Did your mom teach you to “do what the doctor says”? If she’s not following doctor’s orders for medications now, you’re probably feeling confused. And concerned. 

It’s common for patients not to take pills as directed. Some typical reasons: 

• “It’s too costly.” One quarter of new prescriptions are never filled because of cost. Make sure the drug is on the insurance plan formulary. Or ask about generics. Find a discount pharmacy, or consider mail order.
• “I don’t have symptoms.” Many illnesses lack noticeable symptoms. High blood pressure and high cholesterol, for example. These prescriptions often go unfilled. Many people don’t finish their antibiotics for similar reasons: the symptoms went away. Ask the doctor or pharmacist to review with your loved one why a medication is necessary.
• “It made things worse.” Consult with the doctor or pharmacist. Reducing the dose or changing from morning to evening may fix the problem. Or taking a different medication may be advised.
• “It was too complicated.” Some drugs require multiple doses in a day. Others are restrictive (“30 minutes before eating”). Ask the doctor or pharmacist about alternatives.
• “I can’t get the bottle open” or “I can’t read the label.” Arthritic hands and poor eyesight can make it difficult to follow directions. Ask the pharmacist for large type on the label and a NON-child-proof container.
• “Why bother?” Hopelessness and depression are common reasons why people don’t take their medications. If you suspect depression, ask the doctor to do an evaluation.
• “It won’t do anything.” Perhaps your loved one has an entirely different interpretation of what is wrong with their health. Ask to learn more.
• “I forgot.” Simple memory lapses are a fact of aging. It may be time for an automated pill dispenser or pills that are pre-packaged into morning, noon and night time doses. 

Are you worried about medication management?

You are not alone! As the San Francisco experts in family caregiving, we at Compassionate Community Care have witnessed how important it is to understand your loved one’s perception of the situation before you can find a resolution. Let us help. Give us a call at (415) 921-5038.

Food and oxygen are the basic fuels that we need for the cells of our body to do their jobs. People with COPD have to expend more energy breathing. Because their exhales are not always efficient, they tend to develop high levels of carbon dioxide. Not good. 

Fortunately, there are food choices that can reduce the problem and provide maximum efficiency for breathing. Check these out:

Foods to limit

• “Gassy” foods. Beans, cauliflower, brussels sprouts, and broccoli are examples, and so are carbonated beverages. They cause the stomach to expand, which puts pressure on the diaphragm. Some people also get gas from apples, stone fruits (e.g., apricots, peaches), and melons.
• Sugars. Simple carbohydrates (sugars and starch) produce more carbon dioxide than do fats or proteins. They make more work for the lungs. Avoid candies, cookies, cake, and soft drinks. 
• Salt. It can cause the body to retain fluid, making it harder to breathe. 
• Dairy. Milk and cheese often produce thicker phlegm, making it difficult to keep the lungs clear.
• Fried foods. While healthy fats are good, the fats that are typically used in frying—saturated fats that are hard at room temperature, such as butter or lard—often cause bloating and indigestion. This puts pressure on the diaphragm, making it harder to breathe.

Foods to eat

People with COPD need more protein and calories to build up the muscle of the diaphragm and to provide fuel for the extra effort they have to expend to exhale effectively. Carbohydrates provide calories, but have the side effect of increased carbon dioxide. A focus on healthy fats and proteins is the best way to help your loved one keep carbon dioxide low and calories sufficient for the extra work of breathing.  

• Healthy fats. Polyunsaturated fats provide calories without the carbon dioxide that carbohydrates tend to produce.Natural sources of these “healthy fats” include avocados, nuts and seeds, oily fish (e.g., salmon, mackerel, sardines), olives, and olive oil. 
• Protein. Eggs, lean red meat, and oily fish are excellent sources of the proteins that provide the building blocks for the muscles needed to handle heavy respiration. 
• Water. To make it easier to keep the lungs clear, have your loved one drink between six and eight 8-ounce glasses of noncaffeinated beverages each day. Good hydration will help keep phlegm thin and easier to cough up. Best to drink water between meals.

