New Years Resolutions for Caregivers

A very Happy New Year to all! I have been off the grid for a while - again 'life' happened and I was side-tracked. One of my New Year Resolutions is to get back to posting. Thanks to all who seem to continue checking in with the blogs and thanks to some new people who joined/decided to follow. While we all make personal resolutions, which is a good thing, one thing to think about is making caregiving ones too. Whether it is to check on some family member or friend more often, pitch in some more to help, make changes to a home to make it safer for an elderly parent(s), now is a good time to start thinking.

Right now my husband and his brother and sisters are working to help their parents stay at home one way by trying to get them more organized: from a large desk sized calender to use for any appointments or calls to be made, to seeing if there is a way to get an apartment sized washer/dryer on their first floor, and hiring someone to do a 'cut out' in their bathtub, to make it more of a walk-in shower. This we did for my mother in her place. It was less expensive and invasive than taking out her tub/shower and putting in a walk-in. While we can all include grab bars and mats and ramps in our lists, Caring.com suggests 7 designs to help people 'live in their house forever'. They talk about 'universal design', products and features for use of anyone regardless of their physical limits. These came from the Center for Universal Design at North Carolina State University which is a resource for useful designs for anyone of any age or ability or disability.
* Design that is equally appealing to all users: "wherever possible, universal design creates spaces that can be used by everyone equally and that are appealing to all. UD doesn't stigmatize any one group of users -- like those obvious wheelchair ramps tacked onto the fronts of older homes."
For example - a no-step entry, a lever-handed front door (no knob), mirrors placed where you can be seen in them sitting or standing, no changes in floor levels.
* Flexible use: accomodates for left and right handed people and a variety of uses. Have at least one bedroom and one bathroom on the main floor (even if it starts out as a playroom or storage room), possibly a laundry area too. Use paddle handled handles in the sinks, a small rolling cart to use, pull out boards in different spots in the kitchen to help with cutting (if possible put them at different heights to accomodate someone standing or sitting), pocket doors to use less space.

* Simple and intuitive use: things that are easy to figure out. D-shaped drawers, smart shower handles, install lazy susans in areas that are hard to reach, use adjustable shelving.
* Presents essential information clearly: information can be easily received through sensory, tactile, or pictoral means. Keyless locks that use a remote control or pad, appliance controls that use words as well a pictures (like blue for cold, red for hot), a circuit breaker on the main floor that is clearly marked, smoke detectors and carbon monoxide alarms should verbalize the situation as well a show an alarm.
*Allow for user errors: install grab bars, handrails, there are also curbless showers, floors made of non-slip materials, rugs that are low-pile and tightly woven like Berber, spring loaded switch for garbage disposals that has to be held so no hands or forks get in there, contrasting edge on counters for those with visual problems - these corners should also be rounded.

* Requires low physical effort: you should not have to contort yourself or use alot of effort. Use a rocket panel light switch, switches and controls are placed at easy to reach heights like 42 - 48 inches from the floor, thermostats should be installed 48 inches from the floor, electrical outlets and phone jacks - 18 to 24 inches off the floor, mount kitchen outlets and garbage disposal controls on the counters, use raised front loading washers and dryers.
* Appropriate size and space use regardless of body size or mobility. No matter what your size or posture or mobility or intellect you should be able to use the area and equipment. Open floor plan with 5 1/2 foot halls, a variety of work surface heights, fold back doors under a cooking island for those in a wheelchair or step stool, wall mounted sink (drain at the back) with open space below for those in wheelchairs, raised or adjustable toilet seats, a moulded seat in the shower stall.
I am sure if you go through someone's house you can come up with different ideas to make the space more useful to those inside. Get creative.

Elderly parents need caregivers to protect them against telephone scams.

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(picture from Clipart) Oh that all familiar sound, especially at dinner time! We all get it, most of us avoid it. Deep down inside, all of us know it is just someone doing their job - calling to see if we need something or want to donate to some charity, lower our mortgage, get a better credit card rate, the list goes on. Unfortunately though, not all callers are legit. The news in our area has been ripe with telephone scams, mostly aimed at the elderly. So what can you do to help your parents?
Sometimes the elderly will answer a call and keep talking because the other person is 'nice' and they don't want to be rude. Mom would do this sometimes. Unfortunately, the longer they talk, the better chance the caller has to get your elderly parent involved in their 'deal'.
'Fraud.org' has a webpage to help you educate your parent on what to look for in a call, to determine if it is fraudulent. One is to remind them that not everyone is just trying to make a living - there are actually people out there trying to take their money, that free prizes or gifts are not always available, easy money is not easy. Here are what they consider to be the red flags:
•A promise that you can win money, make money, or borrow money easily;
•A demand that you act immediately or else miss out on this great opportunity;
•A refusal to send you written information before you agree to buy or donate;
•An attempt to scare you into buying something;
•Insistence that you wire money or have a courier pick up your payment; and
•A refusal to stop calling after you’ve asked not to be called again.
Seniors should also be reminded that:
•It’s illegal for companies that operate contests or sweepstakes to ask you to pay to enter or claim your prize or even to suggest that your chances of winning will improve if you buy something;
•It’s illegal for telemarketers to ask for a fee upfront to help you get a loan if they guarantee or strongly imply that the loans will be made;
•There is no reason to give your credit card number or bank account number to a telemarketer unless you are actually making a payment with that account; and,
•If you have to pay first before getting detailed information about the offer, it’s probably a scam.
Check mom and dad to make sure that they do not:
•Receive lots of mail for contests, "free trips," prizes, and sweepstakes;
•Get frequent calls from strangers offering great deals or asking for charitable contributions;
•Make repeated and/or large payments to companies in other states or countries;
•Have difficulty buying groceries and paying utility and other bills;
•Subscribe to more magazines than anyone could normally read;
•Receive lots of cheap items such as costume jewelry, beauty products, water filters, and knick knacks that they bought to win something or received as prizes;
•Get calls from organizations offering to recover, for a fee, money they have lost to fraudulent telemarketers.

What to do to help? Put their number on a do not call list and do the same for their cell phone number. Check their bank and credit card statements. Screen calls. Learn how to hang up.
Robocalls are similar; these are recorded messages, usually shows 'unknown' for a number if you have Caller ID or 'spoofed'. Of course, these are easier for people to hang up on. 'SeniorSavvy.org' also suggests registering your phone number with the National Do Not Call Registry @ 888-382-1222. Do not press any numbers prompted, even to disconnect, since that will tell them that this is a good number and they will continue to call. You can also check with Nomorobo to see if they can help you get their number off the list. If your parents seem to get a lot of calls, someone can keep track of those calls with a form from 'Fraud.org' - that way if you need to pursue some type of action, you will have a record. Click here for the form.

