Caregiving in a Rural Setting

Living in “Rural America” is gratifying.  The sounds of clattering suburbia are replaced by serene quietness.  Days and nights are peaceful, absent of commotion and traffic.  The view of the moon and stars isn’t obstructed by city smog.  People and nature are at peace with the environment.  I’ve lived in a rural setting my entire life and LOVE it!  Whippoorwills, white-tailed deer, locust, blueberry fields, and cranberry bogs are daily sights and sounds of my “Rural America”.  But, with peacefulness comes seclusion.  I currently live 30 minutes from the nearest grocery store, 40 minutes from my physician, 40 minutes from the nearest shopping mall, and 25 minutes from the “local” Chinese restaurant.  For some this is mindboggling, but for me it’s life.  I never realized the inconveniences of living rurally until my grandmother fell ill and needed healthcare support.  Those inconveniences were immediately magnified.  I’ve stressed the importance of utilizing resources available to caregivers and care-recipients.  However, most of those resources are not available to individuals receiving homecare in a rural setting. 

1.)  Transportation Services

Small towns in “Rural America” compared to urban and suburban communities lack funds to provide necessary transportation services to caregivers and care-recipients.  Residents living in exurban communities are limited in their independence and abilities to complete daily errands.

2.)  Adult Daycare Centers

Limited monetary resources and poor infrastructure both contribute to unavailable homecare resources.  We can’t compete with the wealth of populated cities.  Therefore, healthcare relief facilities are absent in rural communities.  And, without transportation services, caregivers and care-recipients can’t be transported to neighboring facilities. 

3.)  Home Healthcare Agencies  

Remote locations hinder the process of hiring dependable home healthcare agencies.  Nurses and aides are reluctant to travel to these locations because of travel time and distance.  

4.)  Respite Care

We realize the importance of respite care during caregiving, but a short-term break is not always readily available, especially in a rural setting.  The inability to find home healthcare agencies willing to travel to your location narrows your options when trying to obtain respite care.  Without agencies, your main source of relief care is dependable family and friends.  But, most families live at great distances from the caregiver and care-recipient.  Friends and neighbors work or are raising families.  Daily/weekly respite care may not be an option.     

If living in “Rural America” is inconvenient for the aging population, why don’t they relocate to an area better equipped for their needs?  The elderly in rural communities have limited incomes and live at or near poverty level.  Most live alone and have health concerns.  How can they relocate?  Why should they be disadvantaged by their living location? 

I was an informal caregiver for 11 years in a rural setting.  Getting good, quality care for your loved-one is nearly impossible.  Caregivers are required to perform many heath-related procedures beyond their training because healthcare agencies are not willing to travel 40 miles.  How do you transport a bed-bound patient to a doctor’s office 35 miles away with no medical transportation services?  How can you provide the proper care to a loved-one when skilled nurses are unwilling to travel to your location?  Caregiving is difficult, but lack of proper resources makes it more stressful and overwhelming.  Respite care?  Yeah right!  That’s a luxury provided by a family member every couple months.

Caregivers and care-recipients living in rural communities deserve more resources.  Location shouldn’t hinder the quality of care received by a loved-one.  Do you live in “Rural America”?  How can homecare resources be improved?  Leave a comment!  Thank you!         

    

Why do I feel guilty….caregiver guilt?

You became a caregiver to give your loved-one unconditional love, support, and quality care within the comforts of home.  Your daily devotion enables them to live a more meaningful, joyful life.  You absorb ALL of the stress from the current complex situation.  The mental and physical exhaustion is depleting your own health, but you still smile.  Socializing is limited, but isolation is in surplus.  Why do caregivers expose themselves to such a stressful, unpredictable environment?  We care about the welfare of others and believe our participation in their lives will create nurturing relationships.  We give hope to an otherwise hopeless situation.  Providing an ailing loved-one with a fulfilled life is rewarding, but do we care too much?  Is there such a thing as caring too much?

