Caregiver by Design

A follow-up conversation from episode 43.   Taking a deeper look at the strategy needed to build connection through the challenges of caregiving.  

After working with a couple the other day, I wanted to share a deeper perspective with you.  Example of a couple working through a basic task that could otherwise cause stress and potential resentment; they discovered how to work together and develop a deeper connection. 

How could this change your life? Well, consider this: 
Your Types of strength:

• Physical
• Health
• Relationship

Imagine improved strength in any one of those 3 areas.  What does that look like in your life?  What if all 3 areas were stronger.  They are pillars for a well-balanced, healthy, fulfilled life.

First: what prevents effective connection?   Take a listen to previous episode 43 “how to build a deeper connection with your partner”  some examples:

• Poor communication
• Resentment 
• Loss of hope and vision
• History of arguments, poor outcomes
• Lack of self-insight.  You have to know yourself very well, identify your true emotions and the cause of them, to be an effective communicator

Next: opportunities for connection

• co-Developing a plan for living life with a focus on fulfillment.  not just existing
• Building trust that is developed through allowing your partner to try to do more OR to help them in areas that they need help with the way they ask you to ( pause your preconceived ideas, hesitations, expectations and let them lead for this.  Learn together. Remember to be partners)
• Exercising together or coaching your partner through a program with a specific goal
• Meal planning
• Community outing/travel
• Socializing with friends

What do you need?

• Insight  (the capacity to gain an accurate and deep intuitive understanding of a person or thing.)
• Knowledge (facts, information, and skills acquired by a person through experience or education; the theoretical or practical understanding of a subject.
• Persistence

If you need more help/support on your caregiving journey, you can find it over at https://www.caregiverbydesign.com/coaching
Free training now : watch a short free video I created on coaching vs caregiving https://www.caregiverbydesign.com/freetraining

October is national depression and health screening month: Did you know that 20% of family CG experience it?  That is 2x the rate of the rest of the population! why?

October is national depression and health screening month. Did you know that 20% of family CG experience it.  That is 2x the rate of the rest of the population! Some causes: limited socialization, lack of touch, isolation, and stress.    https://screening.mhanational.org/screening-tools/depression/?ref=CAN
The one you are caring for may also be experiencing depression and is definitely at risk for experiencing it.  They are more likely to face the risk factors that lead to depression due to life changes they feel out of control of, loss of independence, lack of socialization and getting out of the house with friends or engaging in hobbies, lack of exercise, etc . 
1. Impact of isolation: https://www.nature.com/articles/s41598-020-58297-9. Depressive symptoms are associated with less social interaction, being with other depressed people, lacking group interactions, less time with friends. Research shows that social isolation increases the risk for coronary heart disease, stroke, and mortality,  and can negatively influence psychological health leading to depressive symptom
2. Importance of touch in avoiding depression and dealing with depression: FROM ARTICLE https://www.medicalnewstoday.com/articles/touch-starved#complications

*affectionate touch promotes psychological well-being. * touch can also reduce the feeling of loneliness *Research also notes that those who report loneliness show dampened cognitive function and a higher chance of experiencing mental health conditions such as anxiety and depression. So, if you aren’t around people you probably aren’t getting enough physical human contact. Are you getting what your body needs?  Too much cortisol, caused by stress, can cause: 

• Anxiety
• Depression
• Digestive problems
• Headaches
• Muscle tension and pain
• Heart disease, heart attack, high blood pressure and stroke
• Sleep problems
• Weight gain
• Memory and concentration impairment

Oxyctocin is a neurotransmitter that acts like a hormone and it is released that is the counterbalance to cortisol.  And guess what?  It is released most potently with touch.   We were created with the most effective tools to combat stress: skin and the ability to touch.  So what can you do right now to minimize you and your partner’s risk for depression:   1. Minimize isolation : Find time to be with people.  Connect in person.  Find time to get out or have friends come over.  Avoid isolation.  This includes while being with your partner.  Use your partner as a source of deep connection.  Make your relationship meaningful beyond your current role.  Serve each other. 2. Touch/interact using affective touch that helps your brain to release oxytocin, the hormone that combats cortisol, the stress hormone.   

