HOPE Behavior Health Services offers the following three programs:

HOPE Geropsychiatric Program:

• Addresses behavioral care needs of adults 65 years and older including depression, psychosis, panic and anxiety states, delirium and behavioral symptoms
• Provides a comprehensive assessment of medication regimes, physical and psychiatric diagnoses, and functional abilities
• Supports abilities through physical therapy, psychotherapy, music therapy, and activity therapies according to individual needs
• Provides services for persons living independently or in a long-term care setting

HOPE Medical Psychiatric Program:

• Addresses physical and psychiatric needs of adults 65 years and older
• At admission the client’s presenting problem must be psychiatric or behavioral with significant secondary medical issues
• Addresses complicated medical and psychiatric problems
• Supports abilities through physical therapy, occupational therapy, psychotherapy, music therapy, and activity therapies according to individual needs
• Provides services for persons living independently or in a long-term care setting

HOPE Women’s Program:

• Addresses psychiatric needs for women including eating disorders, marital and family conflicts, emotional adjustment during life transitions, sexual and physical abuse, co-dependency, grief, depression, and loss
• Program encourages women to self-nurture, develop skills for self- empowerment, gain self-awareness, learn to cope with overwhelming feelings, redirect ineffective patterns of behavior, and examine negative thinking

The Caregiver Wellness Program of Park Ridge Hospital is founded on Christ’s commandment “You shall love your neighbor as yourself.”   (Matthew 22: 36 to 40)  Caring people must love or take care of themselves by balancing caregiving responsibilities with personal wellness.  These web pages contain suggestions for honoring the commitment to care for a loved one while also tending to the caregiver’s needs. 

Americans are strongly committed to their elders and make great sacrifices to care for frail, older adults as the following facts show. 

• 80% of the care that is needed by frail, older adults is provided by a family member or friend
• 46 is the average age of the caregiver
• 18% of workers under 30 are involved in eldercare
• 73% of all caregivers are women
• Nearly 50% of employed caregivers are men
• 64% of caregivers are working
• More than one in five caregivers take care of someone who suffers from  dementia
• $659,139 is the estimated average lifetime loss of wealth for caregivers.  The loss is a result of lost wages, retirement benefits, etc.
• $60 Billion dollars a year or more is spent by U. S. businesses on Alzheimer’s disease alone.  Poor work performance, job turnover, absenteeism, and health care costs were included in determining this figure.

The following question reflects a common concern caregivers may have about depression.

 
Dear Ruth:  I’m currently caring for my parents.  About two years ago my father had a severe stroke and is dependent on my mother for most of his needs.  My mother has been in fairly good health, but recently she seems confused and talks about being “worthless”.  I’m wondering if she may be depressed.  When her physician asked her if she was depressed, my mother answered “no” and the doctor shrugged her shoulders and dropped the subject.  Is this an accurate way to diagnose depression?  Should I pursue other options such as a psychiatrist? 
                                                       Worried over Mom

Dear Worried:  Since your mother is the primary caregiver for your father, keep in mind that Clinical Depression is more common among caregivers than non-caregivers.  Confusion can be a symptom of Depression.  Psychiatrists are specifically trained in the diagnosis and treatment of Depression.   A careful examination by a psychiatrist is a good option that may alleviate your worry while also improving your mother’s well-being. 

   Here is a list of the psychiatrists who work with the HOPE Behavioral Health Program at Park Ridge Hospital. One of these physicians can assess your mother’s symptoms and recommend any treatments if needed. 

   The following paragraphs/lists provide more information about the specific symptoms of Depression and some of the methods of treatment. 

