What Non-Caregivers Need to Consider...

Greetings,

Lately we’ve been noting how many times people are surprised at a comment or statistic about Caregivers of veterans.  It made us think that compiling several of them might make more of you aware of what people don’t know, and therefore they cannot offer to help you.  So, in the spirit of hoping others may read this (or you can send it to them), here is a brief and incomplete listing – feel free to add to the list!  This just might make your family holidays a bit easier?

1.      “The VA takes care of all medical care for your veteran and you, what are you complaining about?”  (The VA takes care of the Vet’s care and Caregivers receive CHAMPVA or TRICARE depending on service status, caregiver program, and other factors, but not all care is covered for the caregiver.  It can be very hard to find a doctor who takes CHAMPVA or who understands PTSD, so don’t assume life is “easy”.)

2.      “As a Caregiver, you are paid for your work.”  (Not in every case and not at market pricing for commercial caregivers. It is very challenging to explain to others what a "typical" day looks like, but the pay is not why you do what you do, but it helps meet the bills that stress you.  Ask that person to accompany you on your next set of doctor visits; it may open their eyes and their hearts.)

3.      “Besides, s/he’s your husband/adult child, you should take care of them just because you love them.”  (Judgment by others not familiar with your days of constantly being on edge, dealing with a large bureaucracy, trying to apply logic to an illogical system, scheduling countless appointments, juggling 20 medications carefully, and being bone-tired has nothing to do with paybacks for love.  Visible and invisible injuries take a great deal of patience and work to manage with the care team. It’s hard to keep the train on the tracks.  This is why there is a Caregiver program at VA that covers at least some of your needs because it’s fairly obvious that if you all dropped off your vet at the VA that the system would crumble rapidly.  These may be people you don’t need in your life…)

4.      “You should get a therapist if you are stressed or not sleeping.”  (That might be the case, but being a Caregiver is draining and stressful at times, and only a clinician can advise you.  Having said that, talking with your peers or a professional might lighten your load. We bristle when we hear the words "you should"...)

5.      “Never continue the conversation if the Caregiver is in tears.”  (We disagree.  We think this is a perfect time for active listening and compassion.  If you can’t let down with those you’re close to or who need you, they miss out on an opportunity for support.  Be a safe haven for them.)

6.      “Don’t discuss talk of suicide or suicidal thoughts if the Caregiver brings it up.”  (This is an excellent time to compassionately listen, and to also ask if they need other resources and professionals to discuss this serious topic.  If they are seemingly a danger to themselves or others, call emergency services.  If you are unsure, a call to the VA Lifeline would be appropriate to ask what to do for support.  Sometimes, though, just providing a shoulder and a kind ear calms the anxious moment and the almost-crisis moment passes.  However, when in doubt, always reach out for help!)

7.      “PTSD and TBI are excuses for acting like a jerk!”  (Perhaps, but unless you’re a physician and know the background and medical record of the veteran, the symptoms of either PTSD or TBI may not be managed well, or needs may have changed.  Educate yourself on both, and know what to look for when medications are changed or someone is in denial over needing help.  Great resources exist on both conditions, and alternative therapies may work when traditional first-line therapies aren’t working.  No two vets are alike.  No two Caregivers are either.)

8.      “You’re not the one with PTSD – s/he is!”  (Potentially false.  Secondary PTSD or Generational PTSD are the terms used for the cumulative effect of being around those with PTSD and having to alter your normal way of living to accommodate the veteran with PTSD.  Insomnia, hyper-vigilance, walking on eggshells, avoiding surprising someone, isolation, and altered communication may indicate that the Caregiver needs supportive clinical care also.  Again, it helps to educate yourself and your family so they don’t inadvertently trigger a situation unwittingly.)

9.      “S/he’s been back for two years, what’s the problem?”  (War is hell.  People come back from war changed, and they change those around them.  Physical loss doesn’t get easier and invisible injuries are still misunderstood.  There are Vietnam vets who have suppressed their emotions and experiences for 40 years and they suffer still.  There is not a timeframe for “getting better”.  Please do not judge Caregivers or veterans on their issues; judgment is not yours to make.  Offer resources, a gentle ear, and recognize that everyone heals at their own pace and with appropriate care.)

10.   “You need to make time for yourself – you’re running yourself ragged!”   (We think that each and every Caregiver has probably heard this at one time or another.  And, if you have run yourself ragged by always putting others first, then please, ask for and access respite care, a half-day off, or even begin seizing 15-minute intervals to breathe.  Consider that if you fall down, the entire family structure will wobble.  Don’t underestimate your critical role; you are the heartbeat of the family and you matter, so taking care of yourself is critical.  To family members, please keep offering help proactively so that the Caregiver knows you really mean it.  Caregivers are an independent, resourceful group, so coax them to lean on you and be there when they do.)

