the bottom of his feet and he'll jump back in. Really, I hope they do better than that now. But 20 years ago, that's the Way it was exhaustion. When you're hyper vigilant, it's exhausting Even if you're sleeping well. Hyper vigilance takes a lot of energy. But people who are, and people who are hypervigilant don't sleep so well. They don't sleep as comfortably or as easily. If you've got an older adult and you're living in your house and you may hear every creek in the house and you think, oh, they got up, maybe they need help, maybe they need something. So you're getting up to check on them multiple times in the night, and that can disrupt your sleep. You may have sleep changes because you're sleeping in a different bed if you are not living there. But you have to come for episodic care that changes your circadian rhythms, that changes your habits, and that can be exhausting. Planning for that. If you know that you need a particular pillow, planning for that, it trying to set rules for good sleep hygiene. Even when you're at, in at their house, caring for them is really important because you need to be rested. Poor sleep is going to contribute to a whole lot of other things and just exhaustion from being constantly on the go. If you're living with somebody who has a lot of doctor's appointments and they can't clean around the house and they're not able to cook for themselves right now, or whatever, you may be doing your duties that you normally do, plus, you know, doing two thirds of their duties. Not that you're complaining, but it can be exhausting. You can pretty much spend all day on your feet. Whether you're taking care of children or older adults or anything in between. Caregiving takes a lot of energy and you may have increased pain. When we get stressed, we tense our muscles. When we tense our muscles, we can start getting aches and pains and throwing things kind of out of whack. And we know that when our stress response system gets dysregulated, it impacts our pain perception. And you may perceive more pain than you did when you weren't stressed. It doesn't mean you're making it up. It means your threshold is actually lower because your neurotransmitters have changed. And when we're in pain, that's a vulnerability we are aware of. That can make us much more vulnerable to irritability, to emotional distress, to, to brain fog. Recognizing that if I'm in pain, I need to take care of that. I need to do whatever I need to do to prevent pain as much as possible. Just like you would if you weren't caregiving, but understanding that caregiving increases the likelihood that you may experience these things. So what can you do preemptively if you need to stretch in the morning when you get up before you start helping grandma up out of bed and doing those sorts of things? That's a smart thing. Increased exposure and susceptibility to illnesses if you are caring for someone who is in and out of the hospital a lot, or if you're caring for kids who are in and out of school a lot and around other kids, they're snotting everywhere. You are going to be exposed to a lot more germs than you would if you were staying at home. That's not necessarily so bad. But you have to pay a lot of attention to hand hygiene. Pay a lot of attention to social distancing when you're in the hospital and around people who may be sick and your susceptibility to illness is going to go up? Well, when stress goes up, your immune system goes down. Therefore you're exposed to a lot of different and and more germs and your immune system is somewhat compromised from the stress. How can you address this? Reduce the stress? Wash your hands. Social distance if you feel you need to wear a mask. Whatever you feel you need to do in order to keep from getting unnecessarily sick. We're all going to get sick occasionally, but unnecessarily sick. And most of us I think recognize that when we get stressed we tend to get sick a lot easier. And caregiving is stressful. Even if you are not right there caring for the person. If you are sort of an on call caregiver like my father is, it's stressful and you're kind of always waiting for that phone to ring. It can be really exhausting. Muscle strains can happen if you're not careful about number one, stretching and making sure you're okay and using proper form. When you're lifting and I know some of you are rolling your eyes right now. I know when I pick up boxes and stuff I don't use proper form. I should, but I don't. But definitely when you're lifting a human being who may not have the best balance in the world, it's important to make sure that you are lifting with your legs etc you are wearing. If you've got poor core strength, you're wearing a back brace. A lot of nurses working in long term care facilities and stuff wear back supports in order to help them help people in and out of bed and up off the off the commode and things like that. And as I mentioned, your own health deteriorates not just because you can get sick easier, but because when you're exhausted, your body is not regenerating at the same rate, your neurons are not regenerating at the same rate, but we'll get there. And you're probably not taking as good a care of yourself. You're probably not going to the gym and getting your 150 minutes a week of cardio. You're probably not eating as healthful of a diet as you would if you didn't have these other obligations. And that is one thing that you definitely, most definitely can plan ahead a little bit and prepare for. What do I need to do in order to make sure that I'm eating a good diet, that I'm eating healthfully? What do I need to do to make sure that I am doing the things that are necessary for my personal health care, my personal physical health and well being. And some of these don't apply as much to caregivers in residential facilities. But it, even if you're working in a hospital, it still