Understanding the Problem

Caregiving involves solving problems, such as how to manage a symptom, when to call for professional guidance, how to get help from other family members and friends, and how to care for yourself during periods of stress.

You have been solving problems throughout your life. The only difference now is that many of the problems that come with caring for an elderly person at home are new to you. This book will help you to solve these new problems; it will give you information and guidance organized in the steps you need to take.

Use the Eldercare at Home book the way you would use a cookbook.

Read the chapters before you start dealing with a problem - not after the problem has become severe - just as you would read a cook book before you start to make a recipe - not when you are half way through. Reading the chapters early allows you recognize problems early, take action before problems become severe, and even prevent some problems from happening. You can then develop plans which give you a sense of purpose and hope in coping with the problems.

It is important to involve the person you are caring for as much as possible in developing and carrying out plans.

If the older person is able, encourage him or her to read the Eldercare at Home chapters or, if this is too complicated, explain what you are doing and why. If the older person has difficulty understanding, make your explanations simple. There is a good discussion of how to communicate with older people in the "Communication Problems" chapter in this book.

The more the person you are caring for understands the plan, the more he or she can participate in carrying it out. If you are in doubt about how much the older person can understand, still explain the plan. The worst that can happen is that he or she does not understand - but the older person can still appreciate that you are trying to help and that you care. The best that can happen is that the older person understands more than you thought possible and will actively cooperate with you in creating and carrying out the plan.

back to top

How this book is organized:

Each Eldercare at Home chapter deals with a problem that may occur when giving care to an older person at home. All chapters are organized with five major topics:

Understanding the problem (What is the problem? Who is most likely to have it? When do they have it? What kinds of things can be done to help? What is a realistic goal when dealing with the problem?)
When to get professional help (When to call immediately and when to call during office hours, what information to have ready when you call, and how to explain the problem to a health care professional.)
What you can do to help (to deal with or to prevent the problem.)
Possible obstacles (Misinformation that can interfere with carrying out the plan and how to deal with it.)
Carrying out and adjusting the plan. (How to check on whether you are making progress, how fast to expect change, and what to do if the plan isn't working)

The chapters in this book deal with only the most common problems that caregivers of older people at home can have. But they can also serve as models for the kinds of information you need to solve other caregiving problems.

back to top

How To Make the Best Use of Eldercare at Home Chapters

Read information headings first

In each chapter, topics are in bold. Information/explanations about the topics are in regular type.

Arrows mark the actions you can take or symptoms you should look for. A good way to approach each chapter is to first, read the "Understanding the Problem" section, and then the bold type (especially if there is an arrow in front of it). This is a quick way to understand the problem and what you can do to solve it.

Read the regular type later to understand why you should do certain things.

Re-read chapters when problems persist

Eldercare at Home chapters contain many ideas and strategies for dealing with caregiving problems. So, it can be hard to remember them all. A good strategy is to re-read chapters when problems persist, to be sure you are doing everything you can.

Use the Eldercare at Home book as a part of an orderly approach to problem-solving.

back to top

There are six steps needed for successful problem-solving using the Eldercare at Home book:

Have a positive attitude about solving the problem
Understand the problem you are trying to solve
Decide if and when you need professional help
Decide what you should do to deal with the problem
Consider possible obstacles and how to deal with them creatively
Develop, carry out, evaluate, and adjust your plan

STEP ONE: Have a positive attitude about solving the problem.

How you think about problems can have a strong effect on how you handle them. For example, if you believe that you can solve your problems, this will help you to try hard and will increase the likelihood of success. On the other hand, if you expect to fail, you may not try your hardest. Also, if you avoid problems or try not to think about them, then there is a good chance that they will become worse.

Having an optimistic but realistic attitude will increase your chances of successfully solving caregiving problems.