Clinical Depression means having a depressed mood or loss of interest in life.  The person must have at least five (three with a diagnosis of dementia with 1 and 2 being 2 of the 3) of the following symptoms over a 2 week period: 

  1. Diminished interest or pleasure in activities
  2. Depressed Mood most of the day, nearly everyday
  3. Sleep disturbances
  4. Major changes in appetite and weight
  5. Motor retardation (Move more slowly) or agitation
  6. Difficulty thinking or concentrating 
  7. Loss of energy or fatigue
  8. Feelings of worthlessness, self-reproach, excessive guilt
  9. Suicidal thinking or attempts
 10. Social isolation or withdrawal

 Other Symptoms to Be Alert to:

Vague Complaints of Pain
Lack of Eye Contact, 
Anger
Decrease in Sexual Drive 
Stooped Posture

   In the early stages of dementia, depression may appear as primarily apathy.   All the usual symptoms of depression may not be as prominent.  Look for lack of initiation, disorganization, and starting and stopping behaviors. 

If you suspect Depression, you will want to be sure the patient has had a thorough physical examination by a physician.  Underlying conditions include diabetes, hyperthyroidism, endocrine disorders, Parkinson’s or Alzheimer’s disease, congestive heart failure, pancreatic disease, and pernicious anemia.  Certain medications can cause or exaggerate Depression such as anti-hypertension drugs, beta blockers, diuretics, steroids, anticancer drugs, and anti-Parkinson’s disease drugs.

Other Ways to Help 
Be aware of some older adults’ resistance to mental health terms, e.g., “Therapy”, “Psychiatrists”, etc.

Encourage conversation/Acknowledge the person’s feelings.

Encourage expression through activities - drawing, reading, music, exercise, gardening, taking care of a pet, etc.

Enhance food intake if the person has a poor appetite: spice up meals, serve small portions more frequently, involve themin making the food, provide favorite foods.

Encourage normal routines, e.g., to be up and out of bed.

Schedule interventions during best time of day. 

Encourage companionship with peers.

Match the Depression’s persistence with your own persistence.

Encourage them to follow the treatment plan. 

Observe for medication side affects. 

Be alert to increased risk for falling. 

Celebrate small successes. 

If you are a caregiver, be aware of your own vulnerability to depression and seek help.  A caregiver who is depressed is less able to help someone else and treatment becomes all the more important. 

The most commonly used medications are serotonin reuptake inhibitors (SSRIs).  These include Celexa, Zoloft, Paxil, and Prozac.  Physicians may also prescribe antidepressants that inhibit the reuptake of brain chemicals other than serotonin, including the medications Effexor and Effexor-SR, Remeron and Wellbutrin. 

Antidepressants in a class called tricyclics, which includes Pamelor and Norpramine are no longer used as first-choice treatments, but are sometimes used when individuals do not benefit from other medications. 

(Source for above two  paragraphs is The Caregiver, Vol. 22: No. 1 pages 13 -15, Spring 2003, published by Duke University and taken from the Alzheimer’s Association.)

Caregivers bring unique circumstances, attitudes, and family backgrounds to caregiving.  Each person who receives care brings personal history, opinions, and preferences along with distinctive care needs. 

The following steps are guidelines that are based on Change, Continuity and Diversity among Caregivers by Dr. Rhonda Montgomery and Dr. Karl Kosloski along with the personal observations of Ruth Perschbacher Price, Coordinator, Park Ridge Hospital’s Caregiver Wellness Program.  For some caregivers, these steps may not be consecutive and/or more than one step may occur at the same time.  All the steps may not apply to every caregiver.

 1. Performance of Initial Caregiving Tasks.

These tasks might include arranging for doctor’s appointments or purchasing groceries for a mother who was previously able to complete these tasks herself.  Tasks might involve assisting with financial decisions or discussing whether the person who needs care should continue driving a car.  As early as possible, it is important to discuss the carereceiver’s desires about care needs including advanced directives, i.e., legally establishing what a person’s wishes are for end-of-life/health care needs in the event she is unable to make decisions at some point in the future. 

 At this time the loved one may resist the caregiver’s efforts or may become more dependent than is necessary.  The caregiver often feels conflicted about providing the right balance of assistance. 

Throughout caregiving, sadness and grief become the companions of the caregiver as it is difficult to witness a loved one lose former abilities.  For many caregivers, taking care of another also brings rewards as this new relationship brings with it opportunities to heal, to forgive, and to know a loved one in a more intimate way.