We caregivers have very nurturing, caring, independent mentalities.  These mind-sets wreak havoc on our health and create unsatisfactory care environments.  Caregiving is mentally and physically draining. Most of us have suffered from caregiver stress and burnout.  It’s an emotional roller-coaster!  What emotions surface while caregiving?  Anger, sorrow, happiness, love, fear, and surprise are just a few emotions encountered by caregivers. The most mentally exhausting emotion during my caregiving journey was guilt.  I was devoting my life to the happiness and well-being of a loved-one.  Why did I feel guilty?

After her second stroke, my grandmother received all nutrition and hydration through a feeding tube.  She couldn’t eat or drink by mouth, only via peg-tube.  How could I possibly eat anything in front of this wonderful lady?  I felt guilty eating because she wasn’t able to indulge in the foods she once found so delicious.  I ate many meals at the kitchen counter, in a location not visible to her baby blue eyes.

My grandmother was left bed-bound after suffering two strokes between the ages of 73-78.  She was unable to eat, stand, or complete any daily tasks. She was completely dependent on me….for EVERYTHING.  This once independent woman was now dependent on an 18 year old!  The irony, in previous years I was her dependent!  Again, guilt surfaces and shows its ugly face.  My mind is overwhelmed with WHY, WHY, WHY?

  • Why did this healthy woman have multiple strokes? 
  • Why is this master of culinary arts unable to eat the food she loves?
  • Why did this kind, sweet, and giving lady get such a “raw deal” in life?

I felt guilty because I was healthy.

Heart failure ended my grandmother’s life.  As a caregiver for an elderly loved-one, I knew my responsibilities would end, but not exactly when or how.  It’s frightening trying to be prepared for the unexpected.  When she passed I was overwhelmed with guilt. Again, my mind was flooded with questions. 

  • What did I do wrong?  She was fine last night when I put her into bed.
  • Could I have prevented this?
  • Maybe I should have done this instead of that?
  • Did I overlook some detail that caused this?
  • Did my grandmom die because of something I did or missed?

Caregiver guilt exists during and after caregiving.  Because of faithful devotion to helping others, we caregivers create an unhealthy emotional environment for ourselves.  We can’t accept certain terms and outcomes.  Our mind is geared for success not failure.  Please share this post to prepare other caregivers for their emotional but rewarding journey.  Thank you and good luck! 

How to Help a Caregiver

We caregivers are experts at keeping a “happy” face, even when times lack happiness and joy.  Our constant smiles and understanding give the impression everything’s always OK.  True feelings are pushed aside for the benefit of the patient.  We never ask for help because caregiving duties are solely our responsibility.  However, there are times when we need help, but don’t voice our feelings.

When asked if he/she needs help, a caregiver will often respond, “No thank you.  I have everything under control.  I appreciate the offer.”  How can you help a caregiver that refuses assistance?  Try indirect help.  Provide items or services that make their caregiving duties easier.

  1. Provide encouragement in the form of a card or casual conversation.  Show appreciation for their devotion.
  2. Caregiving is costly especially when living on a limited income.  Provide a gift card that can be used for everyday expenses.
  3. Most caregivers have very limited time for errands.  Volunteer to grocery shop or pick up medications.
  4. Balancing family and caregiving is difficult.  Offer free childcare services to the caregiver.

Directly assisting a caregiver in their own environment can be difficult.  Most have a set daily schedule.  Any deviation from this schedule can cause unwanted stress.  How can you directly help a caregiver without interfering with their daily schedule?  

  1. Prepare meals for both the patient and caregiver.  Deliver meals a few times per week.  When preparing meals abide by proper diet restrictions.
  2. Depending on the patient’s medical condition, homecare can involve massive amounts of laundry daily.  Volunteer to pick up and drop off laundry during the week.
  3. Offer transportation for medical appointments.  “Free” hours allow the caregiver to take a break and catch up with daily tasks.
  4. Provide RESPITE CARE.  Allowing the caregiver a short-term break from their daily monotonous schedule is beneficial.  The caregiver is able to enjoy activities outside of their duties, enabling them to de-stress and recharge.  A healthy caregiver can consistently provide quality care to the patient.

Caregivers can be stubborn.  This stubbornness will eventually lead to stress and burnout.  As a third-party, you can indirectly and directly assist the caregiving process by providing your time and services.  Don’t take “NO” for an answer.  Work behind-the-scenes and provide deserved support.  Thank you and good luck!

