Elder Care: Little Clues to a Change in Condition

Suppose your elderly parent has been trundling along at the same level of cognitive functioning or physical health for some months. As a lay person, how can you assess on your own the changes in their condition? Do you have to have medical knowledge in order to know that something's different? Actually, in many cases, you can determine this yourself if you're willing to keep your eyes open for little clues.

Take, for example, a dementia sufferer. In my hypothetical example, my dementia sufferer (I'll call her DS) has noticeable short-term memory loss. Still, DS knows the days of the week. She gets herself to all meals on her own. She's well-groomed and enjoys being tastefully dressed. She likes going to her favorite shops to snoop around, or for a walk at the beach, knows where she is and where she wants to go. She remembers significant dates, too, and the celebrations that go with them. She can hold a conversation, although it's a repetitive one, with the same question being raised or statement being made every few minutes. Nevertheless, people who talk with DS casually would be surprised to learn that she's already well into the decline of dementia.

Over a 6-month period, DS's dementia progresses with some sharp drops in cognitive functioning. What are the clues?
Clue number 1: As per family tradition, DS phones her children on Thanksgiving Day. Four weeks later, she does not call her children on Christmas morning.
Clue number 2: DS wears the same T-shirt for a week. Her hair is sometimes disheveled at meals.
Clue number 3: A beloved daughter's birthday draws near and DS cannot remember that daughter's birthdate.
Clue number 4: Reading material is scattered around her apartment, with every magazine turned open to an article.

Any one of these clues might not be considered big enough or definitive enough to indicate a significant shift in DS's dementia. But them together and it's obvious that DS has experienced a steep decline since Thanksgiving. She's not grooming herself well, crucial dates which she's known most of her life have vanished from memory, she's unable to remember a sentence long enough to actually read and finish a magazine article.

Of course, this is just an example. Still, you might try to collect bits of information pertinent to your own parent's condition and then track it. Start with a baseline, which is simple to do. Just jot down a few observations on the essential aspects of your own parent's present condition. Start to keep your eyes open for little clues, such as I made up above. Teach yourself to value the small, indirect bits of information that form your parent's life and don't wait for just the big changes. Keep a record of your observations (and don't self-edit!!). Every 3 or 6 months, read back over what you've noted down. Doing this will help you put together a broad pattern of health or decline. You'll be amazed at what you can learn from it.

Elder Care: Long-Distance Caregiving

One of the more difficult issues to manage when caring for an elderly person is knowing when there's been a paradigm shift in their mental or physical well-being that's significant enough to warrant action on your part. I've been ruminating about this quite a bit lately, in part because I've been overseas for two months. But also because, even when I'm at home, I'm 1500 miles away from where my mother is.

I rarely see my mother, yet I'm responsible for managing her care. How do I do this when I'm so far away? I can summarize the gist of what I do in the following list. I am aware that the frequency of what I do may seem lackadaisical to some, while others may find it more than they have time for. As you read this list, don't get stuck on how often I do something. Take the general types of actions and communication I'm suggesting and see if you can make it work for you in your own way.

Here we go:

1. I work hard to open and then maintain channels of communication with the directors and staff at my mother's assisted living facility. They are my most immediate eyes and ears. I speak with them at minimum quarterly. In between I email them updates on anything of interest from my mother's doctors, so they know I value their attention to these things. If there's something that I deem of critical importance to me, I don't hesitate to pick up the phone and talk to them. I try not to leap to hyper-critical conclusions when something seems to go wrong (though this is hard sometimes!). The more I talk with the directors, the more I learn there are usually two or more valid sides to every issue. And the more they speak with me, the better sense they have of my involvement with my mother's care and what I need from them.
   
2. I keep in touch with my mother's medical specialists. Although I've asked each of them to inform the Geriatric Specialist who's the overseer of my mother's health after any visit with my mother, I realize they don't always get to this. Instead, I get reports from the Care Manager who accompanies my mother to each doctor visit. If she hasn't been able to get a report from the doctor herself, I will call the physician's nurse and ask her to fill me in. Then, I circulate that information by email or fax to the other medical specialists myself. I've gotten only thank yous for doing this. Every doctor seems to appreciate having this extra information in their file.
3. Every 4-6 weeks, I speak with my mother's two morning companions who take her on morning outings 5 days a week. When we talk I express to them how appreciative I am of their insights, even if they haven't told me much new. I also give them emotional support and kudos for their caring and attention to my mother's needs. And I offer suggestions of what they can do to handle whatever tricky situation(s) they may mention to me. I want them to know that I'm grateful for their loyalty. And I also want them to know that I'm aware of what they're doing, even though I'm far away.
4. Lastly, and most importantly, my sister (who lives near my mother) and I continually reevaluate the role that each of us plays in supporting our mother. She regularly updates me on what she sees and what she's done during her frequent visits to my mother. I factor her assessments the setting of appointments, the follow-through that I ask of the assisted living staff, the information that my mother's companions need to know about her and more.

