Family Caregiver Support

Not all socks are created equal

Not all socks are created equal

What do a marathon runner and your aging parent have in common? Both could benefit from compression socks! By applying pressure to the legs, compression socks help the valves in the veins do their work—so blood is pushed back to the heart and doesn’t pool in the legs. The socks also help keep lymph fluid moving. Older adults with edema (swollen legs), varicose veins, or deep vein thrombosis find that compression socks ease discomfort and can even prevent problems. This is especially true if your relative spends a lot of time sitting.

Compression socks are safe for the vast majority of older adults and are an underutilized option. Consider them for your loved one before a long plane flight or car trip. You can even find fun ones online if you include “fashionable” or “crazy” in your search.

If you wonder about your relative using them regularly, consult with the doctor first. You want to know the right compression and size. Also, these socks are not recommended for those with diabetes and persons with certain heart or vein conditions. For long-term use, ask the doctor for a prescription. This will allow for graduated compression socks to be professionally fitted to your loved one’s calf and ankle dimensions.

Tips for compression socks

  • Follow the fitter’s directions. Ask for tips on getting the socks on and off.
  • Have your family member wear them an hour or two each day to start. Increase time gradually.
  • Get a refit if your loved one gains or loses 10 lbs.
  • Hand wash and hang to dry.
  • Replace the socks when they lose their stretch.
  • Check your relative’s skin for dryness, chafing, irritation, redness, or dents.
  • Ensure your family member wears a clean pair each day so socks don’t stick to the skin and become difficult to remove.

Does your loved one struggle with edema?
It’s nice to know there are nondrug ways to ease your relative’s discomfort. As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we at Iowa City Hospice always like sharing nonpharmaceutical approaches to common eldercare problems. If this philosophy appeals, give us a call at 1-800-897-3052, toll-free.

Dealing with anxiety

Dealing with anxietyIt’s only natural for family caregivers to worry. Understandably, we spend a lot of time thinking about “what’s next.”

But if you are in a pattern of persistent worry and are starting to feel the stress in your body too—perhaps headaches, loss of appetite, or trouble sleeping—you may be dealing with anxiety. You are not alone. An estimated 40 million Americans report problems with anxiety each year.

Does this sound familiar?

  • Focusing on worst-case scenarios. Not seeing the things that are working well.
  • Playing a worry over and over in your mind. This may distract you during the day and interfere with sleep at night.
  • Thinking in black-and-white terms only. Your self-talk often includes “always” or “never.”
  • Getting stuck on details. Forgetting to look at the big picture.

Try these challenges to negative thinking to help you arrive at a more balanced view:

  • What are you saying to yourself? Write it down. Is this extreme or worst-case-scenario thinking?
  • What do you know to be true? What is fact? What is just a thought or feeling?
  • What is the worst that could happen? Is it a probability or just a possibility?
  • What skills, resources, or qualities do you already possess? Give yourself realistic credit.
  • What can you do now to make life easier (learn new skills, ask others for help)?

If anxiety is getting in the way of your sleep or peace of mind, talk with your doctor. And certainly, if you experience chest pains, a racing heart, and/or episodes of fast breathing, get checked out. Talking with a therapist can quickly get you back on a confident and even keel. And consider getting help with your caregiving.

Do you find yourself with anxious thoughts?
Perhaps it’s time to get some caregiving help. As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we at Iowa City Hospice find that families often underestimate how much work it is to care for an aging loved one. They end up paying for it in terms of distress, poor health, and trouble sleeping. Not a very good quality of life. You don’t have to do this alone. Give us a call: 1-800-897-3052, toll-free.

