LIVE The Cognitive Impact of Caregiving : Burnout Prevention | CE Webinar

Foreign, Everyone. We have, pardon me about two minutes before we get started, but I always like to log in and say good morning, see if there are any pressing questions before we get started. I hope everybody's having a wonderful day. Today we are finishing the series on caregiver burnout prevention. Next week we're moving into, well, we're just doing a one off on, on chronic fatigue syndrome. And then we will move into a series on living and thriving with chronic illness. So good morning, Dana, Laura, Paula, Stephanie, Mark, Sage, Mitch. Hope everybody's doing well. Hello, thomas and john. Make sure I have this on. Yes, Okie dokie. Let's go ahead and get started. I'd like to welcome everybody today's presentation on caregiver burnout prevention, the cognitive and environmental aspects. And you may be asking yourself, Doc Snipes, why are we doing both of those? Well, because I have that mnemonic peace, physical, interpersonal, emotional, cognitive and environmental. And I didn't want to leave off environmental because there are some things that are important. So I wanted to make sure we address all aspects of how caregiving can cause stress and burnout and the effects of that, and ways to intervene. Today we will identify cognitive and environmental signs of burnout, explore issues in those areas leading to burnout, and identify strategies to maintain cognitive, cognitive and environmental health. Just a brief overview. If you're talking with caregivers of loved ones, you may be working with somebody who's taking care of their mom or a new parent or a teacher or whatever. We want to recognize that not everybody knows all of our lingo. And at its most basic level, cognitions is just a fancy word for thinking thoughts that are triggered based on our feelings, and those feelings are triggered based on stimuli from the environment. Things we he see, hear, smell, think, whatever. Just like feelings aren't facts, thoughts may not be factually accurate in the current context. We can perceive things, we all perceive things through a lens that is shaded by, by our prior learning. And it doesn't mean we're wrong, but it means we are going to interpret things differently than pretty much everybody else in the world. And, and that's true for everybody. So we don't want to assume in the moment that what is going on in this context at this time is necessarily threatening, is necessarily a problem. We want to check our thoughts to make sure that we are thinking accurately in the moment and people's environment represents their ability to maintain stable housing, to keep a roof over our head, and to feel safe and not overwhelmed in that environment. And for caregivers it also means knowing that your loved one, whoever you're caring for, if it's not a loved one, your patient, your student, whatever is safe, that's part of that environmental safety. If you know that you can take a break for 30 minutes or an hour or go home for the day and it's going to be okay, then it's easier to let your hair down, it's easier to relax than if you're worried that, oh, okay, Johnny was in class today and I'm worried about him because I don't know that he is safe in his home. It doesn't rise to the level of an abuse report or something. But I am worried about Johnny. So that's harder when those environmental stressors are weighing on you. Burnout represents exhaustion and a sense of being overwhelmed due to prolonged states of fight or flight. Prolonged stress, we get burned out. And that is a lay term, if you will, for what happens when our nervous system is dysregulated, when our nervous system changes in response to chronic and ongoing stress. So briefly, what do you as a caregiver, all of us are caregivers, I would guess. And, and whether it's your pets, your kids, your clients, whomever, your parents, what do you as a caregiver think about regularly that triggers your stress response? You're just bebopping along and all of a sudden this thought pops into your head, what is it? And I encourage people to write those things down so they can address those thoughts. Yeah, we don't want to belabor them, we don't want to nurture them and keep these ruminations going. But if there are certain things that pop into our head, then that might be our brain saying, have you remembered to check on this? Have you remembered to check on that? And we can address those things so we don't keep having that recurring thought. When we have that thought, we can say, yep, got it covered. Are you thinking about whatever it is that's causing you stress from the perspective of what can I control in this situation or what can I not control in this situation? And if we're dealing with people with illnesses, with mental or physical illness causes, children, you know, any other human being, you can't control everything and you can't control when your child gets sick or how quickly they recover. There are things you can do to help it along. There are things that are in your control, like making sure they're getting good rest, etc, but if you focus on the things that are out of your control, then you're going to have this persistent anxiety, persistent stress. And thinking back to the pandemic, a lot of us experienced a lot of this where whenever we thought about, oh my gosh, is it safe to go out? Is it safe, am I going to get sick? We were focusing on it from the aspect of it seemed very uncontrollable. Instead of thinking about, if I do XYZ and and so on, am I taking steps to reduce, significantly reduce the probability that the bad thing will happen? Are you constantly in a state of cognitive overload? And this is true for a lot of caregivers, whether you're a new parent or you are taking care of your parents, you're a new caregiver and you're having to learn about dementia and diabetes management and end of life care and all those, it can be overwhelming. There's just so much to learn. And it's important that we recognize that learning, thinking, being takes energy and cognitive overload is a real thing. And we're going to talk about it later, but we need to be willing to reach out and not expect ourselves to know everything. Juggling is another thing. As caregivers, we do, and it takes a lot of mental energy that goes in that executive functioning area of planning. And I'm juggling these things. I've got to get the kids to soccer practice, I've