Thursday, January 31, 2019

Calm is a Superpower

So many times we wait for answers, decisions, and choices OTHERS will make.  In the meantime, we have choices: recognize the choices are not ours, surrender the control we'd like to make to influence them, and wait before responding to the parts of the answer that affect us.  That's the calm way and the least exhausting way.

Other times, our choice is to overthink.  To ponder the worst, anticipate how it will affect twenty different things in our lives, and to make ourselves miserable, both day and night.  Sleep doesn't come easily when we're spiraling, food either becomes an enemy or absent, and we're not much fun to be around.

Remember the video on the Waste of Worry? (https://www.youtube.com/watch?v=naN4PfT-jQs&t=3s)  Do you want to waste your one precious day today on fruitful thinking or worry?  It's a choice and it is also tiring to actively push the negative or wasteful thoughts away, but it gets easier with practice.


Picture credit:  LordsOfHustle
Calm is a Superpower, and within your grasp.  Like everything else, breaking poor habits and building new ones takes practice.  Perhaps you need to inwardly rant for an hour - go ahead!  That can release some angst and you've affected only yourself.  BUT, if you're able to look inside and PAUSE to realize your efforts to hasten a decision or to influence a decision is not serving you well, you've achieved a breakthrough!

Here's to knowing we can only control our own responses to life's situations, and that we have kind friends who will help us when we reach out to them.  If you don't, work on finding/making friends, and don't underestimate the power of a pet!

Blessings and care,

Linda Kreter and the VeteranCaregiver.com Team

Friday, January 4, 2019

Failure, Helplessness, New Hope, and Growth


It may have been a hard week, month, year for you.  You’ve stepped mightily into each challenge with hope, optimism, and sound strategy.  Yet, each time, you find yourself plunged a little more into bewilderment, sadness, and anxiety.  Standing up strongly, you know you have that little bit more within you to take another step – but it’s a hard step to take.

This is not about mistakes you’ve made, or choices made.  It’s about those times when you’re absolutely not in charge of the outcome despite your best efforts.  Despite your insanely wonderful capabilities, and personal drive.  It’s when logic does not prevail that brings on that feeling of helplessness.  Sometimes, it’s only a mere step to hopelessness, and that’s to be avoided.  If it can’t, professional help may be needed, and seek it. 

So, what do you do?  Maybe it’s time to hit the PAUSE button.  Slow down and think about the steps you’ve taken and those you haven’t. Take time to look closely at the situation and slowly remove emotion from the equation.  Mostly let’s talk about this with relationships, professional and personal. 

 We all know we cannot change other people, but only ourselves.  Looking at situations from a different perspective, and looking at the possible priorities of others may provide a glimmer of understanding.  Those times when you’ve revealed that your plans and hopes were hampered by others either afraid of change, or because of power or ego show you valuable lessons.  

Why?  Because you aren’t likely to make those fears go away (hint:  they are not your fears), and those who misuse power with inflated egos usually show a pattern of behavior, also not likely to change.  Bottom line:  only YOU can change the course. And, YOU are creative and innovative, strong and strategic.  Trust this.

Possible steps:
1.      Look at options.  Could you alter your timing, your approach, find alternatives, or refine your goal?  If so, explore those opportunities as a new approach to achieve the same goal.
2.     Scrap your plans.  This is a severe but possible response.  For example, if you’ve been trying to achieve change with many approaches and failed often due to others’ actions or behavior, it may be time to walk away.  Staying too long at anything just because you invested time in it seldom works out. However, if you scrap your plans, insert a new plan to take its place, even if that plan is to pause.  Nature will fill a vacuum; make it YOUR choice to do so.
3.     Use the Pause Button to explore an entirely new path you may not have considered because SURELY one of your previous explorations would have worked.  Now that it didn’t, let your mind walk down different paths.
4.     You are NOT alone.  Talk with trusted friends and advisors.  Talking things through with someone who really "hears" you is invaluable
5.  Nurture your confidence.  You are only in this temporary helplessness place BECAUSE YOU TRIED.  Those who don’t try may not know the feeling of failure, but it’s often failure that leads to fresh ideas and renewed optimism.