When managing an elderly person's care from afar, the key is building and nurturing a circle of communication. You might think that the most important word in that last sentence is "communication." It isn't. The most important word is "circle." Why? Well, think of a bicycle wheel. You're the hub. The spokes reach out from you to the significant others on the team, whose presence enables you to manage appropriately. And the wheel to which the spokes connect ensures that the information that's vital to everyone gets to them, not just to you. Without that potential to circulate, information is lifeless...it's just data. To transform information into actionable elements you have to help it get beyond you, to the others who need it. Doing so is what will make you more comfortable with your parent's well-being, even when you can't check on them yourself. And, as important, it'll give you options and resources to call on when an emergency arises.

Elder Care, Stress and Ego

The issue I wrote about last time had to do with handling the guilt of not being able to do everything you, as caregiver, think needs to be done for your elderly parent. There was a great comment from Linda in response to my last post. She advises something which I hadn't thought about: think about how your parents see themselves and then try to do what's needed to support their vision of themselves, rather than your vision of them.

This is a wise statement in a very simple form.

I think that in order to implement this, you have to take some of your ego out of the picture. In some respects, elder care giving for parents can become weirdly competitive. Here are some hypothetical examples, just to explain my point: So-and-so's parents are 99 and still able to live at home, but yours have been in assisted living for years and are only in their 80s. Or, so-and-so's parents have so many friends and go out visiting all the time, but yours can't seem to get along with anyone and spend their time alone.

I'm making this up, but you can see where it leads. As we talk to each other about our respective situations, inevitably comparisons crop up. I don't know about you, but I do find myself feeling wistful when I think someone else's setup is so much more together and fulfilling than mine. And I start to wonder then whether I should be doing things differently or if I could do things better.

If I do a good job of thinking in the terms that Linda suggests, I'll be able to refocus on the fact that the way things are set up for my elderly mother, who has dementia, are really ideal for her. They're not going to change her into the sort of elderly person I wish she could be, but they are perfect for her as she is. And, after all, that's the point, isn't it?

Elder Care: Managing Stress when you can't do everything

In one of my early posts, I presented a list of 10 ways to reduce the stress of having an elderly parent who needs your care. I'd like to return to that list, to share some thoughts on my suggestion #5: accepting that you may not be able to do everything that could be done for you parent.

How do you do this? If you recognize that something needs attention, how can you then ignore it?

There are several facets to this issue that may help explain it:

1. Realize that you are already skilled at selecting what to do versus what you can't or won't do. I offer for your consideration that in all aspects of your life you are already making choices about what you will do among the many options available to you. You do this when you prepare a meal, when you attend your son's soccer game, when you enroll in a night class at the local college, when you get up early to exercise before work. Every one of these examples presents you with a choice. Making these choices is so common in all adult lives that we don't even realize that we are accepting not to do some things when we decide to do others.

In each example above, the decision you make, by its very nature, means that you are not going to be doing something else during that time. The difference between my examples and making the same choices for your parent, is that you are already so practiced at the choices in my example, that you probably don't even think about them. Nevertheless, in each example I give, choices do exist. If you deconstruct for yourself why you are going to your son's soccer game (instead of working on a house project), or why you're getting up early to exercise (instead of sleeping in), you will find reasons for each choice you've made. And you'll relearn how you've made your priorities. That same goes for deciding what to do or not to do as a caregiver for your parents.

2. The notion of not doing everything that could be done for your parents is charged with guilt. Unlike some other aspects of life, it seems there's an unwritten code that, when it comes to aging or elderly parents, everyone's expected to be a super-hero. My question is: If it's unreasonable to believe that you can do everything in other parts of your life, why do you think you should now be able to do everything that needs to be done for your parent? If the former's not possible, why is the latter supposed to be possible? The obvious answer is simply: It isn't possible. Yet because this is our parents we're talking about, not doing everything makes you feel guilty.

