Stage Three, section 1: Preventing Caregiver Burnout

Caregiver burnout is something you may not notice, but people you know may notice changes in you and express their concern. Here are some signs of caregiver burnout:

• Being on the verge of tears or crying a lot
• Feeling helpless or hopeless
• Overreacting to minor nuisances
• Feeling constantly exhausted
• Losing interest in work
• Decrease in productivity of work
• Withdrawing from social contacts
• Increasing use of alcohol or stimulants
• Nervous habits such as chain smoking
• Change in eating patterns
• Change in sleeping patterns
• Increasing use of medications for sleeplessness, anxiety, depression
• Inability to relax
• Scattered thinking
• Feeling increasingly resentful
• Being short-tempered with care recipient frequently
• Increasing thoughts of death

If you are so frustrated that you are afraid you will hurt your care receiver if you don't find help right away, see Stage Three, section 2. "Avoid Abuse" is near the end of that section. Resources such as the telephone number of a twenty-four hour crisis and information line and a list of things you can do to cool down immediately are provided. Resources are also provided for suicide prevention, since caregivers and caregivers are among the people at risk of suicide.

If you are not in a crisis situation but want to avoid or relieve caregiver burnout, consider the suggestions below:

Emotional Support

• Support group. Even though it seems that you have no time for your support group now, it is even more important to attend. Some people attend more than one group. Participants in your support group will understand how much the inability of some family members and friends to be with you and your care receiver now hurts, how hard it is to remain patient with some of your care receiver's behaviors, and how frustrating trying to "navigate the system" to get affordable assistance can be. If you are attending support group meetings, you are also likely to hear about caregiver workshops that might provide further support. For more information, see Stage Two, section 3.

• Internet web sites that address caregiver feelings. One web site that explains the negative emotions that caregiving can cause is Beth Israel Medical Center's site, Stop Pain, www.stoppain.org. The "For Caregivers" section of the Stop Pain web site includes "Emotional Needs". Tips for coping follow checklists of feelings and physical symptoms that indicate anxiety, depression, guilt, etc. Find a "Fact Sheet on Caregiving and Depression" on the Family Caregiver Alliance web site, www.caregiver.org.

• Sharing your emotions can provide relief. Write out your anger in your journal as suggested in Stage Two. Reading and sharing caregiver stories may help you feel less isolated and alone. If you use the internet, ALZwell Caregiver Support, www.alzwell.com, is an example of a web site that gives caregivers a chance to share their stories and feelings. Look for chat rooms for caregivers on other sites. Many web sites offer tips for preventing caregiver stress and burnout. See the Caregiver Web Sites section in this Handbook online at www.agingcarefl.org/caregiver/Websites.

• Counseling. Consider counseling to deal with the natural feelings that come with caregiving, especially heavy-duty caregiving for someone whose mental and physical health is deteriorating. Among these are anger, frustration, sadness, anxiety, and guilt. Some feelings are part of the grieving process you and your care receiver are experiencing.

• A counselor can help you see things clearly and set goals for maintaining your own life while caregiving. It's a good idea to talk with one while in the midst of caregiving. Unfortunately, many caregivers don't take time for counseling until their caregiving days are over.

• Counselors have a variety of educational backgrounds. They include psychiatrists, who are medical doctors and who can prescribe medications if you need them but who may refer you to a different type of counselor to "talk things over," psychotherapists, psychologists, licensed mental health counselors, licensed clinical social workers, clergy, and more.

• If you are a working caregiver, counseling may be provided as part of your health insurance package even if it is an HMO. Many health insurance providers use a subcontractor to provide counseling services, so you may not see a listing in your health insurance directory. Call your health insurance provider. Employee Assistance Programs (EAP's), for those companies that offer them, may also cover counseling.

• If you are age sixty or over yourself, you may qualify for counseling under the Older Americans Act, Title III-B. Counseling may be available to the person for whom you are caring, also, if needed. These services are usually available without a long wait. There is no charge for services, but donations are accepted. In Pinellas contact SUncoast Center at 727-323-2528 ext 236. In Pasco, call The Harbor at 727-841-4200.

• The National Family Caregiver Support Program provides counseling for eligible caregivers of any age. This is one of the new caregiver programs described in the More Resources and Tips section of this Handbook. Other government funding may cover the cost of counseling for active clients. For information on "Formal Support Services" see Stage Two, Section 5.

Respite Care

Respite care means taking a break from caregiving, usually because someone else is taking care of your care receiver for a few hours, days, or weeks. At this stage you must get away from caregiving at least half a day once a week (more often, if possible) and take longer breaks when needed.

