It can be difficult to acknowledge the fact that your parent needs some help with day-to-day activities, let alone introducing to them the idea of hiring a caregiver for help. Your parent is likely to react to this decision with some resistance. Approaching the subject requires patience and tact. However, there are certain considerations to keep in mind that can help you approach this conversation with your parent with greater success.

Below are some ideas to consider, based on our experience with families facing these struggles:

1. List advantages. Make quality home care provided by a hired caregiver desirable to your loved one. Some benefits for hiring in-home care for your parent may be: rather than having to move to an assisted living facility or nursing home, they can remain at home; in-home care is often less costly; they will be given one-on-one attention when their caregiver is there.

2. Focus on independence. Explain why hiring a caregiver is a way for your parent to maintain their independence in their own home. Of course, this is easier said than done. Perhaps paint a visual picture for them. Have they already fallen once or twice? Explain what could happen if they fall again – how it could lead to broken bones, surgery and hospitalization, followed by a lengthy recovery period. The same method could be used if they frequently forget to take their medications, or often miss doctor appointments.

3. Try a different approach. If your parents are still living together, try suggesting that in-home care would benefit their spouse. They may be more willing to accept the care for the sake of their loved one, even if in reality, it is equally beneficial for both parents. If they live alone, focus on concerns or activities that are important to them. For example, your parent may deny needing help, but may be amenable to someone helping with housekeeping and preparing some meals. They may acknowledge that they don’t like to drive at night but still want to attend their weekly bridge game.

4. Make it about you. Explain to your parent how much you worry about them. Or if you have been acting as primary caregiver explain that it has become too much on top of career or parenthood responsibilities. According to a recent study by Genworth, 55 percent of people say being a burden on their family is their biggest concern regarding long term care issues. Take this into consideration when approaching your parent about accepting in-home help. You might say, “Mom, I worry about you…and even if you tell me I shouldn’t, it keeps me up at night. Would you try having someone come in once a week for me?”

5. Mitigate fear. An elderly person can act hostile towards a hired caregiver at times, but this action is most likely out of fear. Prior to attempting to alleviate this fear, it is important to understand it. Common fears include loss of independence, losing control and dignity and financial worries. The presence of an outsider is likely to leave the elder feeling vulnerable. Take this into consideration when communicating with them, and respond with empathy rather than with frustration. Realize how your own emotions may be impacting the conversation and increasing resistance. It is important to choose an appropriate time and place for these discussions and set aside time for them.

6. Test it out on a trial-basis. Try hiring an outside caregiver for in-home help on a short-term basis for respite, or recovery care, after being discharged from the hospital or after a fall. This provides an opportunity to show your parent that having a caregiver is not something to fear and often leads to them being open to receiving ongoing care. If they currently rely on you, another family member or friend as their primary caregiver or source of help, try using vacation as an excuse to bring in a professional caregiver while gone. Explain that it is for your own peace of mind.

7. Get advice from a professional. Try discussing the situation with your parent’s G.P. (this is most likely someone they have known for years and trust). If they share your concern for your parent, they are likely to help by talking to them, explaining why in-home care is the best option for them.

Our experience has shown that people quickly see the benefits of home care once it has been put in place and ask themselves how they livd without it before. Home care is all about maintaining someone’s independnace not taking it away.

Home Care; Dementia care

As we get older, we need less sleep. This reduced requirement for sleep may result in the older person complaining that they suffer from insomnia when, in fact, this is a normal consequence of ageing. Reduced activity levels or mobility may also make the older person more likely to take naps during the day which, of course, will result in needing less sleep at night.

The relatives of many older people often attribute daytime sleeping to the fact that older people need more sleep and are napping because they are tired. They may not consider that the sleeping may be a symptom of boredom or just a habit after eating.

Putting an older relative to bed early so that they can get some rest and give the family a break does not mean they will spend the following 12 hours asleep! The answer to this problem is not sleeping tablets but an attempt to identify and cope with altered sleep patterns and needs.

Features of the sleep patterns of older people

 
• Fragmented sleep associated with frequent wakening.
• A longer time is needed to get off to sleep.
• REM sleep is unchanged but occurs earlier in the night than in younger people.
• Night-time sleep loss is usually compensated for by daytime napping. Patients and relatives often don’t count this as sleep.

One in four male 60-65 year olds needs to get out of bed at night to urinate. This rises to 90% of the very old. The rate also increases for women, but not as substantially. Many elderly people will not consider this a cause of poor sleep, thinking that they should be able to return to sleep immediately, as they did when younger.

