Preventing Burnout in Caregivers | Case Manager Certification Training

I'd like to welcome everybody to today's presentation on caring for caregivers.

This is part of older Americans awareness month. And so I figured we would talk about not only the older Americans, but also the caregivers. I AM your host, Dr. Donnelly Snipes.

In this presentation we're going to explore what caregivers really are. Because a lot of people who are.

Caregivers kind of get ignored because they are not formal caregivers.

Well, I identify some of the things caregivers do.

Identify the consequences of adopting a caregiver.

Role and review cognitive behavioral strategies to.

Help caregivers prevent physical, emotional and interpersonal problems.

Caregiving can be thought of like a company merger. If you have ever gone through a merger.

Like the company that I used to work for used to be behavioral health and then it decided to be a fellow fellow federally qualified health care center or something. So it became integrated behavioral health and we added doctors, primary care physicians, and there was a whole lot of hubub.

We didn't change our location, but there.

Were a lot of alterations in our current structure. Different departments got shuffled around so you know, what was your office was your office no more. There were new policies and procedures to learn. Some of our old policies and procedures got changed in order to meld better with the medical providers policies.

There were new supervisors telling us what to do.

Our quality assurance risk management person changed. And there were new people, new C level executives that were directing what was going on.

There were alterations in the mission and.

Vision of the organization. We were no longer straight up behavioral health, we were health. So there were different things that we were trying to accomplish and different things that we were allotting our energy to.

Now not everybody in the company was on board with the merger. And regardless of where it happens, change causes crisis. So when we talk about caregiving, you.

Have an individual who may move somebody into the house in order to help care for them. So maybe somebody gets booted from their bedroom.

There could be alterations in the current structure.

They have to put in handrails or things like that.

Or the person, the caregiver may end.

Up spending a lot more time away from home and with the, with the patient at their home.

There are new policies and procedures. There are new things.

The way things are handled. Who mows the lawn, who does the grocery shopping when you have to be quiet may change when a loved one is moved into the house or if someone in the house, like you know, a primary caregiver in the house becomes a caregiver for a patient.

New supervisors Telling you what to do.

You've got doctors, nurses, multidisciplinary team members that are directing care. I remember when my son was in the nicu, he was in for a lot longer than my daughter, so there was more opportunity for me to get frustrated because I was the caregiver in my mind, of my son, and even though he was living at the hospital. But there were nurses and there were nurse practitioners and there were doctors who all had their own ideas about what needed to happen and when it needed to happen. And so there was often a.

Little.

Bit, you know, I tried to be as patient as possible, but a little bit of a power struggle between me trying to be mom and them trying to be medical professionals. Thankfully, my husband is very good at saying, you know, you need to just chill out. They're doing their job, and, you know, you can be. You can be mom when he comes home. Which at that point in time was, you know, it ended up being the best, best option.

But it was challenging because.

I felt as a, you know, I was the queen of my domain, so to speak, I. I felt like I was having that undermined. When there were other caregivers that were added to the mix, that started trying.

To direct things, There were alterations in the mission and vision. When you bring a loved one into.

Your home, maybe because they have dementia or they had to have a hip replaced or something, what you used to do, you know, all of your normal routines and the things that you focused on are often going to switch a little bit because now you have this additional thing that you're responsible for.

And this can be true with adding.

A baby to the house. You know, whether it's, you know, you have a baby or you are a grandparent who decides or ends up needing to take care of, raise your grandchild.

Or something, there are alterations in your.

Life, in your mission and vision. You envisioned, you know, your. Your 30s or your 60s or whatever being a certain way, and now not so much.

Not everybody in the family is often.

On board with what's going on.

If you're bringing somebody into the house.

There could be people that are not happy about the fact that grandma's coming to live with them, or they're getting booted from their. Booted from their room, or there's a new baby, and that's taking up all of mom's time, and I'm not getting it.

So there is a lot of hubub.

That happens, and all of this hubub.

Causes crisis, change causes crisis, and crisis causes change. And it's important to recognize, although it.

May not be a severe, know, debilitating crisis, it's going to create some turmoil.

And we need to prepare for that and recognize and prepare caregivers for the.

Fact that, okay, you know, maybe you feel that this is the right thing to do and this is something you need to do and your heart is in it.

However, no matter how much your heart.

Is in it, it is not going to be easy and there are going to be some adjustments that have to be made, some growing pains.

Which is why I like the idea.

Of a company merger, because a lot of times mergers end up creating a company that is bigger and stronger and more robust and all that kind of stuff. But anyhow, come to Better Help every day looking for a counselor.

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So who are these caregivers? Well, you've got formal caregivers, and we don't want to forget about them either.