One type of respite care break is when relatives, friends, or volunteers from a faith community stay with the care receiver so that the caregiver can leave the home. Faith in Action of Upper Pinellas is a program that uses volunteers to provide respite care to individuals in north Pinellas. For more on how to ask for help from others, see Stage Two, sections 1 and 2.

Formal respite care services are provided by businesses and non-profit agencies. There are several types of formal respite care: companions, homemakers, home health aides, adult day care, and overnight care for a few days or longer in a facility such as a nursing home. Sometimes you have to ask for these services by name rather than asking for respite care, but all of these provide a break for the caregiver. Two types of respite care that have proven valuable to caregivers are described below:

• Adult day care. Many people think going to an adult day care center will be the same as going into a nursing home, but adult day care programs actually help people remain independent longer. These programs are wonderful both for care receivers and their caregivers, who can get away from caregiving for a day at a time.

• Adult day care programs offer close supervision, lunch, snacks, and excellent activities suited to various levels of participation: lounging in recliners, playing board games, singing, or playing indoor balloon volleyball. For tips on "Dealing With Resistance", see Stage Three, section 2.

• Adult Day Care is available through government-funded programs and through agencies on a private pay basis. See Stage Two, Section 5. Even if your care receiver is on the waiting list for state-funded programs such as Community Care for the Elderly, you may be able to get a service such as adult day care started through Older Americans Act (OAA) funding. You may also combine OAA-funding with private-pay days.The National Family Caregiver Support Program provides respite, including day care. Some assisted living facilities offer a senior day program at a reasonable rate. Cost depends on how much assistance is needed. The hours are flexible up to twelve per day, and short notice is okay after client information is on file. Some Adult Day Care centers will provide transportation to and from the elder's home.

• Home Health Care. There are several reasons to ask for home health care (personal care) as part of respite. Besides the fact that you can leave the house when the home health aide is there, you will be relieved of some personal care such as bathing, toileting, and dressing. These tasks, hard both physically and emotionally, contribute greatly to caregiver burnout. For more about this, including ideas for special garments to protect your care receiver's dignity when being bathed by others, see Stage Three, section 2.

Paying for a service privately gives you ability to get a service started quickly and the choice of paying for the amount of service that you need, whether it is a few hours or a day at a time. Compare rates for different types of service and consider using the least expensive choice that would meet your needs.

To access the services or programs described in this Handbook, call the Senior Helpline at 727-217-8111 in Pinellas or 1-800-861-8111 in other areas of Florida.

Here are several ways to take a respite care break without leaving home:

• Buy respite videotapes. These occupy a care receiver, including those with Alzheimer's, with something enjoyable while the caregiver takes a break.

• Ageless Design's Alzheimer's Store, www.alzstore.com sells sing-a-long to oldie's and memory tapes, beautiful scenes such as fish swimming in an aquarium, spiritual sing-a-long tapes, a videotape showing the four seasons while Handel's Water Music plays in the background, and more. These can be relaxing and allow an opportunity for singing together and reminiscing. The Alzheimer's Store has other products you might find helpful - alarms, mini-fire extinguishers to attach above the stove, and Alzheimer's activity aprons just to name a few.

• Innovative Caregiving Resources sells a different type of respite videotapes. Call toll-free 1-800-249-5600 for a catalogue or use their web site, www.videorespite.com. Sharing Christmas Cheer, A Visit with Maria, and a Kibitz with David are three of the titles. The promotional video shows Alzheimer's patients enjoying their video visitors, speaking to them and singing along. Videos to facilitate exercise, relaxation, and cooperative activities are also for sale.

• Do something nice for yourself. No matter how much respite care you arrange from outside sources, also take a short respite break every day by doing something just for you. Use the list of favorite leisure activities requiring little time to enjoy that you made as a beginning caregiver or make a list now if you don't have one. Pick something and do it each day. Then write what you did for yourself in your journal. For days when you can't get away from home long enough to visit a museum or walk on the beach, do something simple at home. Use the checklist below as a daily reminder to choose at least one activity.

• have a cup of tea or cocoa or a glass of sparkling water
• read your favorite section of the newspaper
• pet the dog or cat
• work in one flower bed or garden patch
• feed and watch birds or fish
• read a magazine or one chapter of a book
• enjoy a bubble bath or shower with music and candles
• watch escapism movies or television programs
• spend time in a private spot in the home or yard
• call a friend
• meditate for fifteen minutes.
• use the Internet for fun and to plan outings.