Some thoughts for the end of the year.

End of Year Thoughts:

The end of the year, as we look toward a new year, time to assess what the year has brought us: what happened and what we did about it as well as what we need to do again or change in the upcoming one. Our family situations change, health needs change (sometimes even mental health needs), legal responsibilities change. Maybe it is time to talk to a legal professional.

If you choose to speak with an attorney, make sure you find one who is versed in the type of legal issues you need help with: elder care or special needs child, healthcare Power of Attorney or Social Security -- you get the picture.

On ElderCarelink there is a page on the link - 'Ask the Expert Elder Law Page'. The article shows things to discuss (some of these pertain to both categories of those we care for):

*estate planning
*Medicare/Medicaid
*elder abuse
*age discrimination
*guardianship

As I mentioned, some of the above can pertain to our special needs children. You may want to check out the U.S. Department of Education site and see if anything can help. Laws vary by state but you may see something there that can help. Talk to their teachers too - they can put you in the right direction.

Most of all remember - as I remember being told when I was growing up: 'the only stupid question is the one not asked'.

Ask for Help:

Short and Sweet -- As we all run around preparing for Christmas, Hanukkah, or any other holiday you may celebrate, anyone will tell you - make sure you take time for yourself, care for YOUR emotional and physical well-being. You can't help others if you are not feeling well. ElderCarelink offers 2 ways to help reduce the stress, which I am sure everyone is aware of.

*Hire in-home care to help with transportation, meals, housekeeping, companionship, and personal care.

*Adult care services so your elderly parents too can stay active and be with their peers.

Simple and easy solutions that caretakers should take advantage of. Don't feel bad about wanting to take time for yourself to go to a party or shopping or get your hair done or out for lunch with friends you haven't seen for awhile. You know what?? Sometimes your loved one enjoys time doing something different with someone else, talking about the 'old days', remembering 'the big band era', or what their family used to eat during this time of year -- all the stories WE have heard so many times. It's different with others - a new audience, so to speak. It can be a better thing all the way around for everyone involved.

In a sense, this can also go for help with your special needs child. Use respite care to step in if you need to go out. Depending on the child, he/she might not like all the hustle and bustle and loudness of shopping and parties. Respite care through a variety of agencies can help. There may be teachers or teacher assistants who can help too. I know some of Willie's teacher assistants do this. When mom passed away, Willie's Special Olympics coach stepped in to watch Willie at the funeral home during the wake hours. We wanted him nearby with the family but knew he wouldn't sit or stay still for a long time; so his coach graciously stepped in to stay with him and wander or go out to the car for a time, go to the bathroom -- whatever he wanted to do, It was such a GREAT HELP. I can tell you - use your resources; the guilty feeling goes away in a short time!!

Feeling like the walls are caving in? Need help with remembering?

The holidays are here, again. So on top of a caregivers regular 'to do' list, comes the errands of buying gifts, writing cards, going to school plays or musicals, decorating the house or houses, etc., to name a few things. Most people automatically assume when you talk about memory issues, you are referring to an elderly parent or family member. Any caregiver worth their salt, will say it is not so. It is a pretty good assumption that the brain will get fried to a certain extent during this time of year. Some families have helpful other family member and friends; some families have to go it on their own.

According to AARP, there are memory boosters. Not only are they good for the older member of the family, but will be good for those caregivers who may be 'sandwiched'.
Check out these 8 memory boosters from the site: 1 - lift weights - In one study of 65- to 75-year olds with normal cognitive function, women who exercised for an hour once or twice a week, using dumbbells, weight machines and other calisthenic exercises significantly improved their long-term mental focus and decision-making. The control group — which did not see the same brain benefits — did "balance and toning exercises" including stretching, range-of-motion. Another study, of 70- to 80-year olds with mild cognitive impairment, showed cognitive improvemet among women who did either resistance training or aerobic exercises. Men weren't included in that study, but other research involving both genders finds that strength training helps preserve or improve memory.
2 - laugh - A hearty laugh provides short but similar benefits of aerobic exercise for improved heart (and brain) health and immunity. Other benefits: Laughter elevates the production of neurotransmitters linked to improved memory and alertness while decreasing stress hormones that can cloud thinking. And when listening to jokes, as you wrestle to understand the punch line, areas of the brain that are vital to learning, creativity and decision-making activate, much as they do when working out

"brainteaser" crossword puzzles and Sudoku.
3 - take a nap - In addition to improved daytime alertness, good sleep — night after night — helps keep memory and learning well-tuned. But even with Rip Van Winkle-like nocturnal habits (and certainly without), consider a regular afternoon nap for about 90 minutes. It costs nothing but time — and the payback, according to studies, could be significant. Compared to non-nappers, those who partake in daytime zzz's display measurable improvements in tests gauging decision-making, problem-solving, creativity and even tasks like recalling directions.
4 - meditate - Studies find that daily meditation can strengthen connections between brain cells, increase growth in the part of the brain that controls memory and language, and may even bolster the ability to process information and make decisions more quickly. There are various forms of meditation, but most involve spending 15–60 minutes — best if done at least once a day — of focused attention on a word, object, sound or even your own breathing.
5 - rate your plate - Grains like oatmeal, brown rice, barley and quinoa supply energy to the brain, which may boost learning. Nuts and seeds — including low-cost peanuts, sunflower seeds and flax — are loaded with vitamin E, which helps combat cognitive decline as you age. Blueberries, cherries, raspberries and red grapes contain antioxidants to feed brain areas responsible for memory and learning (apples, bananas and oranges are also good). Spinach, tomatoes, onions and asparagus are vegetable standouts. And while salmon remains supreme, less expensive fish — also rich in omega-3 fatty acids — include tuna, sardines, anchovies and mullet.
6 - step lively - Just walking briskly — no equipment necessary — cuts your lifetime risk of Alzheimer's disease by half. So does most anything else (including money-saving DIY gardening and housecleaning) that gets your heart pumping for at least 150 minutes per week, ideally for 30 minutes or longer per session. Why? Boosting heart rate improves blood flow to areas of the brain involved with memory, learning and decision-making. Hint: Studies find a walk in the park boosts energy, focus and well-being more than indoor exercise.
7 - socialize - Take a free class at the local library. Volunteer. Make use of Facebook. Or just hang out with friends. Any of these no-cost activities reduces the risk of dementia and slows or prevents cognitive decline. Theory: Social engagement means mental engagement — talking or just being around others requires focus and attention to details (while combating loneliness, itself a risk for dementia), and some research suggests even brief but regular social engagement bolsters memory, self-awareness and the ability to not be easily distracted.
8 - brush & floss - For just pennies a day, good oral hygiene can help prevent gingivitis and gum disease. Most people know that inflammation in your mouth has been linked to heart disease; what's less well-known is that gingivitis has also been linked to several cognitive problems, including declines in memory and verbal and math skills. More serious gum disease boosts the risk of memory problems as much as threefold (plus factors into stroke, diabetes and heart disease).

