caregiver Archives ⋆ Page 3 of 6 ⋆ Cathy Cress

Caregiver Assessment- When The Caregiver Loses Sense of Self

September 22, 2019

One Homeostatic System

When you assess an older client with a family caregiver, you really have two clients. The needs of the family caregiver are different than the needs of the care receiver and the geriatric care manager or aging professional must differentiate those needs to make sure the care receiver’s functional and psychosocial needs are met. The care receiver and the family caregiver are one homeostatic system encompassing the whole aging family. To keep that family healthy and whole, in the middle of swirling care crisis, the care manager must first recognize that there are multiple clients including the person who gives or supervises care. In a health care insult, family members who give care are often referred to by the inanimate wooden term “ resources”. They have also been referred to as “ informants “.

Stripping Caregivers Personhood

This stripping of personhood denudes them of their status as individuals and melts them into the caregivers, thus breeds professional ignorance, like the crowd who watched the emperor with no clothes. We are blind to caregiver’s humanity and thus their own needs.

Seld-Esteem Vanishes With Caregiving

Many family caregivers lose their self-esteem because they fail at so many other parts of their lives when their whole life seems to be taken up by caregiving. They do not get vacations as the care-receiver does not take a break from illness and aging. Often there are few others to give them respite. Caregivers, often they just do not know where to find help or even ask for it. If family caregivers have children and husbands, they are often squeezed between their needs, the needs of the care receiver – thus have no room for their own needs. They are breathless and slogging forward.

Find out more in the YouTube from My Geriatric Care 1 Channel.

Caregiver Assessment- Here’s What It Takes Professionally

September 15, 2019

Doing TWO Assessments

To meet the needs of the whole family, principally the care receiver and the caregivers, GCMs need to begin assessing the caregiver as well as the care receiver. A caregiver assessment is defined by the National Center on Caregiving at the Family Caregiver Alliance as a systematic process of gathering the information that describes the caregiving situation and identifies particular problems, needs, resources, and strengths of a family caregiver. This new measure means that the care manager must see issues from a caregiver’s perspective and culture focuses on what assistance the caregiver may need, examine outcomes the family member wants for support and seeks to maintain the caregiver’s own health and well-being.

Create a Circle of Care

One resource that a GCM can bring to a caregiving family is what Gail Sheehy calls a circle of care. To create this supportive connection, the GCM needs to take her or his coaching skills and put together a support system around the formerly isolated, solitary family caregiver. The GCM can coach the family caregiver to ask for help so the GCM can assist in reorganizing the family so adult siblings can share in the care of the older client with the identified family caregiver. The GCM is what Sheehy calls a compassionate coach who can help the beleaguered caregiver attract and assemble a platform to keep on giving the care she or he wants to give the aging person.

Caregiver Resources

A circle of care includes emotional resources for the direct family caregiver. These emotional resources could and should include adult siblings. Reconnecting midlife brothers and sisters, through the circle of care, is an important GCM task, as siblings are the longest and deepest relationships in any person’s life. The GCM may have to depend on his or her clinical skills in helping siblings with forgiveness or reconnecting siblings who live long distances apart to add them to a circle of care. Midlife siblings have often spent the last 30 years tending to their own families, so the point of reconnection of midlife brothers and sisters often happens when they are in middle age in the midst of a crisis in parent care. This is where the GCM needs to employ clinical skills in midlife sibling work or to find the resources for the family to help with this healing sibling reconnection.

Genogram -Tools to Relieve a Family Caregiver-

September 9, 2019

What should be in your caregiver assessment toolbox?

A tool that you can tools use to solve the caregiver and care receiver’s problems you found in your care plan is a genogram.

A geriatric care managers assessment of the family caregiver is critical. Caregivers can and do fall apart. If you already did your caregiver assessment- great. But the extended family of the care receiver (client) should be assessed to find their strengths, weaknesses, dangers and real ability to help render caregiving services. This is where a genogram comes in.

A genogram allow you to see family patterns on a single page

Using a tool called a genogram can really show you the view of a family on a chart.Patterns in a family, especially the aging family that geriatric care managers and ALCA members serve, can be seen in a genogram showing you, for example, the generational cut off that happens over and over or alcoholism, or spousal abuse. You can see the weakness of family ties and where the care managers needed to focus to help the family get care for an older person.

A genogram allow you to see family support

A good genogram can be helpful in assessing the care receiver’s family support network and each relative’s relationship to the older client. Your genogram when paired with a psychosocial assessment, can help you assess whether the older client is living with a helpful spouse or partner, living with a difficult spouse, has relationship with an ex spouse, has cooperative and supportive children or grandchildren, has fighting or alienated children or grandchildren, has warring or alienated stepchildren or adoptive, has several children but only one child who “does it all,”.

In other words you pull up a traffic light, it is green, yellow or dangerous red. The genogram also can help tell the GCM whether you have ex spouses or partners who want to participate as caregivers and what their emotional relationship is the care receiver. In other words is there green-lighted support or red saying stop here-when the family caregiver desperately needs your GPS to find that that new road.

