Archives for Barbara

Primary care providers

Primary care providersA primary care provider (PCP) is charged with monitoring and treating a person’s whole body. Specialists abound and indeed are important. But we are more than the sum of our organs. Your relative’s PCP helps ensure that specialists are not doing things that counteract each other. If you are looking for a new PCP, there are several types of providers to consider.

Family practice doctors. As the name implies, this is a physician who can care for everyone, regardless of age. Their residency covers pediatrics to geriatrics. The downside is they cannot stay deeply up to date on all age groups. Much as your loved one may have been with the same family doctor for decades, it could be time to switch.

Internist. Internists focus on the health needs of adults. Their residency is 100% adult medicine. Some internists pursue additional studies to add a specialty, for instance in rheumatology or neurology.

Geriatricians. These are internists who did specialty training on the needs of older adults. They are versed in the management of multiple chronic diseases. They also understand the complex psychosocial changes of aging, such as loss of spouse and/or friends, loss of independence. Often their approach is more holistic, and they are more apt to consider the importance of quality of life. Unfortunately, there is a shortage of geriatricians. An alternative is an advance practice nurse or physician assistant with a specialty in geriatrics.

Concierge doctors. New to the landscape is the primary care doctor who has opted out of being an employee in a medical group. Instead, they charge a yearly membership fee to keep their practices small. With a “concierge doctor,” you are seen within 48 hours and appointments are longer. Medicare does not pay for the membership fee. This can run $1200–$2400 per year.

Searching for a new PCP?
With so many medical providers retiring, you are not alone in the hunt! As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we at Iowa City Hospice see lots of families looking for a new PCP. Wondering which direction to go? Give us a call at 1-800-897-3052, toll-free.

Cooking tips for the visually impaired

Cooking tips for the visually impairedIs low vision making it harder for your loved one to cook? If food preparation has been one of their pleasures, they are probably grieving not only the change in their eyesight, but also the loss of creating and serving delicious meals. Even if cooking has not been a passion, the ability to safely prepare food for oneself is critical for maintaining independence and self-esteem.

Fortunately, there are ways to empower your relative with simple strategies and inexpensive tools. Here are some techniques that augment and use all the senses. They also protect safety.

  • Lighting. Identify workstations in the kitchen that could use extra lighting. Add a flexible arm lamp to shine a spotlight on the cutting board or on the recipe.
  • Color and contrast. Use a white cutting board for dark foods (carrots, beets, meat) and a dark cutting board for light-colored foods (onions, chicken).
  • Touch. Buy a “tactile pen.” These exude a liquid material that dries into easily felt lines, dots, numbers, or letters. Label measuring cups, “on/off” or other settings on appliances, and key positions for stove or oven dials.
  • Sound. There are several “talking” devices for visually impaired cooks. For instance, a thermometer that speaks the temperature out loud. Or a device set at the edge of a bowl or measuring cup that beeps when liquid is near the top.
  • Cut prevention. Use devices other than knives whenever possible. A vegetable peeler, for instance, or a cheese slicer or tomato/onion cutter. Another tip: The sharp edge of a knife blade is usually rounded. Rock the knife on the cutting board first. If it doesn’t rock easily, the cutting edge of the blade is likely pointing up.
  • Burn prevention. Position the pan on the burner before turning on the heat. Similarly, turn off the burner before removing the pan. Wear short sleeves or sleeves rolled up so clothing doesn’t brush against burners and catch fire. For baking, get long oven mitts that cover the forearms. Also, pull the rack partially out when removing food, reducing the need to reach deep into the oven.

For those with a diagnosed low-vision condition, Medicare will pay for the services of a low-vision rehabilitation specialist. With a doctor’s referral, a specialist can come to the home and help your loved one identify easy adaptations that will make cooking—and other daily life activities—safe and enjoyable again.

Is vision loss making meal prep difficult?
As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we at Iowa City Hospice know that the ability to cook for oneself is vital to an aging relative’s self-esteem. Doubly so if cooking was a joy or part of their reputation. If the person you care for is struggling with vision loss and issues of independence, we can support you in supporting them. Give us a call at 1-800-897-3052, toll-free. You don’t have to do this alone.

Interrupt the stress cycle with deep breathing

Interrupt the stress cycle with deep breathing

We’re breathing all the time. But when it comes to stress relief, not all breathing is equal.

The body’s stress cycle

  • Our bodies are built to handle periodic crises. When we sense danger, our bodies release “stress hormones” that enable us to respond powerfully and fast. When the crisis is over, those hormones are no longer released. The body returns to relaxed, “normal” mode.
  • But chronic stress is damaging. When we’re stressed every day, the “fight-or-flight” hormones keep running. Not a lot, but enough to upset the body’s balance and undermine physical health and mood. The body is distracted from its routine tasks of repair and maintenance. This can result in significant consequences.

