People with heart failure (HF) often tire easily, especially if they exert themselves. In HF, the heart is swollen with fluids and cannot beat efficiently. The body’s cells then become hungry for oxygen. If your loved one has HF, you witness this in his or her fatigue, shortness of breath, and frequent naps.

Even with HF, however, your relative needs to be physically active. Physical activity helps the heart muscle gain strength. It improves circulation. It helps with weight control, and, oddly, with reducing fatigue. Exercise also helps with depression, which is common in HF.

Pacing is the key. Talk with the doctor about optimal forms of physical activity. Initially, walking, swimming, or biking may be recommended. As HF progresses, simple tasks, such as taking a shower or cooking a meal, may qualify as exercise. Ask the doctor for a prescription to work with a cardiac rehab team to create an activity plan tailored to your loved one’s needs.

Conserving energy. Think of personal energy as a tank of gas. With HF, your relative has a small tank and needs to be “fuel efficient.” Conserving energy when doing chores leaves more “in the tank” for doing things that bring joy and meaning.

• Alternate periods of activity with periods of rest. Divide large chores into smaller tasks throughout the day or across the week.
• Avoid rushing. It wastes energy.
• Work smarter. Minimize trips up or down stairs. Cook large quantities of food and freeze for heating later. Instead of towel drying, slip on a terry cloth bathrobe after bathing.
• Get help for mundane tasks. Have groceries and prescriptions delivered.
• Create workstations that permit cooking, grooming, dressing, bathing while seated.
• Use a cart or walker with a basket for carrying things from place to place.
• Avoid bending or reaching. Use extenders.

Looking for ways to ease fatigue?
Give us a call at (415) 921-5038. As the San Francisco experts in family caregiving, we at Compassionate Community Care understand that quality of life is based on how much time your loved one can spend doing things they truly enjoy. Let us help you identify ways to conserve on chores so your relative can go full throttle on pleasant activities.

If the person you care for has a low vision diagnosis, three types of modifications to the home can make life easier: Lighting, glare control, and the use of color contrast. Fortunately, these strategies are relatively inexpensive.

Lighting. Sunlight is the best. It’s full-spectrum light. But it fluctuates depending on the time of day and the weather. Fluorescent bulbs are advised for general room lighting, although they cannot be dimmed. Incandescent lights can be dimmed, but they tend to produce visual “hot spots” or glare. Their best application is in a gooseneck lamp for close-up tasks. Lights recessed into the ceiling are optimal for spotlighting dark areas without creating glare (for example, a closet, hallway, stairs). Track lighting is lower cost, but it sometimes creates glare.

Glare control. Glare arises when reflected light creates too bright a hot spot relative to the rest of the room making it difficult for the eyes to adjust. Strive to reduce shiny surfaces. Also, to control surrounding light.

• Choose mini blinds or vertical blinds for maximum control of glare from the sun.
• Install dimmer switches to even out lighting brightness.
• Avoid using glossy paints or polishing furniture or floors to a shiny finish.
• Have tablecloths or other throw-ons available to cover bright surfaces as needed.

Color contrast. Light colors used in contrast to dark or bright colors instantly make it easier for your loved one to locate important items or get oriented in a room. For instance:

• When walls are white, paint doors, doorjambs, and baseboards with bright colors to highlight the boundaries of a room. Use a dark switch plate around light switches and outlets.
• Choose solid floor coverings (carpet, wood, tile) instead of those with patterns.
• Provide a dark desktop for tasks involving paper or a white plate for dining on a dark table top (or cloth).
• Place a dark armchair against a white wall and/or a light-colored floor or rug.
• Place brightly colored tape on the edges of cupboards and drawers to help your relative know when these are open, safeguarding against bumps, cuts, and falls.
• Red, orange and yellow—solid, bright colors—are more visible than pastels and/or dark colors.

