Chapter 1: Caregiver Responsibilities

A caregiver is an unpaid relative or friend who cares for a person who is ill, frail or disabled. The "sandwich generation" is the term used for people who care for their aging parents while supporting their own children.

You may not see yourself as a caregiver. You might think you are just taking care of a person who needs you. You might think you are just doing what any wife, husband, sibling, child or friend would do. Start thinking of yourself as a caregiver and you will see how important your job is.

Becoming a caregiver is not always an easy or natural thing. You might feel forced or pressured into being a caregiver. You might have other demands, such as a young family or a busy job, or not be very close to the person you care for.1 It can also be a big change, and it might take time to get used to your new role. It is normal to feel confused and stressed when you are a caregiver. You might think it will help you cope if you ignore your own feelings and needs. This might work for a while, but it will be hard to keep doing this; ignoring your feelings could affect your health. When you are a caregiver, you have an important role, and you have to stay healthy to keep doing a good job. A caregiver needs to take care of him or herself.¹

"You are not alone. Did you know that approximately one out of every four Canadians is a caregiver like yourself? You are joined by adults of all ages caring for their spouses, parents, friends, relatives and neighbours."

Facts

• In 2006, 23% of Canadians say they took care of a family member or close friend with a serious health problem.²
• Caregivers often have other jobs and responsibilities. Over 1 in 4 (27.8%) Canadians who work also take care of elderly friends or family. This number will likely go up, as the baby boomers get older.³
• Almost one in five employed Canadians (16.8%) takes care of both their children and an older loved one.³
• Did you know that almost 75% of the care that older adults get comes from their family?⁴ As the number of older adults in our city goes up, there will be more and more caregivers taking care of older adults.
• Almost 77% of caregivers are women.³
• Caregivers give many billions of dollars worth of unpaid work to their loved ones.⁵

Many caregivers say they feel better prepared and less worried when they get information about the tasks they will be doing and the skills they need as a caregiver.⁶ The skills you need to become a caregiver are sometimes harder than you think. For example, driving an older adult to an appointment is not just about going for a drive - you might have to dress the person, transfer them into and out of a wheelchair, into the car and out of the car safely.

Many caregivers learn the skills needed from health care providers.⁷ The following information will help you with the practical tasks that caregivers do.

Tips

• Ask for help! Some of these skills might be new to you. If you have questions or need support ask a health care provider, family member or friend. Community agencies may also be able to help.
• Respect the choices your loved one makes, even if you do not agree with them. It is important for people to make their own decisions as long as there is no risk to themselves or others.
• Help your loved one enjoy some of their favourite things like music, television, crafts, etc.
• Take care of yourself and make time to do the things that you enjoy.

Emotional Support

Your loved one might feel afraid, sad, angry or lonely because of everything they are going through. They are often dealing with changes in their body, the way they look, their mental abilities, the roles they play in life and thinking about what might happen to them in the future.

When you are helping someone deal with these feelings, it helps to show respect and kindness. Be patient and listen to your loved one; allow him or her to show you how they feel.

You might not be able to fix their problems, but it can help if you listen to them.

Tips

• Ask your loved one how they are feeling.
• Ask general questions so they can give you more information like 'How you are feeling today?'
• Tell them how you are feeling if they do not want to talk. This might help them feel better and talk about their feelings.
• Avoid saying things like "Don't worry about that", "You'll be just fine" or "What do the doctors know anyway?" These will end the conversation.
• Repeat back what they say to make sure you understand.
• Help your loved one focus on what they can do instead of what they cannot do.
• Make eye contact when you talk to them.
• Give the person time to talk. Do not have long conversations when you do not have the time.
• Touch your loved one's hand, stroke their hair, or kiss them on the cheek to show them you care.

If you need help with your feelings or those of your loved one, ask for it. You can talk to another family member, a social worker, nurse, doctor, chaplain, or spiritual advisor.

See Chapter 3: Caring for you...the Caregiver for more information on when and how to get help.

Enjoying Time Together

Enjoy time with your loved one. Share a morning joke or go for a walk outside. Pleasant activities will make you and your loved one feel better.

Plan things to do that your loved one will like. Maybe you can watch an old movie together or find music that your loved one enjoys.

Remember that fun activities can be simple. Even watching a sports game together (if the person likes sports) can make your loved one less lonely. Do not forget cards and board games are fun too!

Ideas:

Picnic lunch:

A picnic gives you some quality time with your loved one. You can even have a picnic in your living room (or any other room) if your loved one cannot get out. Spread a picnic blanket out and decorate the area (perhaps with some flowers, photos etc.). You might want to play some relaxing music, like sounds of birds or water.

Be creative:

Painting, drawing and doing crafts are fun ways to get rid of stress and be creative. It will also help you and your loved one to feel more relaxed and you can laugh together.