can be exhausting. You're still constantly on the go and may experience increased pain. You empathize with your patients and you're increasing your exposure and susceptibility to illnesses just working in a hospital facility. So again, a lot of these things apply, whether you're a family caregiver or a hired caregiver. Interpersonally, the benefits, and there are more benefits here than there were in physical, you can grow closer to the cared for if you're a hired caregiver. You know, people that I work with, I learn a lot from and some of the people that I've worked with have had led absolutely fascinating lives. And I really enjoy getting to know them and developing a connection and feeling like I'm able to play some part in improving their quality of life. Even if it's just, you know, being a listening ear and somebody that they play gin rummy with once a week or something. There is a positive aspect to it. And that not only is emotionally and spiritually uplifting for me, but it also increases oxytocin. And we know that's a good thing. You may discover new hobbies, activities, music, etc. Again, some of the people that I work with, especially if we're doing reminiscence therapy where you're playing songs that they used to listen to back in their 20s, back, you know, during the good times, I'm getting exposed to big band music. I'm Getting re exposed. My, my grandmother always used to listen to Lawrence Welk. We used to watch that every Saturday night right before the Love Boat. But I'm re experiencing that. And I'm discovering jazz and I'm discovering other types of music that I don't typically listen to. New hobbies. Not that I can do them anymore because of my carpal tunnel, but seeing people derive so much joy off of needlepoint and some of those other, other activities. As I mentioned, we increase oxytocin and we make new friends. When I'm in a facility, I'm not only communicating with my patients, but I'm communicating with everybody on the team. When, even if you're doing home care, you're not only communicating with your family member or your patients, but you're communicating with everybody in the family and everybody on the treatment team. If you're a family caregiver, you also. It's recommended that you also reach out to support groups and especially if you're working with somebody who, for example, has dementia. There is a really awesome dementia support group on Facebook that I'm a member of and there is a lot of excellent insight, excellent support in there. And a lot of people have really developed some strong friendships. Even if they haven't met in real life, they've developed some strong friendships bonding over this, their, their similar challenges. Drawbacks. Interpersonally, your relationship with yourself may be put on the back burner. A lot of times when you become a caregiver, whether it' for an infant or an elder or somebody who is not capable of independent living for some other reason, again, it takes time, it takes energy. And you may not be thinking about, oh, hey, I used to enjoy going rock climbing, or I used to enjoy doing this or that. I love gardening, I need to go out and plant my garden. You just don't have time for it. So the things that are important in your rich and meaningful life start getting put on the back burner, which eventually can lead to a sense of resentment and regret. And that's one of the things I encourage a lot of caregivers to be cognizant of. Yes, you may not be able to spend as much time doing it. However, how can you still sort of dip your toe into that thing that was meaningful to you, the family caregiver. If the person is living in your house, the cared for person may always be there and there always may be a need or you may feel guilty. A lot of people feel guilty leaving their care, their loved one alone, even if they're safe Alone. They feel guilty leaving them alone. When my mother was on hospice, my stepfather always felt super guilty going out, even going to the drugstore, the grocery store or something because he didn't want to leave her alone. And, you know, even if the nurse was there giving her, her, her bath and stuff, he still felt guilty leaving her. He felt like he was abandoning her. And that's something that caregivers really need to think about in terms of facts in this context at this time. In reality, my mother wouldn't have known if he had gone out to the grocery store or gone out on a walk for 30 minutes or something and come back because she was involved with the nurse who was there. But in his mind, she would know. We really want to help caregivers focus on that and recognize the need, their need for devoting some energy to their rich and meaningful life. I will have caregivers write down the things that are important in their rich and meaningful life, just like I do with, with my clients, and I will say, okay, now how can you still integrate these things into your life in some sort of meaningful way? Because caring for this person is a marathon, not a sprint. And it's really important that you don't lose yourself in caregiving. It's really important that you don't lose yourself in dealing with the day to day for hired caregivers. You may have difficulty leaving work at work, so you may put in extra hours, working 50, 60 hours a week because you care for the people that you work, that you work for, and you have difficulty even just not thinking about it when, when you're not at work. And that can draw a lot of physical as well as emotional and mental energy away from the people and things outside of work that are important in your rich and meaningful life. Boundaries. We need to figure out how to set boundaries if it means, you know, when you leave work, if you have a ritual that you do, maybe you go to the gym or you go to the park and go for a walk or do something to separate work you from home you. That's important if