It is important to seek the help you need to stay healthy, taking care of your mental health needs to be a priority or you will not be able to provide the most effective caregiving.  Talk to your doctor about stress and depression.  

Make time every day for your mental health

If you need more help/support on your caregiving journey, you can find it over at https://www.caregiverbydesign.com/coaching
Free training now : watch a short free video I created on coaching vs caregiving https://www.caregiverbydesign.com/freetraining

  First some facts:

• 61% of caregivers are women  
•   1 in 5 Americans     
•   CG face declining health 

Here are some of the most common challenges faced by partners who are CGing:   

• Resentment
• Isolation
• Depression (research shows that CG experience at a higher rate than their partners)
• Anxiety
• Loss of employment
• Failed relationship
• Family strain impacting children and extended family

What causes this? 

• Focusing on limitations that face you and your partner vs possibility
• Lack of transparency with yourself about your feelings
• Neglecting your interests, friends, activities
• Neglecting your partner’s needs that are beyond those related to health 
• Missed opportunities to provide the support that grows your connection
• Role reversal
• Finances

Exercise to try: download a worksheet to help you here

Visualize yourself the way someone else would see you if they watched you for a few hours.  How would they describe you?  What energy do you put off?  (sad, quiet, angry, frustrated, exasperated, chipper, positive, encouraging)   

Now, what would you do to help or support this person? What would you offer them?  

TAKE NOTE OF YOUR ADVICE, YOUR WORDS TO THIS PERSON.    This is you! You need to care for yourself like this and avoid repeatedly going back to the state that you found this person in.  What can you do to avoid that?  What’s causing this problem?   What activities, hobbies, interests would help you to make this connection/bridge to a healthier lifestyle.

 Repeat this process for your partner.  Look at them as if you are a stranger.  Someone just walked into the house and is meeting your partner for the first time.  What do they see?  How would they describe them?  What advice, support would they offer?   

When seeing your partner through a 3rd party perspective: How would tomorrow be, how would it go, if you took time to see your partner in this perspective a few times a day?  What emotions would you feel?   It’s likely that you would have more patience and take things less personally.   You might see areas of interest and activity or opportunity that your partner is missing out on that is contributing to the way they interact with you. 

Last thing:  how do these realizations make you feel and what don’t you like about them?    There is more work for you to do here and it doesn’t happen overnight.  This is uncomfortable but uncomfortable is good because it means that you are moving out into a new area of growth. 

Need more help with this exercise:  Check out the option for more support at https://www.caregiverbydesign.com/waitlist to help you to see your partner differently.  Develop a clinical eye that will help you see their strengths and know what to do with them.

If you need more help/support on your caregiving journey, you can find it over at https://www.caregiverbydesign.com/coaching
Free training now : watch a short free video I created on coaching vs caregiving https://www.caregiverbydesign.com/freetraining

Get ready to train your newly recruited caregiving backup with essential skills to build confidence.  Consider these top 6 areas.  

• Comfort in physical contact: 

1. If there are any areas of injury, skin issues, tenderness issues: make these known
2. If your LO has preferences about contact make that clear

• Conversational skill and comfort with communications: 

1. asking the right questions and reading body language.  If there is a certain way that you ask your LO something or an answer that they typically give you in response to a question you ask, make note of that. 
2. Write down topics that your LO easily talks about, interests, TV shows, history 

• Bathroom confidence

1. Show by example then repeat with demonstration.  
2. Create a timed schedule of use of the bathroom while you are away
3. Have all areas accessible for different sized people

• Mobility confidence / transfers

1. Step by step approach with verbal prompts 
2. Maximize your LO participation
3. You can be the “test” case for them to practice on then repeat this with roles reversed so they can feel it
4. Make avoidance of injury the goal.  This is where injuries often occur ( shoulder, falls)

• Cooking or meal prep and meals

1. The Where, What, and How.  Don’t skip any details.  
2. What size are the bites? Do they cut their own?  Do they use special utensils? 
3. What snacks (again, where what, and how)
4. Drinks - make them aware of any risks for aspiration.  The obvious is sometimes not obvious to others.  Remember that liquid intake is usually a priority so don’t let them forget about this. 