Relaxation exercises:

Exercises that help you relax and meditation exercises are easy to do, and are great ways to get rid of stress. They help you sleep, make you more alert, and improve your mood and health. You can buy guided relaxation tapes or CDs and meditation music in many book and music stores. You can also find these things at the Ottawa Public Library.

See Section 3: Caring for You...the Caregiver for relaxation exercises.

Scrapbooking:

Making a scrapbook is a fun way to spend time with your loved one. Let your loved one do as much as they can, and help if they ask. You can find everything you need at an art store, department store, or dollar store. You will also learn a lot about each other when looking at photos for the book.

Read a book:

You and your loved one can enjoy a book by reading aloud together. Visit your local public library and take advantage of the many books, audio books, and programs.

Go to: Ottawa Public Library

Caregiving is not all about work. Having fun is important - not just to reduce your stress but also to create a sense of self worth and belonging for your loved one.

Give us your feedback

Please share your comments or concerns on this section of the Guide. Your comments are important to us. We appreciate and thank you for taking the time to complete this short Feedback Survey. If at any time, you wish to speak with a nurse at Ottawa Public Health please call 613-580-6744 TTY/ATS: 613-580-9656 or email us at healthsante@ottawa.ca.

References

1. Concord Cancer Centre [Internet]. Concord (AU): Sydney Local Health District; c2013 [last updated 2013 Jul 10]. Relationships and Communication; [cited 2013 Jul 12]; [about 2 screens]. Available from http://www.slhd.nsw.gov.au/concord/cancer/rel_comm.html#caring
   
2. National Profile of Family Caregivers in Canada - 2002: Final Report [Internet]. Ottawa (ON): Health Canada; c2002 [date modified 2006 Feb 20]. [cited 2013 Jul 12]; Available from http://www.hc-sc.gc.ca/hcs-sss/pubs/home-domicile/2002-caregiv-interven/index-eng.php
   
3. Duxbury, L., C. Higgins, and B. Schroeder. Balancing Paid Work and Caregiving Responsibilities: A Closer Look at Family Caregivers in Canada [Internet]. Ottawa (ON): Canadian Policy Research Networks; 2009; [cited 2013 Jul 12]. Available from http://www.cprn.org/doc.cfm?doc=1997&I=en
   
4. Hollander, M.J., G. Liu, and N.L. Chappell. Who Cares and How Much? The Imputed Economic Contribution to the Canadian Healthcare System of Middle-Aged and Older Unpaid Caregivers Providing Care to the Elderly. Healthcare Quarterly. 2009 Apr; 12(2):42-49.
5. Hollander, M.J., G. Liu, and N.L. Chappell. Who Cares and How Much? The Imputed Economic Contribution to the Canadian Healthcare System of Middle-Aged and Older Unpaid Caregivers Providing Care to the Elderly. Healthcare Quarterly. 2009 Apr; 12(2):42-49.
6. Given, B., C.W. Given, and P.R. Sherwood. What knowledge and skills do caregivers need?  American Journal of Nursing. 2008 Sep; 108(9): 28-34.
7. Schumacher, K., C. Beck, and J. Marren. Family caregivers: caring for older adults, working with their families. American Journal of Nursing. 2006 Aug; 106(8): 40.

Start with talking to your family Doctor. You may also contact your Community Care Access Center (CCAC) as they are a first step to the health system in your area. A CCAC care coordinator can help connect you to many services available in your home and/or help you move your loved one to a Long-Term Care home. Once you have a CCAC care coordinator, it is important to update your care coordinator as your situation changes for possible adjustments in your services. Visit CCAC for more information.

Many caregivers provide practical care to their loved one. Practical care could be helping them take a bath or to get dressed. These tasks are easier to do if you have good information and know how to help.

Bathing, showering and grooming

Bathing or showering is a private activity. Allow your loved one to do as much as they can on their own. Cover the person as much as possible so they feel less exposed. Wrap a towel around private body parts and clip it with a clothespin (or Velcro tabs), or use a long, plastic apron in the tub or shower for more privacy.

Make bathing a comfortable and enjoyable part of the day. Keep the bathroom as warm as possible. Play music if your loved one finds it relaxing. (Remember to keep the music player or radio away from water). Use scented pot-pourri to make the bathroom area more inviting. Do not use bath oils; they make the bathtub slippery.

Tips

• Use liquid soap and a large sponge to make bathing easier.
• Use mild, gentle soap and shampoo such as baby wash and shampoo.
• Get everything ready before you help the person to the bathroom.
• Keep the area around the bathtub or shower dry. Wipe up any extra water off the floor right away.
• Test the water temperature with your wrist to make sure the water is not too hot or cold.
• Ask the person if the bath water feels okay for them.
• Cover their eyes with a dry cloth when washing their hair in the tub. You can also use a bath visor to keep shampoo out of the person's eyes. Bendable and waterproof visors have a large hole at the top of the hat for putting the hair through. You can find them in a department store or at specialty stores.
• Use a hand-held showerhead if you can. Washing and rinsing hair will be a lot easier.