Social workers, counselors, nurses, clergy, doctors, people who are. That's our profession to be a caregiver.

And then you've got informal caregivers, and.

Those are the family and friends of the person.

When people are in hospice, for example, you've got formal caregivers that are. You've got formal caregivers that come in.

Like the nurses and the cnas and the whomever to provide that kind of care.

But then you've also got informal caregivers.

That are filling the gaps. They're sitting with the person, they're getting the person's water. They are, you know, noticing when the person is having pain management issues or something and calling, doing case management, to call the hospice team and say, hey, we're having a lot of breakthrough pain here. We need to handle something.

Same thing if the loved one has.

Dementia or whatever, whatever we're talking about. A caregiver is someone who is having to devote a fair amount of time and energy to take care of someone else, infant, adult, adult with a disability, or, you know, someone who is an older adult who may be aging and just has normal consequences of aging and some frailty or maybe developing some cognitive issues.

Either way, we want to look broadly.

At who these caregivers are.

Caregivers can do, maybe asked to do.

Activities of daily living or help the person with activities of daily living, including bathing, feeding and toileting. Now a lot of times nurses or CNAs are called in to help with some of these things, but that's not always a luxury that people have.

A lot of times Medicare and, or.

Medicaid depending on what the person has.

So sometimes.

Private health insurance like Blue Cross and Blue Shield and a lot of times people will also have additional riders through something like Aflac that can help pay for some skilled nursing for somebody in an, on an acute basis. If they have a hip replacement, for example, or if they get into a car accident and have a, a head injury or whatever the case may be.

There are times where there the insurance.

Will pay for a limited amount of acute, what they call custodial care. And that is really helping the person with all the activities of daily living.

Meal prep, I put that separate from.

Activities of daily living because bathing, feeding and toileting can be very personal. And it is very hard on some families, very hard on some caregivers to adjust and some patients to accept a, some person in their family doing this. My mother was adamant that I was not going to be sponge bathing her or, or changing her, changing her pants. She was very adamant about that. And so, you know, figuring out ways to make, to keep her comfortable, to keep her hygienic was a little bit challenging when my, when my stepsister would go out shopping or something. But it was important also to respect her wishes.

So anyway, meal prep, not near as.

Personal, that can be done by a lot of different people. I think I shared in a different presentation that in my mom's church they used to have a list of volunteers at the church who are part of the congregational care ministry who are willing to pitch in and do some of the non personal tasks that people may need on a short term basis, like after surgery or after the death of a spouse. Meal prep was one of them. A lot of people in the congregation were, you know, really happy to make casseroles or come over and get meals or even do the grocery shopping and bring it, you know, to the person's house.

Cleaning and laundry can be handled by informal caregivers.

You know, sometimes people can't do that. Right now my, my, my arm is still, you know, kind of questionable. So getting things out of the washer can be really challenging, partly because I'm short and reaching down and getting everything is difficult.

But you know, even things like that.

You don't recognize how much you're hindered when you are not at full capacity. So having people come in that can help with those things can be really helpful. You can hire people that will do it. You can have people who are family or friends that are willing to come in and do it.

Yard work.

Another thing that a lot of congregational care ministries will be willing to, you know, help with on a short term basis, animal care. I have a client right now whose mom just had her hip replaced, which is why I use that as an example a lot. And she has three dogs and she can't off get out of bed right now to take those dogs out. So she is struggling to. And they are struggling to find ways to fill in the time because he.

Has to work so he can't be.

There to let the dogs out four times a day.

Companionship. Sometimes it's just a matter of the person is lonely.

If you are on bed rest, I've been there. I was on bed rest with my daughter and it was miserable. I'm an extrovert anyway and being know stuck in bed was ridiculous. So sometimes companionship can be all that's needed.

And even.

Virtual companionship is better than no companionship at all. If you can video chat with somebody or even telephone chat sometimes, it can make the time go by faster. It can make people feel less lonely, less isolated.

Sometimes if people are.

If the patient is anxious for some reason, they're afraid to be alone or their anxiety levels are high. Just having somebody that is on the other end of the line can also be huge. With my son I had wicked postpartum depression and it helped me sometimes when I was home alone with him to be able to be on the phone with someone just. Just because, you know, there. There are things about postpartum depression that can be very scary. And so companionship can be an important thing.

And bill paying, especially if someone is.

Struggling cognitively like someone with dementia or if they are grieving like after their spouse dies or their child dies. Unfortunately, they may have difficulty remembering to pay bills and to do all that other stuff. So it may be helpful to have someone who can come in and at least sit with them while they do it. If not have a financial advisor or somebody who can do it safely, legally. All that stuff help them get their bills paid.

So it's important to recognize that there are a lot of things that are that informal caregivers will do.