got to get to the grocery store, I've got to make sure that somebody's here to care for mom, blah, blah, blah. How am I going to get this all done? And that requires energy. And then strategizing. And I use this kind of generally, how am I going to handle what's coming up, whether it's an hour from now or three, four years from now? But strategizing, what is it that I can do to address this situation and live my most rich and meaningful life while also trying to assist my caregiver in working toward their most rich and meaningful life? And finally, is your environment calm and welcoming? Can you sit down and breathe and go, okay, I'm safe. I know my caregiver is safe. You know, it's, it's all good. I, I can take a beat. Or is it chaotic and cluttered? You walk in and there's just people and sounds and it's exhausting. I remember when my son was in the neonatal intensive care unit and it took a while for me to get used to all the different beeping and movements and everything. Eventually I got to the point where I learned how to tune it all out and be present with him, but it was really Overwhelming at, at first. So let's talk about cognitive signs of burnout. And basically these signs of burnout are your brain has kind of shut off. It says no energy, not computing. You may have. And it usually has to do with executive functioning. Memory lapses. You are trying to remember something and it can be something that you've remembered for 20 years, like your kid's birthday and you just lose track of time or you forget things that you normally would remember. You just forget poor attention and concentration. That's another one. When we are in fight or flight, we are trying to get away from the threat, the hungry lion. And our executive functioning, our prefrontal cortex is, it's not engaged or not engaged a lot. So attention, concentration, information processing, all the energy we use for those executive functions is being devoted to survival. So we have poor attention and concentration. It is, it is what it is. We need to accept it and instead of fighting against it, mitigate it. What can I do? Do I need to change my environment so it's not so over stimulating? So there are not things pulling my attention in six ways? Do I need to write things down? Do I need to break things into smaller chunks because I can't concentrate for more than a minute? Lack of awareness, and that can mean lack of awareness of what's going on around you, but also lack of awareness of what's going on inside you. We go into autopilot. We, when we're in burnout, we're not introspective. We're running from the hungry lion. It makes sense. You're trying to juggle all these things. You're trying to keep your caregiver safe so you're focused on that slowed information processing goes back to that impaired executive functioning and difficulty problem solving. Now I have these under brain fog because it's generally these are symptoms that people describe as brain fog. Having difficulty coming up with words, that information processing can be difficult when we are burned out, when we're exhausted. And there's a lot of reasons behind that. One of the reasons, and I know some of you who've been with me for a while are going to roll your eyes, but it's true, one of the reasons is poor sleep. When your stress response is activated, when you can't relax very well, you are going to be more likely to get poor quality sleep. When you get poor quality sleep, you don't clear out the adenosine in your brain. You don't clear out everything and get ready, get your brain ready for powering on the next day and that leads to a sense of, of brain fog, a sense of fogginess. Additionally, adenosine is one of those chemicals that builds up in our brain that causes us to get tired. As adenosine builds up, it causes us to have what they call sleep pressure. And when that doesn't get cleared out, you feel groggy all day long. And that can contribute to brain fog. Additionally, when we are getting burned out because we're in fight orf flight, we tend to want to control more. We tend to have more rigid thinking patterns partly because we're having difficulty be thinking of options. You know, it's not something that when you're really stressed out, you're not going to sit back and go okay, well I could handle it this way or that way. You're not going to ponder, you're going to try to solve the problem. And those rigid thinking patterns can keep you stuck in a, in an unhelpful loop. And pessimistic perceptions and this kind of, it's on the borderline between thinking and feeling. But we tend to interpret things so cognitively interpret things pessimistically based on their threat value when we are feeling unsafe, when we are feeling vulnerable, when we're feeling threatened. So you may have a tendency to perceive not only things that are going on with the caregiver, but with everything as more pessimistic than maybe it really is. Environmentally there aren't a whole lot of signs in this, but environmentally there may be a significant decline in and lack of care about organization, cleanliness, home maintenance. You may look outside and go, well the grass is coming up to my knees, but I just ain't got it in me to, to mow today. It's just not going to happen. And this would be a divergence from what the person's normal organization, cleanliness, etc is like. If you're one of those people who is very obsessive about have, have having everything just so then you know, when somebody walks in and things are not just so might be a clue. So we do need to look at it on a spectrum because not everybody is Martha Stewart. So let's talk about what's causing all this cognitive overload. We are trying to learn. We are trying to learn at a breakneck pace to be able to take care of our caregiving. When my son was born, since he was a micro preemie, I was like, well, you know, I studied all the books on, you know, early child development, but I have no idea what's going on here. So I went online and I ordered every book Amazon had on life in the nicu. Raising a preemie, issues with preemies. You know, of course I overdid it a little bit, but I wanted to know and I was soaking up that information, but it was tiring, it was exhausting and it took not only a lot of energy but a lot of time. Now he was just, you know, growing in, in his incubator, so it wasn't keeping me from him. Those first few weeks, we weren't even really allowed to touch