8 Ways to Care for Elderly Loved Ones in Assisted Living

This is a special guest post from contributor Krisca Te.

When the time comes to move a loved one to an assisted living facility (ALF), it can be an emotional period for everyone involved. While it’s undoubtedly the right thing to do when they are no longer capable of living on their own, it is inevitable that some negative feelings will surface. 

On your own end, there may be feelings of guilt that you aren’t taking your parent or grandparent in yourself, while for them it means the beginning of the end of their independent lifestyle and will require some pretty big adjustments.

I experienced this firsthand when the time came to move my grandma to an ALF. She had always been very active and independent; she loved playing golf on the weekends, meeting up with friends for bridge games and hosting elaborate dinner parties.

However, as she got older, it gradually became more and more difficult for her to climb up and down the stairs and get around the rather large home where she lived alone. On one occasion she suffered a fall and injured her ankle; luckily it wasn’t too serious, but it did lead us to reevaluate her situation.

When we brought it up with her, she was naturally very distraught at the thought of leaving her home and insisted that she would never move to an ALF where as she put it “everyone was just waiting to die.”

Eventually we suggested that she come along and have a look at some of the places in our area, just to get a feel for what they were like.

Once she saw the facilities, met some of the residents there and talked to the staff, she actually began to warm up to the idea of moving to a smaller place where she would have more help, and also more opportunities for socializing. 

She has since moved to an assisted living facility nearby and although it certainly hasn’t been an easy process for her, she has managed to readjust and is still enjoying most of the same activities she did when she lived in her own home.

I’ve learned that although you can’t change your loved one’s circumstances, there are things you can do to help them through the transition. The most important thing you can do is to simply be there for them and give them your support when they need it.

The following are some of the things that helped in our situation, and hopefully they will be helpful to others as well.

1. Deal with any feelings of guilt first. If you’re feeling guilty about placing your loved one into assisted living, it’s important that you are able to work through those feelings before you move forward as these feelings could negatively influence your loved one’s transition period.

Keep in mind the reasons why you initially decided that moving your parent or grandparent to an ALF was the right move and remember that it will benefit their health and well-being.

2. Talk through any concerns well in advance. If your loved one has any concerns about the move or about what will happen to their current home or belongings once they move, it is important to go over these concerns long before you being any other preparations. Find out what they are worried about and then work towards coming up with solutions that will put their mind at ease.

3. Visit the ALF with them a few times before the move takes place. Most of us are more afraid of what we don’t know than what we do, so taking your relative to visit the facility and acquaint themselves with the grounds, staff and amenities can do a lot to ease their worries and help them adjust more quickly.

Go to a few meals, talk to other residents and familiarize yourselves with the grounds and layout of the facility so that your loved one knows what to expect.

4. Keep in touch as much as possible. During the first few months or even year of your loved one’s transition into assisted living, they will likely be feeling vulnerable and insecure in their new surroundings. Knowing that they can count on your support can go a long way in helping them to adjust. Make regular visits and when you can’t come in person, be sure to phone them or send a little note so that they know they haven’t been forgotten.

5. Help them make new contacts and get involved with activities. Elderly people can often become shy when placed in a new environment and may turn down suggestions of activities or social gatherings. However, getting involved with others in their community and making new contacts is an important part of the adjustment process.

If they seem reluctant to participate, try accompanying them to some of the planned activities and gatherings so they don’t feel too intimidated. There is bound to be some activity your loved one is interested in, whether it’s art, book clubs or music lessons.

6. Don’t coddle. Showing support is important, but make sure you give your parent or grandparent the space to be independent as well.

In the first few days, for example, you may want to visit every day to make sure they know you haven’t abandoned them, but as time goes on, it’s better to space the visits out a bit more so that your loved one doesn’t become too dependent on you.

7. Set up their new living space with familiar furnishings and personal effects. Most elderly people are quite attached to their belongings, and parting with them can be very stressful. Obviously, they will be moving to a smaller environment, so not everything can be moved with them, but incorporating as many of their favorite objects like armchairs, beloved knickknacks and photographs can give the new place a familiar feel.

8. Form good relationships with the staff. You may not always get straight answers from your loved one about how they are doing and whether or not they are adjusting well into their new home, so forming good relationships with the staff can help you stay better informed of their progress and any issues there may be.

Krisca Te works with Open Colleges, Australia's leading provider of TAFE courses equivalent and aged care training. When not working, you can find her on Google+ or spends the day with her baby boy.

8 Tips for Staying Healthy and Happy During the Holidays

Christmas, Hanukah, New Year’s—these are supposed to be times of celebration, togetherness, and happiness. Yet, they can bring challenges to our physical and emotional health. Here are 8 tips for staying healthy and happy during this holiday season.