I think some of this guilt comes from the fact that we no longer live in extended families, yet we still recognize what the extended family provided. It used to be status quo that the elderly and infirm lived with or near their relatives, that sisters, cousins, et al were nearby, and everyone could pitch in to help care for those who needed it. In our society, which is almost defiantly mobile, that support net no longer exists. It's great that we can all live where and how we want, but many people are also wistful for that sense of community and the support of family which have been lost in the process of endless moving. The one person who's left to take care of a nearby parent shoulders the burden of what used to be done by the extended family. We still know what could be done if there were lots of relatives around and because of that, we feel guilty that we can't accomplish it on our own. Remind yourself that you're only one person. It is not a platitude to say there's only so much that one person can do.

3. Doing the best you can is good enough. Here the issue is accepting that indeed you are doing the best you can. Deep down inside, no parent expects more from their child. Yes, in the throes of sorrows, aches and uncertainties, your parent may well gripe about many things. I think that's normal. It's not fun to feel bad all day long, to be worried about your health, to be confused. Putting aside our parents, many of us would agree that we have experienced those close to us dumping their aggravations on us. In my view that comes with the territory of being close to someone....you get great love and you also are the closest at hand and so get lashed out at from time to time. It seems it's no different with parents. But (and this is a big caveat), that doesn't mean that everything your parent says they need, or everything you may recognize could help them, has to be fulfilled. And it doesn't mean that, just because your parent asks for something, that they really need it or expect to get it. Sometimes it just helps them to express a wish, even when they know that reality won't match it.

To diminish the stress of not being able to do everything, you have to keep foremost in mind all the things that you are doing, and doing well. Congratulate yourself for those. Focus on what you've accomplished for your parent, whether small or large. This could be things like the fact that you are indeed calling them every day (and, no, you're not able to visit them every day and that's OK). Or you've set up a reliable meal service for them (and, no, you're not able to provide them with meals at your house every day, and that's OK). Or that you've gotten them involved in a fun and engaging outing once a week (which you can't attend with them, and that's OK).

I hope you see what I'm driving at here. If you train your mind to appreciate what you have accomplished, and allow yourself to feel good about that, there'll be less and less room for the distress of not doing everything.

Elder Care: The Link between Stress and Illness

As caregivers for elderly parents, managing day-to-day issues and health emergencies, we are loaded with stress of all sorts. I heard a fantastic interview on my local public radio station this past Sunday (Sept. 7). The interviewee was Esther Sternberg, M.D., a rheumatologist and specialist in neural-immune science. Her latest book is titled The Balance Within.

Much of the interview was spent discussing whether there is a cause and effect relationship between high levels of stress in one's life and illness. In other words, is there scientific evidence connecting the presence of the former with the onset of the latter? Sternberg is a down-to-earth speaker, not a high-fallutin' medical-ese sort of speaker. I was riveted by what she described. It's worth listening to the interview and you can do so on the following website for the program: http://speakingoffaith.publicradio.org/programs/stress/index.shtml

Her book, which was published in 2000, addresses question such as:

• Will stress make us sick?
• Will believing make us well?
• Why do we feel sick when we get sick?
• How does our health affect our moods?

If you're interested to know more about her, her website is http://www.esthersternberg.com/.

Have you ever experienced a situation where you were pretty darn sure that your health was being affected by the stress in your life?

Elder Care: Being your own expert

In introducing this blog, I wrote that, especially in the realm of caring for one's elderlyl parents, it's important to bring into play your own wealth of experience in life, your intelligence and your intuition. It strikes me this deserves some elaboration.

When I say that each one of us is an expert, I don't mean that fatuously. I'm not claiming that we have more medical knowledge than a doctor, or more legal knowledge than an attorney. Obviously, they are the experts in their field. But each one of us is the expert in knowing what's right for our family, for us, for our geriatric parents.

In my opinion, we've gotten too used to relying on professional "experts", those with a special degree, an impressive title, or "consultant" after their name, to tell us what to do. It calms us to think that Dr. So-and-so has declared the best course of action and all we have to do is follow it.
It makes us complacent: the big decision is theirs, not ours.