you're a family caregiver. Figuring out how to set boundaries. So there's caregiver time, and then there, there's me time. And even when my kids were small, we, you know, I remember struggling for me time and thinking, oh my gosh, I can't wait till I can take a shower by myself without having these little fingers under the door shaking it, going, mommy, when are you gonna come out? And that. That's. Boundaries are really important. Figuring out what you feel comfortable setting when you're caregiving, you can have challenged relationships with your nuclear family and your friends. If I still had kids at home, we'll just kind of back up a couple of years. If I still had kids at home and you know, my parents were needing my help and I was going to travel to take care of them or I was moving them in, that would take time and energy and hopefully the family would be supportive of moving mom in. But if they weren't, then that could cause some consternation if I did it anyway. And these issues come up with family caregivers, the people in the house, the children may feel unheard and unseen. If you've, you're devoting a lot of energy and time to the cared for, even if it's episodic, especially younger children may start acting out and showing behaviors that you don't want to see because they're not feeling like they're noticed anymore. Behaviors, communication. When a change happens, like we start caring for somebody, whether it's in our home or in their home or whatever, when a change happens in our life, we need to be aware of the people around us. And if their behavior starts to change, we need to explore what are they saying with their behavior, especially kids. Hopefully your spouse, your partner is able to articulate, hey, I'm feeling kind of neglected because it's either you're over at mom's house or you're taking care of the kids and I don't feel like I've seen you for a month. Okay? But we can look at that. And as a caregiver, it's easy to get caught up in caregiving and not even notice. A month goes by and you're like, oh yeah, you're right, we haven't had dinner together in a month. Sorry about that. And that's where everybody needs to come together. If the cared for person is out of the home and you're going to a long, long term care facility to visit the other people again may feel neglected. If you have to choose between going to Sally's soccer game or going to see mom in the hospital and you choose mom, Sally may feel rejected. If you choose Sally, then mom may feel rejected. So you may feel like you're caught between a rock and a hard place. And it's important to openly communicate with both groups about what you need as well as how you're going to try to meet everybody's needs and make sure that everybody is openly communicating about what they feel their needs are at the time. And how they're feeling and we can explore again. We can explore the facts in context and see if somebody's using emotional reasoning. I'm feeling abandoned and neglected, therefore you must be abandoning and neglecting me versus fact based reasoning. I'm feeling abandoned and abandoned and neglected. But in reality, you're actually paying a fair amount of attention. It's just not as much as I want. And, and we can examine those things. You may have less time and energy to nurture friend relationships too. You used to go out with the girls every Thursday night or something, and you haven't done that in two months. You may have time demands that prevent engaging in old hobbies and activities. Even going to the gym for a lot of people becomes a luxury when they take on caregiving. Frustration at other people's lack of understanding. When they get angry at you, the caregiver, because you don't have the time or energy to go out on Thursday night. It can be really frustrating. It's like, do y' all not see how much time and energy and how I feel like I'm, you know, burning the candle at both ends? We need to make sure as caregivers, we're not assuming people are reading our minds. They don't see all the stuff that we do most of the time. Therefore, it's important to communicate what's going on in your life and what's taking your time and what your needs are. And there can be frustration, especially if you move somebody into the house at a loss of authority or control over your children. If grandma moves in and starts telling you how to parent, or grandma moves in and the kids figure out how to split the family, and if you say no, they'll go to grandma, she'll say yes, and then they'll do it anyway. That can cause a lot of distress. Same sort of thing with medical caregivers. If they come in and your loved one is suffering or struggling in some way that you're aware of and you're trying to advocate for them, and the medical caregiver is not being sensitive to that person's needs. It can be really frustrating and it can damage the relationship between you and that provider. Not that it's your fault, but just acknowledging there can be a lot of tension in relationships. Emotional impact. Caregiving can be, can make people happy. You can really enjoy caregiving a lot of the times. There are going to be some times where it really sucks, but there can be some times where it's just the best thing ever. It can bring up curiosity. You're Thinking, all right now, how's all this working? Grandma was doing fine for the past three weeks and then all of a sudden she started becoming agitated. I don't know why and she can't tell me why. So I need to get curious about what changed and that it may not be something we can see. It may be Grandma's got a urinary tract infection, is in pain and can't communicate that to us. So we need to get curious and we can develop and really it takes effort, but we can develop compassion. We can take a minute practicing mindfulness to breathe, to have compassion on ourselves, for ourselves. When we get frustrated, when