There are many more, but this posting is long enough.  We wish you a Happy Thanksgiving, and may you have a calm and peaceful holiday.

Linda Kreter & the VeteranCaregiver Team

Mental Health Support - Individual/Group & Moral Injury/PTSD

Greetings, friends,

We've been talking about Moral Injury on the American Heroes Network radio broadcast lately (15Oct), and a new discussion yesterday has provoked new thinking.  

[An example of moral injury would be a fierce firefight that resulted in the inadvertent killing of innocent civilians that haunts a veteran afterward. This has gone on as long as war has been waged.]

Two issues are provided for your thought here today.  

When a unit experiences a trauma together that goes against personal values and creates a moral dilemma, service members are forever changed.  In past eras, it was very hard to reconnect with members of a unit, especially if the war fought was considered an Unjust War (Vietnam).  With today's Social Media capabilities, we learned a great deal from a wonderfully articulate Marine who has found 80% of his unit.  This online effort has now grown to include annual reunions that are highly significant and meaningful to them.

This unit/peer connection appears to be a growing phenomenon and began years ago with Facebook pages for a specific unit, and has morphed into using GPS geo-locators for identifying other veterans (POS REP). The action of organically connecting to prior unit members is showing positive outcomes for many, including finding some semblance of peace and improved mental well-being.  

Interestingly, most mental health care is administered to each individual. Which works best?This is a tough question to answer since everyone is different, but research appears to be saying that for combat vets, a shared experience and peer connection may be an excellent way to heal.  

Secondly, is Moral Injury separate or a component of PTSD?  Moral Injury is under study to discern whether it is separate from PTSD, even though many symptoms may be the same. Is moral injury defined by guilt and a moral disagreement with personal values and PTSD more a danger response (with biological, psychological symptoms) coupled with a spiritual outlook?  Does this help explain drone operators who are not in physical danger, but suffer greatly as we now know.

This topic will be discussed more fully on the American Heroes Network (www.AmericanHeroesNetwork.com) on 05 November at 11am EST and archived afterward on iTunes and the AHN website.  Let us know what you think of the group versus individual approach to Moral Injury and/or PTSD may be?

Linda Kreter & the VeteranCaregiver team

Moral Injury & PTSD - One Story

Greetings,

We will be talking Tuesday with two cutting edge researchers on the American Heroes Network about Moral Injury:  PTSD and Suicide in the U.S. Military. This term is not often heard, but the stark truth written below may help with greater understanding of our troops' sacrifices and invisible injuries that linger after they return home.  This story was written in 2005 and rings true today (link: http://www.commondreams.org/headlines05/0615-08.htm.

Wednesday, May 04, 2005

IT WAS STILL DARK...

--by Sgt Zachary Scott-Singley

 

It was still dark. I got dressed in that darkness. When I was ready I grabbed an MRE (meal ready to eat) and got in the truck. I was going to go line the truck up in preparation for the raid we were about to go on. The targets were three houses where RPG attacks had come from a few days prior. Sitting there in that darkness listening to the briefing on how we were to execute the mission, I let my mind wander from the briefing and said a prayer. "Just one more day God, let me live one more day and we will go from there..." It was the same prayer I said every day because every day I did the same thing. I left the base. With a small team I would go out each day on different missions. I was their translator.

There were different people to meet each day. There were some who would kill you if they could. They would look at you and you could see the hate in their eyes. I also met with people who would have given me everything they owned. People, that were so thankful to us because we had rid them of Saddam. Well, this day was not really much different from all those other days so far. After the briefing we all got into our assigned seats and convoyed out to the raid site. I was to go in directly after the military police that would clear the building.

The raid began without a hitch. Inside one of the courtyards of one of the houses, talking to an Iraqi woman checking to see if her story correlated with what the detained men had said, I heard gunfire. It was automatic gunfire. Ducking next to the stone wall I yelled at the woman to get inside her house, and when the gunfire stopped I peeked my head around the front gate. I saw a soldier amongst the others who was pulling rear security by our vehicles. This soldier I saw was still aiming his M249 (a fully automatic belt fed machine gun) at a black truck off in the distance. His was the weapon I had heard.

I ran up near his position and overheard the Captain in charge of the raid asking what had happened and why had this soldier opened fire. The soldier kept his weapon aimed and answered that he was sure he had seen a man holding an AK-47 in the back of the black truck. I was amongst the four (along with the soldier who had fired on the black truck) who had been selected to go and see what was up with that truck.

