RetireLife

Articles & Tools

Welcome to RetireLife's Articles and Tools section. Here you can find articles written exclusively for RetireLife and tools we have created along the way to use for our own families.

Tools

Medication Chart

This medication chart can be used to track the daily doses and times for each medication taken by your loved one. Along with being able to fill pill organizers, this chart can also be used to track and schedule non-pill medications (injections, powder supplements, etc.). This is an easy way to see at a glance the medications your loved ones need to take each day.

Sample Chart ↓

Medication	Location	Morning	Noon	Evening	Bed
Seroquel	Pill Box	x			x
Insulin	Refrigerator	x		x
Benefiber	Kitchen Counter	x

Download → PDF Version DOC Version

Medication Log

Use this tool to monitor changes made to your loved one's medications over time. The type, date and effects of these changes can be recorded and monitored between doctor visits. This log can then be brought to future doctor appointments to track the negative and positive side affects to further alter dosages to ensure the right use of each medication individually as well as the effects of all the medications taken together as a group.

Sample Log ↓

Start Date:	12/10/08
Medications For:	Joe Walker, Sr.
Log Prepared By:	Joe Walker, Jr.
Brand Name:	Seroquel
Generic Name:	Quetiapine fumarate
Date Prescribed (mo/yr):	January, 2009
Doctor:	Dr. Ryan Smith
Pharmacy:	CVS - Boston
Monthly Cost:	$50
Reason:	Dementia - Delusions

1/13/09

50 MG

	Morning
	Noon
	Evening
	Bed

Seems to be doing better,
a little tired mid-day.

5/20/09

100 MG

	Morning
	Noon
	Evening
	Bed

Dosage increased by Dr. Smith
at appointment on 4/15/09. Increased dosage is managing delusions better. Still somewhat tired after taking morning
dosage; appetite decreasing.

Download → PDF Version DOC Version

Articles

Home Care Guide: The 8 Questions You MUST Ask When Hiring a Home Health Aide or Agency

By Karen Cherfils, MPH

Whether you're considering enlisting the help of a home care services agency or hiring a personal home health aide, ask these questions to choose the best provider for your needs.

6 Questions to consider BEFORE hiring a home health aide to care for your loved one:

1. What are your expectations for the types of services or care that the aide or agency will provide?

Home care services range from skilled clinical health care provided by nurses or therapists to simple household support, such as cleaning, cooking and running errands.

Think about how much support you need and how much care your loved one requires and write down what specific tasks you'll need the aide/ agency to do and approximately how much time you'll need each day/ week. Then develop a list of agencies or aides in your area that can provide that. Ask doctors, family and friends which home health aides or agencies they would recommend.

2. Is the agency licensed by the state?

Most states – but not all – require agencies to be licensed and reviewed regularly. Reviews may be available by request through your state's health department. Find out what the requirements are in your state. Then take a look at your list and see which agencies are licensed.

3. Does a governing agency such as The Joint Commission, an independent group that evaluates and accredits health care organizations and programs that voluntarily request review, accredit the agency?

If so, ask to see the results of the most recent survey.

4. Is the agency certified by Medicare to meet federal requirements for health and safety?

If not, ask why.

5. Is the aide properly trained and credentialed?

In many states, you have to be a licensed CNA (Certified Nursing Assistant) to be employed by a Hospice or Home Health Care Organization. Find out what the requirements are in your state. Then ask the aide about his/her training experience. Is (s)he certified in CPR and First Aide? Does (s)he have other skills that pertain to the job? Make sure you're comfortable with the level of training and experience the aide has achieved.

6. Is the aide or agency reliable and trustworthy?

Don't rely on the aide or agency's word for this. Always ask for references.

The Aide: if he/she fails to provide any, talk to co-workers and the employer - ask them how they like working with their colleague and if they've heard complaints or praises from clients. You may even ask the employer to give you a list of clients who would offer references - then call them and ask them to rate the aide's level of care.

The Agency: ask for a list of doctors, hospital discharge planners or other professionals who have experience with the agency, as well as a list of former clients - then call them and ask them to rate the agency's level of care.

Checking references can be extremely exhausting and time-consuming. To make the best use of your time, look closely at the list you developed in the beginning of all the agencies/aides in your area and check off those that have the proper licensing, accreditation, certification and credentials. Start with the aides and agencies with the most check marks and follow up with those references first, moving your way down the list.

2 Questions you must consider AFTER hiring a home health aide to care for your loved one:

The evaluation shouldn't end AFTER the person has been hired. After all this person is providing care to someone you love, in your home, it's important to be careful.