• One place to find free games and crossword puzzles online is AARP's web site, www.aarp.org/games. Pinellas County, Florida, residents may enjoy the St. Petersburg Times newspaper's web site, www.sptimes.com. Find interesting things to do locally in the online Weekend section. The Marketplace section has a Restaurant Guide and Coupon Book. The Tampa Tribune Newspaper's web site can be found at www.tbo.com. Games are one of the features of the TBO web site.

Correct Diagnosis

If you have not already done so, make certain that your care receiver gets a correct diagnosis. For more about resources for diagnosis of memory loss, see Stage One, section 3. Having a diagnosis of Alzheimer's or related dementia, to the extent that it can be diagnosed during life, may increase eligibility for some government-funded programs that would provide you with services such as respite care. See Stage Two, section 5.

Hands-On Caregiving Skills

Learn as much as you can about hands-on caregiving skills. This will increase your confidence while helping you avoid injury and exhaustion that lead to caregiver burnout. Also help your care receiver to be as independent as possible, reducing your need to assist with heavy tasks. Here are some suggestions:

• Learn hands-on skills from physical and occupational therapists. Physical therapists help people recover their strength and range of motion. They also can help patients improve balance, relearn walking, and learn to transfer. PT's evaluate the need for assistive devices such as canes, walkers, wheelchairs, and transfer equipment. Occupational therapists focus on activities of daily living including personal hygiene, bathing, dressing, grooming, toileting, and feeding. The occupational therapist evaluates the need for special equipment such as transfer equipment, feeding devices, and hand and skin devices to help your elder be as independent as possible. Make sure your care receiver's doctor orders physical and occupational therapy if needed.

• Learn hands-on skills from caregiving books. A book that describes how to do hands-on caregiving including setting up your home to accommodate a wheelchair, making the home environment safe, preventing pressure sores, caring for someone who is in bed, helping a person get out of bed and into a wheelchair using a mechanical lift or a simple gait belt, and even how caregivers can use tax strategies to save money is The Comfort of Home, an illustrated step-by-step guide for caregivers, by Maria Meyer with Paula Derr, RN. See the Caregiver Books and Videos section for more information.

• Learn hands-on skills from caregiving videotapes. There are also a number of videotapes that deal with subjects such as protecting your back while lifting or while helping your care receiver to transfer. The Home Care Companion Resources for Caregivers Caregiving Series includes How to Help Someone Who Uses A Wheelchair Without Hurting Yourself and Personal Care. These and other instructional videotapes can be ordered from the Home Care Companion web site, www.homecarecompanion.com, or find them in the Pinellas County, Florida, library system.

• Another video series that heavy-duty caregivers should find helpful is The Educated Caregiver Video Series, Volumes 1, 2, and 3, a reasonably priced set created by Life View Resources. Call toll free 1-800-395-5433 or visit their web site at www.lifeviewresources.com and click on the box with the picture of their videotapes. Volume 1 is Coping Skills such as getting support and being realistic about how much care you can provide; Volume 2 is Hands-on-Skills such as bathing, dressing, safety, and bed rest; and Volume 3 is Essential Knowledge including medication management, diet, and prevention of infection. You can see sample clips of each video online.
• 
  Caregiver's Marketplace, www.caregiversmarketplace.com offers a free membership that provides discounts on purchases of these videos and many other products available from catalogues and other web sites. You will receive a Caregivers Market membership code to be used when ordering products.

• Learn hands-on skills from web sites. The Hospice of the Florida Suncoast's web site, www.thehospice.org offers "Caregiving Tips" for physical care at home. Learn more about skills such as giving injections and using catheters, feeding tubes, and oxygen. Hospice programs are experts in end-of-life care, and much of this is physical care that may be provided at home. There are other web sites that include articles on hands-on caregiving skills. See Caregiver Web Sites in this Handbook or online at www.agingcarefl.org/caregiver/Websites. Search for "caregiving skills" on an Internet search engine.

Public Library Resources

Use materials from public libraries to improve your caregiving skills and to get away mentally from caregiving. Many libraries have caregiving books and videos, and more should be available in the future. There are popular and classic movie videos and some new movie DVD's you can check out for several days as well as informational videos you can check out for a week. Anyone with a library card can check out musical CD's and popular books recorded on audiotape. People with visual problems can participate in the Pinellas Talking Book Library. (See page 70 for more information.)

