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PART II of a two-part Series

In Part I we discussed the effect of caregiving on health. In this excerpt, we’ll describe eight tools to help you take better care of yourself.

Tool #1: Reducing Personal Stress

How we perceive and respond to an event is a significant factor in how we adjust and cope with it. The stress you feel is not only the result of your caregiving situation but also the result of your perception of it—whether you see the glass as half-full or half-empty. It is important to remember that you are not alone in your experiences.

Your level of stress is influenced by many factors, including:

• Whether your caregiving is voluntary. If you feel you had no choice in taking on the responsibilities, the chances are greater that you will experience strain, distress, and resentment.
• Your relationship with the care recipient. Sometimes people care for another with the hope of healing a relationship. If healing does not occur, you may feel regret and discouragement.
• Your coping abilities. How you coped with stress in the past predicts how you will cope now. Identify your current coping strengths so that you can build on them.
• Your caregiving situation. Some caregiving situations are more stressful than others. For example, caring for a person with dementia is often more stressful than caring for someone with a physical limitation.
• Whether support is available.

Steps to Managing Stress:

1. Recognize warning signs early. These might include irritability, sleep problems, and forgetfulness. Know your own warning signs, and act to make changes. Don’t wait until you are overwhelmed.
2. Identify sources of stress. Ask yourself, "What is causing stress for me?" Sources of stress might be too much to do, family disagreements, feelings of inadequacy, inability to say no.
3. Identify what you can and cannot change. Remember, we can only change ourselves; we cannot change another person. When you try to change things over which you have no control, you will only increase your sense of frustration. Ask yourself, "What do I have some control over? What can I change?" Even a small change can make a big difference.
4. Take action. Taking some action to reduce stress gives us back a sense of control. Stress reducers can be simple activities like walking and other forms of exercise, gardening, meditation, having coffee with a friend. Identify some stress reducers that work for you.

Tool #2: Setting Goals

Setting goals or deciding what you would like to accomplish in the next three to six months is an important tool for taking care of yourself. Here are some sample goals you might set:

• Take a break from caregiving.
• Get help with caregiving tasks like bathing and pre-paring meals.
• Feel more healthy.

Goals are generally too big to work on all at once. We are more likely to reach a goal if we break it down into smaller action steps. Once you’ve set a goal, ask yourself, "What steps do I take to reach my goal?" Make an action plan by deciding which step you will take first, and when. Then get started!

Example: Goal and Action Steps

Goal: Feel more healthy.

Possible action steps:

1. Make an appointment for a physical check-up.
2. Take a half-hour break once during the week.
3. Walk three times a week for 10 minutes.

Tool #3: Seeking Solutions

Once you’ve identified a problem, taking action to solve it can change the situation and also change your attitude to a more positive one, giving you more confidence in your abilities.

Steps for Seeking Solutions:

1. Identify the problem. Look at the situation with an open mind. The real problem might not be what first comes to mind. For example, you think that the problem is simply that you are tired all the time, when the more basic difficulty is your belief that "no one can care for John like I can." The problem? Thinking that you have to do everything yourself.
2. List possible solutions. One idea is to try a different perspective: "Even though someone else provides help to John in a different way than I do, it can be just as good." Ask a friend to help. Call Family Caregiver Alliance, (800) 445-8106, or the Eldercare Locator, (800) 677-1116, and ask about agencies in your area that could help provide care.
3. Select one solution from the list. Then try it!
4. Evaluate the results. Ask yourself how well your choice worked.
5. Try a second solution. If your first idea didn’t work, select another. But don’t give up on the first; sometimes an idea just needs fine tuning.
6. Use other resources. Ask friends, family members and professionals for suggestions.
7. If nothing seems to help, accept that the problem may not be solvable now. You can revisit it at another time.

Note: All too often, we jump from step one to step seven and then feel defeated and stuck. Concentrate on keeping an open mind while listing and experimenting with possible solutions.

Tool #4: Communicating Constructively

When you communicate in ways that are clear, assertive and constructive, you will be heard and get the help and support you need.

Communication Guidelines

1. Use "I" messages rather than "you" messages. Saying "I feel angry" rather than "You made me angry" enables you to express your feelings without blaming others or causing them to become defensive.
2. Respect the rights and feelings of others. Do not say something that will violate another person’s rights or intentionally hurt the person’s feelings. Recognize that the other person has the right to express feelings.
3. Be clear and specific. Speak directly to the person. Don’t hint or hope the person will guess what you need. Other people are not mind readers. When you speak directly about what you need or feel, you are taking the risk that the other person might disagree or say no to your request, but that action also shows respect for the other person’s opinion. When both parties speak directly, the chances of reaching understanding are greater.
4. Be a good listener. Listening is the most important aspect of communication.

Tool #5: Asking for and Accepting Help

Many caregivers don’t know how to marshal the goodwill of others and are reluctant to ask for help. You may not wish to "burden" others or admit that you can’t handle everything yourself.

Be prepared with a mental list of ways that others could help you. For example, your neighbor could pick up a few things for you at the grocery store. Someone else could pick up a prescription. When you break down the jobs into very simple tasks, it is easier for people to help. And they do want to help. It is up to you to tell them how.

Help can come from community resources, family, friends and professionals. Ask them. Don’t wait until you are overwhelmed and exhausted or your health fails. Reaching out for help when you need it is a sign of personal strength.