1. Does the aide seem professional and take pride in his/her job?

There are a number of personality traits that could tip you off, including punctuality and grooming. So, observe whether or not the aide arrives on time; and take a look at how (s)he is dressed. Are the clothes neat? Does the aide wash his/her hands often and after completing tasks? These observations could tell you a lot about the level of care you could expect the aide to provide.

2. How does the aide interact with the patient?

Oftentimes, an individual receives home health care because their condition has progressed to a point where they can be at home, but still require some medical attention. Individuals choose to be home because of the comfort level it offers. Therefore, aides should be professional, but relaxed. Observe the aide's demeanor with the patient. Is it polite and compassionate? Does (s)he have a pleasant disposition? Do they talk and interact well with one another. The interaction should seem easy and not forced. Make sure you feel comfortable with the home health aide as well.

About the author: Karen is one of the Co-founders of OurHealth, LLC, a health media and education consulting firm that assists its clients in developing and implementing effective, culturally relevant health communication strategies. Karen has a Master's Degree in Public Health from Drexel University, School of Public Health, where her concentration was health management and policy. While there she was awarded a Health Policy Fellowship at NIH's National Center on Minority Health & Health Disparities where she authored a 25-page white paper expressing the needs of aging minority populations and their caregivers. She received training in Applied Gerontology from the Edward R. Roybal Institute in California and holds a Bachelor of Science Degree in Biology from Hampton University.
You can email her at kchefils@ourhealthllc.com or visit her website.

As We Age: The Five Senses

By Nicole M. Farmer, MD

The five senses work together to help us find our way through the world. Ironically as we move throughout life, the five senses change as almost as much as we age. Ask any person approaching fifty and they can tell you at least a few minor changes they may have noted while trying to focus on objects more while driving or while trying to concentrate harder on words said from across the room.

As common as the complaints are about how the senses change with age, the reasons behind the changes and the total impact on the lives of older people are less known to most people.

In this article we will look into the changes that occur with each of the five senses: hearing, vision, touch, taste, and smell.

Hearing

One of the most important senses is hearing. It is thought to be the only sense that can invoke other senses. Not only does our ability to hear affect our ability to appreciate wonderful things in life, such as a favorite song, once our hearing is impaired there may also be balance issues that ensue. Thus making understanding how and when to recognize hearing loss changes all the more important.

Over one-third of those over 65 and half of those over 85 have some hearing loss. The ability to have sharp, clear hearing may start to decline at the age of 50. Age related hearing loss is caused presbycusis.

Loss of hearing can lead to social isolation and depression. Changes with hearing can also cause falls because hearing contributes to balance.

Unfortunately, hearing is often under diagnosed and undertreated. This may be because assessment of hearing and hearing aids has not been covered under Medicare or most other health plans. Another potential reason for under diagnosis is that hearing loss occurs gradually and we may be unaware of subtle changes. One way to help determine if you or a family member is starting to experience age related hearing changes is the whisper test- done by whispering in the ears. Other signs to look for are frustration with talking to family members, problems understanding conversations in noisy rooms, difficulty watching television. With presbycusis, consonants become a major problem in conversation. The subtle sounds made by the letters z,s,f,p,g,t are difficult to understand for someone with hearing loss. An important note to remember is that when raising your voice, consonant sounds become harder to hear. So speaking louder makes it harder for those with hearing loss to actually understand.

While hearing loss from presbycusis is helped by hearing aids, sometimes hearing changes are from problems due to the ability to conduct sound through the ear. For example, impacted ear wax is common in the elderly due to increased water loss and can cause severe hearing impairment. Ironically, those with hearing aids may experience an increased amount of impacted ear wax.

Vision

Vision loss can occur at any age, but as we age there are changes that occur with muscles around the eyes and with our pupils which cause decreased vision. Weakness in the muscles that support the eye and help with movement can cause headaches when older people have to look inward or look closely at objects for a long period of time. As we age, the pupils also get smaller therefore allowing less light to reach the lens in our eye and the retina in the back of the eye. The lens also becomes opacified, or cloudy, and does not curve as much as before and therefore cannot refract light as well. The first time that you may notice this is while driving at night when the lens normally needs to curve more in order to discern objects from darkness.

As with other normal changes that occur in the body, it is important to recognize with the eyes when a change is not due to a normal function of aging but due to an abnormal occurrence. Continuing with the example of vision changes at night, this may also be a sign of developing cataracts or macular degeneration.

Touch

Touch is one of the most important senses – it incorporates not only our sense of touch but also vibration and pain. Therefore touch is a key sense that is needed to help determine danger or harm from objects such as a hot pain or hot water.