We were out of breath when we got to the gun-truck nearest to the black civilian truck (a gun-truck is a HUMMWV or sometimes called a Hummer by civilians, with a .50 caliber machine gun on its roof). There was a group of four Iraqis walking towards us from the black truck. They were carrying a body. When I saw this I ran forward and began to speak (in Arabic) to the man holding the body but I couldn't say a word.

There right in front of me in the arms of one of the men I saw a small boy (no more than 3 years old). His head was cocked back at the wrong angle and there was blood. So much blood. How could all that blood be from that small boy? I heard crying too. All of the Iraqi men standing there were crying and sobbing and asking me WHY? Someone behind me started screaming for a medic, it was the young soldier (around my age) who had fired his weapon. He screamed and screamed for a medic until his voice was hoarse and a medic came just to tell us what I already knew. The boy was dead. I was so numb.

I stood there looking at that little child, someone's child (just like mine) and seeing how red the clean white shirt of the man holding the boy was turning. It was then that I realized that I had been speaking to them; speaking in a voice that sounded so very far away. I heard my voice telling them (in Arabic) how sorry we were. My mouth was saying this but all my mind could focus on was the hole in the child's head. The white shirt covered in bright red blood. Every color was so bright. There were other colors too. The glistening white pieces of the child's skull still splattered on that so very white shirt. I couldn't stop looking at them even as I continued telling them how sorry we were.

I can still see it all to this very day. The raid was over there were no weapons to be found and we had accomplished nothing except killing a child of some unknowing mother. Not wanting to leave yet, I stayed as long as I could, talking to the man holding the child. I couldn't leave because I needed to know who they were. I wanted to remember. The man was the brother of the child's father. He was the boy's uncle, and he was watching him for his father who had gone to the market. They were carpenters and the soldier who had fired upon the truck had seen someone holding a piece of wood and standing in the truck bed.

Before I left to go back to our base I saw the young soldier who had killed the boy. His eyes were unfocused and he was just standing there, staring off into the distance. My hand went to my canteen and I took a drink of water. That soldier looked so lost, so I offered him a drink from my canteen. In a hoarse voice he quietly thanked me and then gave me such a thankful look; like I had given him gold.

Later that day those of us who had been selected to go inspect the black truck were filling reports out about what we had witnessed for the investigation. The Captain who had led the raid entered the room we were in and you could see that he was angry. He said, "Well this is just great! Now we have to go and give that family bags of money to shut them up..." I wanted to kill him. I sat there trembling with my rage. Some family had just lost their beautiful baby boy and this man, this COMMISSIONED OFFICER in the United States Army is worried about trying to pay off the family's grief and sorrow. He must not have been a father, otherwise he would know that money doesn't even come close... I wanted to use my bare hands to kill him, but instead I just sat there and waited until the investigating officer called me into his office.

To this day I still think about that raid, that family, that boy. I wonder if they are making attacks on us now. I would be. If someone took the life of my son or my daughter nothing other than my own death would stop me from killing that person. I still cry too. I cry when the memory hits me. I cry when I think of how very far away I am from my family who needs me. I am not there just like the boy's father wasn't there. I pray every day for my family's safety and just that I was with them. I have served my time, I have my nightmares, I have enough blood on my hands. My contract with the Army has been involuntarily extended. I am not asking for medicine to help with the nightmares or for anything else, only that the Army would have held true to the contract I signed and let me be a father, a husband, a daddy again. 

New Suicide Prevention Tool - Vet-Tested - Coming Soon!

We must talk.  We must reach out.  We must care.  And, we must trust that we can make a difference together.

Twenty-two Veterans take their own lives every day.  That’s one every 65 minutes.  Every day. Many have sought care, and many refuse to seek care.  All need new options.  Service members, veterans, and their families are suffering in relative silence when so many in our communities and nation are willing to help.  

A new suicide prevention tool is launching very soon.  With a single touch, a smartphone app, CallApp, becomes a virtual crisis center that provides choices to a vet and reduces confusion at times of great stress.  Users can select direct connections to crisis lines, battle buddies, trusted friends, clinicians, organizations, and faith and community-based support.  CallApp will be free to our service members, veterans, and their families, and each can personalize their contacts to readily reach trusted friends and support. 

All features are Vet requested and Vet-tested.  Safe locations, peer support, and options in 36 languages will help encourage rapid adoption.  Additionally, continually updated information on PTSD, TBI, anxiety, depression, MST, chronic pain, and local resources will provide further support.  CallApp provides a unique bridge of communication between the extremes of a crisis intervention or waiting and faltering for help, often alone.   

