By JUDD MATSUNAGA, Esq.

Can you believe it? The year 2022 is here!

For the Nisei (still kicking), the problem is that there will eventually come a time when the world tilts and roles begin to shift. It’s the period when their Sansei children begin to feel more like the parent. And, like it or not, the Nisei parent can begin to feel as if they’re being treated like children. None of this is comfortable. All of it feels sad.

This transition can happen gradually, as cognition and physical ability change. However, in the case of a medical emergency, i.e., a stroke or a fall, the balance of decision-making and independence can be transformed overnight. In all cases, navigating the new landscape is full of emotion and confusion. Most importantly, it requires strategies that can help preserve the dignity to the aging parent.

As the population ages, more caregiving is being provided by people who aren’t health care professionals, i.e., their adult children. A caregiver is anyone who provides help to another person in need, such as an ill spouse or partner, a disabled child, or an aging relative. About 1 in 3 adults in the U.S. provides care to other adults as “informal caregivers.”

Taking care of a loved one who has dementia, physical disabilities or other age-related conditions makes demands on your time, energy, and emotions — demands that “can easily seem overwhelming.” (Source: Cleveland Clinic, Johns Hopkins Medicine) “Caregiving can tax your patience and foster fatigue, frustration, and guilt, becoming a grueling grind that takes a heavy toll on the caregiver’s body and mind. They call it caregiver burnout.”

There are many contributing issues that can lead to burnout. There can be conflicting demands as you try to balance the needs of the care recipient, employers, family members, and yourself. There are also unreasonable demands placed upon a caregiver by other family members or the person being cared for. Lack of privacy because caregiving may leave you with little time to be alone.

As the Nisei generation ages, more Sansei children are caregivers, often dealing with high levels of stress.

According to an AARP article entitled “Caregiver Burnout: Steps for Coping With Stress” (Dec. 3, 2021), the effects on physical and mental health are well documented:

● Thirty-six percent of family caregivers characterize their situation as highly stressful, according to the “Caregiving in the U.S. 2020” report from AARP and the National Alliance for Caregiving (NAC).

● Since 2015, when AARP and NAC last conducted the national survey, the proportion of caregivers describing their health as excellent or very good has dropped from 48 percent to 41 percent.

● A November 2021 study from insurance firm Genworth found that 42 percent of family caregivers experience depression, mood swings or resentment as a result of their labors Thirty percent reported sleep deprivation, and 43 percent said caregiving responsibilities have negatively affected their relationship with a spouse or partner.

The Alzheimer’s Association cites the following 10 indicators that a caregiver may be experiencing a high level of stress:

(1) Anger or frustration toward the person you’re caring for;

(2) Anxiety;

(3) Denial about your loved one’s condition;

(4) Depression;

(5) Exhaustion that makes it tough to complete your daily tasks;

(6) Health problems, such as getting sick more often;

(7) Inability to concentrate that makes it difficult to perform familiar tasks or causes you to forget appointments;

(8) Irritability and moodiness;

(9) Sleeplessness; and

(10) Social withdrawal from friends and activities that you used to enjoy.

Now, I can understand why every spouse of a primary caregiving child would look at the 10 indicators listed above and say, “Look at #8, irritability and moodiness. You must have caregiver burnout.” Even if that’s true, or if you’re getting close (borderline caregiver burnout), this year’s New Year’s resolution should be to take care of yourself.

Remember, if you don’t take care of yourself, you won’t be able to care for anyone else. They say that caring for a loved one strains even the most resilient people. So, if you’re a primary caregiver, child or spouse, take steps to preserve your own health and well-being. Fortunately, the Dec. 3, 2021 article in AARP provided the following “Tips to reduce caregiver stress”:

● Give yourself a break. Ask a friend or relative to fill in for you for a few hours occasionally so you can take a walk, watch a movie or go out to dinner.

● If you don’t have that sort of informal support available or feel you need more structured respite care, look into other options through the National Respite Locator. This online service provided by the nonprofit Access to Respite Care and Help National Respite Network can help you find adult day care centers and home care services in your area.