The sense of touch occurs from muscle fibers on the skin. The fibers send signals to the brain that tell our brain how to interpret the touch. As we age, the muscle fibers develop a decreased ability to transmit the message to the brain. The end result is that after touching a hot object, the brain does not interpret the object as hot and we therefore do not withdrawal immediately from touching the object. The same type of phenomenon occurs in diabetics due to nerve damage from high blood sugars.

Taste

There are approximately 9,000 taste buds on the surface of the tongue. The taste buds are responsible for telling us if a substance is sweet, sour, bitter or salty. Over time the number of taste buds decreases. The decrease can start at the age of 40 to 50 in women and 50 to 60 in men. In addition to losing numbers, the remaining taste buds may become smaller, this is called atrophy. For older individuals this means that appreciation for the taste of some foods may lessen and the feeling of enjoyment from eating may dissipate. Some researchers believe this is why older people often enjoy very sweet foods, because their taste buds for sweet things are weakened and in order to taste and appreciate the food it has to be extra sweet. It is usually salty and sweet taste buds that are lost first.

Smell

Smell, like hearing, is a sense that acts on the emotion and memory centers of the brain. When we smell we are actually smelling with our brain. Molecules from the air enter the nose and attach to nerve endings that send signals to the brain. The signals tell the brain if the smell is good or bad and then our brain attaches the smell to either a good or bad mood or memory. Therefore smell is present for our enjoyment but also for our protection.

When older individuals lose a piece of their sense of smell there is equal concern for the loss of enjoyment and possible safety. Like with taste, once smell is diminished there may be less enjoyment for the elderly to engage in eating. It can also lead to decreased attention to hygiene and potential dangers in the home. If there is spoiled food in the home or if there is a leak of gas, an older person with decreased smell may not detect these dangers right away.

About the author: Dr. Farmer is one of the Co-founders of OurHealth, LLC, a health media and education consulting firm that assists its clients in developing and implementing effective, culturally relevant health communication strategies. Prior to forming OurHealth, Dr. Farmer established herself in the field of medicine as a clinical research fellow at the National Institutes of Health conducting research on the health burdens of diabetes and heart disease in African-American communities. Dr. Farmer received her medical degree from Howard University College of Medicine and completed her residency in internal medicine at Thomas Jefferson University Hospital in Philadelphia, Pa. Dr. Farmer holds a Bachelor of Science Degree in Cellular, Molecular Biology and Genetics. You can email her at nfarmer@ourhealthllc.com or visit her website.

Mindful Caregiving Thought Tools for Resilience (Part 1)

By Holly Whittelsey Whiteside

Notice that the stiffest tree is most easily cracked, while the bamboo or willow survives by bending with the wind. - Bruce Lee

This series of articles will teach you ways to strengthen your resilience by building an internal toolkit that will last you for the rest of your life. Article #1, on building emotional resilience, introduces the powerful tools of managing self-talk and learning from anger.

Future articles will include:
Balancing Your Life (Picking Battles, Fine-tuning Relationships & Commitments)
Vitalizing Your Self-connection (Building Well-being & Boundaries)
Designing Survival Strategies (Managing Obstacles, Knowing Thyself)
Building A Support Team (Family, Community, How to ask for help)

Utilizing Your Emotions: Managing Self-talk and Learning From Anger

The voyage of discovery lies not in finding new landscapes but in having new eyes – Marcel Proust

Saying Yes to caregiving feels risky, as it contains many unanswerable questions. Acceptance of unknowns is perhaps the first lesson in caregiving.

You are visiting your parents, as you have done many times before, but this time things seems a little different. You can't quite put your finger on it at first. Maybe things are less tidy than usual, maybe not. Then it happens. Hamburgers are planned for dinner. While casually looking through the icebox for snacks, you see that the hamburger is 2 weeks past its expiration date. It hits you. Your normally meticulous parents are becoming old. Later that night, you think of other signs of decline. It is clear your parents are going to need help, increasingly as time goes on. Your relationship with them has shifted irreversibly, in an instant.

As caregivers, we are characters in a complex play we cannot fully understand and certainly cannot control. Caregiving can feel like concentrated life–life, but with the emotional volume turned up. Even more than in ordinary times we sometimes feel victim to our emotions. Here are a couple of alternatives.

While some answers can be found in the form of facts and information, equally important others are found by turning inward. It is here that you build resilience to last you throughout caregiving. By being mindful of your thoughts and then shifting them, you become more emotionally resilient. Your capacity as a caregiver broadens.