Also some quick mental workouts:
1) Play a brain game

2) Don't retire
3) Make musice
4) Pay attention
5) Do a jigsaw puzzle
6) Go back to school
7) Take a tech brake
8) Get a library card

Similar information is offered by Fox News from a study that was done in 2002 - 2003. It was recently published in the British Journal of Medicine acknowledging that physical activity not only helps cognitively but a seniors physical well-being, to boost healthy aging. Thank you + Caring for Aging Parents and their post from Securus GPS on Nov 26, 2013 for mentioning this Fox News article.

Gobble & Fa-La-La - 'Tis the Season to Get Stressful !

Ok - so you have your own stash of candy carefully hidden after Halloween, in a secret place where you can get sugared up and find nirvana at the same time. The wine has been carefully chosen (the story is that you want to sample some wines early so you can plan the Thanksgiving Day dinner in advance and make it the 'best day ever'). Phineas & Ferb would be so proud! The bottle of aspirin or ibuprofen is handy, has been since the creation of those superhero or princess costumes or the running around for the perfect 'look'.

Caregiver to caregiver - we know the real story!!! Down the homestretch, we see the next 2 holidays wherever we go. Between the foods and dinner ideas to the decorations and reminders of gift lists, we start to get bleary-eyed. OH BOY - how many directions can I get pulled in this year!!
As much as we like to handle things ourselves, to make sure things get done 'right' or 'just the way mom or dad likes it', we as caregivers need to let others into our world and help.

The Sams Club November/December 2013 Magazine has an article on 'Seasonal Stress' written by Michele Mongillo, RN, MSN. It acknowledges all the stressors that affect families: gatherings to plan, buying gifts, cooking for groups, organized activities. Of course all these are on top of the normal everyday, more personal tasks that need to get done for our elderly parents or special needs child. Michele has what are called 'tools and tactics' you can use to help relieve the stress.

*** COMMUNICATION: open the conversation with other family members about limited time to participate in some activities. Ask for help so you can accomplish your own tasks. When you send holiday cards, put in a note to say your time may be limited due to caregiving. Suggest other family members have the family meal at their home. Sometimes people are waiting to be asked to help, they may not want to intrude on your privacy.
*** PREPARATION: shop online for gifts or save catelogs that come through the mail so you can identify presents and go straight to the store to get them thus saving time wandering. Cook or bake things that can be frozen ahead of time. Check your calender for those days you need time off and ask a friend or family member to help. If that can't be done, try a local agency.
*** ENJOYMENT: make a choice and find a holiday tradition to 'keep' and let some others go; focus on those to make them memorable for all. Take time for yourself - exercise, get a massage, take time to slow down and just enjoy your loved one.

These next months need to be enjoyable for all. They can be with a little planning and recruitment from friends and family to stop in for a 'visit' so you can leave. Lastly - don't forget where you put the candy and wine. I'm not sure how much it helps at times but it certainly can't hurt in moderation.

Concerned about your parents nutrition?

(Picture from Seniors List site) I found an article on Seniors List website called
' Nutritian and Hydration in the Elderly'. For those of us with older parents, we can all attest to the fact that their eating habits change. They want to eat less so we worry about their health, will they lose too much weight. If there is an illness, how does that impact their eating or drinking, are they focused too much on their condition? Is the condition the problem - with dementia or Alzheimer's they may forget to eat or drink. Sometimes incontinence is an issue. I know with mom, she would watch her drinking or fruit intake to stop her from going to the bathroom every couple of hours, especially if we were traveling or had to drive a long distance. 'Seniors List' mentions some things to investigate to see if you can find the root of the eating and/or drinking problem.
* Has there been a swallow study (Modified Barium Swallow) done to rule out a physical problem which makes swallowing difficult?
* Are ill-fitting dentures or poor dentition to blame for a decrease in eating?
* Is there a fear of drinking or eating because of problems with incontinence?
* Is depression a factor?
* Are medications to blame?
* Is dementia a factor?
* Is a decrease in appetite the result of a terminal illness?
Mom had issues with a couple of these - incontinence and dentures. So we adjusted her drinking with what we were doing. For her dentures, she would take them out before eating, we would cut up food in small pieces or shred it, eat more things like applesauce and yogurt. One time a dental hygienist told me that when older folks start losing weight, it affects their mouth and dentures will not fit properly. The 'Seniors List' site also lists questions caregivers need to ask if thinking about alternative nutrition methods. They are:
* Will alternative nutrition/hydration improve nutritional status?
* Will alternative nutrition/hydration decrease the risk of disease or prevent disease?
* Will alternative nutrition/hydration help to increase life expectancy?
* Will alternative nutrition/hydration improve the quality of life?
* Is alternative nutrition/hydration a short-term or long-term intervention?
* What are the risks involved with alternative nutrition/hydration?
* Are there any considerations if alternative nutrition/hydration is provided, but there is a "change of heart"?
So it is important to make decisions specific to the parent's condition and other medical concerns. People need to talk to their healthcare professional for advice.

Practical Tips from Caregivers.

I was looking for something on Caring.com and came across some tips offered by caregivers for caregivers. They are wonderful ideas that are easy to put to use, practical, and will not make the elderly parent or family member feel awkward. They are...