Inter-library loan is a helpful feature. Materials can be sent over from other libraries within the local system or even borrowed from libraries outside the system. Your local librarian can help with this. Many libraries offer public access catalog training sessions and basic Internet classes. For example, volunteers at Main Library in St. Petersburg, Florida, teach free, one-hour, one-on-one classes on the use of the Internet. Interpreter services and special support can be arranged. Some of the other libraries offer group classes in their new computer labs.

If you have a computer with Internet access, you can search the electronic card catalog of the Pinellas and Pasco libraries. The Pinellas County Library Cooperative has a web site, www.pplc.us. Select "Cooperative Libraries" on the main menu, choose the library you want to visit, and type in your library card number (you do have to have a library card). If you need a broader search of all libraries in the system, select "Anywhere/Anytime Library". Search by a topic such as caregiver, an author, or the title of a book. Books and videos can be reserved online and sent to your neighborhood library for quick pick-up. The Pasco County Library System is at http://pascolibraries.org. See our list of "Caregiver Books and Videos" for caregiving materials you may want to reserve.

For fun, remember that the online catalogs also list popular and classic movie videos and DVDs, and there are exercise videos such as tai chi and weightlifting for seniors.

Saving Time and Trouble

• Mobile services. Save time and the difficulty of getting your care receiver in and out of a vehicle and into stores and offices, where he or she may become confused and frustrated, by using mobile services that come to your home. In Pinellas County, Florida, there are mobile pet groomers, a mobile veterinarian, hair dressers who make house calls, personal trainers who work with disabled people in their homes, and at least one mobile medical van that brings doctors, nurses, and technicians to your home for medical treatment and lab tests such as a blood test with results in two minutes. The mobile medical van?s services are covered by Medicare but not by HMO's.

• Membership medical services. This is an innovative medical practice concept that has been implemented in some areas. Patients of these physicians pay a membership fee. Membership benefits include easy access to physicians by phone and in person and the availability of home visits.

• More efficient grocery shopping. Shopping can be stressful for caregivers. Here are some suggestions to make the chore easier.

• Here are ideas for making grocery shopping less of a hassle:
• Ask your store whether they can give you a printed floor plan or list showing the aisles where various types of items can be found. If your store's customer service desk can't give you this, suggest the need to the store manager. If you can't get something like this from the store, consider making your own. This may help you and persons who shop for you.
• Ask for other special help your store may provide. This can be personal shopping assistance for blind or disabled persons, ride-on grocery carts for persons who have trouble walking, and someone to lift a fifty pound bag of dog food into your cart or help you reach a can on a high shelf. Chances are you will have plenty to load because of stocking up in case you can't get away for a big shopping trip the next week. Ask for help in loading the car.
• If you go shopping with your care receiver or you are disabled yourself, see "Florida's Disabled Parking Program" in the More Tips and Resources section. To improve your chances of finding a good parking space, find out when the store is least crowded and shop then.
• Carry a cell or mobile phone into the store after giving the number to your care receiver or substitute caregiver. That way you can check on things at home. Knowing that you can be reached in an emergency may give you peace of mind, and your care receiver may worry less. If you are concerned about courtesy to other shoppers, buy one of the new earphone/microphone combinations.
• Use assistive devices. Some shoppers bring a grabber tool to reach items on top shelves - this type of tool extends your reach and will hold up to five pounds. Find these in drug stores or order from television commercials, catalogs, or caregiver web sites. See the Caregiver Web Sites section.
• Save time and prevent injury by using a cart to bring in the groceries. At discount stores you can buy lightweight, inexpensive carts that unfold to look like plastic cubes or baskets with wheels and handles. A moment unfolding the cart can save several extra trips to the car. These carts are handy also when visiting fruit stands that do not have shopping carts with wheels.
• Keep a grocery list in a magnetic holder on the refrigerator or in another handy spot in the kitchen to add items as you run out of them. If you write down the specific products that you and your care receiver prefer (brand name or store brand, sugar-free or regular, low-fat or fat-free, gallon or half gallon, etc.), it makes it easier to have a relative, neighbor, or friend shop for you.
• If you need a hard-to-find or new item, call the store and ask whether they have it and what aisle it's on. Write the aisle number on your grocery list. Also use the telephone to place deli, meat, or bakery orders for quicker pick up in the store. Consider convenience items such as salad bars, shrimp steamed by the grocery store while you shop, pies and cakes from the bakery, and holiday dinners you can order. Although more expensive than homemade, these items may be worth it for the time saved.
• When you can?t get away or are too exhausted to shop, review your list of people who offered help and ask a neighbor, friend, relative, or volunteer from a faith community to shop for you. If you feel guilty, remember that you stocked up when you went to the store yourself, which means that the list you give your volunteer shopper will be shorter. For more on how to ask for help, see Stage Two, sections 1 and 2.
• If you can afford it, you may want to use businesses that run errands such as shopping for a fee. Look up "Errands" in the Senior Resource Directory Subject Index or call the Senior Helpline. Besides errand services, there are homemaker services and transportation providers that also do grocery shopping. For a list of transportation providers, see "Transportation Options for Seniors" at www.agingcarefl.org/aging/transportation or call the Senior Helpline for a copy.