Good News/Bad News - Thoughts Generate Experience

What goes through your mind as you ponder the expired hamburger incident? These are your parents, they taught you about food safety! You remember the lecture your Mom gave you about it. Perhaps you think, "She's out of her mind! I can't handle this!"

The way you think, what you choose to believe about this journey and everyone concerned, can either stop you in mid-stride or allow you to move forward. You are at the mercy of emotions to the degree that you think you are. Put another way, your thoughts actually evoke your experience of life, and more particularly, your caregiving. If that is true, it's good news. It means you can learn to think in ways that shift your emotions. You begin to gain control by noticing the words you think and speak, the ones that are creating your current reality.

Society trains us to be assessment machines, firing off judgments about the world around us. Just look at the news headlines and you'll see what I mean. And we do the same to ourselves. We forecast bad news headlines for our lives so fast we're not even aware of doing it. "THIS IS GOING TO BE HARD." "THAT FAMILY MEMBER IS GOING TO BE A PAIN IN THE NECK."

Of course, we all have our dramas, those moments when your mind strays into its "bad neighborhood." Unhelpful thoughts don't just happen at four in the morning. Even in the daytime we invent stories about the past or future that undermine our well-being. But the better you can distinguish between the real facts and your made-up dramas, the more clear cut and smooth your caregiving path will be.

It all starts with paying attention to your language. What are the words you choose when talking to a nurse, in emails to your siblings, or in your head? Notice the power of everyday thoughts. "I look like hell today!" "That guy is such a jerk." "This is never going to work." Each time you tell yourself even seemingly casual negative phrase, you are depleting your energy and knocking down your coping ability, notch by notch. Practice editing your inner caregiving editorials.

As surely as the negative messages in caregiving undermine you, constructive messages make you stronger. Notice the energetic difference in your gut between saying, "Caregiving is so Hard!" and saying, "Caregiving is a challenge." Ask yourself each step of the way, What is caregiving calling on me to do or say? What quality of caregiving am I choosing in the words I speak? What personal reality am I committed to creating through the words I think? What will support my well-being as well as that of others?

While negative thinking can make caregiving more difficult, there are things that we think of as negative that actually can support us. Anger, for instance.

The Gift of Anger

That night at your parents', perhaps the first night of your new caregiving role, do you feel angry with your parents for not paying attention to expiration dates? If you have siblings who are less close to your parents, do you resentfully anticipate the caregiving load you feel falling on you?

As a culture, we are confused about anger. Is anger a good thing to let out, or an inappropriate self-indulgence? How can we manage it well if we're not sure how to think about it? Might it even be useful to us during caregiving?

Before you get carried away with yourself, stop and think. Understanding your anger could be an act of self-preservation. Rather than denying anger or wishing it would go away, try thinking about it this way.

Anger is normal. Not only that, within limits it can be healthy and useful. We're not talking about pathological anger that is unleashed as a weapon to damage or control others. Rather, this is the domesticated variety that can be a highly valuable signpost.

Anger can let you know what you are ignoring. It may show you when you are neglecting your own needs. If you are over tired, haven't taken time for yourself, haven't been exercising or eating properly, you may over-react to things you would normally handle well.

Anger may also raise its head when you are resisting some aspect of life that you would be better off accepting. Caregiving gets a whole lot smoother when you look at what you're resisting and accept what you cannot change.

If you have unrealistic expectations of yourself, others, the medical community or your caregiving experience you have set yourself up for anger. Life simply can't measure up, so try lowering or changing your expectations.

Finally, anger will show you when you need to be speaking up about something. Feelings of constructive anger are often valid and understandable. When we tamp them down instead of exploring and expressing them appropriately, they build up.

The next time you find your anger welling up, ask yourself:

Is this an immediate life or death issue? If not then perhaps your reaction is out of proportion, or at best, unhelpful. When you take the time for a deep breath, you can see that these off-the-wall reactions give a clear message. If you have spoken harshly to someone, apologize. Ask them to understand the stress you are under. Then some downtime. Take a walk. Do some yoga. The best way to respond to issues will be found. The answers will come.
Am I upset about something over which I have no control? You can't change other people or certain aspects of caregiving. Of course there will be instances when you need to take action, but other aspects simply are as they are. You can always try to shift your interpretation of them, or even consider accepting them. If you find yourself thinking, "Why can't he see what he's doing?" or "Why can't she be different!" stop and think about the other's personality traits or changing life conditions. Who must they be to be speaking or acting as they are? Precious time and energy are spent railing against the personality or behaviors of others, when understanding them and/or making clear requests gets a situation resolved.
Do I need to communicate about something important to me? If you do, plan out what you will say and how you will say it. What words might the other person be able to hear? Speak with compassion. Using "I" statements will make what you have to say easier to hear. For instance, let's say you need to ask your life partner for help. Make your request cleanly, as in, "I am feeling major stress from doing all my usual home chores AND helping my Mom. Could we just talk about another way we could team up to get the household chores done? I think I might crack otherwise."