● Simplify your communication. Keeping extended family and friends up to date about your loved one’s situation through phone calls or individual emails can be tiring, and you may not want to broadcast that information on social media.

● Try using a website like CaringBridge, PostHope or MyLife Line that allows you to post updates for everyone simultaneously with controls to protect your loved one’s privacy.

● Tap into online resources. The U.S. government’s Eldercare Locator can connect you with your local Area Agency on Aging, which can guide you to resources in your community to help you deal with the challenges you are facing.

● Join a support group. If you feel like you’re alone in your struggle, talking with other family caregivers can lift your spirits and help you think through solutions to various problems.

● Nurture positive relationships. You may be overwhelmed, but take the time to talk with your closest friends and family members.

● Spend an evening with someone who is a good listener. Limit your interactions with negative people who will drag down your mood and perspective.

● Take care of your own health. Set a goal to establish a good sleep routine and to exercise a certain number of hours every week.

● Be sure to eat healthy foods and drink plenty of water. See your doctor for recommended immunizations and screenings.

● Tell your physician that you’re a caregiver and bring up any concerns you may have. A daily relaxation and meditation practice can be beneficial as well.

Of course, caregivers know they should practice “self-care.” If you’re Japanese, you’re probably taking on the role of the “dutiful daughter,” meaning you’ll endure your predicament ’til the end. That’s why it’s so important to watch for signs of caregiver burnout and take proactive steps to deal with it before it spirals out of control.

However, finding the time for self-care activities, such as exercising or having lunch with your friends, is a challenge when there never seems be an end to the caregiving tasks. This year, resolve to protect even one hour of guilt-free time a week for rest and replenishment and not to allow a loved one’s needs to intrude. With a little luck, you may just make it to December without burning out.

You ask, “But how?” Here’s where a little-known county public program comes into play — In-Home Supportive Services (IHSS). Get a professional caregiver, paid for by the county, to come in for a few hours a week to provide some rest and relaxation (R&R) for yourself. Services almost always need to be provided in your parent’s own home, or the home or the son or a daughter (if the parent is living with you).

The goal of the IHSS program is to allow the senior to live safely in their own home (or family member’s home) and avoid the need for out-of-home care, i.e., nursing homes. Most IHSS recipients can hire, fire, and supervise their own caregivers under the independent provider (IP) mode of service. So, IHSS will pay adult children, friends. family members and in some instances, spouses, for help with housework, meal preparation, and personal care.

Since IHSS is run by the Department of Social Services, all you have to do is first qualify for Medi-Cal. “But Judd, I was told I don’t qualify for Medi-Cal since I have more than $2,000 in the bank.” Not true. You are legally allowed to convert non-exempt assets into exempt assets, “spend down” excess assets, or transfer them to a trusted adult child without triggering a three-year waiting period.

“But Judd, I was told that if I get any benefits from IHSS, the state can recover from my home upon my death.” Again, not true. Payments made for personal care services under the In Home Supportive Services (IHSS) program, the cost of premiums, co-payments and deductibles paid on behalf of either qualified Medicare beneficiaries or specified low-income Medicare beneficiaries (QMB/SLMB) are exempt from recovery.” (Source: www.canhr.org/factsheets)

In conclusion, whether you’re a caregiver spouse or caregiver child, you need to practice self-care in 2022. Get a professional caregiver to come in a few hours a week to provide some R&R for yourself. The county will pay for it provided you first qualify for Medi-Cal.

Let’s face it, if you the primary caregiver gets sick or dies, who’s going to take care of the aging parent?

Judd Matsunaga, Esq., is the founding partner of the Law Offices of Matsunaga & Associates, specializing in estate/Medi-Cal planning, probate, personal injury and real estate law. With offices in Torrance, Hollywood, Sherman Oaks, Pasadena and Fountain Valley, he can be reached at (800) 411-0546. Opinions expressed in this column are not necessarily those of  The Rafu Shimpo.

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