Background:

The caregiver lives several hours away from her mother.  Most of their interactions are virtual using a device such as a phone, tablet, or computer using Zoom or Facetime.  Personal visits occur mainly on holidays.

Chain of Events:

• The caregiver calls weekly and notices some mistakes in what her mother says but assumes that it is typical “old age” and thinks nothing of it. No alarm bells go off after their telephone calls. She would forget someone’s name or a place they had visited but nothing significant.
• Since the caregiver used Facetime to talk to her mother, she began to notice some changes in her Mom’s appearance.  No longer was she dressing up each day.  In fact, many days, she seemed to stay in her PJs.  She began to look different Changes in body posture, tone of voice, facial expressions, general appearance, and other background clues (dirty clothes, trash accumulation) indicated that her Mom was not taking care of herself.
• Neighbors and acquaintances started calling the daughter to report they had concerns for her Mom’s safety. 
• The caregiver receives a call from a neighbor who reports that she found her Mom wandering around in her garden at night, pulling up plants. A crisis occurs that requires the new caregiver to rescue the familyThe basic unit in society traditionally consisted of two parents and their children but the family has now been expanded to include any of various social units differing from but regarded as equivalent to the traditional family. More member, and the full extent of the problem becomes apparent.

Challenges with Long Distance Care

• Limited time at the location where the family member resides.
• Unfamiliar with local resources.
• Conflict with taking sufficient time away from work to deal with issues at the distant location.   Often home, work, and the office compete for caregiver’s time, and all have critical projects due at the same time. Determining who gets the focus is difficult to decide on whose need is more significant when all three are urgent.
• Feelings of guilt
  • feelings of deserving blame especially for imagined offenses or from a sense of inadequacy;
  • a feeling of deserving blame for offenses;
  • the fact of having committed a breach of conduct especially violating the law and involving a penalty
  More, frustration, fear, anxiety, and a desire to take care of the family member are common and make emotional acceptance of the role difficult.
• Additional expenses to cover potentially 24-hour care or monitoring
  • Watching to give warning;
  • To watch, keep track of, or check usually for a special purpose
  More. Since the caregiver cannot be onsite, they may need to hire someone to stay with their family member full time. The expense of hiring someone else to do the care can be costly!
• The new caregiver needs a way to feel confident that the family member is getting good care when the caregiver is not present. Creating a process to monitor the quality of care received and establishing an effective communication method is essential
  • Of, relating to, or constituting the essence
  • inherent, of the utmost importance
  • basic, indispensable, necessary,
  • being a substance not made by the body in an amount great enough for normal health and growth and requires us to eat it instead.
  More for everyone’s peace of mind.

Background:

For emergencies, the event occurs suddenly and without warning. All involved parties are in emotional shock. Fear and anxiety lead to difficulty in decision making and cloudy thought processes.  Through the hospital stay, the caregiver is anxious and afraid. She gets only short periods of sleep, eats poorly, rarely leaves the hospital, and then does business. The caregiver’s laser focus is on the one who is sick or injured. Whatever the healthcareefforts made to maintain or restore physical, mental, or emotional well-being especially by trained and licensed professionals More professional request, the caregiver promises will happen at home – whatever it takes to return them to the way things were.

As time wears on, a conflict between responsibilities inside the hospital and outside develops, creating frustration and resentment. Fear of what lies ahead surfaces as talk of long-term rehabilitation begins, and the impact on job responsibilities becomes a reality.

Chain of Events:

• After the next of kin receives notification of serious event, emotional shock develops, along with narrowing of focus, difficulty thinking, anxiety, physical symptoms, etc.
• Requests come from the medical team to make decisions regarding life-saving measures and potential end-of-life preferences (i.e., Advance Directive documents).
• Details of medical problems, requests for medical history and information for registration occupy the caregiver’s time. Meanwhile, during breaks, the caregiver must call other familyThe basic unit in society traditionally consisted of two parents and their children but the family has now been expanded to include any of various social units differing from but regarded as equivalent to the traditional family. More members to update them on the status of the one who had the emergency. If the affected person is alert, the caregiver may be providing support and comfort to that person too.
• Eventually, the caregiver receives the final determination regarding the family member’s medical status.  The caregiver either makes the final decision regarding the course of action or assists in making that decision with others. 
• During the next few days in the hospital, the caregiver gets little rest and has a lot of anxiety alternating with fear. As the family member progresses and moves out of intensive care to the patient floors, the nursing staff begins to prepare the caregiver for what to expect going home. The Care Coordinator discusses what equipment may be needed, and a discussion regarding transportation to get home starts the planning process for either obtaining an ambulance service or other means.
• Throughout the hospital admission, the caregiver monitors the patient’s care for accurate timing, safe delivery, and appropriate practice.
• If the family member starts rehabilitation to continue recovery, the caregiver must learn to be both a physical and occupational therapist, maybe a speech therapist and counselor, too.
• Though being discharged is joyful, a lot of preparation is required before someone can comfortably go home. The house may need structural changes. Engineering and construction skills help in adapting the home to the needs of the recovering family member may be required.
• In preparing for home, the caregiver needs engineering and construction skills to adapt the house for their family member’s arrival. Often doors need widening for wheelchairs or new showers installed for bathing. Maybe they need to arrange for the installation of a new ramp.
• Rehab and prevention of wounds, pneumonia, or complications of immobility continue after returning home. Once home, long-term preventive maintenance programs begin.

Issues with Crisis Caregiving

• In crisis situations, emotional acceptance is beyond reach due to exhaustion. The individual never has the opportunity to restore their energy reserves and runs “on fumes” all the time. 
• Burnout –Caregivers living in crisis get little rest. They rarely have time to eat or sleep and live on adrenaline and caffeine. They are exhausted most of the time.  They walk around in a fog of sleepiness as a way of life and fall asleep without warning such as when driving, resulting in a risk for themselves and others.
• Becoming ill or injured themselves due to not taking care of themselves.
• Developing depression or committing suicide from becoming overwhelmed.

Background:

The familyThe basic unit in society traditionally consisted of two parents and their children but the family has now been expanded to include any of various social units differing from but regarded as equivalent to the traditional family. More member has a chronic health condition and does self-care for an extended period.  Over several years his health condition becomes worse. His physical state declines to the point that he needs help and begins to ask the future caregiver to assist him. Requests come more frequently until the family member comes to rely on the caregiver’s assistance in order to function daily.

Chain of Events:

• The family member initially performs self-care without assistance.
• His condition declines to the point that he needs part-time help.
• Periods of intermittent dependence increase with progressively prolonged time frames where total dependence occur. 
• The family member and caregiver discuss the need for full-time help with the caregiver serving as a coordinator of care rather than a provider.

Issues with ChronicCare and treatment provided to individuals with long-term continuing health problems. Rehabilitation facilities, nursing homes, and mental hospitals are often considered chronic care facilities. More Caregiving

• The caregiver gradually assumes additional duties as the needs of the family member slowly grow over time.  Therefore, the caregiver absorbs the extra responsibilities into their daily routine, not realizing the additional work assumed over time. Eventually, they feel the weight of the extra burden and are at risk of developing caregiver fatigue or caregiver burnout.
• Caregiver fatigue and burnout are both characterized by withdrawal and symptoms of depression to different degrees. With fatigue, the caregiver demonstrates a grumpier attitude, whereas with burnout, they just no longer care.  Their emotions have become so numb, and they feel so isolated that they no longer feel anything.  The term “burnout” is an appropriate description because everything they feel has burned out of them, and there is nothing left to give.
• Caregivers providing long term care are at high risk for developing chronic healthcareefforts made to maintain or restore physical, mental, or emotional well-being especially by trained and licensed professionals More problems themselves due to the tendency to neglectNeglect is to give little attention or respect to;  To leave undone or unattended through carelessness More their own care.  Many caregivers set aside their own medical appointments, eat poorly, get limited sleep, rarely exercise, and may use caffeine or over-eat for energy—all of which increase their risk factors for future healthcare problems.  As a result, many of them suffer from chronic health problems that cause them to succumb to fatal events before the death of the one under their care. Whereas in the early phases of their role, they had adequate emotional acceptance (and adjustment), when personal care is not a priority, they eventually burnout. 

Background:

A familyThe basic unit in society traditionally consisted of two parents and their children but the family has now been expanded to include any of various social units differing from but regarded as equivalent to the traditional family. More member becomes forgetful, begins to wander, becomes fearful, does not recognize others, forgets to pay bills, and gets lost easily. Completing self-care becomes increasingly challenging.  At night, he wanders around the house instead of sleeping, although he rarely naps during the day. People he should know well, he no longer recognize, including his own children and siblings.  He may not be sure about when and where he is at any given time. If this sounds familiar, then your family member may have dementia.  Alzheimer’s is a form of dementia. 