The pain of arthritis may also keep an elderly person awake. Judicious use of pain relief may be more effective than sleeping tablets in the long term.

Fear, anxiety, bereavement and depression will cause sleeplessness at any age. They are more commonly found in older age groups and thus these issues must be addressed. Conditions such as angina and palpitations may lead to insomnia due to secondary anxiety.

Poor sleep patterns are a predictor of depression in the elderly and changed surroundings may cause insomnia, which is usually temporary.

Common causes of sleep disturbance

 
• Pain.
• Angina.
• Shortness of breath (dyspnoea).
• Generalised itching (pruritus).
• Prostate gland enlargement in men (benign prostatic hypertrophy, BPH).
• Asthma.
• Cough.
• Palpitations.
• Leg cramps.

‘Dangers’ of sleeplessness

• No serious medical consequences or complications.
• Depression and anxiety over not sleeping enough.
• Inappropriate day sleep, eg. during social events.

Advice for patients to avoid sleeplessness

• Avoid napping by day.
• Do not go to bed until tired.
• A pre-sleep ritual is important. It should be calming and familiar.
• Try a pre-bed warm drink (no caffeine), a bath, an easy reading novel or magazine.
• Try a new electric blanket to ensure that the bed is warm and safe.

Elder health; home care dublin

If you do one thing this week . . . put some adventure in your cuppa

Many of us love a cup of tea: whether it’s part of the morning routine, a comforting break when you have a few minutes to yourself or just to round off a satisfying meal.

But are you adventurous when it comes to your cuppa? It’s easy to stay on the autopilot of the standard-issue teabag, but why not break out and try some of the increasingly exotic varieties for sale in cafes, shops and online?

With names such as Rooibos Creme Caramel and Lemongrass and Ginger Twist, these are no run-of-the mill brews.

Many blends contain naturally occurring antioxidants, and if you can refrain from spooning in sugar or diving on an accompanying biscuit, then few or no calories will change hands.

So stick on the kettle and get steeping for a new kick to the senses.

Elderly Care

Our feet work hard and are vital to our health, comfort and balance. 

During a lifetime, your feet may walk the equivalent of four times around the world, so it is essential that you take good care of them.When buying new footwear, it is important to remember that:

• It is a good idea to buy shoes in the afternoon as your feet may swell during the day
• The size and shape of your feet may change as you get older, so it is important to get your feet measured when you buy new shoes
• There should be a half inch gap between the tip of your toes and the ends of your shoes
• The widest part of your foot should rest in the widest part of the shoe
• Always try on shoes before buying them
• Footwear with rubber soles and soft leather uppers will be most comfortable and safe.

Socks, tights and stockings

• Avoid garters as they reduce the circulation of blood to the feet and ankles
• Cotton socks are best as they allow the feet to breathe
• Always wear socks or stockings that fit properly
• Change your socks or stockings each day.

Foot Hygiene
Where possible:

• Wash your feet daily in warm (not hot) soapy water, rinse them well and dry with a soft towel
• Make sure your feet are completely dry (particularly the area between your toes) before putting on socks and shoes
• Trim your toenails regularly using nail clippers. Always cut straight across to avoid in-growing toenails
• If you have dry skin on your feet you should apply moisturising cream (except between your toes)
• Massage your feet gently upward from the toes towards the knees to get the blood flowing freely.

If you cannot manage to do this on your own ask someone for help, e.g. family or friends.

Exercise
Exercise can help to keep your feet healthy by toning up muscles, strengthening arches and stimulating circulation.Walking is one of the easiest and best forms of exercise. When sitting, move your foot up and down to keep blood flowing and strengthen your muscles.

Common foot problems
Always treat your feet gently and with care. A small cut or sore can take a long time to heal.

Corns and calluses- are a build up of hard dead skin caused by pressure when bony parts of the feet rub against the shoes. Wearing shoes that fit better or using special pads may solve the problem. If corns or calluses become painful, visit the chiropodist (a specialist who treats foot problems) or doctor. Avoid using corn plaster preparations as they may contain acid. Do not treat them yourself.

Bunions develop when the joints of the big toe no longer fit together. This causes a painful swelling which makes walking difficult. Wearing shoes made of soft leather or fabric uppers, or bunion shields which are available from the chemist, may help to ease the discomfort. Your chiropodist or doctor will advise on how to treat the condition.