we're exhausted, acknowledge that and say, all right, you're going to do your very, very best, but you can only do what you can do. And we can have compassion on the cared for recognizing that sometimes they're just going to be in a foul mood and all right, you're in a bad mood today. I'm not going to take that personally. I'm going to have compassion on you because that tells me that mentally or physically you're not in a good place. And so I'm going to take that in stride. Drawbacks. Anxiety about what's going on. Your life changes as a result of becoming a caregiver. It's like, okay, well I guess I'm gonna have to let that promot promotion go and we may need to move to a bigger house in order to accommodate grandma moving in with us. There are a lot of things that may need to change and you may have anxiety about what the fallout's going to be by committing to caring for this person, you may start to worry about your own death. If you're taking care of someone who's in hospice care or in who's aging in place or even if they're aging in a long term care facility, as you see their health and start to deteriorate, which happens as we get older. You may start worrying about when I'm there, when I'm 70, when I'm 80, when I'm 90. And you know, I don't know. My, my mother laments right now about mother in law laments about not wanting to get to the point that my grandparents are at because she is, she sees what they're going through and she's like, I don't ever want to be that frail. I don't ever want to be that dependent on other people. So there's some anxiety there and obviously anxiety about the cared for, what's going on with them, what's tomorrow gonna bring yada yada. There's grief, grieving about your losses, loss of your time. Another one we haven't talked about yet is your vision of the cared for. I remember my mother as a strong woman and she always was and she was always something of a firecracker. But the last time I saw her was at the end of her hospice care and she was a shell of herself. Cognitively her, the cancer had spread to her brain and she wasn't even cognitively there. And it was just heartbreaking to see her like that. And I, I forced myself to remember her before that. Same thing with my dad. I remember him before the cancer, not after the cancer. You can, you're going to lose money. Caregiving is expensive. Whether. Well, we'll get into that in a minute. You may grieve the loss of time for your hobbies and time for your relationships, and you may lose some relationships. Some people just may not be compassionate and supportive. And in my mind, okay, fine, you know, if you're not going to be here through the bad as well as the good. But anticipatory grief can occur regarding the loss of your loved one either because of death or loss of your loved one to dementia. You see their, their mind going and you can start fearing that you can also fear again your own loss. If you're watching somebody develop dementia, go through the stages of dementia, you may fear that that's going to happen to you and you're going to lose your memories, you're going to lose your awareness and that's terrifying for a lot of people. And grief of the loss of the role. If the person that you're caring for goes to long term care or dies. If you are a family caregiver, if you've been caring for somebody for months or years and that becomes part of your identity, you're a caregiver. And then if that person doesn't need you anymore you because they've gone to long term care or they've died, that is a huge loss that we don't give enough credit to. And figuring out what do I do with my time now and realizing all the things that you had given up for the past six months or six years, there can be a whole lot of stuff that comes up. Preparing for that is important. Allowing yourself to grieve is important. You may not be able to prevent it, but being aware of it and being compassionate, it goes a long way to helping you integrate the losses that you may experience. You may have guilt or regret about unresolved Past issues, you and your parents may not have gotten along. And now that they are frail and fragile and needing extra care, you may have guilt or regret about not being there for them until they got to this point and stuff comes up. You may have guilt or regret about feeling resentment. You may feel like, well, when I was growing up, you were nowhere around, you were a horrible parent and now you expect me to take care of you. There's, there can be a whole lot of trauma that's opened up and a whole lot of resentment. And the key there is identifying what it is and working through it, not pushing it down because it will come up, it will come up. At the worst times, dealing with resentment and anger over things that they did or you think they did in the past is going to be essential to allow you to effectively care for them in the present. People who are caregivers often have guilt or regret about not having all the answers. My loved one is struggling and I don't know how to fix it. I don't know what to do. They're sundowning or they're in pain or this or that and the doctors don't seem to know how to fix it and I don't know how to fix it and I can't see stand to see them suffer. I mean we go through that with children too when they're in pain. It's like mommy wants to make it better, but I don't know how. And it can be painful. Having to make a caregiver move in a cared for move in or having to move them into long term care if you can't care for them safely in your own house can also cause a lot of guilt and regret. You may feel guilty and because a lot of times people don't want to move in with you or go to long term care. So they may be very angry with for a period of time and processing that as recognizing anger is a response to a perceived threat. And for the older adult, you aren't the perceived threat. For