Watch this video for more tips on bathing your loved one:

Bed baths

Your loved one will need a bed bath if they cannot get to the bath or shower. To give a bed bath:

• Get everything ready first.
• Fill two large bowls with water, one bowl for the soapy water and one with clean water for rinsing.
• Test the water to make sure it is not too hot or cold.
• Wash, rinse, then dry one part of the body at a time.
• Cover the rest of the body with a sheet or large towel when you are washing one part.

Dressing

Make sure your loved one has clothes that are easy to put on. Pants with zippers and buttons are hard to get on. Loose fitting pants with elastic waistbands are easier to pull up and down. Clothes with Velcro are easy to use. You can find these at specialty stores. If your loved one has an arm or leg that does not move very well, put it into the shirt or pants first.

Include your loved one as much as possible when you are buying them clothes. Let them pick out the colours that they like. This will help them feel more in control of their life.

Mouth care

Make sure your loved one is cleaning their mouth and teeth. Help them if they cannot brush, rinse and floss by themselves. Make sure they brush their teeth twice a day and floss once a day. Also brush and rinse dentures twice a day. (Put a face cloth in the bottom of the sink when you are brushing dentures; they can slip out of your hand and break if you drop them). Store dentures in water, this will keep them from drying out or cracking. If they do not fit properly or hurt your loved one, talk to their health care provider.

Watch this video for tips on mouth care

Dental Care

See the resources at the end of this section for information about dental care.

Foot care

Check your loved one's feet when you are bathing them or helping them get dressed. You need to check them every day if they have diabetes or circulation problems.

Look for:

• Cuts
• Blisters
• Sores
• Red spots
• Calluses
• Ingrown nails
• Cracked skin

Tell your health care provider if you see an open sore that is red or swollen, or has pus or is painful. For more information, visit the Saint Elizabeth website ²

Toileting

If your loved one needs help to go to the bathroom, give them as much privacy as possible. For example, you can help get them to the toilet then leave the room until they call you for help.

Bedpans or bedside urinals

You will need to use a bedpan or bedside urinal if your loved one cannot get out of bed.

Ask your loved one to lie on their back with their knees bent. Next, get them to use their feet and legs to lift their buttocks off the bed so you can slide the bedpan under them. If their legs are too weak, have them roll onto their side so you can put the bedpan against their buttocks. Then get them to roll onto their back while you hold the bedpan in place. You can put baby powder on top of the bedpan so it does not stick to their skin.

You have to clean the bedpan with hot water and soap, and rinse it out well every time you use it. You can rinse it with cold water and baking soda to keep it smelling better.

Tips

Clean and dry your loved one's skin after they use the bedpan. Wet skin can cause painful bedsores.

People get bedsores when they are always sitting or lying down. This constant pressure damages the tissue underneath the skin and causes sores. If you see red areas of the skin that do not go away, tell the health care provider.

Incontinence pads (bed-pads)

A person has incontinence when they cannot control their bladder or bowel. An incontinence pad is a plastic pad you put on the bed, under the person's buttocks. The pad protects the bed, and you can easily change it when it gets wet or dirty.

Some pads can only be used once (these pads are "disposable pads") and are put in the garbage when they are wet or dirty. Put them in the garbage or outside right away. You can wash, dry and re-use reusable pads. Keep reusable pads in a tightly sealed container or plastic garbage bin until you wash them.

Plastic bed coverings

You can buy plastic bed covers (sometimes called mattress covers) at a department or linen store. This cover goes under the bed sheets to protect the mattress.

Adult diapers or briefs

Adult diapers and underpants with pockets to put liners in can help your loved one stay dry and more comfortable. The type of product you choose depends on the amount of body waste.

It is very important to change the adult briefs or liners as soon as they are wet or dirty.

Transferring

You might have to move, reposition or transfer your loved one when you are caring for them. To avoid hurting yourself and your loved one, it is important to do this properly.

Watch these short caregiver videos for lifting and moving a person safely.³

Tips

• Tell your loved one you are going to lift or move them (e.g. "I would like to help you sit up now, Dad"). Spread your feet apart (as wide as your shoulders); bend your knees, and use your leg muscles to lower your body. Keep your shoulders and neck muscles relaxed.
• Keep the person as close to your body as you can when you lift them.
• Tighten your stomach muscles and use your stomach and leg muscles to lift and move your loved one.
• Do not make sudden movements. Lift and move slowly, step-by-step. Take a break between each step.
• Move your feet with your whole body when you turn or pivot. Do not twist your body.