Ninety-seven percent (97%) of all military families receive information from the Internet or their smartphones according to a recent study, making smartphones the optimal choice for outreach.  Post-Traumatic Stress Disorder (PTSD), Traumatic Brain Injury (TBI), Military Sexual Trauma (MST), financial strain, relationship fractures, substance abuse, homelessness, chronic pain, depression, anxiety, and feelings of isolation may be precursors for suicidal ideation.  With an average of 25 suicide attempts before a completion, there's enormous opportunity to save lives and guide our service members, veterans, and their families to clinical services they trust, and to compassionate people who care. 

Technology doesn’t save lives; people do, but it’s essential to first connect with and support our service members, veterans and their families. 

Together, we can and will stem the tragedy of military suicides.  

Linda Kreter & the VeteranCaregiver Team 

Post-Disaster Care for a Rabbit, but not a Veteran? Consider this during Suicide Prevention Month...

Greetings,

One of the most difficult things for a caregiver to deal with after a suicide attempt is obtaining postvention or aftercare.  VA protocol says you should receive contact within 24 hours, but this happens more in theory than in practice.  We know of cases where an SPC has not returned a call after six weeks, even with intervening advocacy calls.  We cannot know the full statistics, but we sincerely hope this is an exception rather than the rule for most at-risk veterans.

If you view a suicide attempt as a “disaster”, then perhaps you’ll relate to the paragraph below requiring contingency planning at the USDA for a rabbit.  Don’t our veterans deserve to have an operational after-care plan from the VA after a suicide attempt “disaster”?  Or even a combined caregiver/VA care-team plan?  Here’s the link to the article from the Washington Post http://articles.washingtonpost.com/2013-07-16/politics/40610671_1_rabbit-magician-u-s-department.

The U.S. Department of Agriculture is working hard to ensure that Americans have safe food to eat. The latest case is that of a children's magician in Missouri, who received a letter from the USDA requiring him to develop an emergency evacuation plan. For his rabbit. "I just received an 8 page letter from the USDA," he said, "telling me that by July 29 I need to have in place a written disaster plan, detailing all the steps I would take to help get my rabbit through a disaster, such as a tornado, fire, flood, etc.," and "what I will do after the disaster, to make sure my rabbit gets cared for properly." (italics added).

Let's show better postvention care of our veterans who are taking their own lives every 65 minutes - every day.  Let's support and care for the family members who bear heavy loads and are also at-risk.  Each life is so complex, with no one solution, but with an average of 25 suicide attempts before a completion - that's a LOT of room for help, support, and a new perspective on living.

Linda Kreter & the VeteranCaregiver Team

The Little Things Matter

You don’t ask for much for yourself, and you do so much for everyone else.  

Sometimes it’s the little things that matter when you’re a Caregiver. 

It’s the person in the grocery store line that urges you to go first because you have your hands full with a small child or two and a visibly uncomfortable veteran spouse.

It’s when someone you know writes you an “I’m thinking about you, how are you?” email, card, or posting.

It’s when a small child pats your daughter’s artificial leg and asks if she can still play soccer?

It’s a hug from a friend when no words need to be spoken, and you really needed that hug.

 

It’s when you’re in a crowd, things start feeling dicey for your family, and without a blink, a kind stranger guides you out to an open space.

It’s a callback, a referral, a resolution to a long-standing challenge, or an appointment that fits your schedule without juggling.

It’s when your son shows a glimmer of his old self; a remembered quirk, a breakthrough comment.

It’s a jug of wildflowers left outside your door with a note saying, “Sorry I missed you”.

It’s when someone offers you a flexible job because you clearly have it together and they love your work/life ethics.

It’s when you sit down and weep for what you’ve lost, and at the same time, you realize that you’re wiser/stronger/better than you were before.

It’s when your pet curls up beside you, simply because they sense that you need it.

And, when those small things occur, and you’ve noticed them?  You have become someone extra-extraordinary with a grateful heart.

Blessings and care,

Linda Kreter and the VeteranCaregiver Team

Seeking Help - Part 1 Reprise

Greetings, friends,

For many of you, the following information will be basic and instinctive to you. We originally posted this in December, and scores of calls and emails are asking the same questions about how to navigate the medical or legislative system, and we thought the following guidance might be helpful.

What do I do when I need caregiver help?

If you are already in the National Caregiver Program, contact your Caregiver Support Coordinator (CSC) at your local VA medical center.  If s/he is not in, ask for the alternate, and leave a voicemail.  It’s a good idea to also follow-up with an email, and their email can usually be found through an Internet search.  You can ask for the email address, and if it’s not forthcoming, ask who else can help you.

If you’re not in the Caregiver Program, you can still use the Caregiver Support Line and request help and guidance.  If your issue is outside the responsibilities of the CSC, then ask who you should be directed to for problem resolution.  It will likely be someone else in the Social Work Office. 