When to eat

• Smaller, more-frequent meals are optimal. Try for five or six per day.It’s harder to breathe when your stomach is full. Similarly, reduce fluid intake at mealtime to keep the stomach from getting distended. 
• Eat the big meal in the morning. This will provide an energy boost ahead of the day’s activities rather than closer to bedtime. 

As always, check with a doctor or dietitian to determine the diet that is right for your loved one. 

Does your loved one have COPD?

This is a difficult disease. As the San Francisco experts in family caregiving, we at Compassionate Community Care can help you create strategies to deal with the stress of the respiratory flares that come with this lung condition. Give us a call at (415) 921-5038.

If you develop health problems—mental or physical—what happens to your loved one? Their well-being depends on yours. So it’s vital that you keep yourself healthy and in balance, for your sake as well as theirs. Not taking the time to do this is the biggest regret of former caregivers. There is always a way.

Take breaks
No one can be “on” all the time.

• Ask family to relieve you. A little time after work or on the weekend. Or some of their vacation time dedicated to taking care of your relative so you can do something nourishing for yourself.
• Consider an adult day program with activities and social opportunities for your loved one.
• Investigate respite programs for short-term relief.
• Maintain a hobby or social connection that is completely unrelated to caregiving.
• Take a mental break at least 10 minutes a day. Perhaps you talk with a friend who has a good sense of humor, or watch silly videos. Maybe you meditate or pray.

Take care of yourself

• Keep up with regular doctor visits and preventive exams. Take your own health seriously. Do not postpone surgeries or other treatments you need.
• Cultivate healthy habits (seven to eight hours of sleep per day, regular exercise, and a healthy diet). Avoid unhealthy crutches such as alcohol, overeating, or medications.
• Be alert for signs of depression, the number one mental health problem for family caregivers.
• Nurture your other relationships (spouse and kids, especially). They deserve your attention, and you need them. Find a healthy balance.
• Stay connected with friends, even if just by text. Isolation is bad for your mental and physical health.

Periodically step back and acknowledge all that you do. It’s easy to feel you don’t do enough or aren’t doing things perfectly. Instead, recognize the service you provide. Salute your achievements. You are doing noble work!

How are you pacing yourself?
Whether by setting limits or doing daily exercise or meditation, you need to guard your own well-being. As the San Francisco experts in family caregiving, we at Compassionate Community Care assure you that it’s not selfish, it’s imperative! Give us a call to learn how you can maintain a healthy balance in your life: (415) 921-5038.

Look for financial support for caregiving
Medicare doesn’t pay for home care or other nonmedical support. You’ll need to find other options.

• Benefits. Does your loved one have long-term care insurance? Did they serve in the armed forces? (If so, they may be eligible for veteran benefits.) BenefitsCheckup.org may uncover other sources.
• Local programs. Are there state or local programs that help pay for some caregiving time? Or pay for respite? Check for a housing subsidy. Or a government waiver to reduce the cost of care.
• Tax deductions. If you provide more than 50 percent of the financial support for your loved one, you may be eligible for some tax relief. Talk with a tax specialist.
• Family Medical Leave Act. While it does not provide for paid leave, this legislation can protect you from losing your job if you have to take time off work for family caregiving. Talk to the HR department at your place of employment.

Get paperwork in order

• Medical records. Keep a current list of doctors, medications, current diagnoses, and past medical history. Find out how to access medical providers online. Also, keep records/notes from the hospital, lab, and doctor visits.
• Financial overview. Learn about your relative’s income and expenses. Find all their accounts and account numbers. This will help you with eligibility requirements and deciding what services can be afforded.
• Powers of attorney. Whether due to coma, dementia, or some other condition, your loved one may not always be able to voice their wishes. Have your relative work with an attorney to choose a decision maker for finances and one for health care.
• A will and/or trust for disbursing assets. Likely your loved one has thoughts about what they want to have go to whom. Work with an attorney to draft the appropriate documents.

Are you concerned about finances?
As the San Francisco experts in family caregiving, we at Compassionate Community Care find that paying for care is the number one worry. Understandably so! Many families are surprised to learn about all the things Medicare doesn’t cover. Let us help you find out about local programs and eligibility requirements. Give us a call at (415) 921-5038.

Family caregivers typically spend four to five years caring for an aging relative. While gratifying, it can also be overwhelming. Pacing yourself for the long haul is part of the solution.

