Eldercare at Home: Helping with Recovery from Illness
Caregiving How Tos
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 section 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 section is a part on setting up a sickroom and administering care with practical suggestions for giving care to a person who is ill.
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, and discharge planners) can tell you what equipment you will need and will 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 safety, support, encouragement, and assistance to the older person. Tender loving care is the best way to boost the person's 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 questions such as, "What clothes would you like to wear today?" and "When would you like to take a walk?"
As the older person becomes 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 meaning, "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 or lying in bed can cause many problems to the body such as pressure ulcers, chest infections, like pneumonia, 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 then gets up may experience dizziness, fainting, stiff joints, weakness, and problems with muscle malfunction (muscles that don't communicate with the brain). You should encourage the person to get out of bed as soon as the person is medically cleared to get up.
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
- Any new symptoms
New symptoms mean a change in the older person's condition and should be reported to the doctor or nurse. Report any symptom that suddenly becomes more severe or difficult to manage. This usually means a change in the older person's condition that the doctor or nurse should know about.
- If you have questions about medicines
Call the doctor or nurse when you are uncertain about what time to give medicines or whether or not to give them with food. Call the primary care doctor if another doctor has prescribed medicine and you are not sure the new medicine should be given along with the old medicines. You can also call a pharmacist and ask if certain medicines can be or should not be given together.
- If you need to learn nursing skills
Ask the doctor or nurse practitioner for a referral to a home health agency if you need to learn basic nursing skills such as how to make a bed with someone in it or how to help an older person to stand up safely. Medicare will often pay for a home health nurse to visit the home, do a physical assessment, and teach home care skills to the family. This can often be done in only two visits and may qualify for Medicare reimbursement.
Know the answers to the following questions before calling the doctor
- Where is the symptom located?
- What is the symptom like, including its severity?
- When is the symptom better or worse?
- What medicine is the older person taking? Include prescription, non-prescription, and any herbal or alternative therapies.
Here is an example of what you might say when calling for help
"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. The only medicine he is taking is Vicodin occasionally for pain."
- 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 help with bladder and bowel function, 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 or nurse in an emergency. Find out how to do this. Ask the doctor or nurse if he or she wants daily reports on the older person's care. Different doctors and nurses work differently. Know your provider’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 remainder 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 throughout 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 and time.
- Consider having a remote control switch to turn lights on and off from the bed.
- Consider putting a portable commode next to the bed
if the older person can get out of bed but will have difficulty walking to the bathroom.
- Make hand sanitizer handy for everyone who enters the room.
- Ask the doctor or nurse if a special diet is needed.
- Keep a routine for mealtimes
But be flexible if the older person wants to eat little and often. This sometimes works better than three regular meals a day.
- 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 cups, 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.
- Serve finger foods if the older person is having difficulty using utensils
A platter of nutritious finger foods can be attractive and encourage eating.
- 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 the effects of the medicine are smallest. (For more information about appetite problems, visit Nutrition.)
- Prevent boredom.
The older person needs activities or visitors to prevent boredom. Television and radio are good sources of entertainment. Invite grandchildren and friends to 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. These feel good and increase circulation. A favorite pet can be therapeutic and give great love and comfort to a recovering older person.
- 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 and have the person sit up for meals. 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 while the person is awake.
- Prevent circulatory problems.
Bed rest can cause thickening of the blood and an increased stress on the heart. Blood clots (thrombophlebitis) can form in inflamed veins of the legs when a person does not move around very much. This is a serious condition as the blood clots may travel to the heart or lungs, causing a life-threatening emergency.
The best prevention is to get out of bed. Help the person take walks around the room and move to the chair or bathroom every two to four hours. Have the person wear loose clothing and avoid tight elastic waistbands, sleeves, socks, and stockings. When in bed, remind the person to 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 or nurse 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. It is important to encourage and help 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. Remember to check non-prescription medicines also. Laxatives, if used too often, can cause problems. Contact your doctor or nurse if constipation persists. He or she may recommend over-the-counter laxatives such as Metamucil(tm) or Senocot(tm). If the problem is very severe, a suppository, enema, or laxative administered by you may be in order, but check with your doctor or nurse first.
- Prevent pressure ulcers.
Older skin is thin and fragile. If an older person remains in a wheelchair or chair for a long period of time without moving, there is a high risk of pressure ulcers. Pressure ulcers happen at pressure points of the body-elbows, heels, toes, hips, and fingers. Skin breakdown also can be caused by the body rubbing against sheets and clothing.
