Who is a Caregiver?

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  What if we need more help than we can get
  at home?

At some point, it may become impossible to provide care in the home. Necessary care may be too specialized, too expensive, or may be needed 24 hours a day. Residential care may be the right decision if:

1. The person has health needs that can't be met at home.
2. The caregiver is emotionally and physically exhausted, and community resources have already been tried.
3. The person can't be safely cared for in-home.
4. The caregiver's safety is at risk.

When care at home is not possible, there are various residential services to consider. The most common are adult family homes, boarding homes (which may contract to provide assisted living services), and nursing facilities.

Some programs offer special care to meet the needs of a specific population, such as people with Alzheimer's Disease or a developmental disability.

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  I'm exhausted from providing
  around-the-clock care. Is there any service
  that can help me?

Respite Care Services are designed to give unpaid caregivers a break in an emergency or on an infrequent basis. It's designed for caregivers who are responsible for the primary care or supervision of a family member or friend.

To find out if you are eligible, contact the ALTC office in your area.

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  How are services paid?

There are a number of financial programs that pay all or part of the costs of in-home, residential, and nursing home care. The most common funding sources are: Medicare (a federal program), Medicaid (a state program), veteran's benefits, and long-term care insurance.

Each has its own limitations. Medicare has many restrictions on the kinds and length of services; Medicaid is only for people with low-income and limited resources; and veteran's benefits have specific eligibility criteria. Long-term care insurance policies vary and are hard to get if the person already has a significant illness or impairment.

Many people pay for some or all of their long-term care services with their own money.

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  What about legal and financial planning?

In the hustle and bustle of providing daily care, it is easy to forget or put off talking about the difficult decisions that lie ahead: costs of long-term care, difficult health care decisions, financial protection of those we leave behind, and so on.

As a friend or family caregiver, you should encourage the person you care for to have the following legal documents complete and up-to-date: a Will, a Durable Power of Attorney, and Advance Directives. It is possible to prepare these documents without an attorney, but many people prefer legal help.

Advance Directives provide guidance to health care providers when the patient is unable to give consent. These Directives commonly include a Living Will, Durable Power of Attorney for Health Care, Code/No Code (Do Not Resuscitate or DNR), and Anatomical Gifts. Caregivers should know and respect the Advance Directives of the person they care for.

It is also helpful to discuss wishes about funeral arrangements and memorial services. The Office of the Attorney General has prepared a useful guide called "Dealing with Death".

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  How can I help my aging parents?

Many caregivers are adult children caring for their parents. They speak of the awkward feelings if roles are reversed and they find themselves feeding, bathing, or supervising a parent who once took care of them. They speak of the frustration when parents don't listen to advice or accept help. They voice fear that one parent will fall ill or die from the stress of caring for the other parent. While many remember a loving relationship with parents, other adult children find themselves caring for parents they never got along with very well.

Caring for parents can also affect relationships between brothers and sisters. For some, the experience of caring for parents can bring together siblings who have lost contact, and forge deeper family ties. For others, caring for parents can bring out old rivalries, or reinforce old communication problems. The adult child in a caregiving role may experience siblings who fly into town with questions or challenges to existing arrangements. A visiting sibling may not see the problems, because the parent has "rallied" for the visit.

These problems are very common. A support group, long-term care consultant, or family pastor may be able to help you find ways to work things out with your parents and siblings. Individual counseling can also be helpful. To find resources in your community, contact your local ALTC office.

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  How do I cope with memory problems?

If the person you care for asks questions repeatedly, has trouble performing simple tasks, or forgets recent events, he or she may have a form of dementia. There are several causes for dementia, so you should have the person diagnosed by a doctor. Some dementia may be caused by factors that can be treated, such as severe depression, improper use of drugs or drug interaction, severe diabetes, or severe vitamin deficiencies. If the person you are caring for is very depressed, emotional, or frequently angry, the doctor can also assist with medications.

The most common kind of dementia is Alzheimer's Disease, and it is not curable. Symptoms will get worse over time. Although Alzheimer's Disease is not a "normal" part of aging, it is more common in older people. Almost half of people over 85 will have some signs of the disease.

Alzheimer's Disease is very hard on families. Long-time roles start to change, as you or other family members take on tasks once handled by the person with the disease. When adult children step in to help, they may find that their independent-minded parents decline help or ignore advice.

Here's the good news: there are many helpful resources for families coping with dementia, including organizations, books, pamphlets, websites, support groups, medications, respite care, day care, and specialized residential care. Hard though it is to care for someone with this disease, it can be made easier by using the resources on this website and those available from your local ALTC office.

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  Is there help for families caring for people
  with developmental disabilities?

The Washington State Department of Social and Health Services Division of Developmental Disabilities  offers support services to families caring for someone with developmental disabilities.

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  What do I do when someone is still driving
  the car but shouldn't?

This is a very common problem. Cars give people independence and control, especially if public transportation is not available. You are correct to be concerned.

If you believe someone has a condition that seriously impairs driving, try talking directly to the person and urge him or her to re-take the driver's test or give up the car. If this doesn't work, some family members take direct steps such as hiding keys or disabling the car.

If this approach is not right for you or fails, you may want to contact the person's physician, who can write a prescription advising the patient not to drive.

Physicians can also send a letter suggesting a re-exam to:

The Department of Licensing
Medical Section
PO Box 9030
Olympia, WA 98507-9030

What can I do about feeling sad or
  depressed?