This issue of our newsletter outlines the top support strategies recommended by millions of family caregivers who have come before you. Take advantage of their insights.

Seek information, training, and support

• Medical information and skills. Get a thorough and accurate diagnosis. Learn from the medical team about treatments. Ask what you can do at home. And explore online at credible websites. Nonprofits specializing in the disease are a good bet. For instance, the COPD Foundation or the Alzheimer’s Association. The National Institutes of Health are a respected source. Also, the Mayo Clinic, Cleveland Clinic, and WebMD.
• Guidance from a professional in the field of aging. Go to Eldercare.acl.gov for free information and referral to services anywhere in the United States. For more-robust help, hire a certified care manager or advocate. Look for someone who understands the biopsychosocial aspects of aging. A person who also has a deep knowledge of local and national resources, as well as the best providers.
• Practical tips and support from other caregivers. Look to the professionals for medical advice. But join a caregiver support group for emotional support. You’ll also get invaluable tips on coping with daily challenges. Caregiving is very isolating. It helps to know you are not alone.

Find help for physical tasks

• Family and friends. They are the first to help, but they are not always available. Call a family meeting to strategize together.
• Community programs. These deliver specific services for free or a nominal fee. For example, Meals on Wheels delivers free or low-cost meals once a day to homebound persons. Or there may be help with transportation. Look for a volunteer driver program offered by a faith organization or senior center. There are usually eligibility requirements.
• Hired care. Paid help is the most reliable source of assistance. Especially for the time-consuming, hands-on tasks. But Medicare does not pay for this type of care. Home help is generally an out-of-pocket expense.

Are you a new family caregiver?
As the San Francisco experts in family caregiving, we at Compassionate Community Care love to meet with family members early to help them get oriented so they can pace themselves for the long haul. Give us a call at (415) 921-5038. Let’s start the conversation.

If your relative needs medical oxygen, it’s crucial that you plan ahead for plane travel. From oxygen requirements to battery power, you need to be sure they have enough to cover the whole trip. (You don’t want to run out midair!) You’ll need to cover not only the flight, but layovers and inevitable delays.

First, work with your loved one’s health care provider to get medical clearance to travel. The natural oxygen available in an airplane is equivalent to that at 8,000 feet above sea level. Can your relative tolerate this “high altitude” environment? Is it safe? What do they need to do differently to compensate?

Once you receive the medical go ahead:

• Determine how much battery power will be needed. Most airlines require that you have enough battery power for 150 percent of the anticipated length of the flight. The length of the trip and the flow of the oxygen affect how long the batteries will last. For added measure, also find out if your loved one can safely unhook from the oxygen to go through security.
• Make reservations carefully. Contact the airline directly to discuss arrangements for oxygen. Only portable oxygen concentrators (POCs) are allowed. But which ones varies by the company. Consult the airline’s website to determine if the manufacturer’s brand and model are accepted. Confirm when you speak in person. If there is no match for your relative’s equipment, ask what the airline offers in terms of an oxygen service and what it costs. Also, if it is not a nonstop flight, consider longer layovers. This way the batteries can be charged at the airport.
• Special requests. Strive for a window seat so the tubing does not pose a danger for others in your row or people walking in the aisle. Bring the doctor’s order for the oxygen. (Ask if the airline has a special form to be filled out by the doctor. Many of them do.) Consider reserving wheelchair assistance. It makes the TSA process much easier.
• Gather oxygen and battery packs days ahead. You want to be sure you have everything on hand well before departure day. The airline may not let your relative on board if they don’t have all the supplies that are needed. Also pack a three-prong adapter and a spare power cord, just in case.

At the airport

• Get there early as the entire process will be more complicated with the oxygen.
• Check in at the counter. Bring the doctor’s prescription, the oxygen, all necessary battery power, and any signed form the airline requires from the doctor.
• Get wheelchair assistance to go through security and to take your loved one to the gate.
• If your relative can walk through the detector at security without oxygen, consider unhooking and sending the oxygen container separately through the x-ray on its own. Otherwise, a more thorough inspection will be required.
• Use every opportunity to charge up the batteries whenever you are in the airport. Although the plane theoretically has plugs on board, they don’t always work.
• Board when the crew calls for those who need extra time getting settled. This early boarding is designed exactly for your relative’s situation.