What do I do when I need help with my Veteran’s medical care?

If you have already spoken with your primary care physician, or in the case of mental health, the psychologist, we suggest contacting various VA advocates.  If your veteran is an OIF/OEF/OND veteran, there is a specific OIF/OEF Coordinator, whose name may be found with an Internet search, a VA website search, or by calling your local VA medical center.  They are often able to cut through issues very simply for you.

If the issue relates to a disagreement over care or other conflict, you would contact the VA Patient Advocate at your local VA.  This person may be found on the VA website, through an Internet search or by calling.  If there is a formal report or complaint to make, ask for the proper forms and be sure to follow all the steps directed so that you will find resolution.  You may need to be quite persistent, and you will need to judge the seriousness of your issue.

What do I do if I need help understanding VA process (paperwork, fee base, etc.)?

The Internet is an excellent source of information, but it may be a huge undertaking to find out the nugget of information needed.  Obtain one of the VA Handbooks on Benefits (you can download it or obtain a hard copy at your local VA) to find out who to talk with for specific needs.  

Why use a VSO?

We also highly recommend contacting one of the chartered Veterans Service Organizations (VSO’s) such as AmVets, Vietnam Vets of America, DAV, the Legion and others.  You can find a list on the va.gov website.  It is highly recommended that you use an organization to help you since VA benefits and processes change with the legislation and it can be a daunting task keeping up with the changes.

The importance of peers is...

Ask your fellow caregivers.  Your peers often have great experiences to share, so post here, write to your friends, and seek out others locally who can provide you practical information.  Seek out others while at the VA and absorb all you can; what you learn will either help you, or others in the future.

This is a starting point...

Linda Kreter & the VeteranCaregiver Team

Wishing a Safe & Thoughtful Fourth

Dear Caregivers, Veterans, Service members and all your families,

We thank you, our service and veteran families this week for permitting this nation to openly celebrate Independence Day on the 4^th of July.  We truly are the Land of the Free because of the brave.  We are grateful for your service and the sacrifices your families make each day.

We are also conscious that any holiday with explosions may be more difficult for the Caregiver, Veteran, and family.  Former traditions may be out of the question for you.  If you can, forge a new tradition this year.  It’s okay to watch a movie instead of going to the local fireworks.  Perhaps the town parade, watched from the sidelines is a better choice than the crowded park, in the dark with explosions and possible perceived threats.  We are very aware that this week may be a challenging one for you, Caregivers.

And, if your family is just fine and can enjoy the day smoothly, we share your joy at that capability.  No matter which side of the Fourth of July observations you fall on, we again say THANK YOU for the service given, the caregiving provided now, and your combined continued efforts for the future.  We support and applaud YOU, the Caregivers, without whom countless service members and veterans would live lesser lives.

Wishing you a safe and thoughtful Fourth of July!

Linda Kreter & the VeteranCaregiver Team

PS: The Pride of Baltimore Tall Ship with flag unfurled shown above

Heart Cracks ...

Today it's about perspective.  It’s not the heart-wrenching stories that drain us the most. It's the overall indifference.

There are hundreds of very tough stories, with just a few here: 

• -       A father of three dying of early onset dementia brain lesions after an FOB is set up directly over a 500 gallon fuel spill in the desert
• -       A daughter who will forever re-live the systematic rapes and abuse for three years by her CO
• -       A son who drove his car into a tree at over 120 mph to die, but gratefully who lived and continues to fight his PTSD
• -       A family that lives on edge awaiting the rages/destruction/fierce silence of PTSD in a husband and Dad who won’t seek help, but whom they still love

What hurts us (and our nation) the most is the numbness of bureaucratic indifference.  In just the last three days, we guided four caregivers to official contacts to improve their specific long-term situations (overdue expense reimbursement, foreclosure/eviction, cancelled utilities, change of physician).  We made 17 calls of our own to try to break through the logjam.  

Not a single time was a solution provided.  Of the two people who answered their phones, they sympathized, but were also unable to help.  We were cordial, asked for further guidance, thanked them, and yet, it is the ones that will not answer or respond to calls and email who could ultimately help.  At least that is what we hope, for there is always a solution when people want to help.

We who support our veterans and their families do not have compassion fatigue.

We have Bureaucracy Fatigue.  Lord, please help us to continue to press forward despite the weariness, indifference, and malaise. These caregivers, families, and veterans matter!

Amen,

Linda Kreter & the VeteranCaregiver Team   

Gnarly Roots Are the Most Interesting

Greetings,

Do you have a fondness for driftwood like I do?  I’ve been known to drag an interesting piece for miles and then let it dry out for three months if it was sufficiently unique!