Does the person you care for have low vision?
The older we get, the greater the chance of visual impairment. Cataracts, glaucoma, macular degeneration, and diabetes are the most common causes. As the San Francisco experts in family caregiving, we at Compassionate Community Care have worked with many families needing to make adjustments for their loved one’s low vision. You don’t need to do this alone. Give us a call at (415) 921-5038.

Frustrated in your search for a paid caregiver? You are not alone. There is an extreme shortage of helpers right now. Even before COVID, the demand for aides was greater than the supply. The “Great Resignation” hit the caring professions hard. Caregivers close to retirement left early. And many younger workers decided to opt for safer, less demanding jobs. In some states, as many as 38% of direct-care workers chose other occupations last year.

Caregiving is strenuous work, usually for very low pay. And there’s little societal respect for the career. The work can involve unpleasant personal care tasks. As well, clients with dementia may behave unkindly. Even clients without memory and thinking problems have been known to take out frustrations on paid helpers.

Adding to those realities, there is little growth opportunity for direct-care workers. Even jobs at fast-food chains pay better. Corporate employers can also provide more-flexible schedules so parents can be home after school. All these factors make direct care a less appealing career choice. Nearly half of paid caregivers quit within their first year.

By 2030 we will have twice as many people over 65 as we had in 2011. And we will have fewer young people in the population, so fewer potential helpers.

Yikes! As a family in need of help, this can be distressing news. As many as 85% of home-care companies reported having to turn away new clients at least once because they didn’t have the staff.

If you are lucky enough to get help, strive to make it a lasting relationship. Don’t tolerate poor work, but make an effort to thank and treat with respect those aides who do good work. It will be in your best interest, and in your loved one’s. The shortage is very real.

Are you having trouble finding help?
It can be daunting. As the San Francisco experts in family caregiving, we at Compassionate Community Care are actively strategizing about this problem every day. It’s a challenge throughout the nation. Give us a call at (415) 921-5038. Let’s see what we can do together.

Distance makes caregiving more challenging, from knowing what’s needed, to getting tasks accomplished. Here are some tips:

Stay in touch. This is a win–win. You stay current on issues, and your relative gets the emotional boost.

• Use the phone, email, and/or Web-based video calls. Connect at different times of day to see what’s up. Is mom sleeping a lot? What’s on the table at dinnertime?
• Ask about any injuries or falls. This information is important but may not be volunteered.
• If your relative lives alone, consider having them give you an “I’m up!” call or text by a preset hour.

Plan ahead. When visiting, use your time wisely. Do things with your family member that are just plain enjoyable. But also

• go to medical appointments. Get to know the providers. Ensure that releases are signed so you can talk with the doctors as needed.
• address housekeeping issues. Fix potential hazards, such as loose rugs, rickety stairs, and burned-out light bulbs. Check for signs that regular help is needed, such as garbage or laundry piling up.
• get into the kitchen. What is in the refrigerator? In the cupboards? Scorched pans may indicate your relative is forgetting to turn off the stove, a common sign of memory problems.
• check the desk. And ideally, scan the checkbook. Is the register in order? Any overdue notices?
• connect with the neighbors. And/or nearby close friends. Give them your contact information.

Stay organized. At your home, keep a binder up to date with documents essential to healthcare and money management.

Are you a long-distance caregiver?
As the San Francisco experts in family caregiving, we at Compassionate Community Care understand how precious your time is and how difficult it is to get everything accomplished from afar. You don’t have to do this alone. Give us a call at (415) 921-5038.

Catching things early is big with Medicare. Every year, all Medicare enrollees are eligible for a free “Wellness Visit” with their primary care doctor.

This is NOT an annual physical, so don’t use that term when making the appointment. Beyond basic vitals—height, weight, blood pressure, and pulse—there is no physical examination. If a physical exam is done, your loved one may have to foot the bill.