the, for the cared for, the perceived threat is their loss of independence. The perceived threat is their age and their failing health. They start recognizing that they are not 20 anymore. And that can be very terrifying to them. If they'd always envision themselves as a very independent, strong, you know, I don't need anybody but myself sort of person. There can be resentment toward the cared for, for the upheaval. Whether it's you resent them and you're their caregiver or other people in the family resent having the Whole house turned upside down because you moved grandma in. Resentment happens and it's a natural feeling. Resentment is a form of anger. So we need to look at what's the threat. What are people worried about? What are people resenting because grandma moved in? Well, grandma moved in and so now they, against their will, potentially lost their bedroom or lost time with you. Or what did they lose as a result of grandma moving in? What did they lose as a result of the upheaval? Or what are they afraid of losing as a result of the upheaval? And then address that. Talk about it, communicate about it, figure out how to prevent it. As much as possible, there can be resentment for the demands required by the cared for. Whether it's a new baby in the house and the four year old starts feeling neglected because the baby needs so much attention, or it's, you know, your parents move in and your partner starts feeling neglected because the cared for needs so much time. And you may even again resent the person at times for all the demands. And sometimes it seems like no matter what you do, they're not going to be happy. And that can also trigger feelings of frustration and resentment. You can have resentment toward other people for not pitching in, whether it's people in your own household, whether it's your community. And it could be the cared for themselves. You know good and well they can take a bath by themselves but they refuse to. Or you know good and well they can do something but they're refusing, they're insisting that you do it for them. And that can cause a power struggle. You can have resentment towards medical personnel for not listening, you know, enough said. And you can have resentment from the cared for for taking over. And remember again, it's generally probably the resentment and anger is not toward you. You're just in the way. You are the representation of everything that's going wrong right now. And they're, but they're really angry and resentful about their body shutting down and, and the situation. There can be embarrassment when helping the person in and out of the tub, changing their clothes or doing personal hygiene for them. And, and, and again, it doesn't matter if you're a family caregiver or a caregiver hired caregiver. There's an element of dignity that comes or goes when you're having to have other people take care of some of your most intimate details or when the cared for does something embarrassing. Sometimes the caregiver doesn't, or the cared for doesn't realize when they've done something embarrassing. Because they are cognitively not that present anymore. And it can be embarrassing to the caregivers. If your care person that you're caring for has dementia and they start getting frustrated in the middle of the grocery store and they just start screaming and throwing a tantrum or they soil themselves, it can be embarrassing. They're trying to communicate that they're frustrated about something, but, you know, other people are kind of wondering what's going on. And it can be embarrassing for the caregivers. Having compassion for the cared for, having compassion for yourself for the embarrassment and planning ahead. If there are things that you know are going to be potentially embarrassing, how can you prevent that? As much as possible, there can be frustration at not being able to understand, fix, or manage certain issues, like their eyesight's going, or for my grandfather, his hearing's going. And it's really challenging for him to communicate right now unless he's in a room by himself or with one other person. There's not a lot of chatter going along. There's not a lot of TV in the background. If he's looking at you and there's no other background noise and he's got his hearing aid turned all the way up, he can hear just fine. But there are. There's a lot of ifs there. And it can be really frustrating when other people are insensitive to that. And you're like, well, Pop needs to have everybody be quiet so he can hear what's being said. And people are still just yammering. And in their own world. There can be frustration at not being able to get a straight answer from the cared for. The cared for may not be able to tell you what's causing their agitation or, you know, what's going on, what's causing their pain, they are just feeling it. They may not be able to tell you why they're so depressed and. And weepy today. And that can be frustrating because you want to help. And it can be frustrating at not being able to get a stray answer from providers. All right, tell me what the course is we're looking at here for whatever's going on with my caregiver. And a lot of times you'll get hedges and, you know, maybes, and you won't get a straight answer. And it can be exasperating. And you can get frustrated at the cared for for not following instructions, and not that we're ordering them around all the time, but if you tell the cared for not to turn on the stove and they turn on the stove anyway, you know, that's dangerous. And obviously you're probably not micromanaging everything they're doing. So the things you tell them to do or not to do, it's important. And when they ignore you, it feels disrespectful. But it can also be scary because they're doing something that's probably potentially dangerous and hurt. For people who are taking care, especially taking care of parents or