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Methodist leader John Wesley urged: “Do all the good you can, by all the means you can, to all the people you can, as long as you can.” In Ethics of the Fathers, sage Rabbi Hillel asks rhetorically: “If I am not for myself, who is for me; but if I am only for myself, who am I; if not now, when?” Here are two different faiths espousing the same basic admonition: care!

How much more prescient could the comments be than in November, National Caregivers Month? The National Family Caregivers Association (NFCA) claims we’re “quickly becoming a nation of caregivers, tens of millions of us caring for disabled, chronically ill, or aged family members or friends. As is any relationship, it’s complicated.

For example, on the one hand, disabled people who hire attendants are bosses, signing paychecks with the right to hire/fire. Conversely, they often become physically dependent on the caregiver for basic human survival: food, oxygen, bathing, toileting.

Celebrate 
NFCA explains that each year the president proclaims November as National Family Caregivers Month “to thank, support, educate, and celebrate more than 50 million family caregivers providing nearly $306 billion in ‘free’ care giving services.” This year, the focus is on caregivers “speaking up for their rights,” a time to “advocate” for stronger public policy on care giving issues and awareness about community programs supporting caregivers.

Some organizations endorsing National Caregivers Month are: ALS Association, Alzheimer’s Association, American Academy of Nurse Practitioners, American Academy of Physician Assistants, Christopher and Dana Reeve Foundation - Paralysis Resource Center, Disaboom.com, Huntington’s Disease Society of America, Lupus Foundation of America, National Association of Councils on Developmental Disabilities, National Bone Marrow Transplant Association, National Multiple Sclerosis Society, National Organization for Rare Disorders, National Pain Foundation, Paralyzed Veterans of America, Rosalynn Carter Institute for Care giving, United Cerebral Palsy, and Well Spouse Association.

At the Family Caregiver Alliance, the view is that most older persons with long-term care needs—“65 percent—rely exclusively on family and friends to provide assistance. Another 30 percent will supplement family care with assistance from paid providers.” In our complex long-term care system, “women’s care giving to spouses, parents, parents-in-law, friends, and neighbors is essential in providing a backbone of support.”

Long-distance 
Then, factor this in: a National Council on Aging (NCA) message for baby-boomers is, “You’re going to do much of your parents’ care giving yourself, often doing it long-distance. If you’re an older woman caring for your husband, you have a good chance of winding up poor and alone.”

"Family care giving is going to mean the disruption of people’s lives,” claims Emily Friedman, a Chicago health policy analyst. She sees 20 percent of women caregivers under 65 sans health insurance, 46 percent with a chronic condition themselves, and 50 percent in households with less than $50,000 annual income. Friedman and others envision an ugly “Catch 22” for women: they tend to be poorer and in greater need of money in later life and are less able to leave the workplace in their 50s and 60s. They must do that to be caregivers. When women become caregivers, they are 2.3 times more likely to “end up living in poverty.” Cindy Hounsell, executive director of the Women’s Institute for a Secure Retirement, told the Philadelphia Inquirer.

As a society, we’re “totally unprepared” for America’s aging, warns James Firman, NCA president. We have “our head buried in the sand” and the whole healthcare system is “out of whack in every way.” Worse, research from Ohio State University and the National Institute of Aging shows the chronic stress spouses and children get caring for Alzheimer’s patients may shorten caregivers’ lives four to eight years. The findings in the Journal of Immunology are the latest from a nearly three decade program at Ohio State investigating links of psychological stress and a weaker immunity.

Feeling SAD
Also this month, disabled or caregiver, if you notice your mood, energy, and motivation nosedive each November only to return in April, you may have Seasonal Affective Disorder (SAD), Loyola University Health System doctors contend. SAD is characterized by depression, exhaustion, and zip interest in people and regular activities. “It interferes with a person’s outlook on life and ability to function properly,” says Dr. Angelos Halaris, chair of Loyola’s department of psychiatry and behavioral neurosciences.

Not to despair, because this “most common type of mood disorder occurs during the winter months,” adds Dr. Halaris, professor of psychiatry at Loyola’s Stritch School of Medicine in Maywood, Illinois. “SAD is thought to be related to a chemical imbalance in the brain, brought on by lack of light due to winter’s shorter days and typically overcast skies.” He observes that bright light affects brain chemistry in a helpful way and acts as an antidepressant. “With less exposure to light in the winter months, many people become depressed. Those susceptible to SAD are affected even more so.”

“SAD can be treated effectively with light therapy, antidepressant medication, and/or psychotherapy,” Dr. Halaris maintains.

Team effort
AARP helps on care giving, urging that “without a plan, your financial future and the welfare of those you care about are at serious risk. No government agency or private organization is going to take responsibility for your family’s well-being.” So it offers a checklist:

• Prepare yourself. How do you discuss with loved ones their wishes and how your family could support them through a serious health crisis?
• Form your family care giving team. Figure out who can help and how.
• Make sure all the players discuss their responsibilities as part of a family care giving team.
• Go over goals. Get the team together to lay out a plan.
• Have loved ones guide the talks around their needs and wishes.
• Agree on and write out a general plan and gather important information.
• Locate, organize, and regularly update documents, contact data and other materials the team would need in a crisis.
• Find key resources or professionals to make the best decisions.

NFCA has 10 tips for family caregivers: Reward yourself with respite breaks often; watch out for signs of depression and don’t delay in getting professional help; when people offer to help, accept it; educate yourself about your loved one’s condition and how to communicate effectively with doctors; be open to technologies and ideas that promote your loved one’s independence; trust your instincts; caregivers often do a lot of lifting, pushing, and pulling—be good to your back; grieve for your losses, and then allow yourself to dream new dreams; seek support from other caregivers, and  stand up for your rights as a caregiver and a citizen.

Come together
You might consider the Fearless Caregiver Conference series held nationally in the “belief that dialogue between all parties involved in care giving not only provides valuable education for caregivers but also allows them to realize they’re not alone.” Topics cover finding help for new caregivers, financial, legal and insurance issues, preventing senior scams, taking advantage of community resources, learning to increase family involvement, time-off techniques, and beating stress and depression. Gary Brag, an author on care giving issues, says the series was created so “family caregivers can come together for a day designed just for them.”

Plus, while you’ve probably heard of Vince Lombardi, the famous Green Bay Packers football coach, have you heard of Marcia Melnicoff? She and others like her actually are much more important and deserve all the recognition they can get.

“Ask yourself: What do you want more of in your life; what do you want less of in your life? What are three things you do regularly that don’t support and increase your satisfaction?” That’s what Melnicoff, the Plymouth Meeting, Penna.-based “caregiver coach,” asks her clients.

Balanced
She asserts that when you hire a coach, you make an investment of your time, energy, and resources. “You take yourself more seriously, gain greater clarity, set better goals, and take effective and focused action, immediately. You stop making choices that limit your growth, stop tolerating what drains you,” she adds. “Coaching deals with the present and takes what’s inside and translates into outer goals. The coaching alliance focuses on action, accountability, and follow-through to support capable individuals in making desired changes in their life.”

Every caregiver’s personal needs vary, she says. “Your needs may range from emotional, physical, and spiritual to help with practical day-to-day tasks. A coach can help you identify your challenges and support you in setting objectives to address them. A coach reminds you of the importance of taking time for you.”

In his wheelchair, Jacksonville, FL resident Herb Drill heads Able Me & Associates. His e-mail address is herbdrill@ableme.com.