The day came when my siblings and I felt we had to take our parents' care into our own hands. It is a difficult realization. Our parents who took care of us now needed to be taken care of by strangers.

My father had dementia and was mobile. My mother was suffering from non-Hodgkin's lymphoma and the disease was taking its toll on her mobility. She was completely in denial that she was seriously ill. Her health was declining. She was oozing through her skin and had to wear special wraps. My brother and I met with my mother and told her that she needed help. She of course thought it was her duty to take care of my father alone. Finally she agreed to hire a caregiver.

Do you know how hard it is to find a caregiver for a dementia patient? Do you hire someone from a service or do you hire an individual? It was fortunate that we found someone who agreed to help my mother give care to my father and who my mother liked.

In the beginning, the caregiver was a great help to my mother in tending to my father's physical exercise and hygiene. She also cleaned the house. It was hard for my mother to accept that someone was in her house taking care of these things. After all, it was her job to do these things. However, my mother became very ill. Soon, the caregiver started caring for my mother as well. I would talk to my mother everyday and ask "is the itching better?" She would always respond, "I'll be fine." Then, she would proceed to tell me about my father's health problems.

Eventually, one caregiver was not enough to take care both of them 24 hours/day/seven days a week. Again, we were fortunate that our caregiver knew of other caregivers who we could hire. They were loving, caring ladies who adored my parents.

What to look for in hiring a caregiver:
Good references
Observe how they interact with your parent
Ask them to keep a log of behaviors, medicine and eating habits; if they refuse you know not to hire them
Ask them to give experiences in caring for patients; give examples of how they handled difficult behavior and/or how they handled dementia patients

Hiring caregivers can be a tricky situation. They have to be adaptable to the patient's needs and demonstrate empathy, yet they have to be firm in caring for them.

Are your parents safe living at home? Are they mentally pretty clear, but beginning to have physical or judgment deficits which might impact their safety? Do you worry that Mom may fall down and not be able to get to the phone? What would happen if Mom or Dad slipped and fell in the bathroom? Falls are the leading cause of injury deaths in people 65 years of age and older, according to The National Safety Council.

Most elderly people cherish their independence and will do just about anything to keep it. Sometimes a simple device or two, especially in the bathroom, is all that is needed to keep them safe and independent. This article will show you how to identify and reduce safety hazards in an older persons bathroom.

• Water temperature: Set the hot water heater to no more than 120 F to lessen the risk of burns.
• Toilet: If your loved ones have difficulty standing up from a low toilet, obtain an elevated seat. There are many types available; I recommend those with attached armrests, if space allows, that fit directly over the existing seat. They are easy to install and don't seem to get in the way when others use the seat. If the toilet height is okay as is, there are easy to attach stand-alone armrests.
• Grab bars: It is not safe to pull on a towel bar or push on a toilet paper holder for support, as many older adults do. Instead, properly install grab bars on both sides of the shower/tub area and also within reach of the toilet.
• Lessen the risk of slipping or falling. Use a non-slip bath mat or non-skid tape on the tub/shower floor and use a shower or bath chair specifically designed for bathing. Do not try to use another type of chair in the tub or shower, as this could actually cause increased risk of injury. There are also transfer chairs available that have 2 legs on the outside and 2 legs inside the tub so your loved one can easily slide over and use the shower.
• Water spills are especially dangerous in the bathroom because fixtures and floor surfaces are typically very hard. Be sure that shower curtains fit properly and there are no plumbing leaks.
• Lighting: Light switches should be easy to reach and in good repair. Check that lighting is adequate, use a night light for the path from bed to bathroom and be sure pathway is clear of obstacles.
• Consider installing a phone line in the bathroom. This could prevent carelessness while hurrying to catch the phone in the next room.

Hopefully these tips will keep your senior loved ones safe and independent at home.

My siblings and I were not use to making decisions involving our parents. My mother always knew what to do and when to do it. However, here we were, my mother was ill and not able to make decisions anymore and now we were responsible for taking care of my mother and father. This role reversal was a rude awakening.

Here are suggestions to assist you if you are in the position of being your parent's caregiver:

Signing over their health decisions
My brother and I spoke about the importance of getting our parents to sign agreements to let us make the health decisions in their lives. This means we would be responsible for "pulling the plug", putting them in a hospital or assisted living facility or rehabilitation center, etc. The enormity of these decisions for us was overwhelming.

Fortunately, my brother is a tax and estate planning attorney and created the documents we needed. It is very important that anyone who is put in the position of taking care of their elderly parents hire an attorney that they trust and that can explain the ramifications of what they are having their parents sign.