1. Eat well. It’s common to pack on 5-10 pounds during the holiday season, but there are ways you can eat both healthy and well! Know which foods are high in caloric content and low in nutrition. Don’t deprive yourself of such treats, but indulge in moderation. Eat smaller meals instead of “saving yourself” for one huge buffet. Opt for healthy options at home, and when visiting others, bring a healthy dish to share. Be careful of liquid calories, including alcoholic beverages.

2. Stay active. Exercise is just as important during the holidays as any other time of the year. You should be active at least four to five times a week, preferably with some aerobic exercise every day. The weather may be cold outside, but the winter offers additional fun, too! Ice-skating, sledding, snow sprints—all of these can be great exercise. Enlist your loved ones to join you for quality bonding time.

3. Prevent illness and injuries. Colds and the flu are most prevalent in the winter. Prevent them by washing your hands regularly and urging others to do the same. Stay warm by dressing in layers. Sprinkle sand on icy patches. Watch young ones, and assist the elderly, who are at increased risk of falls and other injuries during this time.

4. Check your heating system. Making sure your heating works and is safe. Carbon monoxide emergencies can be fatal. Install a carbon monoxide detector and test it once a month. Keep grills and generators out of the house, and don’t run your car for long periods of time in the garage. Most residential fires also occur in the winter; never leave fireplaces, stoves, and candles unattended.

5. Travel safely. Whether you are going down the block or halfway across the world, follow extra precautions. Give yourself plenty of time in the additional holiday traffic. Never drink and drive. Be on the lookout for reports of extreme weather and heed warnings. If you’re traveling away from home, make sure to pack and take your medications. Know how to contact your doctor when you are away and have a medical problem, and where the local ER is.

6. De-stress. Holidays can be a stress time. You may be working, and feel the stress of managing your work duties along with additional commitments to your friends and family. You may feel the financial stress of gifts, and the interpersonal stress of conflicts. Try to anticipate sources of stress and develop a plan to manage them. This may involve committing to fewer get-togethers or setting a tighter budget. Don’t feel guilty; you have to take care of yourself before you can take of others.

7. Help others. Depression and suicidality increase during the holidays. Watch for signs of depression among your friends and family. Take an active role to support those in need. Invite those colleagues or friends who are alone over the holidays to spend them with you. Volunteer and give to those less fortunate.

8. Treat yourself. The holiday spirit is about helping others around you, but you also have to make time to take care of yourself. So treat yourself with something over the holidays. It may be something as simple as sleep. Sleep in and enjoy a day of rest; you need it. How about reading that book you’ve been meaning to for a long time, or getting a manicure or massage? Take the time to do the things that make you happy.

I hope these tips have been helpful! Do you have other tips to share? I welcome your comments. And happy holidays!

6 Ways to Fight End-of Summer Blues

Summer is coming to an end. Feeling down around this time is quite common, especially for those of us who live in colder climates and can see the winter approaching. Here are 6 ways to fight those end-of-summer blues:

#1. Get sunlight. Seasonal affective disorder (SAD) affects up to 10% of people. You may not have full blown SAD, but use the same treatment—and the same preventive measures—to feel better. Soak up the sunlight. Open your blinds at home. Find areas at work that have natural light; perhaps take breaks in a room where the sun streams in or that’s near a skylight. Choose to walk the longer route on sunny days. Eat lunch in the park. Even if it’s chilly outside, the sunlight itself will help you.

#2. Exercise. Physical exercise alleviates stress and makes you feel healthier and happier in general. When you exercise, natural endorphins kick in that improve your mood. It may be particularly helpful if you exercise outside; a brisk power walk when it’s light outside will help you get fit, feel better, and soak up sunlight! Aim to have at least four-40 minute episodes of aerobic exercise per week.

#3. Eat summer foods. In the summer, we tend to eat healthier than in other seasons. Meals are filled with fresh fruit, raw vegetables, and big salads. Keep this up! Just because the weather is changing doesn’t mean we have to load up on the carbs. Aim to have three of these “summer meals” a week. Bring fruit and vegetable snacks to work instead of potato chips. Choose a salad over a carb-heavy lunch. A change in diet can help you feel significantly better.

#4. Sleep early and well. As it starts to get dark earlier, shift your schedule gradually to the earlier side. Make sure you are getting at least 8 hours of sleep every night. Waking up earlier helps you get more sunlight, and good sleep hygiene is essential to good physical and mental health.

#5. Keep reminders of summer with you. Display your pictures of summer vacation. Use lotions and scents with coconut and other summery smells. Light a scented candle, and break out the bubble bath. These little touches can make a difference.

#6. Make good plans for the rest of the seasons. Have some things that you are looking forward to in the fall and the winter. Perhaps it’s a vacation, or party, or other event--maybe it's as simple as viewing the fall colors. Celebrate the little things too, and treat yourself often. There are reasons to embrace the other seasons too! And if all else fails, summer isn’t that far the future again.

