Caring for the Caregiver: Psychological Needs

Written by Aneta Eichler, University of Tennessee Extension Agent, Sequatchie County

Becoming a caregiver can be very rewarding.  You may feel that you are giving back to someone who has given so much for you or you might feel that you are making up for past mistakes.  However, caring for a loved one that is no longer able to care for themselves can trigger many psychological issues for the caregiver.  The caregiver may have overwhelming feelings of guilt, resentment, fear or expectations.

Guilt is a common feeling related to caregiving.  You may wonder if you are doing enough or second guess a choice made on behalf of your loved one.  Evaluate your efforts to serve your loved one.  If you are trying hard to meet their needs, you do not need to feel guilty when things hinder that effort.  One way to off-set this concern is to have a back-up plan in place.  Consider all the ways you serve your loved one, set down with other family members or friends and ask them to be your back-up in case something would hinder you from following through with your responsibilities.  For example, you may be responsible for preparing meals for your loved one.  You may want to talk with a trusted neighbor and sign them up as back up.  Then if a bad storm hits or you fall ill, help is simply a phone call away.  I would suggest keeping this list in a prominent place for other members of the family to locate if needed.

We may develop feelings of resentment when our loved ones are taking up so much of our time.  These feelings may create guilt which puts into motion a vicious cycle of resentment and guilt.  If your feelings of resentment are prevalent, admit that you need a little time to rejuvenate yourself and send out the S.O.S. code to your friends and family members.  Do not feel guilty when you need a little R & R, it is completely natural and normal to need this time.  Your Area Agency on Aging may be able to help provide needed resources for you and your family.

Fear and sadness are other feelings you may experience.  Your parent or spouse is physically or mentally deteriorating.  They may now require assistance for things they gave you in the past.  The roles are reversing.  A fear of the unknown with your loved one’s approaching dying and death process, coming to terms with your own mortality and spirituality, and comforting your loved one may cause an element of fear and sadness.  The sadness may be coming from the times you will not have together in the future or that you wasted in the past.

Sometimes our expectations create dissatisfaction.  As we near retirement, we may make plans to travel or pursue a new hobby.  Instead, we are faced with the reality that we are tied down with the responsibility of caregiving.  This is a good time to remind yourself that caregiving is allowing you a chance to bond closer with your loved one.  Research shows that we feel more satisfaction when we are serving and caring for others.  However, this does not mean that you should not continue with your plans to travel or learn a new skill.  In order to meet your own expectations you may need to hire someone to care for the person for several weeks while you travel or a few hours a week while you work on hobbies. Remember to spend some time and money on yourself to avoid feeling suffocated with too many responsibilities. 

During this difficult time, remember to CELEBRATE LIFE!  Encourage your loved one to participate in your celebration of the little things like a beautiful sunset, the change of seasons, a bird’s song, the sweet smell of lilacs, the laughter of a child, or the succulent taste of fresh bread.  Enjoy a memory shared together by looking at some old photographs or reminiscing over funny stories of old.  Laughter can lift our moods and heal our broken spirits so remember to laugh often!

What are some of the feelings you experience?

Information taken from: DeBois, M & Bosch, K (2006). Who cares for the caregiver. Nebraska Lincoln       Extension. Publication HEF569

 

Be Silent No More

By: Heather Wallace, Assistant Professor and Human Development Specialist, University of Tennessee Extension 

Page Content

 

Losing someone special to death, no matter the circumstance, is never easy. Hearing about the passing of a beloved public figure like actor and comedian, Robin Williams can be equally tough, especially when the cause is preventable, says Heather Wallace, assistant professor and a human development specialist with University of Tennessee Extension.

According to the Tennessee Department of Mental Health and Substance Abuse Services, an estimated 850 people die by suicide in Tennessee every year. It’s the third leading cause of death among youth and young adults in the state and across the nation. “While deeply saddening, hearing about a person’s apparent self-inflicted death provides parents and families opportunities to have open conversations about difficult topics like death and suicide.” Wallace adds that conversations will vary depending on beliefs, culture and children’s ages.