grandparents, trauma wounds can be we reopened and you can feel like that unsafe and powerless child that you were when they were taking care of you. And this can happen in hired caregivers as well. Hired caregivers may start developing a relationship with their patients. Like, you know, you're like my second grandma. And then if second grandma starts being abusive or withdrawn or neglectful, then it may feel like what that person had gone through in childhood. So this is not just family caregivers. And there can be hurt when the cared for person is mean and lashes out. It happens especially in dementia and Alzheimer's. As the disease progresses, there can be a lot of verbal and physical aggression. We need to recognize that these behaviors are communication. And they may mean that the person's feeling vulnerable, fearful of losing control or independence. If they're still in those earlier stages, they may be recognizing and grieving their loss of function and their old self concept. They may be anticipating the loss of cherished things. Like if they know that at some point they may have to go into long term care and they're not going to be able to take their dog and they're going to have to leave their home of 40 years. Then when anybody starts hinting that they may not be able to stay there till they die, they may get very defensive and very angry. Or if they're experiencing pain or illness, we know that it causes people to become more temperamental and potentially lash out. Being curious. If somebody's behavior changes, they're normally pretty easygoing and all of a sudden they just become hateful. Okay, that's telling you something. I don't know what it's telling you, but being curious and not taking it personally is really important. Let's get curious about what's going on. Okay. First, was it something I did? Maybe I did something that was really rude and if so, I'll apologize. But 95% of the time it's not going to be the caregiver, it's going to be something else. And the care the cared for is just is lashing out. Cognitive impact. Well, you're going to learn new things. You're going to learn how to clean insulin pumps. You're going to learn how to do a lot of things you never thought you'd do. And it's always a challenge or a mystery what's going on and what interventions will work for that person. The drawbacks can be mental exhaustion. If you're constantly trying to think, okay, what do I need to do? Or how can I help them better solve this? Or mental exhaustion of how can I meet the needs of my kids and my partner and go to work and you know, meet all their needs and focus on them and focus on the cared for. You know, just saying it sounds exhausting. There can be confusion about the right thing to do. When is it the right time to insist that a loved one moves in with you because they're not safe living on their own? When is it the right thing to do to move them into long term care because you just can't handle their complex medical needs anymore? When it. Or because the rest of your family is decompensating because they're taking so much energy? You could do it maybe, but at the expense of virtually everything else in your life. And there can be a lot of guilt there. There can be insufficient training to complete the necessary tasks like giving insulin boluses, cleaning the insulin pumps, dealing with hearing aid issues. There are a lot of medical things especially that come up that people don't know how to deal with. But there's also a lot of emotional things and interpersonal things that come up when dealing with older adults. A lot of them we've talked about today and over the past couple of weeks, but people aren't prepared for that. I know my mom and dad weren't prepared for that. When grandma and grandpa, you know, at this stage they're starting to become even more irritable and agitated and you know, not knowing how to interact with them in a way that's not going to trigger them is causing a lot of consternation. There can be brain fog in the caregiver because of impaired circadian rhythms. Your even if you're getting enough sleep, you may not be sleeping at the same times. You're just trying to sleep whenever you can or you're not getting enough sleep and then negativity and pessimism environmentally. When you're a caregiver, you're going to have reduced income. You may have to cut back on your work hours or quit your job altogether. You may have to take some of that money that normally you had coming into you and your family to help pay for the cared for's needs. There's increased expenses for your health because as I said a lot of times for caregivers health deteriorates. You get sick a little more often if you're taking great care of yourself and a lot more often if you're not. Increased expenses related to the cared force health, including medicine devices, walkers and wheelchairs and everything, insurance, deductibles, etc, environmental modifications to their house or your house where you're putting in the grab bars and doing things so they can live as independently as possible. Those aren't cheap. There can be increased expenses with respite care and that, I mean for you, having somebody come in to sit with grandma or mom or dad or whomever while you go out and go on a walk, while you go to the grocery store or just take a bath for an hour in peace. You may be pruning at the end, but you may feel better. There may be increased expenses related to child care if you've got children at home, but you're having to go over and take care of mom or grandma or something. Not that you mind it, but you may have to have somebody else watch your kids while you're taking care of your. Your. Your loved one. And increased expenses related to travel, having to drive there, whether it's across town or like my father drives down three hours to take care of my grandparents. There's a lot that goes on with