The negative emotional aspects of anger, frustration, isolation, and guilt are more difficult to deal with. These emotions creep up on you, complicate your life and your care giving efforts, last long after the care giving is over, add to your physical stress, and can shatter families and lead to law suits.

This series of blog posts will try to address these negative emotions and how to deal with them.

Of course, there are positive emotions in elder care. Compassion, responsibility, gratitude, and competence are part of caring for an elderly parent. Some seniors have planned for their care so as not to be a burden on their children. Some families come together to support the primary care giver. Some cultures value older people and family members vie for the honor to care for their seniors. Elder care in these circumstances is a different, rewarding experience.

The positive emotions make care giving a wonderful family building experience. That was the expectations Jill and I had when we started caring for her father.

I loved my father-in-law. I met him the same day I met Jill. In the 35 years up to that day in 2001 when we began caring for him I never had a harsh word with him. He gave us the down payment for our home, the home we were now welcoming him into.

Our home has four bedrooms and our four children were living at home with us. My father-in-law spent the winter of 2001-2002 in California with his son and moved in with us in March 2002. Our son, Eric, gave up his room so my father-in-law had easy access to both the kitchen and the bathroom. In the beginning, he was able to bathe himself, dress himself, make his own meals, and could safely go for walks.

What could cause anger and frustration?

I’ll cover that in the next post.

For a free DVD on elder care go to HomeCareSurvival.com.

This was no problem for us because my father-in-law had a bacterial condition that was not treatable with anti-biotics.  It did not endanger him but it could cause problems for other people. As such he was always segregated when he was in the hospital.  Interestingly, he was not segregated when he was in the rehab facility.

The nice thing about a private room is that it is, well, private.  Your LO doesn’t have to put up with the sounds and smells that come with a room mate.  The stream of visitors, interns, doctors, residents, nurses are bad enough when they come for him/her, it is doubled when they come for the room mate.

My father-in-law was annoyed that his room mate in rehab had fallen asleep and left the TV on too loud.  He got up unescorted and with out his walker.  He fell and broke his hip which required another operation and another stay in the rehab facility.

You can also request that the number of visits from interns be limited so that your LO can get more rest.

The equality of care depends a great deal on the nurses. They see your LO more often and for a greater length of time than a doctor.  We got to know the nursing staff by name.  We brought them lunch from the deli.  We baked cookies for them.  We even called every night so we got to know the night shift.  We wanted them to know that we appreciated everything they were doing for my father-in-law.

Lastly, use the time that they are in the hospital or in rehab to get caught up on your sleep.  Or take a mini vacation.  It helps to reduce your stress and you deserve it.

For a free DVD on the secrets of elder care go to HomeCareSurvival.com

The problem is that while in the hospital your LO could be exposed to more germs or a medical mishap that could make their condition worse.  In our case it wasn’t infection, it was falling.  He had fallen a few times during his many admissions until he finally broke his hip and it had to be replaced.

You want their stay in a hospital to make them better not worse.  You don’t need the additional stress.

To help you to help your LO, I’ll show you how to pick

the right hospital

the right doctor

the right time

the right accommodation

the right care

and the right financing.

You will then get the right outcome

Pick the right hospital

If your LO’s condition could lead to a surgical procedure (joint replacement, heart surgery, etc.) choose the hospital with the best success rate for that procedure.  Go to www.hospitalcompare.hhs.gov (a service of Medicare) to compare how well your local hospitals performs that procedure.  You will get comparisons on general conditions, types of illnesses, and medical procedures.  Everything you will need to make the best decision.

We chose a local community hospital which was a part of a major regional health network.  The hospital was convenient, well maintained, and with a high nurse to patient ratio.

All this was very important to us because we had to drive him back and forth to dialysis three times a week.

Now you know how to find the right hospital for your LO which will increase the odds that your LO will survive their stay.

How to pick the right doctor will be in the next post.

Go to www.HomeCareSurvival.com for FREE DVD on elder care.

Nursing homes and rehab centers are not permitted to restrain a resident, either physically or with medication.  Those facilities are not permitted to use side rails on a bed.  To mitigate the effect of falling out of bed they rely on:

Lowering the bed so that it is only a few inches above the floor.  A mat is placed on the floor so the patient only falls a few inches.

Placing mats around the bed.

Using an alarm system.  One type is placed on the bed and goes off when the
patient gets up.  Another type goes on the floor and is activated when they
step on it.

If the patient is in a wheel chair an alarm device will be activated if they try to
stand up and try to walk.

Hospitals, (at least in New York) are permitted to use restraints.  The most common type is called a Posey jacket.  It fits around the patient’s chest and is secured to the side of the bed.  There are also wrist and leg restraints.  If you want to buy one for home care use you need a doctor’s prescription.

It is my experience that they are very reluctant to issue one.  I have been told that some elderly patients get tangled up in the restraints or that sometimes they wind up hanging by their foot upside down.