2. Self-definition as a Caregiver. 

When a loved one needs care, many people view themselves as a spouse or a child who is simply helping out someone they love.  Caregiving is not necessarily experienced as a new role, but rather as an extension of an ongoing commitment to honor a loved one, whatever the situation. 

Whether or not a person chooses the title of caregiver, as the care of a loved one increases, many of the established patterns of the relationship change, specifically with regard to the increased dependency on the caregiver.  As the older adult’s independence slips away, he may feel frightened, perhaps becoming angry toward the caregiver.

Recognizing that one is providing care in a form that differs from the past offers an opportunity to assess the situation and determine what steps are needed to face this challenge.  Joining a support group or caregiver wellness program can assist the caregiver to learn about caregiving, to make plans for future caregiving needs, and to gain knowledge about community resources. 

Meeting others who are in a similar situation reduces loneliness.  Caregivers are usually generous in their support of other caregivers and can describe how they have coped based on personal experiences.  Planning and gaining information is important to relieving caregiver stress, maintaining personal wellness, and assuring the care recipient’s needs are met. 

3. Provision of Personal Care.

During this step, more caregiving is needed.  Personal care may include assistance with bathing or taking the carereceiver to the bathroom.  The help may be appreciated or resented.  The loved one may state that she can accomplish tasks without any assistance though the situation shows otherwise. 

If the caregiver is employed, he may have difficulty performing at the same level in his job due to the added time that is needed for caregiving.  Absenteeism, tardiness, and poor work performance are common signs that the employed caregiver needs additional support. 

The caregiver may develop stress-related health problems especially if the provision of personal care is time-consuming, physically difficult, or emotionally draining.  Good friends or health care professionals who are aware of the caregiver’s situation may recommend options that focus the caregiver on personal wellness such as a support group or a counselor.  The spiritual community and/or friends may put together a team that provides care and relieves the caregiver for a period of time. 

4. Seeking out or using assistive services. 

It is sometimes difficult for caregivers to ask for help.  Americans tend to pride themselves on being independent and families value being able to take care of their own.  Some caregivers feel it is a personal failing to ask for help.  Those caregivers who remain healthy and who continue to feel rewarded by providing care to a loved one are often caregivers who have learned that asking for help is not about failure, it is about survival.

In this step, in-home assistance such as home health or homemaker services may be used.  A caregiver may take the loved one to an adult day program where participants can receive eight or more hours of care during the day or even during the evenings outside the home. 

Carereceivers may not feel comfortable attending a day program or having “strangers” providing care.  The person who needs care may believe she doesn’t need help or state she is not as sick as the caregiver believes.  Health care professionals or other caregivers are good resources for discovering how to get a loved one to accept paid, in-home assistance or to attend an adult day program. 

5. Consideration of Institutionalization. 

Caregivers may seek information about full-time care outside the home such as the services provided by nursing homes or assisted living facilities.  This often occurs after a sudden decline in the loved one’s health such as happens after a severe stroke, a fractured hip, or an increase in confusion or agitation.   At this point the care needs are overwhelming for the caregiver and may present a safety and/or health risk to either or both the caregiver and the person receiving care. 

Visiting local facilities and/or talking with the regional ombudsman (see the Resource List) assists with this transition.  Whenever possible, it is a good idea to begin looking at facilities before there is an actual need for one.

6. Actual Placement in a Facility.

When the carereceiver’s needs can no longer be met in the home, the loved one enters a care facility.  Family members continue to visit and provide emotional support.  Some caregivers also continue to provide hands-on assistance. 
 

New concerns may arise about the ability of the facility to meet the loved one’s needs.  How to advocate for the loved one while they are in a care facility is a common concern of family caregivers.  The Regional Ombudsman is a resource to resolve issues related to the quality of care.  (See Resource List.) 