it. There's a loss of space or crowding in the home or a loss of privacy if the cared for moves in and figuring out how to negotiate that so you feel like you still have something that's still yours. You still feel like you've got a safe place. You may have to compromise on decor or organization because your loved one comes in and goes, this is not how this kitchen's supposed to be organized. That is supposed to go over there and they just start reorganizing your entire kitchen. And for me, my kitchen is a big deal. I'm like, no, no, no, no. Hands off the kitchen. But it can be a big challenge and figuring out what battles you are going to fight and what battles you're going to let go is going to be important. And as I mentioned earlier, difficulty planning anything because you don't know when the needed intensity of care will change. Maybe things are going well right now and you plan to go on a cruise and two days before you're getting ready to leave on the cruise, your loved one falls and breaks their hip. Well, there goes the cruise. So it can feel very overwhelming if you don't have backups if you don't have on call tall people that can pitch in. So things that are important you can continue to do. And it doesn't every time they have a health issue, it doesn't completely turn your life upside down. In terms of the cared for, the cared for may experience physical deterioration due to feeling stressed. When the caregiver is stressed out and decompensating, they may physically deteriorate because the caregiver, not being well, may be less available or less attentive interpersonally. When the caregiver is stressed out, the cared for may withdraw or reduce communication, which means both of you are reducing oxytocin. And the cared for may not be seeking support when needed. So some of their physical health conditions may actually get worse emotionally. They may perceive, even if it's not the case, you're stressed out over everything that's going on. They may perceive that you're angry at them and that may cause them to get angry right back at you. That may cause them anxiety that you're going to put them in a home. Depression. It could cause worse emotional regulation and increased agitation. If they perceive that you're upset, they're likely going to get upset. Cognitively, the cared for may deteriorate due to stress or withdrawal and their negativity and pessimism may increase stress and stress related deterioration. And then environmentally, when the caregiver is stressed out, they cared for may take more risks. No, honey, you don't have to do it. I'll. I'll make my own tea. When you know good and well they shouldn't be operating the stove, they may engage in more wandering or running away. They may refuse to do their activities of daily living like bathing. And eventually, if the caregiver is sufficiently incapacitated, sufficiently stressed out, they may not be able to care for the older adult. The older adult's health may deteriorate to the point where they actually have to be moved to a long term care facility. Being a caregiver is demanding on every piece of life. Discovering assistive technology can be really helpful. Setting boundaries and practicing mindfulness is crucial to maintaining some sort of balance. Defining and working toward your rich and meaningful life and caregiving at the same time is important. How are you going to re deploy all of your energy and resources? Self care essential for caregiving. If you let your battery get drained, then you're not going to be any good to the cared for. So they're going to be an even worse position. You need to take time to recharge Developing a support system, especially with people who are going through something similar can be really helpful. Nurture important relationships so you have people you can call, people you can vent, people you can rely on, people that just bring happiness. Recognizing behaviors in yourself, in your family as well as in the cared for as communication and not necessarily taking it personally. And finally connecting with an advocate and case manager that can help with short and long term care planning can be really can provide a lot of relief because you know the money is going to last. You know what's coming next. They've been through it before. They can help you navigate Medicare which is just a nightmare. You can also call your local area agency on aging in the US Every area has one that's a government funded organization that can help you identify case managers and start navigating that, that Medicare system and Medicaid in some cases. Are there any questions? Frederick, I'm sorry to hear about your loss and yeah, it's exhausting. I, I been there, done that. It is painful and yes, we do it because we want to, maybe because we feel we owe it to the person or maybe because we feel it's the right thing to do or maybe it's because that's the way we can get those few months or years with that person. Whatever your motivation, caregiving is a labor of love, but it's a labor so it's exhausting. Thank you Dr. Darlene for coming back to or joining Silver. I appreciate supporting the, supporting the channel. And Dr. Darlene, you can sign up on all CEUs to get your CEUs most of the time unless you're in California, that's a, that's a whole different animal. But we're approved in most other states. If you want to get your CES that way and that is huge. That's an awesome way to support the channel because all CEUs and DOC snipes are kind of one in the same thing. So I do appreciate you supporting the channel and getting your CES through us. It can. Cheryl, if you're still here, I, I hear what you're saying. It can feel, you can feel really guilty if you're not able to put in as much time as other people are because they're closer or maybe they don't have as much committed on their plate already. Maybe they're still single and you've got