Creating a Safe and Caring Environment

 Where are WE? Where might we be going?

Introductory information to help you and your family get started and plan ahead.

This information can help you recognize the importance of creating a safe and accessible living environment, and an atmosphere of open and caring communication. Caregivers and care receivers investing their time and energy in this process benefit by prevention of accidents, greater independence, and improved teamwork. Caregivers often report the positive side of providing care to their loved one when active participation and exchanges of thoughts, feelings, and support are experienced.

Some important goals to think about...

• To create a caring atmosphere that facilitates
  • Participation and communication,
  • Problem-solving and negotiation processes, and
  • Mutual exchange of support and appreciation.
• To identify increasing risks and hazards to care receiver safety related to aging and/or illness and his or her environment.
• To adapt the living environment to make it safe, more secure, and accessible.
• To prevent life threatening situations caused by injuries, medication errors, and delays in getting emergency care.
• To protect caregivers from the stress of strained communications and from the physical injuries that often occur when helping with care.

 What will we need to get there?

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

• Assess factors that determine stress and strain within the family environment.

  Consider ways in which family members communicate, express their thoughts, feelings and emotions, and listen and respond to each other.

  Do the nonverbal communications (body posture, facial expression, eye contact, gestures and touching) complement or contradict the words spoken?

  What are the weaknesses and strengths related to the exchange of ideas, information, desires, feelings and emotions between caregiver(s) and the care receiver?

  Do members use collaborative approaches in solving problems, negotiating decisions, and in exchanging support?

• Assess risks and hazards to care receiver's safety associated with aging

  Reduced vision ⇒ falls, collisions
  Slower adjustments to changes in lighting

  Slower adjustment of blood flow to brain when changing body position ⇒ dizziness, fainting

  Reduced hearing ⇒ failure to hear warning, misunderstood instructions

  Changes in balance ⇒ reduced ability to stand, walk without assistance

  Altered sensations, slowed nervous reflexes ⇒ increased hazard of skin / tissue injury due to burns, frostbite

  Reduced muscle and bone strength ⇒ increased chance of fractures, muscle strain, herniated vertebral disc, and injuries from falls

  Reduced total percentage and amount of water in the body ⇒ risk of dehydration ⇒ increased susceptibility to serious complications of infections, fever, hemorrhage, excess fluid loss with diarrhea or vomiting, etc.

• Assess risks and hazards to care receiver's safety associated with Specific Conditions and/or Disorder(s).

  Disorders affecting control and use of muscles result in problems in standing, walking or using arms and hands. Stroke (brain attack), spinal or back injuries, multiple sclerosis and Parkinson's disease are some of the most common causes.

  Risks:

  Falls, inability to take protective actions to prevent injury

  Prolonged pressure on body areas compressed between bony areas and mattress, seating, etc.

  Reduced use of kitchen, bathroom, bedroom and other areas if wheelchair or other assistive devices do not fit within living space

  Inability to accomplish activities of daily living without help or adaptive equipment

  Altered abilities to see, hear, smell, and feel caused by age-related changes in senses, and other disorders such as glaucoma, cataracts and hearing loss, often gradually limit one's ability to function safely and easily interact within their usual environment.

  Risks:

  Falls, burns, bruises and cuts, and pressure sores

  Reduced ability to communicate with others socially and in emergency situations

  Problems that increase fatigue such as cancer, reduce alertness such as certain medication use and altered blood pressure, blood sugar or oxygen to brain, or alter desire to stay involved with everyday life such as depression and anxiety are common.

  Risks:

  Increased susceptibility to accidents (auto collisions, medication errors, fires, injuries)

  Dementia - most often associated with Alzheimer's disease - affects one's ability to function safely in the home environment.

  Risks:

  Falls, fires, wandering away from home
• Assess risks and hazards to care receiver's safety associated with the current living environment.

  Excess furniture that reduces passage or that is unstable, broken or a tripping hazard
  Poor lighting in rooms, stairs, hallways
  Small bathrooms that restrict use of sink, toilet or shower
  Narrowed doorways
  Lack of stair handrails or grab bars
  Obstacles to safe passage such as wiring, loose carpeting and rugs, objects (shoes, wastebaskets, etc.)

• Identify common causes of life-threatening situations in aging and illness.