Matt Devereaux, professor and a child development specialist with UT Extension Family and Consumer Sciences, says children in elementary school or younger should be guarded from exposure to media coverage focused on the cause of Robin Williams’ death. However, if they ask questions about suicide and death, Devereaux says that honesty is the best policy. “The important thing when speaking with young children is short and simple responses to their questions,” Devereaux said.  He also noted that children should be ensured that they always have a safe person to talk to should they ever have such thoughts or feel sad in a way that is different than just stubbing your toe.”

Devereaux adds that parents and caregivers should seize this opportunity to talk open and honestly with youth who are middle- and high-school age about the signs and symptoms of depression and suicidal thoughts. “You will not cause a person to become suicidal just by talking about it,” he said. “Communicate clearly that you are a safe person that he or she can always reach out to for non-judgmental and honest conversations about mental health.”

Here are some of the signs and symptoms of suicidal thoughts and planning, along with resources to guide conversations, and where to turn for help.

Signs of Suicidal Thoughts and Plans

(From the Substance Abuse and Mental Health Services Administration and the non-profit organization Helpguide.org)

● Looking for a way to kill oneself, like searching online or buying items to assist suicide.
● Preoccupation with death.
● Talking about (any of these):
   - Wanting to die or to kill oneself,
   - Feeling hopeless or no reason to live,
   - Feeling trapped or in unbearable pain,
   - Wanting to sleep and not wake up,
   - Being a burden to others.
● Increasing the use of alcohol or drugs.
● Acting anxious/agitated; being reckless.
● Sleeping too little or too much.
● Withdrawing or feeling isolated.
● Showing rage or talking about revenge.
● Displaying extreme mood swings.
● Sudden sense of calm and happiness after being extremely depressed.
● Giving away personal items for no apparent reason.

Need Help Now?

● The National Suicide Prevention Lifeline- 1-800-273-TALK1-800-273-TALK (8255) - a free, 24-hour hotline available to anyone in suicidal crisis or emotional distress.

● Tennessee-specific - 1-855-CRISIS-11-855-CRISIS-1 (1-855-274-74711-855-274-7471) or chat online (2 p.m. - 2 a.m. Eastern time)

If you’re with someone in need of help, experts recommend you take these steps:
● Stay with that person until he or she has the help they need.
● Ask to call a help lifeline for him or her.
● Persuade the person that he or she needs professional help. Take that person to the hospital if needed.

More Information is available from the the Substance Abuse and Mental Health Services Administration website. Evidence-based suicide prevention training for professionals is available from the QPR Institute.

The UT Institute of Agriculture provides instruction, research and public service through the UT College of Agricultural Sciences and Natural Resources, the UT College of Veterinary Medicine, UT AgResearch, including its system of 10 research and education centers, and UT Extension offices in every county in the state.

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Contact:

Heather Wallace, assistant professor and human development specialist, UT Extension, 865-974-7193865-974-7193, heather.wallace@utk.edu

Academic Conference 2014

By Sheldon Barker

Sequatchie County delegates Katie Bragg and Chase Hobbs
with Extension Agent Sheldon Barker

Katie Bragg and Chase Hobbs along with agent Sheldon Barker attended the 26^th Junior High 4-H Academic Conference June 10-13, 2014 in Knoxville. During 4-H Academic Conference, 4-H members received extensive training in their 4-H project area and explored related career opportunities. Classes under the supervision of university scientists and specialists gave the participants the opportunity to learn hands-on.  Programs for sixteen project areas where conducted during the week. Katie and Chase took part in the Dairy Foods/Foods-Nutrition project area, While Mr. Barker served as group leader for the Forestry Project.

Conference delegates working on service projects

Katie Bragg wrote of her experience: “4-H Academic Conference was so much fun.   It gave me an opportunity to look deeper into my project area.  It also allowed me to make new friends across the state that were also interested in that project area.  The project area that I worked in was Food and Nutrition.  We actually got to look at real colonies of bacteria.  That was neat.  We also got to make picture frames and cards for veterans.    I learned a lot about my project, but also about service and helping others.  The trip to Dollywood and all of the extra activities were a blast.   I had a great time, and I think anyone willing to learn would love it!” 