him that much for fear of over stimulating him, but it was exhausting. And then every time I'd read something, I'd learned how much I really didn't know and that was even more anxiety provoking. It was like, ah, what do we need to do here? Yes, you're learning stuff, you're learning new stuff. You're not expected to be to know everything about everything all the time or everything about anything, whether it's having a preemie, dealing with somebody with dementia, diabetes, whatever, that's fine. You're not going to have, you're not going to know it all. Get help, reach out to people who do know. If you're talking about preemies, I would talk with the nurses that were in the nicu. We had some wonderful nurses in the NICU and they helped me internalize it and, and recognize, you know, what parts of this do I need to know to be a good caregiver for this little peanut? If you're dealing with somebody who has just got gotten diagnosed with diabetes, you may not know anything about diabetes. That's fine, you can read, but you can also contact experts. The American Diabetic association, for example, and there are probably some other books that are written in very practical terms to help people understand it. But for any issue that comes up, there are experts out there. And instead of trying to know everything all the time, we can consult, we can ask them. Don't be afraid to have people repeat things. If they've told you this before, and you know they've told you this before about what to do in this situation, but you just can't remember, that's okay, ask them again. Or if you don't understand when they tell, tell it to you the first time. Maybe they used a lot of jargon or you were having difficulty focusing, that's okay, have them repeat themselves. We recognize the people who are not doing the caregiving, who are helping caregivers. We recognize you're under a lot of stress and you're in a pseudo crisis. State and during those times, we know that your executive functioning isn't going to be on its a game. We will encourage you to write it down. And I will encourage you right now if you are learning new things, if you are trying to figure out what next, even if you just need to make a list of what do I need to do today? As soon as you write it down, that's one less thing your brain needs to use energy for. In terms of juggling, I have a formula and there was I tried every way possible to make a mnemonic with it and I just couldn't identify, eliminate, delegate, simplify and schedule. Identify everything that you think you need to do and notice. I said you think you need to do. Write it all down. Whether it's for today or this week or this month, whatever, write it all down. Then go back through and eliminate the things that really don't need to be done. Would I like to go out and do some harvesting in my garden this afternoon? I'd love to, but if I don't have the time, that's not a need, that's a want. So I can cross that off. And do I need to do laundry today? No, I still have enough outfits to get me through in next few days. My husband still has enough outfits to get him through the next few days. I don't need to. Would I like to get it done? Yeah, well, sometime in the next couple of days. But it's not a need. And that's where a lot of people get caught up is they call things needs. They call things musts that really aren't, that really aren't. And my general rule is, I ask myself, is significant harm going to come to myself or someone I love? And if I don't get this done right now, or if I don't get this done in the next three days, paying bills, that's a need. But it may not be something you need to do today. The bills may not be due until I don't even know what day of the month it is. Bills may not be due to the 15th of next month, so you've got a couple of weeks to get that done. If you've got too much to do today, that's fine. Okay, so eliminate all the things that aren't absolutely necessary. Delegate from that list. What can you ask other people to help with? Whether it's doing dishes or picking up groceries or maybe even get stuff delivered. That's delegation. When instead of going out to the grocery store, you put in your order online and have it Delivered. That's excellent. You'd be amazed at how much time you can save when you're not having to drive there, pick everything up, check out, you know, da da, da, da, da. So delegate, delegate what you can, whatever you can't delegate, simplify. And we've talked about this in other, in other classes, simplify what you can. You can order in pre made food, not the healthiest most of the time, but you can do it. You can make casseroles so you have fewer dishes and maybe you can eat, eat leftovers for a while. You can try to combine things as much as possible. Don't make things more difficult than they need to be. If somebody's having a birthday, normally you would make them a three layer cake and blah blah, blah. Well, you ain't got it in you. So go up to the grocery store, go to the bakery and buy a birthday cake. Yes, it's a little more expensive, but it saves you a lot of time or delegate that to somebody else anyhow, Once you're left with the list of needs that's been pared down and delegated as much as possible, whatever's left, simplify it and then schedule it in. So like I said, paying bills. Maybe I don't need to pay bills until the 8th of next month in order to make sure they get there on time. So I'll put that on my calendar, but I'm not. That'll take it off my list. That'll take it. It's one more thing that I don't have to do right now and figure out how I'm going to get the must do's done. And that includes self care. That does include self care. Self care are must do's because if you don't recharge, you're going to end up like a, a cell phone with a dead battery, nothing, not good to anybody or yourself. Strategize. When you are trying to figure out how to handle things. Whether it's, you know, how are we going to handle grandma as she, as her dementia gets worse or how are we going to handle grandma today to reduce her sundowning? Make a plan, review it. Review your plan. Or if you can have somebody else review it, you know, do you, do you think this makes sense? And then set it aside now you have a plan. You don't want to sit there and just go back on what ifs. Well, I could do this, I could do that. You could. That burns up a lot of cognitive energy and you could end up spending an entire