Athlete’s Foot  is a fungal infection and is very contagious. It causes dry skin, an itchy rash, splitting of the skin between the toes and blisters on the skin under the toes. To prevent infection, keep your feet  especially the area between your toes  clean and dry. Change your shoes, socks, tights or stockings often. Regular use of anti-fungal foot powders or creams, available from the chemist, can treat athletes foot. If the condition does not get better within two weeks, visit your chiropodist or doctor.

In-growing toenails  can be very painful and are usually caused by cutting the toenail too short or by wearing shoes that are too tight. Your chiropodist or doctor will advise on how to treat the condition. Never attempt to treat in-growing toenails yourself.

Foot care for diabetics
People suffering from diabetes can often experience loss of sensation in their feet.� Even the smallest injury can lead to infection, which if not treated quickly can lead to problems.�If you are diabetic, you should:

• Check your shoes before putting them on, for small pebbles, rough seams, loose stitching or anything that could rub against your foot
• Keep your feet clean and moisturised � don�t moisturise between your toes
• Examine your feet each day for cracks, bleeding or any signs of infection
• Get your feet checked regularly by your chiropodist or doctor
• Wear comfortable shoes that fit well.

HSE chiropody service
The HSE can provide certain chiropody services to Medical Card holders. The doctor or public health nurse refers patients to the service. For further information on the chiropody service in your area, contact your local health centre or community services office. There are also private chiropodists throughout the country who can be contacted directly to arrange an appointment, your public health nurse may have contact details for chiropodists.

Elderly Health, Home Care

Information

Power of Attorney is a legal device in Ireland that can be set up by a person (the Donor) during his/her life when he/she is in good mental health. It allows another specially appointed person (the Attorney) to take actions on the Donor’s behalf if he/she is absent, abroad or incapacitated through illness.

If someone in Ireland is mentally incapacitated (for example, because of illness, disability or a progressive degenerative illness), all of their assets and property are normally frozen and cannot be used by anyone else unless they are jointly owned or, someone has Power of Attorney to deal with their property or money. In a larger sense, Power of Attorney is just one of the legal arrangements that you can make during your lifetime, in the event you become incapacitated or unable to deal with your affairs. Read more about the legal arrangements in the event of incapacity here.

Types of Power of Attorney

There are two types of Power of Attorney allowed under Irish law:

• Power of Attorney which gives either a specific or a general power and ceases as soon as the Donor becomes incapacitated
• Enduring Power of Attorney which takes effect on the incapacity of the donor

Both cease on the death of the Donor. However, it may be difficult to prove that the Donor is dead if his/her body cannot be found, for example, as in the case of a death by drowning. Once the body is found or the Donor is declared to be “believed dead” by a court (usually after seven years have passed), the Power of Attorney (if there was one) ends and their affairs are passed on in the normal way by will or under intestacy law.

A Power of Attorney can be specific (limited to a particular purpose, for example, sale of your house in your absence) or general (entitling the attorney to do almost everything that you yourself could do). For example, it may allow the Attorney to take a wide range of actions on the donor’s behalf in relation to property, business, and financial affairs. He/she may make payments from the specified accounts, make appropriate provision for any specified person’s needs, and make appropriate gifts to the donor’s relations or friends.

An Enduring Power of Attorney also allows the Attorney to make “personal care decisions” on the Donor’s behalf once he/she is no longer fully mentally capable of taking decisions him/herself. Personal care decisions may include deciding where and with whom the Donor will live, who he/she should see or not see and what training or rehabilitation he/she should get. However, if the Donor wants, he/she can specifically exclude any of these powers when setting up the Power of Attorney or can make the Attorney’s powers subject to any reasonable conditions and restrictions.

You can appoint anyone you wish to be your Attorney, including a spouse, family member, friend, colleague, etc.

How to create a power of attorney

A general power of attorney can be created when signed either by you or at your direction and in the presence of a witness.

The procedure for creating an enduring power of attorney is much more complex.

Creating an enduring power of attorney

Because the enduring power of attorney involves the transfer of considerable powers from you to another person, there are a number of legal safeguards to protect you from abuses. The procedure for executing the enduring power of attorney is complex and requires the involvement of a solicitor and a doctor. The enduring power can only come into effect when certain procedures have been gone through and the courts have a general supervisory role in the implementation of the power.