Emotional availability to life is essential for vital living. It is part of being awake to life. When emotions are managed well, the ebb and flow between practical brain and emotional intelligence creates a rhythm that can buoy and empower you as you navigate caregiving. Let your healthy feelings flow through you. Ride them, giving them their proper place in your scheme of things. Take considered action when you need to, but when a situation is out of your hands, relinquish control and give yourself energy outlets. Be patient with yourself. You are getting your new sea legs. As you move over the shifting ground of caregiving, accept the movement. With acceptance you may be present enough to see the blessings in this time. Look for them.

Next month we will talk about Balancing Your Life by picking your battles, and fine-tuning your commitments and relationships.

About the author: Holly Whittelsey Whiteside is a Caregiver's Coach and Advocate, and author of "The Caregiver's Compass: How To Navigate With Balance & Effectiveness Using Mindful Caregiving." (www.caregiverscompass.com) Holly delivers caregiver support workshops and coaches private clients. She is also on the board of the NH Coalition for Culture Change in nursing homes. Email Holly, visit her website or her blog.

Mindful Caregiving Thought Tools for Resilience (Part 2)

By Holly Whittelsey Whiteside

Notice that the stiffest tree is most easily cracked, while the bamboo or willow survives by bending with the wind. - Bruce Lee

This series of articles will teach you ways to strengthen your resilience by building an internal toolkit that will last you for the rest of your life.

Article #1, Utilizing Your Emotions, introduced tools for managing self-talk and learning from anger.
This article, Conserve Your Energy, offers approaches for gaining control over troubling issues.

Future articles will include:

Build Well-being (Clearing Your Calendar, Practicing Self-care, & Adjusting Boundaries)
Design Survival Strategies (Managing Obstacles, Knowing Thyself)
Build A Support Team (Utilizing Family & Community, and How to Ask for Help)

Conserve Your Energy: Fine-tuning Your Commitments, and Choosing Your Battles

What you resist persists - Carl Jung

All struggles have one thing in common -- they arise from some form of resistance. When our lives (or people) don't measure up, we find ourselves in an emotional traffic jam somewhere between frustration and anger. It pays to look a bit closer at what is really happening.

In ordinary times, society encourages us to be on-guard, defend our rights, and complain about the state of things. When there are no outer battles to wage, we wage inner ones. But caregiving is no ordinary time. Energy conservation takes on a whole new meaning. When you know the source of your discontent, you can take care in the way that you address it. Feelings of being bound up, or are about to do battle, can arise from a host of causes which can include false assumptions, unexamined expectations, conflicting commitments, and childhood triggers. Understanding the root cause will allow you to address upsets appropriately and effectively.

Fine-tuning Your Commitments

Commitments source your energy and drive your life. They're personal. A commitment is a driving principle, something you are unwilling to compromise that is fueled by a deeply held value. Behind every one of your upsets is a strong commitment to something. For instance, if you are upset with a doctor, it may be out of a commitment to your loved one's safety, or a commitment to feeling supported by the medical community. Acting blindly on unarticulated commitments makes you far less effective. Identifying your root commitment in a situation lets you align the way you speak so as to achieve your desired result. But what about when you're incapable of action?

When you feel bound up, unable to speak or act, you may be suffering from conflicting commitments. Living blind to conflicting commitments leaves you feeling ineffective or on the fence without knowing why. A client of mine was feeling constant stress over her tug-of-war with her aging mother. During a coaching session, she recognized her simultaneous urge to act out of two conflicting commitments. She wanted:

To be a good caregiver and health advocate, but also;
To be her mother's best friend.

Once she recognized her stalemate she felt great freedom. Then, in any given moment, she became free to choose her appropriate role.

Do you know your commitments? Are you committed to being well-liked, being admired, or having candid relationships? Are some of your commitments more abstract, like a commitment to peace, fairness, or equality? Your commitments will drive everything you do, informing the way you speak to everyone in your life. Lack of clarity about them will make you indecisive and less effective in your actions and communications.

Make a list of the top commitments operating in all of your life, but especially in caregiving. For your loved one, do you want caregiving to be as smooth as possible? Safe? Redemptive? For yourself, do you want it to be strengthening? Peacemaking? Something else? For your family, what are your goals during caregiving? Whenever circumstances take a turn, and caregiving isn't going the way you would like, look for a connection between what is happening and your stated goals and commitments. Your list becomes your reality check.