Are you planning a holiday trip with your loved one?
Holiday visiting is good for the spirit. But there are often logistical challenges. As the San Francisco experts in family caregiving, we at Compassionate Community Care can help you get ready so you can avoid common holdups. Give us a call at (415) 921-5038.

If you are a perfectionist, you may have noticed that your high standards often backfire. Despite your best intentions, you actually accomplish less. Research confirms this. Studies also show that perfectionism frequently leads to anxiety, depression, and difficult relationships. With a gentler approach, you can still have goals and standards as a family caregiver. And you can have a more enjoyable life, as well as more companionship and support.

Perfectionism is a mental habit.
Also, the “thief of joy.” Try these proven strategies for change:

• Do a reality check. As you strive to accept imperfection be clear about the true risks of a situation. What’s the worst that can happenif you or a family member does something not up to your preferred standard? How likely is it, really, that the worst will occur? What is the more likely outcome? Is it completely unacceptable?
• Challenge your inner critic. The difference between a perfectionist and a healthy high achiever is that the latter is less “black or white” in their approach. Instead, they acknowledge gradations. “This may not be perfect, but it’s plenty good enough.”
• Look for what’s good. For every flaw you find in something you or a sibling does for your relative, stop, think, and acknowledge at least two positives.
• Celebrate small successes. Perfectionists often procrastinate for fear of not doing something well enough. To break the logjam of doubt and inaction, divide tasks into smaller pieces and then recognize each accomplishment.
• You are more than your achievements. Think about who you are, not just what you do. Write down your positive qualities. For instance, that you are “caring,” “honest,” “have a sense of humor.” Make time to be not productive and to just relax. Shift your focus to enjoy being alive and “good enough” versus intensely goal focused and frustrated.

Want to kick the perfectionist habit?

As the San Francisco experts in family caregiving, we at Compassionate Community Care see many families laboring under the burdens of perfectionism. Understandably so! The stakes are so high with eldercare, you don’t want to risk a serious problem. But sometimes that caution leads to other problems that are equally difficult. Let our experience give you the perspective you need to make wise decisions. Give us a call at (415) 921-5038.

We are all vulnerable to an upsell when we want to honor a deceased family member. Fortunately, the Federal Trade Commission offers some protection in the form of standards all funeral homes must follow. This enables you to make apples-to-apples comparisons.

For instance, you have the right to price information when you phone. And an itemized price list when you visit. Basic services must be described in the same way: Direct burial, direct cremation, embalming, etc. You can use a casket or urn that is purchased elsewhere. Or an alternative container. (Consider shopping online and having the casket or container shipped.) Embalming is not required if refrigeration is available. Or if the burial is to take place within two days of death.

Separate the public gathering from disposal of the body. There are low- or no-cost places to hold a memorial service or celebration of life: At home, in a park, etc. This provides the option to postpone the service to a date best for everyone concerned.

Closer is not necessarily better. It’s prudent to check out mortuaries in a fair radius around you. If there is a large price difference, a fifteen-minute longer drive may be the wisest choice. (Morticians will generally travel up to twenty to thirty miles to transport the deceased without charging extra.)

Establish a budget before you start calling. Don’t equate the funeral price with the love you feel for your relative. You don’t want to have to contend with debt on top of grief! In fact, an alternative casket made of reinforced cardboard with personalized notes and drawings on it may be more meaningful than a fancy, lined, lead casket.

Visit the short list. Ask a less emotionally involved friend to check out funeral homes with you. An objective perspective will help you buy only what you truly want and can afford.

Are you making preparations for a funeral?
As the San Francisco experts in family caregiving, we at Compassionate Community Care have walked through this part of the journey with many of our clients. What we notice is that it’s the tender, personal touches that seem to make the service meaningful, not the big flashy displays. If you are concerned about what style of service to arrange, consider the options that will prioritize heartfelt connection and not break the bank. Give us a call at (415) 921-5038.Affordable funerals

Pain is no fun, whether in a knee, a neck, or elsewhere in the body. There are drugs that dull pain. But they don’t cure the problem. Plus, prescription drugs usually have side effects or are addictive. Physical therapy (PT) is a proven treatment that can relieve pain and in some instances, cure the problem. You may think of PT in terms of someone learning to walk after a hip replacement. Or improving their balance after a fall. In fact, PT is a great—and often overlooked—option for addressing pain.