The yearly Wellness Visit is more of a conversation. The goal is to look at ways to avoid health problems or identify them early. The visit includes

• a review of medications and medical history
• a health risk questionnaire. This survey addresses lifestyle issues such as smoking, alcohol, and exercise
• other questionnaires assess memory and thinking problems, depression, anger, and social isolation

Based on your relative’s responses, the doctor may recommend screening tests. The idea is to nip any problems in the bud. It is also a time for your loved one to discuss preferences for end-of-life care. (This is called “advanced care planning.”)

Important to note, this visit does NOT include treatment or management of your relative’s chronic conditions. Diabetes, high cholesterol, and high blood pressure certainly threaten wellness. But they are addressed separately. And tempting as it is to say, “While I’m here, doc, what about this pain in my knee,” that is also outside the bounds. Best to make another appointment or your loved one may be charged for the visit.

Different from the “Welcome to Medicare” visit
If this is your relative’s very first year on Medicare, they are entitled to a free “Welcome Visit.” This is similar to the Wellness Visit but includes other assessments. One for fall risks. Another to identify weight problems. The appointment may also address hearing and vision. These additional assessments are not part of the yearly Wellness Visit.

Are you concerned about Medicare coverage?
Give us a call at (415) 921-5038. As the San Francisco experts in family caregiving, we at Compassionate Community Care can help you unravel the myriad complexities.

In most families, there is one person who takes on the lion’s share of caring for an aging loved one. Perhaps it’s the oldest daughter. Or the emotionally closest child. Or maybe it’s the geographically closest relative. And when there are no siblings, it’s usually the only child.

Being primary can be quite a job. In many cases it involves driving to the doctor and managing medications, handling finances, providing for daily needs, coordinating care services, and keeping the elder’s spirits up. If you are that person, don’t try to do it alone—even if it seems like that’s the only choice.

Here is advice from family caregivers who have been through this journey:

• Take breaks. It may not feel possible, but there are ways. If you forgo breaks, you risk burning out—which has negative consequences for everyone, not just you.
• Call a family meeting to discuss sharing responsibilities. Old family dynamics often resurface in this context. Consider getting the services of a social worker or care manager to facilitate a discussion.
• Be open to receiving help. Some families complain that the primary caregiver is so particular, there isn’t a realistic way to pitch in. Does that ring even a small bell with you? You may feel that you are the only one who can do it right or that you have to do it all. Now is a time to challenge that belief about yourself, even if you are an only child.
• What if it isn’t perfect? Of course, you want the best for your loved one. But consider for a moment: What is the worst that could happen if things weren’t done exactly up to the standard that you set? Perhaps there would be some discomfort for you and your relative, but nothing compared to how bad it would be if you burned out or ended up with a health crisis of your own (not uncommon among primary caregivers).
• Be clear about the costs and the rewards. What are you sacrificing as you carry out this role? (Social life? Career advancement? Your own retirement security?) What do you realistically enjoy or gain? Identifying the pluses and minuses can help you focus on what needs changing and what you want to emphasize.
• Family patterns die hard. Guilt or the perennial desire for parental approval can wear you down quickly! Plus, it’s common for siblings to revert to old resentments and rivalry during the eldercare years. Don’t get hijacked by the past! From your adult self, acknowledge what you realistically can and can’t do. Get professional help if it’s proving too difficult to reset internally.

Do you shoulder most of the eldercare responsibilities?
As the San Francisco experts in family caregiving, we at Compassionate Community Care understand the unique challenges you face. You may feel like you have to do it all, but you don’t. Give us a call at (415) 921-5038. Let’s share the load.

Our eyes show us the world. If something goes wrong with them, it can affect our total well-being. Dry eye syndrome makes eyes feel gritty, burning, itchy, and sensitive—discomforts that are hard to ignore! It typically manifests with age and affects as many as 30% of older adults.

