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Exercise Take a piece of paper Divide it into 3 equal columns

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1 Between a Rock and a Hard Place: Navigating the Challenges of Family Caregiving

2 Exercise Take a piece of paper Divide it into 3 equal columns
First column: Write in the words, “Paid Caregiver” Second column: Write in the words, “Me” Third column: Write in the name of your loved one receiving care

3 Exercise, continued Under the first column, write in some of the challenges you have with the paid caregivers. These challenges can include having a stranger in your home; not knowing how to handle problems such as chronic lateness; or issues about the caregiver’s relationship with your family member

4 Exercise, continued Under the third column, write in some of the challenges you have with your family member. These may include disruptive behavior; physical strain of care; or issues with medication

5 Exercise, continued Under the second column, write in some of the challenges that you face caring for yourself. These may include not having enough time; feeling pulled in too many directions; or guilt about taking a vacation Spend 15 minutes eliciting from participants what they want to learn from today’s class. Have participants share as much as they feel comfortable sharing. Need to be flexible, may need to integrate that content into existing program. If a participant, or group of participants, verbalize a learning need that is beyond the scope of this program, such as help understanding Medicare Part D, we would suggest getting back to them with potential resources. You may even want to schedule a separate program addressing that issue at a later date. As you proceed with the training, refer back to the examples the participants gave throughout the session.

6 What we hope to achieve:
After attending this session, we want you to be able to: Negotiate boundaries with paid caregivers Communicate effectively with paid caregivers Increase repertoire of caregiving skills specific to family members with cognitive impairments Increase repertoire of skills to care for yourself and prevent burnout

7 Some Challenges Associated with Paid Caregiver
Stranger(s) in my home Persons of different socioeconomic or ethnic strata Can lead to different interpretations of “on time,” of “care,” of “involved,” of “place in the family” Hierarchy of the home care agency Different interpretations: for example, someone may have an interpretation of “on time” as arriving exactly at 8 a.m., whereas another individual may believe that he or she has a 15-minute window. In respect to “care,” one PCA may fix additional meals and freeze them, while another will prepare just one meal for the time period he or she is in the home. Place in the family: Family members may ask, “How involved do I get with this person’s life?” For example, we love the PCA who is caring for dad. On a recent snow day, when the schools were closed, Janet the PCA showed up with her 8 yr old son in tow. I wasn’t happy with Janet bringing her son to my house. Would she care for her son and ignore my dad? I don’t bring my son to work. On the other hand, if she didn’t show up, who would? If I “tell” on Janet, will I get a worse PCA? There are no easy answers to these questions, and family caregivers do struggle with them. A home care agency is a bureaucracy, and family caregivers may need to learn who to call for which question.

8 Boundary Issues Is the PCA a friend or employee?
How do I discuss problem behaviors without jeopardizing relationships? Vulnerability of elder Elder gets involved with personal issues of PCA My own feelings Jealousy, inadequacy; is the PCA closer to my family member than I am? When someone comes into my house, I may start to treat that individual more like a friend than an employee. If that person does not care for my family member in the manner that I want my family member to be cared, it may be difficult to move from “friend” relationship to “employer-employee” relationship. The level of dependency increases the likelihood of boundary violations, usually unintended by the PCA, the care recipient, or the family member. The care recipient, who is receiving a lot of help, may want to reciprocate by “helping” the PCA. For example, the elder may want to lend her car to the PCA whose own car is not dependable.

9 Care Needs Is the care recipient really getting what he or she needs?
Is the quality of care and the commitment by the PCA satisfactory? If these needs are not being met, how do you communicate them to the PCA? How do you communicate your concerns to the agency? Example: One of the co-authors, Tony DeLellis, had the following experience. His family member was receiving home health care, and he called to speak with her. The PCA answered and responded, “I’ll get the phone for Linda.” Tony’s response: “I doubt she will tell you this, but my family member would prefer to be addressed as Mrs. DeLellis.” Care recipients sometimes have trouble asking for what they want, and when you do that as a family member, you can potentially become the “bad guy.” That is, you can almost hear the PCA thinking, “My client doesn’t care if I call her Linda or Mrs. DeLellis. She told me that. But her son insists that I call her Mrs. DeLellis. Boy, is he picky!”