Low-level, ongoing stress is associated with

  • heart disease, cancer, and stroke
  • more colds and infections
  • poor wound healing
  • digestive problems and weight gain
  • disturbed sleep
  • depression and anxiety

Deep, diaphragmatic breathing combats stress. Relaxed, easy breathing triggers an automatic reversal of the stress hormones.

Even when stress remains, you can “trick” your body into a less-stressed mode. The key is to get the muscles in your belly, around your diaphragm, to relax. Here’s how:

  • Sit, stand, or lie down. Put one hand on your chest, the other on your belly.
  • Inhale slowly through your nose. As you inhale, count to four. Your belly should expand, not your chest.
  • Exhale slowly through the nose, again counting to four. Feel your abdomen deflate.
  • Focus your thoughts on your breath only.
  • Repeat five to ten times.

As you get more practice, expand the count for each breath to five, eight, and eventually ten.

Get in the habit of taking time to breathe deeply several times a day. Surely you can give yourself five minutes now and then. Your body will thank you!

Are you perpetually under the gun?
We at Iowa City Hospice see this all the time. As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we see dedicated family members on hyperalert trying to juggle all the responsibilities that fall on their plate. Getting help is paramount. But you can also help yourself by enlisting the body’s natural antistress remedy: deep breathing. Give us a call at 1-800-897-3052, toll-free for more assistance. Let’s start the conversation.

Poetry and dementia

Poetry and dementia

If the person you care for has dementia, you may have noticed their withdrawal from conversations, movies, even from reading books or the newspaper. Anything with an involved plot line is now too difficult for them to follow.

Poetry, on the other hand, involves rhythm and images, which can stimulate memories of experiences, emotions, smells, tastes, and other sensations. All quite accessible by persons with dementia. Plus, many older adults went to school when poetry was an active part of the curriculum. Exploring fun poetry together may tap into positive memories from the past.

The Alzheimer’s Poetry Project has developed several ways to use poems as a window of connection.

If your loved one can still read
Consider printing out a few poems to read together. Read slowly enough that your relative can follow, but fast enough that the rhythm is evident. Even if they can’t read aloud, they can enjoy hearing the spoken words and following along. Shared reading provides a rare sense of belonging.

Ask questions drawing on the five senses
Poems with strong images work well. For instance, if you are reading A Red, Red Rose by Robert Burns, ask, “Were there roses in your garden?” “What does a red rose smell like?” “Did you ever get pricked by a thorn?” Or for Going Down Hill on a Bicycle by Henry Charles Beeching ask, “What was it like for you, riding a bike? Did you feel like you were flying?”

Humorous poems
Silly poems may resonate more than serious ones. (The Purple Cow) Or try limericks. They are often funny and the rhythm is infectious.

Finding poems
Do a Google search by topic, such as “tree poems,” or the name of a favorite poet. You can also find poems online at the Academy of American Poets.

Are you caring for someone with dementia?
At Iowa City Hospice we understand how challenging it can be to find appropriate activities. As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we can help you solve this and other dementia-related challenges. Give us a call at 1-800-897-3052, toll-free.

Organ donation

Organ donation

Those who donate organs, eyes, or tissue leave a tremendous legacy, often the gift of life itself: Allowing someone a steady heartbeat. Or the vision to see a grandchild. Or healthy skin to cover a burn or cancer site.

National Healthcare Decisions Day (April 16) is when everyone is encouraged to create or update their advance directive. These end-of-life documents include a section for letting family members and healthcare providers know whether you choose to be an organ donor.

You are never too old to donate. The oldest donor on record was 92! You just indicate your preferences about donation. Then talk with your family to tell them of your wishes. When the time comes, doctors will determine which organs are or are not suitable.

Common questions

  • Cost. There is no cost to donors.
  • Medical care. Some people worry if they are on an organ donor list that they will not receive all the care necessary to save their life. Not true. Doctors will provide all the care you wish right up until death. That is the doctors’ oath.
  • Open-casket funeral. The incisions are small, and funeral directors are skillful in making repairs. There is no disfigurement that would hinder an open-casket funeral.
  • Choose what to donate. Donors can indicate ahead of time what they wish to donate.There are 10 organs that are suitable for transplant. And donation of skin tissue can impact up to 75 lives.

How to sign up. If your loved one is interested, go to organdonor.gov, the national registry. This group matches donors and recipients and provides instructions about what to do following a death. The person you care for can also have their donor status recorded through the state Department of Motor Vehicles so it can be put on their driver’s license or state ID.

Is it time to address the advance directive?
As Ben Franklin so famously noted, “death and taxes” are the only certainties in life. It’s fitting, then, that tax time is also the time dedicated to raising awareness about a critical end-of-life document: The advance healthcare directive. As the Iowa City, Muscatine and Cedar Rapids experts on family caregiving, we at Iowa City Hospice can help you understand what you need to do to be sure your loved one has fully completed their directive. Give us a call at 1-800-897-3052, toll-free. It’s never too early to get this important task done.