Programs where conducted in the following project areas: Beef, Dog, Sheep, Cat, Forestry, Swine, Consumer Education, Garden/Home Horticulture, Wildlife and Fisheries, Citizenship, Horse, Veterinary Science, Dairy, Line and Design, Dairy Foods/Foods-Nutrition and Poultry. 

For more information on the 2014 Academic Conference, visit the Web site at http://4h.tennessee.edu/acadconf

Tips for food safety for outdoor events

With summer in full swing and outdoor barbeques part of the weekly fare, an expert with University of Tennessee Extension reminds consumers that food safety can make or break an outdoor activity.

“Whether it’s a picnic at the park, camping in the mountains, or living on the boat, food is often a common denominator for fun,” said Janie Burney, a professor of family and consumer sciences. Burney says these simple rules can keep foodborne pathogens from ruining your summer:

▪ Plan ahead. If you are traveling with perishable food, place it in a cooler with ice or freezer packs.

▪ Pack safely. Pack perishable foods directly from the refrigerator or freezer into the cooler. Be sure to keep raw meat and poultry wrapped separately from cooked foods and ready-to-eat foods such as fruit or vegetables. If the cooler is only partially filled, pack the remaining space with more ice. Keep the cooler in an air-conditioned area of your vehicle, rather than in a hot trunk. Limit the amount of times the cooler is opened.

▪ When outdoors, keep the cooler in a shady spot and cover it with a light-colored blanket or tarp.

▪ When camping, boating or picnicking, take along only the amount of food that can be used. Avoid leftovers.

▪ Don’t drink water from streams and rivers. Bring bottled water.

▪ Keep hands and all utensils clean when preparing food. Use disposable towelettes to clean hands.

▪ When preparing food, never use the same dish for raw meats and foods that will not be cooked.

 

▪ Don’t let perishable food sit out while swimming or fishing or during other activities. If the temperature is above 90º F, food is not safe to sit out longer than one hour (two hours at room temperature).

Burney also reminds us that safe food habits also incorporate these simple rules:

▪ Frozen food should be thawed in the refrigerator.

▪ Do not put spoons into food after you have tasted food from that same spoon.

▪ Keep hot food hot, and cold foods cold.

▪ Encourage children to wash their hands after playing with pets, playing outside, going to the bathroom, coughing or wiping their nose and certainly before touching food.

 

If your outdoor fun includes grilling hamburgers, Burney recommends you play it safe by handling raw ground beef carefully. “First, be sure you keep the meat cold (40º F or less) until it is cooked,” she says. “Second, cook ground beef to a safe temperature of 160º F so that bacteria such as E. coli are killed. E. coli can cause severe stomach cramps, diarrhea (often bloody), and vomiting. Some infections are mild while others are life threatening. Young children, older adults and individuals with weakened immune systems are more likely than others to develop severe complications,” Burney said.

“Third, when deciding when your hamburgers are cooked enough, use a thermometer. You cannot tell by the color,” Burney cautions. She recommends you insert the tip of the thermometer into the side of the burgers to check that the temperature as reached 160º F.

“You should also clean your hands and anything that comes in contact with the raw meat thoroughly with soap and water so that you do not cross-contaminate other foods,” Burney said.  She also notes that it is best not to rely solely on hand sanitizers.

 

In the event of a ground beef recall, return your meat to the store for an exchange or dispose of it, she said. Don’t take chances—when in doubt, throw it out!

 

For more information, contact your local county UT Extension family and consumer sciences agent.

UT Extension provides a gateway to the University of Tennessee as the outreach unit of the UT Institute of Agriculture. With an office in every Tennessee county, UT Extension delivers educational programs and research-based information to citizens throughout the state. In cooperation with Tennessee State University, UT Extension works with farmers, families, youth and communities to improve lives by addressing problems and issues at the local, state and national levels.