Arthritis. For arthritis, PT focuses on loosening up joints, muscles, and tendons because continued physical activity reduces the pain. Suggestions might also be made for aides such as ergonomic chairs for back or neck pain. Or for back, knees, and hips, a soft cushion mat for standing in the kitchen. Your relative will receive a customized plan tailored to problems in their hands, back, knees, hips, or neck.

Chronic pain. Physical therapists are experts on the musculoskeletal system. If your loved one has chronic back pain, for instance, or other problems with muscle strength or stiffness, they’ll be given exercises to help. Sometimes the focus for pain relief is on flexibility. Other times it’s about building muscular strength.

Headaches. Persistent headaches can be notoriously difficult to cure. A physical therapist will work to define the source and triggers, a pinched nerve, tight jaw, muscle spasm, etc. With an informed plan, PT prevents and relieves headaches by improving posture, neck mobility, and muscle strength.

The body’s natural healing power. The exercises a physical therapist assigns are designed to support the body. They focus on muscle pairs that complement each other, stretching, and contracting. While there may be some soreness from doing unfamiliar moves, there are none of the side effects of medicine. In fact, PT may help your loved one avoid medication altogether. And there’s no potential addiction—except to feeling better! Full benefit does depend on diligence in doing the suggested exercises, however.

Check with your insurance. Medicare will pay for medically necessary PT services. Check with Medicare or your relative’s Medicare Advantage program to learn what is needed. You may be able to find private-pay PT that you can schedule yourself, like a personal trainer.

Are you concerned about chronic pain?

Addiction to pain relievers is a big worry. Fortunately, physical therapists offer relief without prescription drugs. As the San Francisco experts in family caregiving, we at Compassionate Community Care regularly see physical therapists use their skills to resolve challenging pain issues. Your relative needs to do the recommended exercises. But when they do, the results are impressive. Want to learn how physical therapy might fit into your loved one’s care? Give us a call at (415) 921-5038.

Perhaps you wonder if your family member is a “hoarder.” (You may even harbor secret fears about yourself!) We all have cherished possessions. From trophies to teacups. Spare buttons to cans of half-used paint. But hoarding is different.

Most of us can determine when we have “enough.” And we can decide to stop buying things and/or start donating or recycling them or throwing them away. Not so for those with a hoarding disorder.

The characteristics of hoarding include

• a large number of possessions that appear to be useless or of limited value
• significant distress when trying to discard or part with those possessions
• amassing so much clutter that rooms cannot be used as they were originally intended

At its most extreme, hoarding creates social and environmental problems such that the person gets isolated and cannot maintain a safe or healthy home environment.

A hoarder continually brings in more belongings despite having no room to store them. You might first notice piles of papers that pose a fall hazard in hallways. Or belongings stacked high on tables or in the sink. It’s as if these surfaces are for storage, not eating meals or washing dishes. Hoarders become too embarrassed by the clutter and will not allow others to come inside the home. With severe hoarding, mold, bacteria, insects, or rodents start creating a health problem for neighbors as well as for the person who hoards. (At this late stage, the local fire department and/or Adult Protective Services may begin an eviction process.)

Hoarders are people who are unable to determine what is valuable and necessary. Everything seems to be important and to need saving. It becomes too emotionally painful to throw any of it away. This is a disorder, not a decision. You can’t shame a hoarder into changing. And if you force a cleanup, sadly it may harm your relationship. Often it takes extreme action, such as threat of eviction, to cause the person to seek help.

If your relative show signs of hoarding, talk to the doctor. Ask for a referral to a counselor or therapist who specializes in treating this disorder.

Are you worried about hoarding?
As the San Francisco experts in family caregiving, we at Compassionate Community Care can provide insights and assistance. This is a condition that typically needs an intervention. Preserve your relationship. If there has to be a “bad guy,” let it be us. Give us a call at (415) 921-5038.