The Sibling Relationship When Caring for Aging Parents

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Witnessing a parent’s health decline is difficult as adult children come to terms with the idea that the relationship with their mother or father is changing. If you are currently caring for an aging parent, you may be experiencing this sense of anticipatory loss. Your siblings can be a source of support since they are experiencing these same emotions alongside you. However, the emotional impact of caregiving can also cause friction among your brothers and sisters. If you feel you are often in conflict with your siblings while caregiving for your aging parents, know that you are not alone.

The Caregiving Role

Caregiving for an aging parent is a multifaceted job that involves the financial, legal, physical and emotional well-being of your mother or father. You may encounter many different opinions between your siblings on what decisions need to be made, which can lead to confusion about what people will agree upon. In addition, if your siblings have questions about the estate or their inheritance, this can have place pressure on the caregiver who is managing the financial and legal affairs of the parent.

The sibling relationship is an important factor in the care of aging parents. For one, siblings need to make key decisions and communicate their  feelings and opinions in terms of their

parent’s care. Combined with the emotional process of accepting their parent’s declining health, you may observe that your brothers or sisters may be attempting to resolve long-buried feelings with the family or may be unintentionally inciting sibling rivalries by falling into old family patterns.

Family Roles and Patterns

A major complication of the sibling caregiving relationship is that childhood roles within the family re-emerge. Family members can view the adult siblings with the same labels that they acquired—perhaps unfairly—as children. Birth order and gender may also influence these sibling dynamics. For example, if you were the highly-responsible child in the family and are now handling your parent’s care, your siblings may feel that you have everything covered with your aging parent, and not know how to help. Just as you would want to be acknowledged for the person you are today, rather than how you were characterized in the past, it is necessary to acknowledge that these labels may have a damaging effect on the sibling relationship. A question to ask yourself in your communications with family members is whether your feelings or opinions are based on the present situation or are remnants of the past relationship. Be mindful that you are offering space for your siblings to contribute in the way they can.

Relationship with the Parent in Care

Your siblings have a different relationship with your parent than you do therfore they may have different needs in caring for your parent. If your sibling has resentments towards your parent that are coming up at this emotional time, resist judging them for their feelings as we all have our own individual process of letting go. It may be helpful to reframe how the siblings views the role at hand. Express your own need for assistance and ask for their support in your role as primary caregiver, if they cannot offer this to your parent.

In another common scenario, your parent may have helped resolve any disagreements among your siblings. Now with your parent unable to intervene, your siblings might need to devise new communication and conflict management strategies.

Communication

Effective communication is important to ensure trust and transparency between your brothers and sisters. Your siblings can provide helpful input in the decisions you face as the primary caregiver. Regular and consistent communication with your family members (especially those that live out of town) can alleviate tension between siblings. Some primary caregivers may send regular email updates to siblings, or make use the apps such as Tyze now available for managing the care of a loved one. Communication can also motivate people to contribute and ensures that each family member is on the same page with the care of your parent.

A family meeting can help establish new patterns and build trust with your siblings for your abilities to care for your parent. If needed, a counselor or psychologist can help facilitate your family meeting to ensure turn-taking in talking and guide the process towards a productive outcome.

Be aware that each sibling is processing the emotional situation of their parent relationship at their own speed and to the best of their abilities. You can help to create a better connection with your family by providing positive feedback when siblings help, listening intently to what your siblings say, and by clarifying issues as soon as they arise. This does not mean that you have to compromise your own feelings in the relationship; rather, you have a duty to express yourself in an honest and non-accusatory way that. If in the end, your siblings are still not responding to your efforts, it may be time to step back and recognize their limitations in caregiving. At times, you may have to take on the role without any assistance of family members. If this is your situation, reach out for the support of the caregiving community to ensure your own needs are being met.