Pressure ulcers can be prevented by following these strategies:
- Reposition the older person every two hours during the day and every four hours at night
If the older person is able to move himself or herself in bed, he or she might be able to do it independently and not need someone else to help reposition so often.
- Shift body position
from back to side and side to side and 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 donut-shaped cushion
This keeps pressure off the spine where skin breakdown is common.
- Use pressure relieving 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. Dragging the person can tear skin and may cause pressure ulcers.
- Treat pressure ulcers immediately
If you spot a pressure ulcer beginning (redness on the skin), call the doctor to have it treated immediately. Keep pressure off the area that is red.
- Use a draw sheet.
If you cannot move the older person by yourself, have a nurse show you how to use a draw sheet (which is a folded sheet in the middle of the bed and under the torso of the person’s body) used to lift the person up in bed (shifting him or her towards the head of the bed).
- Wash your hands after giving care for pressure ulcers.
This will reduce the chances of spreading infection to other parts of the person's body or to your own.
- Reposition the older person every two hours during the day and every four hours at night
Problems You Might Have Carrying Out Your Plan
"My mother doesn't want to use a bed pan because of the smell."
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, or use a plug in air freshener, or safely burn a scented candle. Keeping an inch of water in the bed pan, even when it is empty, will help reduce urine smells.
"My dad is bigger than me and I can't move him."
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. A mechanical lifting device might help-one of these can be borrowed or rented until the older person becomes more mobile.
Think of Other Problems You Might Have Carrying Out Your Plan
What other problems could get in the way of doing the things suggested in this section? For example, will the older 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 this plan?
Everyone would like a smooth recuperation with a minimum of crises. But this is not always possible. As each new problem arises, step back and develop a new plan. Your goal is to have a plan for each problem.
What to Do If Your Plan Isn't Working
If care-giving problems are getting out of hand and you are feeling overwhelmed, call the doctor's office or your local office on aging and explain your needs.
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.
Renting 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.
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 Unoccupied Bed
The best time to make the bed is after breakfast. Use cotton for bed sheets 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.
Making an Occupied Bed
- 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).
- Loosen the tucked-in bedding on each side of the bed.
- Explain to the older person what you are doing. Ask him or her to roll toward your partner or the side rail.
- Pull all the sheets out from under the mattress and tuck them under the older person as far as possible.
- 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.
- 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.
- 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. Make sure all wrinkles are smoothed out.
- 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.)
The older person should be turned onto one side with legs bent and facing you.
Swing the legs over the side of the bed.
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.)
- 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.
- 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.
- 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).
- Hug the older person's upper body.
- 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.
- Turn and ease the older person into the chair.
Toileting in Bed
- 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.
- 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 onto the bedpan which will assist the bedpan to slide easier.
Raise the head of the bed or help the person into a sitting position, if possible.
- 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.
- Clean thoroughly but gently between the legs: do not leave any urine or feces on the skin. Make sure all soap residue is removed from 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. Close he door so privacy is achieved but give a bell to the person to use if immediate assistance is needed.
The Bed Bath
(Bed baths are used primarily for people with a serious debilitating illness.)
- Give a bed bath only if the older person cannot get out of bed.
- 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)
- razor and shaving cream
- hairbrush and comb
- 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.
- 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).
- Get a clean basin of water when cleaning between the legs and genital area.
The Sponge Bath
- 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.
- 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
- 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.
- Place a waterproof chair in the tub. It is recommended to have a non- slip mat in the tub to prevent sliding.
- Make sure the water is 98' to 101' F. You can test this with a thermometer or on your wrist.
- To get the older person into the tub have him or her step into the tub by using his or her stronger leg. With your arm around the 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.
- To get the older person out of the tub let all the water run out of the tub before removing the 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 person should be sitting at the edge of the chair. Have him or her grasp the grab bars and rise with your help. The person should step out with the stronger leg. You will provide support on the weaker side of his or her body.
- Have a chair nearby after the bath is over, so the older person can rest.
In the Shower
A warm shower can be very refreshing for a frail older person and a shower stall is easier to step into than a tub. A non-slip mat or shower floor, as well as grab bars, are essentials. The person can sit in a plastic chair with non-slip legs, soap himself or herself, and rinse off well. You can help with the difficult-to-reach parts of the body. A toweling bathrobe can be put on after the shower, or a bath towel used, and the body gently blotted dry and lotion applied.