Caregivers often experience feelings of guilt; these feelings of guilt can be compounded if the loved one is unhappy with the placement.  Caregivers may also observe that the loved one enjoys the increased socialization and activities available in a facility.  If the person adjusts well, most caregivers experience a sense of making a good decision.  If the care recipient does not adjust well, the caregiver can benefit from seeking the support of others including the facility’s social worker, the carereceiver’s physician, or other caregivers. 

7. Facing End-of-Life. 

At some point many caregivers face the ending of a loved one’s life.  For some this may come after years of illness. For others the caregiving time may be only a few short months or weeks.  Exactly when life will end is not predictable even by health care professionals; consulting with Hospice (see Resources) early in the stages of caregiving helps both the caregiver and the carerecipient make important decisions about end-of-life preferences and it also opens a door to later invite Hospice into the person’s care team when end-of-life appears to be close by. 

Palliative Care, a relatively new Hospice program, serves chronically ill patients who may or may not be in the last six months of life.  Hospice services are provided at home or in a facility. 

8. Caregiving Ends. 

Caregiving ends as a result of the loved one recovering from an illness or the death of the carereceiver.  This is a time of mixed emotions including sadness, loss, relief, guilt, and gratitude.  Some caregivers may second guess the decisions they made and wonder if they provided the best care possible. 

Others feel a tremendous sense of loss as they begin to realize what an important and fulfilling role caregiving has provided.  Participating in a grief group through Hospice or another organization is helpful.  Private counseling or finding others who have stopped caregiving offers solace during this time of transition.

 9. New Opportunities Arise. 

Many caregivers are positively affected by the experience of caregiving, even if it was extremely difficult.  They find ways to reach out to others by using the knowledge that has been gained. 

Some may write a book about their experiences, others may volunteer at nursing homes or hospice, or others may lobby their congressional leaders for more caregiver resources.  Still others may take up new hobbies, seek different employment, or in other ways, find fulfilling new life roles. 

Following are basic principles for promoting a good caregiving situation:

1. It is the job of the caregiver to take care of personal health.

2. Decisions are neither right nor wrong - 
    they are the best we can do at a certain point in time.

3. Love is the foundation of caregiving.  Love is non-judgmental
    and it strikes a balance with the needs of the caregiver & the 
    carereceiver. 

4. Without a balance of needs, the caregiver can become ill. 
     Who will then take care of the carereceiver?

5. Information reduces stress and assists in making informed
    choices. 

6. Support from other caregivers is vital to knowing you are not 
     alone.

7. Explore All Available Options for Providing Care
    A. Family as a Resource
    B. In-Home Care 
    C. Spiritual Family 
    D. Agencies - e.g., Family Caregiver Support Program or 
         Alzheimer’s Association or Council on Aging
    E. Out of Home Care - e. g., Adult Day Programs,  Short-term 
         Facility Respite Care, Long-term Care
    F. Caregiver Wellness Programs or Other Support Programs

HOPE Behavioral Health Program provides inpatient & outpatient
     mental health consultations.  Dr. William Sandborn, Medical Director of 
     Geriatric Psychiatry Program, Park Ridge Hospital, Naples Road,
     Fletcher, NC  28732, 800-954-HOPE or 828-681-1115

Alzheimer’s Association, 31 College Place, Suite D320, Asheville, NC
     28801-2644, 828-254-7363, 800-888-6671 HELPLINE, www.alz-nc.org

MemoryCare, Dr. Margaret Noel, Director, 100 Far Horizons Lane, 
     Asheville, NC 28803, 828-771-2219, www.memorycare.org

Family Caregiver Support Program - www.landofsky.org/aaa
     Carol McLimans, 800-727-0557, Area Agency on Aging, Asheville, NC

Regional Ombudsman, Land-of-Sky Regional Council, Asheville, NC
     828-251-6622 Ext 113  http://landofsky.org/aging/a_ombudsman.html