day on what IFS and plan C, D, E and F. Which brings us to recognize the principle of diminishing returns. Do you have a plan? Does that plan seem like it'll work great if you keep refining it? How much more effectively will it work? Generally, creating the plan gets you 85, maybe 90% of the way there. And every iteration after that only improves the effectiveness or the efficiency, maybe 1%. Is that worth your time and energy or do you recognize that 90 is good? I'm good with this plan that I've come up with. It may not be perfect, but, but it will get the job done. Mind reading and this is something that I tell y' all not to do a lot, but when you're working with somebody who's non verbal, whether it's because they're an infant or because they are, they, they have dementia and they're no, they have aphasia, they're no longer verbal for some reason, then you may have to engage in some element of mind reading to figure out what's going on with my caregiver. Okay, so we empathize with them and that's really important. I worked with a patient who had aphasia, and I remember one day we went into her room and she was really upset and she couldn't communicate, she couldn't tell us about what, but she was really wound up and gesticulating all over the place and so empathizing with her. I. You are really frustrated today and I want to understand what's going on with you. She started to de. Escalate right away. It's like, okay, somebody's going to try to help me. Use simple language. When you're talking to people, whether it's a child or an older adult that is, is non verbal or not effect being effective at communicating right now? Are you in pain? If so, okay, then can you show me point to where you're in pain using those simple languages, very short sentences and asking very objective questions. Use pictures if needed so they can point to, maybe they're upset about somebody that another caregiver, the, the nurse that came in and worked, worked with them today. Ideally you have pictures of their different caregivers so they know who's supposed to be there and you can point to them and, or you can point to a picture of, you know, a nurse or the dog or the child. And they can point at is there somebody that is causing you stress and they can point to that. So yes, it takes a while, but you're still communicating. And, and that's true regardless of the age. If the person's not able to effectively articulate what's bothering them, then we need to start asking questions and probing and to a certain extent, mind reading. If. If grandma seems to be really irritable today, well, it could be she's just irritable. But I am going to try to think to myself, I wonder if, is grandma in pain? What might be going on? And then we'll. I'll move into empathizing and then trying to somehow get her to communicate it. If you are experiencing cognitive overload with others, they are just. They're coming in here, they're trying to change things up. They're always in your space. It can get exhausting. And. And again, whether you're. If you're in the neonatal intensive care unit, even if you have people at home that are trying to help you bring the new baby home, and every relative that you don't. Haven't seen in 15 years comes by to help, it can feel exhausting and overwhelming because they're. With love invading your space. And it's like, I can't get a moment to myself. That's fine. Let's empathize with them first. Seek first to understand, then to be understood. That's one of the seven habits of highly effective people. But it's so true. Let me empathize with what's going on. Why are you here? What do you. By coming in and trying to change everything, what is that actually saying? What is that behavior saying? You know, I get the sense that you really love grandma and you want to make sure that she is as happy as possible. And so you're coming in and trying to do these things, and that's great. I'd love to hear your opinions. Let's talk about these things before you start making changes and then explain to them. You know, I see that you care about her very deeply, and we've got a system here, and I'm totally open to modifying the system, but we need to do it in a meaningful way for other people. The ones that are verbal ask what they need, want, or are thinking if they're sitting over in the. In the back just being really quiet. My stepfather used to do that, and it took me a long time to get used to it, but he was just a huge introvert. And I would think, you know, maybe he's not happy. Maybe he doesn't want to be here. And my mom's like, no, that. That's just him. He just. He sits in the. Observes. That's just the way he Is okay, so I got used to that. Probably should have asked him directly, but you know, I recognize that, you know, I don't know what's going on in his mind. And instead of trying to mind read, which led me to the belief that, well, maybe he's not happy, I checked it out and then work together with other people to synergize and create win wins. How can we work together so I'm not feeling so overloaded. So we're not fighting each other on planning and things, which just creates more cognitive stuff. Let's put our heads together and come up with a plan. The what ifs can drive you crazy. What if this happens? What if that happens? What if we run out of money before grandma dies and how are we going to pay your medical bills? What if my kid goes to school and the bus gets into a wreck and he said what ifs? We could what if ourselves to death, literally, you could sit there and what if until the cows come home. But we don't know. Those are just possibilities and a lot of them aren't even very probable, but they're just possibilities out here. So I encourage people, when they start what ifing what if this happens, focus on what is, what is going on right now? What do I have control over based on the facts in this context at this time? If you're going through, you're taking care of your, your parents and one of your parents has dementia, okay, well, yes, the parent with dementia, that dementia probably will progress and you know you're going to have to make decisions as that happens, but you don't know how quickly it's going to progress. You don't know what tomorrow brings. So focusing on what if can be exhausting. Yes, there is reasonable planning and I encourage you, if you, if you're working with older adults to reach out to a life care planner to make sure that you have the