And we want to recognize that it takes their time, it takes their energy.

Even if they want to do it.

Like going shopping for, you know, a fellow church member.

That's a very generous kind thing to do. But it Also means it's going to.

Take you more time away from their family.

So it is definitely something to consider.

On top in, in terms of the caregiver.

And yes, Gwen, you're right, some people.

Don'T, don't want to have anyone come into their home.

And it's important to figure out what.

Is safe for that person at that point in time, because as we'll get to in a minute, caregivers need respite. They need time to sleep, they need time to relax, they need time to be them. Because they are not just a caregiver. They have multiple hats that they're wearing. You know, they may be a mom, they may be a spouse, they may be a teacher, they may be something else. And they need to be able to not lose themselves in being a hundred percent of a caregiver.

So that's something that has to be.

Negotiated with the patient for certain.

Issues that might prompt the need for a caregiver. Infants or children.

Just having an infant, you know, even.

If it was one that you desperately.

Wanted, you're going to be a caregiver. And it's exhausting.

Alternate caregivers. If you start raising your grandkids, for.

Example, you know, all of a sudden you're a caregiver. Aging.

If you have a aging relative who.

Has memory issues, balance issues, health conditions that need to be managed and they're not managing them well on their own, they like diabetes, for example, they may need to have a caregiver that either lives with them or you move them into your house or you check on them, you know, in the morning before work and then on the way home from work. So what my uncle did for the longest time.

So it's not always a lot of times we think of caregivers.

And we either think cancer or dementia.

And there are a whole other set.

Of things that can lead someone to be in a caregiver role. And we don't want to minimize that. Like I said, parents and people raising.

Young children are caregivers.

And that is a lot of energy and a lot of time.

Even with perfectly healthy infants.

And in the best of situations, dementias are common issues where people need caregivers. People with schizophrenia often need caregivers or need to be in some sort of supported living.

People with fetal alcohol spectrum disorders, autism.

Spectrum disorders, or down syndrome may need not always. You know, some people, especially with fetal alcohol spectrum and autism spectrum, emphasis on.

Spectrum, at the low end of the spectrum, no problem. You know, independent living is not a big deal. At the other End of the spectrum.

They may need a lot of assistance and they may not be able to live independently. So somebody may be a caregiver, you know, from the day the person is born until whenever.

Chronic medical conditions, kidney failure, liver failure, heart failure may require that the person.

Has a caregiver at least part time who can come in and assist them.

When you have organ failure, you get tired very easily.

There can be problems with balance.

There are a lot of physiological and mental health changes that can occur or.

When some of these.

Necessary organs start to go, or acute injury or illness like a hip replacement, an amputation or open heart surgery. My old boss, bless his heart, was.

Always very active and on the go.

And I don't think the man slept. But unfortunately that contributed to his diabetes.

Getting worse and he ended up having to have an amputation and that.

Until.

He adjusted to that and everything that went along with it, you know, he needed assistance. It was a long recovery process.

So caregiving may be a short term, relatively speaking process, or it could be.

A process for the rest of that person's life.

So what do we want to do.

With caregivers or for caregivers? Prevention.

Now, primary prevention means we don't want.

Them to ever have the problem.

So that's ideal. However, they may already have the problem.

Even before they start becoming caregivers.

So if they get the problem or.

If they already had it, we want to keep it from coming, becoming worse.

And we also, in tertiary prevention, we, we want to prevent them from developing.

Additional issues as a result of the original issue.

Regardless, you can just kind of put.

It all under this umbrella of prevention.

We want to be alert for depression.

Anxiety and addiction issues.

It can be very, very stressful.

And some people may respond by coping with substances or addictive behaviors.

Stress related health issues, hypertension, autoimmune flare.

Flare up of autoimmune disorders, difficulty managing blood sugar.

There are a lot of stress related health issues. Cardiovascular family dysfunction, where some people are.

Unhappy about the situation, they feel jealous because their caregiver is spending so much time with the patient. They because the caregiver is spending so much money on the patient.

There can be a lot of resentments.

And anger that come up. There can be a lot of guilt that comes up and the caregiver in turn may respond with anger and frustration because the, those other family members are not being compassionate and sympathetic and empathetic to the situation. Excuse me, situation.

So family dysfunction is, is a reality.

That we need to be alert for and try to prevent as much as Possible job loss.

If the caregiving requires the person to.

Take a lot of time off from.

Work, or sometimes the caregiver makes the choice that they have to quit their.

Job in order to take care of their loved ones.

And if they're financially able to quit.

Their job in order to take care of their loved one, okay, so maybe finances won't be a problem.

But if even then they're losing their.

Social support system that they had at work. So we want to make sure that they're not completely feeling isolated and immersed in this caregiver role.