(picture from Caring.com)

Parkinson' Nighttime Safety: "My mom has Parkinson's and lives with me, but I still worry about her getting up in the middle of the night to use the bathroom. So I bought one of those push lights that stick to the wall for her room. Then I cleared out a space in her closet and put a potty chair in there. At night, I bring the chair out and set it by her bed. She likes that she doesn't have to walk far from bed, and I get a better night's sleep." -- Kate, from Alabama City, Alabama

Keeping Up With Dad: “Dad tends to wander off into parts of the house or yard without telling me, so I bought a carabiner clip and put some old keys that I don’t use any more on it. It’s like a cat’s bell that I can hear (but it isn’t insulting), and even though he no longer drives I think he likes having keys. He even wears them now when we go to the store. I can hear him three aisles over.”
-- Thomas, from Castle Rock, Colorado

Lullabies for Mom: "Mom needs to go to bed earlier than I do, but she doesn’t want to stay back in her room alone. I moved an old alarm clock that has a CD player in it into her bedroom and bought some music she likes -- Doris Day and Rosemary Clooney. Now I hear her singing herself to sleep." -- Janie, from Port Joe, Florida

A Collection of Scarves: "Mom’s hair is really thinning, and she’s quite self-conscious about it. She doesn’t want to wear a wig or a hat, but she has taken to scarves and has just a little bit of her hair fluffed out the front. We’ve started collecting them wherever we go: antique stores, nearby small towns. Now she’s known as the scarf lady, and people give her scarves as gifts."
-- Kathleen, from Augusta, Georgia

Read more here.

Alzheimer's & Eating.

(picture from Sams Club site) In reading our copy of 'Healthy Living Made Simple' from Sams Club, the September/October 2013 edition, I found they offer some advice about meals.

While I have not found this magazine online yet to refer to, I thought I would share an article in it titled "Alzheimer's and eating: a unique burden", by Michele Mongillo, RN. All of us have heard how this disease changes people - their behavior, memory, thinking. It affects daily life. Nutrition can be an issue; we have all heard that certain foods MAY slow it down, there is no fix. But the article states, that it is best if the elderly person can eat a well-balanced diet - to stay strong and maintain a healthy weight. Of course, there is always the fact that your family member may not remember if they ate - been there!!

The article says that if you are the one planning the meal, try to offer a wide selection of fresh fruits, vegetables, whole grains, and lean proteins. Cut the food into bite sized pieces -- makes it easy to pick up with a utensil or fingers. Plus it makes the food easy to chew and swallow. Allow foods with high water content (since they may not drink enough) like soups, fruit, & smoothies. If the person has visual issues, there may be problems distinguishing food on their plate -- limit the amount and types of food being served. Even if it is a favorite, they may not recognize it. Here too, it may be helpful to avoid dishes, tablecloths, napkins that have a busy design.

If you are going out, places with a lot of noise might be too distracting, so choose one with a quieter atmosphere. If at home, eat meals without the radio or TV.

Some of this may be trial and error. From personal experience now -- if there are any other medical issues, you may want to talk to your doctor or dietitian. Mom had to have low-sodium foods, she had a heart condition and high blood pressure. I had to watch her potassium intake (among other things) with her being on dialysis. We had to change from her favorite drink, Ensure, to Nepro (which she did not like as much but we found ways to doctor it up). Several talks with the dietitian at the dialysis center, and many handouts later, we were able to shop for foods and herbs to make things taste better.

I did find a similar post on the Alzheimer's Association website. Read here.

5 Issues That Caregivers May Come Up Against.

Caring.com wrote about 5 things that can sabotage a family caregiver and possible solutions. All are things that you hear people talk about constantly; things that I too came up against. Being an only child, I found it hard sometimes to find someone to take my place with mom -- my boys were teenagers, with one being special needs, so they found it uncomfortable when they would stay and have to POSSIBLY contend with a bathroom issue. They were good with the helping of snacks or the extra hand or arm to move around but the fear was there for personal toileting. Needless to say, I never wandered too far. I had a couple of female friends who could help, but they had their own family issues.

Anyway - back to the Caring.com story. Here are the 5 issues that 'can sabotage family caregivers':

1 - lack of privacy: there is mental and physical privacy. There should be spots to go to for personal time and time for the rest of the immediate family outside of the person/parent you are taking care of. This may be hard to do if the parent/person is living with you. Also if this person has dementia or Alzheimer's, there are times when the loved one may do inappropriate things due to the his/her mental status, disinhibition. Possible solutions?? If possible, the live-in person may be able to have his/her own space to sleep, watch TV, or make household rules for using TVs, radios, the kitchen, etc. Make sure you make time for your own immediate family (the parent or whoever does not always come first) and make sure you still take vacation time - use respite care or other relatives to share in the caretaking. If there is a problem with disinhibition or aggression, use locks or check with the physician to discuss medications or ways to help with these issues. Depending on how serious these become and the safety of the rest of the family, you may need to consider placement.
2 - sleep deprivation: for the live-in elderly family member or the caregiver, this can be hard on everyone's mental and physical health. The elder whose sleep issues are addressed will experience better mood, more energy, and less pain; sleep is closely connected with all three conditions. And the caregiver who makes his or her own sleep a priority will be better able to cope with caregiving stresses and will have more energy for every part of life. Possible Solutions?? No stimulating beverages, electronics, have a dark and quiet room with a bed. Check medications with a doctor. While a mixed-up sleep cycle is NOT normal for aging, it may be an issue with dementia.
3 - the lone soldier syndrome: a lot of people feel like they are on their own, without a way to 'vent' or be themselves. Possible solutions?? Needing other people to help is NOT a sign of weakness - ask!!Join a caregivers group either through a local organization or online. See a counselor if you find yourself depressed. Finally - again - find ways to get time for yourself on a regular basis.
4 - not anticipating what is coming next: you need to step back and see the big picture and not just handling issues as they come uup. Possible solutions?? Make contingency plans - if this happens, then that should happen. Make a list of people or organizations to contact if you need an answer. Talk to your parent's doctor about their condition and what may happen down the
road; ask others who done the same thing. If there is dementia, check Caring.com program for advice. Consider a support group.
5 - overwhelming care tasks: heavy lifting, incontinence, and wandering take their toll. Possible Solutions?? Check with your parent's doctor for possible help with incontinence. Find locks, alarms or ways to reduce anxiety for wandering. Get help in the home and brainstorm with others for ways to solve your issues. Don't feel guilty if you are thinking about placement out of the home.

Think about your issues and I hope that some or all of the above can help or lead you to help.

Managing Incontinence.