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Contact:

Dr. Janie Burney, UT Family and Consumer Sciences, 865-974-7402, jburney@utk.edu

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Getting Health Insurance Coverage After College

In addition to finding a job and housing college graduates who were covered by their university’s student health insurance may also need to replace that coverage. Financial planners point out that obtaining health insurance is basic to being able to budget and manage money responsibly. “Most young people think of health insurance as something that allows you to pay for treatment for an illness or accident,” says Dr. Dena Wise, Professor and Consumer Economics Specialist with UT Extension. “What they may not realize is that health insurance is a necessary financial management tool as well. Health insurance makes health care costs predictable and controllable so you can actually plan for them in your budget rather than having each medical event or issue become a financial emergency.” UT health insurance experts offer the following advice to new graduates.

For graduates who live in Tennessee, there are three basic options for health insurance after college: (1) continuing to be covered on a parent’s traditional plan, (2) purchasing a traditional plan through a private insurer, or (3) purchasing a catastrophic health plan.

Provisions of the Affordable Care Act made it possible for young people, regardless of whether they are students or living independently, to remain on their parent’s insurance policy until their 26^th birthday. Remaining on a parent’s plan is often a more economical way to maintain coverage and it’s especially helpful if the new graduate has not yet landed a job with health insurance benefits. Even if the graduate’s new job offers health insurance, they can still opt for continuing coverage under the parent’s policy. New employees should be aware, however, that if they initially decline employee coverage, they may pay a sizable penalty if they decide to enroll in employee coverage at a later time.

 If graduates have a job that offers employee health insurance coverage, it generally offers the next-best alternative to remaining on a parent’s policy. Particularly if the graduate only needs individual—rather than family—coverage, premiums may be affordable.

If an employer’s health insurance plan is not available, a graduate may be able to find private insurance through the through the Health Insurance Marketplace. Graduates whose student health plan is ending may qualify for a Special Enrollment Period to sign up for private insurance or evaluate other options.

If they’re under 30, graduates can purchase a catastrophic health plan through the Marketplace. The catastrophic plan’s high deductible makes it a good plan only for those whose health is good enough to expect they would just need basic preventive care, which is covered without the deductible applying. The low premiums make it affordable, and even though the high deductible may be a burden in the case of a serious medical issue or emergency, it protects a young person’s future earnings from very large medical costs or debt.

Contact:               Dena Wise, 865 974-8198, dkwise@utk.edu

Understanding Your New Health Insurance

After the hoopla about the implementation of the Affordable Care Act last winter, many people never want to think about health insurance again. But others who have health insurance for the first time are just learning to use their new policies and services. In case you are in the latter category, you may still be confused by the health insurance landscape, which can be very complex.

Health insurance is essentially a contract between you and an insurance company designed to protect you from health care expenses exceeding what you might be able to pay out of your pocket. In the contract, the health insurance company specifies the percentages or amounts of charges they will pay and how much will be your responsibility for different health care services.

These are some of the terms and definitions associated with health insurance:

• The amount the insurance company charges you for a policy is called the premium. The premium is determined by the level of coverage you have—generally, the more medical expenses that are covered by the insurance company, the higher the premium. (The Affordable Care Act requires that all policies now cover at least 60 percent of expenses.)
• The deductible is the amount that you must pay for expenses other than preventive services each policy year before any insurance coverage kicks in. The Affordable Care Act designates which basic preventive services are covered by your premium with no deductible. Preventive services may include annual physicals, immunizations and screenings that can keep you from getting sick.
• For every medical service not a part of your preventive care, you will be charged a co-pay (co-payment). A co-pay is a fixed fee (such as $15) that you are asked to pay, usually at the time of service. The co-pay is subtracted from the amount filed with your insurance company. The amount may vary from doctor to doctor.
• Coinsurance is the percent of the cost of covered health care services paid by consumers. The level of coverage you have determines your coinsurance. For example, your coinsurance at different levels might be 10, 20, 30 or 40 percent. Obviously, a policy with 10 percent coinsurance would have a higher premium than a policy with 40 percent coinsurance.
• The Affordable Care Act places a cap, or limit, on your out-of-pocket expenses, currently at $6,350 for one person and $12,700 for a family. If you reach that amount, then deductibles and coinsurance will no longer be charged, although you will continue to pay co-payments.
• A claim is a request for payment that a consumer or healthcare provider submits to the health insurance company for items or services rendered.  For example, once you have completed a doctor’s appointment, the doctor’s office will submit the information to your health insurance company to process (if the doctor is an out of network provider you may be responsible for submitting the paperwork to the insurance company yourself).  The health insurance company will make a determination and send payment to your healthcare provider if applicable.  The insurance company will also send a claim statement to you for your records explaining what services were covered.
• An allowed amount is the maximum amount allowed to be paid for covered health services by a health insurance company.  This may also be called “eligible expense,” “payment allowance,” or “negotiated rate.”  In most cases your doctor will accept the allowed (maximum) amount paid by the health insurance company as ‘paid in full’ and you will not be responsible for the difference.
• Balance billing is when the provider bills the consumer for the difference between the provider’s charge and the amount allowed by the health plan.  For example, if your doctor does not accept the maximum allowed then you may receive a bill from them charging you the difference between the doctor’s charge and the maximum allowed by your health insurance company.  You will then be responsible for making this payment.