If there are financial issues. There are, and I think I talk.

About it later in the presentation.

There are some opportunities through state Medicaid.

Programs, state Medicare programs, where family caregivers can get paid. It's not a lot, but can get paid a little bit to be a full time family caregiver.

So do reach out.

If it's an older adult, reach out to your local area agency on aging. They will be able to tell you if there's any way for family caregivers to get compensated.

And if it is a person who's.

Not an older adult, reaching out to the state board or department of Developmental disabilities to find out, or the state Medicaid program to find out if there are options for family caregivers to get.

Paid, which also goes along with financial hardship. Even if they are getting paid, like.

I said, it's a paltry amount. So there may be additional financial hardship because they may be taking on the loved ones bills as well as their own and, and losing their job. So making sure that they're connected with any financial resources that they can access is going to be really important to prevent financial hardship. And I believe we talk about that more in a minute.

Behavior equals communication. That's important enough.

It got its own slide.

So it's important to remember that behavior.

Will tell us a lot about what's going on.

If Sally decides to bring her mother.

In because her mother is aging and starting to, you know, become more frail and have more difficulty with memory, and.

Sally's young child starts acting out all.

Of a sudden, quote, unquote, then we.

Want to look at, you know, what happened right before the child's behavior changed.

And what is that child trying to say?

And it's important to help people investigate.

And explore behaviors in terms of what.

Does this mean, physical issues? Sleep and circadian rhythms are important. You know, that's one of my favorite topics. And sleep and circadian rhythms are involved.

In energy, in mood, in immunity, in pain management. You Know, the whole ball of wax. If sleep is not sufficient in quality and quantity and, or the circadian rhythms get out of whack, then people are often going to start to exhibit health and potentially mood issues.

People. And, and so whether it's. And when we think about caregivers, you.

Know, what would cause them to lose sleep or get their circadian rhythms messed up. Well, if you've ever had a new baby in the house, you know that circadian rhythms go out the window, as does sleep. And when my son came home from.

The nicu, I don't think I slept very well for the first couple of.

Months because I was so afraid he was going to stop breathing be because he kept doing that in the hospital. So I had a reason to be a little bit concerned about it. So I didn't sleep as soundly. Every time he would rustle a little bit in his. In his bed that was next to mine, I would wake up.

So that can be extremely draining on people. If you have an older adult who, who is.

Has dementia, for example, their circadian rhythms may be out of whack. They may be prone to wandering. You may be worried that they're going to get up in the middle of the night and do something to harm them, hurt, hurt themselves inadvertently.

Um, so their anxiety and stress about.

The loved one can also be a problem.

If you've got a loved one who.

Needs care around the clock, maybe they need medication every four, four or six hours.

That's going to mess with your sleep.

And your circadian rhythms.

So it's important to recognize that it's really hard on your body. Even the things that were, quote, supposed.

To be programmed for, like parenting.

It'S. It takes a toll. People need respite.

They need time where they can relax. They need time where they can have fun. They need time where they can reconnect with who they are and what they like to do.

We need to be aware that people may experience fatigue from chronic stress, even if theoretically they're getting the sleep they.

Need and maintaining their circadian rhythms. If it is a stressful environment, it can be exhausting.

People with dementia, for example, and even.

People with autism or schizophrenia, there's a.

Lot of variation here, but a lot of times when people are in a.

Position where they need a caregiver, their days are not the same. You can't expect that what worked on Tuesday is going to work on Wednesday. And so there can be a lot of stress because you don't know if it's going to be a good day or, or a bad day. You don't know if they're going to be lucid or if they're going to be having hallucinations. And that can be exhausting. We want to help people understand the condition and understand what's going on so.

They can cope with it as intellectually as possible. We want to have them, help them have a plan for managing some of.

The things that are triggering chronic stress for them and again, have an opportunity, have options for respite. And that may even be adult daycare. And I've said before, I hate that phrase, but adult daycare is typically what they refer to for adults who need some sort of medical supervision. They are not people who can just go to a senior center. They need to be in a protected environment.

We want to make sure that caregivers are managing their current personal health conditions.

Their weight, their exercise, their nutrition, their blood pressure, their autoimmune issues, whatever the case may be.

We want to make sure that they are getting good nutrition and hydration.

People can forget to eat or drink when. When my mother was ill, I know.

There were a lot of times that.

I was on bed vigil and I would forget to drink anything, like all day long. And I get really dehydrated.

My stepfather would forget to eat unless.

We forced him to eat and like put it in front of his face and said, walter, you gotta eat. He didn't have an appetite, he didn't care about eating. And you know, in his upper 80s, that was, you know, a problem more so than somebody who might be a little bit younger. But it contributed more to problems with balance and other things.