Services at home: Medicare

Services at home: MedicareMedicare is health insurance provided by the federal government. It covers adults 65 and older, as well as persons with disabilities. In terms of home care, Medicare pays for visits only by medically trained staff. In that light, there are two programs:

Home health care involves periodic home visits for a month or two. The focus is to bring the patient back to their previous level of health and ability. It is often initiated after a surgery or a multiday hospital stay. To be eligible, your loved one must have great difficulty leaving the house. Depending on your relative’s needs, services may include the following:

  • A nurse to oversee progress
  • A physical therapist to assist with rehab
  • An occupational therapist to suggest strategies for living with new disabilities
  • A speech therapist to address difficulties with speaking and/or swallowing
  • A social worker to suggest community assistance programs

Hospice care is for people with an incurable illness. It involves weekly home visits over a period of six months. Sometimes more.

  • A nurse to manage pain and difficult symptoms
  • An aide to assist with bathing
  • A social worker for emotional and other support
  • A chaplain for talking through spiritual concerns
  • A volunteer to periodically visit with your loved one, offering family members a few hours off

A hospice patient is not expected to regain their health. Hospice care supports the patient and the family. The goal is to allow the patient to live at home without pain or discomfort in the weeks or months that remain.

Both home health and hospice require a doctor’s order. If you think either one would be of benefit, ask the doctor for a referral. Most families wish they had received help earlier. Better to ask sooner than later.

Looking for home-based support?
As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we at Iowa City Hospice have seen firsthand how wonderful it is to have medical professionals come to the home when a loved one is too ill or frail to leave. If you are looking for help at home, give us a call at 1-800-897-3052, toll-free. We can help you find the help you need.

Coping with another person’s pain

Coping with another person's pain When your family member is in pain, you are suffering, too. The “mirror neurons” in our brains are programmed to recognize pain in others. That’s good news in that it arouses compassion and spurs us to action. But it can be bad news, too. When you are highly attuned to a loved one’s pain, you are at higher risk of depression, burnout, and poor health yourself.

Be aware of your distress as separate from your loved one’s
Those mirror neurons can hijack your emotions. Take a moment to separate your experience from that of your relative:

  • What are you feeling? Naming the feelings can help you observe them and diminish their power.
  • What is triggering you? Are you remembering a similar episode of your own pain? Do you feel like a bad daughter/son/spouse because you can’t make the pain go away?
  • Are your thoughts accurate or constructive? Do what you can to maintain a balanced perspective. Your past pain may or may not be like the pain your relative is feeling. You aren’t responsible for your loved one’s pain. All you can do is your best with the tools at your disposal.
  • What do you need to do to come to a calm, centered place? Perhaps it’s some deep breathing. Maybe a walk around the block. Eating something healthy. You are not going to be as effective in alleviating your loved one’s pain if you are distracted by your own distress.
  • What can you realistically do to help your relative?

Learn about pain management. Your ability to reduce your relative’s experience of pain will help both of you.

  • Report symptoms. Check out the Pain Log hosted by the American Chronic Pain Association, or find the free mobile app at the Apple Store and Google Play.
  • Explore nonmedicinal approaches to pain management. Ask about the steps your loved one can take to lessen pain when it occurs and how you can be supportive.
  • Learn about medications. Be cautious about potential addiction while at the same time understand that in cases of life-threatening illness, the hazards of narcotics are very different than when pain is caused by chronic conditions.
  • Ask the doctor for a palliative care consultation. If your loved one’s pain is related to a life-threatening illness, these specialists can assist with pain control.

Accept what is beyond your power and focus on what you can control.
Some diseases just do cause pain that may not be fully conquered. That said, you can help in other ways and make it a point to keep your own ship afloat so you can continue to provide care over the long haul.

  • Emphasize comfort and well-being. Remind yourself, “Today, I may not be able to stop the pain, but I can still [prepare food, massage feet, etc.].”
  • Provide distractions. If your family member is engaged in an activity, he or she is less likely to be aware of the pain.
  • Take a time out. Be stress free for a while. Do something fun. Guilt is not productive, and being in emotional or physical pain yourself is not going to make your loved one feel any better. When you as the caregiver are refreshed, however, everyone benefits.
  • Complete a project. Counteract your feelings of powerlessness by accomplishing something. Think small and simple. Clean out a drawer or bake a loaf of bread.
  • Tap into your spiritual/religious beliefs. Make time for prayer or meditation. Listen to a podcast. Sing hymns. Read an inspirational book. Talk with the clergy of your faith community. 