(picture from NAFC site)

According to the article in the recent July/August Healthy Living Magazine from Sams Club, the types of incontinence are stress, urge, reflex, overflow, functional, & mixed. The National Association For Continence can help you understand what type you may be dealing with. The first step in helping someone with this problem is to acknowledge it. Hold private conversations with your elderly parent or whoever you are taking care of if you suspect the issue - they may be too embarrassed to talk about it. Mom was pretty open with me and we tried to make time for bathroom stops, extra time to leave home or wherever we were, making sure we took 'extra supplies' - just in case. You have to be patient and supportive.

A clinical nurse, Michelle Mongillo, who wrote the article has tips for managing incontinence:
.. prepare a clear path to the bathroom -- remove clutter, furniture or rugs.
.. assemble sturdy arms or rails to assist the person getting out of bed or a chair. Mom had bed rails that she loved!!
.. provide adequate lighting and night lights.
.. dispense adequate fluids so urine will not become concentrated and irritate the bladder.
.. establish a pattern to take the elderly parent to the bathroom, start at 2 hour intervals.
.. supply incontinence products that correlate with the problem; the smallest/most minimal will be more dignified for the wearer. Try various brands and sizes -- it took mom a few tries until she found the ones that fit the best and were comfortable, without showing, under her slacks.

If you have any concerns, the NAFC site has an online forum that will provide resources for you.

Respite Care - A Service That Could Be Used More.

(picture froma Place for Mom website)
With summer coming fast and schools closing for a break, families are thinking about vacations. Many families can just leave when they have their vacation weeks and not think too much of it. Now there are many families that have someone who is a caregiver, usually for an elderly parent, and they cannot leave as easily as they could before. Sometimes the parent(s) can still travel so that can be both a blessing and a daunting thought since now the caregiver has to pack and plan for an extra person who may have medical needs and may not move as fast as the rest of the family. Mom traveled with us when she was slowing down and we just had to plan differently -- like how many more bathroom stops will it take us and how much longer the trip will be, making sure she had all her medication, taking doctor phone numbers, etc. Frank is hoping to take his parents to a family wedding out-of-state soon; he now has to plan for extra luggage, stops, possibly a type of handicapped lodging, handling medications, doctor information, etc.
"A Place for Mom" states that:
According to the Center for Disease Control caregivers often pay a high toll for their labor of love:
35% of caregivers have difficulty finding time for themselves.
29% experience emotional and physical stress from their role.
54% said their health has gotten worse due to caregiving, and has affected their ability to give care.
29% have difficulty balancing work and family responsibilities
Studies from the National Alliance of Caregiving and AARP show that a lot of caregivers do not want to say they need a break, only 12% of caregivers take advantage of this. California State University San Bernardino designed a questionnaire to see if someone needs a break.
Sometimes assisted living communities offer respite care - both long term (vacations) or short term (enough time to run errands). Not only is this good for a change but now you have the opportunity to check out communities should your loved one need to move into a more secure location. The National Respite Network suggests that caregivers take this service earlier than later, that it is best to take advantage of this before becoming overly stressed or tired. "Respite will be most helpful if you use it before you become exhausted, isolated or overwhelmed by your responsibilities.” You can also use respite if the main caregiver falls ill, business travel comes up or some weather type of factor.
Communities already offering respite care say that they try to make it easy for someone to sign up and take advantage of the service - usually short forms or a package that is easily filled out.
Of course, you can always contact "A Place for Mom", "A Place for Dad" (the same as mom) for help.

Caregiving Skills.

(picture from the FCA website) I was thinking about my in-law's (both 91) and their situation as they help my father-in-law get back on his feet after some hospital and rehab stays. As they get visits from the Visiting Nurse Association (VNA) and their physical and occupational therapists ( PT and OT) to work with them, it reminded me of what the VNA did for mom and showed me how to help her with different aspects of daily life. I came across some tips on the Family Caregiver Alliance website that bears sharing. It has some great ideas on how to handle your elderly parent or whoever you are taking care of. I will copy it directly here because I do not want to miss anything.

**Approach from the front and retain eye contact. When assisting someone physically, do not approach him/her from behind or from the side. This can startle and confuse the person in your care, leading to increased levels of agitation and/or paranoia. Instead, approach from the front. Touch the care recipient on the shoulder, upper arm or hand, and tell them what’s going on. Use a calm voice to walk him/her through the whole process. For example, “Okay, let’s stand up. Good. Next, we are going to… .” Retain eye contact throughout the duration of the activity.

**Elicit your loved one’s help. Even when frail, your loved one might be able to shift his/her weight or move his/her arms or legs to make physically assisting them easier. Some examples are: “We’re getting ready to stand now, mom, so lean forward as far as you can,” or, “Can you move your leg, honey, so I can change the sheet?” A little help from them means a lot less work for you.

**Allow the person to finish what they’re doing. If, as a caregiver, you are running late, the tendency is to hurry your loved one, too. However, this rushed atmosphere is very difficult for care recipients, especially those who suffer from memory loss or brain impairment. Though you may try to sound calm and encouraging, it’s easy for loved ones to pick up our “anxious vibes.” So, even if running late, allow some time to finish the current activity before moving onto the next. For example, “Mom, after you finish that last bite of cereal, we’re going to get you dressed and ready to see your friends.”

**Utilize the major bone and muscle groups. When physically assisting a loved one, pulling or supporting them by their hands or arms is not only difficult, but may lead to injury for you and them. Instead, utilize the major muscle/bone groups.

**For example, when taking someone for a walk, stand directly behind and to the left of him or her. Place your left hand on their left shoulder, and your right hand on their right shoulder. In this way you are walking with your loved one in a comforting hug rather than pulling or pushing them. And when turning someone in a bed, utilize the large bones in the hip and shoulder, and the large muscles in the legs. Pull them toward you with your right hand over their hip or at the knee, and your left hand at their shoulder. Finally, when pulling someone to a standing position, it’s best to use a transfer belt (one can be purchased at any medical supply store for around twenty dollars).

**Once they are sitting at the edge of the bed or chair, pull up on the transfer belt, “hugging” your loved one close, again, utilizing their large muscle groups in the shoulders and the back. Remember to keep your back straight and to always change position by moving your feet, rather than twisting at the waist. And before going home from your next doctor’s appointment, ask for a referral to an occupational therapist who can help you develop your transferring skills.

