Promoting Caregiver Health ... Preventing Caregiver Stress

 Where am I? Where might I be going?

In this module, you will be introduced to information about the stress that often occurs in family members caring for a chronically ill partner or aging or ill parent. What is stress? What causes it? How does it make you feel? What are the dangers of caregiver stress? What can I do to prevent, control, and adapt to stress? Getting and staying healthy - physically, mentally and socially - are the most important goals for balancing your life.

Some important goals to think about...

• Illness ⇒ Multiple Changes ⇒ Stress + Coping ⇒ Adaptation

  Your body has an incredible ability to continually balance your body temperature, blood pressure, flow of nutrients and chemicals and other functions to maintain a dynamic, yet stable, state. This ability to balance is essential for your survival and enables you to adapt when changes occur inside and outside your body.

  Let's say that you get sick with influenza. The virus enters your respiratory system and infects the cells in your nose and throat. As the virus begins to destroy these cells, your nose starts to run like crazy, your body aches, and your body starts to fight back by turning up your temperature and rushing blood cells to attack the virus. You know quickly that you are sick and so do the others around you. Some people want to avoid you, while others will increase their efforts to help you get comfortable, run to the pharmacy for medicine, and bring you warm beverages. You show your appreciation and both you and your "caregiver" take precautions - frequent hand-washing, covering nose and mouth to prevent transfer of the virus, etc. You end up losing 2 weeks of work, and your "caregiver" tries to make up the lost income by working overtime. Your children or grandchildren have to fend for themselves during this time - meals, laundry, and no homework help. The point of this example is to show that when even an invisibly tiny virus infects the tissues of one person, it truly affects others' feelings, behaviors and health. The body adapts, recovers and the changes experienced are short-lived. But what would have happened if the virus had fallen into the depths of your lungs causing pneumonia and you had a weakened immune system? You and your family would be faced with a life-challenging situation - many changes for everyone that might affect lives for a long time. While you and your family may be able to weather short-term disruptions and adapt to stress, long-term changes in your health often lead to chronic stress and additional consequences. In thinking about this situation now, you might consider ways of preventing it - starting with getting a flu shot! Of course, each person varies in their experiences and their reactions to them.

  What would happen if your family member was diagnosed with a disabling chronic illness such as multiple sclerosis or Parkinson's disease - or a life-threatening illness such as brain or lung cancer? Illness-related changes are anticipated to progress to the point when it will be necessary for you to help with treatments and activities such as walking, bathing, and dressing. As losses increase, psychological (fear, anxiety, depression) and social consequences (loneliness, isolation) often occur not only in your ill loved one, but also in you, the person who loves and cares for him or her. In addition, the work of caregiving can be exhausting - leaving less time for other family and employment responsibilities, and for taking care of oneself. Changes often strain family relationships and financial resources. Caregiving responsibilities often last for months, sometimes years, and may lead to a chronic state of stress.

• What we have learned from other caregivers about stress?

  Thirty Delaware professionals who offer services to family caregivers were individually interviewed about their experiences. They described...

  The Nature of and Responses to Caregiver Stress

  • The stress of caregiving is experienced as "all consuming." It is a "24/7" job. Caregiving involves major changes in lives and roles. "Loss of life as it was supposed to be." Everything from sleeping habits to social activities change.
  • Fear of the unknowns occurs - not knowing what to do, where to turn, what to expect. "What do we do if there is an emergency?" Threats to safety and financial security occur. A variety of barriers may make getting help more difficult.
  • Difficult feelings include extreme frustration and/or guilt due to placing him or her in adult daycare or in a nursing home. Tension and irritation in caregiver-care receiver relationship increase. Need to stay in control makes taking a respite difficult.
  Within these themes, many stressors (causes of stress) in caregiving are described. Certain characteristics of the situation or experience may increase or decrease the caregiver's stress. As you start to ask yourself, "What is it that I feel and what is causing me to feel the way I do?" consider these ...

  Common Factors Contributing to Distress

  • Situations such as multiple responsibilities for children and job, family issues, and living at a distance from the person needing care are factors that make caregiving more challenging. .
  • Care receiver's status - age, level of independence, type and impact of illness including symptoms - have a significant impact on caregiver stress level.
  • Caregiver's health such as pre-existing mental illness or physical disorders that limit the ability to provide care needed.
  • Poor knowledge of the health disorder and prescribed care and health benefits eligibility are two common causes of distress.
  • Limited availability of affordable care adds to the distress of caregiving families.