Are you sometimes overwhelmed by a loved one’s pain?
At Iowa City Hospice, we have seen the most empathetic and loving family members get ground down by the pain of a relative’s serious illness. As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, let us help. Give us a call at 1-800-897-3052, toll-free. You don’t have to do this alone.

What is a daily money manager?

What is a daily money manager?A financial advisor manages investments. A daily money manager (DMM) is someone who comes to the home once or twice a month to handle the mundane aspects of personal finances: Paying monthly bills (but your loved one signs the checks). Balancing the checkbook. Navigating health insurance claims. Resolving billing errors. Tracking donations. Organizing paperwork. Gathering documents for tax time. Their job is to catch unnecessary expenses while making sure important payments are made on time.

When to call in a DMM. If you are seeing piles of unopened envelopes or shut-off notices, that’s a sure sign extra help is needed. Many families bring in a DMM when the spouse who typically handled the finances dies, as the remaining spouse may find getting up to speed just too overwhelming. Or consider a DMM if your loved one needs help but no one in the family lives close by or has the necessary time or temperament. Conversely, there may be a person who seems a little too interested. The oversight of a DMM can deter a relative or “friend” from taking financial advantage.

Benefits. A DMM can help your loved one continue to live independently and still feel in control. They check for duplicate billings and missed payments. (You don’t want the insurance cancelled!) They can identify cost-cutting measures. For example, trim the cable plan or negotiate a phone plan that better fits actual usage. A DMM can catch unexplained charges on a credit card. Plus, they get to know your relative and can alert you if they notice problems, such as drowsiness or slurred speech. Perhaps bruising from a fall.

To find a DMM. Go to the American Association of Daily Money Managers. Ask about training, background checks, and professional insurance. And certainly, check on references.

Is paperwork getting neglected?
If you notice your loved one struggling with routine finances, it may be there are more serious issues at play. As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we at Iowa City Hospice can help you explore the root of the problem while also directing you to support services to keep the finances in order. Give us a call at 1-800-897-3052, toll-free.

The decision to stop dialysis

The decision to stop dialysis

Dialysis is life sustaining yet also quite taxing for the patient. About 25% of people who choose dialysis later decide to stop. Typically, this is because the burdens of this kidney disease treatment have severely reduced their quality of life. The tradeoff becomes no longer acceptable.

Ending dialysis is essentially a decision to let nature take its course. It means that death will follow in the near future. Patients make this choice to regain control of their life, even if only for a short while. This doesn’t end their being under a doctor’s care, but regular treatments and lab tests are no longer required. They can stop many medications, remove the access port, and eat a more enjoyable diet. Generally, they then have weeks of time to spend with family and friends—before growing weaker and sleepier, until they die.

Dying from kidney disease is typically peaceful and pain free. The discomforts can be managed. Most people choose hospice care. This includes weekly visits from a nurse and visits by a home health aide to assist with bathing. Social worker and chaplain services are also available.

If your loved one wants to stop dialysis, have them talk first with their health care provider. The dialysis team will want to know the reason. They may be able to adjust the treatment to ease difficulties.

If your relative remains resolved to quit, death is certain. They must have all affairs in order before stopping dialysis. This includes financial paperwork such as a will or trust, and a durable power of attorney. Also, a completed advance directive that names a health care decision maker and outlines treatments they do or don’t want when the end is near.

Rather than focus on shortened life, as a family take this time to express your love for each other. Enjoy the time you have left to make pleasant memories.

Is dialysis getting to be too much?
Hard as it is to ponder, for many there comes a time when the treatment is just too burdensome. As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we at Iowa City Hospice can walk beside you through this process. Give us a call at 1-800-897-3052, toll-free.