  Infections such as influenza and pneumonia that can quickly lead to lung or heart failure

  Bladder infections not treated soon after symptoms begin may enter bloodstream causing life-threatening septicemia

  Side effects and adverse reactions to treatment - medication errors and interactions of multiple medications

  Acute complications of chronic diseases such as

  Coma (high blood sugar) or shock (low blood sugar) in diabetes mellitus
  Heart attack (myocardial infarction) in narrowing or spasm of the arteries in the heart muscle
  Cardiac arrest due to heart beat irregularities
  Choking / airway blockage after stroke or other chewing and swallowing problems

  Delay in getting emergency care if unable to get to telephone due to injury, if emergency services are unavailable or at a long distance, or person delays in attempt to get help

  Treatable conditions such as those listed above or bleeding due to an injury may become life threatening without first aid and follow-up care.

  Hazards of reduced mobility or bed rest such as

  Inflammation of leg veins and blood clot formation (thrombophlebitis) ⇒ blood clot travels to and lodges in lungs (pulmonary embolus) ⇒ sudden loss of lung tissue, possible death.

  Poor circulation of air and blood to sections of the lungs ⇒ collapse of areas of lungs, risk of pneumonia

  Reduced muscle and bone strength ⇒ weakness and increased risk of falls, fractures, sprains. Hip fractures result from falls and then lead to prolonged further hazards of immobility listed here.

  Changes in fluid balance ⇒ dehydration, dizziness on sitting, standing, increased risks of urinary tract infections, etc.

  Prone to skin and underlying tissue breakdown, loss, and infections in areas of pressure (buttocks, elbows, heels, back of head)

  Reduced sensory stimulation ⇒ disorientation, altered alertness

• Checklist of health hazards related to family / caregiver stress and most common preventable injuries and disorders related to providing care.

  Health habits of caregiver including overall fitness, nutrition, stress and weight management, and sleep hygiene

  Chronic fatigue and sleep disorders

  Existence of disorders of back, neck, bones, muscles, and joints caused by previous injuries and surgery, osteoporosis, arthritis, fibromyalgia, nerve and muscle disorders associated with pain, weakness, poor balance or control

  Mental health disorders in caregivers such as depression, bipolar disease, schizophrenia, and anxiety disorders compound caregiver stress and further threaten health

• Make Your Own Assessment Checklist (based on the information included in this module).
  • What specific factors cause stress and strain within care receiver - caregiver - family relationships?
  • What caregiver health habits, medical (physical and mental) disorders and conditions may influence caregiving abilities and health?
  • What disease or disorder related changes affect thinking, feelings and emotions, and behavior?
  • What specific sudden, life-threatening complications or events are often associated with the care receiver's disorder, altered functioning, and prescribed treatments?
  • What are the early signs and symptoms of infections, illness or treatment complications, and advancing stages of diagnosed disorder that signal need for immediate medical attention?
  • What are possible physical and mental adverse effects of altered activity level of the care receiver? (Most important if bed rest or restricted mobility are factors.)
  • What age-related changes are occurring that affect safety and independence?
  • Which areas of the care receiver's home are in need of remodeling and rearranging to increase accessibility and safety?
  • What are barriers to getting emergency care or early diagnosis and treatment of new conditions?

 How will we do it? The Power of Pulling Together

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

• Involve everyone in assessing the various aspects of the current interpersonal and care "environment" that enable the highest level of care receiver independence and caregiver support.
• Identify factors and conditions that increase susceptibility for care receiver injuries, complications, and life-threatening conditions, and caregiver stress, illness and injuries - see previous section.
• Develop a written plan to improve the care receiver - caregiver /family atmosphere through collaboration, communication and exchanges of support and compassion. Include adaptation of the physical environment to allow safe passage, prevention of injuries or complications, and quick access to first aid and medical care.
• Start to make the planned changes gradually - starting with the easiest, least costly, and most essential alterations first. Assess changes in the health of the care receiver (and caregivers) to adjust the time line and changes planned.
• Practice strategies that strengthen relationships and support from within the family and the community.
• Get the help needed from your community. Use the abundance of information, referrals, and services that have been developed to help families make necessary changes.

To "remodel" the family partnerships as well as the environment in which your parent or you and your partner live, a variety of actions may need to be taken based on your situations. Starting with the first family meeting, everyone will be involved in assessing needs, planning changes, and taking actions to keep their loved one as safe, independent, and happy as possible. Here are some tips, exercises, and resources that you may find helpful.