And people may who are caregivers may.

Have pain from new physical demands. Having to turn somebody so they don't get bed sores, having to help them in and out of the bath or the shower can all be challenging things. So we do want to recognize and.

Acknowledge these things, even if it's just.

Oh, you know, I kind of ache all over.

Well, that's stressful. Let's not minimize the fact that that's.

Just one more stressor you're having to deal with right now and try to help you figure out what can you do to make it easier.

There are a lot of aids that.

You can use to help flip people. For example, if you are not as strong.

Emotional support if a trauma was involved. Some people may have acute stress reactions, such as a baby that's born with.

A severe birth defect. The parents may be grieving. They, you know, the baby was born with heart. Some Kind of a heart defect and it needs to have three surgeries before it's even a week old.

Um, that is extraordinarily traumatic. So these people who are caregivers are.

Also dealing with acute stress reactions.

If an adult has a stroke or.

A heart attack, it can be very traumatic for the, the family members, for the caregivers. So they may be dealing with their acute stress.

So when the person comes home every time they have heartburn, the family member.

May get really stressed out or if.

They are, you know, sleeping comfortably, the.

The family member may be worried that they've stopped breathing and be very, very hyper vigilant and an expected reaction. But we do want to recognize and help people recognize their acute stress reactions and deal with them.

There may may be anger at other.

Care team members and I told you about that earlier. You know, you may. With my mother's hospice team, some of the caregivers were amazing. There was this one particular caregiver that.

Had her own idea about how to.

Do things and it was, you know, completely opposite of what everybody else did.

So it was frustrating. The doctors wouldn't give us a really.

Clear, straight answer to a lot of our questions, even though, you know, we knew that this was terminal. And it was a blessing when we finally had a nurse from hospice come in and read through the chart and look at the scans and everything and go, okay, let me tell you what's going on. So.

Not everybody is going to respond.

In the same way. And it can be be very frustrating. And it's important to encourage people to advocate for themselves as they need in order to get the, the answers they need or to get the care for their loved one that they need.

There's going to potentially be grief about their loved one's condition or about their change in circumstance.

You know, maybe they feel they're grieving the fact that they had to quit their job or move their loved one in with them and it's changed completely, turned their, their lifestyle upside down. We want to acknowledge that grief, all the denial, anger, bargaining and depression that.

Goes with it, there may be anxiety.

About their loved one and their abilities to care for that person or cope with what's going on. Whether it's cancer or dementia or schizophrenia, you know, their autism spectrum people may.

Be very concerned about their, their abilities. There may be frustration at subsequent problems.

Like children acting out job challenges or caregiver turnover.

Sometimes people who are in pain or.

Who have dementia can, or other mental.

Illnesses can be challenging to work with.

And not all caregivers, even Formal caregivers are equipped to handle that. So there can be a high level of caregiver turnover, which can be really frustrating. If the patient develops a rapport with one person and that one person leaves.

Because the patient is, is challenging to.

Deal with then or leaves for some.

Other reason, it can create a lot.

Of chaos in the environment and for the, for the patient, which can be frustrating to the caregiver.

There can be guilt in the caregiver.

About being angry at others, about being angry at the patient, about being angry at the treatment team, about being angry.

At their higher power, whatever. There can be guilt about anger. There can be resentment at other people.

For not having to go through this or for other family members who aren't helping enough.

And there can be guilt about feeling.

Resentful and there can be guilt about.

Feeling resentful of the patient.

There can also be guilt about feeling.

Happy because this person is struggling and.

The caregiver had a moment of happiness.

So we want to recognize guilt can happen for a lot of reasons, but it's important to be open to it and acknowledge it so we can process it. And the caregiver can have feelings of.

Emptiness if the condition resolves and they're no longer needed or when the loved one passes and they no longer have that role of caregiver because that was a huge time consuming aspect of their life for, for a period.

Caregivers need validation. It's hard.

You know, it may, you may think it's not, not all that bad, you know, oh, compared to what I went through with my great uncle Jim Bob, you know what you're dealing with, oh, it's a piece of cake.

Well, it's not a piece of cake for that person.

That person may be going, I'm way out of my depth here. So we want to validate people's experiences.

That's so important. Too often because formal caregivers are so.

Used to working with that population, whatever that population happens to be. What seems overwhelming to an informal caregiver is, you know, a normal day at the office for us. So it's important that we don't minimize people's feelings.

Caregivers with positive experiences viewed caregiving as a responsibility. People who had a negative experience with.

Caregiving viewed it as having no choice. They felt like they were forced to take on the caregiving role in order.

To help create positive experiences.

We want to engage an empowerment framework.