10 The Triad: You, the PCA, and Your Family Member
You may sometimes feel like the middle of a seesaw as you balance the needs of your family member on the one side and the responsibility of working with a paid caregiver and the agency on the other Good communication skills can help you address problems and issues without inadvertently creating more

11 Why are we talking about communication?
Challenge to communicate with loved ones who have dementia or are ill Challenge to have strangers come into your home and care for your loved ones Differences between you and the PCAs can cause communication difficulties Different ethnicities, socioeconomic strata In rural communities, people often have multiple roles. A family caregiver may know the PCA from church, where the PCA is a deacon. Also, in rural communities, people tend to know a great deal about others. May see a situation where a family caregiver is upset because Miss F was assigned to the case, and Miss F is a member of the Smith family, with whom the caregiver has been feuding for 5 years.

12 Communication We think we are communicating, but are we?
We may be sending unintended messages, either nonverbally or extraverbally Opposite-speak Sarcasm Sometimes, we are sending intended messages, but cloaked in pointed humor (this way, we can deny it if the interaction becomes uncomfortable We think we heard the message, but did we interpret it correctly? When involved in an interaction, we may tell ourselves stories to fill in the blanks. For example, my husband calls me at work to tell me about a terrific meeting he just had with his boss, and how he is finally being recognized for his hard work. I am so pleased, and I tell him so. But I am distracted a little because I was in the middle of working on a difficult report with an uncooperative computer AND I need to get the report finished in 30 minutes because I have to present the report at a meeting with my boss and HER boss. My husband hears the distraction in my voice and he becomes hurt, because he interprets the hesitation as “She doesn’t care about me.” He may even start telling himself a story about how I care more about my work than him, which isn’t true. Before I can explain that I am very pleased and happy for him, but I really can’t talk, he cuts the conversation short and hangs up on me. I don’t realize what happens, and I tell myself the story that he is a selfish twit. By the time we both walk in the door, we are barely talking to each other. While this example may seem silly, in reality, we do tell ourselves stories to fill in communication blanks. We need to be aware of these stories, and return to the interaction in order to get more clarification before we jump to conclusions. Opposite-speak: covered in upcoming slide, but here is the definition: we say the opposite of what we really mean. For example, after waiting on the telephone for 30 minutes for a customer representative to help me, I may tell him, “Geez, it was wonderful to sit here for half an hour and listen to Barry Manilow’s Greatest Hits,” instead of stating, “I am upset that I had to wait this long for assistance.”

13 Giving respect - names are important
Call people what they want to be called: If her name is Mary Jones, do you call her Mary, Ms. Mary, Miss Mary, Mrs. Mary, Ms. Jones, Miss Jones, Mrs. Jones? Be clear about how YOU want to be addressed and how you want your family member to be addressed

14 Communicating with Clarity and Respect
Avoid “opposite speak.” Opposite speak is when one uses sarcasm by saying the opposite of one’s true feelings in an attempt to express one’s true feelings. (e.g., I really enjoy being spat on by people, it just makes my day!) If what you really mean is that you don’t like being spat on then just say, “I don’t like to be spat on.”

15 Communicating with Clarity and Respect
Communication is a two way event Listening is an active event Listening actively is one way to demonstrate respect.

16 Communicating with Clarity and Respect
Listening actively requires letting the speaker know that s/he was heard and understood. Listening actively requires direct eye contact, sometimes standing or sitting still, verbal and non verbal gestures, sometimes writing a note about what is being said, taking turns, not interrupting.

17 Respect is listening Listen actively
Look, stop, wait - let them finish Don’t interrupt Turn off radio, TV - completely off Let them know you heard and understood Paraphrase If you need to take notes, please let them know that you are taking notes, ask if that is OK, and tell them you are taking notes in order to ensure accuracy. Paraphrase is NOT parroting. If one person says, “I came into the house and the PCA was reading a book while my dad was slumped over in a chair and unshaven, and I am not paying the agency big bucks for this nonsense!” the other person would paraphrase by perhaps saying, “Your dad needed to be shaved and you saw the PCA sitting and reading a book.” Paraphrasing is a good technique for summarizing the content of what the person is saying and making sure you are understanding the message. Dealing with emotional content: We provide an example, where Rita plays the role of an unhappy care recipient and Tony the family member. We address whether or not the family member wants to acknowledge the emotionality. Tony makes the point that it is often better to move past the emotionality, although it can be helpful to acknowledge the emotions you see and the person expresses, e.g., “I can see that you are angry about this…”

18 Communicating with Clarity and Respect
Listening actively let’s the speaker know s/he is worth listening to. When speaking to older individuals assess the level at which you must project, don’t assume everyone has hearing loss and therefore presume to shout at them.