Stay within the realm of hope, consider how strong you’ve been to persist, and take the time to ponder your new path.  Often, the failures of the past lead to growth and plans you might have missed – failure is grounding for options, opportunities, learning, and even gratitude.  Do we LIKE this experience?  Of course not.  Yet, look at each life experience from all angles, and grow in wisdom, creativity, and confidence you’ll achieve your goals.  It’s just around the corner!

Linda Kreter and the VeteranCaregiver Team

Monday, October 29, 2018

Protect Your Family with a Disaster Plan


Have you ever considered what you would do if a disaster struck you and your family? Would you know what to do? Would you take the right step to take to protect your life and that of your family? Many of us assume that disasters only happen rarely and to other people. But unpredictable weather can affect any area of the country, and recently we've witnessed wildfires, tornadoes, floods and other natural disasters in places we least expected.

Although natural disasters can cause catastrophic loss of property and injuries, you can reduce their effect through careful planning and preparation.

The first step to planning a disaster response is to be informed. Especially if you’re new to an area, you should become familiar with its frequent natural disasters. Identify the known risks such as earthquakes, flood zones and frequency of extreme weather. Some information about the area can help you understand some of the initial responses to include in your plan. For example, if you live close to the water, you'll likely want to have a well-thought out plan in the event of a flood. 

Tornadoes are another example. As HomeAdvisor explains, “Although they are mostly associated with the Midwest and “Tornado Alley”, no state is immune to tornadoes. Even sunny California experienced seven of them in 2014. Therefore, it only makes sense to take some precautions and have procedures in place in the event of a tornado.”

After acquiring information about your particular disaster likelihood, the next steps to developing a plan is to consider these four questions with your family and friends:

How will emergency alerts and warnings be transmitted? What is your shelter plan? What is your evacuation route? What is your communication plan?

When answering all these questions, consider any particular needs of your family. Small children, seniors, people with special needs and even pets can all affect how you develop and execute your plan.

Next, consider what sort of supplies you should need if there is a disaster. Creating an emergency preparedness kit is simple, and although you hopefully will never have to use it, it’ll be the best investment you've ever made in the event disaster strikes. Having the following basic supplies can make a life or death difference:

-       Water - 1 gallon per person per day
-       Nonperishable food, such as canned goods
-       Flashlight
-       Battery-operated or hand crank radio and/or phone charger
-       Extra batteries
-       Medications
-       Personal hygiene items

And if disaster strikes, be ready to put your plan into effect. None of these preparations are useful in a state of chaos, so your plan should include designating someone to be in control.

And if a natural disaster hits, consider the impact on your pets as well. Contact your local emergency management office or Humane Society to see if a temporary shelter is available for your animals. Emergency shelters for people impacted by natural disasters can't always accept displaced animals, so your plan should provide for their care.

You can also reach out to friends and family members who aren’t affected by the disaster to see if they could temporarily house your pets. Other options include making a list of pet-friendly hotels in your area in case you have to find shelter quickly for the entire family.

When natural disasters occur, all too often victims are unprepared, believing that such calamities only happen to other people in other areas. Be prepared for these events, no matter how unlikely. It may be the best plan you ever put to paper.

Bradley Davis
www.DisasterWeb.net 

Monday, September 24, 2018

You Matter!

You Matter!  Caregiver Awareness & Self-Care
T KarcherYears ago.... self-care was an eye roll.  A weakness.  Last on the list.
Thankfully, this has changed; caregivers are no longer willing to be continually mentally exhausted, ill-nourished, overwhelmed, or physically unable to provide care, it causes too much additional family stress. While it is difficult to make time for yourself, you’ll hear it repeatedly: Make the Time for You.
Caregivers often have their head down, their task list in hand, and they execute logistics that would make a 4-star amazed. However, this focused effort is rarely sustainable. This will vary for everyone, but no one is a robotic machine forever. Please don’t wait until you fall ill or become so overcome that you don’t see which end is up. Sharing your experience and gaining perspectives with friends and other caregivers can be very beneficial.
You probably micro-schedule the rest of your life, so try to add good nutrition, exercise, relaxation, meditation, quiet, social time, or something that is yours into that schedule too. There are numerous options for small-group fellowship in local organizations, the faith-based communities, and sports facilities. Respite care is hard to find, so intentionally carving out time for you is necessary.  Every little bit helps. 
You need it.  You matter.  Take charge of your self-care.
Linda Kreter and the VeteranCaregiver Team