**Allow for Their Reality. Remember to accept your loved one’s reality, even when assisting with a physical task. If, for example, your spouse becomes shy because he/she thinks that you are a sibling and doesn’t want to get undressed in front of you, don’t force the situation. Try leaving the room and coming back in a couple of minutes. Perhaps on a second or third attempt your spouse will recognize you and be amenable to your care. If all else fails, consider the situation. Is it an emergency? Changing a loved one’s soiled garments cannot be delayed. However, if a care recipient is being difficult and doesn’t want to take a bath or wash his/her hair on a particular day, that’s okay. Plan on doing it at a later time that day or the next day, when your loved one may accept your help.

**Finally, don’t try to physically assist with caregiving unless you can. Injuring yourself will not help the situation, and will often make your caregiving responsibilities that much more difficult. If you find yourself in a nonemergency situation where you are unable to physically assist your loved one (for example, after he/she slides from their chair to the floor) call your local fire department and request a “fireman’s assist.” They will come to your house and help you. If it is an emergency situation (where either you or your loved one are injured), contact the paramedics by calling 911.

Tales of a Daughter-in-Law (or Out-law).

My father-in-law, 91 years old, has been having some major health issues lately. He has been in and out of the hospital, first home for a few days, now in a 'transition center'/rehabilitation center. He has had a heart condition for awhile but with the emergence of 'shingles', it may have made it worse. He has had his ups and downs. The medicine given at the hospital for the shingles may have made him retain fluid; he went home for a few days then back into the hospital since the fluid retention was not lessening at home and making him feel sick. That was taken care of but then the arm with the shingles was not moving well, he could not use it. So they started physical therapy, PT, to help. In the meantime, appetite and wanting to drink has been up and down. Back to the hospital after some type of 'spell' but sent back to rehab after a few hours. Also, a little confused about where he is and what day it is (which is normal).


(family pic)

The other day, I stopped by to visit and ended up watching him in PT. His physical therapist gave him a good workout!! So we walked him back to his room and I visited for a bit. He seemed fine, tired but kept up with the conversation pretty well (had a hard time finding the right words sometimes - who doesn't) but right on with the talk. Strangely enough, a short time after I left, he had another 'spell'; I was told his blood pressure dropped quickly but doing better by the end of the day.

Just wanted to set the background to my saga. A year ago, I dealt with mom - similar scenario in and out of the hospital, rehab, therapy, etc. My husband has 3 siblings; one sister lives out of state while the others are local. I have a sister-in-law, (my husband's brother's wife) who lives near my in-laws; we are about 45 minutes away. She has been helping out with the doctor visits for quite a while for both my mother-in-law (90 years old; she had 2 heart valve replacements - 1st one didn't take - a couple of years ago) and father-in-law, which is wonderful!! She has been doing a great job and I commend her for it!! My other sister-in-law, my husband's sister, has moved back into the area to help out and has been a great help with the cooking and errands, etc. My husband stops by to help as well and relieve his sister so she can have some time off. I guess my situation is that having been through a similar situation recently, I tend to have 'opinions'. My husband's sister has called to talk to me about offering my opinion (unfortunately I also compare to my mom's - probably not the best thing to do). Most times my opinion I feel is valued. I know my husband and his siblings have to come to agreements on how things will progress. I just let people know that I can help if needed but try to stay out of final decisions except to ask if everyone is in agreement and do his parents feel the same. I also try to remind people about paperwork for the nursing home and/or hospital, power of attorney paperwork for healthcare or otherwise, asking about talking to the pharmacy when he was home, reminding people to ask for VNA services before going home, etc. So I haven't figured out if I am better being an 'out-law' and staying out of things, or keep voicing my tales of caring for an elderly parent. I don't think they feel I am interfering but is the comparison/I just went through this/I am somewhat more familiar with this, the best way to offer my '2 cents'. Anyone out there want been through this and want to offer me some advice??

Geriatric Care Manager and When to Use One.

(picture from 'caring.com' website)

One position that I have been coming across a lot lately has been the 'Geriatric Care Manager'. I see it a lot in the websites dedicated to elderly parents and caregivers. 'Caring.com' had an interview with Kaaren Boothroyd who is the executive director of the National Association of Professional Geriatric Care Managers. Their NAPGCM site educates consumers on the role of the GCM and how to find one.


Facts:

The average lifespan in the U.S. is 78.2 years.
On average 10,000 people in the U.S. turn 65 every day.
There are 40 million people – more than 13 percent of the U.S. population – who are 65 years or older.

This role of geriatric care manager came about from the changing family life, where a lot of adult children live away from their parents or have work lives that cut down on the time they can spend taking care of mom and/or dad. Kaaren lists reasons what people should consider before hiring a GCM and what the benefits are to doing this.

What should people consider before hiring a geriatric care manager?

Person has limited or no family support.
**Family has just become involved with helping the individual and needs direction about available services.
**Person has multiple medical or psychological issues.
**Person is unable to live safely in his/her current environment.
**Family is either "burned out" or confused about care solutions.
**Family has limited time and/or expertise in dealing with loved ones' chronic care needs.
**Family is at odds regarding care decisions.
**Person is not pleased with current care providers and requires advocacy.
**Person is confused about his/her own financial and/or legal situation.
**Family needs education and/or direction in dealing with behaviors associated with dementia.

What are the benefits of hiring a geriatric care manager?

Help meet goals of older adult and all involved.
**A care manager's knowledge, education, training, and experience can objectively help set realistic expectations while addressing obstacles that might be present.
**Often families are overwhelmed with the many options presented. A care manager can efficiently streamline decision making.
**As a neutral third party with knowledge of issues of older adults, a care manager can often help resolve conflicts that a more emotionally involved party can't.
**A care manager can often be a cost-effective alternative to families doing it themselves. Knowledge of entitlement programs, the elimination of often hours of research, reduction of time off from work and crisis-based travel can prove to not only provide positive outcomes but save time and valuable financial resources.
**Avoid problems. The proactive nature of care management can help avoid many of the unfortunate problems that face older adults.
**Supervising caregivers, home safety precautions, and safe financial management can be vital parts of a care manager's role.
**Avoid family conflicts. Having a facilitator to assist with difficult decisions can maintain family stability. Difficult decisions including end of life, driving, and relocation can be addressed in a positive manner.

I would suggest that you could probably talk to your parent's doctor or medical professional, or local social service agency and gather information on a GCM in your area and talk with your family to see if you need one. I have read in other posts that there may be a fee involved - whether it is a one time fee or a fee for each consultation, I do not know. Something else to ask.