What to do if your loved one has these symptoms: First, visit the eye doctor to understand the exact cause and identify any medications that are contributing to the problem. Then, try some proven soothing remedies:

• Warm compresses. Place a warm washcloth over your relative’s eyes for five minutes twice a day, pressing gently at the base of the eyelashes. Reheat the washcloth whenever it gets cold. The water hydrates the eyes and the heat loosens oils in the eyelashes that can build up and interfere with tears.
• Baby shampoo. The doctor may recommend massaging baby shampoo gently along the eye lashes to cleanse them more thoroughly.
• Eye drops. Over-the-counter “artificial tears” can help, but avoid those designed to eliminate redness. Better are eye drops that come in small individual-dose containers. These drops lack preservatives and can be used five times a day or more.
• Eye ointments. Ointments last longer than drops in terms of lubrication, but they make vision blurry. Save ointments for nighttime use.
• More fluids. More water consumed means more moisture for the eyes.
• Humidifiers. Adding moisture to the air, especially in winter, reducesthe likelihood of the eyes drying out.
• Change contacts. Daily disposables may be less irritating to the eyes. Or change to glasses now and then.
• Wraparound sunglasses. These can help reduce the evaporation of tears if your loved one spends time outdoors in wind and sun.
• Less screen time. Try the 20/20/20 rule. Have your loved one get up every 20 minutes for 20 seconds, stretch, and focus on something at least 20 feet away.

Are dry eyes a problem?
Sometimes it’s the little things that make quality of life so difficult. As the San Francisco experts in family caregiving, we at Compassionate Community Care know how important something like eye comfort can be. If the person you care for is struggling with daily life issues, give us a call at (415) 921-5038. You don’t have to do this alone.

The dangers of cold weather are obvious outdoors. But there are dangers indoors, too, most often because the house thermostat is set too low. People can die from being too cold. Older adults are especially at risk.

Signs of low body temperature (hypothermia). Shivering is the body’s first response to cold. Later symptoms include stiff or slowed movement, slurred speech, sleepiness, mental confusion, or a weak pulse.

If your loved one’s temperature is 96 degrees or less, call 911 for emergency assistance. While you wait, make sure the person you care for is dry. Cover him or her with a dry blanket and offer a warm, nonalcoholic beverage.

The key risk factors for hypothermia

• Health conditions that affect blood flow, such as heart disease, diabetes, and stroke
• Medications such as sleep aids and major tranquilizers
• Lack of physical activity
• Alcohol consumption and/or inadequate intake of liquids (dehydration)
• Concern about finances and the cost of heating

The key preventives

• A warm-enough house. Set the thermostat to 68–70 degrees. Even a home temperature of 60–65 degrees can set off hypothermia  in an older person. Consider a thermostat that you can read remotely.
• Appropriate clothing. Many layers of light clothing trap body heat better than one heavy coat. If your family member is sedentary, consider adding a hat, mittens, or socks with fleecy slippers.
• Close doors to unused rooms. Also block drafts from windows and doors.
• Eat well and drink plenty of fluids. The body needs fuel to keep up its temperature.
• Consider a portable heat source. If you add a space heater in the bedroom or beside a favorite chair, be sure it is placed far from items that can catch fire.

Check in often to be sure they are doing well. Look for signs of hypothermia.

Options to reduce energy costs

• Add weather stripping around windows and doors. Hang curtains that keep heat in and cold out.
• Provide a personal heat source such as a hot water bottle or a warming bag that can be reheated in the microwave.
• For help with utility bills, contact your state’s branch of the national Low Income Home Energy Assistance Program (LIHEAP), or call the National Energy Assistance Referral (NEAR) project toll-free at 1-866-674-6327 for a referral.
• For help with making a home more energy efficient, contact the Weatherization Assistance Program.

Are you concerned about winter?
The cold weather is not easy on older adults. As the San Francisco experts in family caregiving, we at Compassionate Community Care can help you keep your loved one safe. Give us a call at (415) 921-5038

Take any roomful of people and likely two-thirds of them have relatives who aren’t talking to each other. Families are messy. Hurts abound. Some people wait until a serious diagnosis to reconcile. They often regret the years of separation they can never retrieve. Others try forgiveness earlier in the process. There’s no right or wrong. Simply who has the courage—and when—to either give or request forgiveness.