You will find a more complete glossary of health insurance terms at Https://www.healthcare.gov/glossary/ . The better you understand your health insurance, the more you can benefit.

Barbara Metzger and Dena Wise

Summer adjustments for cattle and fescue management

Watch for fescue toxicosis

 Article by: Dr. Jim Neel, UT Department of Animal Science

Posted by: Sheldon Barker

Fescue toxicosis is still a problem for cattle producers in Tennessee and beyond during the summer months. Photo courtesy UTIA.

Fescue is the primary forage for cow-calf production in Tennessee and the upper Mid-South. It is the source of both pasture and hay, yet in spite of the contribution fescue makes to the cow-calf industry, the problem of fescue toxicosis still results in reduced cattle performance.

The greatest problem with fescue occurs during the summer months and extends into the fall. University of Tennessee Extension beef specialist Jim Neel refers to this period as the “summer slump.”

“Here in Tennessee, when the grass goes to seed, the endophyte concentration is the greatest,” Neel says. “Early grazing pressure in the spring and harvesting fescue for hay before it goes to seed will aid in reducing the concentration of the endophyte,” he recommends. Neel adds that producers should try to get fescue cut in the “boot stage” – that is while the grass flower is still in the sheath. Grazing pressure can also contribute to the reduced formation of seed heads.

Neel also reminds producers that throughout the summer they need to provide shade and water for the cattle. “The environmental temperature will be probably the hottest during the summer slump,” he says. “In addition, digestion of the forage also adds to the body temperature of the cattle.”

Another big source of the cattle’s elevated temperature is the toxic effect of the endophyte, Neel said. “Consider weaning and conditioning the calf crop for marketing. Generally, the gain of the calves is very poor due to the reduced forage availability and quality as well as milk production of the dams. However, if weaned and fed a concentrate ration, the calves will efficiently convert the feed to gain. “On-the-farm” field trials conducted here in Tennessee several years ago support these recommendations, he adds.

The cattle specialist says mature cows get along well on summer’s lower quality forage, and they gain both weight and body condition, which help with reproduction. Research done over five or more decades at Southeastern land-grant universities demonstrates that maintaining 30 percent clover in fescue stands improves the performance of the cattle.

Neel adds that there is no silver bullet that can replace management of fescue and cattle to reduce the effect of the endophyte. “There are times in the annual production cycle of fescue that the grass quality is better and this can be capitalized on by appropriate cattle and forage management,” he said.

For more information about fescue toxicosis or beef cattle management, contact your local county UT Extension agent or visit the UT Beef and Forage Center website: http://utbfc.utk.edu

UT Extension provides a gateway to the University of Tennessee as the outreach unit of the UT Institute of Agriculture. With an office in every Tennessee county, UT Extension delivers educational programs and research-based information to citizens throughout the state. In cooperation with Tennessee State University, UT Extension works with farmers, families, youth and communities to improve lives by addressing problems and issues at the local, state and national levels.