Family Caregiver Support

Preventing flare-ups of COPD

Chronic obstructive pulmonary disease (COPD) thickens airways, making it harder to breathe in and get enough oxygen. Damage to the lungs also makes it harder to exhale and get rid of waste gas (carbon dioxide).

COPD is characterized by flare-ups that rather suddenly make breathing much more difficult. Often the patient needs to go to the emergency room. Every flare-up has the potential to make the disease get worse at a faster rate.

Here’s what you can do to prevent a flare:

Aim for quality air.

  • No smoking. If your loved one smokes, he or she has already been told to quit. Ask visitors and other family members not to smoke in the house.
  • Reduce exposure to common irritants. Keep the house well ventilated and free of dust, animal hair, and other allergens. Strong fumes, such as those in cleansers and paints, should also be avoided.
  • Limit exposure to outdoor pollution. Check for local air quality at epa.gov/airnow. Stay indoors when the pollution level is high.

Beware of infections. Any cold or respiratory infection can cause a flare.

  • Stay current on vaccinations. Make sure your relative keeps up with flu and pneumonia vaccines.
  • Avoid crowds. During flu season, your loved one should avoid public places. Ask friends to be mindful of their own health before visiting.
  • Wash hands frequently. Fingers and hands collect bacteria from everything! Have your relative avoid touching his or her eyes, mouth, and nose. Bring a personal pen for use in stores, at the doctor’s, etc. Carry hand sanitizer or wipes.
  • See the dentist regularly. Good dental hygiene helps protect against infection.

Promote overall health. Getting adequate sleep is important for a person with COPD. So is getting enough exercise. Walking is recommended. But talk with the doctor first. There are special lung-friendly activities designed for persons with COPD.

Frequent ER visits wearing you out?
They may not be completely preventable, but as the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we at Iowa City Hospice can support you in doing what can be done to reduce the likelihood of a COPD dash to the ER. To find out how we can help, give us a call at 1-800-897-3052, toll-free.

Red flags for COPD

November is COPD Awareness month. COPD (chronic obstructive pulmonary disease) is a lung condition that gets steadily worse over time. It is often characterized by “flares,” or “exacerbations,” periods when breathing suddenly becomes more difficult. It can be very frightening and often results in a dash to the emergency room.

It’s important to know the early signs of a flare and to have an action plan. If you know the signs and what to do, chances are good for managing the condition at home. Skip the stress and cost of trips to the emergency room!

Develop a personalized action plan with your relative’s health care provider. They may even have classes or nurse educators to help. Ask what you should do if your family member suddenly shows symptoms such as these:

  • Feeling more breathless than usual
  • Extreme fatigue
  • More coughing, with thicker phlegm or mucus
  • Needing to use a quick-relief “rescue” inhaler or nebulizer more often
  • Weight gain of three pounds or more in a day’s time. This may be due to fluid build-up. Check for increased swelling around the ankles.
  • Inability to sleep well because of breathing or coughing difficulties
  • Lack of appetite

Plan with the doctor what steps to take to address these symptoms. Among other things, the doctor may suggest

  • special medications
  • special breathing exercises
  • increased oxygen

Have these on hand and ready for use at the first sign of a flare. Call the doctor immediately if these treatments don’t help and the condition seems to be getting worse.  

Does the person you care for have COPD?
We at Iowa City Hospice understand how frightening it can be to see a loved one struggling so hard to breathe. As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we can help you do what you can do at home to keep things stable. Give us a call at 1-800-897-3052, toll-free.

Emotions following a stroke

A stroke usually results in damage to the brain. Some of the effects will be permanent. Others, temporary. Through exercises and practice, your relative may regain many if not all of his or her physical abilities.

The emotional toll
What takes most patients and families by surprise are the emotional changes that can come with a stroke. Depression is common. Some 30% to 50% of stroke survivors experience depression. Sometimes severe depression—to the point of suicide. Becoming suddenly dependent on others may trigger down feelings. For instance, needing help with basic activities, such as dressing or eating. Even if there is no disability, the stroke’s injury to the brain may itself cause depression, even a long-lasting depression.

Does your loved one laugh or cry out of the blue?
These unexpected emotional storms are another common outcome of a stroke. They are often out of sync with current activities and can be very distressing. Your loved one may feel hijacked by his or her feelings. And both you and your relative may feel embarrassed, and worried. Ask your loved one how you can help: Briefly check in and move on? Or should you actively offer comfort? Distraction, slow breathing, and relaxation exercises can help interrupt such episodes. In social situations, let others know this is simply an aftereffect from the stroke.