Taking care of their monetary affairs
It was decided that I would take care of paying my parents bills and keep up their bank accounts. It is essential for you and your siblings to agree that one person should take care of your parents' money. It just makes things simpler if one person does it. I kept my brother and sister apprised of the monetary affairs and felt trusted.

If you are an only child and are not comfortable with taking care of your parents' bank accounts and bills, find a friend or bookkeeper you can trust.

Taking care of their nutritional needs
I never thought that I would have to decide what my parents would eat. I would go to the grocery store every Saturday and shop for their foodstuffs. Sometimes my brother and sister-in-law would take meals over to my parents' home. Sometimes I would take them out to eat.

The time I spent in either taking them out to eat or in choosing what foods they would eat is special to me. I took great care in choosing the exact foods that I knew my mother would approve of. And of course going to restaurants reminded me of when they use to take me and my siblings to restaurants every Sunday while we were growing up.

Spending quality time with your parents while they are alive will help your pain after they have passed.

Caregivers
Luckily, we found caregivers who were very caring toward my parents. If you hire people to take care of your parents, you must be careful. There are people who take advantage of the elderly, whether they steal their money or mistreat them. Take your time in interviewing caregivers and get as many references as you can.

Choosing an Assisted Living Facility
The time came when we had to choose other living arrangements for my father. His dementia was getting worse. Caregivers could not handle his moods and strange reactions to things. One of the hardest days for my brother and I was moving him to an assisted living facility. The move wasn't difficult for him, but very difficult for us. He had dementia so it didn't really matter where he lived.
In choosing a facility, make certain that the aides and nurses are of the caliber you desire, that the food is cooked to your liking, that the beds are changed daily, that your parent's personal hygiene is attended to and that you can visit unannounced.

My parents took such good care of me and my siblings. They deserved the very best at this time in their lives. Perhaps you think that your parents would not have made the same choices you made for them, but never, never second guess yourself. You make the best decisions you can with the information you have at hand.

Are you fortunate enough to have not been effected by Alzheimer's stages in your family? Then know that November is Alzheimer's Awareness Month and this makes it a good time to reflect on the impact Alzheimer's disease stages has on our population. An estimated 5 million people in the U.S. are living with Alzheimer's disease. New case is diagnosed every 72 seconds.

Alzheimer's is a disease that was first identified in 1906 by German physician Alois Alzheimer. The exact cause of Alzheimer's disease is not known. Alzheimer's disease stage tends to affect people who are over 65. However, there is estimated that about 500,000 people who are considered middle-aged have some forms of dementia or Alzheimer's stage.

The risk of developing the disease increases with age. Alzheimer's disease has many symptoms that are often quite obvious and require medical attention. Some of them are memory loss, difficulty performing normal daily tasks, disorientation with time and place, changes in personality, loss of initiative and depression.

This deadly disease progresses through different Alzheimer's stages. The memory is usually the first to go and can be notice by family members. Patients' ability to think clearly is gradually lost over time.

When disease moves to the next Alzheimer's stage other people usually start notice as well, because patients may do things that are consider being strange. Some who were consider a calm person may become agitated or easily upset. Also behaviour problems and communication difficulties may surface.

Support and help can be provided by social services for those with Alzheimer's disease but when the things move to the next Alzheimer's stage that's when full-time residential care may be necessary and family of the patients has to make this painful decision. For people in severe Alzheimer's stages it may be difficult to perform everyday tasks, they may not recognise people around them or their surroundings.

"Don't take life so seriously, you'll never get out of it alive," was the simple advice I saw on a greeting card once and it makes sense, especially when thinking about the incredible pressures placed on those in the important role of caregiver for a loved one. You've got to lighten up the load to prevent major burnout. Many times it's easy to overlook just how tired, frustrated or angry someone feels when they are buried in the dozens of day to day tasks required of a primary caregiver. This special report is designed to help you spot the warning signs when you've done too much for too long and don't have enough energy left in the tank to help anyone, including yourself.

There was a popular song many years ago that had the lyric, "he ain't heavy- he's my brother" which isn't exactly accurate. If you are piggy-back riding your brother, sister, child or any other family member, their actual weight is still the same, but because you love and care for them you have extra energy to serve them. Love will allow you to carry someone you care about for a while- but after a while they do get heavy again and you will feel the pressure to want to take a break. That's normal and not a sign of lack of love, rather just a sign of being human. So what does it mean to be a 'Care-Giver" anyway?