• Increase everyone's participation in the planning process to develop increased trust and understanding, and to use everyone's interests, talents and gifts. This participation is important from the beginning. Many primary family caregivers prefer to coordinate care that is shared than be left to do it all. Communication is the key to providing shared responsibilities in a truly caring atmosphere.
• Refer to ideas for sharing your feelings and communication between partners and between adult children caregivers and their parents in the introductory Caring Partners kits, Caring for Your Partner and Caring for Your Parent.
• Strengthen your relationship patterns to improve communication, including listening. Refresh yourselves on the steps of problem solving, negotiation, and compromise. Tell each other what kind of support is most helpful, exchange support and find simple ways to appreciate it.
  Couples Confronting Cancer: Keeping your Relationship Strong by J.L. Fincannon & K.V. Bruss (2003), available through the American Cancer Society (800-ACS-2345 or www.cancer.org) is an excellent book with detailed information about the impact of illness on close relationships, challenges, as well as strategies and resources to strengthen communication, intimacy, and coping.
• Active listening is a critical part of communication, as it connects the listener and the speaker and can be healthy (reduced blood pressure and increased relaxation) for the listener, as reported in August 27, 2004 The Caregiver's Home Companion article, Spiritual Caregiving: Lessons from a Boot Camp for Listening.
  Information in the August 27, 2004 The Caregiver's Home Companion article, Spiritual Caregiving: Lessons from a Boot Camp for Listening ( www.caregivershome.com/Spiritual/index.htm) addresses the natural instinct to want to jump in and solve the speaker's problem when it may be best to listen and acknowledge feelings before providing information or other help. It also provides details on responding as a good listener by paraphrasing, being empathetic, asking open-ended questions rather than "yes or no" questions that express judgments or values, and learning to use silence.

  Active communication tips:

  • - Use direct eye contact.
  • - Use expressions and gestures that support your words and encourage discussion.
  • - Clarify what you heard /understood
  • - Use a respectful tone in your voice when continuing the conversation.
  • - Use simple sentences.
  • - Use "I" sentences starting with "I feel..." "I need..." "I believe ..." rather than defensive "You" sentences such as "You think..." or "You always ..." and "You never..."
  • - Be patient. Silence may feel uncomfortable but it allows time for thought and response.
  • - Remember to stand close to someone who is hard of hearing and raise the volume of your voice without shouting. As a husband of a young woman with breast cancer shared, "There is a reason why God made us with one mouth and two ears."
• In other cases, it is important to bring up difficult topics, knowing what and how to talk about them. It may include a topic such as surrendering the ill person's driver license, discussing a change in living arrangements, or preparing for end-of-life care.
  Family Conversations That Help Parents Stay Independent ♥ , available through AARP ( www.aarp.org/programs/connect) (or write to AARP Connections for Independent Living, 601 E. Street NW, Washington, DC 20049), is one of several excellent resources from AARP. It supports family members in starting important conversations with their parents early before illness or problems advance. It suggests that a direct approach be used by adult children in sharing their feelings about changes in their parents' health or needs, and then asking the parent(s) to talk about how they feel. Another way to approach some tough topics is to write down some questions for future discussion. Sometimes, it is easier to talk about similar situations of your friends or wait for natural opportunities that lend themselves for discussion of related concerns and questions. Information is provided for dealing with resistance, having family meetings, assessing parents' needs, and communicating constructively.
  It's All About Talking: Starting Conversations About End-of-Life Issues ♥ , a 2002 publication of "Last Acts," a national coalition to improve care and caring near the end of life, provides specific tips related to why talking is important, how to start the conversation, what to say and important points to discuss, and additional resources.
• Find out about help available through Geriatric Care Managers who identify a variety of needs related to home care that may include an environmental assessment as part of their evaluation. They often use tools / checklists to rate specific items as satisfactory or unsatisfactory related to lighting, sensory stimulation, the conditions of floor coverings and furniture, features of bathroom, bedroom, kitchen and dining room, and safety mechanisms. Some of the items in the last category, safety, include smoke detectors, covered electrical outlets, accessible doorways for walkers and wheelchairs, distance between blankets, towels, papers and sources of fire.
• Fall Prevention
  What YOU Can Do to Prevent Falls, produced by the Department of Health & Human Services, Center of Disease Control and Prevention, National Center for Injury Prevention and Control at www.cdc.gov/ncipc provides suggestions that include beginning a regular exercise program, making your home safer, reviewing your medicines with your health care provider, and having your vision checked.
  Check out the National Institute of Aging's publications by requesting a list by calling (800) 222-2225 or going to www.nih.gov/nia. Their Age Page, "Preventing Falls and Fractures," is excellent. Suggestions given include frequent hearing and vision testing, and well-fitting hearing aids and eyeglasses as prescribed, reduction or elimination of alcohol use, dizziness controlled by slowly rising after lying down, keeping room temperature moderately warm or cool, and using a cane or walker as needed. The resource lists room-by-room features to safeguard against falls.
  The Mayo Clinic produces a web page (from their website at www.mayoclinic.com) entitled Practical tips for Alzheimer's Caregivers that includes techniques to assess independence, create a safe environment, adjust expectations, and limit distractions and to promote communication. For example, to create a safe environment, it is suggested that to reduce risks of wandering, that the car keys should be hidden and slide bolts should be used high on doors leading to the outside and stairwells. (Never leave your loved one alone when using these measures.) Control access to matches and lighters and never let a smoker be alone to smoke. Smoke detectors, fire extinguishers, first aid kits, and access to emergency services need to be available.
• Infection prevention

