The Caregivers

C2

The Caregivers

• Support system that serves as a nurse, homemaker, spouse, head of the household and more.

The Responsibilities of a Good Caregiver:

• Respect the patients privacy and individuality.• Cultivate the patient’s trust.• Be objective in dealing with the patient. Never

show pity.• Approach the patient with an open mind.

Never antagonize.• Be organized in the process of caregiving.• Have good hygiene.• Perform the different caregiver skills

adequately.

Invoving the Whole Family in Caregiving

• Usually one person assumes the role of primary caregiver because:– Closest geographycally– Closer to the parents emotionally– A take-charge person.

1. Involving the parents is crucial.

• Talk with the parents about working together.

• Talk openly about issues and agree on ground rules.

• Establish limits to avoid unrealistic expectations.

2. Involve siblings and other close family.

• Limit participation to siblings or others directly involved in care. People who cannot attend in person can participate by phone.

• Develop a series of questions and concerns (health, legal, economic or housing issues). Involve problems that may have occurred in giving or getting help and following the schedule.

2. Involve siblings and other close family.

• Reassess the parents’ situation every few months

• Bring up topics that may have arisen since the last meeting. Discussing such issues openly avoids hurt feelings, suspicions and gets problems solved

• Be neutral when moderating, if necessary, to keep meetings constructive

2. Involve siblings and other close family.

• Have a clear agenda for each meeting and agree on rules of conduct at the outset

• Avoid arguing. Stick to facts, not opinions or generalities.

• Focus on the task of taking care of the patient

3. Involve the spouse.

• Encourage the spouse to talk about his/her feelings.

• Caregiving responsibilities affect the spouse in a major way.

4. Involve the children.

• Be honest with the children about the situation.

• Answer their questions.

• Listen to their concerns.

• Ask them if they would like to help out.

Detecting Caregiver Strain

• Demands of caregiving among the chronically and terminally ill are greater

• Caregivers are strained to the point of fatigue; can no longer offer continued support

• Physical and psychological resources of the caregiver are often stretched jeopardizing the patient and the entire family

Caregiver strain can occur in:

– Sleep disruption

– Physical strain

– Family adjustments

– Competing demands

– Changes in personal plans

– Added responsibilities

– Emotional adjustments

– Adjustments to patients’ personality changes and upsetting behavior

– Feeling of being overwhelmed

– Financial strain

Modified Caregiver Strain Index (MCSI)

• Provides invaluable clues to the physician as to the needs of the caregiver and to tailor interventions to address them

• MCSI scores of 23 and below = normal

• MCSI scores of 24-28 = predisposition to strain

• MCSI scores of 29 and above = severe caregiver strain

MODIFIED CAREGIVER STRAIN INDEX (MCSI) QUESTIONNAIRE

(Bautista and Maglonzo) LAGYAN NG TSEK ANG KAHON NG IYONG NAPILING SAGOT.

Madalas

(3)

Paminsan-minsan

(2)

Halos hindi

(1)

1. Naaabala ang aking pagtulog dahil sa pag-aasikaso sa pasyente.

2. Ang pag-aalaga sa aking pasyente ay nakakapagod dahil sa pagkarga, pag-alalay at pag-asikaso.3. Ang pag-aalaga sa aking pasyente ay nagdulot ng mga pagbabago sa buhay ng aking pamilya dahil sa nagulong pang-araw-araw na gawain,

4. Nauubos ang aking pansariling oras sa pag-aalaga ng aking pasyente

5. Ang pag-aalaga sa aking pasyente ay nagdulot ng mga pagbabago sa aking mga plano sa buhay tulad ng pagpalit o pagtigil sa trabaho o pag-aaral, paglabas-labas, pagbabakasyon, at iba pa

Madalas

(3)

Paminsan-minsan

(2)

Halos hindi

(1)

6. Bukod sa pag-aalaga sa aking pasyente, mayroon pang dumagdag na responsibilidad na nangangailangan din ng aking oras.

7.Ang pag-aalaga sa aking pasyente ay nangangailangan ng tibay ng loob dahil sa hindi naiiwasang mga alitan at hindi pagkakaunawaan.

8. Ako ay nalulungkot dahil malaki na ang ipinagbago ng aking pasyente mula ng siya ay magkasakit.

9. May mga pagkakataon na nauubos ang aking pasensya at ako ay naiinis dahil sa ikinikilos ng aking pasyente.

10. Lubos akong nag-aalaala kung paano ko makakayanan ang sitwasyong ito.

11. Malaki na ang aking gastusin dahil sa pag-aalaga sa pasyente.

TOTAL SCORE

Managing the Stress of Caregiving

1. Take care of the caregivers’ health.

• Enough rest, sleep, exercise, and nutrition

• Regular medical checkups• Symptoms of depression (extreme

sadness, trouble concentrating, apathy, hopelessness, thoughts about death) addressed

2. Involve others.

• Make a list of jobs that need help: household chores, home repair or maintenance, driving, paying bills, finding information on services you need.

• Let them have a break and ask friends, neighbors, or other family members to help out.

3. Maintain social contacts.

• Isolation increases stress.• Let them have fun, laugh, and focus on

something besides the problems.• Let them have emotional balance.

4. Get help from community services and organizations

• Get assistance– hiring people to care for the person– hiring people to help with chores, errands,

or childcare to free up some of caregiver’s time

– family, friends, members of religious organizations, and people in community groups are often willing to assist

5. Talk about it.

• Don’t keep the negative feelings bottled up.

• Talk to family and friends.• Join caregiver support groups.• Talking can help the caregiver cope with

common feelings of anger, guilt, isolation, fear, sadness, or anticipatory grief.

6. Deal constructively with negative feelings.

• Many caregivers experience occasional bouts of anger or frustration and then feel guilty for having these feelings (anger-guilt-anger cycle).

• Stop it immediately by forgiving themselves for being angry.

• Distance oneself from situation, figure out what caused the anger, decide how to respond constructively next time.

7. Talking to older parents about independence.

• Having family conversations about these topics can be hard.

• They can make all generations uncomfortable.

• Plan in advance.

It’s always helpful to plan a sticky conversation through:

A. Approaching the subject indirectly

Ex. “I know your taking lots of pills. How do you keep track of them? Would a pill organizer from the drug store help you?”

B. Being direct, but non-confrontational

Ex. “Mom, I’m worried that you seem to be unsteady on your feet. I’m wondering how I can help protect you from falls.”

C. Watching for Openings

Ex. “Grandma, after you said last week that you had trouble turning the handles on the water faucets, I wondered how you were managing with the shower.”

D. Sharing your own feelings about your parents changing life

Ex. “It’s hard to see you give up reading, Mom, now that your eyesight is getting bad. Do you miss it? Would you like to try a book on tape?”

8. Make a list.

• For sensitive topics like finances

• List of questions or concerns

• Scheduled

– To give family members time to think and prepare for the conversation.

9. Dealing with resistance.

• Resistance about independence is normal

• Respect your parents’ feelings

• Act firmly, but with compassion

• Involve other people whom your parents respect (Minister, lawyer or a family friend)

• Hold a family meeting

• Listen to your parents’ opinions

9. Dealing with resistance.

• Parents must feel a sense of involvement and control over their lives

• Recognize their rights to make decisions

• Focus on current needs

• Avoid past resentments

• Look for community resources and share the options with them

10. Focus on key points.

• Ask your parents about:

– Their own thoughts

– Current needs and concerns

– Worries about the future

– Hopes and goals for their older years.

Community Resources For Caregivers

• Friends

• Civic groups

• People commonly seen by your parents

• Other caregivers