Get help if you think you or your loved one might get hurt.

Watch the short videos below on moving people safely.⁴

Walking

Walking can increase your loved one's appetite and make them feel better. To help your loved one walk, put your closest arm around the person's waist. Use your other arm to reach around in front of you and hold the person's hand or elbow for extra support and control. Ask them if the walking speed is okay. Move slowly because your loved one might be dizzy if they have been lying down for a long time.

If your loved one falls down when you are transferring them or walking with them be sure not to hurt yourself. Make sure you:

• Don't try to hold them up because it may hurt both of you.
• Help them go down slowly, bend your knees, tighten your stomach muscles and go down with them. Protect their head if you can. Call for help if they are injured or in pain.
• Keep them as comfortable and calm as you can until help comes.
• Help them into a chair or wheelchair if they are not injured or in pain. Make sure that the brakes are on. If they can kneel in front of the chair and have a strong arm, get them to pull them self up to a standing position.
• Help them into the chair using the Transferring tips above

Watch this short video on assisting someone from the floor⁵ for specific moving techniques.

Turning in bed

If your loved one cannot move in bed, you need to turn them every couple of hours. This will prevent bedsores and make your loved one more comfortable.

Moving a person in bed:⁶

• Start with the person lying on their back
• Put the person's arm that is farthest from you across their chest toward you.
• Bend their leg that is farthest from you at the knee while the foot rests on the mattress. Bring the bent leg toward you. The shoulder that is farthest from you will start to move toward you. Reach over with your hand to guide the shoulder toward you. Your loved one will now be on their side and their bent knee will help them stay in that position.
• Place pillows behind their back and between their legs for added support and comfort.
• Adjust their head pillow as needed.

Pain Support

You might need to help your loved one deal with pain. They might have pain because of a disease or illness they have (cancer, arthritis pain or other) or from a treatment they are getting. You can treat most pain by making sure your loved one gets the right pain medication and takes it regularly as prescribed.

Your loved one's health care provider is the best person to help them deal with pain and any side effects from the pain medication. For more information: Saint Elizabeth website how to deal with pain.⁷

Give us your feedback

Please share your comments or concerns on this section of the Guide. Your comments are important to us. We appreciate and thank you for taking the time to complete this short Feedback Survey. If at any time, you wish to speak with a nurse at Ottawa Public Health please call 613-580-6744 TTY/ATS: 613-580-9656 or email us at healthsante@ottawa.ca.

References

1. Van Bommel, H. Caring for loved ones at home: an illustrated, easy to follow guide to short and long term care. 4th rev ed. Scarborough (ON): Legacies: Family and Community Resources; 2006.
2. St. Elizabeth Health Care [Internet]. Markham (ON): St. Elizabeth Health Care; c2013. Why is foot care so important with diabetes?  2013 [cited 2013 Jul 12]. Available from http://www.saintelizabeth.com/Caring-for-Family/Ask-an-Expert/My-grandmother-lives-with-me-and-she-has-diabetes.aspx
3. St. Elizabeth Health Care [Internet]. Winnipeg (MB): Canadian Virtual Hospice; c2013. Caregiver demonstrations for lifting and moving someone safely; 2013 [cited 2013 Jul 12]. Available from http://www.saintelizabeth.com/Caring-for-Family/Caregiving-Information/Providing-Care/Lifting-and-moving-a-person-safely.aspx
4. University Health Network [Internet]. Toronto (ON): Princess Margaret Hospital; c2013. A Guide for Caregivers: Moving People Safely: Introduction; 2013 [cited 2013 Jul 12]; Available from  http://www.youtube.com/watch?v=HbldorHIhzI&list=PLWYuRSjQI5zEDSwar0xa-h1Zl9ezsBoYm
5. University Health Network [Internet]. Toronto (ON): Princess Margaret Hospital; c2013. A Guide for Caregivers: Moving People Safely: Introduction; 2013 [cited 2013 Jul 12]; Available from  http://www.youtube.com/watch?v=HbldorHIhzI&list=PLWYuRSjQI5zEDSwar0xa-h1Zl9ezsBoYm
6. Van Bommel, H. Caring for loved ones at home: an illustrated, easy to follow guide to short and long term care. 4th rev ed. Scarborough (ON): Legacies: Family and Community Resources; 2006.
7. St. Elizabeth Health Care [Internet]. Markham (ON): St. Elizabeth Health Care; c2013. Pain management and medications; 2013 [cited 2013 Jul 12]. Available from http://saintelizabeth.com/Health-Info/Health-Resources/Pain-Management-and-Medications.aspx

Meal planning

Your loved one may have problems planning meals, shopping for groceries or making meals. You can help them plan meals ahead of time so they do not have to decide what to eat every day. Weekly plans make it easier to get the groceries you need. If your loved one has a treatment or surgery coming up, make and freeze meals for them.