Tips on How to Ask for Help:

• Consider the person’s special abilities and interests. If you know a friend enjoys cooking but dislikes driving, your chances of getting help improve if you ask for help with meal preparation.
• Resist asking the same person repeatedly. Do you keep asking the same person because she has trouble saying no?
• Pick the best time to make a request. Timing is important. A person who is tired and stressed might not be available to help out. Wait for a better time.
• Prepare a list of things that need doing. The list might include errands, yard work, a visit with your loved one. Let the "helper" choose what she would like to do.
• Be prepared for hesitance or refusal. It can be upsetting for the caregiver when a person is unable or unwilling to help. But in the long run, it would do more harm to the relationship if the person helps only because he doesn’t want to upset you. To the person who seems hesitant, simply say, "Why don’t you think about it." Try not to take it personally when a request is turned down. The person is turning down the task, not you. Try not to let a refusal prevent you from asking for help again. The person who refused today may be happy to help at another time.
• Avoid weakening your request. "It’s only a thought, but would you consider staying with Grandma while I went to church?" This request sounds like it’s not very important to you. Use "I" statements to make specific requests.

Tool #6: Talking to the Physician

While caregivers will discuss their loved one’s care with the physician, caregivers seldom talk about their own health, which is equally important. Building a partnership with a physician that addresses the health needs of the care recipient and the caregiver is crucial.

Tips on Communicating with Your Physician

• Prepare questions ahead of time. Make a list of your most important concerns and problems. Issues you might want to discuss with the physician are changes in symptoms, medications or general health of the care recipient, your own comfort in your caregiving situation, or specific help you need to provide care.
• Enlist the help of the nurse. Many caregiving questions relate more to nursing than to medicine. In particular, the nurse can answer questions about various tests and examinations, preparing for surgical procedures, providing personal care, and managing medications.
• Make sure your appointment meets your needs. For example, the first appointment in the morning or after lunch and the last appointment in the day are the best times to reduce your waiting time or accommodate numerous questions.
• Call ahead. Before the appointment, check to see if the doctor is on schedule. Remind the receptionist of special needs when you arrive at the office.
• Take someone with you. A companion can ask questions you feel uncomfortable asking and can help you remember what the physician and nurse said.
• Again, use assertive communication and "I" messages. Enlist the medical care team as partners in care. Present what you need, what your concerns are, and how the doctor and/or nurse can help. Use specific, clear "I" statements like the following: "I need to know more about the diagnosis; I will feel better prepared for the future if I know what’s in store for me."

Tool #7: Exercising

You may be reluctant to start exercising, even though you’ve heard it’s one of the healthiest things you can do. Perhaps you think that physical exercise might harm you or that it is only for people who are young and able to do things like jogging. Fortunately, research suggests that you can maintain or at least partly restore endurance, balance, strength and flexibility through everyday physical activities like walking and gardening. Even household chores can improve your health.The key is to increase your physical activity by exercising and using your own muscle power.

Exercise promotes better sleep, reduces tension and depression, and increases energy and alertness. If finding time for exercise is a problem, incorporate it into your daily activity. Perhaps the care recipient can walk or do stretching exercises with you. If necessary, do frequent short exercises instead of those that require large blocks of time. Find activities you enjoy.

Walking is a great way to get started. Besides its physical benefits, walking helps to reduce psychological tension. Walking 20 minutes a day, three times a week, is very beneficial. If you can’t get away for that long, try to walk for as long as you can on however many days you can. Walk around the mall, to the store or a nearby park. Walk around the block with
a friend.

Tool #8: Learning from Our Emotions

It is a strength to recognize when your emotions are controlling you (instead of you controlling your emotions). Our emotions are messages we need to listen to. They exist for a reason. However negative or painful, our feelings are useful tools for understanding what is happening to us.

Even feelings such as guilt, anger and resentment contain important messages. Learn from them, then take appropriate action.

For example, when you do not enjoy activities you previously enjoyed, and your emotional pain overshadows all pleasure, it is time to seek treatment for depression—especially if you are having thoughts of suicide. Speaking with your physician is the first step.

Caregiving often involves a range of emotions. Some feelings are more comfortable than others. When you find that your emotions are intense, they might mean the following:

• That you need to make a change in your caregiving situation.
• That you are grieving a loss.
• That you are experiencing increased stress.
• That you need to be assertive and ask for what you need.

Summing Up

Remember, it is not selfish to focus on your own needs and desires when you are a caregiver—it’s an important part of the job. You are responsible for your own self-care. Focus on the following self-care practices:

• Learn and use stress-reduction techniques.
• Attend to your own healthcare needs.
• Get proper rest and nutrition.
• Exercise regularly.
• Take time off without feeling guilty.
• Participate in pleasant, nurturing activities.
• Seek and accept the support of others.
• Seek supportive counseling when you need it, or talk to a trusted counselor or friend.
• Identify and acknowledge your feelings.
• Change the negative ways you view situations.
• Set goals.

It’s up to you!

Excerpted from Taking Care of YOU: Self-Care for Caregivers, a new Fact Sheet from FCA. For the full text, click here, or send $1 for a printed version to Family Caregiver Alliance, 180 Montgomery Street, Ste. 1100, San Francisco, CA 94104. See our Spring 2003 issue of Update for Part 1.

Summer/Fall 2003

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