Come by and borrow these library resources:

  • Caring for your Parents: The Complete Family Guide (Book) by Hugh Delehanty and Elinor Ginzler
  • Family Meeting: A Media-Based Approach to Planning Care for Family Elders (DVD) by Sheri Hartman and David Kleber
  • Online: Handling the Sibling Relationship (Podcast), http://archcare.ecarediary.com/CommentRadioShow.aspx?id=215

 

By Lindsay Kwan

*Adapted from the July/August 2016 Family Caregivers’ Grapevine

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Dementia Tips Caregivers Need: Part Two

Last month I posted my notes on a Dementia Education workshop I attended hosted by Karen Tyrell (Lower Mainland Dementia Educator). Here is the previous post:  https://northvancaregivers.wordpress.com/2018/04/12/dementia-care-workshop-highlights/

I now turn to the mains stages of AD, which are:

  1. Mild/Early 2-4 years (doing just fine)
  2. Moderate/Middle 2-10 years (middle stage more difficult-family stressed)
  3. Late 1-3 years

To date, 1 million Canadians are affected by Alzheimer’s Disease.

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Diet and exercise are important, sleep also. Common behaviors and changes are:

  • Repeated questions
  • Denial (of AD, dementia)
  • Difficulties doing daily activities, such as forgot how to use microwave
  • Increased anxiety
  • Increased agitation
  • Aggression (verbal or physical)
  • Wandering, pacing
  • Paranoia and misperceptions
  • Losing things

Here are some tips on how to manage:

  • Try to keep the peace, validation of the feelings they are experiencing
  • Time outs
  • Say: ‘I can see you’re frustrated, angry’

I hope this helps.  My father has early dementia, and life is certainly a challenge. Probably the most helpful tip of Karen’s is to keep the peace, at least for me.
Also, time outs and time away help a lot. Here is Karen’s website: www.DementiaSolutions.ca

All my best to you in your caregiving journey,

Calm Pond

Dementia Care Workshop Highlights

Early this year, I attended a workshop (‘Dementia Tips Caregivers Need to Know’) presented by Karen Tyrell of Dementia Solutions

Tyrell provides online training, guidance, and emotional support.

Did you know? 1 million Canadians are affected by dementia.

1 in 11 Canadians over age 65 have Alzheimer’s Dementia

This statistic increases to 1 in 3 in those over age 85

Half a million Canadians are living with Dementia

However, every dementia journey is different, says Tyrell. The following are some symptoms of dementia:

  • memory impairment (especially short-term memory)
  • thinking impairment
  • judgement problems (such as wearing inappropriate clothing, or bad decision-making)
  • communication problems (words not understood)
  • personality changes

What exactly is the ‘science’ of dementia?

Alzheimer’s dementia was discovered by Dr. Alzheimer 100 years ago. It is characterized by plaques and tangles in the brain. A good analogy is that AD acts like a computer virus, it starts in the hippocampus (area of the brain used for memory).

People with AD can have difficulty performing daily tasks, for example, they can make mistakes driving. They can move into a different era.  They can also have difficulty recognizing people and objects.

Want to know more about the stages of AD and some more of the signs?

Stay tuned to my next AD post in May…

Calm Pond

Incapacity Planning: The documents you did not know you needed

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Almost everyone has heard of an understands the general purpose of a will. It dictates how you transfer assets when you die; it allows parents to appoint guardians for their minor children when they die, it sets out the extent of the powers you want your representative to have when making decisions for you after you have died. The common thread – a will allows you to make decisions when you have died. A will therefore only operates from the time of death. A question that many people do not consider:

How do I make decisions when I am no longer capable of acting for myself during my lifetime?

What is a Power of Attorney?

A power of attorney (POA) is a legal document that gives you the opportunity to appoint someone (an agent) in advance to help you make legal and financial decisions on your behalf if you were ever unable to do so yourself. The powers that are granted in a POA are incredibly broad and range from dealing with your day-to-day banking to selling your house.

Why is a Power of Attorney important?

Consider the following scenario:

An adult child is caring for their elderly parent who has dementia. The dementia however, has began to progress to the point where the parent no longer recognizes loved ones and the parent requires continuous care that can only be obtained through a care facility. The adult child cannot afford to pay for the care through their own finances and looks to the finances of the parent. However, the parent’s bank accounts are all in their own individual name and the banks will not allow the adult child access to the money. The parent’s home where he/she is currently living is also registered in the parent’s name alone and the land title office will not allow the home to be transferred without the parent’s authorization and signature.

