4 http://staging.healthinaging.org/eldercare/cocoon/elder.xml The AGS Foundation for Health in Aging
The Empire State Building
350 Fifth Avenue, Suite 801
New York NY 10118 staff@healthinaging.org (212) 755-6810 www.healthinaging.org
Sections in this chapter:

Understanding the Problem
When To Get Professional Help
What You Can Do To Help
Possible Obstacles
Carrying Out And Adjusting Your Plan


Understanding the Problem
Taking care of a family member who is recovering from surgery or an illness can be very demanding for both the caregiver and the person who receives care. This chapter will give you guidance in how to make the older person feel comfortable and at ease while he or she gets stronger with your help and support. At the end of this chapter is a section on setting up a sickroom and administering care with practical suggestions for giving care to a sick person.

You may need to purchase or rent medical equipment and assistive devices. If so, check the yellow pages in your phone book for local medical equipment companies. Hospital staff (nurses, therapists, and social workers) can tell you what equipment you will need and make suggestions about how to obtain it. The doctor can arrange for visiting nurses and therapists to visit the home to assess your equipment needs and to show you how to use it.

Your number one goal is to provide support, encouragement, and assistance to the older person. Tender loving care is the best way to boost his or her spirits. Keep in mind that he or she was once independent and now needs to depend on you for encouragement and assistance.

Give the older person as much control as possible. You should involve him or her in the decision making process. Ask: "What clothes would you like to wear today?" "When would you like to take a walk?"

As the older person gets stronger, do not rush him or her into new activities. It takes time to gain strength. The older person may not want to do new exercises saying, "I can't", but really mean, "I'm scared". Introduce new activities slowly and explain them in detail.

It is a myth that bed rest is good for a person recuperating from illness or surgery. Sitting in bed can cause many problems to the body such as bedsores, kidney failure, muscles shrinking away, reflexes becoming inactive, and blood pressure increasing. In addition to these problems, a person who remains in bed for several days and gets up may experience dizziness, fainting, stiff joints, weakness and muscle malfunction (muscles that don't communicate with the brain).
Your goals are to:
  • Prepare a room where the older person can be cared for
  • Make sure the older person is comfortable
  • Be encouraging about progress
  • Prevent the complications of bed rest
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When To Get Professional Help
Any new symptoms. New symptoms mean a change in the older person's condition and should be reported to the doctor. Report any symptom that suddenly becomes more severe or difficult to manage. This usually means a change in the patient's condition that the doctor should know about.

If calling about an emergency, know the following facts before you call:
  • Where is the symptom located?
  • Describe the symptom - including its severity.
  • When is the symptom better or worse?
  • Tell the doctor what medications the older person is taking.
Here is an example of what you might say when calling

"This is Sandy Johnson. I'm calling for my dad, Joe Johnson. He has been feeling really dizzy every time he gets out of bed since his hip surgery. The doctor did not mention that dizzy spells would be a problem