  Control the spread of bacteria and viruses to reduce the spread of infections such as influenza. As a person at high risk due to age, health conditions and /or being a caregiver, it is important to protect yourself and your loved ones by getting vaccinated against influenza (annually) and pneumonia (every ten years). Other important precautions include reducing the spread of the influenza virus by covering your nose and mouth if sneezing, coughing or if nose is running, and practicing thorough and frequent hand washing.

• Reduction of hazards of bed rest and inactivity Teach and practice exercises that
  Increase airflow in and out of the lungs such as diaphragmatic, pursed lips deep breathing. Take a deep breath through your nose, allowing your diaphragm to descend and expand the abdomen. Then slowly exhale the air through "pursed" lips as if you were blowing out candles. Repeat this exercise as least ten times every hour.
  Changes body position frequently to reduce prolonged pressure on one part of the body and to increase blood circulation and the inflation of each lung.
  Improve blood flow through leg veins by doing each of the 3 exercises, 5 times each every hour:

  1. sliding one foot (flat on bed) at a time up and down the bed, bending at the knees;
  2. moving each foot in a circle from the ankle;
  3. pointing toes up and down on each foot as if stepping on the brake and gas pedals of a car.
• Home modifications planned to increase safety and accessibility

  Seek professional advice and services as necessary to provide in-depth assessment of needs related to home renovations to increase access. For example, if wheelchair use is anticipated, several agencies in the community can connect you with homebuilders who specialize in renovations for families with older and/or disabled members.

  Questions about accessibility and ADA requirements can be answered by the Statewide Coalition for the Americans with Disabilities Act by calling 302-292-3066.

  Check out the "Virtual House," a website developed by Novartis ( www.novartis.com). It is a great site for people interested in rearranging various rooms in their living space most appropriately for safety concerns in disorders such as Alzheimer's disease, Parkinson's disease, asthma, and age-related loss of sight. Rooms with hazards and changes specific to the personalized information you provide are pictured and can be printed for your reference.

  Check the experts in adapting and constructing "accessible" homes in your community.

  The Administration on Aging provides an online catalog ( www.aoa.gov/ALZ/media/safety_catalog_pf.asp) for families caring for someone with memory loss entitled Alzheimer's Safety Catalog: Making Your Home Safe for Your Loved One ♥ It includes information on home modifications and on products that help create a safe and secure home environment. Sections include everything from bathroom safety, lifelines, and lighting, to monitors and wandering prevention and much more.
• Assistive devices to promote social, recreational and emergency communications

  When the abilities to participate in conversations and recreational activities are affected by poor hearing, eyesight, and shortness of breath and disorders affecting the ability to speak or to understand speech, some of the most important life activities are jeopardized. These activities include the exchange of social support through verbal communications, the enjoyment of music, movies, and television, and getting help in emergencies.

  A variety of devices and services are available to people with disabilities to enable them to reconnect with others. Assistive technology is a growing area that supports the development of new tools to help people with disabilities do what they want to do.

