email: zissieg@walla.com
Remember the TV commercials for Energizer batteries? That one bunny rabbit just kept on going and going and going. Well, it may work with bunnies, but it sure doesn’t work with humans. This column is devoted to pitfalls I encountered when I thought I could be Superwoman and various resources available to help both the patient and caregiver get through difficult times.
Progress and the conservation of energy
About four weeks after my father’s stroke, my daughter, son-in-law and their three children moved in with us during the period between vacating their rental apartment and waiting for their apartment under construction to be inhabitable—including my parents that made nine, but who’s counting? Right about then I came down with the flu (flu-shot notwithstanding) and I
came to the realization that this old machine just can’t keep going at its present pace.
Remember the TV commercials for Energizer batteries? That one bunny rabbit just kept on going and going and going. Well, it may work with bunnies, but it sure doesn’t work with humans. This column is devoted to pitfalls I encountered when I thought I could be Superwoman and various resources available to help both the patient and caregiver get through difficult times.
Progress and the conservation of energy
About four weeks after my father’s stroke, my daughter, son-in-law and their three children moved in with us during the period between vacating their rental apartment and waiting for their apartment under construction to be inhabitable—including my parents that made nine, but who’s counting? Right about then I came down with the flu (flu-shot notwithstanding) and I
came to the realization that this old machine just can’t keep going at its present pace.If you’ve read my previous postings you know that I try to maintain a lively sense of humor to get myself through the day and advocate the same for everyone else having to endure a crisis such as this. But make no mistake. I do not take this situation lightly. We had a rocky road ahead of us, and my batteries were running down. How could I provide the maximum amount of care for my parents, if I myself could barely function?
Things had improved somewhat with my father to the point that he had “graduated” to having physical and occupational therapy at the kupat cholim, rather than at my home. He also started speech therapy, and as much as possible we tried to coordinate the appointments to minimize the number of times we would have to travel to the clinic.
Coordinate appointments to minimize hardships on patient.
Although this was a milestone, it further complicated my schedule—now I could add chauffeur to my long list of occupations. It actually was a two-person job to transport him anywhere, as he had to be dropped off near the entrance to the building with one person accompanying him and another parking the car afterwards. In addition, it took two people to get him into and out of the car. This situation can be circumvented by ordering special transport services in vans equipped to handle wheelchair-bound patients. Besides the YadSaraVan service, there are other places that provide similar transportation options. One that I know of is Ezer MiZion. Though these services are certainly helpful in getting the patient into and out of the vehicle, they do have at least one drawback—they are not always available to suit your schedule, unless you don’t mind going to the appointment a couple of hours early and being picked up a couple of hours late. For some people this may not be a problem, but my schedule was so tight already, and my father was in no condition to be hanging around sick people for hours on end, that we rarely availed ourselves of these services.
Things had improved somewhat with my father to the point that he had “graduated” to having physical and occupational therapy at the kupat cholim, rather than at my home. He also started speech therapy, and as much as possible we tried to coordinate the appointments to minimize the number of times we would have to travel to the clinic.
Coordinate appointments to minimize hardships on patient.
Although this was a milestone, it further complicated my schedule—now I could add chauffeur to my long list of occupations. It actually was a two-person job to transport him anywhere, as he had to be dropped off near the entrance to the building with one person accompanying him and another parking the car afterwards. In addition, it took two people to get him into and out of the car. This situation can be circumvented by ordering special transport services in vans equipped to handle wheelchair-bound patients. Besides the YadSaraVan service, there are other places that provide similar transportation options. One that I know of is Ezer MiZion. Though these services are certainly helpful in getting the patient into and out of the vehicle, they do have at least one drawback—they are not always available to suit your schedule, unless you don’t mind going to the appointment a couple of hours early and being picked up a couple of hours late. For some people this may not be a problem, but my schedule was so tight already, and my father was in no condition to be hanging around sick people for hours on end, that we rarely availed ourselves of these services.
Another option is for the patient to apply for handicapped parking privileges. I myself never did this, however, and have no experience with the procedure. I would venture a guess that pretty much the same type of medical information that is requested for Bituach Leumi would be requested here. There may also be restrictions as to who bears ownership of the vehicle.Could things possibly get any worse?