Use positive self-talk

Stop and listen to the messages that you are saying to yourself. For example, if you are feeling tired because of your caregiving work, you might say to yourself, "I'm always tired and can never do anything I need to get done." This "self message" will make you feel depressed. But, if you say to yourself "I am feeling tired now, but I'm looking forward to taking time tomorrow to do some things I want to do" you will have made a promise to yourself which will help you feel positive and hopeful.

Control negative self-talk

Avoid using words like "should" or "ought" and replace them with "hope" and "try." Instead of saying, "I should invite my friends to visit," say, "I will try to invite my friends."
Challenge irrational beliefs and over-generalizations. If you think "I'm a failure," challenge those thoughts. Say, "No, that's wrong, I have been successful and here is a time when I was a success!"
Question words such as "disaster" and "hopeless" and think carefully about what really happened.
Use positive self-statements such as "I can solve this problem; I don't have to please everyone; I can cope with this; I can reduce my fears; it's normal to feel upset in this situation."

Accept that problems are inevitable

Problems are part of life and having them when you are giving care to someone is normal and common.

Ask yourself, "How have my problems changed since I have become a caregiver?" Many problems will be the same as before, others will be worse, but some will be better.

Use your feelings as cues or signals to tell you that a problem needs to be solved. Negative feelings may be a sign that a problem is there. Use your negative feelings to help you begin your problem-solving efforts.

Realize that you are already an effective problem-solver

Solving the problems that come with caregiving takes training and practice. But you have a "head start" because you have been dealing with problems all of your life at home, at work, with friends and with family. You are capable of solving caregiving problems too. This book will help you to make the best use of the problem-solving skills that you already have.

If you are feeling very anxious or "down," go to the "Depression" chapter in this book. This chapter can help you manage these feelings and, if your feelings are severe, it will also tell you when to get professional help and how to get it.

back to top

STEP TWO: Understand the problems you are trying to solve

A problem well-defined is a problem half-solved. A good place to start is the Understanding the Problem section of each Eldercare at Home chapter. This section has information about what causes the problem, who tends to have it and when, and the kinds of things that can be done with the problem. You can also ask your doctor, nurse, or social worker for information and recommendations. It is also helpful to read books and pamphlets that give advice and guidance.

Get the facts

You need to know the facts about your special problem. It helps to think of yourself as a detective, investigative reporter, or personal scientist. Your job is to find out what really happened - and to avoid vague reasoning. Don't guess or assume. Separate what might be true from what you know is true. Your job is to know, as clearly as possible, the facts about your problem and to match those facts with information in the Eldercare at Home book about what can be done about it. Ask the following questions when seeking the facts: who, what, where, when, and how?

Avoid focusing on just negative facts. Be sure to include what went right as well as what is not right.
Break down your problem into clear, specific details and use objective words. For example, instead of saying, "I'm upset because nothing happens the way I want it to," try, "I feel upset because I don't have the time to visit my friend." By stating your problem precisely, other people can understand exactly what you mean and you give yourself a clear goal to work toward, for example, visiting your friend.
Separate facts from impressions and assumptions. Try not to say, "She doesn't like me anymore.," Instead say, "When I passed her in the hall she didn't notice me." The second way of stating the problem doesn't make any assumptions and shows that there are many possible reasons why she didn't notice you and that she may still like you.
Identify exactly what makes a situation a problem. It is not beneficial to get into a panic and say, "He's getting worse." Instead, try saying, "He feels warm and I wonder if a fever might be starting." The first statement is too general, but the second statement tells you what to do. (Take the temperature and read the "Fever" chapter to decide if you should call a doctor).

Set realistic goals

A realistic goal is one that you have a reasonable chance of reaching if you try. If you set unrealistic goals for yourself (for example, expecting yourself to do everything you used to do before you started caregiving), you are setting yourself up for failure. By setting goals that you can achieve (such as talking to a friend on the phone instead of having a meal together), you can feel that you have accomplished something.