  The Delaware Assistive Technology Initiative (DATI), a joint endeavor of the University of Delaware and duPont Hospital for Children, has locations in all three counties. It provides demonstrations of assistive devices and lends equipment for those with disabilities to use. Call (800) 870-DATI or 302-651-6790 to request a resource guide or more information. Easter Seals of Delaware and Maryland's Eastern Shore supports Assistive Technology Resource Centers in each county also. In New Castle County, call 302-328-ATRC.

  Assistive technologies and some funding for people who are visually impaired are offered locally. Everything from used and loaned equipment, to service dogs, and books on tape, written in Braille, or enlarged print are becoming increasingly available. You may wish to start by calling the Delaware Association for the Blind at 302-655-2111 or the Division for the Visually Impaired, Delaware Health and Social Services at 302-739-4748.

  Closed caption television, TTY services for people with hearing loss (and those wishing to communicate with them), and agencies that help in locating sign language, oral, and tactile interpreters are available.

  In Delaware, check out these services if you are looking for an interpreter for people who are deaf or hard of hearing:

  Office of the Deaf and Hard of Hearing 302-761-8275

  Delaware Registry of Interpreters for the Deaf 302-761-9700

  Deaf Communication Services, Inc. 302-266-6877

  Deaf Contact at 302-761-9700 and Delaware Relay Service at 800-232-5470 support two-way conversations between hearing and deaf callers using TTY.

• Prevention of medication errors, overdoses, and adverse effects

  Many actions can be taken to prevent risks to safety related to taking medications. These include some of the following suggestions:

  Keep up-to-date information about the prescribed and over-the-counter medicines taken. This information should include a list of drugs taken or used, the brand and generic name of each and the group of medications in which it belongs, as well as the reason each medication is taken. Do not forget to list eye, ear or nose drops, skin patches and ointments, and injections. The amount, time of day and "sticker" bottle warnings regarding when and how to take or store the medicine should be written down in an easy to read chart. Keep files containing the written information provided with the purchases of medicines from your pharmacy. Highlight information that is most important related to your situation - particularly common side effects and signs of adverse effects or overdose. Pharmacists are excellent sources of information and should be able to have or get answers to any questions you have.

  Always keep a list of allergies and any past drug reactions with your medication list. Because interactions frequently occur between medications, it is wise to carry the list with you to share with all of your health care providers. Do not forget your eye doctor and dentist. Dangerous interactions can be prevented when all of your medicines are on file or are filled by one pharmacy.

  Be organized not only in keeping this vital information, but also in dispensing medications. While it is important to store medicines in their original containers, counting out a one-week's supply in sectioned pill planners / containers that are labeled by time of the day and / or day of the week helps to keep track of what medicines need to be (or have already been) taken for the day. This practice saves time, but does not replace the care that needs to be taken. It is easy to spill pills from one section to another and to make mistakes while filling the pill planner. Many tablets and capsules are similar in appearance as well as name. Attention to administrating medications is essential so that the "5 Rights" -

  the right medicine

  to the right person

  in the right dose

  at the right time

  by the right method - are followed.

  Be alert for drug overdoses resulting from errors in taking medicines and from the reduced breakdown or excretion of the prescribed dose caused by reduced liver, gastrointestinal or kidney function. Notify your physician to inquire about changes that may be related to medication. Changes in alertness, level of consciousness, and behavior are some of the most common signs of dangerous drug reactions. You may need to call 9-1-1 in life threatening situations. Always keep the Poison Control Hotline number available.

• Adaptive equipment to support functioning and independence

  Locate adaptive equipment and devices that aid functioning (examples: magnifying glasses, amplified, large numbered keypads on programmable and cordless telephones, easy grip kitchen utensils, portable commodes) and services that facilitate independence (examples: grocery, meal and pharmacy delivery services, online shopping, banking and bill payment).

  One way to reduce the out-of-pocket costs for a variety of products such as nutritional supplements, home care and modification equipment, drugs and more, is to enroll in the Caregivers Marketplace. Phone (866) 327-8340 or enroll on line at www.caregiversmarketplace.com. Cash back checks and discounts directly from participating companies are a few of the reasons to sign up for this free and confidential service.
• Prevention of accidents -- auto collisions and fires that can result in serious injuries and death

  To drive or not to drive - that may be one of the first questions to be discussed with your loved one. Driving is a privilege that carries a connection with one's right to independence. When your loved one can no longer drive safely due to illness and /or the effects of aging and is resistant to giving up his or her license, discussions must be firm but understanding and tender. Be ready to provide support and information about transportation options. However, don't say, "Well, you can still drive - if someone goes with you."