Having the caregiver ask themselves, how am.

I coping better today than I did yesterday with what's going on? How am I reacting better to everything today than I am than I did yesterday.

How is the patient doing better today.

Than they were yesterday? Even, you know, for example, with somebody.

With dementia, yesterday could have been an.

Okay day and today they may be having, you know, some agitation.

However, you know, how is the person.

Doing better today and how am I responding to their agitation? Better today than I did the last time they had an agitated day.

So encouraging them to see progress, even if it's just progress in managing the.

Disease, in what ways is my help improving the quality of life for that person?

With people with dementia, you know, there.

Can be situations where they get confused and start you confabulating and think that their caregivers are stealing from them or.

Trying to harm them or trying to poison them.

And they may start refusing to eat food because they're afraid they're trying, the caregivers are trying to poison them. There can be a lot of stuff that happens with paranoid delusions that can.

Be really heart wrenching for caregivers, especially family caregivers that are like, oh my.

Gosh, I would never do anything horrible.

To my loved one.

And there's a lot of grief that goes along with that because sometimes, sometimes the caregivers are afraid that, you know, mom's going to die thinking that I was trying to poison her and empty her bank accounts when that wasn't happening.

Now, Gwen does raise the point that any outside caregivers, whether it is a housekeeper or a, you know, CNA that's coming in, you know, it's important to.

Make sure that they've had a background check and, you know, if even then.

It'S still important to make sure, in.

My opinion and in my husband's opinion, and he was law enforcement for 20.

Years, to keep valuables locked up, to.

Not have credit cards and things laying around.

Not saying that good people are going.

To do bad things.

But it's just.

Better to, you know, try to eliminate.

Any possibility, any ability for something to go wrong.

So that is always important to do.

And if the person, if the patient.

Is vulnerable in some way, it's ideal if there's going to have a stranger caregiver in the house to make sure that somebody else is there.

Even if the care, the primary caregiver.

Is taking a break, sometimes it may be advisable for them to still stay at the house or on the property somewhere, but they're just not in charge of taking care of the person who needs caregiving. My grandmother, when she was before she ended up having to go to Assisted living got taken advantage of by some people that were supposed to come in and do some plumbing work on the house and instead they came in and they tinkered with the plumbing some and they stole all her jewelry.

So it is, if my uncle had.

Been there during that time, it would have been better. So, yes, unfortunately, there are a lot of people that will prey on vulnerable, vulnerable people, children, adults and otherwise. So you do need to exercise caution. Make sure there's a background check, fingerprints on file, use a reputable agency, yada yada.

For positive experiences. Encourage people to spend 20 minutes a.

Day journaling on what went right today, what were the blessings from today.

Encourage them to consider embracing the dialectics.

Yes, my, my loved one is having a agitated day or doesn't recognize me today. You know, let's go with that one. My loved one doesn't isn't recognizing me today, and that hurts. However, they're at peace, they're not agitated. So yes, I wish they recognized me, but I am glad they're not in pain or agitated. So embracing those dialectics take trying to find as much good as you can.

And reminiscence can also be helpful for positive experiences, not only for the patient, but, but also for the caregiver. If, especially with people with dementia, finding.

Objects from the past back, you know.

Those places in their memory where they.

Do still have, you know, very clear memories.

Talking about things that were happy times.

Back then can help the caregiver reflect on those happy times and it can help calm the person with dementia because they are actually remembering something clearly and it's a happy memory and it's, they feel calm. Whereas in the present everything seems so hazy and fluid and confusing. It can be very stressful.

So that kind of helps transport them.

Cognitively back to a time when they did feel safe and they were happy. And it also helps bring the caregiver with them so they're experiencing that contentment together.

We can help people cognitively by making sure everybody that's able to has health literacy regarding the condition and the prognosis.

You know, obviously if it's an infant, there may not be a condition.

But if we're talking about autism spectrum.

Disorders, fetal alcohol spectrum heart conditions, dementia.

Whatever it is, is this progressive? If so, what's that progression look like?

What do I need to be aware of?

With people with dementia and even alcohol.

Related dementia, we need to be aware of confabulation. And that looks like lying, it looks like making up stories.

But, but in those cases, the person.

Has gaps in their Memory or gaps in their understanding of what's going on, and their brain fills it in with something that's logical.

They're not trying to lie.

Their brain is trying to make sense and fill in the gaps. It's kind of like they dozed off in the middle of a show and they woke up five minutes later and they're trying to figure out what they missed.

Um, but confabulation is not malicious.

It's just it happens and they truly believe what they're saying is what actually happened, even if it isn't.

And hallucinations and delusions are not uncommon in people with Parkinson's, in people with.