  Once these factors are recognized, it may be possible to focus personal and community efforts to prevent or reduce their stress-promoting effects. Early recognition of the added risks for caregivers may significantly alter plans for providing care.

  Common Factors Associated with Less Stressful Caregiving

  • The caregiver's positive outlook is important as well as a sense of empowerment. Perceived resources of friends, family, faith.
  • Loving and respectful relationships between care receiver and caregivers make caregiving less stressful.
  • Knowledge of "normal" changes, what questions to ask, where to find information about caregiving options, legal issues, caregiver education and support programs, people with services for caregiving families, etc. Caregivers want to know about aging, diseases, conditions and what to expect during various stages.
  • Coping strategies that include humor, ability to laugh, and taking a "mental vacation" to get away, giving and receiving support, turning to faith seem to be the most helpful ways to prevent and manage stress.
  • Individualized care should be based on frequent assessments of the care receiver,caregiver, and the environment in which care is provided. The selective use of available resources is most likely to result in the best health outcomes for both caregiver and care receiver. From caregiver to caregiver telephone support to hospice care and grief counseling, finding and using needed services and resources is important.

  The Caring Partners' "Preparing for Caring" Program was developed from the research described here and includes additional data from family caregivers, the "real" experts. Delaware caregivers and spouses who are members of the Well Spouse Foundation answered questions related to their needs, where they find information and support, as well as the changes they experienced in their health and in relationships with the care receiver and family.

  There is little doubt that changes and stressors, along with factors that increase and reduce their impact, result in short- and long-term benefits and consequences for both care receivers and caregivers.

  Benefits include:

  Personal Growth	Sense of competency, accomplishment, and satisfaction Development of skills as well as patience, tolerance, empowerment Relief, reduced guilt, the ability to move on
  Care receiver Well-being	Reaffirm their importance, wishes and needs Positive results - comfort, control of symptoms
  Relationship Closeness	Increased opportunities to exchange love, support, and appreciation

  Many changes, "piling-up" in a short time or lasting for months and years, may lead to stress, physical, psychological and emotional distress, and an increase in the risks of symptoms, "burnout," illnesses, and death.

  Some of the Negative Consequences of Caregivng described included:

  Physical disorders/ illnesses in Caregivers associated with

  Stress and exhaustion
  Less attention to health needs leading to chronic health problems
  Current health transitions (such as menopause)

  Injuries related to

  Fatigue ⇒ inattention
  Poor understanding of body mechanics required for giving care

  Emotional and Psychological Distress

  Confusion in identifying needs, resources, information and support
  Anxiety, fear, depression - related to multiple stressors
  Less opportunity to maintain mental health
  Sense of isolation
  "Burnout"
• What does this mean for your health?

  It is essential to reflect on your thoughts, feelings, and reactions of your body to the multiple changes in your life associated with your caregiving role. Practice reflection frequently to help understand the changes that are occurring. Seriously consider keeping a log or even a diary. By taking these actions, you may identify the benefits of your efforts as well as the negative health consequences of chronic stress. Pinpointing your stressors and what relieves them or makes them more troublesome gives you the opportunity to determine if and how you can prevent, control, or cope with them. As in many new situations, you will learn what works and what does not work by trial and error. By keeping "notes," you can discover and keep track of these connections and the most helpful actions you have taken.

  Start with understanding what stress can do...

  Think about the last time you experienced a sudden (acute or short-term) threatening situation. It could be getting up to give a speech in front of an audience or reacting to an emergency you witnessed. It is usually easy to remember how scared you felt or how your adrenaline level allowed you to respond in ways you never imagined. This reaction is the body's stress response. You may remember feeling the results of a rush of chemicals -

  your rapidly pounding heart
  unevenly flushed, warm neck and face
  cool and moist hands and feet, and dry mouth
  lack of appetite
  increased muscle tension
  need to empty your bladder frequently

  Your attention may have been so focused in an emergency that you didn't notice these signs and symptoms.