• Exiting the home/car transfers

1. Exiting the home should be a priority in case of emergency.  Give them the easiest exit option.  
2. Car transfer should be a goal so they can go places if it is appropriate.

 Ready for change in your caregiving experience?  Be one of the select students in a small group coaching series that helps you design the lifestyle that focuses on your needs and maximizes your LO strengths and independence.   https://www.caregiverbydesign.com/waitlist

If you need more help/support on your caregiving journey, you can find it over at https://www.caregiverbydesign.com/coaching
Free training now : watch a short free video I created on coaching vs caregiving https://www.caregiverbydesign.com/freetraining

Finding a backup caregiver so you can get some time for yourself is essential but takes some planning.  You might be thinking, "Finding the perfect caregiver would be a great luxury."   This is not true. 

First let's look at what the benefits are: 

1. Exposure to different people and experiences for your LO
2. Time for you to spend doing whatever you need to do that adds value to your life
3. Safe and planned dry runs in the case of an emergency need for help/backup
4. Building confidence for the person you hire to one day help someone else or apply this to their own LO when needed
5. Having a person to call when you need a 2 person approach for moving your LO in the case of an emergency.

Things to consider when selecting someone?   

• Your LO personality   ( be honest about their strengths and weaknesses) 
• Do they need extra energy brought into the room or does that cause them anxiety? 
• This caregiver does not have to interact just like you.  The backup may be a nice change of pace for your LO so don’t take offense.  Think about how you engage with other people.  You might enjoy being around people that are very different from your spouse 
• What are the absolute musts that the CG will need to be able to do for your day away?

If it is an option for your LO to get out with someone else, that is a great option too.  Consider dropping them off at a location and then starting your outing/experience from there. 

Watch what you do as from a third party perspective. Write down the flow of the day and times that you do things.  It doesn’t have to be exact but it is easier to do this as the day is going on, in live time, than it is to sit and try to draw it all up from memory

Leave your expectations for perfection at the door.  Make one absolute expectation be for no injuries and for fun.  

Meet the objections your LO might express upfront:  
Your LO objections might be related to - nervousness, control, antisocial behavior.   Try this approach:

• Listen to them.  Let them talk to you, share their thoughts. Don’t interrupt.
• Understand and repeat what you heard as an active listener.
• Respond calm, genuine feedback that validates their concern
• Confirm the plan you are establishing again in a positive light 

Selecting a caregiver without initial skills in caregiving is okay as long as they have a heart of service and you feel comfortable with them ( although a Google search of their name isn't a bad idea either).   

register for live workshop prior to July 29, 2021 https://wwwcaregiverbydesign.com/workshop and learn how to find freedom
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If you need more help/support on your caregiving journey, you can find it over at https://www.caregiverbydesign.com/coaching
Free training now : watch a short free video I created on coaching vs caregiving https://www.caregiverbydesign.com/freetraining

Buying, building, and remodeling a home is a huge undertaking for anyone but the challenge is real when you are in need of making it suitable for your aging parents, your spouse with a chronic illness or physical challenge, or if your planning for your own future. 