Giving forgiveness. Forgiveness does not mean you approve of what someone did. According to the Stanford Forgiveness Project, people forgive because they want to take control of their life story. Instead of seeing themselves as a victim laboring under significant hurts from the past, they decide to focus on what’s working in the present and the possibilities for the future.

Perhaps your parent was abusive. Or abandoned the family. Or was utterly self-involved. Whatever the cause, you experienced pain—emotional, and perhaps physical. The journey to forgiveness includes understanding (and accepting) that living involves pain. It’s what you do with your pain that makes you the person you are. Doubtless, your past has influenced your life intentions—for instance, deciding not to repeat the pattern. Embracing that goal, you can turn a negative experience into something more than grief.

You may come to accept that the person who inflicted the pain was likely in pain themselves at the time. Perhaps they were not as mature as they might have been. And maybe they even regret their actions now, years later. By extending empathy and forgiveness, you may find greater inner peace on your own journey. You have the opportunity to heal an old wound and maybe even create new and positive memories with someone significant from your past.

Asking for forgiveness. Perhaps it is you who did something unkind in the past and would like to reconcile. It takes courage to ask for forgiveness. The first step is to be honest about the relationship damage you caused. By all means be compassionate with yourself about your abilities at the time. But when talking to someone you hurt, just saying “I’m sorry” isn’t enough. Name and acknowledge your poor choices and actions that caused pain. Then ask for forgiveness. Expect to spend some time listening, humbly and attentively, as your relative shares their experience. At some point, you can ask, “How can we move forward together?” Your family member may or may not be willing. But at least you mended a part of yourself and your history and can move forward better on your own.

Are you ready to heal a relationship?
It’s never too late to initiate forgiveness. As the San Francisco experts in family caregiving, we at Compassionate Community Care are profoundly moved by the courage and grace we witness when a family member decides to prioritize their bond and find forgiveness in their heart. Would you like some help with this? Give us a call at (415) 921-5038.

The grandparent–grandchild relationship can be precious, like no other. But even young children notice if Grandma or Grandpa isn’t acting the way they used to, or the same way others do. And they will have questions. “Why does he keep calling me by Dad’s name?” “She just asked that question five minutes ago!”

Respond to them honestly. Keep it simple and age appropriate. Children under age two may feel scared. Reassure them. “Grandpa has a boo-boo on his brain that made that happen. He still loves you.” For those ages two to six, you might embellish: “Grandma has a sickness that’s affecting her brain and making it hard for her to think well.” School-age children (six to twelve) can understand that their grandparent has a disease that “messes up the brain, tangling all the thinking cells.”

Provide simple reassurance. All children need to know that the disease is not contagious and that their relative’s behavior is not their fault. You may need to remind them often.

Validate feelings. Your child may be upset by the unusual behaviors. They may sense your distress or be jealous of your attention. Let them know that sometimes you too are worried, even frustrated or angry. Give them the opportunity to share their feelings. Talk about healthy ways to cope. Check with a librarian for a helpful children’s book. If you notice acting-out behaviors or withdrawal from usual activities, consider professional help.

Suggest realistic activities both will enjoy. Maybe listening to music or singing. Planting flowers or weeding a garden. Doing arts and crafts. Taking a walk or sitting outside to enjoy nature. Looking at photo albums. Having a picnic. Storytelling. Holding hands.

Never put a child in charge to “babysit.” That is far more responsibility than they can handle. It’s not safe for them, nor for the person you care for.

Are children confused by Grandpa or Grandma?
Especially if they were old enough to develop a relationship before the dementia became apparent, children can be profoundly affected by the changes they witness. As the San Francisco experts in family caregiving, we at Compassionate Community Care highly recommend you address the situation candidly, especially if the person with dementia is a regular part of the childrens’ lives or affects household routines. Want help? Give us a call at (415) 921-5038.