19 Communicating with Clarity and Respect
When speaking to older people be certain that side noises (e.g., TV, radio, traffic noise, other people speaking at the same time) do not interfere with the person’s hearing. Sometimes with older people their ears will hear background noise just as loudly as they hear the person sitting right in front of them. Remind participants about PLST—Progressively Lowered Stress Threshold. This theory proposes that disruptive behavior is the result of decreased tolerance for multiple stimuli. Individuals without cognitive impairments can process multiple inputs (people speaking in background, music, the sound of traffic) and assign importance to specific inputs while ignoring others. Persons with cognitive impairment may lack the ability to assign importance to stimuli while simultaneously losing the ability to process multiple sources of stimuli. The ability to multitask declines with cognitive impairment.

20 Communicating with Clarity and Respect
Address older individuals with respect in tone and language. Use language of their day, not the most hip new slang. Assertive language is plain and clear – and respectful of feelings Avoid slang altogether. Family caregivers may need to remind PCAs about this, especially if PCAs are of a different generation than the care recipient. Watch profanity. Language that may be relatively acceptable today may be offensive to persons from other generations. For example, television shows like “All in the Family” seem tame now, but these shows were controversial 20 years ago. Likewise, language that may seem mild now may still be unacceptable to older adults.

21 Communicating with Clarity and Respect
Assertive language does not suggest or imply – it is direct but is respectful of feelings. Assertive - say what is on your mind, but keep in mind the feelings of others. Aggressive - say what is on your mind, but don’t care about the feelings of others or deliberate try to hurt or offend them

22 Communicating with Clarity and Respect
Respectful tones and words are as important during conflict as during harmony. Use gestures if necessary to aid in communication.

23 Addressing Unsatisfactory Performance
First, make sure to review the contract between you and the agency If your family member is not receiving the care he or she is supposed to be receiving, address it in an assertive manner Keep voice neutral, try to keep emotion out of the interaction State the problem; do not say, “you are lazy.” Instead, keep it factual: “According to the agency, you are supposed to be here every day by 8 a.m. On Tues and Thursday of last week, you arrived at 8:15 a.m. When you arrive late, I’m late for my work, too. I plan on you arriving by 8 a.m. as agreed on by the agency. I really like the care you provide to Mom and she is very fond of you. Is something going on? Is there something the agency can help you with?” Need to be careful here…don’t want to get pulled into the PCA’s life.

24 The Other Part of the Triangle: the Care Recipient
We talked about ways to communicate respectfully to the PCAs and agency employees as you negotiate and advocate for your family member These same principles help when faced with the difficult task of caring for a loved one who may not always be cooperative

25 Cognitive Impairment Diminished “brain power” as a result of temporary or permanent physical changes in the brain or body Can be from dementia (Alzheimer’s AIDS) Can be a result of severe mental illnesses, such as schizophrenia While many people with mental illnesses such as bipolar disorder or schizophrenia are quite bright, when the disease is not controlled by medication the thinking becomes disordered. This disordered thinking is loosely subsumed under the umbrella term cognitive impairment

26 Common Behaviors in Persons with Cognitive Impairment

27 Non-aggressive Moaning, repetitious words or sentences
Wandering, rocking

28 Aggressive Yelling, cursing, screaming Hitting, spitting, biting
Paranoia is not uncommon, especially when the person with CI is trying to make sense out of the environment or situation. CI=cognitive impairment

29 Sexual Behavior Sexual behavior, such as masturbating in public is also not uncommon. Sexuality is present in aging and disabled persons, and the confused person is often seeking sexual solace.

30 Sexual Behavior Persons with CI may confuse another person for a spouse or may forget they were ever married. Inhibitions are removed, which explains why sexually inappropriate behavior may occur in public.