There is a growing trend toward people aging in place, coming home from hospitals sooner, and with more significant challenges in terms of illness or physical limitations. This trend will be growing as we progress through time.  You may be facing this challenge right now? I would love to hear more specifically about it and you can send me your story, your challenges to my website https://www.caregiverbydesign.com/contactme or DM me on IG https://www.instagram.com/caregive_bydesign or FB https://www.facebook.com/caregiverbydesign

I have been in many many homes that were very challenging for people to navigate with their newly compromised LO and they were scrambling at the last minute to make changes. Sometimes, when the hospital would call and say, "your mom is coming home today?” The CG is often a bit frazzled with last-minute changes to be made.

Matt, my husband, and architect answered some questions for us :
Q: What are some of the biggest mistakes made or missed opportunities when people are modifying a home for an aging or disabled family member? 

A: 1. Overcomplicating the widening of doorways.   
2. Using cheaper materials or taking shortcuts suggested by the contractor.                                 3. Not contacting the building inspector in your area for the clearances you may need
Things to consider : seek a local home modification specialist.  Consider making quality improvements that have a longevity factor.  Consider asking an architect to do a consultation for your situation.   Allocate your money to the most used parts of the home.

Q: When looking at a new home build, what are some things to consider?   
A: Be aware of the updated international residential building code.  For example: you no longer need to have a 6" step from garage to home entry. 
A:  consider future use and placement of an elevator in a 2 story home.  It's not as much of a luxury as you might think.  it is more possible than it once was. 
A: consider the use of a kitchen that allows your LO to use it, socially at least
A:  make kitchen mobility as safe as possible, consider railing
A:  more space, less clutter, is very valuable
A: Bathrooms with built-in railing .  The layout that would accomodate a wheelchair. 
Standard bathroom is 5 feet by 7 feet deep.  Consider making this more spacious.  Layout is very important.  Consider making a bathroom connected to the bedroom for them to minimize fall risks. 
A: you could have a home designed so that the entire floor could be gutted and be left with supporting structure that would allow for changes you will need in the future.  
A: Consider laying out bathrooms with room for vertical grab bars 
A: Flooring is an important investment and carpet is not ideal. 
A: think carefully about entry and exit access for someone in a wheelchair

Subscribe and leave a review on apple iTunes and share with your caregiving friends and family. 

If you need more help/support on your caregiving journey, you can find it over at https://www.caregiverbydesign.com/coaching
Free training now : watch a short free video I created on coaching vs caregiving https://www.caregiverbydesign.com/freetraining

We all have self limiting beliefs but those of us who are aware of ours and work to minimize the power they have on our interactions with the world are winning.   

What is a self-limiting belief: assumptions or perceptions you have about yourself, your abilities, that are often subconscious yet have the power to alter your performance day to day

How does your self-limiting belief get in the way of making progress toward more freedom and joy in your life?  

What is your self-limiting belief about caregiving for your loved one?

Example:  you’re the caregiving wife of someone with a physical limitation acquired and you are finding that as time goes by, you are taking on more and more of a “to-do list” and those things are getting more difficult

        Your self-limiting belief may be - “There must be something wrong with me since I feel so edgy through the day and exhausted.”

Example: you're caregiving for your parent or grandparent 

 Your self-limiting belief might be - “it’s just me, doing everything, and I can’t do anything different.” or “If I had more help, they would be doing better”    “ Someone else could juggle this better than me” 

Why is it important to recognize this and what to do with it.   

• Calling them out gives you the power to control them and minimize their impact on your emotions and interactions
•  Consider journaling or voice recording into your phone 

Knowing the limiting belief will help you understand why you are struggling with certain emotions which could be contributing to stress and fatigue

• Once you recognize your own self-limiting beliefs, you can help your LO to do the same and this helps you to ID why they may be stuck in certain areas of their cooperation, participation, engagement.     Imagine what helping them get unstuck could do.  

As an OT , this is something that I would work through with my patients when I found that they lacked the initiation or perseverance to work towards their goals or if they didn’t have any goals and told me that they “had no purpose” and wanted to give up.   There are stories that they are telling themselves, beliefs about themselves that limit their progress, or their ability to even see a different path forward.      