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What You Can Do to Help
  • Get information from the doctor and nurse on how to manage the older person's care at home. You need to ask the doctor or nurse what the older person can and cannot do. Ask about the following: recovery time, diet, exercises, how to take care of a surgical wound, how to give medicines, and if a special treatment needs to be given, how to do it. The doctor may refer you to a home health agency that can send a nurse to your home to instruct you in how to give the care that is needed.
  • Know how to get in touch with the doctor. You need to be able to get through to the doctor in an emergency. Find out how to do this. Ask the doctor if he or she wants daily reports on the older person's care. Different doctors work differently. Know your doctor's particular system.
  • Prepare the bedroom. The bedroom should be clean and neat. Put supplies and equipment in a section of the room so the older person can have the rest of the room for personal belongings and furniture. A person who is recovering from illness does not want to look at reminders of the illness all over the room.
    • Keep a pitcher of water and glass by the bed.
    • Liven up the room with fresh flowers.
    • Put a calendar and clock by the bed, so the older person can keep track of the days.
    • Consider having a remote control switch to turn lights on and off from the bed.
    • Consider putting a commode next to the bed if the older person can get out of bed but will have difficulty walking to the bathroom.
  • Ask the doctor if a special diet is needed.
  • Keep a routine for mealtimes and stick to it.
  • Serve small portions at first. Large portions can be too overwhelming for someone who is slowly getting his or her appetite back.
  • Present food in a pleasant and appetizing way. Use colorful napkins and garnishes.
  • Consider assistive eating devices. These can be helpful if the older person has trouble eating. They include weighted mugs for those who have trouble holding, long-handled utensils for people who have weakness in the shoulders or elbows, plate guards which keep food from spilling off the plate and special easy grip spoons and forks. These can be obtained from medical equipment and supply companies - either locally or from national distributors. (See the list of some national distributors at the end of this chapter.)
  • If there is a problem of low appetite, serve small meals often. You should be able to tell when the older person's appetite is at its best. If it is in the morning, make breakfast the big meal of the day. Keep in mind that medicines the older person is taking may affect appetite. If so, serve meals when these effects are smallest. (For more information about appetite problems, see the chapter on "Weight Loss and Nutrition.")
  • Prevent boredom. The older person needs activities or visitors to prevent boredom. Television or radio are good sources of low key entertainment. Have grandchildren and friends come over and play games or read to the older person. Install a telephone next to the bed. You could give a foot massage or back rub. They feel good and increase circulation.
  • Shift position. Lungs take in oxygen best when a person is standing and moving. When a person lies down, the lungs are compressed and they take in less oxygen. Have the older person turn over in bed often and shift position several times a day. If possible, help him or her to get out of bed and move to a chair or the bathroom. Ask your doctor about exercises that can be done in bed. It is often important to do coughing and deep-breathing exercises every 2 to 4 hours.
  • Prevent circulatory problems. Bed rest can cause thickening of the blood and an increase stress on the heart. Thrombophlebitis is a serious condition to watch out for. It happens when a vein becomes inflamed and blood clots form which may travel to the heart or lungs, causing a life-threatening emergency. The best prevention is to get out of bed. Take walks around the room and move to the chair or bathroom every 2 to 4 hours. Wear loose clothing and avoid tight elastic waistbands, sleeves, socks, and stockings. When in bed, wiggle toes, and move the feet in addition to changing position frequently. When the older person is sitting in a chair, elevate the legs on a stool every now and then. Ask the doctor if you should purchase anti-embolism elasticized bed stockings to improve leg circulation and get blood flowing towards the heart.
  • Prevent constipation. Bed rest causes constipation because the body is not getting the muscular activity or vigorous circulation it needs to help the bowel churn and move food through the system. (See the "Constipation" chapter.) It is important to drink enough fluids and to eat a diet high in fiber (fruits, vegetables, whole grain cereals and breads). See what medicines the older person is taking that have constipation as a side effect. Laxatives, if used too often, can cause problems. Contact your doctor if constipation persists. He or she may recommend over-the- Counter bulk laxatives such as Metamucil or Senocot. If the problem is very severe, an enema or laxative administered by you may be in order, but check with your doctor first.
  • Prevent bedsores. Older skin is thin and fragile. If an older person remains in a wheelchair or chair for a long period of time, there is a high risk of skin ulcers. (See the chapter on "Skin Problems" for more information on bedsores and other skin problems.) Bedsores happen at pressure points elbows, heels, toes, hips, and fingers of the body. Skin breakdown also can be caused by the body rubbing against sheets and clothing. Bedsores, can be prevented by following these strategies:
    • Reposition the older person every 2 hours during the day and every 4 hours at night. (If there is more than one caregiver and you can share the work, then every two hours is ideal - but your rest is important.)

      Shift body position
      • from back to side and side to side
      • move arms and legs
    • Use pillows between legs and under ankles. Also, cushion back and buttocks with a pillow. If the older person is in a wheelchair and cannot move his or her legs often, pad the footrests. Pillows can be used to prevent sliding when moving someone to a sitting-up position.
    • For sitting, use a gel cushion. This keeps pressure off the spine where skin breakdown is common.
    • Use egg crate mattresses or mattress cases that are made from synthetic sheepskin or an air mattress to cushion the bed. These can be purchased at a medical supply store. While these help, you must still reposition the older person regularly to prevent bedsores.
    • Raise bedcovers. Bed covers can become heavy on someone who has to lie flat for days, especially the feet. Cut out one side of a box and put it under the covers with the person's feet inside. This will hold the bed covers away from the feet.
    • Move the older person slowly and gently being careful not to drag him or her off the bed.
    • Use a draw sheet. If you cannot move the older person by yourself, have a nurse or social worker show you how to use a draw sheet which is a folded sheet used to lift the person up in bed.
    • Treat bedsores immediately. If you spot a bedsore beginning (redness on the skin), call the doctor to have it treated immediately. The most important treatment is to relieve pressure on the area.
    • Wash your hands after giving care for bedsores. This will reduce the chances of spreading infection to other parts of the person's body or to yours.
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Possible Obstacles
  1. "My mother doesn't want to use a bed pan because of the smell."