If you even think depression might be an issue, ask the doctor
Talk of suicide should be taken seriously. Also talk of feeling worthless or hopeless. Depression left untreated could become a chronic problem that lasts for years. Help is possible. Several medications for depression have proven quite effective for both post-stroke depression and for the bouts of unexpected crying or laughing. Get connected with others, too. Support groups provide reassurance and useful tips for families and for the person who had the stroke.

Has your relative had a stroke?
If so, it’s good to be proactive about depression. As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we at Iowa City Hospice notice that family members are often the first to recognize that something is amiss. They also end up needing help themselves because stroke survivors need lots of assistance. Let’s talk. Give us a call at 1-800-897-3052, toll-free.

What is a physical therapist?

Trusting the body’s ability to heal itself and get stronger: This is the basis of physical therapy. Physical therapists use exercises and hands-on care to reduce physical pain and limitations. Their motto? “Physical therapy brings motion to life.” Their goal is to help people stay active. And mobile! In some situations, physical therapy can be an alternative to surgery or drugs.

Many benefits
A referral to a physical therapist is likely for situations such as the following:

  • Stabilization after a fall. Special exercises increase strength, flexibility, and balance. These exercises reduce the chance of a repeat fall. Or fracture. A physical therapist can also identify trip hazards in the home.
  • Parkinson’s and other nerve conditions. Therapy can help your loved one retain the ability to move safely.
  • Rehabilitation after a surgery. Think of knees, hips, shoulders, and feet. Exercises can speed recovery.
  • Diabetes management. Exercises are prescribed to keep the blood moving! This can help lower blood glucose levels. It can also lead to faster healing of skin wounds.
  • Chronic pain. Hands-on care and exercises are used to decrease pain. With therapy, many patients can avoid opioids.

A collaborative approach
With physical therapy, your relative is a member of the healing team. Therapists tailor care plans to meet patient interests and special needs. Their goal is to empower patients. Ultimately, the benefits depend on your loved one’s ability to follow through. You may want to brainstorm with your relative about strategies. Some like charting and watching progress. Others give themselves a healthy reward after each session, such as watching the next episode of a favorite series.

Covered by Medicare
Medicare, Medi-gap, and most other insurances typically cover physical therapy prescribed by a doctor. Therapy can take place in an office or clinic or, under special circumstances, in the home.

Could your loved one use more motion?
We at Iowa City Hospice have seen first hand the many benefits of working with a physical therapist. As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we can help you explore the possibility of a referral. Give us a call at 1-800-897-3052, toll-free.

Lessons from theater improv

While there is no denying the hardships of Alzheimer’s and other dementias, a growing number of families are exploring innovative strategies for including lightness and laughter on the journey. One option is to steal a page from the theater arts—specifically, improvisational theater.

In conventional comedy improv, actors are presented with the unexpected and must come up with their lines on the spot. The objective is to have some fun with the situation. In the case of caring for someone with dementia, it’s the disease that’s throwing the unimagined your way. Your role is to respond with good humor.

Keep it positive
It is a tenet of theater improv to ensure that everyone on stage looks good. In other words, that the humor doesn’t shame or belittle your colleagues. With dementia, this may mean turning the joke on yourself. If Mom forgets an appointment, “Silly me, I must have forgotten to mention it.”

Flow with the cue that’s given
If Dad puts on three shirts at once, “Very snazzy, Dad. Looks like I’ve got a choice as to which shirt to see you in today.” If Mom pours ketchup onto her pancakes instead of maple syrup, “Hey, that’s pretty. You’re starting off with a new topping for your cakes this morning. If you want to switch off to syrup, let me know.”

Learn to say “Yes, and….”
Especially with dementia, improvise to respond to the emotion your loved one is displaying, rather than the facts. Adopt a position of “Yes, and…,” suspending disbelief no matter how strange the statement. For instance, instead of telling Dad that the birthday party he’s recalling happened twenty years ago, not yesterday—denying his reality—go with his happy flow. “That was your favorite cherry chocolate cake, right? Yum! Let’s see if we can find some cake today.”