  In an ongoing period of stress, which is common in caregiving, the chemical changes that prepare your body to fight or flight from a threatening sudden situation occur over and over again in your body - damaging the rapidly beating heart pumping blood out to overly constricted blood vessels and damaging them. The release of stress hormones also raises blood sugar and blood pressure and suppresses the immune system -- hindering its ability to detect and destroy abnormal cancer cells, bacteria, and viruses. Changes in cells and chemicals associated with inflammation may influence the development of chronic changes in blood vessels, perhaps restricting blood flow to various important body organs and systems. Often, the signs and symptoms of chronic stress are less obvious, but may be the source of muscle tension, aching, fatigue and trouble sleeping, or changes in appetite or bowel habits.

  Unfortunately, chronic stress raises the risks of cancer, pneumonia and other infections, hypertension and stroke, heart attack and/or heart failure, chronic kidney failure, and reduced insulin availability. It increases risks of alcohol and drug abuse. Recent research (including the Caregiver Health Effects Study (CHES) - see Is Caregiving a Risk Factor for Mortality [2004], a brief review by S. R. Beach and R. Schulz in the Geriatric Times, Volume 1, Issue 1 at www.geriatrictimes.com/g000626.html shows a relationship between being an elderly spousal caregiver with mental or physical strains and experiencing higher risks of death. It was found that strained spouse caregivers with physical illnesses had the greatest risks. These spouses, not only find the demands of providing care more difficult, but they also suffer from the loss of support from their loved one. Another study found that spousal caregivers' anxiety and depression levels were higher than those of their partners with heart disease and that this hindered their partners' recovery.

  It is no wonder that many health care providers are starting to think of caregivers as "hidden patients".

  Identify your warning signals of chronic stress.

  Go to my.webmd.com/content/pages/7/1674 _52145.htm, print out the "Assess Your Stress" page and complete the self-test to identify whether stress is affecting your health.
  At www.familydoctor.org, a section on caregiver stress lists common signs of caregiver stress including:
  "Feeling sad or moody
  Crying more often than you used to
  Having low energy level
  Feeling like you do not have any time to yourself
  Having trouble sleeping, or not wanting to get out of bed in the morning
  Having trouble eating, eating too much
  Seeing friends or relatives less often than you used to
  Losing interest in your hobbies or the things you used to do with friends or family
  Feeling angry at the person you are caring for or at other people or situations"

  What is Burnout?

  The emotional burdens of caregiving may result in "burnout," a condition in which caregivers have given so much of themselves, often without obvious positive health changes, appreciation or support that it is difficult to continue safely in their role. Frequently, caregivers are overprotective, buffering their loved one in any way they can. Caregiver exhaustion and frustration often lead to an extreme sense of burden, anger and/or hostility.

• Managing Caregiver Stress ... Avoiding Burnout
  Family Caregiver Alliance of the National Center on Caregiving, Fact Sheet: Taking Care of YOU: Self-Care for Family Caregivers ♥ at www.caregiver.org/caregiver/jsp/print_friendly provides an excellent guide for taking responsibility for your own health. It includes suggestions for identifying personal barriers (such as the "if I don't do it, no one else will" attitude) and additional steps to manage stress once the sources and warning signs are recognized. Setting goals for taking care of your health, seeking solutions to problems, asking for and accepting help, and exercising your body and mind are included.

  Consider ...

  Your own caregivng situation and how your life is affected.

  Your strengths and weaknesses, and life, in general.

  Your knowledge and abilities to separate causes of stress as those that can be prevented, those that can be controlled through effective coping, and those not controllable.

  Then....
  Consider your abilities to plan ahead, solve problems, build your coping resources, and gather the support of others, so that you can reduce the burden of stress and the likelihood of health problems.
  The Comfort of Home ♥ (2002) published by CareTrust Publications includes a chapter, "Avoiding Caregiver Burden" that suggests many different strategies for dealing with physical and emotional burden. It encourages finding time for rest, relaxation, reflection, and respite among other suggestions.

  How do you cope with stress?

  Now is the time to consider the coping styles and strategies you commonly use. People vary widely in how they deal with different sources of stress.

  You may wish to go a step further and think about how you might respond to a specific situation that is emotionally very upsetting such as the recurrence of cancer in a spouse --

  Or a situation that requires actions to relieve or control it, such as taking the driver's license or professional practice license from a parent who doesn't see the dangers in driving or practicing his/her profession.