Unlocking this limiting belief is important and makes a big difference in how you and your loved one experience life.  This applies to all people but I know that you, a caregiver, are facing excessively challenging situations day to day.  Your loved one is also experiencing challenges that they may not be able to express and it is important to recognize this and help them to gain some control over how it impacts their life. 

For more help with shifting your mindset and finding more joy and confidence in your caregiving -  https://www.caregiverbydesign.com/freetraining
Want to hear more about a specific topic - https://www.caregiverbydesign.com/contactme

If you need more help/support on your caregiving journey, you can find it over at https://www.caregiverbydesign.com/coaching
Free training now : watch a short free video I created on coaching vs caregiving https://www.caregiverbydesign.com/freetraining

These are not in order of importance but here is a quick reference list of the Top 10 preventative approaches to caregiving that you can take right now and see a difference. 

1.  Optimize nutrition and hydration
2. Optimize activity in the home/participation in ADL and IADL if able
3. Analyze and improve quality of movement  with a daily routine
4. Set medications up for ideal times for best effectiveness and consistency ( talk with your MD nurse)
5. Engage in socializations to increase: cognitive activity, visual, verbal, muscle 
6. Get the home modifications you need ( bars, rails, toilet seat, shower seat, lighting in the home day and night)
7. Get a toilet with a self-cleaning feature if they have difficulty with wiping ( UTI, skin breakdown)
8. Adjust flooring in the home (carpets, flush thresholds, steps) to prevent falls 
9. Establish what walking device they should be using and keep them consistent with it
10. Analyze bed mobility safety and safety getting to and from the bedroom to the bathroom

You might notice that these all promote independence in some way.  This should be the goal that you don't give up on because the more independence that your loved one has, the more independence you have. 

Want to be a beta tester of my upcoming membership for free?   go here and let me know your situation and I will send you more information.  I would love to get your feedback before I launch this to the general public for a monthly fee. https://caregiverbydesign.com/membership

Take part in a 3 day free training series that gives you the tools and strategies to minimize your caregiving stress https://www.caregiverbydesign.com/freetraining

If you need more help/support on your caregiving journey, you can find it over at https://www.caregiverbydesign.com/coaching
Free training now : watch a short free video I created on coaching vs caregiving https://www.caregiverbydesign.com/freetraining

Caregivers are a vital part of a nation, a societies, infrastructure and there a few reasons why.  First, let's define Infrastructure : the basic physical and organizational structures and facilities (e.g. buildings, roads, power supplies) needed for the operation of a society or enterprise.
First, some facts to consider: 

The average cost of a 3 day hospital stay is 30K

ER on average charge about $2300 per visit

Average ALF monthly cost is 4K

Average nursing home monthly cost is about $8K

Average in-home care with an average of 44 hrs a week - the 2020 numbers show about $4400.

Average hourly pay for caregiver $12-15 

All of these numbers are very out of reach for most families.  Most, 80% of the help provided in the home, is provided by unpaid family and friends.  This lends to caregiver fatigue, stress, depression and a serious strain on their economic situation as most of them eventually leave their jobs or work less hours in order to provide care.   This often results in the gradual seeking of a higher level of care that usually starts with Assisted Living Facilities.  Insiders tip ( there may not be as much assistance provided in assisted living as you were hoping for) .  These facilities require very mobile and mostly independent residents and they are not usually able to assist with daily tasks such as dressing, that the family and resident assume will be provided. Ex: Usually, the resident must be independently mobile throughout the necessary spaces of the environment. 

Here is a list of things to consider: caregivers are a very important part of the infrastructure that this country needs to progress. 