How to Assess the Caregiver and Avoid Hospital Readmission

September 6, 2019

Assessing the Family Caregiver is a new but crucial concept for geriatric care managers and professionals in aging.As geriatric care managers and aging professional, we are health and social services oriented. For almost 3 decades we have assessed the care receiver for problems with function, social connection, and psychological issues. If we suspect depression we have completed that screen. If our client plans to move, has cultural needs and preferences, exhibits signs of dementia, need ways to improve quality of life or a spiritual connection, we have assessed the care receiver for those problems.

All our assessments have left out the major fact – care is an exchange. To receive care, the patient/client usually needs a family caregiver to give or supervise it. That family caregiver is the glue that holds it all together and his or her inner bond begins to break with the strain of caring.

Other countries have seen what the US has yet to grasp. In the United Kingdom, a seminal law passed in 1995 called the Recognition and Services Act , which provided British caregivers a statutory right to request an assessment at the same time that a frail elder or adult with disabilities is assessed.

So developing a caregiver assessment is critical, especially in this era of penalties to hospitals for readmission. The caregiver is the key to keeping an older person in the community and not back in the hospital. If they are not trained, have physical problems that inhibit caring, find some tasks, like changing adult diapers uncomfortable, have no car to pick up meds or drive to the doctor’s follow up an appointment, you have a problem and probably a readmission.

Learn how to do a caregiver assessment along with a care receiver assessment .This will help you keep your aging client both out of the hospital and potentially out of inappropriate placement in a skilled nursing facility. Plus you will learn just not how to assess caregiver burnout but be able to create a care plan that will help your family caregiver have a better quality of life while they giver better care to their loved one. Read the chapter ” Assessing the Caregiver ” in my book Care Manager’s Working With the Aging Family, Jones and Bartlett. The price has just been cut in half to make it more affordable for the practitioner.

With Dorian’s Carnage- Do You Need a Midlife Family Meeting for Aging Parent Disaster Plan ?

September 3, 2019

What is MidLife Sibling Hurricane Nightmare

The catastrophic disaster of Hurricane Dorian unleashed on the Bahama’s and heading to Florida should conjure up a midlife sibling nightmare. It brings back the goblins of Katrina -the most gruesome weather cataclysm where 39 elderly residents died, trapped or abandoned in retirement centers and 1400 elder overall died in Katrina’s watery wrath.We just plunged into possible horror again. On Dorian’s heels we may have more hurricanes with hurricane season upon us, and global warming making them , like catagory 5 Dorian, monsters storms. This should terrify adult children enough to take emergency action to protect their parents.

Midlife Sibling Need Emergency Disaster Plan for Aging Relatives

This recent confluence of hurricane deaths and hurricanes looming right now, should be a deafening roar in the ear of midlife siblings that they need to convene a midlife sibling disaster plan family meeting to protect any aging family members-, no matter where your elderly parents live or what level of care. You need that disaster plan because older people are more likely to die in catastrophes than any other population. As I pointed out in my last blog, just because they are often in a facility in a facility or alone and too frail to escape .Katrina and Irma tell us perhaps they are more in peril.

So before another hurricane, tornado, earthquake, flood, or any disaster hits, you need to have a midlife sibling family meeting to come up with a disaster plan for aging family members

What would be the agenda of that midlife sibling disaster family meeting?

If your loved ones are in a FACILITY- do not trust the facility to handle the situation. Look at what just happened in Irma.

1)Get a copy of the facilities disaster and evacuation plan.Compare it to state regulations. If it does not include calling the family before the disaster, consider moving your loved one or make sure that is changed.

2)Appoint a sibling to be in charge of reading the disaster evacuation plan and be the contact person.

3)Call your state facility licensing body and find out the state regulations to see if they match the facilities- CCRC, Assisted Living or Nursing Home

4) Have a telephonic family meeting before the disaster if possible

5) Make sure the state requires backup generators for heat and air conditioning- a flaw in Florida’s regulations in Irma

If the loved one is LIVING AT HOME alone or with an adult child.

1) Create a disaster plan for the older person. This would map out what each sibling and family member needs to do

2) Create a disaster team. This would include every adult siblings all over the country, family nearby, caregivers and neighbors.

4) Include someone on the team who can carry heavy objects like wheelchairs.

5) Name a substitute caregiver if the regular one can’t get there.

6) Make an evacuation plan for your aging family member’s house. Where is the nearest Red Cross shelter

7) What disaster supplies do you do you have on hand? Get list from your local Red Cross

8)Find out how many people do you need to make the move to safety or a shelter?

9) Put all of the above in writing.

10) Share a copy your disaster plan with everyone. E-mail copies to everyone on the family disaster team including all adult siblings, neighbors and friends.

11) Get everyone’s agreement especially midlife siblings and the older person. Be a unified disaster team.

12 ) Call a geriatric care manager to manage the plan or help you create it with your elderly parents, if you live long distance. They can do the heavy lifting, can help moderate a family meeting- can research state laws, be there in a disaster immediately, create and implement a disaster plan for your parent, that you approve and can be part of.

Professionals check out the chapter “ Preparing for Emergencies” in my Handbook of Geriatric Care Management fourth edition,

Professionals Check out my book Care Managers Working With the Aging Family, Jones and Bartlett, with its chapter on Family Meetings and the Aging Family by Rita Ghatak, director of Stanford’s Aging Program.

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