  Do you ...

  • Plan and try to solve the problem or prevent and control the cause of the stress?
  • Seek information and the help and support of others?
  • Rely on your faith?
  • Look at the problem in a different, more positive or hopeful way?
  • Avoid thinking about it or deny that a problem or stress exists?
  • Avoid doing anything about it or put it on the "back burner?"
  • Express your thoughts and feelings? How?
  • Accept the situation?
  • Use drugs or alcohol to avoid worrying, thinking, or acting on the situation?
  These are common ways people cope with stress. None is right or wrong for all situations. To find the coping styles and the strategies that may be most effective,

  Consider the nature of the stressful situation or problem.

  Is it a problem or situation that can be prevented, controlled or eliminated? If so, gathering information, planning and active involvement in problem solving may be the best way to prevent future problem-related stress or to control or eliminate current stress. Often, this requires engaging yourself mentally and behaviorally.

  Is it a situation that you have no or little control over? Another person's behaviors, an incurable, progressive illness, or untreatable losses in memory or functioning are examples. By recognizing that efforts to prevent or eliminate the stressor are not likely to be successful, you can cope in other ways to reduce stress. You might wish to change the way you view the problem, to find the "positives," and to focus on more realistic hopes and new goals. Developing acceptance and relying on the support of friends, family and faith are often helpful strategies.

  Is the stress more related to the feelings and emotions generated by the situation than to a concrete problem that can be reduced? Fear, anxiety, anger, sadness or sorrow, anticipated loss, grief and similar feelings and emotions often require coping strategies that help you reorganize how you think about the situation. Expressing your feelings is important, but be cautious so that you do not hurt others or drive away their support. Use of prescribed medications, the short-term use of denial and/or distraction may be helpful. Getting away for the situation temporarily may also help.

  Remember the interpersonal aspects of stress and coping.

  How do you and your partner cope within your relationship to deal with stress? Do you involve your partner in addressing the stressor, empathize with your partner when he or she is ill, or hide stress-producing information to protect your partner?

  Some partners in couples use the same or similar strategies in coping with stress, while others use different strategies that either complement or conflict. For example, if one partner seeks information and plans for dealing with a controllable problem (let's say chronic pain) and the other plans and actively uses the plan to reduce pain, the stress both experience is reduced. If the well partner uses strategies to avoid being with his partner when she is in pain or denies that she has pain, she can not successfully use strategies such as seeking his support, actively involving him in getting information or help, or responding empathetically.

  Overprotecting your partner from problems that you think may increase his or her anxiety, sadness, or anger may seem the right thing to do, but it has consequences for you and your loved one. For you, it means carrying a greater burden without the opportunity of your loved one's understanding and support. For your loved one, overprotecting may reduce his or her self-esteem and trust in you when he or she finds out. It prevents the discussion of suspicions and fears, and participation in decision-making, support exchange or problem-solving. Overprotection is a common element in the development of burnout.

  Balancing work - at home and at work

  Do you feel "stressed" at both home and work? Studies show that stress at home increases stress at work and vice versa. Job stressors are often related to a sense of little control, poor communication, insecure feelings related to lack of clarity about your duties and concerns about your ability to perform the job, and low support from others. Don't these sound like feelings people have when confronted with new demands of caregiving?

  As you assume more caregiving responsibilities, you will need to find ways to balance other responsibilities at home with your family and at work. Emotional and physical exhaustion, distraction and frustration make every job more challenging. At work, you may feel torn between discussing the situation with your employer and taking advantage of help that may be available there. Employers are starting to realize that supporting caregiving employees with flexible work schedules, job-sharing options, and other services such as support groups, counseling, and referral services support production. A new term, "presenteeism," is used to measure the loss of production by employees who come to work too exhausted or ill to contribute. Surprisingly, it decreases many companies' bottom line more so than absenteeism.

  As financial demands of illness increase, caregivers' abilities to maintain income and employment are challenged. This is most evident for women, as discussed in the Fact Sheet: Women and Caregiving: Facts and Figures found at the Family Caregiver Alliance website ( www.caregiver.org/caregiver/jsp/print_friendly.jsp?nodeid=892).