Fascinating driftwood is often the tumbled root section of a tree.  I spent time this weekend thinking about roots.  Roots of our families.  Roots of our friendships.  Roots from our past that make us who we are today. 

Our roots begin within our families, and if we’re blessed, any dysfunction is manageable and safe.  Roots continue to grow and spread as we learn and grow older, putting out tender shoots that grow stronger as we discern our path.  Through experience and hard-earned wisdom, we learn how to prune the roots that are unhealthy, and how to nurture the ones we want to be stronger.  But sometimes, even with help, we cannot self-prune or self-nurture our roots and we must learn to live with dysfunction in our lives. 

Have you ever seen the root of a great tree that at one time ran into an obstacle and was forced to change direction to stay alive?  It’s not predictable or “regular”.  That tree, like you, is determined to keep growing.  The root of a tree that has circumvented an obstacle and kept on growing, lifting branches to the sky is often the most remarkable.  For example, consider the roots that grew around an underground pipe, pressed up through the concrete, or burrow out of the side of a mountain.  They kept growing.  I contend that some of the most interesting driftwood pieces are those that have a challenged root system.

Consider yourself in a new light.  Boring, nondescript, ordinary?  Absolutely not!  Think of a stunning piece of driftwood art in the garden, a driftwood piece like you – unwavering, a bit gnarly but tenacious, with some knotholes and scars, and learn to ADMIRE that driftwood all the more for the progress it made along the way.

May God bless the gnarly roots in your life for the visualization of challenges met – and grown beyond!

Linda Kreter and the VeteranCaregiver Team

Suicide Prevention: Part 2

Greetings,

Today brings a sequel to our prior story about "Jim", the veteran who spiraled downward after the suicide of a close friend.  Jim subsequently survived two more suicide attempts, and his Caregiver wife was working to find a stable solution and postvention care for him (http://veterancaregiver.blogspot.com/2013/02/suicide-attempt-please-seek-follow-up.html).  The story continues this way ...

Jim is still awaiting a PTSD program.  Two additional suicide attempts have been made, prompting 911 calls and hospitalizations.  His wife has endured many personally dangerous situations trying to obtain stable, consistent mental health care for her husband.  Jim's medications have been juggled between three VA's with conflicting opinions and prescription changes.  As we write, the most recent SPC (Suicide Prevention Coordinator), Case Manager, nor primary care Social Worker have returned phone calls or email.  Escalation has gone nowhere.  Caseloads are too high.  It is vacation time.  The voice mailboxes are full.  This is a serious situation.  However, it is not a single story; there are many.   

Together, let's remedy this situation, shall we?  On Tuesday, June 11^th, 11am EDT, please join us for a radio interview on the American Heroes Network (info below).  We will be talking with Edward White, the creator of the CallApp.  CallApp is a suicide prevention smartphone app that permits anyone to build a personal on-call virtual safety/crisis network comprised of friends, family, medical professionals, and community resources.  At the touch of a single button, this technology will permit personalized choices to the person in crisis.  If they need 911, it's there.  Their veteran buddy who calms them; there.  Their mental health counselors; there.  Special wellness programs, calming methods, and a network of caring, responsive people and organizations personally selected would reside on Jim's phone.  This is not a one-size-fits-all solution - but an extraordinary solution that will fit Jim. CallApp is customizable to satisfy the needs of family members, battle buddies, medical/mental health partners, close friends, and others.  These are people Jim trusts and who will answer the phone.  Respond.  It is a lifeline to bridge the gaps in communication support that exist today.

CallApp takes technology and leverages it with people who care about and for Jim. People support and save people.  Join us Tuesday to hear more!

With respect and great care,

Linda Kreter and the VeteranCaregiver Team

American Heroes Radio Network:

(http://hero.ub1.co/page/31) 

Follow-Up is VITAL...

Greetings,

Today's issue:  Follow-up is critical to resolving caregiver and vet/warrior problems.

Yet, it is so very, very difficult to “encourage” follow-up or to escalate the issue(s) because it’s often a case of “Shoot the Messenger”.  Not good. 

There are many unresolved issues we could write about here, but our goal is not to point fingers.  We do, however, want to voice that most problems are best solved while they are small and manageable.  Left hanging, caregivers and vets/warriors become increasingly frustrated, with some descending into depression and high anxiety with no way to receive an answer to a question.  When caregivers direct their questions to a superior, they are often told that they are overstepping, that they should accept that the system is slow, and to “wait their turn”.  Problems grow and ferment. 

 Not good.  There is a better way to manage this for both sides.