To be a Caregiver is to provide financial, relational, physical, spiritual or emotional support to someone who is unable to live independently like:

- newborns or small children

- those recovering from an injury or illness

- aging loved ones

- anyone facing a terminal illness

- those who are disabled in some way (physically, mentally, emotionally)

This just about covers parents and people from all walks of life and all ages, so it probably impacts you or someone you care about. Let's un-package this important issue to understand the dangers of being a 'good Samaritan' and find out how to avoid the often overwhelming stress that can come from being a compassionate parent, adult child or primary caregiver.

Let's start by defining the difference between CARE-TAKERS and CARE GIVERS.

A care taker provides a level of compassionate service for someone in need, often for a fee or salary of some kind. They may feel a special calling to help out, (like nurses, teachers, doctors, counselors or pastors), yet at the end of the day, it's their job and they are compensated in some way for their services. Caretakers can do their important work in many ways, for instance they can work with children, with patients, wounded people, or by managing property or running a museum. It's important work, often tiring, but not usually overwhelming enough to create compassion fatigue or massive distress because there are clear boundaries, defined duties and reasonable expectations, as well as defined hours of service.

Being a care-taker is much less complicated than being a care-giver. Caregivers do the same work, but often with greater intensity, since they often aren't compensated in some way and just work out of the goodness of their hearts to show compassion to the person in need. They often give and give expecting nothing in return, yet that is often why they run out of energy and burnout. They don't have defined hours, schedules or budgets. It can get very stressful, very fast because you can't do everything for everyone all the time without it leading to caregiver stress. Consider the following questions and warning signs I first learned from my friend and fellow counselor June Hunt to see if you are experiencing this type of roadblock to healthy relationships.

-Caregiver Stress Checklist.
In asking yourself these questions, honestly assess your feelings to determine if it could be time to seek professional help to overcome caregiver stress.

- Am I easily agitated with those I love?
- Am I becoming more critical of others?
- Am I having difficulty laughing or having fun?
- Am I turning down most invitations to be with others?
- Am I feeling depressed about my situation?
- Am I feeling hurt when my efforts go unnoticed?
- Am I resentful when other family members are not helping?
- Am I feeling trapped by all the responsibilities?
- Am I being manipulated?
- Am I missing sleep and regular exercise?
- Am I too busy for quiet time with God?
- Am I feeling guilty when I take time for myself?

- Warning Signs of Caregiver Stress:
___Physically- exhausted and worn out
___Emotionally- resentful, stressed, bitter
___Relationally-feeling used or unappreciated
___Financially- overwhelmed or depleted

It's right to care for people in need. It's healthy to show compassion, those are good things and make us feel better for having made a difference in the lives of others. You can show care in a lot of ways and should. Consider for instance the meaning of the verb "Care?" -To have a personal interest in, or be watchful over, to be affectionate toward, to look out for, to be concerned about, to provide for, to give serious attention to and to keep safe. Caring is important- but there are some hidden dangers if you care too much.

Hidden facts about the Good Samaritan

There is no better example of being a compassionate caregiver than the timeless story taught by Jesus about the Good Samaritan. You may remember the story- a man is mugged by thieves and left for dead on the side of the road. Then a pastor and a lawyer pass by on the other side to avoid getting involved, finally a man from another cultural background stops, applies first aid, transports the victim to a respite center and pays for his care. Jesus showed that the person who really showed love for his neighbor wasn't the most religious or best educated, or even from the same culture; rather the one who showed the greatest compassion was the only one who fulfilled the great commandment to 'Love your neighbor as yourself.'

This is a life changing spiritual teaching for anyone, yet don't miss some basic factors to protect the good Samaritan from compassion fatigue. Yes, he jumped in to help a stranger, yes he showed great love for another human being, but he didn't do it alone! The good Samaritan started a healing process in the life of a wounded man and allowed others, like the inn-keeper to be part of the team to make a positive difference in helping a man rebuild and recover. When you are part of a team helping someone going through a crisis, you are less likely to burnout and that's a good thing for everyone so you can have a lot more energy to help others for years to come.

Self Care comes first

Chaplain Max Helton worked next to me at Ground Zero after the terrorist attacks in New York on 9-11-01. He taught me a wonderful process in dealing with overwhelming situations. First, focus on 'self-care' then 'buddy care' and finally 'other care'. This way you can protect your own energy, help others facing the same caregiving challenges and then together be much stronger and more focused to better serve others. It can be done, but it can't be done alone. God designed us to work together in partnership with others. Moms and dads, husbands and wives, brothers and sisters, fellow church members, neighbors, co-workers, community members, basically anyone could be in a situation to be a caregiver, but remember the principle to not go it alone. Let others help you.