  Support to caregivers through the federal law, the Family and Medical Leave Act (FMLA), allows eligible employees up to 12 weeks per year of unpaid leave without loss of job security or health benefits. Many people reading this program work outside of the home and need to update themselves on their employer's programs. Some employers contract with The Family & Workplace Connection to provide information and personalized referral services for their employees. The AccessCare Program of The Family & Workplace Connection is free to the public for people who do not have services through employment. Call (302) 479-1660 or go to www.familyandworkplace.org .

  Check out The American Association of Retired Persons website for ways to balance caring and working at www.aarp.org/Articles/a2003-10-27-caregiving-balancingwork.html. The AARP provides a number of excellent local programs and information for family caregivers in Delaware. Many excellent pamphlets are available to caregivers by request.

 What will I need to do? Taking an Inventory ... OF YOUR OWN HEALTH

Checklists and ideas in this section are designed to assist you in identifying current and future health needs as well as relevant personal and community resources.

• Do a quick "check-up" of your health and habits.

  Check the things that you need to work on, getting professional help, as needed.

  • How is your overall health on a scale from 0 (extremely poor) to 10 (very healthy)?
  • What is your weight _______ and height ________?
  • Your eating habits:
    Do you eat breakfast routinely?
    Typical breakfast includes:
  • Do you control the amount of ____fat, ____ sugar and ____salt in your diet?
  • Take multivitamins?
  • How is your sleep hygiene?
    Get at least 7 to 8 hours of sleep every night? ____
    Resist eating and drinking caffeine and alcohol near bedtime?
  • Do you exercise at least every other day for 30 minutes? How often?
  • How is your muscle strength?
  • Can you walk fast or run without getting short of breath quickly?
  • Do you have chronic or frequent pain? Where? Why?
    How do you manage it?
  • Do you have limitations in your ability to move, bend, support weight or lift?
  • What do you do for relaxation, rest and recreation? How often?
  • Do you protect your skin from the sun?
  • What hobbies do you enjoy?
  • Do you become anxious or upset or get panicked easily? Why?
  • How do you deal with your emotions and feelings?
  • Have you been worried about family or financial issues?
  • Do you feel excessively ___ tired in the daytime, ___sad, ___lonely or ___isolated? Are you depressed?
  • Do you put off dealing with problems and situations at work and home?
  • Do you have concerns related to your employment or other work /school commitments?
  • Have you had a check-up in the last year? Are you taking responsibility to control health issues such as your blood pressure, your weight, or smoking habit?
  • What are your best health habits?
  • What habits need to be changed?
    Want to stop smoking?
    Need to lose weight?
    Increase your exercise level?
    Find new ways to relax?
  • Women - Are you starting through menopause (perimenopausal)?

  Become as healthy as you can be now and establish lifestyle patterns that will protect you later. It is often much easier to put off your own health needs than to think about them, decide to change, find help and take measures to get on the healthiest path.

  NOW is the time - to give yourself the attention you deserve. Build your reserves and your stamina and start by addressing at least one of the habits that take a toll on your health. Come back to the preceding health check-up periodically to evaluate changes made.

  Healthy sleep is essential for both physical and mental health. Caregiving is very often a cause of fatigue, exhaustion, and sleep alterations. The National Sleep Foundation is a top-notch organization, helping Americans to understand the importance of sleep, sleep "hygiene" and the various situations and disorders that disturb sleep.

  Use the "Sleep Diary" to record and identify your sleep-related habits and patterns. Common sleep disorders can be identified by using How's Your Sleep? at www.sleepfoundation.org . Contact the NSF at 1522 K St., NW, Suite500, Washington, DC 20005 for this and other information.

  Other diaries and checklists helpful in monitoring your daily exercise, and eating habits may be helpful to you in recognizing what and how you are doing. The practice of tracking your actions may increase your enthusiasm to make healthy changes.

  Check out the "Health Tools" at the American Heart Association website ( www.americanheart.org) They include:

  Customized reports that result when you complete the Heart Profiler

  Heart Healthy Tracker to monitor your blood pressure, glucose and cholesterol

  Exercise Diary and Milestone Marker and Body Mass Index Calculator

  Consider maintaining a Personal Health Record for yourself and your loved one.