It is important for your loved one to eat a healthy diet that includes:

• Grain Products (breads, cereals, rice, pasta)
• Vegetables and Fruit
• Milk and Alternatives (cheese, yogurt)
• Meat and Alternatives (poultry, fish, legumes, eggs, peanut butter nuts and seeds)

Canada's Food Guide can help you plan meals. You can find the guide on the Health Canada¹ website. If you have more questions on healthy eating, visit Dietitians of Canada² or talk to a dietitian.

Time savers

If you do not have time to make meals, you can get them in the frozen food section of your grocery store. You can also get a volunteer or community service like 'Meals on Wheels' in your area to deliver hot, nutritious meals or packages of pre-frozen meals that you heat when you want. When friends and family members ask how they can help, ask them to make a meal!

The following time and energy saving list has been adapted from Dietitians of Canada³:

• use a slow cooker or microwave (a slow cooker can cook a stew for you while you are busy with other things)
• use a blender, chopper or food processor instead of chopping food by hand
• use a blender if you need to prepare pureed food (if your loved one has a hard time chewing or swallowing)
• make large portions of each meal and freeze the leftovers. Casseroles, soups, stews, vegetable pies and meatloaves freeze well. Store them in single meal containers or freezer bags. Label packages with contents and date, and make sure the labels are easy to read.

Poor appetites

People usually do not eat as much when they are sick. If someone is in later stages of an illness such as cancer, he or she may experience "cachexia-anorexia". This is a serious problem of continued weight loss. Treatments, medications or other reasons that are connected to the illness are some of the causes for this illness.

If your loved one is not hungry, there are ways to help:

• serve smaller meals more often during the day.
• make sure all their meals and snacks are as nutritious and healthy as possible.
• talk to the health care provider about a nutritional supplement like a drink that has all the nutrients of a meal.
• give favourite foods often.

Older adults with dementia have many challenges when eating meals. Information on topics such as food likes and dislikes and improving the atmosphere when they eat are helpful. For more information: Living with dementia - Meal time.⁴

Food safety

Do not forget how important it is to make sure that you make your loved one's food safely. Food poisoning can be a painful or very dangerous result of incorrect food handling.

Tips:

• clean out the fridge on a regular basis. Throw out anything that has been in the fridge for too long or is past the expiration date.
• cook meats well. Never let raw meat, poultry or seafood sit out on a counter - take them straight from the fridge to the grill.
• wash your hands often, especially before and after handling any meat, poultry or seafood.
• clean the cooking area very well. Do not let raw meat, poultry or seafood touch any other food or let their juices leak in the fridge or onto the counter.
• buy all your frozen and refrigerated foods (including meat, milk and eggs) at the end of your shopping trip. Get these foods from the grocery store and into the fridge as soon as you can.
• be sure to keep ready-to-go meals warm. Place small portions of hot leftover meals into tightly sealed containers to store in a fridge or freezer
• keep cold foods cold and hot foods hot

Give us your feedback

Please share your comments or concerns on this section of the Guide. Your comments are important to us. We appreciate and thank you for taking the time to complete this short Feedback Survey. If at any time, you wish to speak with a nurse at Ottawa Public Health please call 613-580-6744 TTY/ATS: 613-580-9656 or email us at healthsante@ottawa.ca.

References

1. Health Canada [Internet]. Ottawa (ON): Government of Canada Publications; c2013 [date modified 2013 Jun 21]. Canada's Food Guide: c2011 [date modified 2011 Sep 01]; [cited 2013 Jul 12]; Available from http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/index-eng.php
2. Unlock Food [Internet]. Toronto(ON): Dietitians of Canada; c2018 [cited 2018 Jun 1]; Available from http://www.unlockfood.ca/en/default.aspx
3. Dietitians of Canada [Internet]. Toronto(ON): Dietitians of Canada; c2013 [cited 2013 Jul 12]; Available from http://www.dietitians.ca/Nutrition-Resources-A-Z/Factsheets/Meal-Planning-and-Cooking/Time-Saving-Techniques.aspx
4. Alzheimer Society Canada (Internet). Toronto (ON): Alzheimer Society of Canada; c2011 (Cited 2013 Nov 6); (About 3 screens);  Available from http://www.alzheimer.ca/en/Living-with-dementia/Day-to-day-living/Meal-time

Keeping your loved one safe is an important part of caregiving. You may need to make some changes to the home to keep your loved one safe.