• Without them, the ALF and nursing homes would be overloaded and they are already short-staffed
• Good caregiving minimizes hospitalizations and ER visits
• Caregivers are a vital part of preventative healthcare and should be recognized as such
• A caregiver that is paid for their role is able to continue contributing to the economy
• A paid in-home caregiver would be able to participate in society/economy with the one they are caring for which further adds to their well being, mobility, social skills
• Caregivers organize the healthcare ( MD visits, meds ) which helps to minimize healthcare error

   In the US there is a current bill (the American Jobs Plan) that is being discussed by the Republican and Democratic parties that is looking at the importance of caregivers as part of the infrastructure of this nation and how to support them.  This includes caregivers of children but the president has specifically mentioned the need to support efforts to keep the aging population supported if they desire to remain in their homes.   This is a move that is a long time coming and needs to be taken more seriously by the citizens.  

I’d be so interested to hear your situation, your story.  Would you consider sending me a short email ? 
 caregiverbydesign.com/contactme
take advantage of a free training to help you minimize stress and be therapeutic
https://www.caregiverbydesign.com/freetraining

If you need more help/support on your caregiving journey, you can find it over at https://www.caregiverbydesign.com/coaching
Free training now : watch a short free video I created on coaching vs caregiving https://www.caregiverbydesign.com/freetraining

Do you know what’s going on in the therapy community?    They are tired of the insurance game, the productivity expectations of their employer, and they are feeling the push toward finding a new career.  Many are actively looking for ways to find a way out of even high-paying jobs.   I am a perfect example.

What does this mean for you and your loved one?

1.  if they are to be placed into STR or LTC you will be seeing this strain.  You may see a different type of “rehab” than you expected.  In combination with the effects of the pandemic on the rehab industry in these settings, the growing burnout rate among therapists is another wave of change that can’t be ignored.  
2. You may have an opportunity to maximize your loved ones’ well-being right now at home.  Don’t wait for something to happen.  A fall, UTI that causes a decline in mobility, a stroke, worsened CHF or COPD, Diabetic complications.  These are the things that cause many otherwise unsuspecting individuals to enter an extended care facility like STR or even LTC

Let’s start working toward preventative medicine at home.  How?  First, you have to believe that you have the power to make an enormous change and that doesn’t mean you DO MORE.  In fact, in means, you do less. You need to make room for the one you are caring for to do what they can do to the best of their ability.  Ready to shift focus? 

Let’s start with imagining your day.   How you feel right now.  Are you listening to this with a burned-out spirit?  Are you approaching it?  Do you dread proceeding through the day?  Maybe not but perhaps you can feel it creeping in.  

I am going to tell you an insider to the healthcare industry secret.  When we begin to perform our roles with less connection, less purpose, and we are asked to see more and more patients; we rush and we begin to feel the beginning of burnout.  Healthcare workers can move onto a different job.  They can leave behind the thing that is exhausting them.  

You can not.  But, you CAN modify it.  So, you need to find a way to begin doing your caregiving differently.  I’ve said it before but here it is again, I know without a doubt that every caregiver has the full potential to be as effective as a certified clinician in developing strength, mobility, social and cognitive growth.  What does it take?  

• Knowing your personal goal/vision for yourself.  Your daily routine.  How you feel.
• Knowing what your client/ loved one’s strengths are and how to use them.  How to build on those strengths while maintaining them as used in your daily routine.  
• Knowing your barriers: (environmental, social, physical, economic, mental) you must know what is getting in the way of your loved one making progress.  There may be several.  Why?  If you don’t know what they are they will grow like a weed and take over your garden that you are so carefully trying to maintain balance in. 

Finding a daily routine that puts all of these things together in a way that puts your vision ( go back to the beginning) first and your client/ loved ones’ abilities and potential right next to that.  You need to be a partner with your loved one, not just a service provider/ caregiver.  You need to think of them as your partner with whom you will work to achieve a goal.    Talk to them about a goal. 
Get help here: http://caregiverbydesign.com/vision
3 part video training t

If you need more help/support on your caregiving journey, you can find it over at https://www.caregiverbydesign.com/coaching
Free training now : watch a short free video I created on coaching vs caregiving https://www.caregiverbydesign.com/freetraining