Dementia, in people with schizophrenia, or even depression or bipolar issues.

So it's important to make sure that the caregivers are aware of what these.

Look like and how to handle them. What do you do if the person is in the middle of a delusion? What can you do to help them stay safe and helps yourself stay safe? What can you do if they're hallucinating to help them, you know, not feel scared or agitated?

The caregiver needs to have competence at and implementing the care care plan and.

Confidence that they are competent at implementing the care plan. Too often, formal caregivers, you know, nurses.

Doctors, whatever, will give people a care plan and be like, okay, this is.

Easy peasy, no problem, goodbye. And again, the caregiver receiving the care plan is looking at it going, yeah.

This, there's a lot here I'm feeling out of my depth. So making sure that caregivers have training and support, preferably in the home setting, and incorporate the caregiver's perspectives.

What about this is scary to you? What about this is not something that you're willing to do? What about this is challenging?

A lot of the training now can is taking place virtually where a nurse.

Or caregiver assistant, whatever case manager.

May interact with the caregiver through Zoom or.

FaceTime or something in order to provide more kind of timely assistance to them.

Mindfulness strategies to assess and understand the changes within themselves.

When I'm getting tired and impatient, you know what's going on, when I'm starting to feel fatigued, when I'm starting to feel like I'm getting sick all the time, what's going on? You know, hello, chronic stress.

But so they understand what these changes.

Are physically, emotionally, attitudinally and motivationally, you know, if they just start becoming apathetic, they can understand why this might be happening from burnout or other things and strategies to start addressing those issues. Because if they are burned out, if they are worn down, if they are apathetic, they are not going to be able to help out their loved one, be the caregiver that they want to be?

Resilient caregivers exhibit attributes including determination and curiosity. They wake up in the morning and.

They'Re like, okay, I don't know what.

I'm getting today, but I am determined.

To make it the best day I can make it.

So let me be curious if, you know, my.

My loved one is agitated or in more pain today than they were yesterday.

What's different?

How can we ameli. Ameliorate this if my loved one is having a better day today than they did yesterday? What's different? And how can I do more of that if my loved one is agitated and taking everything out of their closet or they keep stripping all their clothes off? You know, what is this telling me? What is that behavior communicating? And how can I use that communication to provide them, to help them feel more comfortable?

Resilient caregivers are flexible and resourceful. They recognize that the standard way of.

Doing things ain't always going to be it. So they're resourceful. There was one post or one thread that I was following in a dementia support group I'm in where the patient had decided that the caregiver was trying to poison her. And this is not uncommon in people with dementia.

And so people were offering suggestions about.

What had worked for them with their loved ones and such as their appetite is generally higher in the morning, leaving foods out around the house that they can pick and choose from. You know, so they're.

So the caregiver is not serving food.

But the loved one is going and kind of sneaking food because they feel like they're less likely to be poisoned by that.

Recognizing that just like with someone with.

Schizophrenia, their reality is their reality, and trying to convince them that. That their reality is not your reality. It, it. It ain't going to work.

So flexibility and resourcefulness.

Okay, my loved one thinks I'm trying to poison them, even though I'm not, how can I get make sure that they're eating? Because that's what. That's the big thing. We want to make sure they're eating. And if they're not willing to eat the plate that I serve them, what can I do differently to make sure they're getting their nutrients?

Resilient caregivers find positive gains despite hardship. They find a sense of purpose and.

Increased closeness with their significant other, or feelings of mastery and gratification.

They May see this, experiences, okay, I've.

Never done this before. And then they start getting the hang of it and they're like, okay, I got this. You know, I didn't think I could, but I've got this.

Helping develop a sense of self Efficacy.

Is important.

In handling their, themselves, their health, their family, their other roles, as well as caregiving. And that's a lot. Mindfulness, we already talked about that one. Effective communication and social support. Resilient caregivers are able to notice, mindfully notice when they need help and effectively.

Communicate and reach out to their social supports and say, this is what I need from you right now, or, you know, this week, or whatever it is. So they're able to actually communicate their needs in order to get those needs met.

And spirituality. A lot of resilient caregivers have a.

Sense of meaning and connectedness to the experience, to the world, to what's going on.

It doesn't necessarily mean they have a.

Belief in a higher power, but they have a sense of connection to others and, and to the energy in the universe, if you will.

We want to help people develop a sense of acceptance of his aversive experiences and commitment to personal values when caring for someone who has a chronic condition.

Or is in significant emotional or physical pain.

So some days your care, your loved.

One may be just in excruciating pain and there's nothing more you can do. And it's agonizing to watch them, you know, in pain. But there's a time where you have to reach a level of acceptance with, I've done everything I can do and.

And there are days where the person.