basics covered. So you feel confident that we're not going to run out of money and not be able to pay for my loved ones medical bills. And honestly, I'll tell you one thing right now, most people, for some reason doesn't even occur to them if you've got medical bills, especially with the hospital, contact the hospital's billing department, say, you know what? I can't pay a $17,000 bill right now. I, I ain't got it. They'll work out a payment plan with you that is reasonable and then they're able to write off a certain amount of it at the end of every year as bad debt. Most of the time, hospitals, as long as you're trying to pay, are going to work with you. But anyhow, overgeneralization, jumping to conclusions with insufficient facts. And I. I know those are two different distortions, but they overlap a lot. If your loved one is in pain, if your loved one is sick, if your loved one is just in a mood, we don't want to jump to conclusions. We don't want to assume. And going back, a lot of us developed a certain amount of health anxiety during the pandemic. So I do go back to that, because we're still trying to feel empowered again, I think, in many cases. But every time you get a sniffle, freaking out that, oh, my gosh, it's going, this must be. Or every time you get a pain in your back, thinking, oh, I must have cancer or something, that is. Is it a possibility? Yes. But is it a probability? No. So we want to get the facts in this context at this time. Is this person. Let's take addiction, we haven't talked about that yet. Is this person relapsing? You notice some signs and symptoms and behaviors that were common when they were in active addiction. Is this person relapsing, or is this just a temporary situation caused by something else? Is this person. Maybe they're withdrawn and they're stolen, and that's how they were when they were using. And suddenly they've been in recovery, they're withdrawn and sullen again. Could it mean they're using again? Yeah, but it also could mean something bad happened and they're feeling overwhelmed and they're trying to figure out how to process it, and they haven't relapsed at all. We don't want to jump to conclusions. And with illnesses or moods, for example, is it this catastrophic thing or is it something much more benign that's going on? Is my loved one having a relapse into bipolar mania, or are they just really excited today for some reason? Personalization is another cognitive distortion that drains a lot of us, and especially as a caregiver, because we're trying to do our best to take care of our loved one, and we know we're not going to do it perfectly. We know some things are out of our control. And when it feels like people are expecting us to do it perfectly and control everything, we can feel like we're in this quandary where we are not doing it right. Don't take other people's reactions to what you're doing. Personally, 90% of their reaction is based on their stuff. So if they come in and they're like, oh, I can't believe you're doing that. Well, believe it because I am. That is their reaction. You may choose sometimes to ask, well, what would you do differently? Or you may choose to let it go and go, I am doing my very best and my caregiver is doing just fine, thank you very much. So enough. And find three alternate explanations for their comments or behaviors. Maybe they came in and they were trying to be helpful. Telling you what they believe about how to raise your kids or how to take care of your parents or whatever it is. Okay, Is it that they don't believe you're doing it right? Is it that they aren't competent or confident in you, or is it that they're trying to be helpful? Or is it that it triggers something? They walked in and they've been through hospice four or five times with people they love. And your love, your caregiver is in hospice. They walk in and it triggers all those feelings of powerlessness. And then they start wanting to take control has nothing to do with you. It has to do with their past traumas coming up. So find alternate explanations that don't have anything to do with you or your effectiveness and move on. And don't internalize differences in approaches as criticisms of you. You are you. How you do something is not the same. You may do something differently than somebody else. That doesn't mean you're wrong. That doesn't mean you're bad. That means the way you're doing it may not be how they're doing it, or maybe the way you're doing it is wrong. I mean, it can happen, but that's okay. It doesn't mean you're bad. It means, hey, when it comes to changing out or cleaning the the insulin pump, it would be better to do it this way. It's not a criticism of you. It's a point of information. Take what's useful, leave the rest and separate it from who you are. Just because you didn't know, that doesn't mean you're a bad person or a bad caregiver. It means you didn't know and now you have the information and you can choose what to do with it. Planning for how to keep yourself and others safe in the home, hospital, classroom, playground, wherever. I remember when my kids were little, I just constantly stressed out about going to the playground because especially when there are lots and lots of kids around, if I couldn't constantly see my children, and that was my own paranoia, whatever, and I recognized that. So you Know, I. I took steps, but I have to admit, whenever we were at the playground, I was constantly battling an element of anxiety because I wasn't in control of who else was there and what else they were going to do in the classroom. I've told you before about the little boy that was in first grade with my son who would spontaneously stand up and start throwing chairs and just melting down. You know, felt anxious about sending him to school. And I'm. I know his teacher felt anxious about, you know, what is this kid going to do today? Recognizing that as a caregiver, we want to keep our caregivers safe. And if we don't feel like we're able to do that most of the time, then there's going to be an element of anxiety. So how do we handle it? We consult the teacher, consulted with the school psychologist. The. When I went to the playground, you know, I. I got my husband's opinion. He was a cop working in that area. I'm like, is this. He's like, yes, it's safe. You know, just take a beat. Okay. All right, I got it. And I would talk to other parents. You know, how do you feel? How do