Tips:

• talk to your loved one before you make any changes in their home
• keep rooms and hallways well lit
• put grab bars in the bathroom to help your loved one get in and out of the bathtub or shower
• use a raised toilet seat to make it easier and safer for your loved one to use the toilet alone
• use a shower seat in the bathtub to keep your loved one safe while they are bathing or showering
• raise the seat heights on furniture to make it easier for your loved one to sit down and stand up
• put things that your loved one uses often on lower shelves or furniture so they do not have to use a step stool or chair
• install smoke detectors and check them every month
• keep a fire extinguisher in the kitchen
• set the water heater temperature to less than 49 degrees Celsius or 120 degrees Fahrenheit to avoid burns. When people age, their skin may not feel heat as well.
• keep the driveway, stairs and walkways free of ice

Can you leave your loved one home alone?

If your loved one lives with you, you have to decide if they can stay alone when you go out.

Your loved one can stay home alone for a short time when they can:

• use the phone to call for help
• feel comfortable with being left alone
• know the sounds and signs of danger and how to leave the home to be safe
• make a meal when hungry
• use the bathroom without help
• understand when someone is a stranger

Talk to your health care provider if you are not sure.

Personal Emergency Response Systems (PERS)

PERS allow your loved one to press a button when they need help. The button is on either a necklace or wristband that they can wear or it can be a small remote control or console on the counter. The console has two-way speakers so that your loved one can talk to the staff at a 24-hour response centre. Your loved one can ask them to call friends, neighbours or emergency services depending on what help they need. Your loved one can also use a special telephone that will dial out pre-programmed emergency phone numbers.

Falls prevention

Older adults can fall while living alone or with you. They are more at risk if they:

• are 65 and older
• take more than 4 medications a day
• take drugs to help them sleep or calm their nerves
• have problems with balance, strength or feeling in their legs or feet
• have problems walking, or getting in or out of the bathtub
• had a slip, trip or fall in the last 6 months

To prevent falls

• install sturdy handrails on both sides of the stairs
• use sturdy, non-slip rugs without rips or tears
• keep driveways and walkways free of ice
• install bright lights and night-lights in hallways and bathrooms
• remove extension cords or other tripping hazards from pathways
• remove mats or tape them to the floor

Bathroom safety

• use grip bars and a rubber mat in the bath or shower
• use a hand-held showerhead to help with washing and rinsing
• use a raised toilet seat
• use a bath or shower seat to allow the person to sit while taking a bath or shower
• do not use bath oils

Medication safety

Your loved one will probably be taking medications. Make sure they take them properly. You can buy special pillboxes, called dosettes, with sections to organize all the medications for a day. Pharmacies can also make "blister packs" for your loved one. They have the name and time of each medication arranged in the right order for each day.

In Ontario, the MedsCheck1 program lets you book a free yearly meeting with your pharmacist to review all of your medications. Be sure to include all over the counter medications as well as prescriptions in this review.

Tips:

• keep a list of all medications your loved one is taking
• tell your health care provider about any allergies your loved one has
• ask questions if you do not understand. Medicine labels can be hard to understand (for example, ask if "four doses daily" means taking a dose every six hours around the clock or just while awake)
• use the same pharmacy so your pharmacist can keep a record of all your loved one's medications

See Chapter 2: Finding your Way through the System for more suggestions about talking with health care providers.

Give us your feedback

Please share your comments or concerns on this section of the Guide. Your comments are important to us. We appreciate and thank you for taking the time to complete this short Feedback Survey. If at any time, you wish to speak with a nurse at Ottawa Public Health please call 613-580-6744 TTY/ATS: 613-580-9656 or email us at healthsante@ottawa.ca.

References

1. Ontario Ministry of Health and Long Term Care [Internet]. Toronto (ON): Queen's Printer for Ontario; c2009-2010 [last modified 2013 Jul 05]. MedsCheck: c2008 [modified 2011 Sep 13]; [cited 2013 Jul 12]; [about 1 screen];  Available from http://www.health.gov.on.ca/en/public/programs/drugs/medscheck/

Your loved one may need supplies and equipment to keep them safe at home.

Start with talking to your family Doctor or contacting your Community Care Access Centre (CCAC) for a care coordinator to complete an in-home assessment. Your care coordinator can refer you to professional services such as physical therapy or occupational therapy for aids and other equipment.

Once you have a CCAC care coordinator, it is important to update your care coordinator as your situation changes for possible adjustments in your services. For more information: CCAC.

You can also speak with community organizations about how to borrow, rent or buy specialty devices and products. Different names for these devices and products are:

• assisted living products
• assistive devices
• adaptive devices or
• independent living aids

You can call the Ontario Government Assistive Devices program (ADP)¹ to get help with funding if your loved one has long-term physical disabilities.

Your local health unit, Ottawa Public Health the March of Dimes Canada² and the Canadian Red Cross³ may be able to help as well.