Learning to forgive yourself

Learning to forgive yourself

According to psychologist Rick Hanson, PhD, we all have an inner critic and an inner protector. Together they help us maintain a balanced perspective. But too often as family caregivers, we have an overload of guilt, shame, and remorse, always feeling our performance is subpar, that we haven’t done enough. This is not healthy. The inner critic has an important role, but it’s not to pulverize our self-esteem.

We all make mistakes. The goal is to use our inner voice to acknowledge errors, learn what we can, and move on—leaving personal scorn out of the equation. Consider this process for reviewing your mistakes:

  1. List your positive qualities. This is not self-flattery. This is calling in your protector to provide balance. What do you know in your gut others would say about you? Perhaps there are past actions that reflect your most stellar self. Take a minute to fully recall these attributes.
  2. Honestly assess the damage. List what occurred, factually. Then list your intentions. Then the results. Report the incident as a journalist might. If guilt tries to hijack you emotionally, make the shift from “I’m a terrible person”—attacking your character—to “That was not a wise decision.”
  3. What can you learn from this? Hanson suggests you sort your actions into three categories: Moral faults, simple unskillfulness, and everything else. For actions in the first two categories, make two lists:
    • “I am responsible for … .” Clearly, things you did or said. Give yourself a moment to let this sink in, not beat yourself up. But honestly own it. Neurologically, this helps “wire in” the learning.
    • “I am not responsible for … .” Another person’s action, emotional reaction, or misinterpretation of your intent. Pause. Allow any feelings of relief to settle in.
  4. Take action. Have you already begun to make amends? What more can you do to address the parts you are responsible for?
  5. Forgive yourself. When you have done what you can, look at the situation as if you were talking to a friend. At some point, once your friend has made the possible repairs and gleaned any life lessons, you would advise them to let go and move on. Give yourself that kindness as well.

Is guilt a too-constant companion?
That’s a sign that you are trying to do too much. As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we at Iowa City Hospice understand that caring for a relative is often more than one person can do alone. Let us help. Give us a call at 1-800-897-3052, toll-free.

The healing power of music


The healing power of musicCan listening to calming music actually ease pain? Can singing silly songs make you happier? Researchers say this isn’t just a folktale—it represents some of the measurable effects of music on the mind and body.

Although it’s not yet clear exactly how music works its magic, studies show that it is strong medicine, both in the moment and as treatment over time. Among the benefits, music

  • stimulates the brain. It can sharpen thinking and enhance recovery from stroke.
  • brightens mood. Music with a tap-your-toes, upbeat rhythm can ease depression, reduce anxiety, and create a more positive outlook overall.
  • calms the body. Music with a slower, gentler pace and melody can lower blood pressure, heart rate, and rate of breathing. It can even reduce the need for sedation in surgery.

Bringing music into your loved one’s life is simple.

  • Listen to prerecorded music. Tune in to a favorite radio station or play music by a familiar composer or band. Create a favorites playlist. Especially if your loved one has dementia (memory problems), melodies from the past will bring the comfort of familiarity.
  • Sing favorite tunes at home. If your loved one likes to sing, choose cherished hymns, folk songs, or popular tunes from your loved one’s past.
  • Experiment. Music is personal. Try different kinds of music, including soothing sounds of nature, and notice your loved one’s response. Happier? More relaxed? See what works for your situation.

You can also ask the doctor about music therapy.
Much like physical therapists, music therapists work to relieve pain or support physical or mental healing, which they accomplish by guiding patients through musical experiences. Music therapy is most often available in clinics, hospitals, rehab facilities, and through hospice. It may be covered by Medicare.

Are you finding yourself stressed as a family caregiver?
Caring for a loved one can be extremely stressful! As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we at Iowa City Hospice often receive a call when the family is just at the point of breaking. Don’t wait until you are in crisis! Give us a call at 1-800-897-3052, toll-free. We can help ease the load.