But think about it. Doing just what the expert says without evaluating it thoughtfully against your own criteria for the decision, is really an abdication of responsibility. It takes the responsibility for the outcome of that decision off your shoulders and puts it on the shoulders of the expert. If you do things this way, next time a decision needs to be made, you'll be no stronger, no better able to make that decision. The void where self-reliance should be is filled instead by the declarations of these professionals.

When you know what is right and what is appropriate, and you're confident of that, it becomes easier to make decisions. If you never exercise those values or judgments, they stay weak and fuzzy. And that's why making decisions becomes overwhelming and you get that horrible feeling of being tossed in the waves of circumstance.

What you have to start doing is using those experts as tools. Make it your goal to glean what you need from each professional, then take some time to evaluate what they say, and, finally, make your own decisions based on what you believe is best. Practice this any opportunity you get. You'll find your self-confidence and sense of inner strength as an elder expert growing each time you do.

Need more ideas on this? Have a comment? Click on the Comments link below..

Elder Care: Trust your instincts

One of the main premises of this blog is that we all are experts in our elderly parents' care. All we need to do is acknowledge how much we know and can apply to the elder care situation from our other life experiences. And we have to become willing to find the inner strength to rely on ourselves a bit more. Not that specialized experts don't have their place. Clearly they do. It's just that evaluating what those experts say, and then making judgments and decisions, has to come from within us. It's not up to any geriatric expert to decide what's right. The expert's job is to share information. From there, it's up to each of us to weigh all the factors and make the decision.

Betsy posted a wonderful comment recently. I highly suggest you read it in its entirety. Just click here to link to it. Her comment speaks to the heart of what I'm getting at. She highlights three things that she found invaluable during the last year of her elderly father's life:
1. Trust your gut feeling.
2. Develop a sense of gratitude for what others do for you and be willing to ask for help when you need it.
3. Be creative--think outside the box especially when you are faced with what seems like an intractable problem.

Here are just a few reasons why I think Betsy's comment is so important:

1. When you learn to trust your gut feeling, and are willing to act on it, you move from being a victim to being in control.

2. Being grateful is a good emotion. It removes the guilt many feel when having to ask for help----guilt which is negative and energy-sapping--- and replaces it with a sense of connectedness and support, all of which is positive.

3. Creativity is your greatest ally. When you are not constrained by what others says is the right thing to do, when you begin to allow yourself to come up with seemingly outrageous options, you'll find that your boundaries are suddenly wide open with possibilities.

What do you think? To post a comment in reply, click on the Comments link at the end of this post.

Elder Care: Stress relief for solo caregivers

I received an email after my post on Learning to Speak Up, which raised a good question: "... with regard to having some 'time off': What do primary care givers of elderly parents do if they don't have a spouse or partner..i.e., aren't married or in a committed relationship ? And perhaps don't have siblings that are willing or able to take over?"

In considering this question, I first had to take a step back. Here's what I see: Even people who have family or sibling support have trouble learning how to take a break, or that needing a break is OK. For some, allowing others to help them is really hard. They don't trust that another person will do things as well as they themselves will. Or they think that admitting they need a break or some help is a sign of inadequacy. For others, there's just honestly too much to do and too few hours to get it all done. In all of these scenarioes, there are two fundamental things going on:
1. Not wanting to give up control
2. Not knowing what your limits are and therefore not knowing how to set them.

If you are in the caregiving position without family to support or relieve you once in a while, you can decide either:
--To devote your entire life to your parent's care (because there's an endless list of things that need doing)
OR
--To learn your limits and be willing to give up some control.

There's a spiritual element to this, of course. Setting limits and relinquishing some control means learning to accept that it's OK not to do everything that your parent could possibly need. But this is the way you regain some freedom and diminish the stress that comes with being chronically worried and overloaded.

There are some practicalities to making this happen which you have to be willng to pursue diligently:

1. Take a clear, hard look at priorities for care. Mental and physical health are usually the priorities, along with at least something that pertains to quality of life. What are you doing now that you can eliminate without endangering the first two or totally eliminating the latter?

2. If you can afford it, pay someone to take care of some of your current tasks. These could be things you aren't going to do for your parent anymore, or maintenance things in your own life that you could pay someone else to do:

• Hire an independent caregiver to do what you can't do. To find the right person to work with/for you, you have to network like crazy. Call independent and assisted living facilities and talk to their staff for recommendations. Talk to your parent's neighbors. Search the web for senior services and private nursing services in your parent's area. Talk to them about their services and if they can recommend others who do more precisely what you're looking for.
• Get a bill paying service or bookkeeper for your parent's bills and maybe also for your own bills. Or set up as many bills as possible for automatic payment. Yes, we all can write checks. But this is also something that you can easily job out and free up some of your time each month.
• Get a house cleaner in every couple of weeks.