I’m sure it will come as no surprise to you that things can always get worse--especially when dealing with chronic illnesses and conditions. We would like to hope and pray for full and speedy recoveries for our loved ones, but often, barring some miracle or medical breakthrough, the reverse is often the case.
For awhile we were making good progress with my father’s recovery. He dutifully went to all his therapy sessions for several months, during the course of which time my mother’s condition deteriorated. By this time they had returned to their apartment, and my father was receiving additional hours from Bituach Leumi. We divided up the allocated hours between a woman who came a few hours a week to deal with household chores and a man who came to deal with my father’s personal hygiene issues. My husband and I dealt with everything else—shopping, doctors, medications, therapy, finances, all types of medical tests, apartment repairs—we were on call 24/7. If only someone would lend a hand, I kept saying to myself, maybe I could get through the week in a better state of mind.
During his hospitalization for the stroke and for the first few weeks afterwards, friends and family came to visit my father regularly. As time wore on, however, the number of people that came to visit dwindled. There simply was not much for my parents to look forward to at home, and leaving the house was such a difficult project that they preferred to just stay put. This dreary existence further complicated by deterioration in my mother’s condition started them down the slippery slope to depression. There are organizations (Yad Sarah and Ezer Mizion come to mind) that have outreach programs with volunteers that make home-visits to shut-ins. It has just come to my knowledge that even Bituach Leumi has volunteers for this purpose through their Department of Counseling Service for the Elderly (in a recent advertisement in the Jerusalem Post Lifestyle Magazine they advertise the service with a National Hotline number to call: 02-646-3404). In our situation we made an attempt to recruit visitors, but did not succeed in finding English-speaking volunteers.
Outreach programs are available to boost the patient’s spirits.As my mother worsened, my father’s spirits declined, and he started displaying signs of depression. The fighting attitude he had at the beginning of the ordeal was being eroded by having to cope with the painful deterioration in my mother’s mental and physical condition coupled with additional hospitalizations for pneumonia that he had suffered. He no longer had the will to work at improving himself physically and gave up hope of ever getting better. Things were looking pretty bleak.
How to deal with Hachmarat Matzav
When my mother was initially assessed by Bituach Leumi, her claim was denied. My father, on the other hand, was awarded 9.75 hours per week of care. We were ready to appeal to Bituach Leumi for a re-evaluation on both of them (a process we went through at least twice, as the situation warranted it). In order to apply for re-evaluation one must complete a form claiming hachmarat matzav (worsening of the situation/condition). There is a portion for the family doctor to complete indicating the nature of the deterioration, and there is a portion for the patient or caregiver to complete with basic information (since the initial application had already supplied detailed information).
How to deal with Hachmarat Matzav
When my mother was initially assessed by Bituach Leumi, her claim was denied. My father, on the other hand, was awarded 9.75 hours per week of care. We were ready to appeal to Bituach Leumi for a re-evaluation on both of them (a process we went through at least twice, as the situation warranted it). In order to apply for re-evaluation one must complete a form claiming hachmarat matzav (worsening of the situation/condition). There is a portion for the family doctor to complete indicating the nature of the deterioration, and there is a portion for the patient or caregiver to complete with basic information (since the initial application had already supplied detailed information).
Appeal to Bituach Leumi for more
hours if the situation warrants.
In researching this column I learned that the forms can be ordered online. Again these forms can be submitted directly into the Bituach Leumi mailbox outside their offices to avoid waiting in line. Place them in the envelope provided by Bituach Leumi and complete the necessary information on the outside of the envelope to identify the patient, the liaison for making appointments, and the office to which the form is intended (in this case siyud). Bituach Leumi will contact you to set up a date for the re-evaluation. As before, there is a waiting period of a few weeks until the committee’s decision is available. It is highly recommended to phone Bituach Leumi periodically to see if a decision has been reached. Call your local branch (this response line is usually available only for about two hours in the morning) to check on progress with your claim. With verbal notification over the phone you can begin utilizing the added hours, without having to wait for the written verification, which is often delayed in the mail.