• Most grocery stores do not deliver, but some small specialty markets do provide that service. Compare prices to see if the convenience is worth it, at least for weeks when you can?t get away to shop. Private-pay home delivered meals, described below under Protecting Your Health ? Healthy Food, is another option.

Protecting Your Health

• Preventive medical care. Visit your doctor regularly. Having mammograms, prostrate tests, colon cancer tests, and a pneumonia shot are important. Medicare and private insurance may cover costs. Make sure you put these tests for yourself on your calendar.

• If you and your doctor agree that you need to take medications because of stress, also consider adding some of the other types of support described here:

• Exercise. Attend exercise, yoga or Tai Chi classes at local community or fitness centers, exercise at home to a yoga or Tai Chi video tape, swim, dance, garden, lift small weights, walk around the block or on a treadmill, or use an in-home fitness company. Pinellas County has at least one company that provides a personal trainer with expertise in helping older persons. Care managers sometimes suggest purchasing this service when Medicare stops covering physical therapy.

• For online exercise videos, visit the National Library of Medicine's Medlineplus, www.nlm.nih.gov/medlineplus/exerciseforseniors.html. An inexpensive exercise video can be found on the web site of The National Institute on Aging, www.nih.gov/nia.

• Pet Therapy. Spend time with a pet. Let your dog or cat provide you with comfort and laughs, enjoy a neighborhood walk with your dog, or watch the fish in the aquarium or goldfish pond. Just holding a furry pet is good for your health, and watching fish is relaxing.

• Meditate. Even a few moments spent in quiet thought can reduce stress.

• Healthy food. Eating right is hard to do when you are so busy. Recommendations include the following:

• Eat three well-balanced meals a day, with breads and cereals, milk and cheese, fruits and vegetables, and lean meat, poultry, fish, and eggs. Canned or bottled nutritional drinks may be helpful when you have to skip a meal.

• Choose healthy snacks such as fruit, vegetables, yogurt, cereals, crackers, and low-fat cheese and popcorn. For ice cream cravings, there are many low fat and low calorie choices.

• Limit high sugar and most high fat foods to small servings, but do not eliminate all fat from your diet. Olive oil, flax seed oil, and the oil in nuts and fish such as salmon are considered healthy fats that should be eaten. Also, chocolate in moderation offers some health benefits, and it's a very comforting food enjoyed by people from childhood to one hundred years and older.

• Don't self medicate with alcohol.

• Avoid food and medication interactions by being informed. Ask your doctor and pharmacist about interactions. A web site that offers dietary precautions for each medication listed is the National Library of Medicine's MedlinePlus, www.nlm.nih.gov/medlineplus. See the Caregiver Web Sites section for others.

• For nutrition tips and names of dieticians by area, visit the American Dietetic Association web site, www.eatright.org or call the ADA Consumer Nutrition Hot Line at 1-800-366-1655. This organization provides nutrition tips and names of dieticians in the area where you live.

• If you need to learn how to cook for someone on a special diet, your doctor may be able to refer you to a dietician, often within the same medical facility. At the Veterans Administration Hospital in St. Petersburg, Florida, for example, diabetic patients attend a Diabetes Clinic diet planning session. The Joslin Center for Diabetes at Morton Plant Hospital in Clearwater, Florida, offers diabetes management classes that may be covered by Medicare or other insurance. You may also want to visit the American Diabetes' Association web site, www.diabetes.org or call them toll-free at 1-800-DIABETES (1-800-342-2383). They will mail you materials related to planning meals for diabetic patients.

• If cooking for yourself and your care receiver is becoming increasingly more difficult, consider home-delivered meals services. Your care receiver may qualify for government-funded home-delivered meals. Some spouses may also qualify. Meals can also be purchased from both for-profit companies and from government-funded home-delivered meals. Some companies offer delivery of as few as ten frozen meals at a time to your door with choice of menus and special diets at a cost of around $5.00 per complete meal or $50.00 per delivery. Food preferences are very individual. You may have to try different companies and different menus to find products that suit your tastes.