Does the person you care for live in another reality?
As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we at Iowa City Hospice understand how you might feel confused, frustrated, and sometimes downright embarrassed by their statements and behaviors. We have strategies that can help you. Give us a call at 1-800-897-3052, toll-free.

When Dad resists a walker

For many older adults, use of a walker carries great stigma. It’s a symbol of disability and often of isolation. In actual fact, a walker can be the key to staying actively engaged with favorite activities.

The benefits of a walker

  • It can bear up to 50% of a person’s weight. (A cane holds only 25%.)
  • It supports good posture. A walker keeps a person upright by reinforcing both sides of the body. (A cane steadies only one side.)
  • It is designed for people with moderate to severe balance problems or those with generalized weakness and arthritis. (A cane is best for only minor balance problems or injuries.)
  • It may act as a chair when needed. Many walkers with wheels have a bench. Great for “standing” in line or when your loved one is suddenly tired or dizzy.
  • It can be rather stylish, with modern accessories, such as a smartphone clamp, a coffee cup holder and a basket for carrying things.
  • It stays where you put it! Canes seem to have a mind of their own, scooting out of reach when you least expect it.

If you have had the “walker talk” with no success, make an appointment with the doctor and directly ask, “What’s your experience with patients who fall? How careful should we be?”

Also get the doctor’s input about the type of walker that is best for your loved one. Perhaps he or she will do a mobility assessment. Or make a referral to a physical or occupational therapist to create a plan for safe walking.

Empathize with Dad’s frustration that his body has given out on him in this way. Remind him that with a walker, he can still get around on his own to do what he pleases. It’s often the most effective choice for maintaining independence.

Is mobility a struggle?
As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we understand. At Iowa City Hospice have helped many older adults come to terms with the need for a walker. You don’t have to do this alone. Give us a call at 1-800-897-3052, toll-free.

When caregiving ends: Activities

Reentry
If caring for your loved one was the main focus of your day, after his or her passing, expect a feeling of emptiness to dominate your awareness. In caregiving, you may have given up many personal activities, friendships, and possibly even a career, to accommodate your relative’s needs. This is especially true if he or she lived with you or had Parkinson’s or Alzheimer’s or some other long-term condition.

Take care of your health
Get a physical! Like many family caregivers, you probably ignored your own health needs—symptoms, doctor visits—because your loved one’s seemed more pressing. This pattern is so common that many caregivers suddenly come down with something serious post-caregiving! Also take care by eating well, exercising, and getting sleep.

Who am I?
Because your focus was on your ailing loved one, you may have a sense of having forgotten who you are. This is especially true if the person who died was your spouse. Be curious: What appeals to you? Rediscover your personal balance and preferences.

Reengage slowly
Start with the inner circle of your family. You may have fences to mend if those relationships were put on hold. Reach out to siblings, your spouse, your children to rebuild your connection. Then begin to engage with friends, optimally those who have experience with loss. If you were working, returning to the normalcy of your career may feel comforting.

Avoid big decisions
Grief counselors recommend NOT making big moves or lifestyle changes for the first year. Volunteering may be a great way to reconnect with the world and regain a sense of life purpose. You might draw upon your caregiving skills—give yourself a year before doing that—or do something entirely different. Keep commitments light. Take time to realize the desires and the bandwidth of the “new” same-but-deeper you.

Feeling a bit lost?
As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we at Iowa City Hospice can help you find support resources to ease this transition. Give us a call at 1-800-897-3052, toll-free.

Medicare Open Enrollment Tips

Are you happy with your relative’s Medicare plan? If not, fall is the annual “Open Enrollment” period. This is when you can change plans for the coming year. Open Enrollment for 2019 is October 15 to December 7.

Even if your loved one likes the current plan, consider any new diagnoses or prescriptions since last year. What was a good deal before may not be the best now.

Here are some tips:
The first decision is whether to go with “original Medicare” or Medicare Advantage. Then look at Part D and Medigap as needed.