In the above scenario, if the parent had a POA appointing the adult child in a power of attorney when they did not have dementia or possibly when the dementia was still in the early stages, the adult child would have been able to access the bank accounts/ sell the home in order to pay for the parent’s care. It is likely that the adult child in this case would have to apply to court for a court order – called a committeeship – giving them the authorization to access bank accounts and to sell the house.

A committeeship application takes roughly three months to obtain and will usually cost anywhere between $4,000 and $10,000 to obtain (depending on lawyer fees). In the meantime, the adult child will continue to incur the cost of paying for the care out of their own pocket; a situation that the parent likely did not want for their child.

The above scenario is one that estate planning professionals and health care practitioners see too often. What could have been dealt with via a properly drafted POA will now require an expensive and time-consuming court process. Once you have had the conversation with the adult and the adult has decided that they do want a POA, they then must decide what type of POA they would like.

Enduring and Springing Powers of Attorney

There are two types of POAs.

Enduring Powers of Attorney: A POA that is active at all times and does not require the adult granting the power to be incapable of making their own decisions/incapable of managing their finances. For example, even if the adult was away on holiday or simply did not want to leave their home, the appointed person could go to the bank to deal with their day-to-day banking.

Springing Powers of Attorney: A POA that only comes into effect when medical professionals perform an assessment and determines that the adult is no longer capable of making their own decisions/incapable of managing their finances.

Why an enduring power of attorney?

Many clients will ask why they would “give up control” of their finances while they are still fully capable of dealing with their own finances. There are three main reasons for doing so:

  • Convenience – even if you are not “incapacitated” by medical standards, you may still want some assistance in dealing with your everyday banking (e.g. the out-of-town scenario);
  • Capacity – Even though doctors may not be ready to say your are incapable of dealing with your finances, your family may be fully aware that you are no longer capable of doing so. The enduring POA allows your family to help you even before you are medically incapable; and
  • Continuity – if you trust the person to manage your finances for you when you are no longer capable and may not necessarily be able to monitor their actions, you should trust them to manage your finances for you while you are capable of monitoring their actions.

It is therefore important to have a conversation with anyone you care for regarding obtaining a POA even if they hesitate at first. Many adults – especially those in care – will be open to the idea once they are aware of the negative implications that can arise if they do not have one.

Additionally, the advice of professional should be sought in order to avoid some common pitfalls (e.g. not including the legal name of the adult as it is listed on the title of the home; not having the POA signed in accordance with the law). Speak with an experienced professional today to see what your options are.

Jeremy Wong is an estate planning lawyer at Westcoast Wills & Estates.  He routinely prepares wills, Powers of Attorney and Representation Agreements.  He also advises executors on probate and estate administration.

 

Routines and Reminders for People Living with Dementia

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Humans are creatures of habit. We love and crave routines, even when we don’t think we do. Following at least a loose routine can anchor you in the moment and keep you focused and grounded. “When you regulate your daily actions, you deactivate your ‘fight or flight’ instincts because you’re no longer confronting the unknown,” says Psychology Today. For people living with dementia, reducing fear and increasing feelings of safety is crucial. Creating and maintaining a routine for your loved one may make a big difference in their quality of life and could help with managing their emotions.

Here are some tips supporting your loved one with a routine:

USE THE GOLDEN RULE | Treat others as you would want to be treated. You know your loved one well. Really watch them, and try to think about what they need to enrich their life. How would you like to be treated if you were in their position? This perspective can help you create a routine that works for them, and encourage you to change it as needed. The Alzheimer’s Association says it’s important to consider the following:

  • The person’s likes, dislikes, strengths, abilities and interests
  • How the person used to structure his or her day
  • What times of day the person functions best
  • Ample time for meals, bathing and dressing
  • Regular times for waking up and going to bed (especially helpful if the person with dementia experiences sleep issues or sundowning)

CREATE A PERSONAL CARE ROUTINE AND PROVIDE CUES | For example, it may help your loved one to know that when they awake in the morning, they use the bathroom, brush their teeth, and change their clothes. Depending on how advanced their dementia is, they may need additional cues, such as a toothbrush on the counter or clothes for the day laid out the night before. If your loved one is struggling, you could try breaking the tasks in to chunks to make each step more manageable. “…she may find it easier to continue dressing herself if you put the clothes out for her in the order that she needs to put them on. Or you could pass her the next garment, holding it out ready to grasp at the right place, or encourage her to put her shirt on over her head before you straighten it down for her,” says the Alzheimer Society.