3. Learn about, use and invest in technology. There are senior cams that can be installed in your parent's home. There are services which will call your parent at daily or at preset times, to check they're up and about.

4. Call on your friends, acquaintances and colleagues for any routine chores that can be shared out. If you take your kids to school or sports, can they carpool with someone else?

5. Think long and hard about your parent's ability to continue living in their current home. Are they really coping and doing well? Or are they struggling to maintain the impression of independence, at a high cost to themselves and to you? If your parent's care is overwhelming you, and you can afford it, you may have to bite the bullet and move them, over their objections, to assisted living (see my post on The Big Move).

6. Find the element in life that gives you peace, and award that to yourself every day. This could be getting a breath of fresh air, listening to your favorite music, cooking, picking up your kids at school, who knows... But find out what it is and commit to it for yourself every day. This means returning to living your life consciously and giving as much importance to yourself and your needs as you do to those around you.

And now, here's the key: Accept that you are no longer going to control as many aspects of your parent's care as you used to. Accept that there are some things that simply won't get done... And your parent will still be OK. In some case, you'll hire others to do what you otherwise would have, they'll do things differently and your parent will still be OK. It goes without saying that you're not simply handing over your parent to someone else without assuring yourself that the caregiver is trustworthy, and then checking on them from time to time. But you will build a strong safety net for yourself by doing so. You will give up that control for the benefit of your own health and well-being. This isn't being selfish. This is being pragmatic.

Elder Care: Speaking Up for What you Need

In my last post, I offered some tips on how to start speaking up for what you need and what you want. Of course, one could write a book on the subject (and maybe I will someday)! Within the confines of blog posts, however, I suggested just a few simple steps you could take to start speaking up.

To me, as a caregiver for an elderly parent with dementia, speaking up is an essential skill for regaining some control over your universe. Here are some examples where knowing what you want and speaking up for it can be really helpful.

Medical Matters, including doctor visits, ER and other hospitalizations
Have you ever been in the situation where, after the doctor leaves, you scratch your head and ask yourself, "What did he just say?" Medical matters with regard to elderly parents are always complicated. Typically there are multiple medical issues to consider, various treatment possibilities to understand, a variety of drugs influencing each other, not to mention the anxiety of seeing one's parent in pain or distress. Physicians have less and less time, and sometimes too little patience, with geriatric cases. I've found this can be true even with doctors who claim a specialty in geriatrics.

Being able to speak up in medical situations is difficult, but crucial. Here's how I break this down into the rock bottom need and want:
What do you want? to understand the medical matter confronting you.
What do you need? for the doctor(s) to explain the matter to you clearly and completely.
How do you get this? Present what you want simply and nonjudgmentally. For example:
"Doctor, I am my mother's principle caregiver. I want to be able to make the right decisions and to do that I have to understand the medical issues confronting us. Could I ask you to explain the situation to me as simply and thoroughly as you can, so that I can understand it? And please bear with me if I need to ask some questions. If this isn't a good time to go into the detail I need from you, can we set a time right now when we can talk about this?"

Family matters--time for yourself
One of the recurring themes in caring for elderly parents is how it encroaches on your time. and energy for other things. You're working, you're raising a family, you're keeping your spouse happy, AND you're now responsible for all sorts of things related to your elder parent's well-being. If you don't speak up for your needs you'll eventually explode and one of the above will suffer. Here's how I break this down into the fundamental want and need:
What do you want? Not to be responsible to anyone for anything for a period of time (a night, a few hours, whatever works for you)
What do you need? For your spouse to take over your chores for that particular period of time.
How do you get this? Try this out: "Honey, I want to be able to take care of everyone and keep up with all my responsibilties as well as I possibly can. You know that's really important to me and I take it seriously. Right now, though, I'm truly exhausted by it. I need a break. Could you (take care of the kids for the next few nights) (manage dinner for me this week) (take over the laundry this weekend)? If I just don't have to think about or be responsible for this it'll help me more than you can imagine!"

Ok, ok, maybe you won't call your partner "honey" but you get the idea!