  • Original Medicare Parts A and B. These government policies pay 80% of the costs for services such as hospitals, lab work, and doctor visits. The premiums are usually deducted from Social Security checks. Patients can choose the providers they wish. Drugs are not covered.
  • Medicare Advantage Plans. These plans are typically less expensive and all-inclusive. (You will not need to purchase Medigap and may not need to purchase Part D.) Patients go to a specific set of providers. You’ll want to confirm that the doctors, hospital, and pharmacy you prefer are “in network.”
  • Medicare Part D. Think of “D” for drugs. Review your loved one’s medication list. Be sure those drugs are covered in the same dosages. Compare prices at approved pharmacies. One may offer a better deal than the others.
  • Supplemental or “MediGap” insurance. These are optional policies. They are purchased to cover the 20% of fees not covered by original Medicare. Prices vary a lot! Lower copays at each visit will result in higher monthly premiums. So will the ability to choose between many providers. Be sure to read the fine print when changing policies. There may be extra fees, a physical examination, or a waiting period for preexisting conditions. Or the insurer may outright turn your loved one down.

Got the insurance blues?
It can be confusing for everyone. Give us a call at 1-800-897-3052, toll-free. As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we at Iowa City Hospice can help you determine the best fit for your relative’s situation.

A doctor’s visit after a fall

A surprising number of conditions, from simple to serious, can cause an older adult to fall.

If you observed the fall or arrived soon after, find out if your loved one had a warning or felt dizzy beforehand. Any chance he or she fainted? Was the fall from stumbling on an obstacle? Or more from missing the bottom step on the stairs? These important clues can be useful to the doctor.

Even if there are no injuries, it’s wise to see the primary care provider and ask him or her to review the following:

  • Medications. Many common drugs have the side effect of dizziness. This includes medications for sleep, pain, and anxiety, as well as some antidepressants. If diabetes is poorly managed, that can cause dizziness. Faulty blood pressure medication dosing can also be at the root of a tumble.
  • Sitting vs. standing blood pressure. Some people experience a sudden drop in blood pressure when they stand. This could have led to your relative’s dizziness or fainting. 
  • Possible infections. In many older adults, a urinary tract infection or even pneumonia can develop without the “usual” symptoms. These can cause weakness or dizziness. Lab tests are needed for diagnosis and treatment.
  • Physical pain. Something as simple as painful joints or tight-fitting shoes can cause a change in gait or sudden shift in weight from one side to the other, leading to poor balance and a fall.
  • Vision. Cataracts, glaucoma, and macular degeneration impair vision. Any of these may cause an older adult to overlook a trip hazard.
  • Potential significant conditions. It’s important to rule out conditions of the heart, brain, and circulatory system that can result in a fall. For example, a mini-stroke, atrial fibrillation, or Parkinson’s.
  • Home safety. Ask for a home visit by an occupational therapist to identify any trip hazards and make recommendations.

Has your loved one fallen recently?
Falls are pretty serious. And someone who has fallen once is more likely to fall again. Give us a call at 1-800-897-3052, toll-free. As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we at Iowa City Hospice can help you identify hazards and come up with a fall prevention plan.

What is MCI (Mild Cognitive Impairment)?

“Senior moments” are a normal part of aging.
They happen to everyone. We just don’t process things as quickly as we did in younger years.

Some people develop significant memory and thinking problems.
These people are eventually unable to live safely on their own. Typically, they have a stroke or develop Alzheimer’s or Parkinson’s disease.

And some people function at a level in between.
They can live independently and lead normal lives. But they just aren’t thinking as well as they used to. These people may have mild cognitive impairment (MCI). About 15%-20% of adults over age 65 have MCI.

Signs of MCI include greater than usual difficulty with

  • remembering recent events or scheduled appointments
  • following the thread of a conversation or movie
  • making decisions or following instructions
  • finding familiar locations
  • making well-reasoned choices

People with MCI are at greater risk for dementia.
Every year, 10%-15% of people with MCI will go on to develop dementia as compared with 1%-3% of the entire group of adults over age 65. Some people with MCI simply stay at this mild level of memory and thinking difficulty. Some even improve over time!

If you think your loved one may have MCI, schedule an appointment for a full examination. It may be MCI. Or the explanation could be as simple as a medication side effect or even sleep apnea or alcohol overuse. Follow up every six months to track changes.

If your relative has MCI, there is no treatment. Research shows, however, that strong circulation of blood and ongoing mental stimulation are very supportive of a healthy brain:

  • Manage blood pressure and heart health.
  • Increase physical activity.
  • Increase social and mental activity. People who are socially engaged or who have a hobby tend to keep their mental functions longer. Passive activities, such as watching TV, aren’t as helpful.

Are you concerned about a loved one’s memory changes?
Give us a call at 1-800-897-3052, toll-free. As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we at Iowa City Hospice can help you get your relative the assistance that is needed.