Caring Connection News
Helpful tips for family caregivers

Options for taking a break from caregiving

If you’re providing care for your loved one, you may long for a night to call your own. Better yet, a few days and nights of R&R. Go to bed when you’re ready, sleep deeply, and do what you want all day!

A respite break isn’t indulgent, it’s smart. You need frequent, regular opportunities to wind down and focus on your own needs and delights—daily, weekly, monthly, annually. Respite replenishes your inner resources so you can be the loving, patient care provider you want to be.

To gain respite on a daily or weekly basis, consider these options:

• Adult day centers. These programs provide supervision along with recreation and meals in a group setting. They may be a standalone facility or part of a senior center.
• Enrichment programs. A provider spends one-on-one time with your loved one, doing an enjoyable activity. The service may be offered through a local agency or community organization.

For overnight or longer getaways, you have generally two options:

Your relative stays home. If you already have a hired caregiver, ask if they would provide some multiday help. Or make arrangements with a home care agency. Have the agency’s care provider spend time at the house with you and your relative ahead of time. Easing in helps your loved one feel safer and lets the provider learn the routines.

You stay home. Typically, this means finding a facility that has beds available for short-term occupancy. Plan ahead to get the dates you want and check for minimum length of stay. You’ll also need lead time to complete necessary assessments and paperwork.

• Assisted living. Assisted living fits if your loved one has only mild disability. A person capable of handling some independence may enjoy the social activities and communal meals.
• Memory care. If your relative has moderate or advanced dementia, then a specialized care unit with trained staff and closer supervision is more appropriate.
• Skilled nursing facility. If your loved one has medical needs (wound care, injections, IV medication, pain management), a rehab facility is the best match.

Most of these arrangements are private pay, unless hospice is involved. Check with the VA, fraternal organizations, or your Area Agency on Aging for available respite grants.

When reasoning becomes a concern

When an aging loved one starts making what you consider poor decisions, it’s worrisome. Are they no longer thinking straight? Is this normal aging or something more serious? There are two terms to know when concerns arise about cognition: capacity and competence.

Capacity is a medical term. Having capacity means you can understand information, consider choices, and communicate a decision. Capacity is not all or nothing. For example, your relative may be able to choose what to wear or agree to a medical test. But they may struggle with paying bills or understanding medication changes.

Capacity is changeable. Your loved one may think clearly in the morning but be confused later in the day. Illness, depression, or medication side effects may affect their ability to make decisions. A medical evaluation can assess capacity for certain types of decisions.

Competence is a legal term. Attorneys assess a person’s capacity to address legal issues. Or complete legal documents. Only a court can decide that your relative is incompetent. It means they have shown incapacity to manage life functions overall. If your family member has not named someone to act on their behalf through durable power of attorney, the court may appoint a guardian or conservator.

When to seek an evaluation. Forgetfulness alone does not mean someone can no longer make decisions. But changes deserve attention. Contact your loved one’s primary care doctor and explain your concerns. Ask for a memory screening or capacity evaluation to establish a baseline.

If your relative can still make decisions, now is the time for them to complete legal documents. Specifically, a durable power of attorney and an advance directive. This allows them to name decision makers who can act in their place if needed. If their cognition worsens, those choices may become much harder to make and may require court action.

Who needs a pacemaker?

The signs of needing a pacemaker can be easy to miss at first. You might notice fatigue, dizziness, shortness of breath, or confusion in your loved one. Or hear them commenting, “I just don’t feel right anymore.” If a slow heart rate (bradycardia) is determined to be the culprit, their doctor will look for a reversible cause. If there is none, the doctor may recommend a pacemaker.

What is a pacemaker? A pacemaker is a small, battery-powered device that sends electrical signals to the heart to keep it beating at a steady rate. It is placed under the skin, near the collarbone, in a surgical procedure. Its function can be monitored remotely by the doctor. Within five to fifteen years, a shorter surgery will be needed to replace the device.

Who needs a pacemaker? Pacemakers are most often prescribed to older adults struggling with bradycardia or heart failure. They are also sometimes used in cases of a high or irregular heart rate. For many older adults, a pacemaker can improve energy and quality of life and prevent falls by eliminating the dizziness caused by a slow heart rate.

Still, it helps to know what a pacemaker can and cannot do. It can regulate the heartbeat, but it does not treat frailty. If your loved one has advanced dementia or is diagnosed with a life-threatening condition, a pacemaker may not be appropriate. Though they are low risk in general, they may prolong life when that result is not desired. They should be considered within the greater context of overall health and quality of life. A pacemaker decision may prompt a larger discussion about care wishes and medical interventions.

Other considerations. Medicare generally covers medically necessary pacemakers, but check your loved one’s plan to see if the same is true for follow-up costs and procedures.