We implore the system to consider making customer service a priority – for medical and mental health reasons.  A callback or email is proof that someone cares.  Most of the time, the healthcare provider would not receive 4-6 reminder voicemails if they made a quick return call or email to alert the caller that they are looking into their problem and when to expect a response.    And, if a response time is provided to a caregiver or veteran, they should then refrain from repeat calls and messages and await the response.  Just think, fewer voicemail boxes full and not accepting messages!  Setting expectations is both a courteous and safe alternative to a stressed system.

We all have 24 hours in each day and make choices on how to spend that time.  If overall communication is improved, it would go a long way toward making more of those work hours productive and efficient.  Can we please make a commitment to work on this?

Thanks to countless caregivers and vets for their input and feedback to providing a potential solution to this growing challenge.

Warm regards,

Linda Kreter & the VeteranCaregiver Team

Caregiving Monday Musings

Caregiving is both a loving and a draining experience.

Love can wax and wane and the caregiving experience feels different depending on your phase.

Being thoughtfully pensive is different than being mired in a recurring mental spiral.

Fairness has varying definitions depending on your perspective; learn to raise or lower your expectations depending on your mental outlook of the day. Life is not always fair...

Peers and friends who “get it” are priceless.  It is lonely and isolating to walk this path alone, so please don’t!

As much as possible, give patient, educated responses when coping with the muddle of bureaucracy.  You’ll sleep better when you're less agitated.

Find your “anchor” (a friend, your faith, your journal, your dearest pet…) or a quiet place and give yourself permission to hold still when needed.  Your work will wait.

Finally, know the people that care for YOU in your life and lean on them when necessary. They fervently want to help you.

You matter so much to those that depend on you.  Do you really need to wonder why you’re tired? 

Please be kind to yourself.  You do a huge job, and you’re not going to be perfect, but you are going to do your best.  

You always do.

Caregivers, you are a gift to those you support.

Blessings to you,

Linda Kreter & the VeteranCaregiver Team

The Caregiver Cycle - Rinse & Repeat Only

Greetings,

After years of working with Caregivers, warriors, and families, a particular cycle of emotional health of the Caregiver has been noted.  We call these Caregiver Cycles, and we’ll give you only one visual, though many others would work as well.

There is the Cycle 1, the strong cycle when we feel put together, relatively well-informed, there is a decent communication pattern with our warrior’s care team, and as the Caregiver, you feel quite positive.  Your phone calls are returned, you see and feel progress, and you feel HOPE.  One vital thing about Hope is that it makes you mentally and emotional ready and willing to keep on working to improve your quality of life and that of your family. This is a good place to be!

Because caregiving is seldom a linear process, there are also times that may feel less accomplished and less effective.  This is Cycle 2.  Though you are still optimistic, you’re noticing that you are not making as much progress as before, there is a backslide in your warrior’s or your forward motion, or you’ve hit a new hurdle to overcome.  The longer you’ve been a caregiver, it seems that these periods wear you down more each time you experience them.  They also feel longer to you if you’re battling something for the second, tenth, or fiftieth time.  This is a time of concern for yourself and your family, isn’t it? You are exhausted, and somehow that makes each unreturned phone call or cancelled appointment feel worse.  You may be feeling higher anxiety, or less capability in managing the many details of caregiving.  In other words, you’ve lost some of yourself in the process, you're leaning, and pieces of you are missing.

Then there are those days when you’re not sure you can get out of bed to face another day, or you can’t sleep because your mind is struggling for solutions.  This is the much dreaded Cycle 3. You feel depleted, and search mightily for that spark of light you know you have within, but where is it?  You put one foot in front of the other, but this is a desperate/invisible/spent phase of time.  Please seek help when you feel this way.  Others have been here too, and your work is SO critical that you must stay present and care-seeking.  Reach out to your doctors, friends, and family – you WILL get through this time, but don’t try to do it alone.  We all need somewhere to lean, so reach out for assistance (therapists, pastors, helplines, doctors).

The goal is to keep the cycles to the TWO levels, and construct supports to avoid the third.  Let’s work together to support, guide, and reach out to keep each other strong, okay?  Remember, the shampoo directions give you two cycles only.  Strive for Rinse and Repeat – and avoid that third cycle altogether. 

With care,

Linda Kreter & the VeteranCaregiver Team

The Cascade Potential of Suicide

*Note: all names and identifiers have been changed, but this story is true.

His name was Michael.  He was in the wrong place at the wrong time when the shooter at Ft. Hood created mayhem, horror, and fear.  His friends knew that the incident, deemed “workplace violence” was never far from his mind, but they thought he was okay.  He was not.  He committed suicide this month.  This did not make the newspapers except in a small obituary, but it sent a resounding echo of despair to his circle of friends.