Respite care? Yes, please!

Whether you chose to be a caregiver or caregiving chose you, you’re now responsible for the well-being of another individual.  Physical, mental, medical, and financial responsibilities are included in daily caregiving.  One must assess both physical and mental states and address their effect on the patient’s health.  Medications must be altered and administered per the request of the attending physician.  Monthly bills and long-term finances must be managed in order to compile sufficient funds for care.  These are just SOME of the daily responsibilities encountered by caregivers.  The unpredictability of caring for an ailing loved-one causes a stress-filled environment.  Combining ongoing responsibilities with unpredictable daily outcomes leads to caregiver stress and eventual burnoutHow can you avoid this stress?  Two words….RESPITE CARE.

Respite care is a short-term break for caregivers.  It allows time to de-stress and recharge.  You’re able to go shopping, take a nap, grab lunch, go on a mini vacation, or catch a movie at the local theatre.  It’s easy to forget yourself when caring for a loved-one.  Caregivers can’t become overwhelmed by their full-time duties.  Respite care helps release any physical or mental tension that has accumulated while caregiving.  These small breaks enable you to return refreshed and more focused.

It’s important to have a stable support system while caregiving.  Ideally, respite care would be provided daily.  However, finding willing relatives with similar schedules can be difficult.  Finding a trustworthy homecare agency is equally difficult.  Trying to coordinate family schedules and locating GOOD care is stressful.  Caregivers become deterred and opt for no support system.  I was this caregiver.  Taking full responsibility for an ailing loved-one and refusing breaks is a recipe for disaster.  You’ll become overwhelmed and eventually suffer from burnout.  Learn from my mistakes.

Choosing to become a caregiver is a noble decision.  But sometimes we don’t have a choice and caregiving chooses us.  Whatever the circumstances, try to instate a reliable support system.  Voice your opinions to your family and describe the importance of respite care.  If you don’t mention it, who will?  As a caregiver, we take complete responsibility for our patient and forget OUR daily needs.  If trustworthy friends and relatives offer you a break, TAKE IT!  De-stress and recharge so you can successfully care for your loved-one.

Let me know how your caregiving journey is progressing by leaving a comment.  As always, thank you for reading and take care!

Eat the Sweets!

Fitness entered my life when I became my grandmother’s full-time caregiver 14 years ago.  My daily exercise routine allowed me to de-stress and clearly focus on my caregiving duties.  I wasn’t concerned with a 6-pack or diamond triceps.  Through the days and months, each daily workout became part of my strict schedule.  I began to notice concentration and endurance improvements.  The days didn’t seem so endless and my mood drastically improved.  I began to ENJOY physical fitness and being fit!  It provided stress relief, encouraged a healthier lifestyle, and gave a boost to my self-confidence.  However, I’m not addicted to fitness or healthy eating.  It doesn’t dictate my life.  I’m 5’6″, 125 pounds and can eat more than my husband.  I love food!  Especially CANDY AND DESSERTSBut, can you stay fit and still eat those delicious sweets?  YES, you can eat sweets and still have a beach body!

1.)  Create an Exercise Routine

Create an exercise routine that fits your schedule.  I allow myself 30 minutes each morning for exercise.  Why 30 minutes?  Initially, only 30 minutes were available during my hectic caregiving schedule.  But after trying various exercise routines, it was evident that I lost interest in the routine if it was longer than 30 minutes.  A half-hour each day works for me!

2.)  Mix It Up

Boredom is one of my biggest complaints when exercising.  The same daily routine becomes monotonous over time.  I recommend integrating different workouts into your schedule.  Take your routine outside….weather permitting.  Ride your bike instead of running your usual mile loop.  Variety is key to persistence and dedication during your fitness journey.  

3.)  Eat Health-IER

I’m not considered a healthy eater.  But, I try to eat healthier.  Many people are under the impression that becoming physically fit involves low carb diets and eating only celery and carrot sticks.  WRONG!  Becoming and staying fit is achieved by creating a balance between exercise and eating.  Your body needs carbs and fats.  Without these your body will become depleted and lack energy for everyday activities.  My advice….eat healthier versions of the foods you enjoy!