Picking Your Battles

A major energy drain during caregiving is the battles you are tempted to wage. These are the things that you want to change. They can range from smaller issues that niggle at you, providing a daily drain on your energy, to larger ones that loom like impending war. During caregiving, it is critical to pick your battles, yet you can be so immersed in the day-to-day, so enmeshed in your challenges, that you can't see them clearly. Which are critical? Which aren't worth your time and energy? The following exercise will help you to sift through the issues facing you.

Exercise

First, list the most important challenges, issues, or impending conversations with which you are wrestling. (If you can only think of ones from the past, pretend that they are happening now. That way you will understand the process, and will have it when you need it in the future.)

About each issue ask yourself three important little questions:

Can this even be changed?
Does it seem like a battle-worthy issue?
Is it appropriately mine to handle?

Cross off those that don't rate three answers of "Yes". Put them on a separate "Decommitment" list, which we'll be expanding later.

Step One: Identify Your Interpretations & Expectations

For the remainder of your list, write down a detailed description of each issue, including who is involved, what you think of them or the situation, what you feel about the issue. Articulate what you believe is true about every aspect of it.
Now underline the words you have used that imply assumptions, expectations or interpretations. Watch especially for verbs of assertion (Are, Was, Couldn't, and Didn't) and words pointing to interpretations (Seemed, Looked, or Acted Like.)
About each issue, ask yourself which of your assertions and interpretations are absolutely true and accurate. On a separate page, list the interpretations, assumptions, or expectations you see that you have held in each case in regards to yourself, someone else, caregiving, or life in general. Notice how much of your experience hangs your choice of language. That's good news, because over that you have control. Perhaps your biggest power tool in caregiving is to revise the way you think and speak, in order to give yourself a more empowering interpretation.

Step Two: Clarify the Degree of Urgency

With your caregiving goals in mind, rate each issue on a scale from 1 to 5 with "Critical" at one end and "No Big Deal" at the other. How much energy does each deserve? Put a score next to each issue description.
The most urgent are those that are a threat to the health, safety, or peace of mind, of yourself or your loved one. List these on a new piece of paper, leaving plenty of space below each. Before proceeding, ask yourself: Is this issue critical to my caregiving commitments? Is there another way of seeing this that would diminish its urgency?
By now you may have identified a few non-critical issues, the ones that you truly don't have to address. Cross them off the first list and put them on your "Decommitments" list. Any remaining less urgent issues you can dispatch one/day starting with the easiest or most important. Get help or delegate wherever possible.

Step Three: Engage in Battle

Below each critical issue, note what would need to happen in order to get each issue handled. What is required? By whom? What conversations must happen? What information is needed?
Whose buy-in or counsel would be helpful? List any other assistance that might be necessary or desirable for each.
Enlist any assistance necessary. Make requests. Hire help. If you need help but are unclear how to get it, brainstorm with a trusted friend or professional counselor. (In the article "Building A Support Team," we will go into greater depth about how to ask for help.)
If a more complete conversation is necessary design it carefully. Speak respectfully. Make promises (not threats) that you can and would follow through on.
If the issue has not been solved and is still urgent, then escalate it. Bring it step by step to higher authorities or a good therapist, whichever is appropriate.

In next month's article, "Build Your Wellbeing," I will share a revealing exercise for managing your calendar to expend less energy. We'll also explore ways to build your well-being through self-care and setting boundaries.

Mindful Caregiving Thought Tools for Resilience (Part 3)

By Holly Whittelsey Whiteside

Notice that the stiffest tree is most easily cracked, while the bamboo or willow survives by bending with the wind. - Bruce Lee

This series of articles will teach you ways to strengthen your resilience by building an internal toolkit that will last you for the rest of your life.

Article #1, Utilizing Your Emotions, introduced tools for managing self-talk and learning from anger.
Article #2, Conserve Your Energy, offered tools for recouping energy.

This article, Building Well-being will guide you in scaling down your activities and taking care of yourself.

Future articles will include:

Design Survival Strategies (Managing Obstacles, Developing Boundaries, and Knowing Thyself)
Build A Support Team (Utilizing Family & Community, and How to Ask for Help)

Building Well-being

Once in a while you have to take a break and visit yourself. - Audrey Giorgi

Life was complicated enough before caregiving. Your usual engagements with work, family and friends continue, now compounded by a complex host of new and sometimes disturbing issues. Your life may or may not be close to the edge, but one thing is for sure - it will not magically simplify, and it could easily get more complex. So why not get it under control now? To do that, you are likely to need greater clarity about what is working for you, and what isn't.