  Check into attending an AARP Driver Safety Program with your family member who can safely operate a vehicle. It will update you about the latest driving regulations in the U.S. and your specific state. This program is the only accident prevention course designed specifically for mature drivers. It is affordable, takes 8 hours to complete, and may save you money on your auto insurance. To request information about this program, send your name, address, and phone number to AARP Driver Safety Program, 601 E. Street N W, Washington, DC 20078-1214.
• Knowledge of the causes, signs, symptoms and actions to be taken if life-threatening injuries, illness, and complications of disorders or treatment occur.

  For example, if your partner has had short episodes of symptoms related to narrowing of her coronary arteries (that supply blood with oxygen to the heart muscle) such as chest pressure or discomfort, sensations of heartburn or shortness of breath with increased activity or stress, both of you should know the signs and symptoms of heart attack and emergency actions to be taken.

  How would you know that a heart attack might be occurring?

  Pain (pressure, squeezing, fullness) in the chest that lasts for more than a few minutes or goes away and comes back
  Upper body pain in one or both arms, jaw, neck, back or abdomen
  Shortness of breath
  Lightheadedness, cold sweat, nausea

  These symptoms do not usually go away with rest or nitroglycerine as angina does.

  What would you do?

  Do not delay!
  Give nitroglycerin, if and as prescribed.
  If symptoms continue, many health care professionals recommend chewing uncoated aspirin so that it can enter the blood stream quickly and reduce clot formation in the blocked arteries of the heart. (Check on what your doctor recommends before this emergency occurs.)

  Get emergency help. Call 9-1-1 for transportation to a nearby emergency department immediately. (Clot busting drugs given in the Emergency Department soon after a heart attack or stroke begins can prevent more extensive permanent damage.) The most serious complications of heart attack - heart rate and rhythm disorders - may cause cardiac arrest and death most frequently in the first few hours after the attack. Paramedics and emergency department staff have the drugs, equipment and skills required immediately to save lives from these disorders. So don't wait to call 9-1-1. It is always better to be embarrassed if it turns out not to be a heart attack than regretting help was not available in time.

  If consciousness is lost before emergency help arrives, make sure that the airway is open, check for a carotid pulse on one side of the neck only and for breathing. Start CPR if cardiac arrest occurs (no response to shaking, sudden loss of consciousness, no normal breathing, no signs of circulation). If in a public place, assistance, oxygen and an automatic external defibrillator may be available to help while waiting for emergency help.

  This information was adapted from the American Heart Association's web site. Check www.americanheart.org for additional information about heart attack, stroke, cardiac arrest and CPR.

 What can I do to Preserve my Health while caring for Others?

This section provides information that may benefit your health by reducing caregiver strain, burden, morbidity and mortality.

Scientific evidence from a National Academy of Science study released in November, 2004 showed that a group of mothers, each caring for a disabled child and having ten years of related stress and strains, had shorter teleomeres, the caps on the end of chromosomes, indicative of more rapid deterioration of cells leading to earlier aging. Knowledge of the scientific connections between caregiver stress and health changes is growing. The benefits gained by reducing caregiver stress include preserving your health and life.

By creating an atmosphere of open communication, involvement, and caring, tension often is reduced and cooperation and collaboration is increased among the care receiver, caregiver(s), and other family members. Strains and stresses of caregiving are reduced and coping strategies become more effective when there is greater comfort in asking for and giving help. Listening and being heard are so important in the type of decisions and work required by caregiving. Mental health and social support are promoted.

• Some Important Considerations...

  By practicing good health habits, you can build your muscle and bone strength by exercising, nourishing your body with adequate rest, sleep, dietary nutrients, and vitamins, and maintaining a high level of immune protection through stress reduction. Reducing risk factors for chronic diseases, particularly smoking and obesity, is also very important to caregiver health. Caregivers may be prone to forget about the importance of regular check-ups, renewing prescriptions, and scheduling routine health screenings such as eye exams, mammograms, Pap smears, and colonoscopies - risking their own health. Middle-aged daughters and wives caring for their parents or partners, face the health changes occurring during the years of perimenopause -- often compounding the stress they experience.