Thursday, September 6, 2018

SPAR - Sensitive Patient Access Report

See VHA Directive 1605.01, Sections 7-4 and 38-9

https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3233 (copy & paste into browser


"SENSITIVE RECORDS" - Many caregivers have voiced concern over who is accessing a veteran's records, especially for evaluations.  While evaluations are to be conducted according to the caregiver law, alternative staff is sometimes accessing a veteran's medical records for evaluation or appeal records review.  

If you are concerned, have the veteran request their Medical Records be marked "Sensitive" by the Privacy Officer at your local VAMC. This means the LOG of all those accessing records will be supplied in a SPAR report (Sensitive Patient Access Report). Don't forget to request reporting time frame (all). 

VHA Directive 1605.01 (Sections 7-4 and 38-9) is also posted in our www.VeteranCaregiver.com website Resources section.

Linda Kreter and the VeteranCaregiver Team

Tuesday, August 28, 2018

Obtaining CATS and PATS Records

CATS and PATS Records:   For those in the Program of Comprehensive Assistance for Family Caregivers Program and those anticipating joining the program, obtaining these records on a periodic basis is vital to understanding the entire CG Program picture.


CATS (Caregiver Application Tracking System) and PATS (Patient Advocate Tracking System) are NON-medical records completed by Caregiver Support Coordinators and Patient Advocates respectively.  The information contained is often used for program re-evaluations, continuing eligibility, and sometimes reflect different information than the medical records.  Without this information, you lack the capability to review for accuracy, correct errors, and understand the full picture.

We have concerns.  CATS and PATS were not openly disclosed and found only from patterns discerned through thousands of seemingly illogical caregiver decisions.  VACO has confirmed these records, and acknowledged in writing that both CATS and PATS usage will continue.  Once these non-medical databases became known and caregivers submitted requests (only available through FOIA requests, or Freedom of Information Requests), there have seemingly been deletions from the records, and apparent removal of information that may have assisted in reversing Caregiver Program decisions for Tier Reduction or Program Termination.

Starting the process means a Freedom of Information Request (FOIA) to your local VAMC staff outlined below.  To obtain these records, there is no form, and we suggest language similar to:

TO:              Privacy Officer, VA Medical Center __________ (name)

CC:              VA Medical Center Director ___________ (name)

FROM:        VA Caregiver ___________________ (name)       
                    Veteran _____________ (name)   _____ (last 4 of SS#)

RE:              FOIA REQUEST FOR CATS AND PATS RECORDS
(Caregiver Application Tracking System and Patient Advocate Tracking System Records)

Dear Sir or Madam,

This request is for specific records needed to respond to an appeal/eligibility to the VA Program of Comprehensive Assistance for Family Caregivers (PCAFC).  Our deadline for appeal is ___________ (date).     

We are requesting unchanged, unmodified, non-redacted, and complete CATS (Caregiver Application Tracking System) and PATS (Patient Advocate Tracking System) records from date of application __________ (month and year) to the VA Caregiver Program through today _________ (date) for Caregiver _____________ (name) of Veteran ___________ (name), last four of SS# ____.”  This information is critical to our timely documentation submission.

Thank you for your prompt response.

Very respectfully,

CG name and signature
Veteran name and signature

Submit this request to the Privacy Officer (or FOIA Officer at some centers) at your local VAMC and keep copies for yourself, noting the date and time of submission, the person submitted to, and any notes of conversations.  If you receive a response saying it will be an lengthy time period, exceeding your need for the information to appeal, provide a copy to your Caregiver Support Coordinator, their Supervisor, and request an extension of the appeal period in writing. 