This article contains a simple exercise to help you see some new choices you can make about your activities. It will explore as a necessity, and will recommend ways to have healthy boundaries that will serve you now and in the future. Let's start by making a little more time in your calendar.

Scaling Down Activities

Activities That Drain or Serve You

List down the left side of a piece of paper all of your typical activities in a given week in all aspects of your life. To the right, lay out five or six columns. Put an "E" for Energy at the top of the first column.
In the first column, put plus or minus signs next to each activity indicating whether it gives or takes your energy. The more +/- signs, the greater the impact on you.
Put a "T" for Time at the top of the second column. Put capital T's next to the activities that take the most time, and lower case t's beside the ones that take just a little time.
Put "S/O" (for Self/Others) at the top of the third column. Next to the activities put an "S" and/or an "O" to show which ones are done for you, which for others, and which for both. Your list should begin to look something like this:

Activity	Energy	Time	Others
1. Visit Mom	--	T	0
2. Pick Up Kids	-	t	0
3. Go To Church	++	t	S+0
4. Lunch With Friends	+++	t	S
5. Work	---	TTT	S+0

Add columns for any other parameters that might be important to you. Adapt the system so that it works for you. Is money a stressor for you? Show which activities cost a little or a lot, or which actually make money.
In a final column, write down what motivates you to do each of your activities. This will give you a valuable clue as to the values that drive your life. Notice any values that are not now serving you. Notice when a value might be better expressed by doing something else. For instance, one community service activity might give you more energy than another. Or a change in your visitation schedule with your loved one might take less energy.
What takes the most from you in energy yet takes a lot of your time? Highlight the activities that take a lot from you without giving much in return. From which could you de-commit? Decommitment is a power tool in the caregiver's bag of tricks. Cross off the activities that you could consider discontinuing, at least during caregiving.
Notice if your list is heavily weighted toward things you do for others, but shows few things that you do for yourself.

If it looks hard to make changes to improve your situation, remember, as Henry Ford once said, "Whether you think you can or can't you are right." This is your life. Preserve your inner resources so that you can do the caregiving to which you have committed.

Hopefully you now see ways to lessen your obligations. With a little more time in your calendar, might you be able to practice a little more selfcare?

The Selfcare Necessity

Our culture trains us to tough it out, to take life on, to be a stoic. If self-care sounds to you like self-indulgence, trust me, you're going to want to develop the self-care habit. You can only be as good for others as you have been good to yourself. As a caregiver, tending to your spiritual and physical health is more than a frill - it is an act of survival.

Fortunately, nowadays there is a wide variety of alternative medicine practices that have proven effective in dealing with stress. Yoga and massage are commonly prescribe for anxiety. When you're awake at four in the morning thinking wild useless thoughts, deep breathing techniques slow down the brain and oxygenate the body to help it relax.

Reiki is a form of energy work that is proven to promote healing and relaxation. And the most widely practiced method for achieving better health and sleep is regular aerobic exercise. It releases endorphins into your system that are like happy pills. Walk with a friend and have a chat. Bring an iPod and listen to an uplifting lecture or music. Make your self-care a personal daily treat.

A major catalyst for well-being is humor. Since caregiving is serious business, you might want to begin to take humor seriously. When you're under stress, your body produces Cortisol, the flight or flight hormone. Blood pressure spikes. Your immune system and heart are stressed. Laughter reduces levels of Cortisol.

In an APA article called "More Psychologists Are Finding That Discrete Uses of Humor Promote Healing in Their Patients" (http://www.apa.org/monitor/mar99/humor.html) Patrick A. McGuire, tells us, "Medical experts have already demonstrated that laughter boosts the immune system increasing natural disease-fighting killer cells and lowering blood pressure." Ed Dunkleblau, Ph.D trains therapists to use humor with clients. He says of humor, "It's not a therapy. It's a complementary treatment. It facilitates that which we do as therapists. We're trying to help people problem-solve, to develop, to know they're alive. These are things that humor does." So stock up on comedy films. Bring more humor into your caregiving and all of your relationships.

A Final Word About Silence - So much of caregiving is anything but silence, after all, it is by speaking that we affect our world, isn't it?, and our first instinct is to be effective. By email, cell phone, and in person we ask, tell, inquire, cajole and explain as we try to manage caregiving. When there's nothing to be managing, the urge is to turn off our brain with diversions. TV, reading, or a few drinks feel essential. But if you rush too quickly to tune out, you will miss potentially life-saving moments of silence. Learn to allow the silence to nurture and heal you.