three kids at home or something. And unfortunately other family members can guilt you. I don't know if your family did or not. Other family members can guilt you if they don't feel like you're doing as much as you should. And ultimately it comes down to doing some soul searching and communicating with the cared for about what you can do, what you want to do and figuring out what it is you quote, should do in your own mind. It doesn't matter what your brother or your sister think. It matters what you think. And it may matter what the care for thinks. If it were me, their opinion would matter. But it's between the two of you. It's not. That doesn't have to do with, with them. And that's another issue that comes up a lot in counseling. People who are dealing with someone who is struggling to live independently for whatever reason or who's in hospice care. You may want to do a lot of things, but what we want to do and what is practical and reasonable to do are often two very different things. And people, when they go into long term care a lot of times are very bitter about it. And it's great, Stephanie, that your sister recognized that. She didn't want your dad to have to deal with that. So, yeah, she was angry, but she also recognized it was a reality. And my sense is, for her, there was some anger. Anger there, not at your dad for putting her in or, you know, whatever it was anger at the situation, knowing what was coming, that anticipatory grief anger that was coming up. I mean, clearly she cared about your dad and, and loved him very much and wanted to try to do what was right. And so that's where a lot of these frank conversations need to happen. When you sit down and go, okay, it's not about whether you feel guilty about doing this or not guilty or what. What is it that you need? And I'll tell you what I can do, and then let's figure out how to meet somewhere in the middle. And that can help families a lot live with the choices that they make. I'm sorry to hear about your dad, Stephanie. Like I said, I watched my biological parents both die of cancer. And it's excruciating. It's an excruciating process. And that's where those answers don't come. You know, you really hope you can get a straight answer about, okay, when is this? When's the end? And they're like, well, it could be tomorrow, could be two months from now. Okay, that's not what I need to hear. And so that can be really exasperating for a lot of caregivers. But the same thing is true with dementia and other things that are not as quickly terminal because it's like, is mom going to remember me? You know, how, how much longer is she going to have her faculties about her and that they'll be like, well, it may be six months or a year or it could be tomorrow. We just not, probably not tomorrow, but it could be a few weeks. They can't predict very well how quickly something's going to progress. And there are a lot of things that we can do to slow the progression of a lot of these issues, but we have to understand what those things are. And hopefully when I finish the certification track that I'm working on, that, that information and those resources will be more readily available to people so they feel a little bit more equipped in their journey to support their loved ones, whatever their age. Thank you, ad skipper pro. And I couldn't agree with you more, Paula. It, it's important. When my mom was in hospice, we live lived several hours away and my stepsister and her family lived right down the street. And she didn't let me forget it. The entire every time I would come to visit, she would make sure that I, I knew that she thought she was being a better daughter than I was. And it was just hurtful and hateful. But it was important for my mom and I and my stepdad and I to have a frank discussion about what is it that she, my mom, needs and wants and we can go from there. And there were times that she didn't want us to come because she didn't want my kids seeing her how she was when she was going through chemo. So, yeah, those boundaries and expectations are really helpful in navigating. Yes. Next week's session is on Monday because Wednesday is the day before Thanksgiving. A lot of people are traveling. Typically I have really low attendance when I do it on a Wednesday. So we are doing the live on Monday. And I believe the same thing is true for Christmas and New Year's. This year they all fall on Wednesdays. They both fall on Wednesdays. So there are three days in the upcoming few weeks or three weeks, three times in the upcoming few few weeks when the webinar will actually be on a Monday instead of a Wednesday. Same time, though, I see me What I would encourage you to do is reach out to your local area agency on aging and talk with them. Honestly, a lot of services and a lot of your care can be taken care of by Medicare and Medicaid. Once you become financially eligible for Medicaid services, then Medicaid kicks in and really does cover a lot. It may not be, you know, the five STAR facilities but they do cover a whole lot of care a whole lot of in in house care etc so when you get to the point where or if you get to the point where you qualify financially for Medicaid that will kick in and a lot of those needs will be met. You'll also qualify for the EBT cards which is what we used to call food stamps. You'll qualify for discounted medication. There's a lot of things that you will qualify for. Yeah it's terrifying to think of having to spend down to where you have almost nothing and then the government trusting the government to kick in and those programs to support you in your care. However so far it the system seems to be working but I would encourage you reach out to that local area agency on aging talk to them about your situation and they can tell you what resources are out there and how things might play out for you in the upcoming 20 years or so.