    Response:     Body waste is a sensitive issue for everyone. Going to the bathroom is a very personal act. Try to look at helping as an act of love. Tell the older person you don't mind helping him or her. Be understanding and explain that privacy will be provided. If odor is an issue, open windows and create a cross draft (without making the room cold). You can plug in a fan, open a box of baking soda, light a match or scented candle, or use a scented room spray.
  2. "My dad is bigger than me and I can't move him."

    Response:     A nurse can instruct you on the best way to move a person alone without hurting your back. It is recommended that you get a partner, someone else in the house, or a neighbor to assist you.
Think of other obstacles that could interfere with carrying out your plan

What additional roadblocks could get in the way of doing the things suggested in this chapter? For example, will the person cooperate? Will other people help? How will you explain your needs to other people? Do you have the time and energy to carry out the plan?

You need to develop plans for getting around these roadblocks. Use the six problem-solving steps in the chapter on "Using the Eldercare at Home book to solve caregiving problems."

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Carrying Out and Adjusting Your Plan
Checking on results. Everyone would like a smooth recuperation with a minimum of crises. But this is not always possible. As each new problems arises, step back and develop a new plan. Your goal is to have a plan for each problem.

If your plan does not work. If caregiving problems are getting out of hand and you are feeling overwhelmed, call the doctors' office or your local office on aging and explain your needs. (See the chapter on getting help from volunteer groups and community agencies for resources to help.)

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Setting Up a Room for Administering Care

Home health nurses as well as physical and occupational therapists can help you plan your "sick room" including what equipment you will need. They can also show you how to use the equipment and teach you caregiving skills you may need. The doctor can arrange for them to visit.

Do you need a hospital bed?

If the older person will be spending a lot of time in bed over a long-term period of time, rent a hospital bed with electric controls and side rails. The hospital bed allows you and the older person to position the body with little effort. Serving meals and giving bed baths are also easier to carry out with a hospital bed. A hospital tray-table can also be helpful and can often be rented at minimal cost.

Making an Unoccupied Bed

The best time to make the bed is after breakfast. Use cotton for bedsheets and cotton or soft wool for blankets. These natural fibers let the skin breathe and allow air to circulate. When you wash the sheets, rinse them well (you may want to run the rinse cycle twice). Don't use fabric softeners, since they can be irritating to skin.

Protecting the Mattress

Use waterproof liners under the fitted sheet. You can find them at medical supply stores. Or place a plastic shower curtain/liner inside a folded sheet and lay it across the middle of the bed. Never put plastic directly against skin, it can cause irritation and skin breakdown. Waterproof pads for putting on top of the mattress can be purchased at drug stores.

Making an Occupied Bed
  1. If there are no side rails on the bed, two people must be present: one to make the bed and the other to hold onto the patient. You may find it helpful to use a draw sheet (a sheet folded in half and stretched across the middle of the bed which can be used in moving the person up in bed or turning on his or her side. (Two people - one on either side - are needed to use a draw sheet in this way).
  2. Loosen the tucked-in bedding on each side of the bed.
  3. Explain to the older person what you are doing. Ask him or her to roll toward your partner or the side rail.
  4. Pull all the sheets out from under the mattress and tuck them under the older person as far as possible.
  5. Ask the older person to roll toward you over the hump of linens. Now reach over and pull the sheets off the bed or have your partner do it.
  6. Have the older person roll back toward your partner. Now make your side of the bed with clean sheets. Pull the unmade lengths of sheet toward the older person and tuck them under him or her.
  7. The older person must now roll toward your side over the hump of clean sheets while your partner makes the other side of the bed.
  8. Now make the older person comfortable at the center of the bed.
Moving a Frail Person in Bed

Consider getting a back support for yourself. You can strap the support on yourself before lifting and it can protect your back and abdominal muscles from strain.