4.)  Splurge and Indulge

I’ve tried fad diets and eliminating sweets.  My end result….binge eating on any cookies, cakes, or ice creams available!  Eat the sweets, but in moderation.  My current fitness routine includes eating a delicious cookie before starting any workout.  I eat health-IER throughout the day.  Dinner is followed by my favorite mini candy-bar.  Sundays are reserved for a bowl of ice cream.  Including these sweets in my daily diet eliminates my carb and sugar cravings and keeps me motivated.  No binge eater here!

Striking a balance between the things you love and fitness creates an overall healthier lifestyle.  Who doesn’t want to feel better about themselves or be less stressed on a daily basis?  I want you to realize that you CAN be fit and still EAT the things you love.  Life’s too short not to indulge in sweet delicacies!  Thank you for reading!  Now go eat a cookie and start working out!  Take care and good luck!

‘Tis the CAREgiving Season: The holiday/caregiving balance.

I love the holidays!  Decorations, glowing fireplaces, winter wonderlands, Bing Crosby, and gift-giving.  Long chats with family of days gone-by and sounds of children laughing while opening gifts.  But, the holidays can also be a stressful period.  From long lines at the checkout counter and limited holiday budgets to delayed flights and burnt cookies….it’s not all holiday cheer.  Now, add caring for an ailing loved-one to the seasonal stressor list!  How can you de-stress, be a nurturing caregiver, AND enjoy holiday cheer? Maybe I can provide useful advice and keep your holidays merry and bright.

1.)  Exercise

Don’t neglect yourself.  Caregiving is demanding and time-consuming.  Take care of yourself so you can take care of others.  Exercise is easily neglected by NON-caregivers during the holidays.  Caregivers are no exception.  However, they tend to neglect themselves because of constant dedication to an ailing loved one….not for numerous holiday house parties.  Allow 30 minutes a day for de-stressing exercises.  I prefer yoga or pilates.  Both are mind and body exercises focusing on breathing and elongating muscles.  If you enjoy a more intense workout, try this 20 minute full-body at-home workout.  De-stressing and high-intensity workouts aid your focus and concentration.  After a long day of balancing caregiving duties, baking cookies, and gift wrapping, a mind and body cleanse is welcomed!

2.)  Embrace the Situation

Caregiving is positive not negative.  The amount of joy you bring to the patient’s life is immeasurable.  Embrace your current situation and enjoy time spent in the company of your loved-one.  Realize the gift of giving not receiving.  You give happiness to an individual who may have been hopeless without your unselfish devotion.  Making the best of a difficult situation benefits all involved.  The patient doesn’t feel like a burden and the caregiver feels appreciated!

3.)  Throw a Party

Holidays bring to mind thoughts of parties and family get-togethers.  Relatives reminiscing and laughing about their unique seasonal experiences.  However, because of a demanding schedule and lack of respite care, caregivers are often excluded from these holiday activities.  Bring the holiday cheer to you and throw a memorable party.  My grandmother and I loved having a small number of guests over on Christmas Eve.  It gives you and your loved-one an opportunity to socialize and enjoy the meaning of the holidays….togetherness.  Nothing beats a good party, so turn the music up and put on your dancing shoes!

4.)  Decorate

We’re all aware of our situations and the constant stress engulfing our lives.  Caring for an ailing loved-one can make the holidays depressing.  This may be his last Thanksgiving….She may not see the New Year.  Yes, the holidays can give you a heavy heart.  But, try not to dwell on the what-if’s and focus on the here-and-now.  I’ve found that decorating for the holidays lifts spirits and makes days more enjoyable.  Engage your patient in the festivities.  My grandmother loved handing me the decorations for our Christmas tree.  The joy and happiness seen on her face when the tree was finally lit is a memory I will forever cherish.  We turned a difficult situation into happy memories!

Caregiving brought new meaning to my holidays.  I was able to embrace togetherness and enjoy the small moments with my grandmother.  We often miss the joy and seasonal spirit of the holidays because of our fast-paced lifestyles.  Caring for my grandmother allowed me to slow down and appreciate the gifts around me.  Hopefully my caregiving tips will help you minimize stress so you can enjoy the holidays.  After all, you’re entitled to a little holiday cheer too!  Please share!  Take care and thank you for reading!