Each time there is a significant change in the patient’s condition you can go through this procedure. Conversely, Bituach Leumi can decide to send someone to re-evaluate the situation on their own to determine whether the patient is still eligible for the number of hours they have been awarded. If the situation has improved, they can decide to reduce the number of hours previously granted.
The importance of being earnest
In researching this column I learned that the forms can be ordered online. Again these forms can be submitted directly into the Bituach Leumi mailbox outside their offices to avoid waiting in line. Place them in the envelope provided by Bituach Leumi and complete the necessary information on the outside of the envelope to identify the patient, the liaison for making appointments, and the office to which the form is intended (in this case siyud). Bituach Leumi will contact you to set up a date for the re-evaluation. As before, there is a waiting period of a few weeks until the committee’s decision is available. It is highly recommended to phone Bituach Leumi periodically to see if a decision has been reached. Call your local branch (this response line is usually available only for about two hours in the morning) to check on progress with your claim. With verbal notification over the phone you can begin utilizing the added hours, without having to wait for the written verification, which is often delayed in the mail.
Each time there is a significant change in the patient’s condition you can go through this procedure. Conversely, Bituach Leumi can decide to send someone to re-evaluate the situation on their own to determine whether the patient is still eligible for the number of hours they have been awarded. If the situation has improved, they can decide to reduce the number of hours previously granted.
The importance of being earnest
Let me say at the outset that I am not a medical practitioner, and cannot nor will I recommend any particular medical treatment. I am just reporting on my experiences. Should you feel you need medical intervention you should see a competent licensed medical practitioner to assess your individual case.
Needless to say, the worsening of the situation was taking a toll on my health. I was in a state of denial about requiring the anti-depressants that my doctor recommended—no one was going to fool around with my head, if I could help it. So I began trying alternative treatments to reduce the tension, sleep disturbances, aches and pains and depression I was experiencing.
Reflexology helped with many of my symptoms (and it was during the evaluation by the doctor at the alternative medicine department of my kupat cholim that I was diagnosed with fibromyalgia—a disease I apparently had had for many years, based on my symptoms, but which had been exacerbated by the traumatic and tense situation I was dealing with currently). I also tried the Bach remedies, with no significant results. I tried meditation and conscious relaxation techniques. I had so many conversations with God (one-sided—don’t worry, I don’t hear voices! yet!) that I was starting to bear a close resemblance to Tevye from Fiddler on the Roof. In short, I tried just about anything I could to postpone the inevitable. When I finally reached rock bottom, I realized that in order to get through this period of my life I was going to need some pharmaceutical help. I made an appointment with my family doctor and walked out with a prescription for an anti-depressant. It took a few weeks before it began to take effect, but my coping mechanism has certainly improved. I also rely on sleeping pills now.
Take immediate action upon signs of depression and
suicidal thoughts.
Needless to say, the worsening of the situation was taking a toll on my health. I was in a state of denial about requiring the anti-depressants that my doctor recommended—no one was going to fool around with my head, if I could help it. So I began trying alternative treatments to reduce the tension, sleep disturbances, aches and pains and depression I was experiencing.
Reflexology helped with many of my symptoms (and it was during the evaluation by the doctor at the alternative medicine department of my kupat cholim that I was diagnosed with fibromyalgia—a disease I apparently had had for many years, based on my symptoms, but which had been exacerbated by the traumatic and tense situation I was dealing with currently). I also tried the Bach remedies, with no significant results. I tried meditation and conscious relaxation techniques. I had so many conversations with God (one-sided—don’t worry, I don’t hear voices! yet!) that I was starting to bear a close resemblance to Tevye from Fiddler on the Roof. In short, I tried just about anything I could to postpone the inevitable. When I finally reached rock bottom, I realized that in order to get through this period of my life I was going to need some pharmaceutical help. I made an appointment with my family doctor and walked out with a prescription for an anti-depressant. It took a few weeks before it began to take effect, but my coping mechanism has certainly improved. I also rely on sleeping pills now.