Should Dad move in?

Should Dad move in?

Combining households has many benefits: Less hassle running back and forth between two residences, less worry about Dad eating well and remembering his meds, more family social time for him, cost savings on rent and utilities, etc.

But if things do not work out, disentangling could cause hurt feelings and damage your relationship. Consider these questions before you move in together.

Relationships and lifestyle
How do you and Dad get along? How does he get along with others in the house? How will he fit in with household routines? Will he eat what you eat? How will he cope with children? What about pets? Will he join you on vacation? Can you set boundaries and negotiate when issues arise? Are others in the house up for this change?

Physical space
Can you accommodate him and still have privacy? Will he have his own bathroom? Sitting area? TV? Do you need to install grab bars or a riser seat on the toilet? Is there space for his clothes and possessions?

Time and money
Will he expect to have a lot of your time and attention? Will he need you to drive him places? What should you ask him to pay (for rent, utilities, food, cable)? Will you be paid for any of your assistance?

Care needs
If Dad’s needs increase, are you comfortable doing personal care (bathing, dressing, help with toileting)? What about having someone come into your home to care for him?

If you decide to go ahead with an invitation, review your plans in detail with your relative and other family members. A written agreement is essential. Have it reviewed by an elderlaw attorney. And review it every few months afterward. You want to make sure everyone has the same vision and expectations!

Are you considering a multigenerational household?

As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we at Iowa City Hospice applaud the great intent behind bringing an older relative to come live with you. There are, however, many, many issues to consider. Let us help you realistically weigh the pros and cons. Give us a call at 1-800-897-3052, toll-free.

The journey of late life

The journey of late life

Families spend three to five years caring for an aging relative. At first it may be light chores or small errands now and then. But over time, health challenges emerge and needs grow.

In his book, My Mother, Your Mother, geriatrician Dennis McCullough outlines eight “stations” in the journey of late life. For each one, he offers insights and tips to help you counter the modern system of “fast medicine” with personalized solutions he calls “slow medicine.”

  • Stability. A time of preparation. Get to know your relative at baseline. Stay 72 hours and observe what’s “normal.” Begin to build a support community. Learn about aging.
  • Compromise. The advent of symptoms. Stay in touch and informed about emerging health problems. Diplomatically join your relative and work together as a team when considering options.
  • Crisis. A major event, typically involving ER and hospitalization. Get involved. Look backward and forward to prevent future problems. Rally the support community.
  • Recovery. Often a lengthy process of rehabilitation. Stay involved. Learn what’s needed for recovery. Practice sustained community support. Encourage your relative’s patience. Assess support needs for his or her “new normal.”
  • Decline. An obvious drift into frailty. Frequently precipitates a move into a care facility. Stay engaged. Protect your loved one from loss of identity.
  • Prelude to dying. A change in spirit that acknowledges death as a real possibility. This period often starts weeks or months before actual passing. Enroll in hospice (three to six months of service is optimal). Visit, give attention. Ask their life story. Cope with the uncertainty.
  • Death. The last few days. A time of honoring your relative’s end-stage desires. Advocate as necessary. Address anxiety, yours and theirs. Provide comfort, often touch.
  • Grieving/legacy. An intensely personal experience, often lasting years. Look for opportunities to reminisce.

Where are you in the journey?
Sometimes it helps to pull back and take a wider view. As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we at Iowa City Hospice can help you gain that wider perspective so you can assess where and when you need help. Give us a call at 1-800-897-3052, toll-free. You don’t have to do this alone.

“Chemobrain”

"Chemobrain"People who go through chemotherapy for cancer often complain about “chemobrain.” If your loved one is under treatment and is having trouble with memory, thinking, and concentration, it is likely from the chemo drugs. The fuzzy thinking may not go away right when chemo stops. But it usually recedes over time.

Encourage your loved one to

  • plan the day. Do the most challenging tasks at their “best time,” when they feel most mentally sharp. Get a large calendar/planner.
  • create routines. Habits help because they don’t tax the brain. Keep the same daily schedule. Store essentials (keys, wallet, phone) in one spot.
  • do one thing at a time. Remove distractions. Turn off the TV or radio. Avoid multitasking.
  • use memory aids. Put lists on the refrigerator or smartphone. Use audio reminders from Google, Alexa, or Siri. GPS in the car.
  • reduce mind alterants. Meet with the pharmacist to ask about substitutions for any noncancer drugs that cause mental fog. Stop/reduce use of alcohol or recreational drugs.
  • move, eat, sleep. A daily walk gets essential oxygen to the brain. A diet high in vegetables brings vital nutrients. And getting a good night’s sleep gives the brain time to rid itself of the daily natural sludge that builds up.
  • keep a sense of humor. “There goes that chemo brain!” Remind yourself—and everyone—that your loved one is not stupid. Just experiencing a bodily reaction to the assault of chemo drugs.
  • let others know. Encourage your loved one to be open and to ask for help. Also, to join a support group of others undergoing chemo. There is relief in knowing you aren’t alone!

