Caregiver Health

I'm under a great deal of stress from caring for my husband. Do certain types of music help reduce stress more than others? I've always been a rock ‘n' roll girl, but it's not really helping.

"Music has different effects on us: physically, psychologically, even cognitively," says Al Bumanis, director of communication for the American Music Therapy Association, and a board-certified music therapist in Maryland. "That said, you must be aware of what the music is doing. Is it energizing you or relaxing you? Then you have to find the music that has the desired effect."

Bumanis adds that "music is very individualized. If you're looking for a relaxation response, playing hard rock or faster-tempo rock might not do it—but that's not the case with everybody." He suggests going to a music therapist who would "do evaluation and assessment, incorporating cultural background, and see how different music affects you.

"For most music therapists in clinical music therapy," Bumanis adds, "it's [about] creating music, engaging the client, whether drumming together, singing together, or creating music in other ways. Maybe playing an instrument can be relaxing, rather than more passively listening to music. Or you can do a mix of both. The key is to find what works for you."

Caregiver Support

My husband recently had a stroke. After being at a rehab center, he’s coming home. He’ll work with an occupational therapist here. How can I best work with the OT?

Communication is key. So advises Carol Siebert, a member of the American Occupational Therapy Association and a home care OT. “The occupational therapist needs to know from the client and caregiver what has to happen in terms of daily routine and personal care. A three-way conversation could be helpful” for all to understand what the caregiver expects to do or is expected to do, the caregiver’s health conditions and needs regarding the caregiver’s work schedule.

It’s important for you to express your own goals, says Siebert. “It may require a conversation between you and the therapist alone, without your husband in the room. That helps for formulating goals and prioritizing. Home healthcare has to be goal-identified, from what your husband and you identify as priorities. I strongly urge caregivers to advocate for their own needs. The process is about improving the situation for everyone involved.”

Care Recipient Health

I recently refilled my mother’s prescription and found that she had previously been given pills that were half the dosage of what had been prescribed—even though the pharmacist’s label indicated the vial’s contents were what had been prescribed. How do I prevent such a potentially tragic mistake in the future?

“This problem requires diligence on the part of the pharmacist and being proactive on the part of [the caregiver],” says Mary Kremzner, PharmD, deputy director of the division of drug information at the Food and Drug Administration. “There’s always an imprint on the pill,” she explains, “and you can always verify this imprint with an outside source.” The Internet and up-to-date copies of The PDR Pocket Guide to Prescription Drugs or The Essential Guide to Prescription Drugs are good starting-point references. “Or,” says Dr. Kremzner, “you can call the FDA.”

Being proactive has never been more important because, she adds, “there are so many generics now. A pill may appear different, but it’s only a different manufacturer with the same medicine. People are just not alerted. Don’t ever feel funny about calling a manufacturer or asking your pharmacist.”

Such mistakes, says Dr. Kremzner, “are unintentional—pharmacists feel sick when they’ve made a mistake. This is about establishing a relationship with your pharmacist and checking through sources to make sure [the medication] is what it is.”

Communication

My mom has early-stage dementia and it’s becoming unsafe for her to live at home alone. My husband and I think it’s best for her to move in with us, but how can we be sure? What should I consider before approaching her with this idea?

“Find a way of talking to your mom about it in an extended dialog,” says Gary S. Moak, MD, president of the American Association for Geriatric Psychiatry. “Wait for the opportunity. [When] she brings up something like ‘It’s hard to get around,’ ask what she would think about living with you.”

It is, however, just as vital to consider all sides of your plan. “Concerns about safety are important, but that’s only one value,” explains Dr. Moak. “Independence is a high value as well. This move could leave your mom depressed and resentful. There may be community-based home health services that could improve her safety at home.”

The other vital link in this decision is your mom’s doctor. “Is her impaired safety related to problems that might be treatable?” asks
Dr. Moak. “Getting the doctor’s opinion could be useful in actualizing this transition.” Finally, he suggests that “getting geriatric mental health professionals involved may help Mom move to a position of more acceptance.”

Finance

My 80-year-old mother’s health is taxed as sole caregiver for my 75-year-old stepfather. How can we convince him to let me help?

"Have your mom say to her husband, ‘Your protests are fine but this is my house, too, and I need help,'" says Gary Kennedy, MD, a geriatric psychiatrist at Montefiore Medical Center in New York. "It requires a family meeting and telling him that, if he wants to preserve his autonomy, he has to share a bit of it. It might start with your helping for half a day a week with housekeeping." It's important, says Dr. Kennedy, to stress that your mom has rights, too. "If she's exhausted, what happens to her husband?" he asks. "It's really in your stepdad's best interest."

Part of the dilemma, explains Dr. Kennedy, is that "none of us is happy to admit we have to depend on others. He might complain and be angry, but that's okay as long as he gets the care he needs and Mom gets a break."

Legal Issues

I don’t have any family or close friends, so to whom can I assign powers of attorney?

“You should start to think in terms of professionals who may be available and willing,” says Vincent J. Russo, an elder law attorney practicing in Westbury, NY. “You could ask a trusted financial advisor, a lawyer or an accountant.”

Another possibility, says Russo, is to “have your assets placed into trust and have someone you might see yourself relying upon named as trustee.” The trustee situation is not perfect, however, because “some things may come up that a trustee has no control over. For instance, a trustee can’t sign an income-tax return. Power of attorney allows those kinds of powers.

“Sometimes,” Russo adds, “people will say, ‘I’m not a hundred-percent comfortable naming a [power of attorney] agent, but if I did become incapacitated, then I would.’ Some states have a ‘springing’ power of attorney. That means, when you sign it, the agent you name does not have authority to act for you immediately, only if a triggering event occurs, or ‘springs up.’ You would list what the events might be.”

Travel

My nine-year-old son has cerebral palsy, but I want him to enjoy summer vacation like healthy kids. Are camps for kids with CP, and how can I find out about them?

"Your local chapter of United Cerebral Palsy will be your best source," says Dr. Mindy Aisen, director of the United Cerebral Palsy Research and Education Foundation in Washington, DC. "They will know what other children have done locally and what has or hasn't worked well. They also can put you in touch with other parents."

Along with specialty camps, she adds, "an alternative is to send your child to a camp that is principally designed for children without developmental difficulties. It's been my experience that not-for-profit programs usually make accommodations for kids with developmental disabilities. They put an extra counselor in the cabin to help the child be included. You'd go through your local public school for this."

Asking lots of questions about safety and how your child will be involved in activities is key. "It's a great sign if they're open to your visiting during camping season," says Dr. Aisen. "A child with CP is like any child. How you would you make this decision would similarly be based on word of mouth and personal recommendation more than who's got a good ad."