PLAN ACTIVITIES | Again, it’s important to follow their lead. Have you noticed that new activities make them anxious? Alternatively, do they get bored and restless at a certain time of day? These cues might lead you to make adjustments, which could mean trying a new activity or environment, or cutting back on something you’re already doing.

How do you support your loved one with routine? We’d love to hear from you in our comments!

 

Cassandra Van Dyck

 

 

10 Ways to Survive Pet Loss

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In the days, weeks, and months that follow losing a cherished pet, you may feel a huge hole inside.  Grief can make it hard to think and plan.  Here are some survival tips that might help (courtesy of Moira Anderson Allen (2001)

  1. Eat something (preferably something that makes you feel good.)
  2. Cry (take a day off, maybe?)
  3. Find something to do ( it helps you recognize that while grief is part of your life, it isn’t the sum total of your life.)
  4. Count your blessings (remind yourself of some of the good things you still have.)
  5. Reflect on things that don’t involve your pet (the skills you have, the things you enjoy: like taking long walks or a warm bath.)
  6. Cuddle something furry (another pet or a stuffed animal)
  7. Avoid irrevocable decisions (don’t do anything you can’t undo, resist throwing out all your pet’s toys, get them away, out of sight, you might want to incorporate them into a memorial later on)
  8. Replace negative imagery (Replace the images of the ‘last’ moments with your pet with images of your pet arriving on the ‘other side’, if you believe in an afterlife)
  9. Be honest with yourself (you will heal and it will take time)
  10. Make a decision to work through grief (sometimes, time doesn’t ‘heal all wounds’, as the saying goes. Accept your grief, make peace with it.)

For more information on how to heal from pet loss, see pet loss net

Calm Pond (who speaks from one who has been there)

Creating safety and connection: Memory Care Villages

When you think of a beloved parent, Aunt and Uncle, or spouse- it is natural to want their final years of life to be filled with comfort, friendship, and belonging. In the event of a dementia diagnosis, it can be challenging to figure out how to create positive experiences for a loved one; to allow them to live as happily as possible.

The Netherlands are a leader in providing safe, dignified living choices for those living with cognitive impairment. In the Netherlands there are a number of dementia care villages, and Within these communities are shops, grocery stores, apartments, parks, and anything else you would expect to find in a normal community”. Residents have chosen to live in these communities, which allow for ideal amounts of freedom and normalcy in routine; while having support available. People live in housing units of 6-8 apartments, and registered nurses and care aides provide assistance and support while residents move about their daily lives in an environment of dignity and choice. Hogeway, the example shared here- is a secure community. The staff takes care of everything from cooking meals and planning activities to assisting with bathing, personal care and administering medications. Even the individuals staffing the various village “businesses” are trained in dementia care, to help those with Alzheimer’s go about their day. https://www.alzheimers.net/2013-08-07/dementia-village/

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The benefits as I see them:

  1. Aging in place. The Village option is close to what goes on in regular life, and allows people to stay involved in community life. This helps boost self-esteem as well!
  2. Feeling less stigmatized. Given the opportunity to run errands, walk around the village freely, and make choices about recreational activities gives residents a sense of control and purpose, with less feelings of being “labelled” as impaired.
  3. Personalized care. With care staff being responsible for the routines of a smaller number of residents, there is more opportunity to know residents extremely well, which creates a warm and caring environment.
    The concept has been hugely successful, and residents of the Netherlands who choose to make Hogeway their home seem to be happier: behavioural issues—often a major problem with Alzheimer’s patients—are fairly low due to the freedom they enjoy, the sense of purpose they have in their lives, and reminiscence therapy.