Ironically, the Centers For Disease Control report that restraints do not reduce the incidents of falling, if anything it makes it worse.  That’s because being confined in such a way weakens the muscles making a fall all the more likely.

We also put a touch lamp next to his bed so he could have light if he wanted to get up.  Sometimes he would forget to put it on.  A better solution would have put a sensor that would have put the lights on when he got up from bed.

Other things a caregiver could do would be to get the correct footwear, have all medications reviewed for side effects, and treat underlying medical conditions.

Recovering from falls has a lot to do with the attitude of the elderly person.  An article in the Nov. 8, 2008 issue of the NY Times illustrated the difference attitude can make.

“Katherine Aliminosa, 93, shattered her lower leg while getting snacks for nieces.  Susan Arnold, 87, broke her hip hanging a photograph.  By early autumn, Ms. Aliminosa had graduated to an independent living apartment, and was able to get around with a walker.  She looked like a different person: more robust, content.”

“Though six years younger, Ms. Arnold never recovered her strength after hip surgery.  Her muscles atrophied from inactivity, and she developed pneumonia.  She died on Sept. 6.”

Ms. Aliminosa began a strength training routine which not only improved her physical condition but also renewed her spirit.  Ms. Arnold’s response was, “I have no strength.  Let’s talk about depression.”

In providing elder care it is helpful to remember that your elderly parent’s physical condition is composed of systems that don’t function as well as they used to and that the medications they are taking for those compromised systems don’t always work together well.

I thought it initially that the elderly fell because of loose rugs or some other easily correctable reason.  It is much more complicated than that.  Those complications add to the burden of elder care because they are part of the nature of getting older and something you have to deal with.

Most senior citizens are taking prescription medication.  The side effects of these medications could cause a loss of balance.  This is why it is important to get their meds reviewed by a pharmacist and a gerontologist to eliminate those meds that may be unnecessary and that come with negative side effects.  You know they haven’t done this evaluation.

Sometimes their underlying medical conditions can lead to falls.  If you are now providing elder care you need to know what their medical condition really is.  Take them to a gerontologist for a through exam.  I’ll cover that process in a future post.

As a person ages they experience some muscle weakness.  This leads to unsteadiness and slower reaction time which can lead to falls.  Despite their weakened condition they still may insist on walking unaided.  It used to amaze me that my father-in-law would try to navigate the house by leaning against the walls instead of using his walker.

Dehydration can also lead to confusion and a loss of balance.  Making sure they have enough to drink is yet something else you have to think about and plan for.  And of course, then there is the need to go to the bathroom and al that entails.  It used to astound me that my father-in-law would be satisfied with literally two teaspoons of water.

Inadequate footwear, clutter, poor lighting should be more easily correctable than the above conditions.

Bottom line.  There is no absolute way to prevent falls.  You can however do things to lessen there frequency. That’s in the next post.

“In 2005, 15,800 people 65 and older died from injuries related to unintentional falls; about 1,800,000 people over 65 were treated in emergency departments for nonfatal injuries from falls, and more than 433,000 of these patients were hospitalized.

In 2000 direct medical costs totaled $19,000,000,000 for nonfatal falls and $179,000,000 for fatal falls.”

What falling meant for us was additional work.  If my father-in-law bruised himself dressing became more difficult because I had to move more slowly.  Sometimes exercise had to curtailed because he was in pain.  Getting in and out of the wheelchair and in and out of the car also became more difficult.

The odd thing was that no matter what precautions we took, he still fell.  The amazing thing is that he never injured his head.  The discouraging thing is that he never learned to take precautions himself.  He would try to move around without his walker.  When his he was in the hospital or in rehab he would get up at night to go to the bathroom.  He was supposed to call the nurse but would try to walk unaided and fell repeatedly.

This became a real issue.

Falls are a huge, huge issue in elder care.

Case in point.

I was visiting my father-in-law in rehab. I saw his former room mate and I asked, “Rudy, why are you here?” He said, “I fell and I was on the floor for five days. Now I’m here in rehab.”

Rudy had fallen in his home. He lived alone. His sister who is deaf and half blind and lives near by called on him for five days. When she knocked Rudy would yell but she could not hear him and she could not look in to see if he needed help.

Finally, she contacted a neighbor who knocked on the door and then realized what the problem was. She called 911 and got Rudy to the hospital, and then into rehab.

Could you be on the floor for five days? No water? No food? No meds? No bathroom? How would you sleep? What would you think about?

A woman falls in her home. She has a remote phone in her hands. Her daughter calls twice with in a 15 hour period. The mother never tells her daughter that she had fallen. She did not want to tell her daughter because she feared that she could lose her independence.

It is only when a neighbor stopped by with a tuna casserole that the woman’s plight is known. She was taken to the hospital because she fell in such a way that the circulation in her leg was compromised.

The thing that struck me first about falling was the inability of the elderly to get up. It would seem such a natural thing to do but it is not. And it goes beyond the physical limitations. It seems that mentally sometimes they just can’t figure out how to do it.

It is also troubling that, sometimes it seems, they aren’t interested in their own safety.