• If you are the primary caregiver and your out-of-town relatives want to know what they can do, ask for a care package of home-delivered meals. See "Gifts for Caregivers" in the More Resources and Tips section.

Better Sleep

Lack of sleep is a frequent problem for stage three caregivers. Here are some strategies for improving sleep.

• Exercise daily but not too close to bedtime unless that is your only opportunity.

• Listen to relaxation tapes or do relaxation exercises while listening to relaxing music just before bedtime.

• Avoid caffeine in the evenings.

• Change your sleep cycle to coordinate with your care receiver's sleep pattern. In other words, if he or she sleeps during the day but wakes you up a lot at night, try to nap during the day yourself.

• Get some outside help at night. Hire a home health agency or recruit a friend or relative to stay over and care for your care receiver while you sleep.

• If confusion and fear of going to the bathroom alone are causing your care receiver to demand your assistance every time, adapt the environment. Items that may make the care receiver more comfortable include: grab bars, a raised toilet seat, a bell that the care receiver can ring if he or she has problems in the bathroom, night lights, a sign or picture on the bathroom door, and a tape path on the floor from bedroom to bathroom.

• The tape path idea came from a book called The Complete Guide to Alzheimer's Proofing Your Home by Mark L. Warner, available for purchase on the Ageless Design web site, www.agelessdesign.com and in the library system in Pinellas County. This book lists ways to deal with difficult behaviors by adapting the home. Product suggestions for each problem and information about who makes them are included.

• Find other strategies to help reduce nighttime wandering in "How To Deal With Wandering" in the More Tips and Resources section.

• Find out from the doctor whether anything can be done to reduce the physical need for frequent bathroom breaks. Changing medications, treating physical conditions such as diabetes, and changing the time that liquids are consumed may reduce the number of times that your care receiver wakes you for help.

• If your care receiver seems to be waking you because of a habit that could be changed, you may want to try mild behavior modification. Provide little rewards for letting you sleep more hours at a time or for using the bathroom alone. If you feel your care receiver does not have the capacity to learn new habits at this stage of illness, try the other strategies listed above.

Massage

Therapeutic massage, which is massage by a licensed massage therapist as a form of therapy, has been shown to have physical and emotional benefits. These include lowering blood pressure, promoting healing, relieving pain, reducing stress, and aiding relaxation. Massage does not have to be whole body, but can focus on the face or even the feet. Massage may be available under your insurance coverage. Even if you were never one to splurge on yourself, now is the time to treat yourself to services such as massages. You may also want to suggest a gift certificate as a gift idea.

Spiritual Support

Maintain your spiritual life. See Stage Two, Section 2 for suggestions of support from faith communities. The And Thou Shalt Honor web site, www.thoushalthonor.org, was started in connection with the PBS (Public Broadcasting Service) special designed to raise awareness concerning caregiving, with broadcast date of October 9, 2002. This web site has a section on spiritual caregiving.

Music

Music is good for you and for the person for whom you are caring. Music is called the universal language, connecting us with our inner feelings and with other humans in a way that words alone cannot. Music can be relaxing for you, and it can make working with your care receiver easier. Music is helpful for pain management. Stroke survivors who have lost some of their ability to articulate or use words (aphasia) may get their lost words back by singing. Persons with Alzheimer's disease may play instruments and create songs. Even people with late stage Alzheimer's disease may still respond to music. A person who fights having a shower may follow you to the bathroom if singing, making your life easier. Since music that is invigorating to one person can cause agitation in another, try wireless headphones or personal audiotape, CD or MP3 players with headphones if you and your care receiver like different types of music.

Reminiscing with music may trigger long-term memory. This can be enjoyable for the care receiver and the caregiver. As mentioned in the respite care section above, reminiscence/respite video tapes are available at the Alzheimer's Store, www.alzstore.com, and from Innovative Caregiving Resources, www.videorespite.com, or call toll-free 1-800-249-5600 for a catalogue.

Strategies That Protect Both Your Care Receiver and You

Other strategies that can help prevent caregiver burnout and injury are discussed more fully in Stage Three, section 2. Although this section is titled "Protecting Your Care Receiver", many of the strategies also protect the caregiver.

To access the services or programs described in this Handbook, call the Senior Helpline at 727-217-8111 in Pinellas or 1-800-861-8111 in other areas of Florida.