31 Disruptive Behavior as a method of communication
All behaviors, no matter how distasteful, are the result of your family members’ response to some emotion or fear.

32 Disruptive Behavior as a method of communication
Your family members with CI have difficulty interpreting stimuli and may react with violence if they believe that they are being harmed. It is important to realize that the person with CI does not exhibit disruptive behavior because they choose to, but the behavior is the result of the dementia—communication patterns are altered by the disease causing the dementia Use example of infant crying out of hunger, discomfort, fatigue, pain. Be careful to avoid infantilizing older adults, but draw parallel between a nonverbal infant expressing needs through alternative ways and a person with dementia losing socially acceptable methods of communicating and resorting to socially unacceptable methods, such as yelling, crying, hitting.

33 Disruptive Behavior as a method of communication
Disruptive behaviors can be the result of your family member’s inability to tolerate noises, activities, or changes in the environment. They have a reduced ability to filter out unimportant stimuli, so they are bombarded with everything equally. Use example of getting hit with too many things at once. Ask participants to imagine they are driving a car through an unfamiliar area and believe they may be lost. Ask them to imagine there is a crying child in the car and a teenager fiddling with the radio controls and another person trying to engage them in conversation. Ask the participants, “How do you think you would respond?” Be prepared for participants to respond with answers such as, “I would be short tempered,” “I would have to demand quiet,” or “I may have to pull the car over until everyone settles down.” Remind them that they have control over their environment and can react in both unhealthy (yelling, swearing) and healthy (pulling car over until riders settle down) ways. A person with dementia may not have the energy or insight to react in a healthy way, may become loud, agitated, or withdrawn.

34 Assessing reasons for disruptive behavior
Misinterpretation of surroundings Persons with CI have limited capacity for learning new information. Even though they are told several times, “this is the bathroom,” they may still misinterpret the surroundings and may react with fear Vision and hearing impairment may further create problems with correct interpretation If you keep telling a person with dementia the same thing over and over again, you may worsen the behavior as frustration sets in. Important to keep eyeglasses clean and hearing aids working. May need to change battery on schedule, person with dementia may not be able to tell you that the hearing aid is becoming weaker.

35 Assessing reasons for disruptive behavior
Pain and painful procedures May be aggravated by your family members who are resistant to taking medication and may not receive their pain or psychiatric medications May want to ask primary care provider for liquid prescription pain medicine or use liquid Tylenol. Be careful when adding liquid meds to drinks, if person is feeling paranoid and his or her coffee suddenly tastes funny, you may have caused a worse problem. Also, don’t want to have another member of the household accidentally ingest cranberry juice with liquid medications in them. One of the presenters had a situation where a family member accidentally ingested cranberry juice laced with a liquid antipsychotic. Family member had to be treated at a local ED.

36 Assessing reasons for disruptive behavior
Stress Sensory overload Meaningless noise

37 Assessing reasons for disruptive behavior
Desire for immediate attention Loss of control/autonomy Fatigue Desire for sexual intimacy Change in routine Psychiatric co-morbidities

38 Strategies for coping with disruptive behavior
Determine antecedents to the disruptive behavior

39 Strategies for coping with disruptive behavior
Bathing is a usual antecedent. If water is near the face or head of a confused person, he or she may react in an aggressive manner May need to avoid tub baths, use baby wipes or warm damp washcloths for different body parts

40 Strategies for coping with disruptive behavior
Have your family member control the flow of water (e.g., using a hand-held shower head to direct the flow of water) Let your family member get into the tub slowly Approach your family member in a relaxed manner

41 Strategies for coping with disruptive behavior
Less likely to provoke agitation. If one approaches a confused person in an authoritarian or “bossy” manner, your family member may react in an unfavorable way. Avoid being focused solely on the task Sometimes, your family member does not understand what is expected of him or her with a specific task, and may become frustrated and act out.

42 Strategies for coping with disruptive behavior
It is a good idea to talk to your family member about personal things of interest to him or her during tasks (e.g., grandchildren, previous occupation, favorite activities) Be flexible in approach with your family member The use of gestures and pantomime to show your family member what you want him or her is helpful

43 Strategies for coping with disruptive behavior
Do not limit your conversation to your family member because of the confusion. “Chatting away” with your family member has been shown to improve agitated behavior. Your family member may respond to the verbal stimulation.