I'd love to hear your thoughts and comments about my blog and videocast. What do you use to combat those end-of-summer blues?

Physician, Seek Help--Don't Just Heal Thyself

In my second year of medical school, I attended a reading by Dr. Abraham Verghese, a physician, writer, and humanist. He had just written a book, The Tennis Partner, that was about his friend and then-medical student who lost a slow battle to drug addiction and mental illness. The book was about how their relationship developed—and how he found out about his friend’s problems, then failed to act on it. The reading was poignant because of his obvious emotional involvement, and because the topic hit close to home.

How many of you know medical students, residents, and doctors-in-practice who have been depressed? Who have thought about harming themselves or tried to numb their pain with alcohol and narcotics?

Studies have shown that physicians have a far higher rate of depression, substance addiction, and suicide than the general population. Medical students start out with similar mental health profiles as their age-matched peers. During medical school, one in four medical students become clinically depressed. One in ten entertain thoughts of suicide. Despite their ready access to healthcare, physicians-in-training seek help with lower frequency than other young professionals.

Researchers have come up with various hypotheses to explain these findings, including social isolation during training and greater tendency towards perfectionism. In a New York Times op-ed, surgeon-writer Dr. Pauline Chen discussed the problems with the “survival of the fittest” mentality that is prevalent in the medical profession. While in training, who wants to be the “weak” person who seeks help? Who wants to admit they want more support than someone else, or burden others with time off or shifts to cover?

I faced this issue myself in my second year of residency. My mother died after a long battle with cancer. She had fought it for years with surgery and aggressive chemotherapy until finally she was in remission. Then, during my internship year, we found out that the cancer was back. The last few months of her life were filled with terrible suffering. She fought despite the pain because she wanted to make sure my then-16-year old sister was OK. Finally, she agreed to enter hospice care, but she never quite made it home. She died in the ICU, at age 54.

As much as my family was prepared for her death, and as much as it was welcome because it put an end to her suffering, it was a very difficult time for us. Coming back to work was much harder than I expected. Every cancer patient or critically-ill patient reminded me of my mother and her last days. I cried after every shift. I was on an emotional rollercoaster: things would seem to be getting better, then an issue with my family, or a patient, or a patient’s family, would set things off, and the rollercoaster would come crashing down.

My experience is a pretty specific example of grief and bereavement, but I think the lessons I learned are applicable to other physicians who are coping with their own challenging situations. I share them with you now:

1) Accept the support of family and friends. This may seem obvious, but I made the mistake of shutting people out and burying myself in errands and busywork just to keep occupied. Thankfully, those closest to me didn’t allow me to isolate myself, and I learned that losing ourselves in our training is never a good solution. It may temporize the pain, but will only serve to alienate us from those who care about us.

2) Ask for help. This could be as simple as letting your school, program or hospital know of your need for time off. In my case, I didn’t tell anyone in my residency when my mother got sick. I wish I had, because I would have been able to spend more time with her in her final months. When she died, I even resisted taking time off. In retrospect, I came back to work too soon. I thought I was being strong and wanted to prove—most of all to myself—that I could do it. But the result was traumatizing to me, and I probably ended up delivering less than ideal patient care. There is really no shame in admitting that we need help, whether it’s help for specific things like covering shifts, or if it’s referral to a counselor or support group. Both Dr. Verghese and Dr. Chen wrote about how silence is what leads to deadly outcomes. “Physician, heal thyself” is a mantra that fosters bravado, not compassion.

3) Recognize and help address challenges that others around us are facing. Prior to my experience, I hadn’t realized how prevalent depression and addiction are in our profession. The Tennis Partner describes a very plausible scenario that could happen to any of us. After all, if one in four of all physicians-in-training are depressed at some point in their training, it’s likely that a couple of our friends or colleagues are having problems at this moment. As physicians—indeed, as humans—we have a duty to make sure that those around us are OK.

So do your part. On a personal level, reach out to your friends. If you suspect they are in trouble, reassure them that you’re there for them and that it’s OK to seek help. Make use of student support services in your medical school or hospital. Start your own support groups if none exist. In my residency, I helped to start the Emergency Medicine Reflection Rounds (EMRR) where residents meet to discuss personal reflections and give advice and support for each other. EMRR has been successful so far, and the feedback we’ve received reinforces the importance of establishing and fostering community. 

Medical training is not an easy process, but we are not alone. We can each do our part to preserve humanity, promote wellness, and approach each other, and our patients, with respect and compassion.

Parts of this article have been published in AAEM's Common Sense magazine and on Medscape.  I welcome your feedback and comments on this blog post.