Special Supplies

Some examples of special supplies and equipment that might help you and your loved one are:

Grab bars or grip bars

Grip bars help stop slips and falls. You can use them in the bathroom to help with support in the bathtub, shower, or toilet. You can also put them in hallways for support and safety when walking. Make sure the grab bars are securely installed.

Bedrails

Bedrails help support a person when they get out of bed. They can be plastic or metal. Some bedrails have built-in pockets for magazines and books.

Comfort aids

You can find many things to make your loved one more comfortable. You can use bed pads made of sheep fleece or special cushions filled with foam to make their bed or chair softer. They are very good for people who are in bed or sit for long stretches of time.

Shower heads and hand-held showers

Showerheads and hoses that attach to the tub faucet help you and your loved one with hair washing, back washing and rinsing in the tub or shower. Basic showerheads do not cost very much.

Bath or shower seats and transfer benches

You can use seats and transfer benches to help your loved one get in and out of the tub. They are good for people who have problems stepping over the tub walls, or need to sit while bathing or showering. They also make it easier for your loved one to wash their feet or shave their legs.

Bath and shower mats

Use safety mats inside the bath or shower so your loved one does not slip or fall. You can buy safety mats that will cover most bathtubs from end to end.

Bathing underclothes

You can help your loved one stay covered while bathing by using special kinds of underwear that cover a person's private areas while they are in the bath or shower. You can place a dry wrap over the wet underwear to allow the person to remove the wet underclothes in private. You can lift the dry outer garments easily when someone uses the toilet without showing their private parts. There are also long plastic aprons that the person can wear while bathing, or towels that stay wrapped around the person (with a clothes-pin, clip or Velcro tabs).

Raised toilet seats and bedside toilets

Your loved one might have trouble getting up from the toilet. A raised toilet or raised toilet seat can help. There are different types of raised toilet seats, including seats with arms and lids and other special features. Plastic is more comfortable than stainless steel. You can also find different types of bedside toilets and bedpans.

Adult diapers/underwear

Your loved one might have bladder or bowel control problems. You can buy adult briefs or liners to help absorb any fluid that leaks from him or her. There are many different kinds of briefs. Some slip-on and look and feel like regular underwear. This can help a person keep their dignity and be more comfortable during day-to-day activities.

Dressing aids

Stocking aids will help a person pull up socks, without having to bend. There are also aids used for putting on pantyhose.

Long shoehorns can help a person to put on a shoe without bending down.

Clothing button and zipper aids allow people to dress themselves instead of relying on help. These aids make them feel more independent and they have more dignity. Button pulls and zipper pulls can help someone who has arthritis or problems with moving their fingers. Dressing sticks have different sized hooks on both ends to help with zippers and putting on clothing. They will help a person who has trouble moving their arms or only have use of one arm. Usually, dressing aids cost about $10 to $20.

Mobility aids

Special chairs (chair lifts) and cushions

Chair lifts are chairs that tilt forward to help someone get in and out of the chair. There are many chair lifts available, and they are often modern looking and comfortable. Chairs with power buttons can help lower and raise the person from a sitting position to a standing position and back down to a sitting position. You can also get special cushions to help a person sit and get up off a chair or sofa. For example, self-powered portable lifting cushions can help a person get into and out of any chair by lifting people up as they begin to push off the chair. Swivel cushions can help a person get in and out of car seats by turning in place, so the person does not have to turn him or herself. Stair glides are powered chairs installed on stairways to help a person go up and down stairs.

Electric or manual wheelchairs

Wheelchairs are very expensive. You can buy used wheelchairs, borrow them from a community or health care program, or get financial help through a program like the Assistive Devices Program. Talk to your family doctor, government health office, or local community organizations and centres about these ideas. When you choose a wheelchair, you will need to think about the height and weight of the person you are caring for and their basic needs. Will the wheelchair be used only occasionally for short distances? Will you need a wheelchair for both indoors and outdoors? A qualified sales representative or occupational therapist can help you with your choice.

Walking aids

These devices can help people feel safer and more stable when they walk. It is recommended to have a professional help you choose the right walking aid for your loved one. For more information contact: CCAC.

Canes

Can have different features such as:

• grips
• three-pronged feet for better balance
• picks that you attach to the bottom of the cane for a better grip on ice. Your loved one can raise the picks when they go indoors.

The size of the cane depends on the size of your loved one: Get them to stand up with their arms at their sides. Turn the cane upside down and put the handle on the floor. The bottom tip of the cane should be at the level of your loved one's wrist. This will be the right size of cane for your loved one. If you are unsure, an occupational therapist can help you find the right cane.

Walkers

Most walkers have wheels to allow your loved one to turn and move around easier. Some may have brakes, seats, baskets and can be folded for easier transportation.