Take immediate action upon signs of depression and
suicidal thoughts.I’m starting to sound like a member of Drug-Takers Anonymous, but there are two points I am trying to make:
1) For anyone out there who thinks they are SuperCareGiver—you cannot do it all by yourself and expect to maintain your health. If you need help, do not hesitate to seek it. There are support groups (see end of article for partial list of links) for family members of patients with all types of diseases. Don’t be ashamed to admit that you might need to take medications to help you get through the crisis.
2) If you think you, as a caregiver, are depressed, can you imagine what effect the illness or condition is having on the patient him/herself? He/she has lost his independence and control of his/her environment and is now totally reliant on others for his/her every need. This is a drastic life-change to say the least. Be on the lookout for signs of depression or suicidal indications in the patient. Run, don’t walk, to the patient’s doctor to notify him of these signs and to get prescriptions for the appropriate medications and/or referrals for psychiatric care. It goes without saying that if the patient expresses suicidal thoughts you must get him/her to the hospital immediately. I am not personally familiar with the Israel Mental Health Association, but you can certainly check out their site for useful information if needed.
Without going into details, suffice it to say that I speak from experience. Professional intervention in cases of severe depression is not a luxury, it is an absolute necessity.
“If I am not for myself, who is for me?
And being only for my own self, what am I?
And if not now, when?”
Hillel, Ethics of the Fathers
Looking out for Numero Uno
I hope that I have managed to sufficiently scare you into being alert to both your health needs as well as those of the patient. I must reiterate how important it is to take a break from the routine. What they say about taking care of frail parents all falling on the shoulders of one child is no exaggeration. For whatever reason, this is usually just how it is. So don’t forget to treat yourself
regularly to time-out—at one point my husband and I went on a two-week cruise where we were unavailable by phone or email, forcing other family members to bear the responsibility. That may sound pretty drastic. But a gal’s gotta do what a gal’s gotta do to recharge her batteries.
I welcome your comments.
1) For anyone out there who thinks they are SuperCareGiver—you cannot do it all by yourself and expect to maintain your health. If you need help, do not hesitate to seek it. There are support groups (see end of article for partial list of links) for family members of patients with all types of diseases. Don’t be ashamed to admit that you might need to take medications to help you get through the crisis.
2) If you think you, as a caregiver, are depressed, can you imagine what effect the illness or condition is having on the patient him/herself? He/she has lost his independence and control of his/her environment and is now totally reliant on others for his/her every need. This is a drastic life-change to say the least. Be on the lookout for signs of depression or suicidal indications in the patient. Run, don’t walk, to the patient’s doctor to notify him of these signs and to get prescriptions for the appropriate medications and/or referrals for psychiatric care. It goes without saying that if the patient expresses suicidal thoughts you must get him/her to the hospital immediately. I am not personally familiar with the Israel Mental Health Association, but you can certainly check out their site for useful information if needed.
Without going into details, suffice it to say that I speak from experience. Professional intervention in cases of severe depression is not a luxury, it is an absolute necessity.
“If I am not for myself, who is for me?
And being only for my own self, what am I?
And if not now, when?”
Hillel, Ethics of the Fathers
Looking out for Numero Uno
I hope that I have managed to sufficiently scare you into being alert to both your health needs as well as those of the patient. I must reiterate how important it is to take a break from the routine. What they say about taking care of frail parents all falling on the shoulders of one child is no exaggeration. For whatever reason, this is usually just how it is. So don’t forget to treat yourself
regularly to time-out—at one point my husband and I went on a two-week cruise where we were unavailable by phone or email, forcing other family members to bear the responsibility. That may sound pretty drastic. But a gal’s gotta do what a gal’s gotta do to recharge her batteries.I welcome your comments.
Related Links:
Eran for emotional first aid
Mental Health Services of Ministry of Health
Guide for the Disabled in Israel
Support Groups for Neurological Diseases
Israel Society for Fighting Pain
Israel Cancer Society
Israel Lupus Association
Bookmarks of Ministry of Foreign Affairs for a comprehensive listing of useful sites
Guide to Services for the Aged and Disabled in Israel
© Copyright-2008
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1 comment:
except the link you provided, there is also the mega on-line site, where you can also order groceries via the net.
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