Dealing with criticism

Dealing with criticism

Receiving criticism is never a pleasant experience, especially from family members. Whether it is a sibling griping about how you care for a relative or complaints from the person you are caring for, you may feel suddenly flooded with difficult emotions. Perhaps anger, shame, or confusion.

We can’t stop others from giving criticism. But we can become wiser about how to deal with it. Try these tips:

  • First, pause. Criticism can feel like an attack. To avoid saying something you’ll regret, stall with a remark such as, “Hmmm. That’s an interesting comment.”
  • Then, explore. Without denying it or buying into it, get clarification. “Just to be sure I understand, you are concerned about how I ____ ?” or, “You would like me to ____?”
  • Consider what may be true. Is Mom’s checkbook actually a mess? Instead of crumbling in shame or being defensive, acknowledge what’s yours. That sets a mature tone. Say you’ll look into some solutions. Or ask them to join you in finding solutions. Do they have specific suggestions about what could be done differently? (Privately, remind yourself about all that you are doing well, too.)
  • Consider what may be theirs. Is your sister’s lashing out really deflecting her shame about doing so little for your mom? Or possibly your dad’s faultfinding represents his frustration with poor health. If so, disregard what’s unfair and let it go. Calmly acknowledge the comment by saying, “Gotcha, Dad. I’ll give that some thought.”
  • Maintain appropriate boundaries. Valid criticism focuses on something you’ve done, not on who you are. Meanness, such as being told, “You’re lazy,” is never okay. Set a limit: “I am happy to listen to feedback about how I do things, but not to judgments about me.”
  • Turn it into opportunity. Ask the person who is criticizing to help with solutions by sharing or taking on the task himself or herself!

Are you feeling unjustly criticized?
You would not be the first! As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, it’s sad to say that we at Iowa City Hospice often notice that the one who shoulders the biggest load gets the most “feedback.” It’s important to keep perspective and to set limits so you don’t get overwhelmed. Want some help with that? Give us a call at 1-800-897-3052, toll-free.

What is a Medicaid spend down?

What is a Medicaid spend down?There are two forms of government health insurance:

  • Medicare. Basically, age-based insurance for older adults (age 65+), regardless of income and assets. (Assets include money and belongings, such as a house or car.)
  • Medicaid. Income-based insurance funded with federal and state dollars. (The state where your relative lives may have a name different than “Medicaid.”) This insurance is for individuals who have very little means. The financial asset threshold is often set at $2000 or less.

Medicaid will sometimes pay when Medicare will not.

The most common expense covered by Medicaid is long-term care in a nursing home. Speaking very generally, Medicare pays for the first 100 days after a hospitalization. If a person needs to stay longer—permanently move into the facility—they must cover the cost from their own savings. Once nearly all their resources have been exhausted, they can apply for Medicaid, which will pick up the tab.

How to become eligible for Medicaid

Essentially, one needs to eliminate assets. Paying for care will certainly do that! For many, it’s tempting to dole out early inheritances in an attempt to “spend down” assets. Perhaps by giving the house to their children. Or passing their savings accounts to grandchildren. Beware! The government will look back for asset transfers in the past thirty months to five years. (It varies by state.) Persons deemed to have spent down by gifting are disqualified from Medicaid for an extended period of time. There is no wiggle room on this.

Get legal advice before taking action!

Spend-down restrictions vary by state and are astoundingly complex. If you think that Medicaid will be part of your loved one’s financial strategy, consult an elder law attorney immediately! It’s never too early. There are ways to protect assets, but they require planning and attention to detail. There are too many pitfalls to try this on your own.

Has Medicaid been your fallback?
We at Iowa City Hospice have seen many families be surprised to learn what Medicare will not pay for and how difficult it is to qualify for Medicaid. As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we urge you to begin discussing the options with legal counsel now. Need a referral? Give us a call at 1-800-897-3052, toll-free.

Iowa City Hospice