44 Strategies for coping with disruptive behavior
However, when asking your family member to do something, use short, one-step REQUESTS, not commands. Do not keep repeating the same request, otherwise your family member may become agitated Show interest in your family member, both verbally and nonverbally

45 Avoid interruptions Studies have shown that interruptions resulted in increased agitation and tension on the part of your family member and decreased flexibility and personal contact on the part of the nursing assistant. Stay off of the telephone while doing care Many of us multitask, and I have observed family members talking on their cell phone or portable phone while working with the older adult. The older adult may think the family member is talking to him or her and may try to respond to the portion of the conversation he/she is hearing, or may become upset due to yet another distraction in the environment (think Progressively Lowered Stress Threshold).

46 More Strategies Remember not to take aggression personally, unless you have deliberately done something to provoke your family member, it is not your fault! Praise your family member in an adult-like manner. Have manipulatives in the environment Do not talk to the elder like one would talk to a child or pet, that is, in a high-pitched sing song voice (also known as elderspeak, we discuss this later). This type of speech pattern is guaranteed to create a problem.

47 More Strategies In the home environment, have items available that are associated with activities that your family member previously enjoyed. One family kept jumbo blunt knitting needles and bits of yarn in a basket for their grandmother, who was an avid knitter prior to the dementia. She derived comfort from sitting and holding the items in her lap.

48 More Strategies Use touch judiciously Some your family members respond well to touch; others may react negatively. Find what works with your family members.

49 More Strategies If your family member is already agitated, touching in a forceful manner may escalate the agitation Remove your family member from the area, if possible If your family member is engaging in sexually inappropriate behavior (e.g., masturbating in public), will need redirection.

50 More Strategies Distraction
Humor or playful responses may divert your family member’s attention from the discomforting situation and may stop the aggressive behavior

51 Promote decision making
Give your family member as much REALISTIC choices as possible, within their abilities Helps your family members retain personal power and dignity Emphasize REALISTIC. Do not want to burn out yourself as a caregiver. Realistic choices are often simple, too, such as wearing the red sweater or the blue sweater.

52 Promote decision making
Shows that you care Have your family member do as much care as possible Explain to your family members that doing as much for themselves keeps their bodies working properly (e.g., finger strength, hand coordination) When persons with dementia do as much for themselves as possible, it maintains their self-worth and self-image. These positive emotions may result in less disruptive behavior.

53 Promote decision making
Encourage your family member to use adaptors Sometimes it is faster and easier to do it yourself, but you are not helping your family member in the long run Make sure the environment is best suited for the needs of your family member

54 Promote decision making
Does your family member like all of the stuffed animals on his or her bed, or did someone else place them there because he/she likes them? Does your family member really need the 12 crocheted afghans on her lap or on his bed?

55 Questions or Comments?

56 Group Work Think about a difficult situation involving the care of your loved one When you communicated your concerns, was the situation resolved in a positive way? What worked? What didn’t work? Based on what you have learned so far, what could you have done differently? Have the participants take turns volunteering specific communication challenges.

57 “It’s Like Losing a Piece of My Heart:”
Dealing with Loss, Death, & Mourning

58 Loss Part of life Can be sudden (death of a young person) or expected (death of a terminally ill person)

59 Loss Can be bittersweet
Transition of a child from infant, to toddler, to preschool, to school age Loss of a child leaving home, but going to college and growing up

60 Loss Some losses seem bad initially, but then turn out to be a blessing (a man is laid off from one job, only to find a better one)

61 Loss When losses are ‘bunched’ together, as in older years, multiple effects can be devastating Examples of losses in older years Death of spouse, family, friends Loss of home Loss of employment Loss of activities Loss of roles (caretaker, leader) Loss of own abilities Memory Functioning Independence

62 Reactions to Loss Because losses are personal, reactions to loss are individualized What may be a small loss to me may be a larger loss to someone else The process of grieving is called “bereavement”