Mealtime aids

Special dishes: There are plates, bowls and other products made for people who have a hard time using every day dishes. For example, you can find plastic, circular rims that fit around any plate. These rims keep food on the plate while you push it onto your fork.

Bedside tables and trays: You can find bedside tables and trays in many stores, not just places who sell assisted living supplies. Some of these tables have wheels and easily fold up. Bedside tables and trays allow your loved one to eat in bed and keep personal things such as tissues, books and crossword puzzles close by.

Finding supplies and equipment

To find the right supplies and equipment, talk to your health care provider.

Tips

Private insurance and government-funded programs may cover the cost of some supplies and equipment. See Resources at the end of this section for more ideas about places to rent or buy equipment.

Caregiver Safety

If you do not feel safe when caring for your loved one or do not have the support to give safe care, you may need to find another place for your loved one to live. They might have to:

• sell their home;
• move into an apartment, condominium or older adults' residence;
• move in with a family member or a friend; or
• move into a nursing home. For more information: Chapter 4: Finding Your Way through the System.

These changes may be hard for your loved one. Tell them how you think these decisions will help them in the future.

Caring for Someone Far Away

Caregiving can be a challenge when you live far away. You might be sharing the care with someone who lives closer to your loved one or you may be the only caregiver. You might even find it hard to visit because of the cost and time to travel. Living far from your loved one can make you feel sad or guilty because you think you cannot help them. Sometimes people will move closer to their loved one for a short time. This could work if you want to organize care for your loved one. Of course, this is not always possible. You can think about your loved one moving to where you live. This can work if your loved one will need care for a long time. It is important to talk about this and make a decision with your loved one. Sometimes a move can turn out to be a good decision.

When your loved one lives far away, there are still many ways you can help.

The resource, So Far Away: Twenty Questions and Answers about Long-Distance Caregiving (pdf version), offers information about caregiving from afar. It looks at topics such as complex family relationships, legal issues, housing options, and advance directives.⁴

Give us your feedback

Please share your comments or concerns on this section of the Guide. Your comments are important to us. We appreciate and thank you for taking the time to complete this short Feedback Survey. If at any time, you wish to speak with a nurse at Ottawa Public Health please call 613-580-6744 TTY/ATS: 613-580-9656 or email us at healthsante@ottawa.ca.

References

1. Ontario Ministry of Health and Long Term Care [Internet]. Toronto (ON): Queen's Printer for Ontario; c2009-2010 [last modified 2013 Jul 05]. Assistive Devices Program: c2008 [last modified 2012 Jul 19]; [cited 2013 Jul 18]; [about 1 screen]. Available from http://www.health.gov.on.ca/en/public/programs/ltc/
2. March of Dimes Canada [Internet]. Toronto (ON): March of Dimes Canada; c2011 [cited 2013 Jul 18]; [about 2 screens]. Available from http://www.marchofdimes.ca/EN/Pages/default.aspx
3. Canadian Red Cross [Internet]. Ottawa (ON): Canadian Red Cross; c1999-2013 [cited 2013 Jul 18]; [about 2 screens]. Available from http://www.redcross.ca/
4. National Institute on Aging [Internet]. Bethesda (MD): National Institute on Aging; c2011-2013; Available from: http://www.nia.nih.gov/health/publication/so-far-away-twenty-questions-and-answers-about-long-distance-caregiving-0#

Please share your comments or concerns on this section of the Guide. Your comments are important to us. We appreciate and thank you for taking the time to complete this short survey Feedback Survey. If at any time, you wish to speak with a nurse at Ottawa Public Health please call 613-580-6744 TTY/ATS: 613-580-9656 or email us at healthsante@ottawa.ca.

Chapter 1 survey

Municipal

Algonquin College, Dental Clinic (September to April) 613-727-4723 ext 7630

City of Ottawa, Employment and financial assistance for adults and older adults with low income

Community Care Access Centre: provides care for an older adult in their own home, coordinates care in the community for the older adult, including specialized support services. They also provide information about long-term care options.

Community and Social Service, Financial assistance for adults and older adults with a low income: 613-560-6000

Ottawa Dental Society, Dental Emergency Services: 613-523-4185

Ottawa Public Library

The Regional Geriatric Program of Eastern Ontario:  a network of specialized geriatric services, from hospital to home. 

Provincial

MedsCheck

Ontario Ministry of Health and Long-Term Care, Assistive Devices Program

Saint Elizabeth Health Resources - Topics include diabetes, older adult care, wound care and more.

National

Alzheimer Society of Canada

Bell Canada Telephone Aids

Canadian Hearing Society

Canadian National Institute for the Blind (CNIB)

Canadian Red Cross, Health Equipment Load Program

Dietitians of Canada

Health Canada - Canada's Food Guide

National institute on Aging

Unlock Food

Veterans Affairs Canada