Chain of Events:

• The family member is demonstrating signs of dementia, which began to get progressively worse over several months. His caregiver is concerned about safety because he wanders outside the house. On three occasions, he has lost his way home after multiple attempts to find the way himself.
• A family meeting of the three adult children is planned to discuss whether he should be admitted to a care facility. 
• After looking at several options, the family decides which one he can afford and the risks they are willing to assume based on the current symptoms of dementia displayed.
• They compared the benefits of a facility geared toward patients with Alzheimer’sAlzheimer’s is a degenerative brain disease recognized as the most common form of dementia. It usually starts in late middle age or in old age and results in progressive memory loss, impaired thinking, disorientation, and changes in personality and mood. The degeneration of brain neurons especially in the cerebral cortex and the presence of neurofibrillary tangles and plaques containing beta-amyloid help to diagnosis it on testing. More to try to find their caregivers and install alarms systems to alert them to his wandering. The caregiver’s children decided he would be safer in a facility and proceeded with making plans for admission.

Issues with DementiaDementia is the broad term incorporating diseases and conditions associated with a decline in memory, language, problem-solving abilities, and thinking that affects a person’s ability to carry out everyday activities. Abnormal brain activities trigger responses that result in impaired cognitive (thinking) abilities. Dementia may affect behavior, feelings, and relationships. Dementia is usually marked by a significant loss of intellectual abilities, such as memory capacity that is severe enough to interfere with social or occupational functioning. Criteria for the diagnosis of dementia include impairment of attention, orientation, memory, judgment, language, motor and spatial skills, and function. A usually progressive condition (such as Alzheimer’s disease) marked by the development of multiple cognitive deficits (such as memory impairment, aphasia, and the inability to plan and initiate complex behavior) More

• Fatigue is a significant problem for many people with dementia.  The level of fatigue is extreme because the family member is often up all night. Not only is the family member tired, but the caregiver is as well. The caregiver must continually check on the family member’s location and safety to ensure they have not escaped the house, fallen, or gotten injured.
• CaregiverA person who provides needed help to someone of any age who is ill or injured and unable to care for themselves.  They may provide emotional support, physical assistance, financial assistance, or other types of help. More health issues are common due to caffeine’s use to stay awake and overeating for the same reason. An increase in accidents also occurs.  Many have substance abuse
  •  Improper or excessive use or treatment, physically mistreated
  • To use excessively, to injure or damage;
  • To inflict physical or emotional mistreatment or injury on (as one’s child) purposely or through negligence or neglect
  More issues, divorce, or family issues.
• DepressionDepression is an illness that involves the body, mood, and thoughts.  In addition, depression affects how a person eats, how much he sleeps,  what he feels about himself, and how he thinks about things. Depression is not the same as a passing blue mood. It is not a sign of personal weakness, or a condition wished away. People with depression cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years. A mood disorder marked especially by sadness, inactivity, difficulty in thinking and concentration, a significant increase or decrease in appetite and time spent sleeping, feelings of worthlessness and hopelessness, and sometimes suicidal tendencies. and suicide rates are high for caregivers since death is considered a means of escape from their burden.  Emotional acceptance is difficult to achieve in a positive manner. 

Background:

The familyThe basic unit in society traditionally consisted of two parents and their children but the family has now been expanded to include any of various social units differing from but regarded as equivalent to the traditional family. More member receives a terminal diagnosis and chooses hospiceA program that provides palliative and supportive care for terminally ill patients and their families.  The whole family is considered the unit of care and care extends through their period of mourning. More care.

Chain of Events:

• With hospice, the family member elects to die at home. The healthcareefforts made to maintain or restore physical, mental, or emotional well-being especially by trained and licensed professionals More organization supports the family by training them in the use of comfort measures and the death and dying process.
• Usually, an aide is assigned to provide the family member a bath several a week.  Otherwise, the family provides all care.

Issues with End of life

• The end-of-life period is a mixture of emotions. It can be a time of sorrow due to pending loss, grief, fear, and depression.  People often also dig up old baggage they want to address and resolve before it’s too late.
• Unfortunately, family conflicts may arise over the property in anticipation of gifts and inheritance matters. Final estate matters may also create turmoil as family members declare their rights of inheritance.