Lastly, I just found a section on the 'caremanager.com' site that states that:

Care managers can often help parents who are concerned about a young adult or middle-aged adult child with disabilities. These care managers have experience and credentials to work with all ages. The care manager conducts a comprehensive assessment and helps the family plan for the current and future needs of their adult child.

Helping with:

**Physical Disabilities
**Developmental Disabilities, (e.g. Intellectual Disabilities /formerly called Mental Retardation, Down’s Syndrome, Autism, or Asperger’s Syndrome)
**Brain Injury
**Mental Health Problems
**Chronic or Serious Illnesses of any type

Possible Options for Making A Safer Home: Part 2

THE FOLLOWING IS FROM A BOOK OFFERED BY 'AARP' (AMERICAN ASSOCIATION OF RETIRED PERSONS) - "THE DO-ABLE RENEWABLE HOME". IF YOU WANT TO MAKE ANY OF THE CHANGES FOR SOMEONE, I WANT TO SUGGEST THAT YOU CONTACT YOUR LOCAL BUILDING INSPECTOR OR A GOOD CONTRACTOR TO MAKE SURE YOU ARE FOLLOWING THE BUILDING CODES. WE HAD A CONTRACTOR DO THE CHANGES FOR MY MOTHER AT HER PLACE SO WE COULD BE AT PEACE WHEN WE DECIDE TO SELL IT, ALL WOULD BE FINE. I AM STARTING FROM WHERE I LEFT OFF IN THE SAME TITLED POST - PART 1. AGAIN -- I WILL NOT GIVE DIMENSIONS, JUST IN CASE MEASUREMENTS CHANGE WITH CODES. (pictures from searches on MSN.com)

If you have an elderly parent or someone using a walker or a wheelchair, you may need to adjust the door frame size. The book states you should have easy access through at least 1 entry door, though preferably 2 for fire exits, and all doors along the accessible routes between kitchen, bedrooms, dining room, bathroom and any other rooms that are used on a daily basis.

Four main reasons people have a problem using doors:
*width -- too narrow for wheelchair and/or walker;
*landing -- floor space on either side of the door is too small for someone using a wheelchair or walker to be on & open the door;
*hardware -- a latch or lock is too hard to reach and operate, or hard to operate based on the limited dexterity of person's fingers;
*weight -- door or door closer/spring too strong to easily open.

**When it comes to the width of a door frame - you can of course open the width of the frame/cut out a whole new frame. There are 'swing clear hinges' which will enlarge the opening by 1 1/2" to 1 3/4". You can remove the 'door stops' (creates a stop for swinging doors) and then re-install them about 3" above the floor. This adds about 3/4" to the opening. Remove the entire door by taking out the pins from the hinges. If you think you will not re-install another door, you can then fill the holes putty or spackle and repaint/refinish.
**With landings, you may have to relocate walls or partitions, or just remove the door, or install an electronic door opener.
**Hardware: choices are latches, locks, thresholds, kickplates, vision panels, automatic door openers.
Use a latch that requires no fine gripping or strong twisting like a lever arm.
Locks: to see whether your locks can be used by an elderly parent, you can of course ask them to try or, if your the person is arthritic, you can use your closed fist to see if you can open it. Best replacement might be a level style lock,either changing the one you have or adding on an extension to the knob. Magnetic cards might work or remote control locks. Thresholds can be a hazard if there is about 1/2" change in height; so either remove them or make a ramp. Kickplates can reduce wear & tear on a door and should be thin so will not reduce the opening. A vision panel (glass panel in a door) can be used on a door that normally might stay closed. The glass panel will allow people to see on the other side if anyone is coming & reduce the possibility of someone getting knocked over by the door opening. If you want some type of automatic door opener, you can do your own by using a system of weights & pulleys or install one that uses a remote button and sensor.

There is more to come. Hope this starts people looking around at their parent's home and thinking.

Adult Day Care Facilities.

(picture from 'eldercare' website)

There have been several new adult day care centers in the area. I know a few people who have had their parents attend the programs and they have been pleased and mom and/or dad loved it. I had mentioned it to my mom, figuring once she started feeling better, she could attend one a couple of times a week (we never got to that point). These centers can provide attendees therapies, socialization, activities, exercise, prepared meals. From what I understand, there are social workers there who can assess the adults to see what may be needed and come up with the best plan for them. Many of these centers now will also have programs for those elderly parents who have dementia or Alzheimer's.

You should always go to the facility to visit first; observe the staff, the cleanliness of the rooms, check the bathrooms, ask about their programs. Sometimes there is transportation provided. Ask about nursing care - are there nurses there during the day.

AARP's book "Staying at Home", mentions that you should check with your local agency on aging to check on a facility's licensing. I checked with our local Department of Elderly Affairs and they listed a variety of locations and there were numerous factors to look at. The same site referred to 'Eldercare Locator'. The link will lead you to locator where you put in some information and you find places in your area, hopefully matching your needs. Our local Elderly Affairs website cautions -- while the initial access is free, there may be a charge helping to find a place in your area, so please talk to someone.

Also, check with the facility about fees -- some may be free, some may be based on a sliding scale or full fee. Check to see if Medicaid will help. You have to qualify for Medicaid.

Adult day care services also provide respite for those family caregivers who need a break or let them continue to work.

Possible Options for Making a Safer Home: Part 1.

I AM OFFERING SOME OPTIONS THAT I FOUND IN A BOOK FROM 'AARP' (AMERICAN ASSOCIATION OF RETIRED PERSONS). THERE IS NO DATE ON IT, I COULD NOT FIND IT ON THEIR WEBSITE. THOUGH I FIND THE SUGGESTIONS WORTHWHILE (AND A CARPENTER DID DO SOME FOR MY MOM), I WILL ASK THAT, BEFORE DOING ANY OF THESE, YOU CHECK WITH YOUR LOCAL CARPENTER, HOME IMPROVEMENT BUSINESS, BUILDING INSPECTOR, OR ANYONE FAMILIAR WITH CURRENT REMODELING/BUILDING THAT WHATEVER YOU DO IS TO CODE. I WILL NOT GIVE DIMENSIONS OR HEIGHTS OR ANY SPECS -- I AM JUST PASSING ON SUGGESTIONS.