There is work being done to create Memory Care villages in the Lower Mainland, with Langley’s Dementia Village being built right now. This site will be home to 78 residents, and is set to open in 2019. Providence Health also reportedly has plans underway to open a larger Village in Vancouver, in a few years. Read more at: http://vancouversun.com/news/local-news/canadas-first-dementia-village-to-open-in-langley-next-year

Dementia Villages seem to be a brilliant way to nurture quality of life in a way that is respectful and person-centered.
How would you feel about your spouse or parent living in a Village?

-Karyn

How to Get the Bounce Back In Your Step

 

‘Bounce Back is a program of CMHA (Canadian Mental Health Association) and is free of charge. If you get your doctor to refer you to this program, you will receive workbooks and will get 5 telephone sessions with a coach, however this is not the same as counselling. Bounce Back is proven effective at relieving mild to moderate depression (with or without anxiety). The other option you have if you choose not to do the coaching is to watch the free DVD (available at North Shore Community Resources and most Doctor’s offices). The DVD is entitled ‘Living Life To The Full’ and features people who have experienced depression and anxiety. I found, that as I listened to their stories, I realized that I was not alone and that help was available. It is also inspiring to learn that there is hope, if you use the strategies taught in the DVD. Strategies such as problem-solving and assertiveness. But don’t take my word for it, try it for yourself.

You can obtain more information about this helpful program at:

Https://northwestvancouver.cmha.bc.ca

Https://CMHA.bc.ca/programs-sevices/bounce-back

As the French say: ‘Bon courage!’ (Which means have courage).

 

Calm Pond

Down under Mental Health Websites

Here are two Australian mental health websites that might help:

Mood Gym

This is an interactive website that teaches people to use ways of thinking that will help to prevent depression. It is based on CBT (Cognitive Behavioral Therapy).

Clinical Research Unit for Anxiety and Depression

This site has three sections: self-help, support for professionals and research.  It includes a depression quiz, information about effective treatments, suggestions for planning activities and problem solving, a list of pleasant activities, and cognitive behavior therapy materials and links. The downloadable fact sheets on depression are particularly useful

See also ‘This Way Up’ a self-help course available on mobile devices.

Hope this was helpful for you.  A lot of good work on mental health has come out in Australia recently.

Calm Pond

2 minutes to calm

Feelings of anxiety can become part of everyday life when you have a big responsibility in tending to another person’s well-being. When your spouse is ill or your parents are declining in their ability to manage their home life, you might feel worried about their safety for most of your waking hours.

When your nerves are frazzled and you can’t imagine feeling relaxed ever again, it helps to have a few calming tools in your back pocket. I suggest picking one or two ideas and trying them to see what fits with your personality and daily routines.

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Your invitations
Stay open. Try an idea from the list several times before deciding if it’s helpful. New habits take practice!
Be patient with your progress. It may take a few times to start feeling more calm, or even a tiny bit less tense.
Mark your successes. Notice and be proud of the small moments of peacefulness you experience in your mind and body.

Calming exercises

Heart breathing
Sit upright in a comfortable chair. Close your eyes.  Make note of your feet being secure on the ground.
Breathe.
Put one hand gently on your heart, and the other hand on your tummy. Sit and breathe easily, breathing in for 3 seconds, and out for 5. Keep your hands in place.

Calm ocean
Lay down on the couch and set your timer for 2 minutes. Breathe without much concentration.  Picture yourself on a boat in calm waters, being gently rocked by the soothing waves. You are safe in the boat. Send your anxiety far out to sea, the strained thoughts getting further away with each breath.

Worry box
Create a worry box. It can be a shoe box or something simple. You might want to decorate it with your own style.  Take small pieces of blank paper and have them nearby.
For 2 minutes a day, write down what is worrying you. Write without stopping.
Put those worries in the box and close the lid.  Don’t open the worry box until tomorrow, when it’s your planned “worry time”. Notice how you feel after doing the writing- is there a difference in your body? Your mind?

I hope some of these exercises will help you to regain a sense of inner balance and strength when life feels especially trying. Here is an excellent source for 1-minute meditations by Robin Rice- www.robinrice.com . You may also have a cell phone relaxation app that you like to use.

Be well today.
Karyn