Have you encountered any situations where these ideas could help?

Elder Care: Stress--the first suggestion

In my previous post, Stress and Suggestions #1, I listed 10 ideas for managing the stresses of being a caregiver or care manager for elderly or ill parents. All of the ideas involve putting some (or a lot) of thought into how you evaluate what's happening and then choosing how you wish to respond to the situation. All of the ideas take more energy than having a glass of wine, or going to a movie. The movie or glass of wine is a pleasure, but their benefits are fleeting. The ideas I listed will return broad and continuous rewards for that investment of energy.

Here's the first one from the list: Learn how to speak up for what you need and what you want.
Why is this even important? Whether it's leaving a doctor's office with a clear understanding of a medical issue, or knowing for certain that your parent's laundry will be done regularly, knowing what you want and asking for it is the best way to clean up your To Do list. It's also highly satisfying.

If you can learn how to do this, you'll regain a measure of control. And it's the near absence of control that is often so frustrating and therefore so stress-creating in our situation. Here are a few tips to get started:

First, take a step back and identify what you're seeking. Be honest with yourself here and don't censor what comes to mind. A basic element of managing stress is giving yourself permission to have thoughts that you, or others close to you, might initally react to as socially unacceptable. When you actually mull over those thoughts, you may find that they're not so awful after all. In fact, by not suppressing them you could discover that there's a strong element of reason in them. Or you might learn that there's really nothing you want to do about them.

So, your first inkling of the outcome you're seeking may come attached with a statement like "Oh, I couldn't possibly do that." Or "Gee, I'd like to say that but they might get mad if I do." That's OK. Write down whatever comes to mind, even if you imagine it's impossible for you to do.

Then, write down what action you want to take or what words you want to say. This may sound pedantic, but one of the big bugaboos in speaking up for yourself is not knowing what to say. So, write it down. If you're going to be in a tense situation, work on phrasing that's neutral, non-judgmental, and that has some positives in it.

Now, practice saying what you've written out loud. Practice in your car while doing errands or driving to work. Repeat your key statements until they feel part of you. I'm not saying memorize what you've written. But if you're not accustomed to speaking up for what you want, this is a good way to start to see yourself as someone who does just that. The more you hear your own voice saying things you didn't imagine you could say, the more you'll believe you can speak up for what you want.

Lastly, give it a whirl. This speaking up for yourself business gets easier each time you do it.





Next, pick

Elder Care Stresses and 10 Suggestions for Coping

Stress is the constant companion of those who care for their aging parent(s). There's much that's been written about not forgetting to take care of yourself when taking care of others. I'm not going to repeat it here, but I do want to look beyond the usual advice. I'm not a psychologist or psychiatrist, but even so I think telling someone "be sure to take care of yourself" is a bit glib. Saying "don't forget to take care of yourself" has become ubiquitous. Those who say it think that they're showing empathy, but personally I find it to be an empty statement that doesn't help.

Consider the word itself. What does "STRESS" actually mean? By definition, "stress" means "to subject to force; to put pressure or strain upon."

When you are responsible for your parent's well-being the pressure is continuous and the resulting strain is immense. If you are being continuously subjected to pressure, squeezed in a vise, then the standard of what it means to care for yourself has to change. We all know that we have to take care of ourselves. The question is how best to do so? In my experience, the things that are most restorative are ones that take the lid off the pressure cooker for more than just an hour. They're substantive and long-term. They affect you deeply and offer a chance to take control, something which is sorely lacking in the caregiver's world.

Here are 10 suggestions, some small and simple, others more complex:

1. Learn how to speak up for what you need and what you want.
2. Tell people what's happening with your parents.
3. Dismiss the notion that you can do it all on your own.
4. Contact relatives and involve them in the situation.
5. Know that you'll do everything right and your parent will still get worse.
6. Accept that it's not humanly possible for you to do everything that could conceivably be done for your parent.
7. Pick one thing that you want to thoroughly understand or accomplish and delve into it.
8. Find your center, your core, and listen to what it has to say about yourself and your parent.
9. Figure out one element of your parent's dignity that has been damaged due to dementia or other infirmities and restore it.
10. I've said this before in previous posts, and I'll repeat it a lot in the future: Remind yourself every day that you are doing the best you can possibly do.

Every one of these suggestions is a topic of it own. I'll post on each one in the future.

Can you offer more suggestions?