One friend of his, Jim, reacted very strongly to the news of the suicide.  He became very angry.  He became physically violent toward his wife.  He vehemently threatened systematic destruction of all of his VA doctors (while in the halls of his local VA), and he expressed suicidal intentions.   In each instance, his local VA suicide prevention coordinator was unable to provide help because Jim was not “actively suicidal”.  The Caregiver spoke twice with  the suicide prevention psychologist who said he could not do anything without an in-the-moment attempt.  When saying it makes no sense not to throw a float to a drowning man, his wife said this, “it seems that until you are underwater, going down for the last time, that no one can actually do anything”.

One week later, after two visits to the local ER, (while his wife made careful safety contingency plans for herself), the situation worsened.  Jim took a household knife into the bathroom with him  and attempted suicide. (All firearms had long been removed from the household). When his wife broke into the bathroom, he threatened her with the knife and said he would first kill her, then himself.  Through a near-miracle, she was able to get him to the local ER and began anew to get him VA psychiatric care.  Many calls (some with outside assistance and advocacy) were made to the VA Crisis Line.  Crisis Line recommendations to obtain local VA help went to unanswered voicemail... 

With great compassion but also frustration, it seemed that most everyone’s hands were tied in some way or another, and the hours crept by.  Finally the VA said it would admit Jim, but his wife would have to drive him nearly two hours to the facility – which under the circumstances was potentially too dangerous.  Eventually into the wee hours, the private hospital moved him to a nearby psychiatric facility since no safe transport could be arranged to the VA.  He remains there today, awaiting a private PTSD program.

There are gaps in any system.  However, the current issue is the lack of follow-up by the local VA including his case manager, the suicide prevention coordinator, and the social work office.  The Caregiver is exhausted, emotionally spent, and has no Caregiver Support Coordinator despite being in the National Caregiver Program. They have communicated their situation to leadership at VA for two years.  These at-risk veterans and their families need consistent follow-up after a suicide attempt, and the care gaps back-filled.  There are policies in place to aid in care and recovery.  But – it doesn’t always happen as written.

Please be aware of your fellow veterans and families.  Be aware that the suicide of a friend may create abrupt behavioral changes in your veteran, and in the worst case, lead to another suicide.  Know that long-term frustrations can suddenly spill over and create volatile situations.  And, always have the number of the Crisis Line, an advocate, and a personal support person if this happens to you.  Friends and social media can spread word of suicide in seconds, and information may be wrong, yet the actions some take can be irreversible.

When in doubt, please reach out! And, as caregivers, remember this:  the life you save may be your own.

Blessings and care,

Linda Kreter & the VeteranCaregiver Team

Winter Blahs!

Over the past few weeks I have spoken to a number of families who seem to be struggling in many ways, just to deal with day-to-day life.  One family had multiple health problems with many medical appointments, another had a death which required an out of state trip. Even in my own family we have had various depressing problems.

I went to have coffee with a good friend and I was talking to her about life in general getting harder to deal with.  She looked at me with great seriousness and told me I had caught the Winter Blahs. I laughed thinking she was joking. Well, in part she was but she was also deadly serious.  This time of year is often hardest for families who are caregiving. Getting someone in a wheelchair to hospital appointments can be a nightmare in bad weather. Snow, icy roads and freezing fog combine to make any driving stressful.  Multiple illness in a household causes more stress.  Children can be cooped up in the house with few ways to get rid of excess energy.

I have been trying to think of ways, just small ways, to help get through this part of the year.  For one thing the days of clouds and low light really depresses me so I have switched to full spectrum lights in many parts of my house, especially the lights I use mostly.

I try to find one thing each day to look forward to for myself.  It can be 15 minutes with a good book, a quick manicure or planning my garden for when the spring comes.

 If I have things to do that I really do not want to deal with, I try and do those early in the day if I can. That way they are not nagging at me for hours.

I  get outside in the fresh air even if it is just for a few moments.  I look for joy in small things; an insect creeping up a leaf or a pattern in the clouds (which was always a game when I was a kid). I also remind myself that winter is not going to last and that the sniffles and fog and horrid road trips will be gone soon.

 I get exercise of some sort even if it is with the Wii or the stair stepper. I'll see if I can fit in a new project; being creative is a good cure for the Blahs. Knitting, painting, cooking or sewing are all productive and you can see the results of your work. Right now I am trying to grow some fresh herbs in pots on the window ledge.

Above all the support of friends and family helps. Being stuck together in a small space can make all of us edgy, but  if you can get the family involved with a little planning you can chase away these Winter Blahs.