63 Reactions to Loss Although the process is individualized, there are some general components Sadness The person is unhappy with the loss. He or she expresses sadness, cries Denial “This isn’t happening.” “If I ignore it, I won’t have to deal with it”

64 Reactions to Loss Anger Can be at self or others
May belittle others, may become a “difficult” or “demanding” family member Sometimes, one family member is a target because he or she is “safe;” Mom may be angry at her out-of-state son but vents her anger on her nearby daughter because Mom is afraid her son will never visit again. May express anger by trying to exert control over those items that the person still has control over Example: You are taking care of your mom. You ask her what kind of eggs she wants. She requests “soft boiled.” When you present her with eggs, they are either too runny or too hard. Mom is focused on the consistency of the eggs because that is something Mom perceives she has control over. You, on the other hand, are ready to dump the eggs on mom’s head, or you may find yourself grinding your teeth and saying under your breath, “Just eat the darn things!”

65 Reactions to Loss Blaming
May seek to make someone else the culprit for the loss. This is an attempt to make meaning out of a loss May blame self or others: “if only I had taken my medicine, I wouldn’t have had this stroke,” or “If only I had a better doctor, I wouldn’t have needed that amputation.”

66 Reactions to Loss Bargaining
“If I can learn to walk with this walker, you will let me go back to my apartment, right” Can be with family, health care providers, even God

67 Reactions to Loss Depression
The person may lose interest in food, enjoyable activities May sleep all of the time or most of the day May cry easily and all of the time

68 Reactions to Loss Acceptance
Reconciles the loss with overall picture of self Adjusts self-concept to “fill up” hole left by loss

69 Reactions to Loss This process may take days to years, depending on the extent and importance of the loss Some people move out of one stage, only to return to it later Some stay “stuck” in stages Remind participants that some people stay stuck in one stage for weeks, months, even years, depending on their baseline personality. That is, someone who was always on the pessimistic side as a younger person may be even more so as they age or become sick, and may move back and forth from anger to depression and back to anger. On the other hand, someone may move rapidly through the stages and reach acceptance, until a new loss occurs, and that person starts moving around the different stages.

70 Caregiving Strategies
Avoid even more losses Give your family member as much independence as possible Give family members choices regarding meal ideas, daily activities – make choice options realistic Listen to family members’ ideas about the care

71 Caregiving Strategies
Do not take things personally This is also extremely difficult No one likes to be the scapegoat, but realize that your family member is not striking out at you, the person Tell your family member, gently but firmly, “I don’t like it when you (fill in blank). I understand that you are upset and hurting, and I would like to help you”

72 Death and Dying You will be working through your own emotions as your loved one goes through the dying process Can be prolonged or sudden, no way to predict The PCA will most likely be working through his or her own emotions, too What level of intimacy are you going to allow? What level of intimacy would you find reasonable or acceptable? Use this as an opportunity for discussion. No right answers.

73 Avoiding Burnout:Caring for Others by Caring for Ourselves
The best analogy for presenters to keep in mind throughout this section is the advice given by airline personnel: “Put your oxygen mask on first before helping others with theirs.” That is, caregivers often put their needs last, which, ironically, leads to burn out.

74 Basic Needs Food and drink Sleep Leisure Activities Activity
“I don’t have time”

75 Nutrition Carbohydrates Proteins Fats

76 Food Pyramid High carbohydrate, low fat Works for some people
High jumps in insulin, followed by blood sugar drops In many people, causes carbohydrate cravings Become hungry a few hours after the meal, want more

77 Other Options High protein, low carbohydrates (e.g. Atkins)
May be problematic Works by putting body in a state known as ketoacidosis People lose weight, but raise triglyceride levels and are more prone to heart disease, high blood pressure

78 Healthier Options “Zone Diet” or “South Beach Diet”
Eat protein at every meal Low fat sources: tuna, chicken, cottage cheese, egg whites Balance with “healthy” carbohydrates: fruit, vegetables

79 “Healthier Options Avoid white bread, white pasta (refined foods); Eat whole grain breads The trick is that the food digests slowly, so that insulin levels remain constant Eat small amounts of fat with meals

80 Healthier Options Read the labels
“Lowfat” and “nonfat” may have even more calories than the actual “real” foods More sugars added to replace the fat; May do more harm than good

81 Exercise 2 types Aerobic Walking, running, swimming, bicycling
Cardiovascular benefits

82 Anaerobic Lifting weights
Weight lifting builds muscle so that you can burn more calories while resting You cannot turn fat into muscle!