Lying to Sitting Position
(For your own protection remember to bend at the knees and keep a wide base of support by spreading legs about twelve inches apart.)
  1. The older person should be turned onto one side with legs bent and facing you.
  2. Swing the legs over the side of the bed.
  3. Put your hand under the older person's shoulders and gently pull him or her upright. Do not pull very hard on the shoulders to avoid injury to the older person. (If you have a hospital bed, raise the top of the bed to get the person upright.)
A move from Bed to Chair
(The key to any transfer is to move the person within a 90 degree angle.)
  1. Test for strength. You have to find out which side of the older person's body is stronger. Have him or her squeeze your hands or extend both legs up as you push them down.
  2. If the older person's left side is strongest, place a chair by his or her left side (where the person can best support himself or herself). You help with the weaker side.
  3. The older person should be sitting on the edge of the bed facing you, while you move close to him or her. The chair should be nearby. Brace your knees against the older person's knees. Have the older person put his or her arms around your neck (this makes the transfer safer and easy).
  4. Hug the older person's upper body.
  5. You and the older person stand up together. Hold this position for a minute to make sure he or she is not dizzy and has balance. Also, never lose contact with the older person's knees for they may give way and the person could fall.
  6. Turn and ease the older person into the chair.
Toileting in Bed
  1. If the older person is weak, try this method: Have him or her roll over to one side. Place the top of the bedpan to the top of the buttocks, below the tailbone. Now, have the older person roll onto the bedpan into the middle of it.
  2. If the older person can move with ease try this method: Have him or her lift the hips onto the bedpan. Apply a little bit of cornstarch or talcum powder which will assist the bedpan to slide easier.
  3. When finished with the bedpan, ask the older person to lift his or her hips to prevent spilling. Put a towel over the bedpan and place to the side.
  4. Clean thoroughly between the legs: do not leave any urine or feces on the skin. Make sure all soap residue is washed off the skin.
Toileting in the Bathroom

If the older person can move to the bathroom, he or she may still find it difficult to move on or off the toilet. If so, consider having a raised toilet seat and grab bars available. They can be purchased or rented from medical supply stores.

The Bed Bath
(Bed baths are used primarily for people with a serious debilitating illness.)
  1. Give a bed bath only if the older person cannot get out of bed.
  2. You must be organized and have everything within reach. You will need the following items:
    • basin or bucket filled with warm water
    • three towels
    • two washcloths
    • fresh linens for bed change
    • bath blanket (lightweight cotton blanket or sheet)
    • soap (glycerin-based or moisturizing)
    • lotion
    • razor and shaving cream
    • hairbrush and comb
  3. Start the bath by washing from the face to neck, arm to hand, chest to abdomen, leg to foot and ending with the genital area.
  4. 4. Keep all areas covered with a bath blanket or a sheet except the area you are about to wash (to keep the person warm and for modesty).
  5. 5. Get a clean basin of water when cleaning between the legs and genital area.
The Sponge Bath
  1. If the older person is too weak to use a tub bath but strong enough to get out of bed, give a sponge bath at the sink. Always encourage getting out of bed as much as possible.
  2. Seat the older person near the sink covered with a bath blanket for warmth. You or the older person can clean starting from head to toe. This method of cleaning is to promote independence for the older person. The caregiver does whatever the older person cannot do.
The Tub Bath
  1. More accidents happen in the bathroom than anywhere in the house. When handling someone in the tub, focus on what you are doing. Any distraction or wrong move can lead to an accident or fall. Have all your bathing equipment within reach before you transfer the older person into the tub.
  2. Place a waterproof chair in the tub. It is recommended to have a non- slip mat in the tub to prevent sliding.
  3. Make sure the water is 98' to 101' F. You can test this with a thermometer or on your wrist.
  4. Getting the older person into the tub. Have the older person step into the tub using the stronger side. With your arm around the older person's chest, hold his or her weaker side. Provide support by raising the weaker leg into the bathtub. Have him or her grasp the grab bar.(Some tubs have them installed. You may want to purchase one at a medical supply store if your tub does not have one.) No more than 20 minutes should be spent in the tub.
  5. Getting the older person out of the tub. Let all the water run out of the tub before removing the older person. This will help prevent accidents or falls. Put a towel on his or her upper body so he or she is not slippery when moving. The older person should be sitting at the edge of the chair. Have him or her grasp the grab bars and rise with your help. The older person should step out with the stronger leg. You will provide support on the weaker side of his or her body.
  6. Have a chair nearby after the bath is over, so the older person can rest.
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