If you are facing a major caregiving role alone, let me challenge you to reach out for some help. It could come from friends, family, pastors, churches, a MOPS group or other supportive group, but whatever you do, don't try to do it all yourself. Caring is good, exhaustion isn't. If you are aware that you are feeling pressure to do it all, take the checklists and insights from this article to review with someone close to you for an objective point of view just to keep you from the stress of caring too much that you get lost in the process. Or perhaps you have a friend, co-worker or family member that appears to be struggling with compassion fatigue that you could invite for a cup of coffee to review the key points and then open up a discussion on how you might be an encouragement to help them better manage the stress of caring for someone in need.

You don't have to do it all alone, but you do have to openly bring up the subject to let the people who care about you know that the pressure is building and that you need some help. Here are some strategies to guide you with a sense of balance as you willingly share your heart of compassion without getting crushed from too much care.

How to prevent being so full of "care" that you can't care for yourself

1) Be aware of the common stress signals that come with being a caregiver
___ irritability or moodiness
___ feelings of resentment
___ loss of sleep or feeling frequently exhausted
___ increased susceptibility to colds and flu
___ feeling guilty about taking time for yourself

2) Be aware of the pressure of caregiving and that it builds over time

3) Be aware that as caregiving goes up, additional coping skills should go up too

4) Be aware of your own needs and don't be afraid to ask for help

"You have to decide what your highest priorities are and have the courage — pleasantly, smilingly, non-apologetically — to say 'no' to other things. And the way you do that is by having a bigger 'yes' burning inside. The enemy of the 'best' is often the 'good.'" - Stephen Covey

5) Be aware of the resources around you, and be willing to take a respite

-Ways to add compassionate care- Send cards and handwritten notes - Make visits to the hospital or nursing home - Send flowers or small gifts - Provide food and occasionally an entire meal - Volunteer to be a driver (transportation)- Entertain children or other family members - Shop for needed items - Set aside time for regular reading aloud - Take walks and do other outdoor activities - Offer to do laundry and housecleaning - Be a willing and attentive listener - Extend emotional and physical affection - Provide financial assistance - Pray for someone in a crisis and ask others to join you in providing spiritual support for those in great need.

6) Be aware that sometimes you need to just sit in the floor and laugh or cry

"I am beginning to learn that it is the sweet, simple things of life which are the real ones after all." -Laura Ingalls Wilder

7) Be aware that care-giving is hard work and often times you may want to quit, yet it is still one of the most loving acts of Servant Leadership

Finally, consider the words of Jame Dobson, PhD to encourage you in your important work of providing care and compassion, without exhaustion. 'For the heartsick, bleeding soul out there today who is desperate for a word of encouragement, let me assure you that you can trust this Lord of heaven and earth. There is security and rest in the wisdom of the eternal Scriptures. I believe the Lord can be trusted, even when He cannot be tracked. Of this you can be certain: Jehovah, King of kings and Lord of lords, is not pacing the corridors of heaven in confusion over the problems in your life! He hung the worlds in space. He can handle the burdens that have weighed you down, and He cares about you deeply. He says to you, 'Be still, and know that I am God.' (Psm 46:10)

Finding the right caregiver to take care of your loved is not always an easy task. Here are some key interview questions to help you get started. Be sure to take notes during the interview. Always check the references of at least two final applicants. Do not wait too long to make the offer, as good applicants may find another job. If the offer is accepted, the caregiver and the in-home helper should set a date to sign the contract and begin work. Both employer and employee should keep a copy of the contract.

1. Name, address, home phone number, cell phone number, and the best time to call.
2. Do you smoke?
3. Do you have a driver's license? If yes, do you have reliable transportation and insurance? How far from here do you live?
4. Do you have any CPR or first-aid training? Do you have any formal caregiving training?
5. Do I have your permission to run a background check?
6. What type of position are you looking for? After reviewing our job description, is this the type of position you are looking for?
7. Can you perform the duties required for this position?
8. Are you comfortable with pets?
9. Are you able to work the hours needed?
10. When are you available to start working?
11. Do you have any medical conditions to prevent you from heavy lifting? Would you be able to transfer someone from a wheelchair into a car or onto a bed?
12. If we are delayed, go out of town, or go on vacation would you be able and willing to adjust your schedule?
13. Where was your last job? How long were you there? Why did you leave? May we contact your past employer? Please provide contact name, phone number, and email address.
14. If meal preparation is needed, what kind of food do you cook? Have you had experience cooking for other people
15. How do you feel about caring for an elderly/disabled person? Or a person with memory problems?
16. How do you handle people who are angry, stubborn, or fearful?
17. What type of diagnoses have you cared for?
18. Is there anything in the job description that you are uncomfortable doing?
19. Give an example of a difficult situation you handled with a client. For instance, how did you handle refusing to take a shower?
20. What time commitment are you willing to make to stay on the job?
21. Will you keep daily records? Do you know how to use a computer?
22. Why should I hire you?
23. Are you willing to sign a contract saying you will not accept money or gifts from my parents?
24. How will you keep the family informed?
25. Can you give me two work related and one personal reference?