Another book I came across from AARP is called 'THE DO-ABLE RENEWABLE HOME - MAKING YOUR HOME FIT YOUR NEEDS'. They start out by stating that 'according to most gerontologists, personal happiness in later life is the direct result of an individual's continued physical activity and involvement in everyday life'. I think we can all find someone we know, an elderly person, who wants to stay in his/her home for as long as possible, being independent. There may be things we can do in our home or parent's home to make things easier. If you or your parent lives in an apartment, there MAY (check with the landlord or your local housing agency) be a way to make changes, as long as you change them BACK to the way they were when moving out. I also think that many of these options also work with any disabled person, regardless of age.

Some people have mobility issues, some experience vision loss, others hearing loss. This first part will just go over some basic ideas to make things easier at home. I will get into detail at another time (have to read the book more!!). Most of these are pretty self-explanatory and evident.

* for those with mobility issues - relocate bedrooms or living spaces onto the same level; establish convenient storage areas; remove hazards on paths between commonly used rooms; store frequently used household items where they can be retrieved with a minimum of bending, reaching, lifting, & carrying; limit times going up & down the stairs.
* for those with vision issues - clearly mark (with white or reflecting tape) hazardous changes in floor levels; position furniture away from areas where you walk or move around most often; adjust illumination throughout the house by using higher wattage bulbs & distribute light evenly, avoid shiny surfaces to minimize glare; check the home's color scheme - yellows, oranges & reds are more easily distinguished; avoid using closely related colors together - use contrast colors between doorways & walls, dishes & tablecloths, the risers & flat surfaces of steps; keep a consistent light level in bedrooms & bathrooms, & use nightlights.
* for those with hearing issues - for easier communication be in a quiet corner of a room or in a side room away from a group; position yourself so you can hear easier; carpet the floors and put curtains in the windows to reduce noise & echoes; purchase devices such as hearing aids, vibrating alarm clocks, amplified TV sets, flashing lights to announce information & warnings; ask your local telephone company for amplified headsets, signal devices, TTYs, & extension bells.

Sometimes with all the above comes frailty, disorientation, & dizziness;
*use furnishings that are stable & without sharp corners to minimize the effects of a fall; remove scatter rugs, sharp objects & clutter BUT keep the layout of the familiar furniture & pathways the same; place barriers at dangerous locations to prevent unstable or disoriented people from falling down stairs or entering unfamiliar rooms where hazards may be present.

Just remember: places have to be ACCESSIBLE & to make them so, they must be made ADAPTABLE. Since 1992, the Americans with Disabilities Act has made many public places accessible, most important being an accessible route to travel (this would include home corridors too connecting important areas). This as well as other parts of the home can be ADAPTED to fit the person's needs by making adjustments. Adjustments to sinks, baths, doors, etc.

The book goes into these adjustments -- will be discussed in another post.

Areas of Concern for Elderly Parents or Any Senior.

I found a book that my mother had for awhile. Apparently, I didn't know she had it or else I would have had it out as a resource. I cannot find a printing date on it, though the information seems applicable. It is "AGING PARENTS AND COMMON SENSE - A PRACTICAL GUIDE FOR YOU AND YOUR PARENT". It was put together through the Equitable Foundation Inc (the philanthropic part of The Equitable Life Assurance Society of the United States) and Children of Aging Parents or CAPS. I could not really find much information from The Equitable website & the CAPS website had some info, the last newsletter was from 2008 so I called the phone number to see if they were still around -- they are. The book covers a variety of issues - talking to your parents, where will they live, legal issues, taking care of yourself as a caregiver, etc.

(picture from CAPS website)

One thing that the book covers, reminded me of my visits to the ER with mom. During the initial in-take of information, the nurses and doctors always asked her if anyone was abusing her either physically or emotionally. If she went home the same day, would she be scared to be with someone at home? Which brings us to the problem of elder abuse, which is as it sounds - mistreating an elderly person. This book defines it as: 'assault, threats of assault, verbal abuse, financial exploitation, physical and/or emotional neglect, or sexual abuse' and says usually the abuse from the caretaker rises as the older person's condition worsens. Usually it is unreported due to the elderly parent/person being ashamed, unable to say anything, or fearful that the abuse may get worse if it is reported.

The book reports that The National Center on Elder Abuse lists some indications of abuse as (the website has a some of these):
* burns, bruises or cuts
* dehydration, or malnourished appearance
* anxiety, confusion, withdrawal
* expression of shame, embarrassment or fear
* poor personal hygiene
* over-medication or over-sedation
* sudden bank account withdrawals or closing

If you see anything like this with someone, please contact your local social service agency.

___________________

From caretaker abuse to self-abuse:

Alcohol abuse is seen sometimes as old-age complaints -- it can show itself as tremors, gastritis, confusion, hypertension, depression. The book goes on to describe other indicators as:

* burns on hands and extremities from cooking
* evidence of repeated falls
* other unexplained accidents
* fear or avoidance of doctors and dentists
* paranoid behavior
* mood swings
* malnutrition
* preference for isolation, secretiveness
* inability to remember particular periods of time (blackouts)

(picture from TCSAP website)

The book identifies The Center for Substance Abuse Prevention as mentioning the following 'cautions': (I tried to find these on the website but there were so many different reports that this may be a compilation of them)

* age-related stress such as bereavement, unemployment, a move to a new place; keep in mind with aging comes a change in metabolism so they are more susceptible to alcohol's affects
* there can be an interaction between alcohol and both prescription and over-the-counter medication; have a frank talk with the doctor and/or pharmacist.
* try to lesson the loneliness, isolation and depression - keep them involved in family, spiritual, and community affairs; it may be possible for them to volunteer in some programs to increase their self-worth and self-esteem. My mom belonged to a senior group that met every week and had day trips; she was still pretty good in speaking Portuguese so a pre-school teacher I know had her come in her class to work with a student new to the area who spoke no English, to help translate and learn English. They formed a great bond and 'Miss Lucy' always looked forward to going to be with the kids.

Alcoholism can be beat but you probably need outside help. Talk to his/her doctor for the best treatment.

______________________________________

Depression is big among the elderly. Aging is usually not the cause but ailments of the elderly can be. These could be:

*chronic pain, disability, dependence, isolation, fear
* some medications like steroids and meds for the treatment of hypertension, heart disease, diabetes
* loss of peers or loved ones which may cause a long mourning time
* keeping any fear and /or negative feelings inside.

This too can be treated with their doctor's help. There may be a good counselling service nearby or maybe your parent can speak with their spiritual leader. Sometimes just time helps. Either way - best to get to the bottom of things before conditions worsen.