In next month's article, "Designing Survival Strategies," we'll look at how personality traits can hinder or help during caregiving, and how you might develop new habits of thinking or acting.

Mindful Caregiving Thought Tools for Resilience (Part 5)

By Holly Whittelsey Whiteside

This series of articles teaches ways to strengthen your resilience.

Article #1, Utilizing Your Emotions, introduced tools for managing self-talk and learning from anger.
Article #2, Conserve Your Energy, offered tools for recouping energy.
Article #3, Building Well-being helped you to scale down your activities and take care of yourself.
Article #4, Survival Managing Your Emotions helped you fine-tuning your emotional accessibility and adjusting your shifting caregiving role

This article, Setting Life-Serving Limits & Boundaries concludes the series of articles that teach ways to strengthen resilience as a caregiver.

Setting Life-Serving Limits & Boundaries

(Harmony) is when..."Yes" is tempered by a gentle "No," and "No" is expanded with measured compassion. - Mrs. Chana Rachel Schusterman

While times for silence in caregiving are often a rare gift, opportunities for speaking out abound, offering you practice in setting boundaries. As your loved one ages, your role can shift before your eyes. Within a given day, you may function as child, nurse, entertainment committee, adult friend, healthcare advocate, and sibling, each role requiring a somewhat different voice. Notice that most of these roles are in response to others. (How easily we forget ourselves!)

While dancing with your various and mutable roles, you can remain effective by staying centered in yourself. To stay centered in yourself during caregiving, develop the habit of protecting and asserting your own boundaries. Notice where your responsibility stops and another's begins. Notice what is yours to do, and what could or should be done by others. Notice what you need in order to be effective. If what you need must come from someone else but is not forthcoming, ask for it. Setting your bounds and limits in your relationships and in your life is an art of balancing controlling with allowing. Here are some guidelines for promoting healthy limits and boundaries:

Guidelines for Setting Life-Serving Limits & Boundaries

There is no perfect limit. A boundary is determined by who you are and the situation in which you find yourself. Some of the following suggestions may help you to fine-tune your boundaries:

If you are a responder in conversation, practice taking up more room in conversations than you usually would. Though this may, at first, feel like a big difference to you, your increase in outspokenness is likely to be slight. You can afford to experiment with making room for yourself.
Become a curious observer of yourself (and others,) rather than a harsh critic. Be kind, yet discerning. A harsh demeanor often shuts down relationship. Kind curiosity will have you setting your boundaries within the context of who you and the other are.
Confront what scares you. Look at it head-on, journal about it, describe it. It will diminish. Lack of healthy boundaries are often rooted in fear.
Practice tolerance of ambiguity and uncertainty. Living more easily with unknowns promotes inner peace and diminishes fear. Boundaries established from a centered place in yourself will have more integrity. They will be aligned with your true self.
Notice what is yours to handle, as distinct from what is someone else's. It is easy to jump in to handle what could be done by others. It could be damaging to try to do what is someone else's preprogative. It is deeply frustrating to try to fix or change what cannot be changed (like another person).
Limit yourself to doing one thing at a time. Like the turtle in the race with the hare, you may get there faster. Certainly you will arrive with more peace.
Setting your limits too rigidly increases discomfort. Be flexible, you'll be less disappointed. When you are disappointed, pay attention. Disappointment can show us our expectations, as well as what could be more realistic.
Don't read other people's minds. Keep your attention on yourself while simply being aware of others. Then ask questions when you don't understand someone. Explicit communication goes a long way toward clearly seeing the bounds and limits of each relationship.
Focus less on managing outcomes. As much as possible, limit yourself to what you can do in the moment. Often, if you manage the present moment, the future takes care of itself.

Here are a few simple formulas for gently asserting your boundaries in conversation: A Linguistic Prescription for Empowerment:

Say NO (respectfully) at least once a day.
Experiment with words and phrases other than NO that mean what you want to say. (This will provide safety until you can release the idea that "NO" means "I don't like you.")
Counter self-criticism with 'SO WHAT?'
When someone asks a question that is invasive, instead of answering and giving information you don't want to, respond with the question, "WHY DO YOU ASK?"
Accept compliments. Don't deny or over-explain. Just say "THANK YOU," or better, "THANKS FOR NOTICING!"
When someone is overstepping your boundaries, a useful neutral phrase you can say, without apologizing or over-explaining, is, "That doesn't work for me."
Speak using "I" statements whenever possible. They make clear where you stand without creating unnecessary confrontation or conflict.

Experiment with any of the above approaches that feel right to you. Trust your instinct for what will work for you. The better you know yourself, the clearer it will be where you need to strengthen your boundaries or limits.


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