When you hire a caregiver be sure to provide an employment application, W-4 tax Form, job description, and summary of the care-receiver's condition. Ask the caregiver to provide written references, completed employment application, completed W-4 Form, and signed copy of job description, copy of driver's license, car registration, and insurance.

When the clock strikes midnight on January 1, 2011, the oldest of the baby boomers will turn sixty-five. This remarkable generation, the largest in American history will continue to have an enormous impact on the nation socially, economically and politically as later it ages, transforming old age as no other generation has before in history.

As men and women born between 1946 and 1964 grow older, their parents are also aging and those who have not already experienced the impact of aging on their parents will do so in the next decade. You may find yourself in the season of life where you are an adult child of an aging parent. The cost of travel, phone calls, hired help are tough on the family and your current lifestyle when you don't live in the same local as your aging parent, but it's the additional load of worrying and guilt that can be unbearable.

• Is he / she all right?
• How will I know if he / she isn't?
• Should I be visiting more?
• Should I take time off from work?
• Am I giving enough?

Thoughtful preparation on your part could help to minimize the guilt trip. Make the most of your visits and the time you can give. Now more than ever organization and preparation are the keys to your success and your survival.
 
Lovingly Watch Out for Your Parent
 
Here are a few additional tips for organizing from a distance.

• Establish a local support network as soon as possible. Make a list of friends, family or neighbors who live near your parent. Let these people know of your concern. They can be extra ears and eyes as well as caring friends. They can alert you when they notice signs of trouble and be available if there is an emergency.
• If your parent lives alone, see if a relative, friend or neighbor will stop by occasionally to see how your parent is doing or perhaps drop off a meal or offer a ride into town. A synagogue, might know of volunteers who can check on your loved one. You may be able to hire a companion to spend time with your family member.
• Learn about any local elder watch programs, for example "Meals on wheels"
• Phone calls don't always tell you what you need to know. Visit your parent so you can see for yourself what's really going on, and so you can make adjustments to your parent's home or get additional help when necessary.

Visit Your Parent

• In advance of visiting, plan what you want to accomplish and anything you might need to discuss with your parent.
• If you live far away, organize your visits in advance so you can accomplish as much as possible. If you need to meet with a doctor, lawyer, social worker, or other professional, set up appointments at least a month in advance, as their schedules get filled quickly. Be sure to confirm these appointments closer to the date.
• When you are with your parent, take a mental inventory of her health and living situation. Try to foresee trouble before it happens

Does your mother seem wobbly or dizzy?

Is she well groomed, or has her personal hygiene deteriorated?

Is there ample food in the refrigerator?

Is the food spoiled and moldy?

Are there piles of unopened mail or unpaid bills?

Does she still do the things she used to, like read, knit, and do the crossword puzzle?

Does it appear that she's getting out, seeing friends?

If things seem askew or different than they used to be, it may be a sign of underlying trouble…depression, confusion, illness, diminishing eyesight, or simply a signal to you that she needs more help at home and opportunities to get out.

• Include some time during your visit to talk with nearby relatives, friends or others who see your parent regularly both to hear their thoughts and concerns and to thank they for helping in any way that they do.
• Check out local services and facilities. See what hospital is best, what nursing homes are acceptable, and what community services are offered.
• Even though your life is busy be sure to spend some time simply being with your parent, chatting listening, watching a movie or just sitting quietly. A trip that's all business misses a critical element. Find time to relax to listen to offer support.

Help Your Parent Prepare for Emergencies

• Discuss and call a company that provides an emergency response system to help your parent get immediate help in case of a fall or other health emergency.
• Set up speed dial to automatic all dial out for help on your parent's phone. Create a folder for emergency medical technicians with instructions of who to call including pictures of the people they will be reaching. It might also be helpful if your parent's personal address / phonebook is set up with small photos along with the contact information.

Above all take care of yourself. Recognize and accept the limits of what you can do and give yourself credit for all you are doing. Don't hesitate to ask for help or use community services. And finally, get support from friends or a Seasons of Life Coach to help you alleviate stress and guilt.