  If you have chronic health problems like pain or depression and /or disorders such as diabetes or heart disease, caregiving challenges your ability to maintain control over your condition. Rather than taking chances with your own health, it is usually better to make early arrangements for additional help or changes in the place in which care is provided.

  All caregivers involved with providing direct physical care or assistance should take additional steps to maintain their health and protect themselves from injuries. As you prepare to provide care, it is essential to learn proper body mechanics to prevent neck, back, and joint injuries. Providing support for standing, walking, and repositioning and turning in bed can result in risks for caregivers -- muscle strain, sprains, and herniated discs.

  A variety of illustrated information on body mechanics and providing safe care is available in books such The Comfort of Home: An Illustrated Step-by-Step Guide for Caregivers ♥ by M.M. Meyer and P. Derr (published in 1998 by CareTrust Publications L.L.C. in Portland, OR)

  It is important to practice techniques with a well person before using them with someone who requires assistance. Courses and presentations conducted by health professionals are frequently available and are well worth your investment of time. Combative and disoriented behavior may pose additional risks to caregivers.

  Infection protection and control are also important for everyone within the care environment. Using gloves, masks, eyeglasses or goggles create barriers against direct person-to-person (or body fluid) contact and airborne infections. Appropriate and proper use of safety equipment is important to learn to protect yourself while preventing alienation of your loved one. Accidental needle sticks or problems in disposing contaminated materials need to be prevented through proper handling.

  At the same time you are protecting yourself and your partner or parent, you will want to preserve your relationships with him or her. As a son or daughter, wife or husband, you should experience benefits from your caregiving.

  Some of the most common ways that caregivers (as well as care receivers and others) deal with the losses and hardships they endure in seeing their loved ones lose their independence and their health, while they struggle to provide the care needed is turning to prayer, religious faith, and for spiritual help. Relying on one's faith is one of the most frequently used coping strategies for families facing illness and situations that may not be responsive to other actions such as treatment.

  The October 2004 (volume 3, issue 4) Caregiver's Home Companion includes an article, Turning to Spirituality to Help Cope with Caregiving Stress by Ursula Furi-Perry. It mentions study findings indicating that religious caregivers cope better emotionally, and find greater strength in adapting to their responsibilities. Spirituality can do much to ease the hardships caregivers face. Overall, it enables one to see situations and one's place in the world differently. The caring and support available within one's religious community may extend help in many ways to those in need.
  Finding meaning and purpose in caring may be more easily realized when spirituality and faith are strong. In the Caring Partners' study of Delaware caregivers, the benefits of caregiving included the opportunity to learn about their loved one and themselves, to develop new skills and to strengthen their relationship through empathy, expressions of love, respect, and valuing what each person gives. Perhaps the process of finding meaning and purpose in life through deepened spirituality helps caregivers to recognize the opportunities that caring for someone they love provides.

  Getting emotional and social support was identified as an important need in the Caring Partners' Delaware Caregivers study. Key sources of support included conversations with friends and family, individual and family counseling, telephone support from others in similar caregiving situations and from professionals, local support groups, and global Internet support groups. Investing time to develop nurturing relationships beyond the caregiving partnership and to connect with professionals, agencies and groups by phone, by computer and in person builds an invaluable network of support and information.

  From the beginning of caregiving preparation, caregivers need to plan for time away from care responsibilities to preserve their health. Respite time needs to be a planned priority in caregiving. Some people prefer frequent short breaks for planned activities- a day or afternoon every week or two, while others want the opportunity to travel or rest for a longer time period - a week every few weeks or months. It is most important to check the types and sources of respite care available in your community and then schedule care in advance. Respite care is available in health care settings such as nursing homes, adult day care facilities, hospitals and rehabilitation units and in home settings from home companions, home health aides, and other health care professionals. If professional nursing care is not required, care sharing arrangements can be made in which caregiving hours can be traded among caregivers. A benefit of using respite care early is that the care receiver may be more open to accepting a substitute caregiver or setting, than if respite care is started when he or she is more dependent on the primary caregiver. Dealing with the worries and resistance to new caregiving arrangements, and with the guilt that results, makes it more difficult to take the valuable time away.