In the previous lesson of caregiver school you learned about the natural process the physical body goes through as it prepares for death. And as I mentioned in this lesson I want to focus on the psychological and emotional needs of the dying and those that care for them. As a hospice social worker my focus was on the emotional well being of everyone not just the patient but also the entire family and especially the caregiver. My work with caregivers is the reason I created this education program. Everything you have and will learn from me in this program is what I shared with my hospice families. And one of the hardest lessons is the one on letting go, to allow your loved one to do what they need to do to die peacefully. When the end is near our loved will become increasingly aware that physically they can't stay much longer. And they will begin the process of psychologically and emotionally preparing for their physical death. And there are ways that you can help to ease this transition and for you to say goodbye.

There comes a time when we must begin the process of letting go of our loved one. When the caregiving journey is coming to an end. For some the end is fast and unexpected while for others it's a longer and slower transition. When the disease has progressed to a point that the doctor can offer no more treatment or our loved decides "no more". But sometimes it is the family caregiver who needs to make the difficult decision to stop treatment. Accepting that the journey is ending can be emotionally overwhelming triggering strong feelings of guilt, sadness and fear. But it also can be a time of healing, reconciliation and closure for everyone. As you enter this last stage there are things that you can do or learn that might help ease the stress.

In today's busy world we all suffer from times of stress and anxiety. Add the burden of being a family caregiver and you may feel constantly overwhelmed by stress. For some it is a constant low hum present in the background for others it is a racing heart and a feeling of always being on edge. Learning to manage the stress in your life begins by learning to understand what that word means for you and how it is impacting your enjoyment of life. Stress is different for everyone, while some of us are able to handle a lot; others of us crumble under the weight of a little? Understanding what stress is and what causes it are the first steps to managing it.

Family caregivers who are unable to manage their stress will become burned out caregivers. Too tired to care for their loved one, or constantly frustrated, irritable or depressed.

Usually family caregivers are dealing with changes in behavior or cognitive functioning long before any diagnosis of dementia is made. The forgetfulness seems different or more persistent. You are aware that some days are better then others. One day everything seems to be fine and the next day they're not. Most diseases that cause dementia will follow a predictable path of disease progression and knowing the stages can help family caregivers plan and prepare.

Having an accurate diagnosis and understanding the specific part of the brain affected by the disease and even knowing the stages helps but doesn't solve the problem. It doesn't answer the question, "so what do I do when my husband keeps repeating himself?"

Long distance caregiving can be quite stressful responsibility. Managing affairs from a far and worrying about the "what if's" can be overwhelming.

When you are not with your loved one on a consistent basis and are left to wonder and worry it helps to know what to look for when you are with them. A long distance caregiver needs to know what to look for to know if they need to step in and take action or to stand back and leave well enough alone. There are some warning signs that every caregiver not just those at a distance need to be watching for, as they can be a signal that some help or intervention is needed. And the biggest warning sign is to look for any changes. Sometimes changes are more obvious to the one at a distance then those who are there daily. But sometimes those at a distance will minimize a warning sign dismissing it as just an off day or think "we all do that occasionally".

Long distance caregiving can be quite stressful responsibility. Managing affairs from a far and worrying about the "what if's" can be overwhelming.

When you are not with your loved one on a consistent basis and are left to wonder and worry it helps to know what to look for when you are with them. A long distance caregiver needs to know what to look for to know if they need to step in and take action or to stand back and leave well enough alone. There are some warning signs that every caregiver not just those at a distance need to be watching for, as they can be a signal that some help or intervention is needed. And the biggest warning sign is to look for any changes. Sometimes changes are more obvious to the one at a distance then those who are there daily. But sometimes those at a distance will minimize a warning sign dismissing it as just an off day or think "we all do that occasionally".

So what do you do when your loved one needs more care then you have time or skill to provide?

As your loved one moves from independence to increasing dependence it is the caregivers task to adapt the environment to meet those changing needs. But at some point a family caregiver will need to rely the expertise of a professional caregiver. Whether these professionals provide this care in the home or in a facility the services they provide are an invaluable resource for the family caregiver.

Helping your loved one manage their day to day activities is different for every caregiver. It varies because some caregivers live with the one they are caring for, some live near by and others live far away. And as you learned in the first part of caregiver school their are different caregiving journeys, some of you are caring for someone is just getting older, others their loved one has a disease or physical disability and some of you are caring for someone who is physically healthy but struggling with dementia. So the day to day challenges for each of these journeys can be very different.

Part Six of Caregiver School covers what you need to know to care for your loved one's day to day needs. We'll discuss some of the options available to you whether you are caring for your loved one in their own home, in your home or in a professional care facility. In this lesson we will focus on the challenges, services and options available for caring for someone at home.

Do I need a Lawyer is a question everyone asks when talking about advanced directives.

"It depends" was the answer the attorney gave to a caregiver at the elder law seminar I attended. A very frustrating and unhelpful response but actually it is the right one. But what does "it" depend on? Well everyone's circumstances are different and laws vary widely from state to state, so a lot depends on who you are and where you live. But I thought I would take some time to help walk you through a better understanding of the "it depends" answer. Now I am just giving you some general information and I am not providing any legal, financial or medical advice.

Being a family caregiver involves juggling a lot of different roles and taking on many new responsibilities. I always encourage families to divide these responsibilities among all of them so that the burden doesn't overwhelm just one person. But whether these responsibilities are taken on by one person or shared by a few think of managing your loved one's affairs as three unique areas of responsibility one of medical agent, another as financial power of attorney and as third as Executor of the estate. Each of these roles will require a written document or advanced directive to authorize you to manage these responsibilities. In this lesson we'll go over the role of the medical and financial power of attorney and I'll cover the role of the executor in the next lesson.