Understanding your problem and having the facts about it is the foundation you need in order to set reasonable goals and to carry out an effective and realistic plan. Writing down what is happening often helps people to view facts objectively. Talking to people who have in the past or are now going through similar experiences can often help you see your own situation more objectively. Support groups are a good way to do this. Look in the phone book, newspaper, or call a hospital to find a group of people facing similar problems.

back to top

STEP THREE: Decide if you need professional help

You cannot solve all problems by yourself. Many caregiving problems require help from health professionals. For physical problems, you must get professional help when needed. The health of the person you are caring for depends on it. For emotional and social problems, professional help can give you guidance in developing your plans and, in the case of severe depression or anxiety, they can give specialized counseling or therapy.

The When To Get Professional Help section of each Eldercare at Home chapter tells when to call for help.

This section helps you decide if help is needed immediately or if it is something that can wait until office hours.

This section also tells you the information to have ready when calling a doctor or nurse so you get the help you need as fast as possible.

back to top

STEP FOUR: Decide what you should do to deal with the problem

If professional help is not needed at this time (or if that help has already been given), there are still things you can do to help manage the problem on your own. You can do things to prevent the problem from getting worse and to reduce discomfort.

The What You Can Do section of each Eldercare at Home chapter lists what other people, like yourself, have found helpful in managing their caregiving problems. Look through these lists to find ideas that you think could help you. Usually, ideas that have worked for you in the past are good places to start. We recommend regularly reviewing the lists of things you can do to be sure you are doing everything you can.

You can also get ideas for what you can do from family, friends who have dealt with similar problems, from support groups, and from community service agencies and hospitals. See the chapter on "Getting Help from Community Agencies" for ideas on how to make use of these resources.

back to top

STEP FIVE: Consider possible obstacles and how to deal with them creatively.

What could interfere with your plan? The Obstacles section of each Eldercare at Home chapter lists some common obstacles that other family caregivers have had in dealing with the same problem. Use the list as a start, then think of obstacles that could prevent you from dealing with your problem.

Creativity is the key to overcoming obstacles. There are many ways to be creative.

Talk to someone about the problem or imagine what another person would do about the problem. Explaining a problem to someone else helps you to see it more clearly. You can also imagine that you are talking to someone and see the problem clearly without the person actually being there.
Improve on something that worked a little bit. Too often we discard ideas that worked a little bit because they weren't completely successful. The fact that it worked a little bit means that there is some part that was working. Try to find out what was good about it and use that as a basis for a new idea.
Try a smaller goal. So often we think we are not successful when, in reality, we are actually making progress. We are just expecting change too fast. So a creative solution may be to scale down what you hope to accomplish so that it matches what you can accomplish. Another way of saying this is "If at first you don't succeed, try a smaller goal."
Brainstorm.
- Make a list of ideas that might be useful. Make your list as long as possible and don't censor ideas. Any ideas you have, no matter how strange or even silly, should be included on the list.. The more ideas you have, the better the chance that one of them will be helpful. Other people may help you think of ideas that you wouldn't have thought of alone.
- Combine good ideas into better ideas. When you have finished your list, go over it and try to combine the good ideas into even better ideas.
- Choose ideas likely to be successful. And, finally, go over the list one more time with a critical eye and choose the best ideas that have a good chance of being successful.

STEP SIX: Develop, carry out, evaluate and adjust your plan

Think about what you and other people need to do to reach your goal. You may want to practice what you will do first.

Carrying Out and Adjusting Your Plan is the last section in each Eldercare at Home chapter. This section has suggestions on how to organize your plan and check on results. It also recommends what to do if your plan is not successful.

Keeping a record or diary of what you did and the results will help you see what was successful and also give you ideas for dealing with similar problems in the future.

If your plan isn't working, think of obstacles as challenges. Review what you have done and the results and develop a new plan.

Ask yourself if your goal was reasonable. Perhaps you really were making progress, but you were expecting change too fast. If this is the case, change your goal to something more reachable.

Revise your plan and keep on trying! Always have a plan and don't give up!

back to top