Once records are received, review them carefully with the Veteran’s medical records for accuracy.  If there are errors, you must submit a line-by-line correction document, along with documentation (if available) requesting record corrections.  Submit these to the same Privacy Officer for submission and ask timelines.  Check for confirmation of this information.

There are further steps you may need to make, but please not only obtain these documents, but also document every single step in the ADL’s and Supervision/Protection provisions for program eligibility.  For those pre-9/11 veterans anticipating application into the program, do this documentation now, in advance, and be prepared to follow the same eligibility requirements.

We hope this information is helpful, and if you’re working with an advocate, cc them on the memorandum also.  If this process changes, we will let you know, and meanwhile, knowledge is invaluable, and sharing it with others is as well.

We recommend you print this blog posting and wish you the best of success.

Best to you,

Linda Kreter and the VeteranCaregiver Team

Wednesday, June 13, 2018

Loneliness: An Epidemic and a High Risk for Veterans


Loneliness: An Epidemic and A High Risk for Veterans




Loneliness has doubled in the U.S. In the 1970’s and 1980’s, Americans who responded that they regularly or frequently felt lonely was between 11 percent and 20 percent (depending on

the study).1 Just a few decades later in 2010, AARP performed a national survey that found that
loneliness had increased to between 40 and 45 percent among adults.2    And in 2017, former
U.S.   Surgeon General Dr. Vivek Murthy called loneliness an “epidemic” and stated that “loneliness shortens lifespans in a way similar to smoking 15 cigarettes / day”.3

The destructive effects of loneliness don’t end there. People who identified themselves as  lonely had a statistically significant 45 percent greater risk of death.4 "People aren’t [technically] dying of loneliness. But they are dying of cardiovascular diseases, cancer, accidents, suicide and diabetes. Based on your genetics and your environmental history, loneliness can make these conditions strike earlier than they otherwise would have," said Dr. John Cacioppo of the
University  of  Chicago’s  Center for Cognitive and Social Neuroscience.5    In fact, according to a
2018 study (by AARP, Stanford University, and Harvard University), Medicare spends $6.7 billion more annually on socially isolated older adults compared to adults that are not isolated.6

Isolated Veterans living at home have a high risk of feeling loneliness, so it’s that much more important to identify the warning signs that your loved one is feeling lonely.

Signs of Loneliness 

Here are some of the signs to look for so that you can seek help:

1.       Poor Sleep. Individuals who are suffering from loneliness often have poor sleep. According to Dr. John Cacioppo, "A handful of studies have shown that when you’re lonely, your brain remains alert for threats and you show more micro awakenings or sleep fragmentation. This has an adaptive purpose: If you’re isolated, you could be predated at any moment. It doesn’t matter whether you are sleeping next to someone—if you feel isolated, that causes the brain to remain on alert."7

2.       Frequent Sickness. Individuals that are lonely are more likely to get sick. Dr. Cacioppo stated, “We’ve found loneliness is associated with altered gene-expression, which makes you more susceptible to viruses, a correlation that has been shown in humans and animals.”8


3 See https://hbr.org/cover-story/2017/09/work-and-the-loneliness-epidemic.

3.       Longer, Hotter Showers. Studies indicate that lonely people take longer and hotter showers--the lonelier the person, the longer the shower and the hotter the preferred temperature. According to Dr. John Bargh, Professor of Psychology at Yale University and administrator at Yale's Automaticity in Cognition, Motivation, and Evaluation (ACME) Lab, "[P]eople tend to self-regulate their feelings of social warmth through applications of physical warmth, apparently without explicit awareness of doing so."9

4.       Buying More Stuff. Individuals that are feeling lonely may look to fill a void through more consumer spending. According to a study conducted by Dr. John Lastovicka of Arizona State, "We...find that material possession love is empirically tied to loneliness and social affiliation deficits, which suggests a compensatory basis of consumer well-being."10

