Caregiver Connections
Helpful tips for family caregivers

Five keys to stress management

If you’re feeling stressed, you are not alone. According to a 2011 national survey by the American Psychological Association, individuals providing care to a family member

• report higher levels of stress and lower levels of health than the general population;
• feel “overwhelmed” by the demands of caregiving;
• sense they’re doing a “poor/fair” job of managing stress or getting enough sleep;
• are more likely than noncaregivers to have a chronic illness.

To top it off, the survey also found that family caregivers tend to manage stress in less healthy ways than the general public.

To support you in turning your personal statistics around, use these research-proven techniques for stress management:

• Take a break. When your loved one goes down for a nap, don’t pick up the vacuum cleaner. Take a break. See our article on making the best use of precious time off.
• Exercise. Give yourself a daily dose of exercise. More and more research shows that exercise is as effective as antidepressant drugs. It doesn’t have to be a marathon! Even a 20-minute session of walking, dancing, or swimming can lift your mood.
• Wear a smile. It’s true, smile and you feel better. The smile muscles in your face communicate to your brain that something good is happening. Better yet, stay in touch with the positives about yourself. That’s something to grin about!
• Find social support. It’s important to express your feelings. Cultivate friends who listen with acceptance. Talk with others who truly “get it” in a support group.
• Engage in calming, soothing activities. For some it’s prayer. For others it’s meditation or yoga. Still others move into “the zone” with creative or artistic endeavors. The point is to turn off distressing thoughts and just “be” with yourself in a positive mental state.

Incontinence of the bowels

Bowel incontinence is surprisingly common, occurring in about one-third of the senior population. More women are affected than men because childbirth can cause damage to anal muscles or nerves. Unfortunately, bowel incontinence is also cloaked in silence, secrecy, and shame.

Common causes of bowel (or “fecal”) incontinence in seniors include

• weakened muscles. When muscles around the anus weaken with age, they fail to hold waste matter in the bowel.
• chronic constipation. This is defined as fewer than three bowel movements per week. When hard stool sits in the bowel, watery stool can leak around it.
• overuse of laxatives. Laxatives can cause diarrhea and problems with bowel control.

Conditions that damage nerves and/or give a person less muscle control, such as stroke and Parkinson’s, can also cause fecal incontinence.

If your family member has problems with bowel incontinence

• talk with the doctor. Changes in bowel habits may signal the onset of disease. Also have the doctor check if current medications might be a cause;
• modify the diet. Adequate fiber and fluid intake are key to bowel regularity. Ideally, provide five to seven servings of fruits, vegetables, or whole grains daily. Or use a fiber supplement. Be sure your family member drinks six to eight 8-oz. glasses per day of fluid. Water is best;
• increase exercise. Any kind of exercise is a plus. Ask the doctor for specific exercises to strengthen muscles around the anus;
• avoid delays. Ensure your relative can respond promptly when feeling the need for a bowel movement.

If dementia is involved, your relative may no longer recognize the physical signals of a bowel movement coming on. Provide unrushed time and take him or her to the bathroom within an hour of breakfast (and ideally every two hours after that). Plan outings where you know a bathroom is easily accessible. (Look for mobile apps that may help you locate nearby restrooms.)

When should you choose a skilled nursing facility?

A “nursing home” or “skilled nursing facility” (SNF) used to be the only option for care outside the hospital. That is no longer the case. Care in a SNF (pronounced “sniff”) is highly specialized. It’s also expensive.

Skilled nursing facilities provide mostly short-term nursing or rehabilitation services. The typical patient has just been discharged from the hospital. But he or she still needs additional medical care daily before returning home. This might be your relative recovering from a planned surgery. Or from a sudden crisis, such as a hip fracture or serious infection.

Nurses and other medical professionals are available around the clock. They provide skilled services, such as

• planning and managing care;
• monitoring vital signs;
• conducting daily therapy. For example, physical therapy if your relative needs to learn to walk with a new hip. Or speech therapy following a stroke.

Medicare will pay for some or all of your relative’s care in a SNF, for up to 100 days. But certain conditions must be met. Your relative must

• have Medicare Part A (hospital insurance);
• receive doctor’s orders for skilled care on a daily basis;
• have spent at least three days as a hospital inpatient;
• enter the facility within 30 days of discharge from the hospital.

Some facilities also provide ongoing care for people who need help only with personal tasks, such as bathing, dressing, and walking. Because this type of care does not require medical training, Medicare will not cover it.

If the person you care for does not need daily medical attention, there are less expensive options. We will discuss assisted living facilities in the next issue.