The document creating the power must be in a particular format and must include the following:

• a statement by a doctor verifying that in his/her opinion you had the mental capacity at the time that the document was executed to understand the effect of creating the power
• a statement from you that you understood the effect of creating the power
• a statement from a solicitor that he/she is satisfied that you understood the effect of creating the power of attorney
• a statement from a solicitor that you were not acting under undue influence.

Certain people must be notified of the making of an EPA, including family members.

Who can be appointed?

An enduring power of attorney may be granted to individuals or trust corporations but may not be granted to the following people:

• people under the age of 18
• bankrupts
• people convicted of offences involving fraud or dishonesty
• people disqualified under the Companies Acts
• an individual or trust corporation who owns a nursing home in which you live or an employee or agent of the owner, unless that person is also your spouse, child or sibling.

Registration

The EPA can only come into force when it has been registered. In order to register an EPA, the future attorney makes an application to the High Court once there is reason to believe that you are or are becoming mentally incapable. Before making this application, the attorney must notify you of his/her intention to do so. The attorney must have a medical certificate confirming that you are incapable of managing your affairs.

A notice of the attorney’s application must be served on you and on a number of other people.

The role of the court

The court has an extensive supervisory role in respect of the EPA. Among other things, the court has power to give directions about the management and disposal of your property. The court may confirm the revocation of a power of attorney if it is satisfied that you were mentally competent to revoke it. The court can order cancellation of the power where it is satisfied that:

• you are mentally capable and likely to remain so
• the attorney is unsuitable
• fraud or undue pressure was used to induce you to create the power.

Scope of Authority of an Enduring Power of Attorney

The EPA may give general authority to the attorney to do anything that the attorney might lawfully do or it may merely give authority to do specific acts on your behalf.

The attorney may make certain personal care decisions – these must be made in your best interests, must be in accordance with what you would have been likely to do and the attorney must consult family members and carers in making these decisions. A personal care decision is a decision concerning one or more of the following:

• where and with whom you should live
• whom you should see and not see
• what training and rehabilitation you should get
• your diet and dress
• inspection of your personal papers
• housing, social welfare and other benefits.

The list does not include health care decisions, although the borderline between personal care and health care decisions is not always clear. However, it seems clear that the attorney does not have the power to make a decision as to whether or not a person suffering from dementia should undergo surgery.

Termination of an Enduring Power of Attorney

There are various circumstances in which an EPA ceases to have effect, for example, if the attorney fails to fulfil certain conditions.

Once the EPA has been registered, you cannot revoke it unless the court approves the revocation, even if you are, for the time being, mentally capable.

Home Help, Home Care

Most people become happier with age, and you can too.

Achieving a happy retirement can take work and patience. Many older people complain that they feel useless or don’t know what to do with their time. Here are five strategies that research has found raise happiness levels: 

Keep up a daily routine 
We all know people who work hard for 40 years only to find retirement unsatisfying. Surprisingly, one of the keys to happiness after retirement is doing exactly what you did before. Keep getting dressed in the morning, keep cooking and going out, and keep making an effort. Research shows that people who maintain their personal standards and believe that retirement is just as important as working life are likely to be happier for longer. 

Give attention to people you love
Once people have retired, friends and family are at the top of the list of things that make them happy. Being married can contribute to your happiness, but having friends is also vital. In fact, according to economist Professor Andrew Oswald of Warwick University, we would need an extra £50,000 to make up for not having friends.

Finding friends that share your interests - in the way your work colleagues used to share your day-to-day business - may make you the most contented.

Do interesting things 
People may tell you to keep busy, but mindless activity won’t have the same effect on happiness as hobbies that interest you. The most effective activities are ones that hold your attention so much that you lose track of time. It could be any activity, such as sudoku, gardening or learning a language.

Research on retirement has found that people who spend at least six hours a week doing something active that they enjoy are more likely to be content.

If you want to develop new skills, most local councils and further education colleges hold evening classes in subjects from flower arranging to Pilates.

Show goodwill to all men
Want to boost your happiness whatever your situation? Carrying out five acts of kindness, big or small, a week will help significantly, according to new research. You could help at a local school, look after your grandchildren, weed a neighbour’s garden or say a heartfelt “thank you” to someone who made your day. These will all boost your sense of contentment.

Be realistic about money
Almost everyone thinks money will make them more secure and, therefore, happier. In fact, money is the one thing that has relatively little impact on happiness. Most research suggests that, once everyday needs have been met, more money makes no difference to long-term happiness. Even winning the lottery only gives a short-term boost before happiness levels return to normal.

Home Care