Because We Care
Practical tips for family caregivers

Avoiding the "War of the Wardrobe"

If your relative has dementia and is wearing mismatched or inappropriate clothing, it’s time to step in. He or she has likely lost awareness of personal appearance. Also gone is awareness of the need for a sweater when it’s cold. Or a lighter shirt when it’s hot.

As much as possible, allow your loved one to continue dressing independently and make clothing choices. It is good brain stimulation and supports a sense of personal dignity.

Here are some tips to avoid conflict over clothes:

• Simplify choices. Hang favorite outfits together in the closet: shirt, pants, accessories, all on the same hanger. If your loved one has a preferred outfit, buy several! Then he or she can wear that beloved plaid shirt every day and still be clean. (At the end of the day, when your relative isn’t looking, put the soiled clothes in the laundry.)
• Winnow the wardrobe. When your relative is not around, go through closets and dressers to eliminate excess. Keep only what’s easy for him or her to put on and take off. For example, shirts and dresses that open in the front, pants with elastic waistbands, and shoes that close with Velcro. Remove garments that no longer fit.
• Stash special occasion clothes. Store them in a separate place. You don’t want Mom putting on her fancy dress to come to breakfast.
• Consider the weather. Pack away clothing that is not appropriate so your loved one has only choices that match the season.
• Establish a routine. Set a regular time of day for dressing. If you are laying out your loved one’s clothes, put them in the order they should be used (undergarments on top, pants and skirts on the bottom). Hide shoes until last.

Reduce rushing. Allow extra time. A hurried environment just leads to confusion and potential resistance to getting dressed.

Preventing a second heart attack

Recovery from a heart attack takes time. First there are the physical and emotional reactions to deal with. A big part of recovery, however, is embracing lifestyle changes to keep the heart as healthy as possible and prevent a recurrence. It takes dedication to change old habits. But the effort is much less than what it takes to bounce back from another heart attack!

Your role as “partner-in-care.” You can’t force your loved one to make the necessary changes. And nagging won’t help. Instead, encourage your relative to talk about what he or she looks forward to about quitting cigarettes, for instance: better-tasting food, no more smoking outside in the cold.

Small steps. Help your relative identify which change seems the easiest to start with. Begin there and build up gradually.

To improve recovery and prevent a recurrence, support your loved one to

• make a follow-up appointment. It’s crucial that your relative see his or her doctor soon after a heart attack. You want to confirm the medications prescribed at the hospital are the correct combination.
• take medications as directed. Be sure you both understand the new medications given for heart care. Other drugs may be necessary to control blood pressure, cholesterol, and diabetes.
• adopt heart-healthy habits. The “heart-healthy ABCs” are Avoid tobacco. Become more active. Choose good nutrition.
• engage in a cardiac rehab program. This involves medically supervised exercise. Rehab also includes learning healthy techniques to manage stress. Medicare will pay for these recovery services.
• get support. This applies to you as the family caregiver, as well as the person you care for. Ask about local support groups or check out the online community at heart.org/heartattackrecovery.

It will take a while to recover. But patience, understanding, and following directions are the best way for everyone to reduce the chance of a repeat attack.

"Promise you won't …"

The request every daughter or son dreads: “Promise you won’t put me in a nursing home.” The child in you wants to provide a soothing answer: “Of course. Never.” Best to pause and think this through first.

You can’t predict the future—your loved one’s needs or your own health and abilities. It may be that 24/7 care is exactly what your loved one eventually needs. For example, he or she may lose mobility and need to be lifted in and out of bed. Or perhaps require injections or IV medical treatment.

In the case of advanced dementia, your parent may need full-time supervision, including throughout the night. Is that something you can promise to do?

The root of such a request is typically fear: fear of being alone in an institution, of lingering in pain, of potential indignities, and of overall loss of independence.

A promise of “never” is a setup for you to feel guilty—even when you’re doing what’s best for your loved one! Instead, reassure your relative:

• “We’re a team, and that’s our goal: to keep you at home. If it turns out you need other care, I will make sure you are safe and comfortable.”
• “Let’s talk about your priorities and wishes when we know more about what you actually need to stay healthy and safe. I want to ensure that things go to your liking in every way that I can.”

If you’ve already made a promise, reach out to your parent. It’s not too late to talk things through. And it’s better than feeling guilty later. Choose a quiet time, perhaps shortly after a doctor’s visit. Acknowledge the potential for the unforeseen. Then restate your commitment to ensuring his or her care and comfort regardless of the circumstances.