Caring Connections
Helpful tips for family caregivers

Simplifying the holidays

For family caregivers, the prospect of the holiday season is often more daunting than delightful. How do you decide what to keep and what to trim away?

Prioritize activities with people you enjoy. Spend time with those who nourish your soul rather than those who criticize or deplete you.

Focus on what gives meaning to the season. Often what we are seeking in our activities is an emotional outcome: Feelings of love and closeness. The comfort of belonging, tradition, and community. A sense of spiritual affirmation.

Cull out low-priority activities. Every time you say yes to one “obligatory” event (perhaps the office party?), you are reducing your time and energy for the activities you truly relish. Strive to cut out half of your holiday tasks. Value quality over quantity.

Prepare for others’ disappointment. Explain that your focus is on caring for your loved one—a noble reason. And to do that, you need to pare back. It may be your relative does not do well with disruptions to routine, or that they lack stamina for the usual activities.

Brainstorm simplifications.

• Meals. Prepare a crockpot soup and sandwich for a lunch gathering instead of a full dinner. Or ask others to contribute instead of cooking a whole meal. Order a precooked entrée, or the side dishes, or dessert. Go out to eat.
• Decorations. Bring out one or two favorite symbols of the season. Use music, or simmer herbs or spices to evoke the holiday spirit.
• Gifts. Get 100% off on Black Friday by foregoing gifts altogether! Let your family know you are opting out of gift giving and prefer to not receive any. Or that you’ll give to children only. Maybe send cards of appreciation to key people or write a letter to all, recounting the events of the past year. Perhaps make a single donation in the name of the family to a cause that all might value. Or if you must give something to individuals, consider an experience (an invitation or tickets for an activity to do later in the year). Experiences are typically more meaningful than objects.
• Gatherings. Especially if your loved one has health or mobility challenges, look for online options to connect without the logistics of travel and bad weather (video calls, online concerts or religious services, etc.).

What is "observation status"?

Imagine that your relative goes to the hospital for an outpatient procedure. That’s no big deal. But their blood pressure skyrockets during the event. So the hospital decides to keep your family member overnight for monitoring. They have a bed and receive meals. You might readily assume they’ve been admitted as an inpatient. In this example, they are on “observation status” only.

Financially, this distinction could be very important. In Medicare terms, patients on observation status are outpatients. This means Medicare will likely cover at least some of your relative’s hospital visit. But for observation, they pay under Part B, which could mean greater copays and additional uncovered expenses. Money out of pocket. Another detail: Only those formally admitted for three overnights are covered by Medicare for follow-up care in a skilled nursing facility (SNF). The cost of SNF care adds up VERY quickly.

Medicare has strict rules about whether or not a patient qualifies for hospital admission. If a doctor is unsure, they must put the patient in observation status. Ideally, when this happens you receive a notification called MOON (Medicare outpatient observation notice). This notice explains why the care is considered outpatient instead of inpatient. It usually also clarifies the difference in coverage for the hospital and for any aftercare.

If you feel your loved one has been wrongly assigned, you can appeal the decision. You may want to talk first to someone in the hospital billing office. They can help you determine what the out-of-pocket costs would be under inpatient versus observation status.

Avoid unpleasant surprises! Anytime it looks like your loved one will be staying overnight, ASK several people if they are an inpatient or on observation status.

Handy gadgets for arthritis

Living with stiff or arthritic hands can significantly diminish joy, confidence, and freedom. Among those over age eighty-five, about half of all women and one-quarter of all men are afflicted with the pain of osteoarthritis in the hands. To support your loved one’s independence, try these expert hacks and gadgets:

Equip the kitchen. Look for specialized grippers for opening containers: An electric can opener or spring-loaded scissors for opening food pouches. For carving or chopping, an electric knife or vegetable chopper. Choose tools, spatulas, and the like with cushy, large handles. Add “foam grip tubing” to utensil handles (also useful with pens, toothbrushes, etc.).

Modify the physical environment. Exchange doorknobs for levers or add slip-on, lever-style doorknob adapters. Install faucets with sensors that allow taps to control water flow and temperature. Try easier to grip, dimmer-style light switches. Go hands free with a robot vacuum!

Seek out adaptive devices and clothing. Look for adaptive “turning tools” to assist with keys and other small items. Purchase looser, slip-on adaptive clothing. Avoid zippers in favor of large buttons and elastic waistbands.

Update the computer. Add an ergonomic keyboard or try a table or touchscreen monitor for easier mousing and keyboarding. Easier yet, use voice dictation software whenever possible.

Add smart home features. Smart door locks with a keypad, voice activation, or biometric identification (fingerprint) can take the place of keys. The need to pinch and turn small dials can be replaced by smart lights and a smart thermostat coordinated by voice assistants such as Amazon Alexa. There are even smart stoves and ovens that can be controlled by a smartphone app.

Consult an occupational therapist. A home visit can provide tailored strategies and tools based on individual needs.

With the right devices and support, your relative can have a life that’s more manageable and less limited.