  All the information to start your record and maintain it (including forms you can complete right on your home computer) is available at: www.myphr.com the American Health Information Management Association.
• How is your mental health?
  The National Mental Health Association (800-969-6642 and online at www.nmha.org) publishes a series of excellent pamphlets including Mental Health and You: A Mental Health Checklist that poses questions about how you feel about yourself, about others and how you meet the life's demands. Stress: Coping with Everyday Problems can help you identify if you are suffering from the negative reactions to stress and tension and provides tips for reducing and controlling stress. Locally, phone the MHA of Delaware at (302) 765-9740.

 How will I do it? Getting and Staying Healthy

What can we do to strengthen our caregiver-care receiver relationship and our "caring partnerships" with close friends, family members, and community agencies?

• Know the health risks of caregiving and early signs of stress.
  Review the background information presented in this module and check out resources such as Coping with Caregiving: How to Manage Stress when Caring for Older Relatives ♥ (June 2003) by V. L. Schmall and R. E. Stiehl, a publication of the Pacific Northwest Extension Publication. PNW 315 can be ordered by calling (514)-737-2513 or inquiry at eesc.oregonstate.edu (by going to the Publications & Videos section).
• Take good care of your body and mind. Learn new ways to improve how you look, feel, and behave. Take small steps to improve your eating, exercise, sleeping, and stress relief habits.
  Check out the U.S. Department of Health & Human Services' Small Steps Program to get the Small Steps quarterly newsletter, recipes, and great tips by going to www.smallstep.gov. You will find a list of 100 small step tips and other information.
• Understand and express your feelings. Caregiver depression is a common companion of caregiver stress. Losing interests, feeling very sad, hopeless and helpless, and changes in eating, sleeping and wanting to be with others are signs that you need professional help. Seek help from a counselor, psychologist, social worker or your family doctor to prevent the health risks of stress.
• Consider feelings that may reflect underlying grief related to losses experienced or anticipated.
• Maintain your friendships and support of friends and co-workers. Some recent research has reinforced the importance of exchanging support with those friends and family that are or will be in your life for the long term. Meeting people in similar caregiving situations to your own maybe very beneficial as well.
• Help your ill partner or parent maintain friendships. You may wish to check out local companion programs that link older people with older volunteers who visit or telephone.
  In New Castle County, Delaware, CONTACT Delaware, Inc offers a Reassurance Program in which a caller checks with homebound older adults everyday to make sure they are safe and have a chance to socialize. Call (302) 761-9800 for information. Senior RollCall Lifeline also calls daily to check on qualified people who do not have daily contact with family. For more information about this program, call (302) 239-5151.
• Involve those close to you and your parent or partner in sharing the caring. Increase your comfort in asking for help.
  If you want to get some ideas and direction in setting up a "caring network" to "share the care" of a seriously ill partner or parent, learn how to pull together people with different talents who want to help by reading the book, Share the Care by Cappy Capossela and Sheila Warnock (reviews at www.amazon.com)
• Strengthen your relationships with your ill parent and partner. If you are caring for your parent, keep your relationships with your spouse or partner and children strong. You need them and they need you, so help them understand.
• Plan realistic expectations. Balance what you think you can do with what is realistic. Involve others in care. Learn and practice the specific steps of problem solving and negotiation with the care receiver and others involved with giving care.
  The Oncology Nursing Society's Cancer Survival Toolbox of 6 CD-ROM s includes examples of how problem-solving, communication and negotiation skills can reduce the burden on patients with cancer and their caregivers. It is free of charge by calling (877) 866-5748 or going to www.canceradvocacy.org.
• Be positive, optimistic, and hopeful. It can make all the difference in helping you manage stress. An optimistic outlook not only feels good, but it attracts others willing to help. Being angry, depressed, and pessimistic often drives away the support of others when you need it the most.
• Work on your ability to laugh and see the funny side of new situations. Develop your sense of humor and increase your pleasure.
• Get practical, personal, and important information by subscribing to newsletters written for and by caregivers.
  The Caregiver's Home Companion, published monthly by Pederson Publishing, Inc. is available online and by mail. It is an attractive, very informative newsletter with a variety of topics and tips for caregivers. A good one to start reading. Call (800) 308-3136 or go to www.caregivershome.com.
  Mainstay is the quarterly newsletter for members of the Well Spouse Association. It is full of personal and family stories, lessons learned, and announcements, pictures and information from the many support groups and retreats for well spouses. Membership in the WSA includes a number of opportunities to build in-person and online support. To join, call (800) 838-0879 or go to www.wellspouse.org. Inquire about the local WSA support group.
  Take Care! Self-Care for the Family Caregiver is a quarterly newsletter that is a benefit of membership in the National Family Caregivers Association. It includes reports on advocacy activities of the NFCA, reviews of new caregiver resources, and articles related to dealing with everything from insurance company personnel to the intimacy consequences of caregiving. For membership information, call (301) 942-2302 or go to www.nfcacares.org.
• Check out the support resources for cancer caregivers at www.canceradvocacy.org/resources/essential/caregiving/default.aspx, the National Coalition for Cancer Survivorship Essential Care webpage.
• Join a support group for well spouses or caregivers to learn and connect with others. Call the Caring Partners Program, Caregiver Resource Centers at the Newark and Wilmington Senior Centers for meetings convenient to you. Face-to-face (and online support groups) offer information, support, sharing, and skills to reduce stress, anxiety, and fear.
• Plan (and take) time away from caregiving. Use respite care options even early in caregiving. You need time to recharge.