you help yourself feel calm when you're at the playground? And obviously, this was my. When my kids were really little, like 2, 3. Collaboration with other people that are involved in the care of this caregiving. So everybody's on the same page and you're all committed to keeping the person safe. When I worked in residential treatment, knowing that my staff had it covered when I wasn't there helped me, help me be more relaxed. I knew I could go home, and most everything that came up, they were competent to handle. We collaborated. We'd have team meetings. We knew how, you know, what different people's issues were, and we had plans. So that helped the most of us be able to go home and rest and leave that there, recognizing they were in this safe care of the next shift. And rehearsing can also be helpful if fire drills, it's one of the reasons we do fire drills. If you're worried about fire, rehearsing fire drills, even with your family, so you know that everybody knows how to get out and where you're going to meet up and all that stuff. You don't have to do it all the time, but every once in a while, doing it can help you feel more confident that if this thing happens, it's going to be okay. All or nothing. Thinking. Typically, we want to embrace the good with the bad. If I think the only resolution to this is if this person's cancer is cured. Well, I may be missing out on some other options. Remission is really good too. They found ways to keep people in remission for a lot of things for a long time. My daughter's POTS and her fibromyalgia. Yes, she has flares sometimes and yes, it sucks. And yes, I wish there was a cure for it. Right now there's not. However, I embrace those remission periods and love the fact that she is feeling more empowered to manage her stress and manage her triggers. So her remissions are lasting longer and they're more complete. We want to strive for improvement or progress, not perfection. If we strive for perfection, we're always going to be stressed out because ain't none of us perfect. So strive for improvement. What can I do as a caregiver? What can I do better today than I did yesterday? And maybe that just means being more present. Maybe. Okay, here's a revolutionary one. Maybe that means getting enough rest and self care so I can be more present tomorrow. Hey, concept, consider all the things that are important in your rich and meaningful. Rich and meaningful life, not just one. So thinking about all those things that are important instead of saying, my life sucks right now. Well, certain aspects may. Yeah, you know, that's. That's very, very possibly true. But the likelihood that every aspect is in the crapper right now, not very. Not very probable. So recognizing all the things that are important in your rich and meaningful life. Maybe you hate your job and some people do. Okay, you hate your job, but you love your family, you like your house, you enjoy going to the gym. There are a lot of things that are important that in your life that are going well. Yes, this thing over here needs some work. But acknowledging the good with the bad helps balance it. We don't want to negate it, we don't want to ignore it. We want to balance it and recognize that it's not all bad. Magnification of the negative and minimization of the positive, we tend to do that a lot. We magnify when we make mistakes or don't know something. And when we do something right, we minimize it. Well, everybody would have done that. Of course, anybody would have done that. Well, maybe not. Keep a journal or an ongoing log of both the good and the bad that happens again, embracing those dialectics. But that helps you recognize the good things that happen. So you can say, yeah, I did that. I maintained my cool today when everything was falling apart or whatever it was. But you can identify the things that you did well, then you can recognize your contributions to the good and your powerlessness in the bad. Grandma had a really bad day today. And you know, it wasn't my fault. It wasn't anything I did. It was just, it was, you know, her, her body shutting down or she had a flare for some reason. That's not my fault. And recognizing the powerlessness instead of saying it's my fault that grandma had a bad day. No, you know, very probably it's the disease or the disorder. Same thing for our kids. You know, there's. They may have a bad day and you see their little hearts breaking when something bad happens and you comfort them, but it doesn't make them feel completely better. But that's okay. It's their right to feel their feelings. And you are there, you are doing your best, but you're. You don't have the power to take away their feelings. Emotion based reasoning. Well, we've talked about this a lot, but we'll talk about it again. I feel like I'm a failure, but is it objectively so? I feel like I can't do this for one more minute. But is that reality? Maybe I can do it, you know, a couple more weeks or something. Yes, I don't want to, but can I? Or I'm afraid that this is going to happen. When we're afraid, these are those what ifs Again, is it objectively probable that that's going to happen? I'm afraid that something bad is going to happen to my caregiving quote on my watch. It could. It's possible. But is it probable? And for most caregivers the answer is no. You know, you're taking care, you're doing your very best and by handling all the things that are, that are within your control, you reduce the probability of something bad happening. With the exception. With the exception of if we're dealing with illness. Sometimes germs and illness and things just kind of run off on their own. And it's no fault of our own, but we want to look at what's objectively probable. Is worrying about this going to do any good? I'm afraid that grandpa isn't going to be able to handle it when grandma passes on because it's clear she's going first. Well, we're going to have to cross that bridge when we come to it. I have no idea how grandpa is going to handle it and what is the best way we can use our energy to move towards our rich and meaningful life. My assumption in most cases is that people who are caregivers that's an important part of be of their rich and meaningful life. Okay, great. So how can you be the best caregiver you can be? How can you use your energy to nurture not just caregiving, but all the things that are important in your rich and meaningful life so you feel fulfilled