83 Anaerobic Muscle does not weigh more than fat, but it is denser!!
Think of exercise as “recess” or “playtime” Helpful to involve friends, children Helpful to combine both

84 Sleep Necessity, not a luxury 8 hours/24 hours Sleep hygiene
Go to bed at the same time each night, even on nights off (if possible) Avoid using the bed and bedroom for other activities (eating, paying bills, studying) Need for the mind to associate “bed” and “bedroom” with “sleep”

85 If unable to fall asleep..
Avoid caffeine 8-12 hours before bedtime Avoid heavy meals immediately before sleep Avoid alcohol Try relaxing activities such as warm baths, calm music Alcohol may cause sleepiness or drowsiness, but once the alcohol wears off, the person may reawaken and be unable to fall back asleep.

86 Caring for the Psychological Self
Exploring the body-mind connection Good physical care equals a healthy mind Need down time for thinking and reflection Make a definite transition between your different areas of life, for example, work life and your home life (transition rituals can be helpful—taking off shoes, changing clothes, enjoying the commute)

87 Caring for the Psychological Self
 Hobbies are a necessity Important to change gears before they become stripped and worthless Hobbies are a way to channel energies and to develop other interests outside of work. These activities help “recharge” mental batteries.

88 Caring for the Social Self
Everyone needs friends and fun Do not wait for a 1 week or 2-week “vacation” Plan “mini vacations” Everyone should have at least 1 “fun day” per week Important to have respite caregivers, either paid or unpaid Church volunteers, neighbors, family, friends Do not be afraid to ask!!

89 Stress Management Stress: strain or pressure
Sources: job (problems with supervisors, co-workers, clients), family, societal demands Feelings: of pressure, anxiety, “out of control” Cannot remove stress Can adjust reaction to stress Instead of becoming angry or upset in response to stressors, can change behavior. For example, deep breathing in response to a stressful situation like being stuck in traffic.

90 Stress Management Incorporates all of the above, plus strategies for relaxing Guided imagery Prayer Breathing exercises

91 Time Management Strategies
Understand what demands are causing the conflict Strive to achieve a balance between competing demands Knowing your limits can help you to better use your strengths Lower standards…a little bit of dust is OK Knowing limits: use the word “no” without feeling guilty. If you are a morning person and become progressively less able to handle difficult situations as the day progresses, then schedule doctor visits and other potentially problematic items for the morning as much as possible. Many of us fall victim to hosting “perfect” holiday meals or having a pristine house. These activities may not be possible given the caregiving demands.

92 Unhealthy Ways to Deal with Stress
Eating as stress management When stressed, it is not unusual for people to crave “comfort foods”—e.G. Mashed potatoes, dessert items, chocolate “It’s not what you are eating, it’s what is eating you” People do feel better (temporarily) after consuming certain foods, such as chocolate—certain brain chemicals are affected In the long run, more problems, more stress—vicious cycle

93 Unhealthy Ways to Deal with Stress
Drinking as stress management Binge vs. Constant drinking “Need” for a drink to “unwind” As need grows, potential for dependency CAGE questions—do you have a problem? Cut down; Annoyed; Guilt; Eye-opener CAGE questions: A yes to 2 of these questions indicate a potential alcohol problem. The more “yes” answers, the more likely it is the person has a drinking problem. Questions: Do you believe you should cut down on your drinking? 2. Do you become annoyed when someone criticizes your drinking? 3. Do you feel guilty about your drinking? 4. Do you have a morning drink as an “eye opener?”

94 Unhealthy Ways to Deal with Stress
Other unhealthy ways people “manage” stress Shopping binges Temporary euphoria, followed by increased bills (and increased stress) Smoking Legal and illegal drugs

95 GUILT??? Many people feel guilty or selfish if they put their needs ahead of others Remember the advice from flight attendants: PUT YOUR OXYGEN MASK ON FIRST BEFORE ASSISTING OTHERS WITH THEIRS!! Taking time out to care for yourself is not a luxury but a necessity

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