By taking care of yourself in these ways, you will develop the skills needed later during the course of caregiving.

 What can I do to preserve my Health while caring for others?

• Be your own advocate. Practice assertiveness in communication.
  Choosing to Take Charge of Your Life is one of several excellent brochures available through the National Family Caregivers Association at (800)896-3650 and www.nfcacares.org. It describes the need for self-advocacy - maintaining control and making choices rather than letting the situation control you. It underscores the needs to keep a positive attitude, know your strengths and weaknesses, be proactive by looking ahead and planning to prevent crisis and stress, gather information about illness, and gain an understanding of what you may experience.
• Learn new ways to deal with stress. Two great books...
  Check out Schmall, V. I., Cleland, M., & Sturdevant, M. (2000). The Caregiver Helpbook: Powerful Tools for Caregiving ♥ , Portland, OR: Legacy Caregiver Services for a program guide that presents tools that increase caregivers' self-care, confidence and abilities to manage challenging situations and decisions. Excellent resource for learning practical approaches to solving problems, making decisions, developing action plans, communicating, and dealing with emotions. (E-mail: caregiver@ihs.org for an order form.)
  Ever consider starting a diary or expressive writing to feel better? Check out the book by J, Lepore and J.M. Smyth (2002), The Writing Cure, published in Washington, DC by the American Psychological Society for an interesting look at research that links expressive writing to improved immune, lung, and relationship functioning.
• Take an exercise class. Check community classes on tai chi or yoga. Learn progressive relaxation, self-hypnosis or guided visualization for relaxation.
• Work on plans for future caregiving. Organize information. Record important information. Involve your loved one in this important activity, providing the opportunity to learn more about each other.
• Continue to build your knowledge and coping skills. Consider enrolling in the:
  "Giving Care, Taking Care" workshops offered periodically in Delaware to learn more about home safety, body mechanics, nutrition, communicating, personal care, talking to your health care team and resources in Delaware. Call the Delaware Ecumenical Council at (302) 225-1040 for a brochure and more information.
• Attend informational programs with your parent such as
  "The Healthy Senior Living Forums" - a part of the Wilmington Senior Center's initiative, "The Time of Your Life: Growing Older, Staying Healthy." Free quarterly programs are being held at the BankOne Center on the Riverfront from 10:00 - 11:30 am on selected dates through 2006. Call (302) 651-3460 for more information and a brochure.
• Build your inner strengths, your spirituality, and your resilience as you face the future. Your adaptation to the life-challenging experiences of caregiving may involve building your endurance over time. Building resilience involves actions you take in the face of adversity, tragedy, threats, and stress to strengthen your head (your thoughts), heart (feelings and relationships) and hands (your actions and behaviors). Many of the strategies to build resilience have been mentioned throughout this program and are also described in:
  The Road to Resilience, a brochure available by calling (800) 964-2000 or going to www.APAHelpCenter.org.