Having people. Environmental issues. Sorry, switched gears on you. Environmental issues. Having people in and out of the house or your business all the time. And with hospice, for example, you may have a care team and they say, oh well, the nurse will be over at sometime today to give your loved one a bath or to check on this. And that can be really stressful for those of us who are structured and we don't do spontaneity very well. So try to schedule them or at least narrow them down just like you do with, you know, appliance repair people. Give me a window of when you think you're going to be here so I can plan my day a little bit. That can be really helpful to reduce unnecessary stress if you've got hoverers. And these are the people who come in. They're constantly asking questions. They're constantly, you know, trying to be all up in your business. You're caregiving and they want to know what's going on all the time. And they seem to feel the need to put in their two cents constantly. You may discuss your feelings with them that it feels like they're judging you, it feels like they don't trust you or that they don't think you're doing a good job when they're constantly hovering and not letting you just do your thing and discuss with them how that impacts your ability to caregive. When you're hovering, I can't be present for the caregiver. It stresses me out. It makes it more difficult for me to do my job and it makes it more difficult for me to be me having no time to be at your own home to do what you need to do. Obviously this is if you're caregiving. For people in their, in their homes, it's important to request assistance from your social supports. My my in laws had been traveling down to be with my grand my husband's grandparents and they live three and a half hours away. So yeah, I mean their yard didn't get mowed as often as it normally would. Things didn't get dusted and my mother in law keeps things so clean that you could probably do surgery on them. So you know, obviously that was a stressor not being in her own bed where she could relax that was a stressor. Request assistance from your social supports. Maybe they can do things at your house so you don't have to do them when you go back. Or maybe they can take care of the caregiver so you can go back to your house and do that. So you can go back home and spend time with your kids and your pet and whatever. Set boundaries and schedule it in instead of agreeing to be there all the time. It's important to say I can do this for a week and then I need to go home for a week in order to take care of things. So everybody that's part of the care team is aware and you can plan for who's going to be on duty when hire help if you can afford it. I know that's not always possible. You can also try reaching out if you go to a church or a synagogue or something, reaching out to your congregation. Sometimes they have care teams at the congregation who are more than happy to pitch in for some brief respite for caregivers. And then virtual monitoring can also be helpful. Having them wear the pendants so you're not worried when you're not there. Is. Is grandpa fine or did he fall down again? That virtual monitoring can be really helpful. If they're afraid to be alone. You can also have it going the other way so they can see you. There's a camera at your house, they can see you moving around, what have you. But there's a lot that you can do with technology. They even have have technology now that you can set up. So if somebody for example, gets up every morning and the first thing they do is make coffee and in the microwave, you can put a sensor on the microwave. And if they haven't opened the microwave to make coffee within a certain period of time based on what's normal for them, then the caregiver gets an alert. So you can call them or go over and check on them or whatever. You can do this with the, the refrigerator, the microwave, just things that are normally opened and closed or what have you. They can also put things up that monitor movement. That's a little more intrusive in my opinion, but there are lots of options. Just talk to people who are aware. And the constant input in caregiving environments can be exhausting, even if it's just monitoring your children. Going to a preschool class one day, one of my son's preschool classes I was volunteering and having 15 little 2 and 3 year olds running around trying to make sure that they were staying safe, etc was exhausting. Oh my Gosh, you know, I didn't feel like I could sit down, calm down, whatever, because I was hyper vigilant. And that's, you know, okay, it is what it is. But it's important to be able to take breaks to down regulate when your child is sleeping. For example, if you're a new parent, maybe taking that time to sit down, you're not having to worry about what are they getting into, where did they just crawl to and practice open awareness, Open meditation or focused awareness meditation, whichever works for you. Open awareness is just being and noticing everything around you, just trying to soak it all in. Focused awareness is focusing on one thing like a candle flame or a big fluffy cloud that's right in front of you and you're not noticing everything else around. Either way, it turns your attention and can help reduce the amount of mental activity. Clutter or sights. Do not resuscitate orders. I hate seeing those. I know when I saw my mom's, it was just like devastating. But a lot of times you need to have them. You can put them on the refrigerator so they're easily seeable by paramedics or whatever that come in, but they're not literally in your face every second. Clutter can happen, especially if you've got hospice involved or when you have a new baby. You know, there's, there's Pampers and there's, you know, toys, oh my gosh, the toys and, and everything else. It can start to feel overwhelming. If you don't like clutter, it's important to pay attention to that. And the caregiver themselves as a site can be a source of stress in the environment. If you're looking at your caregiving and you see that they're, you know, not doing well, it can be a source of stress because you're wondering, when is this going to turn bad? What can you do? Increase sights that are calming and empowering. What things can you look at and go, okay, I've got this. Eliminate anything that isn't currently needed in the room. In my kids rooms, we always had bins where