By Cheryl Slean, Staff Writer

Are You Overwhelmed? Caring for Yourself Where to Get Help     When you choose to become a caregiver for someone seriously ill, you’re taking on a whole new batch of duties and responsibilities. Besides your own obligations, you’ve got doctors to talk to, insurance forms to fill out, and financial arrangements to make. You may have to learn how to be a home nurse, and take over daily tasks for your loved one, such as cooking, shopping, and driving. And you’re supposed to manage all this while dealing with the prospect of losing someone you love.   It’s no wonder that 60% of caregivers show signs of clinical depression. Caregivers also take more prescription medications, including those for anxiety and depression, than others in their age group.   “Caregivers often are overwhelmed by feeling responsible for the patient's comfort, the fear of doing harm, and the reality of impending death.”  —Betty Ferrell, RN, research scientist, Hope Medical Center, Duarte, CA In short, while caregiving is rewarding in many ways, it can also be overwhelming. You can avoid becoming run-down, depressed, or even sick by familiarizing yourself with the symptoms of caregiver burnout and learning simple strategies for taking care of yourself.

Research has identified 13 risk factors for major depression and poorer quality of life for caregivers of seriously ill loved ones. This survey provided by the Hospice Institute for Education, Training and Research helps you assess how many of these risk factors you may have.

Survey: www.hospice.com/jdt/wellness.html

Hospice Institute: www.hospice.com/jdt/jdtmain.cfm

The first thing to do when you take on a caregiving role is to remember to take care of yourself! You may have been told this before—but there’s no way around it: You can’t help your loved one if you become so ill, stressed out, or depressed that you’re unable to get through the day. Both you and your loved one will be better served if you pay attention to your own health and emotional needs.

1. Get help. Learn to ask for, and accept, help. When someone asks if there’s anything you need, the only answer is “yes.” Do you need help with an errand? Someone to mow the lawn? A trusted person to stay with your loved one while you get out for some exercise, shopping, or lunch with a friend? See where to go to for help (link below) for suggestions for caregiver respite.
2. Set limits. Many caregivers feel guilty or think they’re doing a bad job if they aren’t there for their loved one every minute. But you need to be realistic about what you can fit in. For example, it might be possible to come home from work to make lunch one or two days a week, but not every day. Rather than overexerting yourself to make it work, see if you can get the other days covered by a family member, friend, community volunteer, or professional caregiver. Also, you may need to say “no” to earlier commitments that ask for too much of your time right now, like hosting holiday dinners, volunteering, etc.
3. Take care of your body. Your loved one’s healthcare needs have become an important part of your life, but it’s equally important not to neglect your own health in the process of caregiving.
   1. Try to get enough sleep. Talk to your doctor if you or your loved one is having trouble sleeping through the night.
   2. Take time for regular meals. Get help with meal preparation and shopping if you need it. See where to go for help for suggestions.
   3. Get regular checkups. Make sure you stick to your own medication schedule, if you have one. Look after any health complaints, even if they seem small compared with your loved one’s problems.
   4. Exercise is not only good for your body, it also combats depression and gives you a break. Just regularly stepping outside for a walk can do wonders for your well-being.
4. Allow difficult feelings. Just as there’s no such thing as a perfect parent, there’s no such thing as a perfect caregiver. Remind yourself that feelings of guilt, frustration, and anger are OK and part of the job. Talk your feelings over with a friend, relative, counselor, or support group. Hospice staff can also provide a sympathetic ear.
5. Education. Learning as much as you can about your loved one’s illness and care, and the many places to turn for assistance, can help you feel less anxious and allow you to be more proactive with your caregiving choices.
6. Social support and activities.  Support can come in many forms: prayer, talking with friends, doing a favorite hobby. Because of demands on their time, many caregivers withdraw from their social networks and end up feeling isolated. Try to continue with supportive activities as much as you can—go to church or temple, talk with friends, see movies, keep up with hobbies, and other enjoyments. It can also be a great relief to share your concerns with others who understand your situation by joining a caregiver support group.
7. Get respite.  It’s important for your health to take breaks from the constant responsibility and stress of caregiving. Below you'll find some suggestions for where to turn for help when it’s time to get away, for an hour or two, or a few days or more of well-earned vacation. Even when you can’t get out of the house, make sure you take time through the day to rest, do things you enjoy, meditate, exercise, or just take a few deep, relaxing breaths.

1. Hospice programs. Hospice provides a team-based approach to caring for terminally ill patients in any setting. Hospice staff work with family caregivers to develop a care plan tailored to each patient’s and family’s needs. The program provides case management, medical assistance, 24-hour advice and support, volunteer aides, spiritual support and other counseling, including caregiver and bereavement support groups.
2. Support groups. Talking with others who’ve experienced what you’re going through can be an invaluable source of information and emotional support. Groups in your area can be located through community social workers (hospice, hospital, assisted living, nursing home), social service agencies (e.g., Catholic Charities, Jewish Family Services, Adult Protective Services), your local senior center, places of worship, and community mental health programs or clinics. In addition, there are now a number of online support groups, including some on this site.
3. Respite services. It’s important for caregivers to get time off to rest and rejuvenate. Here are some ideas for finding relief, from a few hours to a few days or longer.
   • Your loved one might enjoy a few hours of activities, meals, and social interaction at your local senior center or adult day care center. Check with places of worship, social service agencies, and your local Area Agency on Aging for programs near you.
   • Many assisted living facilities and nursing homes offer temporary check-ins to give respite to family caregivers for a few days or more.
   • Friends and family are often happy to visit with your loved one when you need to step out. Sometimes younger family members or retirees may have more time to spare than those with jobs and family.
   • Live-in help. Perhaps a friend, family member, or student would be willing to exchange caregiving assistance for room and board at your home. You can also hire someone to be a live-in aide, or have aides take on different shifts for round-the-clock care, but it’s expensive.
   • Internship programs. High school and college students can sometimes get credit toward a degree by spending time with care recipients.
   • Community-based volunteers are often available to help out with errands, housekeeping, driving, and visiting with your loved one. Check with your local senior center, places of worship, hospice, social services agencies, and your local Area Agency on Aging for volunteer programs.
4. Transportation and meal services. The Administration on Aging (AOA) within the Department of Health and Human Services (HHS) has many programs within The National Family Caregiver Support Program, including transportation services, senior centers, and nutrition programs to help you and your loved one.  Contact your local Area Agency on Aging to find the programs near you.
5. Home health aides can be hired from specialized agencies to come into the home and help with caregiving tasks, from skilled nursing to help around the house. Contact your local Area Agency on Aging for assistance in locating a Medicare-accredited agency in your area.
6. Professional case managers have backgrounds in social work, counseling, or a related healthcare field. They work with you, the physician, the therapist, and the patient to identify and arrange services such as transportation, home care, meals, and day care. Case managers can also help determine eligibility for entitlement programs, plan for long-term care, and intervene in crises.
   • Case management is included in services for hospice patients
   • Federal, state, or county programs such as Medicare or Medicaid may provide free case management services to eligible patients.
   • Free or low-cost case management can be found through hospitals, mental health programs, home health agencies, social service agencies (e.g., Catholic Charities, Jewish Family Services, Adult Protective Services), and other healthcare-related programs.
   • You can hire a private case manager, often called a geriatric case manager, who will typically charge between $60 and $150 per hour.