A Day in My Life as a Caregiver

10:00 PM….I transfer my grandmother from wheelchair to bed via hoyer lift and begin our nightly routine.  Undress, bathe, dress, dental care, administer medication, get comfy, and hope for the best.  “Good night, grandmom.  Try to get some sleep….morning comes early.”  I turn off the lights, kiss her on the cheek, and grab any available blanket.  I fall into my bed….the sofa next to my grandmother’s home hospital bed.  Thoughts of tomorrow wander through my mind before finally closing my eyes.

12:00 AM….I hear the sheets rustling on my grandmother’s air mattress.  She can’t sleep….the cramps in her legs are excruciating.  “No problem grandmom.  I will put you in your recliner.”  I walk across the living room and retrieve her hoyer lift.  The hoyer lift mat is strategically placed…I begin to lift her from bed.  And, incontinence strikes!  It isn’t her fault that bending motions cause her to urinate.  “No problem grandmom.  I will get you washed-up and changed into clean clothes.”

12:45 AM….Bathed, dressed, and two transfers later, she is in her beloved recliner.  The leg cramps are still painful….the reclined position was no help.  “No problem grandmom.  Let me massage your legs and see if that relieves the pain.”  She nods.

2:00 AM….The pain seems to be subsiding a little.  Grandmom wants to go to bed.  “Sounds good Grandmom.  Let me get your hoyer lift.”  Recliner to wheelchair, wheelchair to bed, the hoyer lift mat is removed….another successful transfer.  And, incontinence strikes! “Ok grandmom.  Let’s get you bathed, changed, and comfy.”

2:30 AM….“Goodnight grandmom.  See you in the morning.”  But it is already morning!  I fall into bed hoping this time it will last.

6:30 AM….My alarm clocks sounds.  I quietly leave the comfortable sofa and tip-toe upstairs.  A quick change into workout clothes and my morning workout routine begins. These 30 minutes of freedom are frequently interrupted by my wandering mind….I better check on grandmom and make sure she’s alright.  Running up and down stairs is excellent cardio!

7:00 AM….Going downstairs, I’m met with grandmom’s bright eyes….MY 30 MINUTES of the day are over.  “Good morning grandmom.  Ready to get dressed?”  And so begins our early morning routine.  Undress, bathe, dress, dental care, administer medications, transfer into wheelchair.  The day has begun.

12:30 PM….By now, my grandmother has been transferred 3 times.  Incontinence never fails to burden each transfer.  Why so many transfers?  She must be repositioned every 1-2 hours in order to prevent skin breakdown.  It’s her favorite time of day….the daytime soap operas are on CBS!  We sit together and watch the drama surrounding TV families and try to forget the drama here at home.

5:00 PM….Three transfers later and it’s dinner time.  I eat standing up in the kitchen because I choose not to eat in front of my grandmother….she is fed through a feeding tube.  Guilt surrounds me during each meal.  The woman who taught me how to cook is unable to eat.  Why is life so unfair?

6:30 PM….Grandmom and I retreat to our favorite room….the four season room at the front of the house.  We watch nature from the surrounding windows and talk of days gone by.  She laughs at my stories of younger siblings.  I laugh at her facial expressions to the town gossip.  I would give anything to have these moments back.

8:30 PM….Grandmom chooses her favorite record from the collection.  We dance/roll around the 1st floor of our home without a care in the world.  Right now nobody is sick or ailing….all is right in the world.

9:30 PM….“Welp, it’s that time again.  Time to get ready for bed.”  She smiles and yawns.  We begin our nightly routine.  “Goodnight, grandmom.  Sleep tight.”  I kiss her on the cheek and fall onto my welcoming sofa.  I stare at the ceiling and pray she wakes up in the morning.  

Caregiving never stops.  It’s a physically demanding job with little rest.  Your eyes may be closed but your mind is constantly working.  Care for yourself so you can care for others.  Thank you and GOOD LUCK!