Henderson County Council on Aging, 828-692-4203
   http://www.coahc.org

Buncombe County Council on Aging, 828-277-8288
   http://www.coabc.org/

The Rosalynn Carter Institute for Caregiving www.rosalynncarter.org

Adult Care Services Listing for NC ww.dhhs.state.nc.us/aging/adcadh.htm
 - Day Stay HBC, Candler, NC  - 667-4541 Ext 229
 - CareParnters Adult Day, Asheville, NC - 277-3399
 - Pardee Pavilion Adult Day Health Services, Flat Rock, NC - 697-7070

Hospice:
 - Four Seasons Hospice & Palliative Care, 
     Hendersonville, NC, 828-692-6178
 - Care Partners Hospice & Palliateive Care,
     Asheville, NC, 828-255-0231

Sammy Williams Center Caregiver’s Resource Library, 301 N. Justice 
     St., Hendersonville, NC 28739 - 692-3320

Henderson or Buncombe County Information and Referral, Call 211

Family Caregiver Alliance - www.caregiver.org - 415-434-3388

Eldercare Locator - 800-677-1116, Mon.-Fri. between 9:00am & 8:00pm
     Eastern or check the web site at www.eldercare.gov

The National Council on the Aging  - www.benefitscheckup.com
     (complete a confidential questionnaire to receive details about an elder’s 
      eligibility for financial assistance for home care & prescription drugs) 

Friends of Residents in Long Term Care - www.forltc.org
     883-C Washington St., Raleigh, NC 27605, 888-411-7571 

National Citizens Coalition for Nursing Home Reform - www.nccnhr.org

Children of Aging Parents (CAPS) - www.caps4caregivers.org, 800-227-7294

Well Spouse Foundation - wellspouse.org - 800-838-0879

AARP - www.aarp.org/healthguide - www.aarp.org/lifeguide - 800-424-3410

Video Respite - www.videorespite.com - 800-249-5600 
 Caregiving Resources, P. O. Box 17809, Salt Lake City, UT 84117-0809, 

National Mental Health Association - www.nmha.org

National Academy of Elder Law Attorneys, Inc. - www.naela.org - 520-881-4005

National Family Caregiver Support Program: 
   www.aoa.gov/prof/aoaprog/caregiver/caregiver.asp

Aging Parent Handbook by Virginia Schomp, Mass Market Paperbacks, 1997

The Spiritual Journey of Love, Loss, and Renewal by Beth Witrogen McLeod, 
     New York City: John Wiley and Sons, 1999

The House on Beartown Road by Elizabeth Cohen, Random House, 2003.
     A memoir on caregiving and how neighbors help.

Making the Moments Count: Leisure Activities for Caregiving Relationships
     by Joan Ardlof Decker, $14.95 plus $4.00 shipping, The Johns Hopkins 
     University Press, Box 50370, Baltimore, MD 21211, 410-516-6900

The 36-Hour Day: A Family Guide to Caring for Persons with Alzheimer’s
     Disease, Related Dementing Illnesses and Memory Loss in Later Life by 
     Nancy L. Mace & Peter V. Rabins, M. D., John Hopkins University Press

Finding the Words: A Communication Guide for Those Who Care
     by Harriet Hodgson - Provides advice on how to cope with the symptoms 
     of Alzheimer’s disease, specifically personality changes and deteriorating 
     communication skills

Pressure Point: Alzheimer’s and Anger by Edna L. Ballard, MSW, ACSW, 
     Lisa P. Gwyther, MSW, LCSW, and T. Patrick Toal, MSW, Duke Family 
     Support Program, Box 3600 Duke University Medical Center, 
     Durham, NC 27710, 919-660-7510 - Much of the content can benefit all 
     caregivers whether or not their loved ones have dementia.

Guide to Alzheimer’s Proofing Your Home by Mark L. Warner
     Provides a room-by-room discussion of how to set up the home

Partial View, An Alzheimer’s Journal by Cary Smith Henderson, Southern
     Methodist University Press.  Dr. Henderson was a college professor with 
     a PhD in History from Duke University.  His book provides his personal 
     insider’s view of the world of this disease.