5.       Having Friends Who Are Lonely. Loneliness can be contagious. According  to research published in the Journal of Personality and Social Psychology, individuals are "more likely to be lonely if a person they are directly connected to (at one degree of
separation) is lonely."11      Dr.  Cacioppo  theorizes  that loneliness is passed on through
negativity and lack of trust. "People who feel lonely view the social world as more threatening," he says. "They may not be aware they are doing it, but lonely individuals think negatively about other people. So if you are my friend, and I started to treat you negatively, then over time, we would stop being friends. But in the meantime, our interactions caused you to treat other people less positively, so you're likely to lose friends, and they in turn are likely to lose friends. That appears to be the means of
transmission for loneliness."12    Negative feelings can be passed on by people when they
frown or make unpleasant facial expressions, make negative comments, or even use anti-social body language.
 Ways to Overcome Loneliness

 Where caregivers of Veterans are actively trying to help, often Veterans are still isolated for long periods of time and may still struggle with loneliness. Still, there are ways to combat isolation and loneliness:

1.       Have a Purpose. Regardless of whether Veterans live alone, they can still have a purpose. Even with advancing age, there is a world of opportunity for Veterans to  identify a purpose for their lives. Veterans can record their personal and family history, learn a musical instrument, or start reading that volume of books about World War II that they’ve always wanted to.


10 See https://academic.oup.com/jcr/article-abstract/38/2/323/1894880?redirectedFrom=fulltext.

One exciting way of having a purpose for seniors is starting a “Bucket List.” What have you dreamed of doing in this life? Where have you dreamed of traveling? Whether the answer to those questions is whale watching, eating a new food like calamari, or finally reading “War and Peace,” anything is possible.

Psychotherapist and author Ross Rosenberg recommends to those wanting to overcome loneliness: "Open yourself up, take risks, and allow yourself to be vulnerable. Since loneliness results in isolation, experiment by sharing aspects of yourself, including experiences, feelings, memories, dreams, desires, etc. This will help you feel more known and understood."13

2.       Get Involved. Veterans who are isolated are at greater risk of loneliness. "There's no hard-and-fast rule that everyone needs to be involved with others all the time, but we tend to feel better when we're with others, and we may feel worse if we're often alone," says Dr. Michael Craig Miller, a Harvard Medical School assistant professor of psychiatry.14

There are many ways to get involved in your community. From joining a club (e.g., bridge club, mahjong club, jazz club, etc.) to volunteering (e.g., helping provide information at a local shopping mall, delivering Meals On Wheels, becoming a mentor, tutoring, etc.), there are lots of ways to get involved. Most cities have local resources available for Veterans that has a calendar of events (e.g., women’s events, hikes, golf events, holiday ceremonies, encampments, job fairs, benefit open houses, gun shows, etc.).

If Veterans prefer to stay at home or have mobility limitations, there are more and more resources available online, including online book clubs, online family history, online games (e.g., chess, Scrabble, fantasy sports, etc.) and online classes (e.g., learning a musical instrument, cooking, dance, gardening, mechanics, learning a new language, lectures and podcasts, etc.).

"When you're alone, you focus too much on yourself and dwell on regrets or worries. When you're with other people, you turn your focus outward. When you're thinking less about yourself, you're worrying less about yourself," says Dr. Miller.15

3.       Take Advantage of New Technology. For decades aging Veterans have had very limited options for companionship while living at home, other than family or caregivers. A new company, Veras (www.veras.com), provides a cheaper and easier alternative. Veras provides senior home care via video calling and allows aging Veterans to stay in the place they most love--their homes.



Veras leverages simple video calling technology (similar to Skype or FaceTime) to pair aging seniors one-on-one with Veras Remote Companions to provide companionship and personal assistance. Veras Remote Companions provide medication reminders, schedule doctor appointments, play games, and provide companionship through conversation. Veras Remote Companions also help family members stay in the loop by sending weekly email reports about activities (Watch video at https://www.youtube.com/watch?v=Fbo-NE0l2wo).

Thankfully there is growing awareness around the problem of loneliness, and, where we all make efforts to help those around us, we can make a difference.

Ben Zimmer