That you're caregiving for may be in quite, quite the mood and accepting this aversive experience and taking a breath and committing to personal values of, in this case, maybe caregiving and loving the person as much as you can, recognizing that they may not be acting out of their normal personality.

Subjective appraisal is another cognitive strategy. Caregivers who believe the problem behaviors are voluntary tend to experience more distress than.

Those who view the behaviors as a consequence of the condition or developmental disabilities.

So when you view a child's behavior.

For example, or developmental abilities, when you.

View a child's behavior and acting out.

As developmentally normal, albeit aversive, sometimes it's easier to accept that and modify it than if you think that the child is just willfully trying to get your goat. And I have no idea where that phrase comes from, but whatever.

So subjective appraisal is really important.

It's.

If we can Help caregivers recognize that their loved one is doing the best.

That they can do with the tools they have at any given time, in any given circumstance. We may just not understand exactly what their current circumstance is. If their perception is far different than ours, or if they're not effectively communicating the hallucin that they have hallucinations or that they're in pain.

We can use contextual cognitive behavioral therapy which encourages you to look at all.

Of the context why is this person behaving this way at this time?

What stimuli are present or are absent.

That may be prompting this behavior and.

Fcb Focus on the facts.

Unhook from that emotional reasoning.

Just because you feel angry doesn't necessarily.

Mean there's a threat.

So look at the facts.

You know, is there a threat right now? Or what hap whatever the emotion is, what are the facts in the situation for and against your beliefs about what's going on?

What aspects of the situation can you control?

And actually that should be P not.

B. I got got a little dyslexic there but and and P would stand for probability. If you do all of the things.

Or most of the things that are.

Within your control to address the situation.

Based on the facts at hand, what.

Is the probability P probability that bad.

Things are going to happen?

We want to also assist people with case management assistance in order to help them tap into consumer directed care programs.

That's what I was telling you about. With Medicare and Medicaid in many states, allowing people to tap into monies for short short term custodial care in insurance is another thing. Social Security insurance, Social Security disability, Medicare.

Medicaid, private insurance or long term care.

Insurance if the person has it.

And I do have a video on.

The YouTube channel on insurance aspects of case management that might be helpful. If you work with people who are.

Caregivers, we want to help connect them to financial support programs for nutrition for.

Themselves as well as their loved one insure. And some of those things can get.

Really expensive structural alterations if they need.

Them, like ramps or hand bars or even lowering sinks and cabinets so the person can brush their teeth. Supplies that they might need including catheters and incontinence supplies or whatever the person.

Needs and personal housing or loved ones.

Housing or utilities if they need help one month with electricity or rent payments or something.

A lot of times there are community programs that'll help.

Usually it's only once a year, but it may be anything can be a.

Help Resources for Insurance Assuring Environmental Safety and I will be publishing a video.

This afternoon on environmental safety in case.

Management, community resources for emotional support, respite.

And recreation, and awareness of online employment opportunities if they have to, or they choose to not go to their away from home job and they choose to be at the residence of the person who is needing care.

Cultural values Traditional beliefs about family obligations.

In Asian and Latino Hispanic communities and may lead to dysfunctional thoughts that emphasize.

The need for complete dedication to caregiving.

At the expense of one's own needs and feelings.

On the other hand, other cultural beliefs may focus more on independence, wealth and success and promote institutional caregiving instead of family. So it's important to recognize that culture will play a big part in how.

The person feels about caregiving, where they.

Believe or why they believe this is.

Happening, and the interventions that they believe are appropriate.

It's important to encourage caregivers to engage in social activities that were meaningful before the life event.

If they used to like to go bowling or hiking or whatever it is.

It'S important that they maintain certain aspects of their pre caregiving life even when.

They'Re caregiving, because that is part of who they are.

When someone suddenly is charged with the care of another, regardless of the reason, it generally alters all aspects of their life. There are a multitude of physical, emotional and cognitive reactions that can be explored.

Normalized, and addressed with the individual.

Too often informal caregivers are treated as.

Ancillary to the treatment team or patient.

Which leaves them feeling invalidated, ignored, un.

Unsure of themselves, and confused.

Ideally, all caregivers will be provided with.

Tools to understand the diagnosis effectively, implement.

The care plan, and know how to.

Request help for for their caregiving experience and maintain their own health and well being during the process.

Are there Questions? As I said, there is a lot.

To caregiving I I put out.

And there's a lot to case management too. And a lot of caregiving also involves.

Some element of case management.

So again, if you are working as a caregiver or if you are working.

With people who are caregivers, you may want to check out some of the videos on case management that I have recently added to the YouTube channel to see if they give you, you know, any helpful tips or ideas.

Anyhow, have a fabulous weekend and I will see you on Tuesday.