the toys would be put. You had the Lego bin and the action figure bin, etc. So I wasn't tripping over things or stepping on Legos in the middle of the night. That can be helpful. If your caregiver, for example, moved in with you and there's a lot of clutter because you've got all the stuff from their house in your house, you may consider renting a storage unit. How can you eliminate or minimize the clutter? So you don't feel so overwhelmed. Some people don't mind clutter, but most of us, it's again, it's one of those things that's on a continuum. Some people can't take any. Some people, you know, don't mind it at all. And then most of us are somewhere in between the sounds of monitors or codes. If you're in the hospital, practice refocusing your attention if there are monitors going on. I remember reading books to my son and I'm focusing on reading to him and noticing his reactions as those monitors are going off behind me. I got to the point I didn't notice them. Same thing is true at home. If you have monitors on your loved one, you may refocus your attention because when there's a problem, the monitor changes. Instead of being that steady beep, beep, beep, it starts making all kinds of loud crazy noises. Those are the ones you need to pay attention to, not the background beep, beeps. Add background noise that can help drown out some of the mundane noises. And know the plans for the codes so you feel prepared if you need to act. If your loved one's heart stops beating and it starts to code, what are you supposed to do? That's a horrible thing to think about. But if it's a possibility, especially a probability, it's better to be prepared and needs of the caregiver. Sometimes in the environment, you're doing a lot of things that you don't have to do because there are assistive devices that can help the caregiver and altering the environment to make it more empowering and for the caregiving helps them as well as you. If they're having difficulty with mobility, bathing, toileting, communicating, or even managing a chronic illness like diabetes, there are a lot of things out there that you can use. I mentioned for toileting because that's a big one for a lot of people. There are internal catheters which positives and negatives to that, but they're also. They've also developed some external catheters that are supposed to work pretty well. That can be really helpful. If you're working with an adult who is now incontinent, sanitary garments can be very helpful. A bidet can be really helpful for older adults if they're having trouble wiping themselves, that can help clean things up so they don't feel as vulnerable when the caregiver has to help them, you know, get cleaned up. And then chamber pots are basically toilets that are right next to your bed and those can be helpful to reduce the amount of movement that somebody has to do at night to think clearly and have the energy to caregive and maintain your environment. You need to feel clear headed, safe and empowered in that environment. And you need to know in order to relax, you need to know, think and believe that you are safe and your caregive, caregiver is safe. Sometimes even when you're not around. That way you don't feel like you have to be the one there doing it all the time. All right, are there any questions? As I mentioned, this finishes the series on the multiple ways that caregiving impacts our stress and can contribute to burnout and what to do. So we had physical, interpersonal, emotional, cognitive, environmental, finish that today. Next week we will be talking about briefly about chronic fatigue syndrome and then launching into a series on living your highest quality of life with a chronic illness. I hear you, Paula. Those nosy, gossipy neighbors can cause a lot of stress in your environment because you're afraid to go outside. And around here our neighbors aren't really that gossipy. But we have one neighbor who doesn't keep her dogs restrained and they're not friendly dogs. And so it's always a bit stressful going outside wondering, you know, am I going to get charged by this psycho dog today or not? And y' all know how much I love dogs. But it, it's a little stressful and you know, gossipy neighbors, same thing. You don't want to have to deal with the stress of protecting yourself from them. And that's great, Tanya, that you're talking to your, your grandson who's non verbal and, and we can do that with our caregivers. Even if they can't communicate, they understand, even if they can't understand our words, they understand our tone. If we use a stressed out tone, they're going to get stressed. If, if you use a calm tone, then they're going to be calmer. Infants don't understand language, but they understand tone. People with certain types of aphasia may not be able to speak or understand speak or interpret language, but again they understand tone. They feel our presence and that can be really helpful. It's also a very trauma informed approach to narrate what you're doing as you're doing it. And, and I wish more doctors were trauma informed. But letting them, letting people know, hey, let's, let's go take a bath, all right? Mommy will help you get undressed and so put your arms up so we can take your, take your shirt off your, over your head. You know, just telling them or before you're getting ready to wash their hair, I'm going to pour. Pour the water over your head right now, so cover your ears. They're not surprised. They feel empowered. They know they're safe. And that is. That. That's amazing. Hello, Jason. I didn't see you come in. Always glad to see you. You are quite welcome, David. That is wonderful, Tanya, that you are able to help with your grandson who has autism, and. Yeah, it's exhausting. And sometimes he may have episodes stemming, episodes that you don't exactly know what triggered them. And that's okay. It doesn't mean that you did anything wrong. And not that you said that you had any question, but for other people who are taking care of loved ones, I think it's really important to recognize that sometimes another person's just having a minute, and it could be pain, it could be distress, it could be frustration. We don't know. We can get into that. But just letting them know that, hey, I'm here. I'm here to keep you safe, and I will help you through this goes a long way. Thank you, everybody, for being here, and I will see you next Wednesday. Oh, I'm so freaking hungry now.