If your loved one also has insomnia, sleep apnea, depression, or anxiety, seek treatment for these conditions as they can also add to the fog.

Is your loved one’s brain fog challenging?
While it’s not full-blown dementia, “chemobrain” can still be disconcerting. As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we at Iowa City Hospice encourage you to help your loved one learn to compensate. (Up to 30% of cancer survivors do not get back to their pretreatment abilities. It’s not easy for family members either.) Give us a call: 1-800-897-3052, toll-free. You don’t have to do this alone.

Caregiving apps

Caregiving appsJuggling multiple schedules, keeping other relatives informed, ensuring prescriptions are filled … these are but some of the many duties you may face as a family caregiver. In some instances, a simple spreadsheet can do the trick. But an app makes it easier to coordinate with others.

Admittedly, every app has a learning curve and may feel like “one more thing” to do. But if you have a smartphone and are so inclined, you may find these apps ultimately save you time and distress. (They are free, but there may be ads or other trade-offs.) All are available on the App Store or Google Play.

We are not endorsing any of them. Rather, we are naming apps that have been reviewed by organizations such as AARP (American Association of Retired Persons) and seem generally well rated. They are grouped here in terms of common features. Not all features are in each app named in a group. Conversely, apps are frequently updated to include new features. This review can give you at least a sense of the range of applications. Maybe there’s an app for what you need!

Updating others; asking for and scheduling help
Two apps that have stood the test of time are Lotsa Helping Hands and Caring Bridge. You invite others to join an online community so you can send out group updates, upload recent photos, display a calendar with needed tasks, request help, etc.

Medication management
Common features include tracking prescriptions and refills, sending reminders to your loved one, and receiving alerts if a dose is missed. Most support quick lookup of instructions and side effects. Some deliver discount coupons. Check out Medisafe, CareZone, and MyMeds.

All-in-one app
Consider Caring Village if you want to facilitate communication, scheduling, and medication management using just one app. It includes options for uploading and storing documents (for example, an advance directive).

Too many plates spinning?
We can help. As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we at Iowa City Hospice understand the challenges you face. Give us a call at 1-800-897-3052, toll-free. Let’s start the conversation.

Psychological first aid


Anxiety and stress commonly accompany family caregiving. The ongoing pandemic and its stream of variants are only adding to that. Perhaps you could use a little “psychological first aid.” These are skills or techniques first responders are trained to teach or apply to distressed persons after urgent physical issues have been addressed.

The goal of psychological first aid is to help people feel safe (physically and emotionally), calm, and hopeful. Connected to others. Sound good? Try these strategies on yourself.

  • Maintain healthy basics. This means good nutrition, good sleep, and daily physical activity. Avoid leaning on sugar, alcohol, tobacco and such for coping.
  • Practice deep breathing. When you feel anxiety mounting, practice slow, deep breathing. A few minutes of deep breathing can reduce stress hormones and blood pressure and get you quickly back to your emotional balance.
  • Establish a daily routine. Structure is reassuring in a time of uncertainty or upheaval. It also allows you to save vital mental energy for other tasks since a routine can be done a bit more on autopilot.
  • Avoid further harm. Recognize that what you are feeling is normal. Especially with the pandemic, it’s easy to feel hopeless in the face of new surges. But that doesn’t mean you let your guard down. Stay vigilant! Continue to protect yourself and your loved one.
  • Prioritize. What is urgent? What can wait? What is within your control? What is not? Focus on the things you can control, addressing the urgent before the nonurgent. It will counteract feelings of powerlessness.
  • Give yourself a media diet. Limit your intake of the news to once a day. Ideally, avoid TV news. Too many vivid pictures.
  • Cultivate hope. Admittedly, this may feel difficult. Start by mentally identifying the things that are going well, however small. Be on the lookout for positive moments and savor Keep a gratitude journal.
  • Stay connected. Whether by text, phone, video chat, or visiting safely in person, stay in touch with people who make you feel better, people you can confide in.
  • Consider past coping strategies. How have you gotten through challenges? What worked and is worth repeating? Anything you want to be sure you don’t do this time around?

Are you feeling anxious or burned out?
You are not alone! After two years of the pandemic, we are all tired and stretched thin. As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we at Iowa City Hospice see a lot of families who could use some psychological first aid. Let us help. Give us a call at 1-800-897-3052, toll-free.

Iowa City Hospice